6 ms·

Ebola: learn from the past

42 points by etiam 12y ago

joeguilmette 12y ago
I hope the author isn't being naive in assuming that this outbreak will pass.
- mlwarren 12y ago
  Not trying to be snarky, but what makes you think that this one will not? The mainstream media seems to downplay it, and a good number of people online seem to be alarmist about it. I'm not sure what to think with the data I have available.
  - nmjohn 12y ago
    > I'm not sure what to think with the data I have available. That usually means find more data! The truth is probably somewhere in the middle - but for someone in the US who doesn't work in a hospital, at least for now, you have nothing to worry about. If it starts spreading in the US, that is the time to start worrying (as an individual who doesn't work in the industry) I'm not saying doctors and scientists in this field shouldn't be worrying or doing anything about it - what I'm saying is if you are not one of those people and you're not traveling internationally, there is no logical reason for you to even think about it for the time being - things may change for the worse, but until then it is unnecessary worry for something you have absolutely no control over.
  - tjradcliffe 12y ago
    Alarmists are using a lot qualified language, and remember, every statement with a qualifier like "might" or "could" is exactly as true as its opposite. So when someone says, "Ebola might mutate to become a flesh-eating flying monkey" (which is true, by the way, given enough time) they may as well be saying, "Ebola might not mutate..." Both statements are equally true, but they have chosen to say only one. Why? What actionable information is contained in that choice? I can't see any. Nor (one hopes) does it express their desired outcome. Statements like "Ebola could mutate..." appear to me to be some kind of verbal reassurance behaviour. From this I infer that they are motivated primarily by fear, and one of the things fear does in social primates is--rather like a virus--spread itself. About which I will now proceed to speculate in an unfortunately data-free way. People are hierarchical animals, and when we're afraid we feel better if we're not as afraid as everyone else, so we tend to do and say things that will raise alarm in others. Being afraid lowers one's status in the group (and lower status often leads to more fear). There are two ways of dealing with this: reducing one's own fear, or increasing fear in others. Again, this is purely speculative: I've searched around a bit but can't find any research that bears directly on this question. It would be interesting to see it investigated, and relatively straightforward to do. So "Keep Calm and Carry On" is a good motto to have. It helps us focus on maintaining our place in the monkey hierarchy by controlling our own fear, rather inducing fear in others. And given how frequently fear runs out of control and leads to uncivil behaviour, this seems like a desirable result.
    - A_COMPUTER 12y ago
      So far everyone from the CDC has been describing what we know about Ebola spreading in scientific knowledge, which is extremely conservative. Everyone I know in my profession thinks about it like an pen tester would, "how would it get into the usa if there's screening?" "how would someone get Ebola without physical contact if it's not airborne?" "if bad sanitation in Africa is the reason that it's spreading so quick there, are there any places in my country that have bad sanitation?" It seems like a better strategy to think about these things and be wrong than have it kill a bunch of people, but I know good and well that my actual understanding is superficial. But it's seemed to have good explanatory power for everything that's happened so far that has taken people by surprise.
- nathannecro 12y ago
  For whatever people say, Ebola is still a fairly difficult disease to spread. True, it has jumped borders (even oceans). However, patient's don't become infectious until they start showing visible symptoms. Not only that, the symptoms are pretty obvious. Compounding all of that, the vector by which the virus travels is one of the "slowest" routes available. What I think this outbreak does show however, is that we as a global peoples, need to really rethink how we treat and handle the spread of disease.
  - enjo 12y ago
    Not only that, the symptoms are pretty obvious. Are they? The guy in Dallas originally reported with nothing more than abdominal pain. While he quickly deteriorated after that, was he already contagious at that point?
  - steven2012 12y ago
    Why do people keep saying it's a fairly difficult disease to spread, when a health worker in the US contracted Ebola, even while wearing protective gear. If a health worker with protective gear can contract Ebola, imagine how easy it is for someone infected with Ebola to transmit the disease on an airplane or a restaurant. If they start vomiting around people, and splatter the people around them, will those people not get infected? Will the workers who try to clean up the mess not get exposed as well? The symptoms are obvious, but they are obvious symptoms for much more innocuous diseases as well, so it's easy to miss.
    - serge2k 12y ago
      The health worker was working directly with Ebola patients, something went wrong there and should be investigated but, this is still better than a dozen random people contracting it because it actually does spread easily. Health workers contracting it means that their needs to be either more protective measures or better training to help prevent mistakes.
    - nmjohn 12y ago
      > Why do people keep saying it's a fairly difficult disease to spread Because that is the truth. When someone is working in close quarters to the disease they are substantially more likely to catch it, no? You can wear all the protective gear you want, if protocol for taking off the gear is not followed 100% every single time, you open yourself up to infection. Combine that with fatigue, mistakes happen unfortunately often. If you are just out walking around coming into normal contact with people, it is incredibly difficult to spread.
- davesque 12y ago
  There has never been an epidemic that didn't pass, otherwise none of us would be here. The question, of course, is how many Ebola will take before it dies out. His article didn't mention any figures along those lines.
  - steven2012 12y ago
    That is survivorship bias. Just because the human race hasn't yet been completely wiped out by a pandemic doesn't mean that there is no possibility that a pandemic can kill every single human on Earth. The Black Death killed half of all Europeans, which is pretty horrifying.
    - TeMPOraL 12y ago
      And that was before people lived together in a hyperconnected global urban society that eats petroleum and breathes electricity. A virus doesn't have to kill half of the Europe or US to kicks the western civilization back to medieval.
      - serge2k 12y ago
        No, it was when people in cities lived in terrible conditions and had nothing even approaching the basic aspects of modern medical care.
        TeMPOraL 12y ago
        Urban density back then was nothing comparable to what we have today. But still, the major issue is that feeding all those people heavily depends on long supply chains and energy infrastructure. In the US, only 2% of people are directly employed in agriculture, and that agriculture is working on "petroleum in, food out" basis. The virus doesn't have to kill half of the population to cripple the west. It only has to disturb food production and energy infrastructure enough for modern civilization to collapse under its own weight.
        12y ago
7Figures2Commas 12y ago
Past performance may not be indicative of future results. Obviously, we should heed the lessons of the past, but a virus like Ebola is not a static phenomenon and it's concerning that so many seem to have developed strongly-held assumptions. The number of medical personnel infected in this current outbreak is particularly worrisome and we don't yet understand the exact causes of this. We do know that the strain in the current outbreak is different from those seen before, and that it's mutating[1]. Filoviruses have a rapid rate of mutation, and the longer the outbreak lasts, the more opportunity the virus has to mutate into a form that makes it harder to defeat. The speed with which Ebola kills those it infects is actually disadvantageous to the virus. Natural selection would logically favor a strain of the virus that didn't kill its hosts so quickly. While a lot of speculation revolves around the possibility that the virus could become more easily transmissible, it would be just as worrisome if there were mutations that affected incubation time or the onset symptoms. These types of mutations could significantly complicate some the strategies we're relying on today, if not render them useless. [1] http://www.washingtonpost.com/national/health-science/ebola-virus-has-mutated-during-course-of-outbreak/2014/08/28/98235aaa-2ecb-11e4-bb9b-997ae96fad33_story.html http://www.washingtonpost.com/national/health-science/ebola-...
- danieltillett 12y ago
  There are three large differences with this outbreak than all previous outbreaks 1. The size and the number of people infected. 2. The geographical scale. No outbreak has ever been anything other than localised. 3. It is spreading in urban areas. All previous outbreaks of Ebola have been rural. If any of these differences are important then we can’t really look to past outbreaks to know what is going to happen.
danieltillett 12y ago
If we want to learn from the past maybe we should look at the Plague of Athens [1]. These were the symptoms: "As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress. In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later.” I wonder what this sounds like? The good news was it only killed between 1/3 and 2/3rds of the population. [1] http://en.wikipedia.org/wiki/Plague_of_Athens http://en.wikipedia.org/wiki/Plague_of_Athens
vpeters25 12y ago
I wonder why governments haven't dictated a 21+ day quarantine on any population center where someone is positive for Ebola. That should stop propagation on its tracks.
- danieltillett 12y ago
  The reason why is the countries where the outbreak has occurred do not have the policing or military capacity to do this. A couple of the countries tried to enforce 3 days quarantines to slow down the spread but the population just ignored it, either through lack of care or lack of ability (when you are living day to day you don’t have much choice about working or not - don’t work, don’t eat).
- actsasbuffoon 12y ago
  I live in Braintree Massachusetts, and you may have heard that there's a person suspected of having Ebola in this very city. When I read about it, literally my very first thought was that we need to isolate my city until further notice. Don't get me wrong, I'm not relishing the thought of being stuck here, but we've got a responsibility to keep this thing from spreading. I still stand by that.
bra-ket 12y ago
Ebola evolves. Each outbreak carries a number of distinct genetic changes [1] and there is a risk of a mutation (or a chain of mutations) that would accelerate transmission in unpredictable ways by interacting with new hosts. This happened in the past with Yersinia Pestis that wiped out half of the world population through fleas. I'm not sure sure why there is no centralized effort to accelerate research but rather top virologists focus on logistics of moving dead bodies. [1] http://www.sciencemag.org/content/345/6202/1369.full http://www.sciencemag.org/content/345/6202/1369.full
- danieltillett 12y ago
  >I'm not sure sure why there is no centralized effort to accelerate research Your answer is right at the bottom of the science article. "In memoriam: Tragically, five co-authors, who contributed greatly to public health and research efforts in Sierra Leone, contracted EVD and lost their battle with the disease before this manuscript could be published: Mohamed Fullah, Mbalu Fonnie, Alex Moigboi, Alice Kovoma, and S. Humarr Khan. We wish to honor their memory."

42 points by etiam 12y ago

joeguilmette 12y ago

I hope the author isn't being naive in assuming that this outbreak will pass.

mlwarren 12y ago
Not trying to be snarky, but what makes you think that this one will not? The mainstream media seems to downplay it, and a good number of people online seem to be alarmist about it. I'm not sure what to think with the data I have available.
- nmjohn 12y ago
  > I'm not sure what to think with the data I have available. That usually means find more data! The truth is probably somewhere in the middle - but for someone in the US who doesn't work in a hospital, at least for now, you have nothing to worry about. If it starts spreading in the US, that is the time to start worrying (as an individual who doesn't work in the industry) I'm not saying doctors and scientists in this field shouldn't be worrying or doing anything about it - what I'm saying is if you are not one of those people and you're not traveling internationally, there is no logical reason for you to even think about it for the time being - things may change for the worse, but until then it is unnecessary worry for something you have absolutely no control over.
- tjradcliffe 12y ago
  Alarmists are using a lot qualified language, and remember, every statement with a qualifier like "might" or "could" is exactly as true as its opposite. So when someone says, "Ebola might mutate to become a flesh-eating flying monkey" (which is true, by the way, given enough time) they may as well be saying, "Ebola might not mutate..." Both statements are equally true, but they have chosen to say only one. Why? What actionable information is contained in that choice? I can't see any. Nor (one hopes) does it express their desired outcome. Statements like "Ebola could mutate..." appear to me to be some kind of verbal reassurance behaviour. From this I infer that they are motivated primarily by fear, and one of the things fear does in social primates is--rather like a virus--spread itself. About which I will now proceed to speculate in an unfortunately data-free way. People are hierarchical animals, and when we're afraid we feel better if we're not as afraid as everyone else, so we tend to do and say things that will raise alarm in others. Being afraid lowers one's status in the group (and lower status often leads to more fear). There are two ways of dealing with this: reducing one's own fear, or increasing fear in others. Again, this is purely speculative: I've searched around a bit but can't find any research that bears directly on this question. It would be interesting to see it investigated, and relatively straightforward to do. So "Keep Calm and Carry On" is a good motto to have. It helps us focus on maintaining our place in the monkey hierarchy by controlling our own fear, rather inducing fear in others. And given how frequently fear runs out of control and leads to uncivil behaviour, this seems like a desirable result.
  - A_COMPUTER 12y ago
    So far everyone from the CDC has been describing what we know about Ebola spreading in scientific knowledge, which is extremely conservative. Everyone I know in my profession thinks about it like an pen tester would, "how would it get into the usa if there's screening?" "how would someone get Ebola without physical contact if it's not airborne?" "if bad sanitation in Africa is the reason that it's spreading so quick there, are there any places in my country that have bad sanitation?" It seems like a better strategy to think about these things and be wrong than have it kill a bunch of people, but I know good and well that my actual understanding is superficial. But it's seemed to have good explanatory power for everything that's happened so far that has taken people by surprise.
nathannecro 12y ago
For whatever people say, Ebola is still a fairly difficult disease to spread. True, it has jumped borders (even oceans). However, patient's don't become infectious until they start showing visible symptoms. Not only that, the symptoms are pretty obvious. Compounding all of that, the vector by which the virus travels is one of the "slowest" routes available. What I think this outbreak does show however, is that we as a global peoples, need to really rethink how we treat and handle the spread of disease.
- enjo 12y ago
  Not only that, the symptoms are pretty obvious. Are they? The guy in Dallas originally reported with nothing more than abdominal pain. While he quickly deteriorated after that, was he already contagious at that point?
- steven2012 12y ago
  Why do people keep saying it's a fairly difficult disease to spread, when a health worker in the US contracted Ebola, even while wearing protective gear. If a health worker with protective gear can contract Ebola, imagine how easy it is for someone infected with Ebola to transmit the disease on an airplane or a restaurant. If they start vomiting around people, and splatter the people around them, will those people not get infected? Will the workers who try to clean up the mess not get exposed as well? The symptoms are obvious, but they are obvious symptoms for much more innocuous diseases as well, so it's easy to miss.
  - serge2k 12y ago
    The health worker was working directly with Ebola patients, something went wrong there and should be investigated but, this is still better than a dozen random people contracting it because it actually does spread easily. Health workers contracting it means that their needs to be either more protective measures or better training to help prevent mistakes.
  - nmjohn 12y ago
    > Why do people keep saying it's a fairly difficult disease to spread Because that is the truth. When someone is working in close quarters to the disease they are substantially more likely to catch it, no? You can wear all the protective gear you want, if protocol for taking off the gear is not followed 100% every single time, you open yourself up to infection. Combine that with fatigue, mistakes happen unfortunately often. If you are just out walking around coming into normal contact with people, it is incredibly difficult to spread.
davesque 12y ago
There has never been an epidemic that didn't pass, otherwise none of us would be here. The question, of course, is how many Ebola will take before it dies out. His article didn't mention any figures along those lines.
- steven2012 12y ago
  That is survivorship bias. Just because the human race hasn't yet been completely wiped out by a pandemic doesn't mean that there is no possibility that a pandemic can kill every single human on Earth. The Black Death killed half of all Europeans, which is pretty horrifying.
  - TeMPOraL 12y ago
    And that was before people lived together in a hyperconnected global urban society that eats petroleum and breathes electricity. A virus doesn't have to kill half of the Europe or US to kicks the western civilization back to medieval.
    - serge2k 12y ago
      No, it was when people in cities lived in terrible conditions and had nothing even approaching the basic aspects of modern medical care.
      - TeMPOraL 12y ago
        Urban density back then was nothing comparable to what we have today. But still, the major issue is that feeding all those people heavily depends on long supply chains and energy infrastructure. In the US, only 2% of people are directly employed in agriculture, and that agriculture is working on "petroleum in, food out" basis. The virus doesn't have to kill half of the population to cripple the west. It only has to disturb food production and energy infrastructure enough for modern civilization to collapse under its own weight.
        12y ago

7Figures2Commas 12y ago

Past performance may not be indicative of future results. Obviously, we should heed the lessons of the past, but a virus like Ebola is not a static phenomenon and it's concerning that so many seem to have developed strongly-held assumptions. The number of medical personnel infected in this current outbreak is particularly worrisome and we don't yet understand the exact causes of this. We do know that the strain in the current outbreak is different from those seen before, and that it's mutating[1]. Filoviruses have a rapid rate of mutation, and the longer the outbreak lasts, the more opportunity the virus has to mutate into a form that makes it harder to defeat. The speed with which Ebola kills those it infects is actually disadvantageous to the virus. Natural selection would logically favor a strain of the virus that didn't kill its hosts so quickly. While a lot of speculation revolves around the possibility that the virus could become more easily transmissible, it would be just as worrisome if there were mutations that affected incubation time or the onset symptoms. These types of mutations could significantly complicate some the strategies we're relying on today, if not render them useless. [1] http://www.washingtonpost.com/national/health-science/ebola-virus-has-mutated-during-course-of-outbreak/2014/08/28/98235aaa-2ecb-11e4-bb9b-997ae96fad33_story.html http://www.washingtonpost.com/national/health-science/ebola-...

danieltillett 12y ago
There are three large differences with this outbreak than all previous outbreaks 1. The size and the number of people infected. 2. The geographical scale. No outbreak has ever been anything other than localised. 3. It is spreading in urban areas. All previous outbreaks of Ebola have been rural. If any of these differences are important then we can’t really look to past outbreaks to know what is going to happen.

danieltillett 12y ago

If we want to learn from the past maybe we should look at the Plague of Athens [1]. These were the symptoms: "As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress. In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later.” I wonder what this sounds like? The good news was it only killed between 1/3 and 2/3rds of the population. [1] http://en.wikipedia.org/wiki/Plague_of_Athens http://en.wikipedia.org/wiki/Plague_of_Athens

vpeters25 12y ago

I wonder why governments haven't dictated a 21+ day quarantine on any population center where someone is positive for Ebola. That should stop propagation on its tracks.

danieltillett 12y ago
The reason why is the countries where the outbreak has occurred do not have the policing or military capacity to do this. A couple of the countries tried to enforce 3 days quarantines to slow down the spread but the population just ignored it, either through lack of care or lack of ability (when you are living day to day you don’t have much choice about working or not - don’t work, don’t eat).
actsasbuffoon 12y ago
I live in Braintree Massachusetts, and you may have heard that there's a person suspected of having Ebola in this very city. When I read about it, literally my very first thought was that we need to isolate my city until further notice. Don't get me wrong, I'm not relishing the thought of being stuck here, but we've got a responsibility to keep this thing from spreading. I still stand by that.

bra-ket 12y ago

Ebola evolves. Each outbreak carries a number of distinct genetic changes [1] and there is a risk of a mutation (or a chain of mutations) that would accelerate transmission in unpredictable ways by interacting with new hosts. This happened in the past with Yersinia Pestis that wiped out half of the world population through fleas. I'm not sure sure why there is no centralized effort to accelerate research but rather top virologists focus on logistics of moving dead bodies. [1] http://www.sciencemag.org/content/345/6202/1369.full http://www.sciencemag.org/content/345/6202/1369.full

danieltillett 12y ago
>I'm not sure sure why there is no centralized effort to accelerate research Your answer is right at the bottom of the science article. "In memoriam: Tragically, five co-authors, who contributed greatly to public health and research efforts in Sierra Leone, contracted EVD and lost their battle with the disease before this manuscript could be published: Mohamed Fullah, Mbalu Fonnie, Alex Moigboi, Alice Kovoma, and S. Humarr Khan. We wish to honor their memory."