Honestly what it really boils down to is resources and money ("resource" can also be described as "money" therefore really money and money).
Up until very recently there were simply not enough hazmat suits, not enough burn-able bedding, not enough people (who wants to work with Ebola?), not enough disinfectant, and heck even clean water in SOME areas.
Then you have to consider how damn hot it is there, so a $5 hazmat suit may not cut it (this article covers that). Now you're dealing with suits costing tens of times more than that for basic AC, just to allow the people in them to work longer shifts.
You also have a lot of local population pushback. The hazmat suits scare people, and all locals see is Ebola patients go into treatment and die. There is a lot of suspicion that Westerners are getting people sick to kill them, so they hide away family members until they get infectious.
What can be done? Money, and resources. It isn't a magic bullet but if you train a metric ton of local people and give them everything they could possibly need it would at least slow the spread if not reverse it entirely...
PS - This article is exactly WHY I am not legitimately concerned about a wide-spread infection in the Western world. We are simply too rich, we have or can acquire the resources, and even your average Joe Smith on the street can Google how to protect themselves from Ebola exposure.
>This article is exactly WHY I am not legitimately concerned about a wide-spread infection in the Western world.
Leaving aside the moral argument of preventing huge numbers of innocent people from dying Ebola if we can, there are two reason we in the west should be concerned:
1. There is a serious risk that Ebola will mutate to become more infectious. It is very unlikely to become airborne (this is about as likely as pigs becoming airborne), but it could relatively easily mutate to slow down its kill speed. At the moment Ebola kills so quickly that there is little time for a patient to spread it to other people. Ebola is under huge selection pressure to slow down the disease progression in humans. We could see a strain arise that takes a month to kill you where you are asymptotically infectious for a couple of weeks. Model this sort of virus and things look far less rosy for us in the west. The more people we let Ebola infect the more likely that such a strain will arise.
2. Once the number of cases get very large (25,000 a day by Jan 2015 according to the CDC) this is going to start disrupting international trade as countries close their borders. We already saw the sort of recession that can result from disruptions to trade when this happened in the GFC and the Asian crisis in the 90s. With interest rates at or near zero in most countries there is not much that can be done to buffer us economically.
the real threat is that this disease is going to come to more Westernize countries and fester amongst poor populations who already do not trust their local officials. combine this with a sense of entitlement far too many people have when it comes to travel and restrictions of such, already in the US there is push back from those being monitored who had contact with the Dallas patient. We even have protesters rallying because a dog was put down.
How do you contain irrational actions, the mutation of the disease may occur or not occur, but damn if a bunch of people aren't exercising self destructive behavior.
People love to ridicule the Africans suffering through this as backward and superstitious all the while ignoring that entitlement, arrogance, and such, will cause similar containment issues in supposedly better countries.
The fact that traffic hasn't been stopped already is criminal, its starting to read like World War Z. Europe will have it worse as they cannot easily control people getting in, the US has an ocean but air travel tends to mitigate that.
>Ebola is under huge selection pressure to slow down the disease progression in humans. We could see a strain arise that takes a month to kill you where you are asymptotically infectious for a couple of weeks.
The virus doesn't gave a goal, to kill the patient. The death of the host is just an unfortunate side effect that really harms the spread of the virus. The really successful viruses have mutated to a form where they don't kill the host, don't make you sick enough to stay in bed, and just make you go to work and cough and sneeze all over everyone at the office.
This may all be true, but it does not say anything useful about Ebola and what the selection pressure it is under. At the moment the speed of disease progression to death is so fast that it is slowing the spread of Ebola. If the Ebola took longer to kill it would infect more people.
The problem with Ebola is its mechanism of transmission is quite closely linked to the reason it is lethal (large virus production and body fluid leakage). It would take a very large leap in genome space (mutations) to turn Ebola into a virus that is efficiently transmitted, but causes limited symptoms like a Rhinovirus. It is not a large jump in genome space for it to just become slower in progression.
I gave this some thought, and it occurred to me that smallpox, even after co-evolving with humans for at least 10,000 years, still had a mortality rate comparable to Ebola today, a similar incubation period, and a similar amount of time before the patient was incapacitated.
edit:
It seems that this wasn't accurate. From wikipedia:
>In the United States and South Africa a much milder form of smallpox, variola minor, was recognized just before the close of the 19th century. By the mid-20th century variola minor occurred along with variola major, in varying proportions, in many parts of Africa. Patients with variola minor experience only a mild systemic illness, are often ambulant throughout the course of the disease, and are therefore able to more easily spread disease. Infection with v. minor induces immunity against the more deadly variola major form. Thus as v. minor spread all over the USA, into Canada, the South American countries and Great Britain it became the dominant form of smallpox, further reducing mortality rates.
In regards smallpox there were multiple strains circulating at any point in time and some were more deadly than others. Which ones spread at any point in time depended on both chance and the particular selection conditions in the population. In populations with high levels of immunity (either natural or acquired) the more mild strains tended to spread, while in populations with low levels of immunity the more lethal strains would tend to spread (lot of complicated reasons for this).
Your general idea is correct though. Just because a disease has been in a population for a long time does not means that it is harmless, not are all new diseases dangerous.
Perhaps the problem is your choice of words. Saying "selection pressure" implies intent, determination, a collective mission, if you will. Evolution has none of those drivers. It has no objectives. It sets no goals. And it certainly does not operate in some collective purpose driven form within a population.
It's random mutations that either survive the environmental contex within which they exist, or they don't. In this case the fact that more people are infected does not mean that we are at the doorstep of a "super-ebola" mutation any time soon. It could take ONE mutation or 100 MILLION YEARS of intense mutations to arrive at "super-ebola". Nobody knows.
The virus certainly isn't under any "selection pressure" to do a darn thing. It could become perfectly benign in six months just as much as it could become horrifically good at killing us by the millions.
I guess I could be accused of using technical language with an audience that does not have an biology background. "Selection pressure" means something specific in biology and I used it in that manner.
To put what I said in layman’s terms an Ebola viral strain that has by chance a mutation that results in slower disease progression will have more opportunities to infect people than one that kills people faster. If out of the trillion and trillions of new Ebola viral particles being created every second in west Africa one viral particle were to be randomly created that happened to kill people slower, then anyone infected with this new strain would be more likely to live longer than if they had been infected with an original virus particle. This person would then have a greater chance to infect new people and so on. Such a strain would be more contagious, and depending on the exact properties of the strain it may be able to spread even in western countries.
I am not saying that this is likely (nobody know), but I would prefer we stop generating all those trillions of random Ebola viral particles and so end this rather dangerous experiment.
Thanks, learned something new. Obviously not a biologist. Perhaps a link to the definition would have been useful being that one can't assume the audience to familiar with terms that can easily be confused for something else.
Now to make sure I understand it. Are you proposing that selection pressure is being exerted, among other things, by he time it takes for the virus to kill the host?
Well, I guess one could say everything exerts selection pressure. What makes you focus on time-to-kill? Is there any evidence that time-to-kill is the most important variable here? For example, if the virus mutated in such a way that it caused the host to not develop a fever until a few days after it is communicable it could become really deadly very quickly? The same would be the case if it caused more violent coughing, etc.
In other words, now that I understand how you are using the term "selection pressure" I also understand that time-to-kill is but one of the factors causing it. Why do you focus on time-to-kill when arguably it is the easiest to control by means of isolation.
To further clarify, if someone gets sick with the current time-to-kill duration it will be identified and dealt with in N days. If time-to-kill doubled due to an unfortunate mutation it is unlikely that it will take 2N days to identify and deal with a patient. In other words, the fact that it takes twice as long for the virus to kill the patient is probably irrelevant. This, of course, only holds if the fabric of society holds. If you have sick and contagious people roaming the streets coughing on everyone they come across all bets are off. Then again, that would be true without any change to the time-to-kill time.
So, yeah, not sure I get why you think time-to-kill selection pressure is important in the context of a society that hasn't completely broken down.
If time to kill after becoming infectious increases, then the number of people the host is able to infect becomes greater.
If time to kill before becoming infectious increases then the host can travel further before infecting others and so spread a disease outside an affected area.
If this strain of ebola was killing ~90% in a few days, rather than ~50% in a week or so, then it probably would never have spread this far.
In terms of public health if it had been a lot more deadly to the individual, then it would probably have killed a lot less people overall.
Most outbreaks of an infectious disease become less deadly the further they spread as the longer lived hosts are the one's more likely to be able to pass things on.
> If time to kill after becoming infectious increases, then the number of people the host is able to infect becomes greater.
No. That is not correct. And that is my point. The virus can only infect more people if those infected with it are left to roam freely in the general population. If, for example, everyone is diagnosed within three days of showing symptoms it doesn't matter if time-to-kill is 10 days or 30 days. Those infected will be identified and isolated within the first three days. So, the virus will not infect more people.
What you are saying is absolutely true if society breaks down and infected people are free to roam and transmit the virus or if viral control mechanisms (identification, isolation and treatment) are substandard or nonexistent.
> If time to kill before becoming infectious increases then the host can travel further before infecting others and so spread a disease outside an affected area.
You are confusing time-to-kill with time-to-becoming-contagious (or whatever we want to call it). One does not imply the other. I am only asking about justification for time-to-kill being important in the context of the identification and isolation of people who are contagious within N days of showing signs. As I said before, if you catch them within N days and isolate them the fact that people can die within X days or 2X days is utterly irrelevant. If you don't isolate them the situation is, of course, very different.
> If this strain of ebola was killing ~90% in a few days, rather than ~50% in a week or so, then it probably would never have spread this far.
I don't think this is true either. The death of the person carrying the virus is NOT the end of the virus. A virus killing the infected in five days vs. ten days might be far worst. It depends on a huge number of factors. For example, take the case of a person who takes the subway to go to work every day. He becomes contagious after 21 days and does not go to the doctor until the fourth day. He has potentially infected a massive number of people. The fact that he dies on day 5 or day 10 is meaningless. The only way it could become meaningful is if this person, again, is roaming free after becoming contagious.
I think what's going on here is that many are making the assumption that people will do just that: No medical attention, no isolation, just going around infecting people for days and days without a care in the world. That's not the way things work unless society completely breaks down. Hence my questioning of the assertion that a longer time-to-kill is, by itself, significant in any way.
So I say again:
It is absolutely crucial that we take these outbreaks as the existential threats they represent. They can start small and virtually without notice. People run a fever pop some pills and continue about life for a few days. Failing to recognize the need for serious medical attention they go about life and infect many more. When they finally feel crappy enough to go to the doctor they've already set the chain reaction in motion. If medical professionals are not on their guard and dismiss the patient they could make things worst as well as exposing themselves and other medical professionals to the active virus. Imagine an outbreak of 50 or 100 cases in a city like Austin, TX. It will quickly change society for quite some time. If medical professionals fall victim it will only add a scary layer to the equation. The key to all of this is to both prevent it from reaching our shores and, if it does, have a massive information and awareness campaign to be able to stop it. It wouldn't take much to be in a situation where you have to ground every plane in the US and tell people to stay home for 21 days if a large enough outbreak happens in a mid to large city.
The key is prevention and quick isolation.
Not sure why we still have flights incoming from the afflicted areas without having them land at a military base for a mandatory 21 day holding period before contact with the general population.
The virus can only infect more people if those infected with it are left to roam freely in the general population.
Tell that to the healthcare workers who are having to treat patients in full suits and are still getting exposed. It doesn't matter where you are, the longer you are infectious, the more chance you have of infecting someone, so strains that keep you alive longer are more likely to be passed on.
You are confusing time-to-kill with time-to-becoming-contagious
I misworded it cos I was tired, but yes I did mean time to becoming contagious for the second point.
Oh, please. Think about what you just said. Could it be that they got infected because they did not use proper procedure while wearing or removing the protective suits? Or is the explanation that despite protective suits they contracted the virus?
Let's see. If it's number one, well, it has nothing to do with the time it takes for the virus to kill the patient.
And, guess what? If it is number two it also has nothing to do with the time it takes for the virus to kill a patient. They are probably using the wrong suits. Or maybe they e
Were damaged . Or maybe they were reused or not sanitized or...
Once a patient is identified and quarantined properly and all safety procedures are followed the time that the virus needs to kill the patient is utterly irrelevant as it pertains to spreading the disease. That should hold for all normal circumstances.
The selection pressure doesn't seem to be that huge to me. There are only on the order of 10,000 human cases. That those cases are caused by trillions of ebola viruses doesn't seem relevant to measuring evolutionary pressure.
Selection pressure is the term used widely in evolutionary biology. If you can't get past that choice of words, you wouldn't be able to get anywhere in actually studying the subject, as that choice of words is used throughout.
"Saying "selection pressure" implies intent, determination, a collective mission, if you will. Evolution has none of those drivers. It has no objectives. It sets no goals. And it certainly does not operate in some collective purpose driven form within a population."
danieltillett said:
"At the moment the speed of disease progression to death is so fast that it is slowing the spread of Ebola. If the Ebola took longer to kill it would infect more people."
This seems like a true statement and in line with your own opinion; I can't quite see what you are objecting to.
The death of the infected isn't necessarily the end of the virus.
It looks like a police officer inspecting the home of the guy who just died in Texas has now contracted ebola. As I understand it he inspected the home days after the patient had been in isolation at the hospital. Apparently there was vomit, fecal matter, blood and who knows what else in there. Why he went in there without protective gear is incomprehensible to me.
The point is that death isn't the end of the virus, it's the end of the host. That's why they are cremating the guy who just died.
>> There is a serious risk that Ebola will mutate to become more infectious.
Not likely. Survival of the fittest for a virus usually means allowing the host to live longer - in other words LESS lethal. It is not likely to become airborne, and if it did it would not be ebola any more. The symptoms of most diseases are not an accident, they are tied to the means of transmission:
Colds make you cough and sneeze.
Flu makes you cough, sneeze, barf and sweat.
Rabies makes you crazy and want to bite.
STDs some think may make people horny.
Ebola makes you barf, shit, bleed, sweat.
The one scary thing is I once read that a single gene make Ebola hemoragic, and if that were to transfer to a flu, that would be very deadly. But it would also be less virulent due to that same deadliness and so would be selected against as our response to related flu vidii would wipe it out.
None of that is helpful short term, but this notion of the virus getting more horrible than it already is, I don't think so.
>Not likely. Survival of the fittest for a virus usually means allowing the host to live longer - in other words LESS lethal.
Lethality is irrelevant to a virus, all that matters is the probability of transmission. Ebola is about as rapidly deadly as a virus can be and still be viable. The selection pressure is all on shedding large numbers of virus particle in all directions - there is no selection pressure on preventing you from dying.
So why does Ebola kill then? It is basically a side effect of its mechanisms of transmission. It diverts your body into producing an enormous number of viral particles and then makes your body “leaky” so that they are released into the environment to infect someone else. If you were to design a virus based on Ebola from scratch for maximum transmission in humans you would slow down the disease progression, but you would find it hard to remove the lethality.
Another way of thinking about Ebola is that the current strain is not at the local maximum for optimal transmission in humans as it kills too quickly. Any slow down in disease progression will cause the infectiousness in humans to increase. This is why this is something we should be worried about.
Yes I know, but I thought it better to explain in a different manner than just point this out.
Another way to look at the problem is how optimised the current strain is for human transmission. As a zoonotic virus it is not very likely that Ebola is well adapted for effective human-to-human transmission. We should expect that the more people that it passes through the better adapted to humans Ebola will become and the more difficult it will be to contain. The unknown is we don’t know how well adapted it could become to humans, but personally I would rather not run this experiment in the wild to find out.
"2. Once the number of cases get very large (25,000 a day by Jan 2015 according to the CDC) this is going to start disrupting international trade as countries close their borders."
This is what has me worried. It seems somewhat likely that overreactions will cause more harm (and possibly kill more people) than the disease itself.
I would agree that the economic effects are much more likely to affect most of us in the west directly than the chance of coming down with Ebola. The world economy is not really in a good state to handle an external shock like massive trade disruption right now.
For those that didn't get the reference - this is a reference to the web game pandemic in which the objective is to design a virus/bacteria/parasite to infect the entire world - Madagascar is the hardest country to infect in this game because it only has one port in the game.
It's not like the US intentionally infected a bunch of people in a foreign country with a disease because they were curious about it, then waited 65 years to apologize for their crimes.[1]
And certainly the US government would never lie about treating people for a disease in a government program, and then just watch them die instead of actually helping them.[2]
Snark aside, have you ever considered that maybe there's a reason people don't trust the US government to act ethically or in their interests?
You're referring to things that happened 60 or 70 years ago as a reference basis for trust, for a government who has as its President a man born 53 years ago.
There's a long list of warranted criticism to throw at the US Government, but I don't see how your examples are valid criticism of today's government. The US Government of 1950 no longer exists. Yet you're referring to it as though it does.
I guess Angela Merkel is not to be trusted because of what happened 70 years ago? Or Shinzo Abe?
Well, 60-70 years is about the horizon over which previously secret programs become revealed. The US has been continually caught performing unethical actions in secret which either involve human testing (occasionally on their own citizens) or subverting medical programs for ulterior motives.
There was drug testing that the US got caught at 50 years ago, and only halted 40 years ago.[1] And in the past few years, they subverted a vaccination program in to being a tool of a spy agency.[2]
Had the Nazi regime merely "reformed" rather than been completely replaced following a war, apologized 60-70 years after the fact for their genocide during WW2 which they'd attempted to keep secret, and been caught at least once a decade running similar covert programs, I'd think citing a well documented historic case of their misdeeds would actually be a pretty good way to show exactly why people don't think highly of them.
You always here about this stuff 60-70 years afterwards unless it was leaked. This is because the people involved are long buried and everyone alive can deny involvement...
Whether it's rational to not trust either the US or German government because of what happened in the past, the actual situation is that such actions are not easily forgotten. There are plenty of people who still carry suspicions against Germany for what happened 70 years ago.
What's the international crime statute of limitations these days? Maybe Africans don't want U.S. or European help because those countries used to steal Africans and turn them into slaves.
Or--maybe Africans actually do want U.S. and European help, and have repeatedly asked for it, and have expressed thanks that it is now being mobilized.
I was trying to shed some light on why it was a tough battle to get people to trust Western medical teams, which is entirely relevant to the ebola crisis as this distrust is one of the main barriers to arresting the spread of ebola in Africa.
This is a really important point to consider. We have already had health teams killed by people in the affected countries out of fear. If we were going to start implementing an effective quarantine and treatment process then we are going to need a large amount of security and enforcement resources to support the health care teams. This is going to have to come from outside as the countries affected don’t have the resources.
Thank you for the link about one health team killed in one village in one country. (The comment to which I was replying, not posted by you, mentioned "health teams," plural, that were killed, without specifying a place.) The link you kindly shared reports,
"Eight members of a team trying to raise awareness about Ebola have been killed by villagers using machetes and clubs in Guinea, officials say.
"Some of the bodies - of health workers, local officials and journalists - were found in a septic tank in a village school near the city of Nzerekore."
Reading this, I'm not entirely sure whether or not any Western people were part of the group who visited the village. The participant here to whom I was replying referred specifically to
a tough battle to get people to trust Western medical teams
after previously writing
have you ever considered that maybe there's a reason people don't trust the US government to act ethically or in their interests?
I have considered that possibility, and that is why I am looking for evidence. Where is the evidence that people in west Africa specifically distrust the United States as a source of medical aid more than they distrust their own local officials or modernity in general? (The west Africans I know locally, by definition people who have traveled to the United States to settle and work here, don't seem to have a general attitude of distrust of the United States government. Many of the health care workers who cared for my late dad in the years he was paralyzed after a spinal cord injury were nurses and nursing aids from Liberia.)
I appreciate your follow-up to my question. I'd like to see more on-point journalistic sources from other people who have commented in this thread.
AFTER EDIT: I was aware of the news story from National Public Radio[1] submitted to open this thread (of course!) about one area in Liberia that has enjoyed success in stopping spread of ebola as I asked the questions above in the thread. Fear of Westerners does not appear to be general in west Africa, not even in areas infected by ebola. That's why I think some of the comments here seem so off-topic. They refer to nothing in the article.
You had me until I read the article. Then I came back to the link and saw that the article is from the Mirror, widely known to be a completely unreliable tabloid newspaper dealing in sensationalism rather than careful field-based reporting.
That episode probably (hopefully?) hasn't much to do with the Ebola thing. Apparently it has been a huge problem for the polio eradication effort in Pakistan. A very, very serious error by the CIA.
It may turn that those actions by the CIA result in more deaths than occurred as a result of 9/11. Absolutely no excuse or justification for using the cover of medical treatment for their para-military reconnaissance in that situation, particularly as it turns out it was never needed anyways.
There was Islamist opposition to polio eradication campaigns before anyone in the West was sure that Osama Bin Laden was in Pakistan. (That's why it surprised me that vaccination campaigns were used as a ruse for verifying his whereabouts, but apparently Bin Laden's personal crazy ideas didn't include opposition to vaccination.) It's not entirely a coincidence that even before anyone heard about Bin Laden, the last few places on earth with endemic polio were all places with militant Islamist movements. Personally, I would rather have my children live long healthy lives, no matter whose idea it was to invent vaccines or to use a vaccination campaign as a pretext to find an international fugitive, but logic doesn't always appeal to people who are already making excuses for being illogical.
I was more commenting on zero dark thirty, in which the attempt to get genetic material by the doctor was prevented, and played no role in the actual decision to storm the compound.
You are correct in that the reality may have been somewhat different than the movie.
Your comment is quite irrelevant to the topic of this thread, which is efforts to prevent deaths from ebola, a disease for which there is currently no vaccine.
> This article is exactly WHY I am not legitimately concerned about a wide-spread infection in the Western world.
I guess you have never been in a disaster in the western world. Well, I have. More than once. And I have seen what people can devolve into. I'll probably get voted down mercilessly for saying this:
The truth of the matter is that "civilization" is thin-skinned. It doesn't take that much for people to revert to cave-men behavior. The worst thing we can do, by far, is to adopt a smug "won't happen here" attitude in the "civilized", "educated" and "sophisticated" west.
The minute we don't attack this as the existential threat it is, we are simply setting ourselves up for a catastrophe of unimaginable proportions.
The government/foreign operations had basically shut down Ebola earlier in the epidemic. But there was an atmosphere of conspiracy theories associating the operation with the outbreak of the disease. Ebola cases went underground. The foreigners had started to pack up and go home when it reemerged.
I do agree that we(humans from other countries) should all just dump resources on the people there -
but I think the legitimate concern here is that while we squabble about resources and their cost, the virus spreads and mutates - and if it makes the jump to airborne, I think it will make the average Joe Smith pretty vulnerable.
It's a prisoner's dilemma sort of thing. The best outcome for ME is if YOU dump lots of money into it, so I sit around on my hands hoping you take action, while YOU do the same waiting for ME to take action. As a result, we arrive at the worse outcome- nobody does anything.
This is the philosophical explanation for government taxation. In this particular case I think we can say that it is now beyond voluntary funded NGOs to solve.
Up until very recently there were simply not enough hazmat suits, not enough burn-able bedding, not enough people (who wants to work with Ebola?), not enough disinfectant, and heck even clean water in SOME areas.
Then you have to consider how damn hot it is there, so a $5 hazmat suit may not cut it (this article covers that). Now you're dealing with suits costing tens of times more than that for basic AC, just to allow the people in them to work longer shifts.
You also have a lot of local population pushback. The hazmat suits scare people, and all locals see is Ebola patients go into treatment and die. There is a lot of suspicion that Westerners are getting people sick to kill them, so they hide away family members until they get infectious.
What can be done? Money, and resources. It isn't a magic bullet but if you train a metric ton of local people and give them everything they could possibly need it would at least slow the spread if not reverse it entirely...
PS - This article is exactly WHY I am not legitimately concerned about a wide-spread infection in the Western world. We are simply too rich, we have or can acquire the resources, and even your average Joe Smith on the street can Google how to protect themselves from Ebola exposure.