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W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

nytimes.com

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Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#91

Post by samplonius »

danieltillett wrote: post #75
jewbacca wrote: post #59

Earlier quoted context omitted.

My total layman's impression of this has been that it doesn't matter if the virus mutates to something "worse" -- that, short of some currently politically impossible action several orders of magnitude beyond what is currently being done, there is no really solid, non-magical-thinking, reason to believe this outbreak won't kill tens/hundreds of millions of people and threaten world civilization as we know it, even wi…

While I am firmly on the side that believes that Ebola is very serious and we need to do everything we can to stop it [1], it is possible the R0 could drop below 1 via changes in behaviour of the people in west Africa. Since we really have a poor idea of what factors are driving the spread of Ebola, it is possible that these factors could change spontaneously. For example, people might get so scared of Ebola in the a…

"For example, people might get so scared of Ebola in the affected countries ... and throw them out on the street to die."

That might make it worse. In Africa, the distance between the gutter and the water supply isn't very far nor clearly defined (bad water causes a lot of deaths in Africa already). And given that the Ebola virus causes people to literately leak, dropping them in the street may containment local water supplies. Plus, the Ebola virus can probably survive in wet but dead tissue a lot longer than in the open area. So each one of these bodies would become a mini bio hazard, until the tissue decays to the point that the virus dies.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#92

Post by danieltillett »

tjradcliffe wrote: post #87
danieltillett wrote: post #29

Earlier quoted context omitted.

Yes Ebola can be transmitted that way, but it is an unlikely route. The way Ebola is constructed it is very unlikely to become airborne [1], but it could increase in natural reproductive efficiency (R0). We really have no idea of the R0 for Ebola right now as we don’t have the people on the ground recording what is happening in the community. Ebola does not have to become airborne for it to be a problem. Polio is not…

Spreading fear is a hobby for some people. Every single story on Ebola seems to be taken over by people who are: a) ignorant of virology b) enamoured of a multiply-debunked case "they've heard" that "might have" involved "airborne" transmission despite the massive unlikeliness of that c) deeply, deeply fearful about the "possibility of Ebola becoming airborne" and d) have never once anywhere posted anything wittering…

I am far less concerned about fear being spread than ignorant “solutions” being spread. Things like proposing that closing the borders to people from west Africa will solve everything, that it is somehow's gods way of dealing with “overcrowding” and Ebola will only happen to “those people", etc. There is a real risk that we in the west will go into isolation mode and not do anything.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#93

Post by samplonius »

binaryorganic wrote: post #12
jMyles wrote: post #5

Earlier quoted context omitted.

I've never gotten the flu shot, and hadn't planned to this year. I'm in great health; my immune system seems to be functioning extremely well. I never get sick. However, I am concerned about the needle-haystack phenomenon with ebola. Can you link me to a reasonable, digestible abstract about the real pros-and-cons of flu shot?

Healthy people with healthy immune systems aren't supposed to get the flu shot to prevent themselves from getting sick. They're supposed to get it because it drastically reduces the chances of passing the virus to at risk populations (who would have a much harder time fighting the virus than you). There are almost a quarter of a million hospitalizations due to the flu in the U.S. each year.

And while the number of deaths varies each season, the CDC estimates that the flu kills a minimum of 3,000 people in the US each year. Just to put this Ebola thing in perspective.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#94

Post by danieltillett »

rgbrenner wrote: post #89
bdunbar wrote: post #86

Earlier quoted context omitted.

The military is quite good at operations 'other than war'. I was a minor cog in one effort, in 1991: Joint Task Force Sea Angel. Details are searchable, but the upshot is that NGOs (I no longer recall if the term was used then) provided far more disaster relief assets and supplies, than the military did. What the Marines brought to the party was command and control, and the ability to field, and support, a thousand g…

That is already happening. There are already 565 US military in the region, and Obama plans to deploy up to 4000. http://www.nbcnews.com/storyline/ebola-virus-outbreak/anothe...

Which is way less than the number we need there right now let alone in a couple of months it will take these troops to all get there.

If people want to know what it is like on the ground have a read of this blog post [1].

[1] http://pfmhcolumbia.wordpress.com/2014/10/12/les-roberts-the...

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#95

Post by tjradcliffe »

simplemath wrote: post #18
danieltillett wrote: post #14

Not stopping this outbreak with all the resources we have is running a massive natural experiment in how well adapted Ebola can become for efficient human-to-human transmission. As a zoonotic virus Ebola in its wild state is very unlikely to be optimised for human-to-human transmission. Every new case is increasing the chance that a new strain will arise that will be efficiently transmitted between people. I am not t…

There's already limited evidence that some transmission is occurring via atomized saliva/mucous. A truly airbone variant could cause a "get in your bunker and ride it out" kind of event.

As others have pointed out, Ebola lacks a large number of important features that rhinoviruses, for example, have. It is possible given sufficient time Ebola will mutate in ways that generate those features. It is also possible, given sufficient time, Ebola will mutate into flesh-eating flying monkeys (admittedly, this is marginally less likely than becoming airborne.)

Viruses--parasite and pathogens generally-are incredibly narrowly adapted to their preferred mode of attack. They have to be, because the chinks in the host's immune system are almost by definition incredibly narrow. If they weren't the host species would not have survived.

This gives pathogens and parasites very little room to maneuver. They can't just arbitrarily bolt on new capabilities. They have relatively little genetic material to work with: 19 kilobases in the case of Ebola, which is less than the coding length of the majority of human genes (which can run comfortably into the hundreds of kilobases).

So think of Ebola like an evil eight-bit micro-controller. It's only got 256 bytes to work with. It has been carefully programmed with a tiny attack program that depends on a very specific weakness in the target system that requires it be plugged into a USB port controlled by a particular chipset rev from a particular manufacturer. The claim "it might go airborne" is equivalent to the claim that such a chip, under millions of random mutations, might be able to infect systems via network ports while remaining the same in every other respect.

This is not (provably) impossible, but it is of such low probability that I'm pretty sure anyone concerned about it should be in a state of panic regarding cows, coconuts, coronal mass ejections, and other far-more-probable causes of death if they want to make any claims to intellectual consistency.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#96

Post by cc439 »

oska wrote: post #63

There is a good recent article in The Guardian where three western nurses describe their experience in caring for people with the virus. http://www.theguardian.com/world/2014/oct/13/ebola-nurses-de...

This seemed misguided:

"I have heard media reports calling for people such as me who have been treating Ebola patients to be quarantined for 21 or even 42 days. These ideas are not based on the medical facts. People only need to be quarantined if they are showing symptoms and if you do not have a fever, there is no risk of you transmitting Ebola to someone.:

What happens once you start showing symptoms? They're likely to have touched a large number of surfaces and interacted with a large number of people by the time they realize their worsening condition is the onset of Ebola. By the time I know I'm sick, I'm pretty sick. I'm damn good at trudging on until the point of no return and I'm sure healthcare workers would do the same since Ebola is contagious well before it's debilitating.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#97

Post by danieltillett »

samplonius wrote: post #91
danieltillett wrote: post #75

Earlier quoted context omitted.

While I am firmly on the side that believes that Ebola is very serious and we need to do everything we can to stop it [1], it is possible the R0 could drop below 1 via changes in behaviour of the people in west Africa. Since we really have a poor idea of what factors are driving the spread of Ebola, it is possible that these factors could change spontaneously. For example, people might get so scared of Ebola in the a…

"For example, people might get so scared of Ebola in the affected countries ... and throw them out on the street to die." That might make it worse. In Africa, the distance between the gutter and the water supply isn't very far nor clearly defined (bad water causes a lot of deaths in Africa already). And given that the Ebola virus causes people to literately leak, dropping them in the street may containment local wate…

>That might make it worse.

Of course. I was just trying to give a concrete example of a change that might cause the R0 to drop below 1. It would be great if the R0 did drop below 1 on its own, but planning on this is not any wiser than hoping the small fire in the corner will go out on its own.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#99

Post by hyperpape »

Swizec wrote: post #6
nostromo wrote: post #4

I'm worried about the coming flu season. Many people will have the early symptoms shared by both flu and ebola (a fever and a headache). The medical establishment will need to find needles in the haystack. Don't skip the flu shot this (or any) year, folks.

I have never gotten a flu shot in my life. The last time I remember having the flu was over 10 years ago ... actually, the last time I can remember actually being diagnosed with the flu was on the day before going to first grade. So make that 20 years ago. Do those shots really do anything much? edit: the last time I had a serious viral sickness it was a combination viral and bacterial angina (mononucleosis combined…

I hadn't gotten the flu for over a decade without getting flu shots. Then at age 23, I got it and couldn't leave my apartment for several days. Prior to that, I didn't really understand how someone who wasn't old and decrepit could feel too weak to go outside. I would read it in books, and it made no sense to me.

Re: W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises

#100

Post by hyperpape »

pdabbadabba wrote: post #66
sigmar wrote: post #57

Earlier quoted context omitted.

You pretty much answered your own question- .5M deaths out of 200M. Ebola kills 50-90%

I think the answer can be summarized: "human-to-human" transmission. Malaria, to be sure, has been a much more significant public health problem historically, but with ebola you have the possibility of human-to-human transmission and, thus, geometric growth. You also have the possibility that it will spread elsewhere in the world. And we're not just talking about the western world here either (though that surely driv…

Uncertainty is really the kicker. Ebola may turn out to be substantially less significant than malaria. But we can't rule out it being a good deal worse.
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