The Mathematics of Ebola Trigger Stark Warnings • Hacker News Board

Re: The Mathematics of Ebola Trigger Stark Warnings

#161

Post by wmgries » Mon, Sep 15, 2014, 4:52 PM UTC

gbrown wrote: post #156

wmgries wrote: post #146

I'm no expert and I'm just as frightened by the spread of this disease as everyone else, but I think people in this thread, and the media in general, are being a tad "end-of-the-world"-y about this without looking at some of the important facts. Namely: 1) The article mentions the R0 of Ebola and claims it is between 1-2 in the current outbreak. Previous outbreaks of Ebola have been as high as 2.7. But this is relati…

A basic reproductive number of two can be really really bad, provided it stays that high. If exponential growth holds long enough, it doesn't matter too much what the rate is, so long as it's above one. With that being said it varies a LOT between different countries for exactly the reasons you mention. My initial work shows a lot of heterogeneity: http://grantbrown.github.io/Ebola-2014-Analysis-Archive/Sep_... I agr…

Thanks for the links!

Re: The Mathematics of Ebola Trigger Stark Warnings

#162

Post by gbrown » Mon, Sep 15, 2014, 4:53 PM UTC

aaron695 wrote: post #15

Pxtl wrote: post #2

This should be obvious to anybody who knows about geometric growth. The only time you can really stop Ebola without a cheap and easily-available cure is now while it's small. As it grows, its rate of growth will increase, and it will quickly spread to every vulnerable area.

No, R will stay the same. Or decrease as the population becomes more exposed.

Actually R0 is a measure which captures both population mixing activity and the infectiousness of the pathogen - the two processes are confounded. That means that it varies a lot over space and time.

Re: The Mathematics of Ebola Trigger Stark Warnings

#163

Post by [deleted] » Mon, Sep 15, 2014, 4:54 PM UTC

crusso wrote: post #147

x0x0 wrote: post #112

Earlier quoted context omitted.

The death rate from the current ebola is approximately 50%. While that sucks, what patients have to lose is both a 50% chance of living and their right not to be a playground for medical experimentation. edit: and just who vets the people/companies who get to offer drugs to desperately ill people? Does anybody with $1k to buy needles get to make a sign and advertise curative injections? I'm sure glibertarian idiots w…

glibertarian idiots Please avoid making personal attacks like this on HN. As a mostly libertarian-minded person myself, the height of compassion is to allow dying people to reach out for any hope out there. Cruelty would be to prevent people from attempting to save their own lives "for their own good"; especially when no alternative cure is being offered by the politicians and bureaucrats making such life-impinging d…

[deleted]

Re: The Mathematics of Ebola Trigger Stark Warnings

#164

Post by cstross » Mon, Sep 15, 2014, 5:20 PM UTC

ObviousScience wrote: post #153

cstross wrote: post #122

Earlier quoted context omitted.

There are pros and cons for both sides of this argument. The question is whether to suspend normal precautionary procedures during an extraordinary situation, not whether to ditch normal precautionary procedures which exist for very good reasons (see the Elixir Sulfanilamide disaster for why): http://www.fda.gov/aboutfda/whatwedo/history/productregulati... You're rightly concerned for the possible side-effects of usi…

> who's liable for not deploying an available experimental treatment that is later determined to work, but only after tens of thousands have died while it sits, unused, on the shelf due to lack of test data? No one, that's exactly the point. There's no way to sort out misdeeds, eg, fake cures from real attempts if we lift the normal trial and liability procedures. No one would use untrialed drugs if they had to take…

There's no way to sort out misdeeds, eg, fake cures from real attempts if we lift the normal trial and liability procedures. No one would use untrialed drugs if they had to take the full liability.

I'm ready to assume that medics treating an emergency epidemic are unlikely to knowingly turn to quack remedies -- homeopathic or bogus ones -- as opposed to items like ZMapp, a monoclonal antibody treatment by a well-regulated pharmaceutical company that just happens not to have been approved for human clinical trials yet.

http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa-experimenta...

Furthermore, let me add that conducting a randomized controlled clinical trial (for effectiveness and safety) when dealing with a pathogenic infection with a > 50% fatality rate is arguably unethical: you can collect data on clinical applications and apply a retrospective control sample of patients to determine whether it improved the outcome where it was used, but withholding a potentially effective treatment becomes extremely problematic under some circumstances -- the historic classic example was zidovudine for HIV, which was rushed through human trials into use in just 27 months because it was the first effective treatment for a then-100% fatal disease (HIV). (Some of the double-blind trials were short-circuited when it became apparent that continuing to alternate patients with placebo controls was likely to be injurious.)

http://en.wikipedia.org/wiki/Zidovudine

Re: The Mathematics of Ebola Trigger Stark Warnings

#165

Post by wavefunction » Mon, Sep 15, 2014, 5:31 PM UTC

kijin wrote: post #110

swombat wrote: post #99

Earlier quoted context omitted.

That sounds reminiscent to what happened during the Black Death. Unfortunately, it doesn't sound like it worked particularly well, considering the Plague still took a sizeable percentage of the human population at the time.

Villages that quarantined themselves during the Plague were left completely to their own devices. Back then, you couldn't even try to communicate with other villages without risking the messenger's life. Today, outsiders can airlift food, clean water, and medical supplies to any isolated village that asks for help. So let's stop wasting resources on people who don't want to be helped, and focus on people who actually…

You do realize _how_ isolated these villages are right? Like the only stranger they see in a month is an itinerant trader? How exactly are they supposed to safely get word out to the "civilized" world? That is assuming that they have already heard that there is a disease going around and what the proper precautions are...

Re: The Mathematics of Ebola Trigger Stark Warnings

#166

Post by jnbiche » Mon, Sep 15, 2014, 6:25 PM UTC

fractallyte wrote: post #114

jnbiche wrote: post #12

Earlier quoted context omitted.

>since most of the worlds problems today stem from overpopulation Why do you think that most of the world's problems today stem from overpopulation? What problems? If you're talking about hunger, that's demonstrably false. There is plenty of food produced to feed the entire population. Even African produces plenty of food to feed itself. Famine occurs in times of war and natural disaster, or other great upheavals. Mo…

> What problems? Uh - collapsing ecosystems? More to the point, encroachment of humans into wilderness areas which harbor viruses? The biggest 'man-made' issue here is more 'man': mindless reproduction and consumption without any regard to the future.

>encroachment of humans into wilderness areas...

...has nothing to do with overpopulation and everything to do with tragedy of the commons and destructive corporations. Brazil's rainforests would be cut down regardless of what the population of Brazil was.

>The biggest 'man-made' issue here is more 'man': mindless reproduction and consumption without any regard to the future.

And it's stunning to see the charge of "mindless consumption" being thrown at areas with the highest population growth like Africa, when their rates of energy and food consumption cannot even compare to those in the developed world. They're miniscule [1][2].

1. http://en.wikipedia.org/wiki/List_of_countries_by_energy_con...

2. http://en.wikipedia.org/wiki/List_of_countries_by_food_energ...

Re: The Mathematics of Ebola Trigger Stark Warnings

#167

Post by jnbiche » Mon, Sep 15, 2014, 6:31 PM UTC

phkahler wrote: post #119

jnbiche wrote: post #12

Earlier quoted context omitted.

>since most of the worlds problems today stem from overpopulation Why do you think that most of the world's problems today stem from overpopulation? What problems? If you're talking about hunger, that's demonstrably false. There is plenty of food produced to feed the entire population. Even African produces plenty of food to feed itself. Famine occurs in times of war and natural disaster, or other great upheavals. Mo…

I would argue that war can be a result of overpopulation. Famine is also - it occurs in the places least able to deal with ebola. "Global warming" - we could reduce emissions by reducing population without changing the per capita energy consumption. Unemployment - not enough jobs is the same thing as too many people. Strife in the middle east? Too many people in that area of the world with not enough resource (or gov…

> Famine is also - it occurs in the places least able to deal with ebola

The areas currently buckling under Ebola have not been the regions of Africa most affected by famine in the last few decades, most of which are in the Sahel and Horn of Africa. And which were caused by political problems. Other than that, I'm not sure what this means.

>"Global warming" - we could reduce emissions by reducing population without changing the per capita energy consumption.

This would be true if you reduced population in the West and in Asia but the energy and food consumption of Africa is absolutely minuscule compared to the rest of the world.

See the references in my other post:

https://news.ycombinator.com/item?id=8320473

>Strife in the middle east?

Israel has a relatively low birth rate.

Re: The Mathematics of Ebola Trigger Stark Warnings

#168

Post by waps » Mon, Sep 15, 2014, 7:00 PM UTC

ctdonath wrote: post #144

DanBC wrote: post #121

Earlier quoted context omitted.

What if the risk was survival but with locked-in syndrome and constant very high pain? Or survival but severely brain damaged - no ability to feed yourself; or talk; or understand the conversations of other people.

A risk? yes. But if that risk is significantly less than the other high-risk form of "severely brain damaged, unable to eat, talk, or understand" known as death , many would take it. Remember, the point is trying something that doctors & pharmacists believe has a sensible chance of actual _cure_ (perhaps with acceptable side effects better than death/dementia). I don't understand the propensity of some to demean "hey…

Experimental treatment obviously means unknown risk.

And of course the deal is going to be that you take full responsibility for the risk. In other words, if something like that happens, you get zero assistance, not even from any health insurance you already have.

> I don't understand the propensity of some to demean "hey, there's a serious immediate problem, let's do everything we can to help" with "but it might (with minuscule odds) go horribly wrong! therefore we can't let anyone do anything that's not established best-condition status quo!" With that mindset, it's a wonder such people ever drive to work (you might die in a horrible flaming carbecue!).

Short answer : because it's happened before.

I would also argue that given history, the risks of unknown treatments having major side effects are significant (let's say ~15-20%). The risks of major side effects on pregnancies and later offspring are even more significant (20-40%).

So those odds are not that minuscule and there are going to be victims.

Your attitude stems from the idea that seems to be propagated a lot these days : that science and therefore medicine can fix anything, any disease. That was almost true for a short period at the end of the 70s. In the 80s we found several diseases became fully resistant. Now the counter of completely incurable diseases is in the thirties, and rising fast. Old, well-known diseases are coming back, untreatable. Tuberculosis, pneumonia, dysentery ... all have MRSA variants. And that's ignoring a lot of viruses. Rabies, HIV, Hep C, MERS, Avian flu, Pig flu, ... all of which are essentially untreatable.

The point the CDC has been making for ~20 years now is that ~3 decades ago "net-"scientific advancement against infectious diseases stopped. There were advances, but diseases advanced at roughly the same pace. 2 decades ago we started losing ground and in the last decade we've been losing ground like never before.

And of course we're completely focusing on the wrong solution : don't use medicine anymore ! Great, but that ship has sailed, adaptation has happened and it's generally too late. There have been studies on how long these adaptations last, and how long we'd have to wait if we stopped treating ill people. The timeframe is in the centuries.

Re: The Mathematics of Ebola Trigger Stark Warnings

#169

Post by ctdonath » Mon, Sep 15, 2014, 7:18 PM UTC

waps wrote: post #168

ctdonath wrote: post #144

Earlier quoted context omitted.

A risk? yes. But if that risk is significantly less than the other high-risk form of "severely brain damaged, unable to eat, talk, or understand" known as death , many would take it. Remember, the point is trying something that doctors & pharmacists believe has a sensible chance of actual _cure_ (perhaps with acceptable side effects better than death/dementia). I don't understand the propensity of some to demean "hey…

Experimental treatment obviously means unknown risk. And of course the deal is going to be that you take full responsibility for the risk. In other words, if something like that happens, you get zero assistance, not even from any health insurance you already have. > I don't understand the propensity of some to demean "hey, there's a serious immediate problem, let's do everything we can to help" with "but it might (wi…

So those odds are not that minuscule and there are going to be victims. Your attitude stems from the idea that seems to be propagated a lot these days : that science and therefore medicine can fix anything, any disease.

Yes, there will be victims. No, I don't subscribe to "science/medicine can fix anything" - don't put absurd words in my mouth/fingers.

Balancing those problems vs BEING DEAD, I'm irritated that you'd deny me the former option.

I've been dead once already; may the fleas of a thousand camels infest the armpits of he who would give me little choice but do it again.

Re: The Mathematics of Ebola Trigger Stark Warnings

#170

Post by chestnut-tree » Mon, Sep 15, 2014, 7:18 PM UTC

If you're in the UK, there's an informative BBC documentary on Ebola broadcast just last week. The programme talks to survivors of the virus, to the staff of Médecins Sans Frontières (MSF) treating victims, to Peter Piot, the Belgian doctor who discovered the virus (and established that the disease was not airborne) and the medical staff seeking a cure. There are some harrowing scenes.

It's available on iPlayer until Friday 19 Sept. 2014 http://www.bbc.co.uk/iplayer/episode/b04hcthj/

Someone's uploaded it to YouTube, although the last 10 minutes are missing https://www.youtube.com/watch?v=bjuQofIleOg