
W.H.O. Forecast for Ebola Worsens as Mortality Rate Rises - aaronbrethorst
http://www.nytimes.com/2014/10/15/world/africa/ebola-epidemic-who-west-africa.html
======
ericwhyne
There are a lot of great perspectives and threads in this discussion. If
you're interested and want to develop them further, a few of us have stood up
ebola-wiki.com to share data sources and information. It's a place to build on
these ideas, cite your sources, and refine them. I'd welcome feedback. Also,
if you are a mediawiki admin please contact me. We could use more help and
advice as this scales.

------
Oculus
Dr. Paul Farmer discusses Ebola:
[http://youtu.be/lb11QbP3tOg](http://youtu.be/lb11QbP3tOg)

After listening to the talk, I'm not as worried as this article makes me. I
certainly trust the source in the video better.

------
danieltillett
If anyone is interested I have put up a post on my personal blog about Ebola
and what needs to be done [1].

[1] [http://www.tillett.info/2014/10/08/ebola-what-needs-to-be-
do...](http://www.tillett.info/2014/10/08/ebola-what-needs-to-be-done-right-
now/)

------
atiffany
Donation link:

[http://www.doctorswithoutborders.org/our-work/medical-
issues...](http://www.doctorswithoutborders.org/our-work/medical-issues/ebola)

~~~
jMyles
I've been following this organization for a few years now. Its blogs and
'field news' have informed me about places in the world I didn't realize even
exist - places with unique cultures that are threatened by lack of medical
care and all the ways in which war and capricious borders create shortages in
supply of medical care.

I've given what I can - please do the same everyone!

------
oska
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...](http://www.theguardian.com/world/2014/oct/13/ebola-nurses-describe-
life-death-on-frontline-liberia-sierra-leone)

~~~
cc439
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.

~~~
bokonist
" _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._ "

Also, that above fact is wrong. "Yet the largest study of the current outbreak
found that in nearly 13% of "confirmed and probable" cases in Liberia, Sierra
Leone, Guinea and elsewhere, those infected did not have fevers."
[http://www.latimes.com/nation/la-na-1012-ebola-
fever-2014101...](http://www.latimes.com/nation/la-na-1012-ebola-
fever-20141012-story.html#page=1)

Even letting one-in-ten get through undetected is too high. Especially since
any strains of the virus that are harder to detect are exactly the strains
that most the most threat and must be kept out.

------
Chromozon
What scares me the most is the mortality rate. The numbers right now put it at
50%.

Catch Ebola. Flip a coin and guess heads or tails. If you guess incorrectly,
you die.

It will be interesting to see this number once it (inevitably) spreads to
"developed" nations with much higher standards of health care.

~~~
mikeyouse
> What scares me the most is the mortality rate. The numbers right now put it
> at 50%.

Unfortunately, it's actually worse than that.

The initial predictions about this outbreak were a 50% mortality rate, later
estimations put the rate at closer to 70%. To continue your metaphor; You flip
two coins and try to guess heads or tails. If you're wrong on either coin, you
die.

[1] - [http://www.aljazeera.com/news/africa/2014/10/ebola-
outbreak-...](http://www.aljazeera.com/news/africa/2014/10/ebola-outbreak-
killing-70-percent-victims-20141014132345720164.html)

------
simplemath
I'm trying to remain calm about this, but its growing increasingly difficult.

We're not far off pandemic territory. 10k new cases per _week_?

Very very alarming.

~~~
MichaelGG
Malaria kills over half a million people a year, out of over 200M cases. Why
is ebola so much more alarming?

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

~~~
pdabbadabba
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 drives more than its fair share
of the panic). Imagine, for instance, ebola in Mumbai or Mexico City.

~~~
hyperpape
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.

------
ausjke
why is USA still allowing people from those countries fly in? the body
temperature measure at airport is 99% useless.

When will Duncun's family pay back all those medical expenses here since he
lied to the airport before he boarded? Not to mention he put other innocent
people in ciritical danger at Dallas.

~~~
pdabbadabba
I'm sorry, did Duncan's FAMILY lie on the form? While we're at it, did Duncan?
It's fairly widely reported that he did not know that the woman he helped had
ebola. Apparently her family had been in denial, and told people she was
experiencing complications from the pregnancy.

>Duncan did not know he'd been exposed to Ebola by the pregnant woman, says
his brother-in-law, John Lewis.

>"The family said that the girl did not die from Ebola; they continued to say
it until they went and buried this girl," says Lewis.

[http://www.npr.org/blogs/goatsandsoda/2014/10/09/354645983/f...](http://www.npr.org/blogs/goatsandsoda/2014/10/09/354645983/fond-
memories-of-ebola-victim-eric-duncan-anger-over-his-death)

And in any case: how about you spend a little more time trying to feel
compassion for people like you who just lost a husband/father/son and a little
less trying to figure out who should get the bill.

~~~
Crito
> _" It's fairly widely reported that he did not know that the woman he helped
> had ebola. Apparently her family had been in denial, and told people she was
> experiencing complications from the pregnancy."_

She apparently died several hours later. If that is true, then while he was
interacting with her she was _extremely_ symptomatic. We're talking bleeding
out of everywhere. Ebola is not a subtle disease, and she was not merely
exhibiting flu-like symptoms at that point. Furthermore, the hospital turned
her away because their _ebola_ ward was full.

While it is possible that he was an idiot who believed the claims that it was
simply pregnancy complications, we're deep into _" sufficiently advanced
incompetence is indistinguishable from malice"_ territory. And frankly, it is
_more charitable_ to Duncan to assume that he lied. Better a liar than an
idiot of that magnitude.

[http://en.wikipedia.org/wiki/Thomas_Eric_Duncan#Timeline_of_...](http://en.wikipedia.org/wiki/Thomas_Eric_Duncan#Timeline_of_contraction_and_initial_symptoms)

> _" On September 15, 2014, the family of Ebola virus disease patient
> Marthalene Williams were unable to summon an ambulance to transfer Williams
> to the hospital. Their tenant, Duncan, helped to transfer Williams by taxi
> to an Ebola treatment ward in Monrovia, Liberia. Duncan rode in the taxi to
> the treatment ward with Williams, her father, and her brother. The family
> was turned away due to lack of space and Duncan helped carry Williams from
> the taxi back into her home, where she died shortly afterwards.[11]"_

~~~
pdabbadabba
Most Ebola patients never bleed profusely the way we imagine them to (though,
as it happened, this particular woman was bleeding from the mouth). It
apparently is actually very hard to distinguish from other tropical diseases
in most cases.
[http://www.who.int/mediacentre/factsheets/fs103/en/](http://www.who.int/mediacentre/factsheets/fs103/en/)

In fact, that is why it took so long to identify and respond to the current
outbreak.

>Here, then, still in January, long before the outbreak took off, a team of
doctors stood at ground zero, staring at some of the first casualties. They
had no idea what they were looking at.

> The way Ebola kills would seem impossible to mistake. What the casual
> observer knows of Ebola are its most spectacular cases, or the cinematic
> depictions of them: prodigious bleeding from eyes, ears, nose, anus, and
> nipples. Symptoms like these, presenting all at once, would be impossible to
> miss or misinterpret. But not every Ebola case ends with such a biblical
> scourge, and many of Ebola’s symptoms are identical to those brought on by
> other diseases. Until its final stages, Ebola can easily be mistaken for
> cholera. It can also look a lot like malaria, another long-tenured killer in
> Guinea.

[http://www.vanityfair.com/politics/2014/10/ebola-virus-
epide...](http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-
containment)

I don't know why it's so hard to believe that the woman's parents, in denial,
said that she was merely suffering from serious complications from her
pregnancy and he believed them. It's not as though he would have conducted a
thorough exam. He just helped the family carry her a short distance.

And, I should add, the very fact that he did this is probably the best
evidence there could be that he did not know she had ebola.

~~~
Crito
Regardless, in this particular case it seems rather apparent that Duncan lied.
If she was bleeding from the mouth and he was aware of it, in Liberia during
an Ebola outbreak, then there _at the very least_ he should have answered that
_" history of contact with ebola"_ question with a strong _" maybe"_.

I am suspicious of the family being in denial, but I don't think that it is
impossible. However for Duncan to also be in denial is far less probable.

It also should be noted that _" I thought she had cholera/malaria"_ and _" I
thought she was having complications with her pregnancy"_ are two rather
distinct claims. Had he said _" I don't think that I had contact with ebola,
but I did interact with somebody who seemed to have cholera recently..."_ then
I would be far less critical.

~~~
pdabbadabba
Look, I don't say it was A-OK that Duncan checked "no" in the form. (Which, by
the way, asks the question in several different forms, to try to capture cases
where people were exposed to something, but don't know what to.) But I do
wonder why people are so quick to demonize. He was not a highly educated
person, he didn't know the woman he was helping and only saw her briefly, and
was (or would have been, had he known) terrified of the consequences of
checking "yes" on that box, both in terms of what the authorities would do
down the line (quite possibly stick him in a decrepit hospital full of people
dying of ebola) and what that would mean coming to grips with.

I'm also surprised that people so uncritically accept that his coming here was
so terrible in any case. I would bet money that his dying in Dallas means he
has infected far fewer people than if he had stayed in Liberia. It certainly
serves our purposes to convince people that people with ebola should stay put
but I've never heard it explained why, objectively, that is actually the case.

------
nostromo
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.

~~~
jMyles
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?

~~~
binaryorganic
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.

~~~
samplonius
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.

------
danieltillett
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 too keen to see how well adapted Ebola
can become to humans.

~~~
simplemath
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.

~~~
danieltillett
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
airborne and it has a very high R0 (5 − 7). The difference is polio is adapted
for human-to-human transmission while Ebola is very unlikely to be. I don’t
want to find out how well adapted Ebola can become.

[1] Something that I have noticed about the discussion here is many people are
unclear about what it mean for a virus to be “airborne” (this is not
surprising since most people are not virologists). What airborne mean is that
the virus is adapted to spreading via small mucosal droplets. The classic
virus for this is rhinovirus (the most common cold virus). Rhinovirus infects
the mucosal cells of the upper respiratory tract, it causes you to produce
lots of mucus, it makes you sneeze a lot releasing this mucus in small
droplets into the air, the virus is hardy enough to survive in the small
mucosal droplets, and it doesn’t make you that ill so you still go to work
where you can spread it around your co-workers. Doing all the things required
the evolution of many interlocking adaptations in the Rhinovirus genome.

Ebola's infection mechanism is nothing like Rhinovirus. While in theory it is
possible that Ebola could acquire all the adaptions required to be spread
efficiently by small mucosal droplets, it is really unlikely as there are so
many changes required. This is why most experts think it is unlikely that
Ebola will become “airborne”.

~~~
TheOtherHobbes
Not everyone is convinced:

[http://www.cidrap.umn.edu/news-
perspective/2014/09/commentar...](http://www.cidrap.umn.edu/news-
perspective/2014/09/commentary-health-workers-need-optimal-respiratory-
protection-ebola)

Some health workers have been infected even though they were equipped with
significant protection.

Clearly infection rates in unprotected populations would be non-trivial, even
without the kind of mutation that would make Ebola as infectious as a
rhinovirus.

Given that many public spaces in Western cities are more densely populated
than equivalent spaces in Africa, and there are much greater numbers passing
through them, I'm genuinely concerned this has the potential to blow up in a
vey bad way.

I'm not heading for the hills yet, but if case numbers begin increasing I'm
going to consider it seriously.

~~~
pdabbadabba
I'm not a doctor or epidemiologist, but I think, as a matter of common sense,
that there's a distinction between being an "airborne contagion" and being
merely transmissible through saliva. We know that Ebola can be transmitted
through saliva, but it does not cause any symptoms that would tend to
aerosolize that saliva (coughing or sneezing).

This would mean that you're not at all likely to get Ebola if you just happen
to stand near an infected person, but we will still occasionally hear of
people who seem to have been infected "through the air." These, one would
think, would tend to be healthcare workers since they see patients at their
sickest and may be performing procedures (e.g. intubation) that aerosolize
saliva.

