
Fears of Larger Contagion as Ebola Spreads to Major Congo City - mcone
https://www.nytimes.com/2018/05/17/world/africa/ebola-congo.html
======
cmrivers
For what it's worth, I maintain a data repository for this outbreak
([https://github.com/cmrivers/ebola_drc](https://github.com/cmrivers/ebola_drc))
and the 2014-2015 outbreak in West Africa
([https://github.com/cmrivers/ebola](https://github.com/cmrivers/ebola)).

~~~
Fomite
A spectacular contribution that doesn't get enough credit, and which I'm
eternally grateful I don't have to do.

/cmrivers former lab mate

------
Bucephalus355
So this has happened before. If anyone here has read “The Hot Zone”, which is
one of the great ‘techno-thrillers” of the 90’s (but still nonfiction), the
virus spreads to Kinshasa. It’s the capital of Zaire and a major city. But
then...it disappears.

Ebola is a weird virus. Extraordinarily fatal, about 90% during the 1995
outbreak (smallpox is around 20% for comparison), although they have better
treatments now for Ebola that bring it closer to 50%.

Either way, lots of health workers have been documented working in a hut with
an infected person and never getting infected, yet others have just passed an
infected person on the subway and died.

The real concern here is what this means for the future of warfare.

A lot of people have noted that chemical weapons, and perhaps biological
weapons, are perfect for distribution by drone due to their light-
weightedness. Biological weapons, much like computer viruses, also can be hard
to attribute, making them attractive to use.

The Japanese cult that put Sarin in the Tokyo subway in 1996 was also working
on biological weapons. They never got far enough, but it demonstrated even
non-state actors can pull off credible bio-weapons.

~~~
forapurpose
> others have just passed an infected person on the subway and died.

Who? That's a false, alarmist rumor and the parent reads like a
"technothriller", which is probably the wrong way to talk about real diseases
that might alarm people. Remember during the Ebola epidemic in West Africa,
some people coming to the U.S., including a nurse who was effectively
imprisoned, were subject of a public panic that had nothing to do with
reality. There was no risk. Ebola, like any disease, is contagious only in
certain ways. The U.S. CDC says:

[https://www.cdc.gov/vhf/ebola/transmission/index.html](https://www.cdc.gov/vhf/ebola/transmission/index.html)

 _The virus spreads through direct contact (such as through broken skin or
mucous membranes in the eyes, nose, or mouth) with:_

* _Blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with or has died from EVD_

* _Objects (such as needles and syringes) contaminated with body fluids from a person sick with EVD or the body of a person who died from EVD_

* _Infected fruit bats or nonhuman primates (such as apes and monkeys)_

* _Semen from a man who recovered from EVD (through oral, vaginal, or anal sex)_

 _The Ebola virus CANNOT spread to others when a person shows no signs or
symptoms of Ebola Virus Disease (EVD). ... There is also no evidence that
mosquitoes or other insects can transmit Ebola virus._

Please don't spread these rumors. EDIT: It also distracts people from the real
risks.

~~~
Johnny555
I don't know if you've ever ridden the subway, but coming into contact with
someone's bare skin, even broken skin, is not unheard of in a crowded subway.
So it's plausible that your cat scratched arm could come in contact with some
infected person's sweaty arm as you try to make your way through a crowded
subway car.

It's certainly plausible that someone with an early stage infection may take
the subway to go to a doctor. I've seen plenty of obviously sick people on the
train (and I keep my distance, not because I think they have Ebola, but
because I don't want to catch whatever illness they _do_ have)

~~~
forapurpose
> I don't know if you've ever ridden the subway

Many, many times.

> it's plausible that your cat scratched arm could come in contact with some
> infected person's sweaty arm as you try to make your way through a crowded
> subway car.

You've got to be kidding me.

Again, who has ever caught Ebola on a subway?

~~~
Johnny555
_Again, who has ever caught Ebola on a subway?_

Good question - how many times has there been a significant Ebola outbreak in
a city with a subway system?

Mbandaka is not exactly a bustling metropolis:

[https://en.wikipedia.org/wiki/Mbandaka#/media/File:Stadsaanz...](https://en.wikipedia.org/wiki/Mbandaka#/media/File:Stadsaanzichten_f.JPG)

------
forapurpose
A few points/questions about U.S. policy and response:

* IIRC, the current administration cut NIH or CDC funding for preventing and/or dealing with foreign disease outbreaks. Under the prior administration, IIRC the GOP in Congress told the NIH/CDC to re-purpose those funds toward other uses. Does anyone know the current status?

* Regarding the Ebola outbreak in West Africa recently, I later read that the only organization in the world with the logistical resources to respond quickly at the necessary scale was the U.S. military, and Obama eventually deployed them.

* The article doesn't mention the U.S. at all. That seems like a major omissions; not even a no comment. Is the U.S. just standing back while these people die and an epidemic spreads, potentially to other places too?

* What is the current administration's stance on funding UN/WHO health operations?

~~~
ForHackernews
This article, [https://www.theatlantic.com/health/archive/2018/05/game-
chan...](https://www.theatlantic.com/health/archive/2018/05/game-changer-in-
the-congo-as-first-urban-case-of-ebola-is-confirmed/560651/) mentions that
USAID and the WHO are proving resources:

> Both Mbandaka and Bikoro now have mobile labs, where researchers can test
> blood samples locally—a huge difference compared to most previous outbreaks.
> Provided by USAID, the labs contain generators, freezers, and equipment for
> doing diagnostic tests. The Mbandaka lab is expected to be operational
> tomorrow afternoon, once the WHO delivers a generator.

------
olliej
It’s a good thing that CDC employees are taking vacation time to go there and
monitor the situation with no support from, well, the CDC.

~~~
Andre_Wanglin
Are the disease control agencies of every other nation expected to physically
monitor every such outbreak?

~~~
olliej
Most do actually because it’s useful to know what the risk to your own country
is.

Specifically if we don’t think the effected country actually has the resources
to do so. The alternative is wide spread contagion - take swine flu and bird
flu, both started in China, and yet the lack of any monitoring allowed them to
spread around the world before being contained. In that case the outbreak was
deliberately not disclosed, but choosing not to disclose and not having
resources to disclose have the same effect for /other/ countries, including
your own.

Things like where a disease has spread is important to work out the risk of it
reaching your own country.

You do know that most of what the cdc does is monitor right? It’s not actively
going out to spend Your Tax Dollars treating patients - that’s something that
the US doesn’t even do in America.

Alternatively we could choose to not track outbreaks and just hope that Ebola
knows we’ll deport it if it comes here. (That works right?)

~~~
Andre_Wanglin
What is the benefit of physical presence in an area where there is an outbreak
of a highly contagious disease? How will CDC employees "monitor" citizens of
other countries? Please explain the mechanism by which this is supposed to
work.

I do not see any evidence that Swine Flu started in China nor that ineffective
monitoring is what led to its spread.[0][1] How would a problem like China
fudging their numbers have been ameliorated by the presence of CDC employees?
Why would China have allowed them in? Even if they did, would they have
allowed them to work? If we can't trust foreign partners, we simply can't
trust them and I fail to see any case where the problem of unreliable foreign
partners can be fixed by the physical presence of CDC employees.

>spend Your Tax Dollars treating patients - that’s something that the US
doesn’t even do in America.

Medicare and Medicaid alone accounted for $1.237 trillion of My Tax Dollar
spending in 2016, which accounted for 37% of National Healthcare
Expenditures.[2] That same year, ACA tax credits accounted for another $100
billion[3], the VA $166.9 billion[4], and TriCare (healthcare for milfare
recipients) is usually another $50 billion. This notion that spending on
healthcare is something the government "doesn't even do in America" is one of
biggest and strangest (because of the ease with which it is refuted) whoppers
regularly promulgated by leftist propagandists.

[0][https://en.wikipedia.org/wiki/2009_flu_pandemic](https://en.wikipedia.org/wiki/2009_flu_pandemic)

[1][https://en.wikipedia.org/wiki/2009_flu_pandemic_timeline](https://en.wikipedia.org/wiki/2009_flu_pandemic_timeline)

[2]: [https://www.cms.gov/research-statistics-data-and-
systems/sta...](https://www.cms.gov/research-statistics-data-and-
systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-
sheet.html)

[3]:
[https://www.cbo.gov/publication/53094](https://www.cbo.gov/publication/53094)

[4]:
[https://www.va.gov/budget/docs/summary/fy2019VAsBudgetFastFa...](https://www.va.gov/budget/docs/summary/fy2019VAsBudgetFastFacts.pdf)

~~~
IggleSniggle
It seems to me that having boots on the ground would allow you to talk to
healthcare providers, morticians, community members...do a kind of internal
reporting where you asses risks and make recommendations to anyone with the
power to help contain, whether that is educating community, suggesting
policing actions to local govt, or lobbying for the appropriate kind of
external mediation (whether that’s vaccines, clean water, quarantine, etc,
depending on the situation on the ground)

Edit: ...gathering samples, studying samples (shipping is not always
trivial)...basically anything where you don’t really trust the local response
for whatever combination of reasons, and you want to prevent or at least be
ready in case there’s a global outbreak

------
forkLding
Relevant Vice youtube video of the 2015 Ebola outbreak in Liberia:
[https://www.youtube.com/watch?v=ANUI4uT3xJI](https://www.youtube.com/watch?v=ANUI4uT3xJI)
for those who want more context on why its so hard to stop it in
underdeveloped and insufficiently prepared African cities (not the developed
ones, those tend to be able to contain epidemics)

------
joejerryronnie
One aspect of Ebola which makes it so terrifying and also less likely to
spread widely is its rapid progression and mortality rate. The detailed
accounts of a person succumbing to fatal Ebola infection are horrific. But the
virus' effectiveness at rapidly multiplying results in its host dying so
quickly that transmission is limited. It would be interesting to see if the
reduction in mortality rates (from 90% to 50% according to another poster)
correlates with a greater length/breadth of the outbreak.

On another note, if human strains of Ebola ever mutate for airborne
transmission, we're all screwed.

~~~
ocschwar
The thing is Ebola is evolved to have a stable impact on its host population,
which is the common fruit bat.

We're just collateral damage.

So mutating for airborne transmission among humans is just not on the
evolutionary agenda here.

~~~
ridgeguy
>So mutating for airborne transmission among humans is just not on the
evolutionary agenda here.

Airborne transmission isn't an evolutionary agenda item. It's an evolutionary
event with a non-zero probability of occurring, so far as we know.

Evolution is a great mechanism based in part on the aphorism, "If it can
happen, it will".

------
lurquer
I see hysteria about Ebola. As if it has the potential to wipe out millions.

If Ebola was prone to causing large-scale epidemics, Ebola would have caused
large-scale epidemics.

Want to worry? Worry about flu. Worry about smallpox. Those viruses have
killed millions and, most likely, will continue to do so now and again in the
centuries to come.

But Ebola? Not a chance. How do I know? Because, there is every reason to
believe the virus has been around forever, and it's never caused the type of
pandemic described by doomsayers.

------
elihu
Interesting:

> The vaccine will be kept in the capital until shortly before use because of
> the lack of facilities in the provinces for storing it at the required
> temperature, between minus 60 degrees and minus 80 degrees Celsius, or
> between minus 76 degrees and minus 112 degrees Fahrenheit.

Are there any other vaccines that have to be kept at such low temperatures?

~~~
olliej
Many have fairly low temperature storage requirements, a -80C is a fairly
standard freezer for dealing with long term storage of anything biological.

But the real problem isn’t -60 or -80. It’s -[Anything]. If there isn't a
reliable source of electricity refrigeration (to the extent required by many
drugs and vaccines) is the largest problem faced when you’re trying to get
vaccinated new and drugs to remote locations.

~~~
digikata
One of the more interesting uses of UAVs is for transport of samples and drugs
back and forth to remote areas. There is at least one company trying it.

~~~
jeffreyrogers
Seems tough in this case. The DRC is huge.

------
SpikeDad
And you realize that the US is even less prepared for any major epidemics that
might occur in the world and here in the US due to the Trump administration's
relentless dismantling and defunding of both research and global disease
research.

------
KasianFranks
When you do the research you'll find that it spreads to fast. Look out for
those that control the speed of the virus. Source: my research in extending
human lifespan.

~~~
simias
I couldn't tell if you were serious or not so I went to your profile page and
I saw "Smart Contracts for On-Demand Datasets in Machine Learning & Artificial
Intelligence". I still can't tell if it's an elaborate joke or not.

