
Ebola cases pass 2k as crisis escalates - howard941
https://www.nature.com/articles/d41586-019-01735-0
======
georgehayduke
I am amazed at the bravery of the medical staff, health professionals and
volunteers who are trying to contain Ebola in the DRC.

Not only are they potentially exposed to the deadly disease, they have to
content with violent attacks from the population they're trying to help.

It sounds incredibly complex - a mix of political mistrust, lack of education
and difficult terrain making containment difficult.

While spreading to populous areas would be a major concern, I imagine that
nations blessed with more resources may be in a better position to quarantine,
contain and prevent the spread of Ebola.

~~~
gingabriska
How likely is that most Nurses working there do are not able to comprehend
risk in real terms?

~~~
Zenst
Extremely unlikely, that it's not even an edge-case. I dare say that anybody
who has seen directly or indirectly the effects of Ebola, would be more than
aware of the risks and if anything, be more inclined to over-react (look at
how leprosy was treated socially historically or even AIDS).

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i_am_nomad
To those of you worried about a global outbreak: USAMRIID is closing in on a
highly effective (near 100%) treatment for Ebola. So far it is 100% successful
in macaques, which is a good animal model for the disease in humans. The
project lead spoke to my research group - his talk about Ebola, and some of
the cultural and geographic challenges in fighting it, was fascinating.

~~~
mieseratte
Could you elaborate on those challenges?

~~~
jbob2000
The doctors and medical staff are mostly white, while the people they are
treating are mostly black. To the ignorant, this would appear like an attempt
at a genocide or recolonization.

~~~
mieseratte
Is that actually the case on the ground, some type of "the doctors are
actually the ones making us sick" scenario?

~~~
HarryHirsch
That's absolutely the case: [https://www.nbcnews.com/news/world/congo-s-ebola-
response-th...](https://www.nbcnews.com/news/world/congo-s-ebola-response-
threatened-conspiracy-theories-rumors-n994156)

------
Balgair
The WHO reports are very informative as well:
[https://www.who.int/ebola/situation-
reports/drc-2018/en/](https://www.who.int/ebola/situation-
reports/drc-2018/en/)

The latest report (4 June 2019):
[https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...](https://apps.who.int/iris/bitstream/handle/10665/325126/SITREP_EVD_DRC_20190602-eng.pdf)

Figure 1 on Page 3 is a good-ish overall representation of the situation.
Ebola is sustaining itself. It hasn't gone geometric yet, but it could at
nearly any time, if not already.

One important thing to note is that though it may seem that in the last 3
weeks the epidemic has been tapering off, that is an artifact of the reporting
situation there. There is a significant lag in identification of deaths and
causes. Feel free to look back over the other reports to see this reporting
lag effects.

Another thing to note is that North-Kivu province is about the same size as
West Virginia with about 2.5X the population. Goma, the capital there, has a
population of about that of San Jose proper.

Combined with other sources that other HNers have linked, the Nature article
is correct to sound the alarm here. The Ebola fighters are trying their best
(despite the complicated social situations, weather, gear, humidity, and
resource limitations), but Ebola is not quitting either. This situation is not
something to wave away and is very deserving of international attention.

------
favorited
As always when an Ebola discussion happens, I want to recommend people
interested in the origins of the disease read Richard Preston's 'The Hot
Zone.' It details the history of the disease (as well as some related
filoviruses, like Marburg), specifically following several doctors and
researchers as they track outbreaks and treat victims.

It was turned into a 6-episode miniseries on National Geographic (just aired
last week), but the book is 100% worth the read if you're interested in the
topic.

------
waynecochran
Could someone explain the graph used in the article where the y-axis is
labeled as "cumulative" \-- does this mean that each bin includes the sums
from the previous bins? If so, then this will always be a non-decreasing
graph. Ebola outbreaks are horrible, but it doesn't do any good to use stupid
graphs like this to make it look worse than it is.

~~~
thenipper
If they're using the same data source I am at work it's because that is what
the ministry of health for the DRC is releasing daily. They don't track active
cases but rather cumulative cases in a health zone.

~~~
thenipper
Also if you want to explore the data UN OCHA has it here:
[https://data.humdata.org/dataset/ebola-cases-and-deaths-
drc-...](https://data.humdata.org/dataset/ebola-cases-and-deaths-drc-north-
kivu)

------
jeffdavis
Do these ebola outbreaks give the virus substantially more opportunity to
evolve? Or is that not a significant risk?

~~~
HarryHirsch
They do:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/)

But the jury is still out on what evolutionary processes are ongoing. Is the
virus adapting to its new host and consequently evolving more slowly, or is it
quickly developing increased transmissibility? It's not quite clear.

~~~
phkahler
The best evolutionary path from virus point of view is to reduce lethality so
the host can spread it longer. I thought I read that HIV did something similar
and used to be more deadly - even without modern treatment.

Problem with Ebola is that its transmission among humans is via the same thing
that kills humans.

~~~
HarryHirsch
It depends on the environment. Mortality of cholera is high (~ 60 % if
untreated), but by spreading abundantly the bacterium finds a supply of new
victims.

I seem to remember a study from ages ago where they compared strains of HIV
from South Africa and Japan. Condom usage in South Africa is low, so the virus
evolved to develop a high viral load quickly. In Japan the opposite was true,
condom usage was high, the strains that caused the victim to die early became
extinct.

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fredgrott
seems like a role of UN troops to maintain peace so that WHO workers can do
their jobs

~~~
_djo_
That is part of what the UN troops are attempting to do, but it's an
impossibly difficult task. There are far too few troops for the size of the
area and population size they need to defend, and that's before you take into
account issues like logistics, the unwillingness of some national contingents
to deploy far from bases, etc.

To provide some context, just the eastern provinces of the DRC, where most of
the violence is concentrated, have a population of more than 20 million people
and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has
just 15 000 troops. A figure which shrinks annually as a result of US-forced
budget cuts.

Those budget cuts (which the Trump administration has loudly boasted about,
FWIW) have also severely depleted the aviation budget, preventing MONUSCO from
being able to deploy as many attack helicopters as its commanders say it needs
to go after armed groups and reducing its ability to transport troops by air.
This forces them to take long, slow journeys on the country's dilapidated road
network, even in cases of urgent responses. During the rainy season it can
take hours to travel a few kilometres despite having specialised vehicles.

Add to that the fact that government troops are often corrupt and local
commanders can be in league with some of the rebel groups, and it's a pretty
difficult mission at the best of times.

------
ajnin
The june 2 WHO bulletin about the outbreak, which I believe is the source data
for the article. It contains more data including a graph of number of cases by
date of illness onset, which I think gives a better idea of the progression of
the epidemic :
[https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...](https://apps.who.int/iris/bitstream/handle/10665/325126/SITREP_EVD_DRC_20190602-eng.pdf)

------
DisposibleHero
It's interesting to note how we can have consensus on 2,000 individual cases
being called a true crisis, but we still cannot agree ~76,000 monthly border
crossing[1] is a true crisis.

Perhaps it's because Ebola is deadly and it's easy to remain ignorant of the
humanitarian crisis plaguing many of those 76,000 monthly refugee/asylum
seekers... both before and after crossing. Perhaps it's because we all fear
catching Ebola from an airport or shopping mall, but none of us fear catching
"run-for-your-life-itus", or have to wonder how we'll feed, clothe, and
shelter ourselves in a brand new country where we don't speak the dominant
language or understand the culture, but we know it's safer than where we came
from?

Or perhaps it's simply because it's not a political punching bag issue? ...
that's probably the real truth neither "side" wants to admit.

Ebola isn't going to run rampant through the US - we have a great medical
system that wouldn't be trying to treat patients in a field in the middle of a
war zone. We should lend all the support we can to DRC to help prevent the
spread of this terrible virus - not out of fear of it spreading to our home
nation, but out of compassion to the people of the DRC.

At the same time, we should really step back from our trenches and objectively
examine our own domestic problems - not through the lenses of political
ideology, but through the lens of a decent human being.

(ya, this is a throwaway... advocating we stop being political about our own
domestic crisis is sure to attract a lot of negativity, unfortunately).

[1] [https://www.nytimes.com/2019/03/05/us/border-crossing-
increa...](https://www.nytimes.com/2019/03/05/us/border-crossing-
increase.html)

~~~
choult
> Ebola isn't going to run rampant through the US

This insular, isolationist attitude is precisely what is currently eroding the
United States' soft power in the world today.

------
sixQuarks
The internet was supposed to create an educated society with information at
your fingertips, instead we got fake news and echo chambers spreading extreme
thinking

We have huge groups of actively ignorant people supporting the growth of
climate change, anti-vaccination, and a host of other dangerous actions.

Now those fighting Ebola outbreaks are getting attacked.

I hope I’m wrong, but it looks like rationality is fast disappearing from this
world. It’s only a matter of time before we destroy ourselves.

I realize this type of gloom and doom stuff has always been predicted
throughout history, it just seems “this time is different” for real with the
intersection of technology and ignorance reaching levels we’ve never seen.

~~~
UI_at_80x24
I would really love to know if this phenomenon is limited to
Britain/Canada/USA and the rest of the world wonders if we have collectively
gone insane, or if each demographic region is experiencing similar paranoia.

~~~
pm90
Stupid people live everywhere. It’s not a uniquely North American thing
unfortunately.

They may face other issues and we just aren’t aware of it.

------
coldcode
It's just a question of time before it reaches the US. We were lucky with
Dallas. It likely will escape the next time into the general population since
many people without health insurance are unlikely seek medical care in time
and when they do at the last minute, it will spread.

~~~
low_roar1
Ebola should actually be easier to contain in any civilized country such as
the US. Quarantine measures and disposing of infected bodies properly would
limit the pandemic.

In Congo Kinshasa, it's just the chaos politically, there is no real
government in many parts of this country, the real danger is that it is not a
small country at all, 80+ millions of inhabitants, many can't be reach by the
WHO because of the wars and infighting between the "government" and militias.
So the crisis there has great chances of getting worse, not better.

Furthermore, many many many people locals despise foreigners and particularly
white people, for historical reasons, or just ignorance, and the culture is
extremely unsanitary (touching and living with the dead, consuming bush meat
or worse, ritualistic cannibalism, and what not), some straight out think
Ebola is a white conspiracy.

This isn't a problem only money can solve this time.

~~~
edubs25
>Ebola should actually be easier to contain in any civilized country such as
the US. Quarantine measures and disposing of infected bodies properly would
limit the pandemic.

I would be careful of the use of the word 'civilized' in this context. You're
implying DRC and/or other African countries are uncivilized. Which is just not
true.

~~~
low_roar1
> I would be careful of the use of the word 'civilized' in this context.
> You're implying DRC and/or other African countries are uncivilized. Which is
> just not true.

No, I stand by what I said and by the following definitions of the word
"civilized", and never talked about "other African countries":

> easy to manage or control; well organized or ordered:

> having an advanced or humane culture, society, etc.

Given the tragedy that has been going on for more than half a century in that
part of the world, I couldn't care less about euphemisms and political
correctness, they have not solved anything.

The culture absolutely needs to evolve if locals want to survive Ebola, there
is absolutely no way around it, I'm not a cultural relativist. It's a matter
of life and death.

~~~
edubs25
> easy to manage or control; well organized or ordered: > having an advanced
> or humane culture, society, etc.

So the US meets these characteristics by your logic but DRC does not? Have you
traveled much in rural/poor US? Have you been to puerto rico? Are those areas
equally uncivilized? Would you characterize south chicago as uncivilized as
well?

In anthropology (maybe specifically american anthropology), the descriptor
'civilized' was pretty much thrown out during their reformation (I think it
was 1970s?). At best, today it's pretty much considered a coded term for 'not
conforming to my view of what a society should look like'(aka it's
ethnocentrically viewed as inferior). At worst, you can tie the usages of the
descriptors 'barbaric' and 'civilized' back to the biological determinism and
eugenics movements.

>Given the tragedy that has been going on for more than half a century in that
part of the world, I couldn't care less about euphemisms and political
correctness, they have not solved anything.

What tragedy? and which part of the world? DRC is not near Liberia or Guinea
where the other more recent highly publicized Ebola outbreaks have been. Are
you referring to the civil war in DRC? It's really complicated and at the end
of the day has root causes that tie back to neocolonialism and colonialism
constructs created by so-called civilized societies.

I'm not trying to be politically correct. I wasn't even being all that
critical of your original statement. I was trying to point out that word
choice matters. While most of what you wrote originally is valid, my family
(which is Cameroonian) would not listen to anything you had to say because you
used the term 'civilized.' It would immediately shut down discourse.

