
The Ebola Wars - cwal37
http://www.newyorker.com/magazine/2014/10/27/ebola-wars
======
oska
> The town [of Kenema] sits in fertile, hilly country, dotted with small
> villages, ninety miles southwest of the place where the borders of Sierra
> Leone, Guinea, and Liberia converge in a triskelion. This border area was
> the cradle of the Ebola outbreak.

I was unfamiliar with the word _triskelion_ in this description. So I looked
it up on Wikipedia [1]. Turns out it is an ancient motif or symbol consisting
of three interlocking legs or spirals.

So then I checked the border area between these three countries and indeed, it
is quite well described as a triskelion although the top border is more like
180 degrees than 120. I have uploaded a cropped Google Map to imgur showing
the area [2]. The town of Kenema is in the southwest corner. Guinea is the NE
section, Sierra Leone is the western part and Liberia is the SE area.

[1]
[http://en.wikipedia.org/wiki/Triskelion](http://en.wikipedia.org/wiki/Triskelion)

[2] [http://imgur.com/cOPx4Ty](http://imgur.com/cOPx4Ty)

------
suprgeek
The description of the conditions in Liberia, Guinea, and Sierra Leone and the
over-whelming odds that the doctors there are facing was heartbreaking to
read.

The Ebola outbreak in West Africa is as much a function of poverty as it is of
the Ebola Virus. One of these all of us can fight.

~~~
mblevin
As someone who has spent extensive time in West and Central Africa, poverty is
as much a second order (or third or fourth) effect as the Ebola outbreak, and
much harder to fight. System fragility (whether it's relative to disease,
famine, or other natural disasters), is a function of poor leadership more
than anything. What is scary is that there is plenty of evidence that
government to government aid does more harm than good, and Western attempts at
fixing the problems only make things worse.[1]

[1]See any of Bill Easterly's writing -
[http://williameasterly.org/](http://williameasterly.org/)

~~~
authatheist
By "poor leadership" did you mean "warlord rulers taking the vast majority of
the aid money thrown in their general direction"?

~~~
mblevin
"Warlord" implies a military bent. Many of the worst culprits are bureaucrats
- spending most of their time wearing $10,000 suits while being wined and
dined by Western leaders and skimming millions into the accounts of their
inner circle. Power is not always held by physical force.

------
ddlatham
_A sample of the Ebola now raging in West Africa has, by recent count, 18,959
letters of code in its genome; this is a small genome, by the measure of
living things._

Does this mean mean Ebola is essentially about 38 kilobytes?

~~~
throwaway_yy2Di
38 kilobits = 4.7 kB, but yes.

Here's the complete genome of the pandemic strain (scroll down a bit):

[http://www.ncbi.nlm.nih.gov/nuccore/KJ660346](http://www.ncbi.nlm.nih.gov/nuccore/KJ660346)

Here's the paper sequencing it. ([edit]: I just realized the _New Yorker_
article is largely about this exact paper -- I commented before reading,
sorry). Note that five of the authors died before publication; there's a short
tribute accompanying it.

[http://www.sciencemag.org/content/345/6202/1369.full](http://www.sciencemag.org/content/345/6202/1369.full)

[http://news.sciencemag.org/health/2014/08/ebolas-heavy-
toll-...](http://news.sciencemag.org/health/2014/08/ebolas-heavy-toll-study-
authors)

Here's another phylogeny of this strain, including github repo:

[http://currents.plos.org/outbreaks/article/phylogenetic-
anal...](http://currents.plos.org/outbreaks/article/phylogenetic-analysis-of-
guinea-2014-ebov-ebolavirus-outbreak-2/)

~~~
ddlatham
Oops, thanks for the bits to bytes correction.

It is simply incredible to me that it could be so small (in an information
sense).

This article (gzipped) is 22KB, more than 4 times as much information.

~~~
rads
Yeah, but don't forget the complexity of the hardware you need to run ebola
versus a website. Our bodies provide most of the implementation details.

~~~
JoeAltmaier
Thank you for saying that! Its so often repeated that our DNA contains the
entire program for a human being. That's patently false. The cellular
machinery provides almost all of the OS; DNA is just a script.

I liken DNA to a paper tape containing one of two punches: MAN or MOUSE. Feed
it into a bio-replicator and get a man or a mouse. Does the paper tape define
the man? Of course not.

~~~
ghkbrew
> I liken DNA to a paper tape containing one of two punches: MAN or MOUSE

I don't think that really captures it. Yes, it requires external machinery to
actually do anything, but DNA is much more information dense and carries much
more of an exact definition of the organism to be produced.

Personally, I prefer the analogy of compiler source code. Sure, it can't do
anything on its own. But it defines how an working external system (another
compiler or an functional cellular environment) can produce a second possibly
different system

~~~
JoeAltmaier
Yet the dynamic biochemistry of the cell is orders of magnitude larger and
more complex than DNA. So its larger than a paper tape, sure, but the
comparison is pretty good really.

~~~
1457389
Paper tapes can't catalyze their own creation and modification. DNA can with
the addition of ribonucleotides.

------
astrange
What I get from this article is that they let the most important candidate for
the drug die without taking it, but then two random Americans got it because
no one was watching.

Is the lesson here to always steal people's vaccines without asking?

~~~
kevinskii
This is a good point. A dose of ZMapp was being stored on the very same
premises where Dr. Khan lay dying. But instead of giving him the treatment on
the spot, considerable risk was instead taken to deliver it to two Americans
in another country 250 miles away.

However it would be unfair to say that this was because the Americans' lives
were valued more than Dr. Khan's. He was being cared for by Doctors Without
Borders. For quite rational reasons they decided to withhold the treatment
[1]. The Americans were under someone else's care and thus weren't subject to
DWB's decision.

My main ethical disagreement is with DWB's decision not to inform Dr. Khan of
ZMapp's existence while knowing that it would be used by others.

[1]
[http://www.nzherald.co.nz/world/news/article.cfm?c_id=2&obje...](http://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=11308894)

~~~
TeMPOraL
I think this was just a bad timing. When deciding to withhold treatment for
Dr. Khan they weren't aware that the next patients in line were two white men
- a situation they explicitly wanted to avoid.

------
jrkelly
Couple old, enjoyable blog posts from Bunnie Huang on viral genomes from CS
standpoint:
[http://www.bunniestudios.com/blog/?p=353](http://www.bunniestudios.com/blog/?p=353)
[http://www.bunniestudios.com/blog/?p=1676](http://www.bunniestudios.com/blog/?p=1676)

------
001sky
On the author of this piece, some useful context

[http://www.nytimes.com/2014/10/20/books/the-hot-zone-
author-...](http://www.nytimes.com/2014/10/20/books/the-hot-zone-author-
tracks-ebolas-evolution.html)

------
johnnybravado
You idiots wouldn't recognize propaganda if it were wearing a name tag... "I'd
like to poke them in their prying eyes with things they'd never see if it
smacked them in their temples." -Arctic Monkeys

------
mlatu
i now have a strange fear of the letter "o"

------
FD3SA
Good thing we've been cutting science funding across the board! Doubt the NIH
and NSF grants were helping science much anyway.

As a matter of fact, science should be privately funded and privately run.
What idiot thought it was a good idea to make scientific research a government
mandate?

To thy weary, I say: The market shall provide.

P.S. Yes, I am bitter about the current state of science. I've written about
it in great detail before [1][2], but the current fascination with free-market
everything has truly made me lose hope for this iteration of society. The free
market will work, until it doesn't. Some activities which are absolutely
crucial, will not be profitable until it's too late. Medical research is a
good example, but there are others (energy sources to replace oil,
overproduction of consumer waste, pollution etc.)

Seems like today's societies must learn by sticking their fingers in the
proverbial wall socket. So be it.

1\.
[https://news.ycombinator.com/item?id=8337837](https://news.ycombinator.com/item?id=8337837)

2\.
[https://hn.algolia.com/#!/comment/forever/prefix/0/by%3AFD3S...](https://hn.algolia.com/#!/comment/forever/prefix/0/by%3AFD3SA%20science)

~~~
jerf
The CDC was and is plenty funded to deal with this threat. If you think they
didn't spend it well, well, join the club.

 _No_ amount of money is ever "enough" if it not managed responsibly. I'd
really appreciate it if those who think the answer is always more government
money would start putting more pressure on their goverment to spend it
_responsibly_. I mean that quite straight, not as a snark. It would go a long
way towards getting me on the bandwagon of more government spending if it
didn't appear to me that the people making this claim didn't always take every
opportunity to dodge away from the question of responsibility in practice.

~~~
throwaway5752
It is not. Sorry, $6B annual budget is not a lot in the context of their
responsibility, which is substantially greater than ebola [edit: or even
outbreak containment in general, for that matter]. In fact, ebola (as
evidenced by the lack of transmission to Duncan's own family or any additional
caregivers of his [edit: not to mention a lack of host reservoir in NA])
probably and appropriately very low on the CDC's radar, since it is _not_ a
public health threat in the US.

late edit: To put it in perspective, approximately $3B was the total operating
expenses for just Massachusetts General Hospital, alone, in 2012. Or just 50%
greater than the 2014 budget for UCSF. Or just half of what Apple spent on
SG&A in the 12 months prior to Sept 27.

~~~
jerf
Then my point is even more important given the proportion of it actually spent
on infectious diseases. If that's _so allfired important_ than why were they
doing anything else with that money?

The answer, of course, is that it wasn't considered so important until a
couple of months ago, and thus, it wouldn't _matter_ how much money was thrown
at them, it wouldn't have solved the fundamental _priority_ problem.

Contra to some of the press, I took the time to read the CDC's summary budget
from the government's website. It wasn't hard to find ("Center for Disease
Control" budget). It's full of things that sound superficially wonderful, but
none of it matters if it's being spent incompetently or with priorities not
connected to the real world, and throwing "more" at such an organization is
not a good investment.

You can't get away from it. It isn't about _more_ , it's also about _what_.
_What_ matters a _lot_. Again, I'd be less vocal about not just handing the
government _more_ if the advocates of _more_ would pay more attention...
_much_ more attention... to _what_ , and _how well_. But I can't help but
notice the advocates of "more" seem to consider that an attack, when in all
seriousness they really ought to be _leading the charge_. If you are an
advocate of giving the government more, shouldn't you consider it very
important to your own position that what the government already has be used
well? You give away an enormous weapon when you leave it solely to your
opponents to point out problems!

~~~
throwaway5752
I am not trying to be difficult, but I don't understand your point. Ebola is a
vanishingly unimportant concern as far as infectious diseases go. This current
"outbreak" has resulted in _2_ transmissions in the US to date. The reason it
appears that the system failed is that the system correctly reacted to a low
value threat, but it was amplified into a hysteria because of dynamics in
media economics and US political cycles.

If I were the CDC, I'd be spending a boatload on SARS, MERS, MERSA, MDR/XDR
TB, any number of the highly virulent seasonal influenza strains, social
programs to promote vaccinations (pertussis, for example, kills more babies in
the US annually than there have been total US cases of Ebola), annual rabies
tracking programs, general education (good hygiene practices)... so many
others. And the good news is they are doing this, as I'm sure your research
into their budget shows.

edit: thus the downvoter exemplifies the problem, without saying a single
word.

~~~
hga
OK, I'll down vote you _and_ explain why: your studied inability or
unwillingness to do math, to whit, what a disease like Ebola can do in a 3rd
World urban environment (or village/small town ones different than the former
locations of outbreaks), specifically double the number of infections
approximately every 3 weeks.

Right now this Ebola outbreak gives every sign of having the potential to be
the most significant public health event in a number of centuries. Like, maybe
we'll end up having to go back to the 1346–1350 Black Death for comparison,
unless we can develop, test, produce and distribute a vaccine very quickly.

~~~
throwaway5752
Malaria kills 500K-1M people EVERY DAMN YEAR in subsaharan Africa
([http://www.who.int/malaria/media/world_malaria_report_2013/e...](http://www.who.int/malaria/media/world_malaria_report_2013/en/)).

~~~
hga
The CDC's worst case, last I heard, was 1.4 total million infected with Ebola
in _January_. At the current estimate of 70% lethality, there's your 1M
million people 10-16 days after infection.

Then it all doubles in 3 weeks. And another 3 weeks.

Do the math.

If you want to be conservative, dial the starting point back, it won't matter
for long. But when I did my own calculations, I found 20,000 cases as of a
week or two ago (a fairly conservative guess at the true number) would get you
to 1.4 million in January.

~~~
smeyer
Your assumption for those numbers is that it will keep doubling everywhere it
goes, correct? For example, Nigeria seems to have stamped it out in Lagos,
refuting the idea that it automatically breaks out exponentially in "3rd World
urban environments".

~~~
hga
Here's what I said, emphasis added:

"what a disease like Ebola _can_ do in a 3rd World urban environment"

Nowhere did I say or ever imply that it " _automatically breaks out
exponentially_ " in such environments, just that in this outbreak, it has, and
I would hope you would not deny it could in others.

------
androidb
Very well written article, but does anyone else think that the cartoonish
image advertisements don't really fit well with the purpose of the article?

The photo of an aid worker removing the body of a dead woman also looks
surreal...

~~~
anigbrowl
It's a _New Yorker_ thing - they've had whimsical cartoons mixed with serious
reportage in their printed editions for decades, if not over a century. It is
odd but I suspect it gets people to read more articles than they otherwise
might.

------
vijaygirija
Found this article in google how big data can help Ebola statistics.
[https://www.promptcloud.com/blog/the-big-data-
cure/](https://www.promptcloud.com/blog/the-big-data-cure/)

------
srcmap
newyorker should help setup a fund to donate to doctors/nurses who are working
in the frontline of Ebola.

~~~
manachar
Or just link to an existing fund with a pretty great track record and truly
heroic volunteers:
[http://www.doctorswithoutborders.org/](http://www.doctorswithoutborders.org/)

