
Ebola Is Now Curable - jelliclesfarm
https://www.wired.com/story/ebola-is-now-curable-heres-how-the-new-treatments-work/
======
est
Canada removed virologists and their students who helped develop ZMapp from
the lab because they are Chinese

[https://www.cbc.ca/news/canada/manitoba/chinese-
researcher-e...](https://www.cbc.ca/news/canada/manitoba/chinese-researcher-
escorted-from-national-microbiology-lab-amidst-rcmp-investigation-1.5211567)

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jonnycomputer
This is great news. The headline here "Ebola is Now Curable" seems premature
when the observed mortality rate is @30%.

What I am specifically interested in is whether the rate of new infections can
be curtailed to below the self-sustaining threshold.

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WheelsAtLarge
An Ebola cure is impressive but what's just as impressive if not more is the
method of getting to the cure. Virus based infections have notoriously been
hard to cure once infected. The fact that antibodies can now be engineered to
cure a virus-based infection is mind-blowing to me.

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thomas
Didn’t it just get more deadly a few headlines ago?

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devit
Is there a reason to not just take all those drugs at once?

Wouldn't that give the best results?

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Alliva
The title is a bit of a clickbait as it clearly states that they didn't manage
to cure it 100%

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joelx
Did anyone else run into the nightmare subscribe pop up on wired?

~~~
Tenemo
I really wanted to actually read the article but I just had to go back to the
comments. The page was unusable, I got some subscription/popup endless loop,
had to close a popup every 5 seconds. I assume it's because of some
limitations of the built-in Chrome browser in materialistic app, but still,
come on wired.

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RickJWagner
Awesome. And humanity got a little better.

There has never been a better time to be alive. We're so lucky.

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JulianMorrison
Good.

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Iv
A fact that many people miss about Ebola is that while its survival rate is
very low when untreated, it becomes relatively high (I think in the 80%) with
simple things like IV hydration. Basically you are going to lose a LOT of
water through that infection. Feeding you water (and minerals) directly in the
veins gives a surprisingly high survival rate.

What makes Ebola so dangerous is the ease at which infection spreads within
the medical staff and how quick it can occupy all your beds and "simple" IV
devices.

Depending on how it is made, a cure may not change much. If it relies on
medical attention, then it probably won't change the high death rate of people
outside medical care, which is what allows an epidemic to start.

~~~
tigershark
Then why in the article says that when untreated the mortality is over 75%?

~~~
Iv
That's what I am saying:untreated it is very high, treated (even without a
cure against the infection) it is much lower.

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OnlineCourage
WHO: two of the four drugs we thought would work did not work as well as
expected.

WIRED: EBOLA CURED

[https://www.niaid.nih.gov/news-events/independent-
monitoring...](https://www.niaid.nih.gov/news-events/independent-monitoring-
board-recommends-early-termination-ebola-therapeutics-trial-drc)

~~~
aembleton
Off topic, but does this meme/way of writing have a name?

It's used a lot in Youtube comments and it weirdly grates me.

~~~
laszlokorte
nobody: [1]

[1]:
[https://knowyourmeme.com/memes/nobody](https://knowyourmeme.com/memes/nobody)

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_Nat_
The title calling it "curable" feels a bit misleading. To explain...

Ebola's a viral infection, like the common cold or the flu. If someone gets
sick with it, then usually their immune system should fight it off naturally,
just like the common cold or the flu. And just like a cold/flu, there hasn't
really been a cure for it; instead, Ebola sufferers would be put on bed-rest
with fluids to resist dehydration, fever management, etc., while the body
fights it off.

However, Ebola's symptoms tend to be severe. Glancing at Wikipedia's figures,
it seems that about 50% of people who get it die -- which probably varies a
lot by the exact strain, health of the victim, support received while sick,
etc.. Many victims end up making a full recovery, though some end up taking
more long-term damage from the trauma.

As I'm reading it, they've observed that some victims tend to fight off Ebola
with relative success. So, they appear to be trying to copy those survivors'
defenses via [monoclonal
antibodies]([https://en.wikipedia.org/wiki/Monoclonal_antibody](https://en.wikipedia.org/wiki/Monoclonal_antibody)),
then pass that on to Ebola sufferers.

Since they're basically optimizing a victim's immune system with specially
selected antibodies, the victim still suffers Ebola and fights it off as
usual, just they're getting some pretty powerful backup in that fight.

And apparently the results are pretty good so far! The article reports:

> The monoclonal antibody cocktail produced by a company called Regeneron
> Pharmaceuticals had the biggest impact on lowering death rates, down to 29
> percent, while NIAID’s monoclonal antibody, called mAb114, had a mortality
> rate of 34 percent. The results were most striking for patients who received
> treatments soon after becoming sick, when their viral loads were still
> low—death rates dropped to 11 percent with mAb114 and just 6 percent with
> Regeneron’s drug, compared with 24 percent with ZMapp and 33 percent with
> Remdesivir.

The article exaggerates a bit by citing the mortality rates for people who
don't receive any support; that seems like an unreasonable figure since this
treatment is an advanced form of support, so presumably it'll improve the odds
of those who _do_ get support.

So, if mortality rates are about 50%, then presumably they can drop that to
about 29% overall, with people who seek treatment earlier enjoying the
greatest benefit with mortality rates dropping to 6%.

Realistically speaking, this seems to suggest that this "cure" reduces an
individual's odds-of-death by a bit shy of 50%; that leaves a lot to be
desired. Still, it's awesome because:

1\. Any progress on something like this is awesome.

2\. This sort of technology can rapidly improve, so the current positive
results may just be the beginning.

~~~
Izkata
Wellll, an crude guess from 5 years ago made the point that 50% is in African
countries, and US healthcare may drop it to 30% on its own:
[https://www.livescience.com/48263-ebola-mortality-us-
africa....](https://www.livescience.com/48263-ebola-mortality-us-africa.html)

~~~
solidasparagus
It's important to note that the Liberia outbreak was a strain with a
particularly high survival rate as well as asymptomatic carriers. This is part
of the reason that it spread while most outbreaks tended to burn themselves
out due to a much higher mortality rate (80-90% is not uncommon).

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MaxBarraclough
Much-needed Outline.com of the article:
[https://outline.com/MJaPqX](https://outline.com/MJaPqX)

Wired.com is almost literally unreadable. It's a caricature of all that's
wrong with modern web design. Is everyone else seeing what I'm seeing?
[http://u.cubeupload.com/temp9871/wired.png](http://u.cubeupload.com/temp9871/wired.png)

~~~
akkartik
I recently got into the habit of swinging Firefox's reader view
([https://support.mozilla.org/en-US/kb/firefox-reader-view-
clu...](https://support.mozilla.org/en-US/kb/firefox-reader-view-clutter-free-
web-pages)) on a hair trigger. A single click on any of my devices, it cuts an
awesome swathe through the internet jungle. For now.

~~~
inetknght
I like it enough that I automatically prepend `about:reader?url=` to many
links I come across. Navigating the web into something I _almost_ enjoy in
Reader Mode. I will rue the day that sites start mucking about with it.

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bifrost
This is awesome that we've seen another horrendous disease go from incurable
to curable in my lifetime. While ebola hasn't touched my community like
AIDS/HIV has, reading this cracked my RBF and I smiled.

~~~
Retric
A 6% to 30% fatality rate depending on how early the treatment is not what I
would call a cure. However, at best 6% fatality rate is still huge progress.

~~~
kijin
That fatality rate could be the difference between "Meh, I'll probably die
anyway and there's nothing anyone can do about it" and "Get me to the doctor
asap!" in people's minds -- especially if it is known that early treatment
dramatically increases the odds of survival.

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lisper
> Patients receiving Zmapp in the four trial centers experienced an overall
> mortality rate of 49 percent, according to Anthony Fauci, director of the
> NIH’s National Institute of Allergy and Infectious Diseases. (Mortality
> rates are in excess of 75 percent for infected individuals who don’t seek
> any form of treatment.)

That doesn't sound like a "cure" to me. Significant progress to be sure, but
in my mind to be considered a "cure" the mortality rate would have to drop to
near zero.

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ladon86
I really have to apologize if this is not a HN-quality comment, but I
initially read this as a startup rebrand announcement.

Ebola is now Curable (YC 17)

~~~
billpg
I did that too. "Who the f... calls their business Ebola?".

~~~
class4behavior
May I suggest to you two HN's noprocrast feature. I think, you spend way too
much time here. ;)

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pkaye
Aren't monoclonal antibodies harder and thus more expensive to manufacturer
though?

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toyg
Does it really matter?

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opportune
Well, most of the countries impacted by ebola are quite poor, but I think even
ignoring humanitarian concerns, it's probably in wealthier countries' best
interests to pay for it strictly from an epidemiological perspective

~~~
Fomite
One thing I've often said about infectious disease epidemiology is the Bush
Doctrine ("We fight them over there so we don't have to fight them here") is
terrible for insurgencies, but excellent for microbes.

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bigend
So how many people ebola ever killed? Compared to, for instance, cancer or
traffic accidents?

~~~
jraph
If you are making the point that we'd better address cancer or traffic
accidents, then your argument falls under the false dichotomy fallacy. This is
probably why you've been downvoted.

If your were not making this point, then I don't have the answer. :-)

~~~
aflag
Besides cancer numbers are a bit inflated because people are living more now.
If you live long enough the odds of getting cancer is quite high. Whilst it's
always good to extend life even more, even if it was a dichotomy, that seems
less pressing than a diseases that are killing in their prime or even before
they had a chance of having a good go.

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Medicalidiot
I want to know how long it will take for Ebola to evolve a resistance to this
therapy.

~~~
pvaldes
> I want to know how long it will take for Ebola to evolve a resistance to
> this therapy.

Maybe never. A lot of time in any case, probably. Ebola is a plant's virus
adapted to trees. Evolved to use bats (and probably arboreal snakes also) but
can't survive for a long time in primates, and can't survive in soil at long
term. We are a dead end for it. Would need infected humans munching some
inedible leaves of a tropical tree or visiting hollow trunks where bats live.

News cases of Ebola in the future will be from a new strain, but this does not
imply evolution or resistance. Is just that the number of ebola specimens in
contact with humans is limited.

~~~
Medicalidiot
In practical terms, there will be a resistance that develops eventually. Even
though the reservoir is hypothesized to be bats, that doesn't have much
significance because of its ability spread from person to person without a
vector.

What is notable about Ebola is that its virulence keeps dropping while its
ability to spread has significantly increased. The larger issue is that Ebola
is in areas that don't have the resources to handle any serious outbreak. It's
becoming more likely that Ebola is going to be self sustaining soon.

I'm kind of amazed that a comment expressing interest in when this therapy
will be obsolete, see that 96% of bacteria are resistant to Penicillin G now,
gets a negative response. Drugs are only effective when the pathogen is still
sensitive to them.

~~~
Dylan16807
For a resistance to develop, ebola that has been exposed to the treatment
inside a hospital has to escape back into the wild. There are significant
barriers in the way of that.

If everyone on penicillin was kept in an isolation chamber, the effectiveness
over time would be different.

~~~
Medicalidiot
As someone who works in a hospital, we can bleach every single patient room,
wear all the PPE we want, but pathogens will always spread; the only question
is when, not if. Even in an isolation chamber a resistance to penicillin would
develop independently of each other as penicillin resistance is usually
predicated on a mutation in the penicillin binding protein.

~~~
Dylan16807
Nothing's perfect, but ebola levels of paranoia drastically slow down any
chance of spread.

While partial resistance can be encouraged in a single person, that doesn't
matter if it dies inside them. And if a resistance mutation happens in the
wild, away from drugs, there's no reason to expect it to spread at all.

~~~
Medicalidiot
There's a significant amount of fake news around the Ebola outbreak
epicenters, such as aid workers trying to take people's blood and other
conspiracy theories. We have to keep in mind some of these places recently had
a genocide and/or are generally unstable.

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throwaway5752
It's great news, but they're observing a 30% mortality rate for the "cure".
Absent medical intervention there is still a nontrivial survival rate
(mortality rate of 75-90%). With supporting medical treatment before this new
treatment - fluid support, etc - I think it's up to 50%? It sounds like the
monoclonal antibody treatment has improved odds of survival from 1:10-1:2 to
2:3.

edit: The 6% figure is population restricted to early interventions. I am
uncomfortably out of my limited knowledge here, but I think that early
intervention numbers are better across the board. I'd want to compare the 6%
number to the control. And I don't want to see a control! It is such a good
result no matter how you look at it that they wisely halted the trial.

~~~
DoreenMichele
Just as a point of comparison:

Toxic epidermal necrolysis, a severe form of Stevens-Johnson Syndrome, has
about a 30% mortality rate. I understand it to be a _first world problem_
typically caused by taking certain strong medications. It's a severe and often
deadly allergic reaction.

(I'm not going to provide links because both Wikipedia entries have disturbing
photos. I've verified that I'm spelling both correctly so you can google it if
you want. However, you probably would be hard pressed to find an article about
either condition that didn't have similarly graphic photos.)

To clarify: _epidermal_ means it's a skin condition. Skin conditions that kill
people tend to not be pretty and the symptoms are highly visible.

~~~
xkcd-sucks
Unpacking the name totally is even more brutal!

"necro" \-- "death"

"lysis" \-- "busting open"

"epidermal" \-- "skin"

"syndrome" \-- "no known cause"

However, it's a little unclear why TEN is a point of comparison to Ebola, as
one is a transmissible disease and one is something that happens to unlucky
people typically in response to common small-molecule drugs. I guess TEN
sounds like a probable side effect of antiviral immune therapy, but it's not
mentioned in the article. And it seems a little tricky to separate the side
effects from the disease when dealing with hemorrhagic diseases in particular

~~~
lonelappde
The comparison is to show that even in technologically advanced societies,
there are diseases with 30% survival rates.

~~~
jquery
A doctor once told me that so much of our higher survival rate is based on a
few key drugs and supportive care to keep us alive while the body heals
itself. We seem to possess remarkably few cures for the majority of diseases
out there, we are mostly able to treat symptoms to buy time for our bodies to
self-repair.

~~~
jquery
To add, the reason it has such a high mortality rate is TEN/SJS are almost
isomorphic to 2nd and 3rd degree burns over a high percentage of your body,
which is also very commonly fatal. The "30%" mortality rate is greatly
dependent on how bad the SJS/TEN manifests.

------
dankohn1
There is no news I enjoy reading more than that a clinical trial had to be
ended early because the treatment was so effective that it would be unethical
to continue with alternative treatments (or a placebo).

~~~
jcranmer
Actually, it's quite terrifying when you remember that stopping a clinical
trial early is a _great_ way to create statistical fraud.
[https://blogs.sciencemag.org/pipeline/archives/2019/08/08/st...](https://blogs.sciencemag.org/pipeline/archives/2019/08/08/stopping-
early) cites an example of a drug whose clinical trial was stopped early due
to obviously effective success... only to discover later on that the
"obviously effective" was a statistically spurious event, and the drug did not
confer _any_ benefits whatsoever.

~~~
IfOnlyYouKnew
It's only a "great way to create statistical fraud" if you assume that the
statisticians, and the FDA, are either stupid or corrupt. And contrary to
popular belief, they tend to be competent enough to at least cope with the
sort of hair-brained schemes HN believes would fool them.[0]

Stopping a trial early and it's statistical implications should, by the way,
be somewhat familiar with web developers: it's commonly done with A/B tests,
and the related problem is the "One-armed bandit"
([https://en.wikipedia.org/wiki/Multi-
armed_bandit#Empirical_m...](https://en.wikipedia.org/wiki/Multi-
armed_bandit#Empirical_motivation))

[0]: Legend says they are even familiar with correlation != causation, and
some have mastered the advanced skill of knowing that trial size matters,
which is why they started, a few years back, to test drugs on more than one
person.

~~~
WhitneyLand
>> _the sort of hair-brained schemes HN believes would fool them_

Is there much value in an ad-hominem reply?

Or in generalizing it to an entire community? The irony seems hard to avoid
when such a generalization is made without mentioning any statistical
foundation, while pontificating about statistics.

~~~
eitland
> Is there much value in an ad-hominem reply?

> Or in generalizing it to an entire community?

I don't like this style either but _sometimes_ I think we deserve it for being
a smug echo chamber.

Basically, much the same thing could have been said in a different way and I
would have upvoted it.

~~~
nindalf
> we deserve it for being a smug echo chamber.

This and more. Almost every comment here is made with absolute confidence and
authority, much more than is warranted. The tone of the person who said that
"it's a great way to commit statistical fraud" without a caveat sounded like a
know-it-all who knows better than the FDA and the scientists who made this
cure in the first place or that they're outright unethical.

Most times such comments get upvoted. Sometimes they get downvoted when
they're called out on their BS. So there's some balance.

