
The Mathematics of Ebola Trigger Stark Warnings - 0cool
http://www.wired.com/2014/09/r0-ebola/
======
ChuckMcM
Going 'meta' for a moment, this is a tragedy of huge proportions, the question
I have been considering is whether or not it is even _possible_ to avoid?

Updates from MSF which highlight the level of mistrust and superstition
amongst the infected population, where people hide their sick relatives from
isolation wards and take them back to their village. We cannot exactly put a
giant fence around the place (and not that this would be a reasonable goal
anyway).

Do we invade these countries and force our will on them in order to prevent a
humanitarian tragedy? What gives us that right? What gives anyone that right?
To someone who is not sick, forcing them from their village, for forcing them
to stay in their village violates their basic human rights, and yet it is for
their own good, but if they don't believe that, what moral authority allows us
to overrule that belief?

As you can see I struggle with the challenge of imposing a solution on these
people, knowing that without aggressive actions tens of thousands, perhaps
hundreds of thousands of them will die. While explaining to someone who
doesn't understand the virus, or the danger, who undergoes forced relocation
to a quarantine camp and is never sick during the outbreak, that they were in
very real danger from this thing they do not believe in.

~~~
narrator
The American perspective is to solve every problem with the military or money.
We believe that violence and more money are the only effective solutions to
every single problem the world faces. Original thinking just doesn't happen.

A creative solution would be to temporarily halt all regulations on anti-ebola
drug development and let them experiment on any willing person in Liberia who
wishes to receive treatment. The example of Banting and Best in the 20s is a
great example of the enormous progress that can be accomplished if there is no
regulation on medicine. These guys came up with the idea for extracting
insulin from animals and injecting it into humans. They tested it out on
willing patients, the first being a 14 year old, released the invention for
use by the public and won the Nobel prize in the span of 3 years (1921-1923).
That speed of drug development and testing is impossible today.

A good analogy of the present situation would be this. Someone is drowning in
the river. You can use the military to prevent him from knocking any nearby
bathers into the river as he floats down stream but don't you dare throw him
something handy like a branch or a quickly improvised flotation device because
that might help him float and it may not work and there would be lawsuits or
regulatory violations! You can pay someone to swim after him and try and save
him, but the stream is really rushing fast and they might drown too, but
that's seemingly a-ok.

~~~
waps
And who pays for the, potentially unbounded fallout from that decision ?

Let's say this happens :
[http://en.wikipedia.org/wiki/Thalidomide](http://en.wikipedia.org/wiki/Thalidomide)

(First read about the advantages of the drug, then move to the crises. in
particular the birth defects crisis)

And please don't just say that people knowingly took the risk, read the
article first to see how that played out.

People won't accept the consequences of decisions made under duress (and this
decision would be "death or we experiment on you". Decision to be made in an
isolation camp, guarded by soldiers with guns), for obvious reasons, and this
has been an accepted legal principle since a millenium before Jesus was born.
You're suggesting just canceling it ? Really ?

What you're suggesting is a really, really, really, really bad idea.

~~~
ekianjo
Why? When you are going to die you should have the choice to go on a treatment
which is untested. That's what people with AlS have been asking for YEARS and
still cannot get because they have to follow the usual regulatory
process.Cancer patients can get drugs as soon as Phase I, I don't see why we
don't allow other patients who are in critical condition to try whatever is
new out there. What do you have to lose?

~~~
x0x0
The death rate from the current ebola is approximately 50%. While that sucks,
what patients have to lose is both a 50% chance of living and their right not
to be a playground for medical experimentation.

edit: and just who vets the people/companies who get to offer drugs to
desperately ill people? Does anybody with $1k to buy needles get to make a
sign and advertise curative injections? I'm sure glibertarian idiots will say
it was a freely made choice, but choices made while infected with ebola (or
even scared of being so infected) aren't freely taken, not to mention the
asymmetric information.

~~~
crusso
_glibertarian idiots_

Please avoid making personal attacks like this on HN.

As a mostly libertarian-minded person myself, the height of compassion is to
allow dying people to reach out for any hope out there.

Cruelty would be to prevent people from attempting to save their own lives
"for their own good"; especially when no alternative cure is being offered by
the politicians and bureaucrats making such life-impinging decisions.

Yes, the quacks and charlatans will try to take advantage and they should
specifically be combatted. That doesn't mean that people should not be able to
make decisions about their own lives.

------
tokenadult
The author of the article kindly submitted here, which I found quite
interesting and informative, notes that she used to write for the Center for
Infectious Disease Research and Policy (CIDRAP) based at my alma mater
university. Sure enough, CIDRAP has its own current write-up on ebola[1] that
is a good supplement to the information in the _Wired_ article we are
discussing here.

"The possibility of an airborne-transmissible Ebola virus is one 'that
virologists are loath to discuss openly but are definitely considering in
private,' wrote Osterholm. In its current form, the virus spreads only through
contact with bodily fluids, he noted, but with more human transmission in the
past few months than probably occurred in the past 500 years, the virus is
getting plenty of chances to evolve."

The current rather high rate of transmission of the disease from one patient
to another is alarming, and is perhaps preventable by better public-health
practices aided by significant overseas funding, but if the virus haphazardly
mutates into a form that spreads though more modes of transmission while still
being as lethal, the world is in for a very severe challenge. As it is, the
predicted number of cases by the end of the year will overwhelm several
countries in the region where ebola is now spreading.

[1] [http://www.cidrap.umn.edu/news-
perspective/2014/09/experts-r...](http://www.cidrap.umn.edu/news-
perspective/2014/09/experts-raise-specter-more-contagious-ebola-virus)

~~~
rdtsc
How hard is it to predict (if possible at all) the mutation based on the virus
type and particular strain (maybe somehow computationally simulate or mutate
it) ?

In general do mutations follow probability distributions that are known?

And then let's say someone wanted to cause mutations that would make it
airborne. Could they do it?

~~~
tstactplsignore
>In general do mutations follow probability distributions that are known?

In some ways, yes. Substitution matrices[0] describe how likely it is for an
amino acid to mutate into another amino acid. However, they are generalized
descriptors. At the same time, PWMs[1] describe how the probability of any
given variant (mutation) is in a specific sequence, and are created by
analyzing all known homologs (similar sequences) of that sequence.

However, the number of mutations required for a virus which is incapable of
becoming airborne is probably large and definitely unknown. I'm not an expert
in virology, but I believe that there are two requirements for a pathogen to
become airborne:

A. It must infect and replicate in an area of the body capable of generating
aerosols (generally, the respiratory system, like Influenza and Tuberculosis).

B. It must be good at surviving in aerosols- I believe this requires specific
environmental adaptations and the right surface proteins and sugars.

I believe that Ebola meets neither requirement (especially the first), and you
could see how meeting both would require not just large physical adaptation,
but also a complete change in the virus' life cycle in the host.

>And then let's say someone wanted to cause mutations that would make it
airborne. Could they do it?

I think in general it would be easier to start with an airborne virus, and
make it deadlier. I'm not an expert but this BBC article[2] quotes that a
deadly virus has never been observed to change their vector of infection.

0\.
[http://en.wikipedia.org/wiki/Substitution_matrix](http://en.wikipedia.org/wiki/Substitution_matrix)

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

2\. [http://www.bbc.com/news/blogs-
echochambers-29168905](http://www.bbc.com/news/blogs-echochambers-29168905)

~~~
rdtsc
That made sense. Thank you for explaining.

------
ihnorton
Doctors Without Borders/Médecins Sans Frontières (MSF) is on the ground and is
one of the most effective ways to directly support efforts to aid Ebola
victims and stop the spread (disclosure: I just donated):

[https://donate.doctorswithoutborders.org](https://donate.doctorswithoutborders.org)

The health systems in these countries were already overwhelmed and under-
resourced long before Ebola broke out, and the international governmental
response has so far been alarmingly tepid.

Recent AmA with an MSF doctor:

[http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doct...](http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doctors_without_borders_ask_me/)

Note that MSF has an excellent efficiency rating (~87% of revenue goes to
program expenses, 11% to fundraising):

[http://www.charitynavigator.org/index.cfm?bay=search.summary...](http://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=3628#.VBZqlHWx3UY)

------
schrodingersCat
I hate to be the cynical one here, but the countries with the power to stop
this outbreak aren't going to start taking it seriously until more people from
western nations start dying. It is true, it will be really bad if it is not
stopped soon. Containing an outbreak of >5000 is out of the reach of most of
the states affected by the disease and quite honestly very expensive for any
nation. Once this spreads closer to Europe, watch people start to take more
action. I hope it won't be too late

~~~
s4sharpie
There are massive global political ramifications that restrict the ability of
those countries that do want to make a difference. As the article refers to,
it is ultimately the UN that has the powers to essentially trample on a
country's sovereignty (that is what you need to do to make a difference). The
UN has been called a toothless tiger in many respects - this is another
example where they can and should take a more proactive and aggressive stance.
Only then can we comment on the actions of other Western nations.

The way that South Africa dealt with their AIDs epidemic (from a western
perspective, true head in sand activity) is a case in point: despite many
aggressive offers of help from western governments, the South African's
continued their denial. To make a change would have required going against the
government policy of the time. This is viewed legally as an invasion by an
outside force.

~~~
joe_the_user
I am not sure what relation your (or the article's) talk of trampling
sovereignty has to do with the present situation on the ground.

The articles I read describe the problematic issues being; a lack of running
water in existing clinics, a lack of medical supplies, a lack of clinics and
notably a lack of food everywhere - patients are escaping isolation in efforts
to find food.

Liberian officials have pleaded for help in fairly abject terms (one official
mentioned the possibly of nation ceasing to exist - I think that means they're
worried). The details of what Western nations have done so far is fuzzy but it
seems like there not been a sufficient rush to deliver these acutely needed
supplies.

Sure, once the existing clinics have food, supplies and running water,
parachuted in field clinics sound grand. There's no evidence I've seen that
the Liberians would refuse these.

~~~
s4sharpie
The article references having burial specialists. This would require certain
people having the right to take deceased corpses and burying without regard
for the family/tribal/religious requests/requirements etc. This would at the
very least be seen as impinging on the rights of the family, it would likely
need armed support. If these burial specialists were say American, they would
NOT be deployed without American armed support. Having American armed support
(most likely the army) on the ground supporting people who are likely to be
impinging on perceived rights will be viewed as trampling sovereignty.

Australia and the Netherlands had a similar issue with the downing of the
Malaysian Airliner in Ukraine. In this case, the Ukrainian government had to
pass legislation to allow armed Australian and Dutch military to support
inspectors. They were just 'inspecting', not creating forced closures of
specific areas, forcing burials, witholding care, etc all under significant
armed guards.

The present situation on the ground (and the lack of 3rd party government
level interaction) is largely a result of weak leadership by the UN. The
better question is why the UN hasn't taken ownership of the outbreak?

~~~
joe_the_user
Well,

Liberia does have Liberian burial specialists now, who do what you describe
and it indeed is probably the most awful job in the world. Indeed, the
Liberian government, with varying levels of competence, has attempted to do
most of what you describe. Essentially, there's no evidence, _no indication_
that the Liberian state would resist UN or US aid but also very little
evidence of such aid. If anything, the Liberian government has done some
stupid impingements on rights itself (quarantining the entire poor sector of
Monrovia for example).

Yes, the Liberian state is already taking desperate and extreme measures but
when most clinics _without running water_ , their options are limited. I'm
sorry, this stuff make me so angry I could ask what it says about you and your
ilk when you're so eager solve things with guns that you don't notice that
_lack of food and water_ is the primary problem?

Obama some announcements about military assistance but I've read not article
about anything materializing.

Seriously, we're talking pretty well unprecedented disaster - the response has
been much than even the response to "typical" third world disasters, much less
than the response to the Haitian earthquake for example.

~~~
icelancer
> no evidence, no indication that the Liberian state would resist UN or US aid

It is not official action that the parent commenter is referring to.
Individuals themselves could treat actions they see as counter to their
religion and belief as very hostile.

------
rwallace
I recommend anyone proposing solutions to the crisis first read this
explanation of events to date:
[http://www.vanityfair.com/politics/2014/10/ebola-virus-
epide...](http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-
containment)

In particular, the history of events to date makes it clear it is _not_ a case
of the world doing nothing. Back in the spring, when there was reasonable hope
that sending a bunch of foreign doctors could stop the outbreak, that was done
- for a little while, it even looked as though it had worked.

Unfortunately, it didn't, by a long shot. Now WHO and MSF want to repeat that
strategy on a much larger scale.

My opinion is that this is a very bad idea. The epidemic in West Africa not
going to be stopped. That window of opportunity closed months ago, if it was
ever open. If we send in thousands of doctors now, a large percentage of them
will end up dead, and the epidemic still won't be stopped. It will be a waste
of life, and at that, of the lives of trained doctors and nurses who will be
all too soon and badly needed if the epidemic does start hitting other regions
where the outcome would still be in doubt.

And no, sending in the military is not the answer. Not only does "it's for
your own good" not morally justify aggression, but by further eroding the
trust of the local population for authority in general and foreigners in
particular, it would make matters worse, not better.

The affected area needs to be sealed off so the disease can't spread to the
rest of Africa and the rest of the world. By all means airdrop medical
supplies to Liberia, but _don 't_ for heaven's sake start sending hordes of
doctors, soldiers and camp followers there to create more fodder for the
virus.

~~~
ghshephard
Your recommendations are exactly contrary to the guidance from those who have
spent their entire careers studying the best way of responding to these types
of epidemics.

Attempting use "force" to seal off the area, is perhaps the single most
effective way to lose all control of this disease, and see it spread to
hundreds of thousands, if not millions of people who (quite reasonably) decide
to fight back against such an activity.

Careful Training, use of locals who have developed immunity, _massive_
injections of beds, medicine, and supplies, can have a huge impact, and keep
this current epidemic under control

~~~
rwallace
Your argument is from authority, but authority is trumped by empirical fact.
The kind of strategy you advocate was, yes, the right thing to try back in
spring, when there was reasonable hope that it could work. It conclusively
failed, at a time when the outbreak was far smaller and more tractable than it
is now. It cannot possibly _keep the current epidemic under control_ , because
the current epidemic is _already not under control_ , hasn't been for months.
Meanwhile, hundreds of healthcare workers have, despite training, been among
the dead. No amount of training can compensate for the fact that with a
caseload of this magnitude you get overworked to the point of exhaustion and
start making mistakes.

By contrast, the strategy I advocate has thus far been working.

Nigeria? Cut travel to the affected area. One idiot had slipped through,
causing an outbreak. Because it was only one small outbreak, it was possible
to contain it.

Senegal? Same. Tougher problem because it has a land border with the affected
area. In response, citizen groups have been supplementing the security forces,
patrolling the border and turning back people trying to enter the country,
thus far successfully.

Ivory Coast? Cut off travel from the affected area. Thus far, no Ebola
detected.

Do you believe in results? I advocate abandoning the strategy that has been
proven not to work and focusing on the strategy that has been proven to work.

------
IvyMike
I had a discussion with a friend, and he pointed out that Malaria infects
something like 200 million people a year in Africa, and kills around half a
million. It's brutal.

So this new paper is projecting that Ebola deaths in Africa will be about as
common as Malaria deaths.

I guess I'm trying to draw any conclusions or imply anything here other than
life in Africa is pretty freakin' tough.

~~~
gizmo686
The two main differences I see are: 1) The Ebola death rate is still
increasing, which makes it scarier that Malaria, which has a relativly stable
death rate. 2) Malaria (being tied to mosquitoes) is inherently a regional
disease. Ebola has much more potential to spread to other regions.

------
DanielBMarkham
Time to face some brutal facts here.

1) We are due for another pandemic. If this one isn't it, there will be
another.

2) Democracies run on public opinion. Right now everybody is riled up about
some homicidal idiots in Iraq. This is off their radar. Hundreds of thousands
of people die from some natural cause or another all of the time. It's not a
huge spectacle on YouTube.

3) The enemy really isn't Ebola. Ebola is just the opportunistic pathogen that
came along. The enemy is really weak governments with little or no public
health systems, combined with very poor local sanitation practices.

4) There was a time when air-dropping in a thousand healthworkers with tent
hospitals _might_ have stopped this. That time is over. Now it's in the big
city, and trying to control or service a population of several hundred
thousand is beyond most any country's ability to project intervention.

5) If it doesn't go airborne and stay lethal, which is where the safe money
currently is, we'll end up with hundreds of thousands or millions dead and it
should burn itself out over the next year or two. That's the optimistic
scenario. We have no reason not to believe that's the way it's going to play
out.

6) If it goes airborne and stays lethal, we're in for a major shitstorm. But I
really don't think second-guessing how we responded will be useful. There are
different countries in the world. They have different governments. We do not
have one world government, nor do most of us want one. That means that there
are always going to be large pockets of humanity where something like this can
take off. Structurally humanity is huge. Disease is going to be an issue for
us for a long time.

~~~
jplewicke
Saying that we're due for another pandemic is quite simply the gambler's
fallacy:
[http://en.wikipedia.org/wiki/Gambler's_fallacy](http://en.wikipedia.org/wiki/Gambler's_fallacy)
. The odds of a pandemic may well be higher than recent experience would
indicate, but pandemics still occur randomly.

------
mjn
The article this Wired post is mostly reblogging is quite a bit better imo, at
least in having a higher ratio of facts to commentary:
[http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2...](http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894)

~~~
Crito
Seriously, what utter crap: [http://www.wired.com/wp-
content/uploads/2014/09/Nishiura-cur...](http://www.wired.com/wp-
content/uploads/2014/09/Nishiura-curves.jpg)

Did they seriously screenshot that image with a tooltip up?

------
Pxtl
This should be obvious to anybody who knows about geometric growth. The only
time you can really stop Ebola without a cheap and easily-available _cure_ is
now while it's small. As it grows, its rate of growth will increase, and it
will quickly spread to every vulnerable area.

~~~
aaron695
< As it grows, its rate of growth will increase

No, R will stay the same. Or decrease as the population becomes more exposed.

~~~
wcoenen
He's taking about the number of people infected per unit of time, which will
indeed increase over time if the reproductive number stays larger than 1.

~~~
biot
Growth is number of people per unit time. Rate of growth is number of people
per unit time squared. Just as with speed vs. acceleration, there certainly is
a distinction.

~~~
wcoenen
I'm not a native speaker so I could be wrong. But in the wikipedia article
about exponential growth, "growth rate" is defined as the first derivative
with respect to time, which contradicts what you are saying:
[https://en.wikipedia.org/wiki/Exponential_growth#Differentia...](https://en.wikipedia.org/wiki/Exponential_growth#Differential_equation)

I understand the distinction you are trying to make, but I think what you call
"growth rate" would actually be "growth acceleration".

------
vfclists
This seems to be the usual knee jerk military can solve everything response
you would expect from Americans, and also African governments who are always
eager for handouts from Western governments.

So you want to send the military in? Do you have any idea of the size of the
area in which you would have to deploy them, coupled with the panic their
presence might cause, together with the issues which would be caused by
militia factions which would inevitably arise to tackle what they would
rightfully see as an invasion of their countries?

What did the UN manage to do after the Haitian earthquake that the Haitians
couldn't have done themselves, besides introducing cholera to the region and
nearby countries?

What African countries need to do is what they would have to do if there was
no possibility of outside support. In this case it is not even a question of
central government intervention when it is more a question of dealing with
Ebola at the local level or county / village level.

Moving infected people to centralized locations for treatment means more
travel and the possibly infected relatives and carers for the ill spreading
the disease more, unless they are transported by specialist units. The process
of travelling to report an infection and calling for a specialist unit itself
carries the risk of the traveller spreading the disease let alone the person
with the symptoms.

The only way to contain Ebola is to give the families or communities of
infected people the knowledge, the drugs, the equipment and the protective
clothing to they need to treat themselves and the economic support they will
need when they are isolated, which needs to be done at a local level. That
means sustained public education via television and video, protective clothing
for carers and disease detection kits.

------
wmgries
I'm no expert and I'm just as frightened by the spread of this disease as
everyone else, but I think people in this thread, and the media in general,
are being a tad "end-of-the-world"-y about this without looking at some of the
important facts. Namely:

1) The article mentions the R0 of Ebola and claims it is between 1-2 in the
current outbreak. Previous outbreaks of Ebola have been as high as 2.7. But
this is relatively low compared to other diseases... the R0 of the Measles for
instance is 12-18 (and nobody is really talking about the recent outbreaks in
the US due to parents not vaccinating their children). Chances are, this rate
would even be lower in the West because conditions in African slums and even
hospitals are downright deplorable. Doctors aren't using suits or even gloves
to examine patients, medical staff are reusing disposable needles, hospitals
rely on family members to wash soiled linens because they don't have in-house
cleaning services like western hospitals, etc. And don't forget that cultural
norms are feeding the spread of the disease: well family members are observed
to be sharing beds with sick loved ones in hospitals, people are practicing
cultural burial routines of washing and in some cases kissing deceased loved
ones, people are still eating the meat of things like bats and gorillas that
are sick with the virus (and even found dead), etc. These are all things that
just wouldn't happen in the West. People also do much better here at heeding
the advice of the medical professionals - for instance, bodies of people who
had died of Ebola would like be burned without concern for any regular
traditions, without much complaint.

2) Part of the reason Ebola is so scary is the high fatality rate cited in
articles: 50-90%. If you extrapolate to the entire planet, this sounds like it
would be devastating to the human race. But is this the actual fatality rate?
Western hospitals do a much better job of carefully monitoring patients and
tending to every minor development. The main problem with Ebola isn't that the
body can't fight it, it's that it kills you before your body can recover - the
drastic difference in care between the West and Africa would likely make a
huge difference in mortality. Make no mistake, this is a deadly disease, but
probably not quite as bad as 50-90% in the West.

3) This article and others like it have shared the concern that Ebola could
mutate into something transmissible by air. This would make the R0 of the
disease skyrocket up into something that could quickly overwhelm Western
medicine and very rapidly turn into something perhaps even more devastating
than the plague. It's possible of course the virus could mutate in this way,
of course, it's already believed that it can spread like this in pigs. One
important thing to recognize is that Ebola in humans affects the liver not the
lungs, which poses a barrier to being airborne. In addition, to become truly
airborne, the virus would have to mutate it's outer coating to resist the
drying effect of the air. So in order to become transmissible by air, it would
have to mutate 2 different major adaptations and completely change everything
about itself. The example I've read is that we don't worry about HIV becoming
transmissible by air, and it is thought to mutate more quickly than Ebola.
We've never observed any deadly virus change it's method of delivery, although
of course airborne diseases evolved that adaptation in the first place.

None of these points mean we should sit back and do nothing. We need to help
at minimum because of the following reasons:

1) People are dying and we can help them. With effective medical care, the
mortality rate as mentioned in point 2 above should go down.

2) Ebola is destabilizing the region. This is already a region prone to state
failure, corrupt and ruthless governments, etc. This disease could well cause
wars in Africa, which in turn would make conditions worse and likely increase
the fatality rate and the infection rate.

3) While there is a reasonable scientific case to be made against the
unlikelihood of the mutation of the virus into airborne transmissible, it's
possible and very scary. When considering the risks, we need to multiply the
rather small chance against the rather large negative effect of such a change.
We need to stop this to avoid this thing from becoming more deadly.

~~~
gbrown
A basic reproductive number of two can be really really bad, provided it stays
that high. If exponential growth holds long enough, it doesn't matter too much
what the rate is, so long as it's above one.

With that being said it varies a LOT between different countries for exactly
the reasons you mention. My initial work shows a lot of heterogeneity:

[http://grantbrown.github.io/Ebola-2014-Analysis-
Archive/Sep_...](http://grantbrown.github.io/Ebola-2014-Analysis-
Archive/Sep_08_2014/Ebola2014/figure/unnamed-chunk-11.png)

I agree wholeheartedly with your last three points. Also, from the looks of
things the cheapest and most effective time to tackle the disease was months
ago. The second cheapest and most effective time to try to stamp it out is as
soon as possible.

P.S. The ProMed daily digests are some of the best and most comprehensive
updates on this situation I've seen:

[http://www.promedmail.org/](http://www.promedmail.org/)

~~~
wmgries
Thanks for the links!

------
quarterwave
I searched for R_0 data on flu pandemics and found this:

[http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pan...](http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pandemic_influenza_pandemics_of_influenza.pdf)

Note the sharp jump as R_0 goes from sub-2 to over-2, which should not be
surprising (hand wave about branch processes, light of a thousand suns, etc).

Over to someone better qualified to comment - is the present situation with
Ebola taking us into a pandemic territory similar to 1918 H1N1?

------
privong
> in particular by bringing in local residents who have survived Ebola, and
> are no longer at risk of infection.

I have seen this several places over the past week or two – is it actually
true that people who survive Ebola are not at risk of re-infection? I can see
where that might be true shortly after recovery (i.e., due to there still
being antibodies in one's system), but how long would the immunity last?

~~~
philsnow
Antibodies generally last a very long time [citation needed], but would they
be useful against such a rapidly-changing pathogen ?

~~~
privong
> but would they be useful against such a rapidly-changing pathogen ?

Does that explain why people are not immune from the flu after having it once
– the version they have antibodies to is not the same as the mutated version
which circulates later?

~~~
learc83
>Does that explain why people are not immune from the flu after having it once

Yes. There are many strains of Influenza, immunity to one strain doesn't
necessarily confer any immunity to another strain.

However, Ebola mutates much less rapidly that Influenza.

------
chestnut-tree
If you're in the UK, there's an informative BBC documentary on Ebola broadcast
just last week. The programme talks to survivors of the virus, to the staff of
Médecins Sans Frontières (MSF) treating victims, to Peter Piot, the Belgian
doctor who discovered the virus (and established that the disease was not
airborne) and the medical staff seeking a cure. There are some harrowing
scenes.

It's available on iPlayer until Friday 19 Sept. 2014
[http://www.bbc.co.uk/iplayer/episode/b04hcthj/](http://www.bbc.co.uk/iplayer/episode/b04hcthj/)

Someone's uploaded it to YouTube, although the last 10 minutes are missing
[https://www.youtube.com/watch?v=bjuQofIleOg](https://www.youtube.com/watch?v=bjuQofIleOg)

------
JulianMorrison
> In a worst-case hypothetical scenario, should the outbreak continue with
> recent trends, the case burden could gain an additional 77,181 to 277,124
> cases by the end of 2014.

What I wonder is: why do they think it will _stop_? What's going to put a
brake on the epidemic's explosion? This is not a world where a disease can
burn itself out on the local level by simply killing everyone susceptible.

------
jtolds
Just for those of you wondering somewhat about the risks of Ebola becoming
airborne - it has been shown to be transferred without contact before:
[http://healthmap.org/site/diseasedaily/article/pigs-
monkeys-...](http://healthmap.org/site/diseasedaily/article/pigs-monkeys-
ebola-goes-airborne-112112)

------
FollowSteph3
My fear is that we're not able to stop a simple stomach flu which is spread
almost the same way, through bodily liquids, so I don't think it will be easy
to stop once it hits first world countries like most people currently
assume...

~~~
pyre
Wait a minute, when was the last time that the stomach flu was an epidemic?

~~~
rst
The last flu epidemic with a major death toll was the pandemic of 1918, which
is estimated to have killed more people than World War I. A less deadly
version of the same strain was officially listed as an epidemic in 2009.

~~~
Pxtl
Stomache flu, which is the symptom gastroenteritis, is unrelated to influenza.
It's a misnomer. So the Spanish Flu is not a good example here.

And to the point, we've never successfully "beat" GI because the stakes were
never this high.

------
msie
How does the world's response to Indonesia, Haiti compare to this? Do we need
some celebrities to put on a telethon to get more nations acting AND acting
immediately on this?

------
hollerith
Informative graph:

[http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png](http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png)

~~~
StephanTLavavej
The log graph is scarier:
[https://upload.wikimedia.org/wikipedia/commons/2/2d/Evolutio...](https://upload.wikimedia.org/wikipedia/commons/2/2d/Evolution_of_the_2014_Ebola_outbreak_in_semiLog_plot..png)

(It's easier to recognize a straight line on a log scale, than to distinguish
an exponential line on a linear scale from a line that's "merely" quadratic,
say.)

~~~
csdrane
What do similar charts for prior outbreaks like?

~~~
throwaway_yy2Di
Here's one of the previous largest outbreak, 2000-2001 in Uganda. (Note unlike
the Wikipedia one, it's not cumulative). Looks like a sudden decline in new
cases right after a CDC intervention -- very sharp inflection point. The
cumulative version would be roughly a sigmoid.

[http://web.stanford.edu/group/parasites/ParaSites2012/Lassa%...](http://web.stanford.edu/group/parasites/ParaSites2012/Lassa%20Libby%20Burch/images/LassaEbolaMarburg_LibbyBurch_3-8-2012_img_19.png)

[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm)

Looks like there were about 10 new cases/day at its peak; the current outbreak
is at 150/day.

A couple things stood out to me:

    
    
        Fourteen (64%) of 22 health-care workers in Gulu were
        infected after establishing the isolation wards; these
        incidenses led to the reinforcement of infection-control
        measures.
    

So that's not novel to the current outbreak at all!

    
    
        During the 4-month outbreak and response period,
        approximately 5600 contacts in Gulu District were under
        surveillance for 21 days by approximately 150 trained
        volunteers.

------
aaron695
I find it interesting that people worry about Ebola going airborne but not
something like AIDS.

I guess there's a biological reason....

~~~
nostromo
Because Ebola has already been shown to be transmissible via the air, but only
in other species.

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498927/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498927/)

> Piglets [with Ebola] were transferred to the room housing macaques in an
> open inaccessible cage system. All macaques became infected.

~~~
techdragon
Dont overstate this particular study, the team did nothing to eliminate the
possibility that there was transmission via droplets flung off the animal, and
did not fully eliminate the possibility of particulate cross contamination
which could have lead to transmission via infectious fluids piggybacking to
the macaques on the particulate cross contamination.

Yes there is a risk of mutation to transmit via air, but we have not yet seen
it. We have merely proven that 'shit happens' and 'ebola is dangerous'.

------
phkahler
[http://www.telegraph.co.uk/news/worldnews/europe/france/1084...](http://www.telegraph.co.uk/news/worldnews/europe/france/10847344/Jean-
Marie-Le-Pen-Ebola-epidemic-would-solve-immigration-problems.html)

I'm afraid some people either think this is a game, or just an opportunity -
since most of the worlds problems today stem from overpopulation.

~~~
jnbiche
>since most of the worlds problems today stem from overpopulation

Why do you think that most of the world's problems today stem from
overpopulation? What problems?

If you're talking about hunger, that's demonstrably false. There is plenty of
food produced to feed the entire population. Even African produces plenty of
food to feed itself. Famine occurs in times of war and natural disaster, or
other great upheavals. Most of the causes are man-made and have nothing to do
with overpopulation.

~~~
phkahler
I would argue that war can be a result of overpopulation. Famine is also - it
occurs in the places least able to deal with ebola. "Global warming" \- we
could reduce emissions by reducing population without changing the per capita
energy consumption. Unemployment - not enough jobs is the same thing as too
many people. Strife in the middle east? Too many people in that area of the
world with not enough resource (or governments that squander what they have).

I'm not saying all of these are correct in an absolute sense, just that
population certainly plays a role.

~~~
jnbiche
> Famine is also - it occurs in the places least able to deal with ebola

The areas currently buckling under Ebola have _not_ been the regions of Africa
most affected by famine in the last few decades, most of which are in the
Sahel and Horn of Africa. And which were caused by political problems. Other
than that, I'm not sure what this means.

>"Global warming" \- we could reduce emissions by reducing population without
changing the per capita energy consumption.

This would be true if you reduced population _in the West and in Asia_ but the
energy and food consumption of Africa is absolutely minuscule compared to the
rest of the world.

See the references in my other post:

[https://news.ycombinator.com/item?id=8320473](https://news.ycombinator.com/item?id=8320473)

>Strife in the middle east?

Israel has a relatively low birth rate.

