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Ebola outbreak in Eastern Congo is moving toward a major city (vox.com)
86 points by pseudolus 27 days ago | hide | past | web | favorite | 41 comments

I’m not looking to incite a political flame war, but genuinely interested in how the current US government shutdown affects the response to this. The CDC is funded through 2019, but are there “non-essential” services whose absence will be detrimental towards combating a potential crisis like Ebola? Airport screeners? FDA? Research programs?

Wouldn't China step in before the US if things got bad to the point of threatening the African Economy? I thought China had an economic foothold in Africa, thats why they have a military presence there.

I think op is talking about if or when Ebola reaches US.

It's not a widespread concern for the US. Not that it can't happen here in small pockets, but Ebola is a uniquely African problem, which is allowed to spread from a combination of political instability, African ritual family washing of the dead, aversion to cremation, poor health infrastructure, endemic malaria which has similar initial symptoms, lack of education, porous borders, poor public health infrastructure, and a seasonal migratory workforce that can carry disease across borders.

I'm inclined to believe that a significant urban ebola outbreak in Africa would be sufficiently frightening that politicians, regardless of their political stripe, would authorize the appropriate funding. In any case I'm sure it would fall under the rubric of being a national emergency and funding would be authorized by the executive branch with little controversy.

You do bring up an interesting point about airport screening because presumably that would require significant manpower. In passing, however, it appears that screening at airports hasn't advanced to the stage where it's particularly effective. [0].

[0] https://www.bmj.com/content/349/bmj.g6202

> I'm inclined to believe that a significant urban ebola outbreak in Africa would be sufficiently frightening that politicians, regardless of their political stripe, would authorize the appropriate funding. In any case I'm sure it would fall under the rubric of being a national emergency and funding would be authorized by the executive branch with little controversy.

I'm not so optimistic. I'll believe any of this when I see it.

My belief isn't grounded in any recognition that politicians really care. It's grounded in the fact that no politician would want to be blamed if ebola reached US shores. Ebola cases in the US would dominate the news cycle and incite a lot of fear.

WHO accepted donations in previous outbreak. https://www.who.int/csr/disease/ebola/funding/en/ If the emergency funding won't be available somehow or blocked, the business/private/government entities interested in stopping the outbreak will donate to the cause.

It's also worth considering whether the absence of these officials is a net positive or negative in terms of the overall response. Their response last time was abysmal. Be reminded, for example, that 19 days after Thomas Eric Duncan was treated without proper gear, the CDC still had a cheesy "under construction"-esque web page on the topic that said, "PPE Recommendations are forthcoming".

Hospitals were waiting instead of making their own preparations.

And they told Amber Vinson it was OK to fly with a slight fever, only later to vilify her in the press for "breaking protocol."

What an absolute shitshow.

On the other hand, Nigeria had an amazing response.

"In both cities, all the ingredients for an explosion of new cases were in place. That explosion never happened, thanks to the country’s strong leadership and effective coordination of an immediate and aggressive response. As in Senegal, an emergency operations centre was established, supported by the WHO country office. Also like Senegal, Nigeria had a first-rate virology laboratory, affiliated with the Lagos University Teaching Hospital, that was staffed and equipped to promptly diagnose a case of Ebola virus disease.

"The government generously allocated funds and dispersed them quickly. Isolation facilities were built in both cities, as were designated Ebola treatment facilities. House-to-house information campaigns and messages on local radio stations, in local dialects, were used to ease public fears. Infrastructures and cutting-edge technologies in place for polio eradication, were repurposed to support the Ebola response, putting GPS systems to work for real-time contact tracing and daily mapping of transmission chains. Contact tracing reached 100% in Lagos and 99.8% in Port Harcourt.

"In what WHO described as a “spectacular success story”, the country held the number of cases to 19, with 7 deaths. World-class epidemiological detective work eventually linked all cases back to either direct or indirect contact with the air traveller from Liberia. WHO declared Nigeria free of Ebola virus transmission on 20 October."


at what point institutions lose sight of common sense ..

I’m curious if the more people who catch Ebola increase the risk it becomes spreadable by an airborn vector. I assume that’s the case, but does anyone know?

(I'm not an expert,i have limited knowledge on the subject) Much more likely is resistance to UV without changes in transmission route, so it survives longer in droplets. However there is a (tiny) chance of "recombination" with another airborne RNA virus that is "compatible", where two viruses share genetic material while infecting the same cell and the resulting hybrid is viable "airborne Ebola", however it would be sharing traits of both viruses. Some links: https://www.sciencedirect.com/topics/medicine-and-dentistry/... http://www.recombinomics.com/News/11150702/Ebola_Recombinati... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787895/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324781/

Ebola would have to change a good bit to become airborne. If that were to happen, it would be a very different disease and there is no reason to assume it continue to be nearly as deadly.

Why would becoming airborne make it less deadly?

Genetic/phenotypic trade offs.

It does, the more a virus replicates the more opportunities there are for a mutation to occur. The probability of specifically developing an airborne vector is pretty low though - there are significant differences between the physical properties required for fluid vs airborne transmission. A lot of specific mutations would have to accumulate, and there is no guarantee an airborne variety would see the same level of success and persistence as the original.

The good news here is that virus genomes are usually so small and parsimonious that they find it hard to cross significant fitness valleys between different local maxima. But they also have monstrous cohort sizes, so it's not impossible for them to get "lucky." (Lucky for the virus in a Darwinian sense, unlucky for its host.)

Here's another more detailed article that gives some history and context: https://www.irinnews.org/special-report/2019/01/16/ebola-cri...

Vice had made several videos of the Ebola outbreak, they showed that there is a lack of trust in govts among the population as govts tend to be corrupt or ineffective so there is even groups of people who believe Ebola was a govt hoax, not sure if they still hold the same views but it shows the complexity of the situation.

What I read is that most outbreaks spread a kind of linear while Ebola spreads exponetial.

That's what is scary about Ebola. And ofcourse the fact there is still no cure.

> no cure

Sort of, their are treatments that increase survival rates significantly. Supportive hospital care might not seem as useful as a wonder pill, but an IV drip can make a huge difference.

Luckily it looks like having it once confers immunity.


Also bodes well for our ability to make a vaccine.

There are vaccines being deployed but stocks are extremely limited. If I remember correctly, they are focusing on inoculating the social circles of known infected. But you can only inoculate someone's social circle if you know they have it...

It also doesn't help that medical teams sometimes get attacked by locals.

EDIT: Ignore my question, apparently rumors and skepticism about modern medicine is why they attack medical teams: https://www.reuters.com/article/us-health-ebola-congo-attack...

> It also doesn't help that medical teams sometimes get attacked by locals

Who is attacking them for what reason? Anti-vacciners or something?

Rural Africa has had bad luck when it comes to white people coming in and telling them what to do.

Eating portions of their dead? I never heard that. I just heard that they weren’t able to do traditional funerals. Presumably that could be part of the traditional funeral, but I’ve got close friends and family I would have expected to hear that from. Do you have a reference?

I just finished Virus Hunters of the CDC, a 1996 book written by a couple of CDC epidemiologists, one of which had led a couple of Ebola responses in (what was then) Zaire and CAR. (He was even on the team that named the disease for a river near the town the outbreak was in.)

He certainly didn’t mention cannibalism. They were most concerned about the ritual washing before burial. Apparently the bodies are cleansed, bowels washed, etc. Given how Ebola spreads, this was virtually a guarantee that anyone handling the dead would contract the disease.

Their biggest successes were in teaching families how to use gloves, masks, and bleach. Any danger the CDC teams were in seemed to be mostly limited to political instability.

Another problem with the last outbreak is that one of the things Westerners were telling them to do was to stop eating portions of their dead. This is a tradition there, and local shamans started saying they were getting sick because they weren't honoring the tradition.

The last outbreak started from people eating infected bats. I'll have to read up on this one.

You are thinking of kuru.

That too, but bats are also frequently associated with ebola: https://www.google.com/search?q=ebola+bats

I thought all diseases spread exponentially, with the rate being determined by how contagious on one side and how deadly on the other?

...plus the -hm- incubation period?

That is - for how long you can transmit the disease without showing symptoms.

The nightmare, of course, being a highly contagious, very deadly disease which let its victims infect others for weeks or months before falling ill themselves.

I recall having read somewhere that a 'good' thing about ebola is that it mostly gets its victims before they've had a chance to travel very far, thus limiting its spread.

The nightmare, of course, being a highly contagious, very deadly disease which let its victims infect others for weeks or months before falling ill themselves.

That’s a very good description of Variola Major, and one reason (along with lethality and disfiguring effects) that it was so terrifying.

HIV/AIDS also.

HIV isn't very contagious. That is why dying of AIDS was a strong indicator that you were gay. If it had been able to spread easily, everyone would have had it rather than just a tiny subpopulation.

Yes, what you describe is the classic doomsday disease.

Sounds much like rabies.

The other critical feature is how easy it is passed on to a new victim, the worst scenario is being airborne.

The simplified model is a sigmoid function, if it looks like exponential growth, exponentially dampened, or linear depends on where you are on the curve.

A fun read on Ebola and the outbreak in Virginia: the Hot Zone

NPR has an article on the Central African Republic's scouts who promote vaccination, relay messages about the Ebola outbreak, and domestic chores — https://www.npr.org/sections/goatsandsoda/2019/01/19/6808273...

Twitter thread from a MSW/JD with some more info regarding the Ebola outbreak and interactions between DRC, CAR, and South Sudan — https://twitter.com/geopoliticaljd/status/108699357731649945...

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