Biggest Ebola Outbreak In History- ~10000 Cases

[Borgholio]

Yeah things are not looking good. I wonder how long until major airports in non-African nations start canceling or quarantining inbound flights from Africa?

[Simon_Jester]

This is exactly why it is bad to tolerate the idea that there are large groups of people in the world who are kept ignorant of basic facts about medicine, who are not educated.

It is not that simple. Education alone doesn't work. Just look at the whole climate change debacle. Both sides know all the arguments yet the deniers simply refuse to believe the proof. It's not ignorance it's belief.

This is where my last paragraph comes in, about ignorance as a stance.

Something Staha said a while back to a person who was being very obtuse in an argument is helpful to explain what I'm really getting at here:

You fall into the old enlightenment-humanist trap of ignorance being an absence of knowledge. It isn't. Ignorance is a position, a stance that is informed and held for its own reasons. This is why everyone is frustrated in this thread, people who are well-versed, professionally trained, and even professionally employed in these fields are offering up facts and explanations about why you are wrong and you smacking them down out of hand on faulty facts. When we try to explain that these facts are faulty you either duck the question or simply disagree without warranting your explanation which drives us (and the people reading this thread who aren't posting) to exasperation.

Put another way, your ignorance and unwillingness to admit you might be wrong is preventing you from seeing that you are wrong, and makes you look stupid to everyone who does have common sense.

Now, note the bit in there about ignorance being a stance or viewpoint that is informed for its own reasons.

In the West, there are certain classes of experts we mostly defer to reflexively, and others we don't. Doctors are among the groups we do defer to, at least in times of specific emergency even if we don't lose weight and get some freaking exercise when the medical profession as a whole tells the people as a whole to.

The mindset of deferring to experts has drawbacks, but it has great social utility in time of crisis.

In sub-Saharan Africa, this mindset breaks down due to a combination of corruption (which makes many of the normal day-to-day authorities untrustworthy by nature) and ignorance (which leads the people to embrace bizarre and stupid ideas as co-equal with logical ones, which is how you get people thinking that the Ebola isolation ward is actually a coverup for cannibals and should be protested).

Education, in the sense of giving people all the right information, is often not enough. Even telling people their what they believe is wrong is not enough. In fact it can be counterproductive if their belief system includes some form of conspiracy theory about the government/scientists/the authority suppressing what they believe.

The only approach I've seen that works is to make fun of that belief. Make it a stigma to profess a belief in a conspiracy theory and people will stop believing. But it's not easy. And it's hard to do it as a deliberate campaign.

Well, the real key in my opinion is to teach people not what to think but how to think. What are the proper ways to respond to a crisis? What tools are appropriate? Is doing research better than listening to a random friend you met in the marketplace?

To me that's part of education... but it's not part of any school curriculum I know of. I wish there were a series of classes all humans had to take on how to perform basic logic, on the structure of what a valid thought looks like regardless of its content.

Would that fix everything? No, but it'd help.

[Broomstick]

I think you need to take into account that even people who would support quarantine of people infected with a deadly and contagious disease seldom want to be quarantined themselves. Particularly since post-WWII quarantine has been used less and less to contain disease. Even low-level isolation for not-so-deadly disease can be scary - when you're lying in a bed, sick, and anyone who approaches you is swathed head-to-toe getting a little freaked is a common response. Being even potentially infected with a bio-hazard 4 pathogen and locked into isolation/quarantine has to be frightening.

In other words, I can understand the impulse of those airplane passenger to run away. It's the wrong response for the greater good, it's also the wrong response for those who are ill and who only chance of survival is medical care, but it's a very normal response to deadly danger.

They're not bad people, they're frightened people.

[Bedlam]

Is the disease infectious before the vomiting / diarrhoea phase?

On Jul. 24, Nigerian authorities confirmed that a Liberian man, Patrick Sawyer, had collapsed in Lagos after flying there from the Liberian capital, Monrovia, and tested positive for Ebola; Sawyer died on the night of July 24-25.

The World Health Organization says that Sawyer, who worked for the Liberian finance ministry, turned himself in to Nigerian health authorities after he began vomiting and having diarrhea in the middle of the three-hour flight from Monrovia to Lagos.

Going by the above the victim died within 24 hours of hitting that phase possibly much less. That by itself doesn't leave much time for the disease to spread although it's methods are highly effective.

The greater problem is the week or two before hand when there is the fever or no symptoms, how readily transmissible is it then? If it is then the man hunt isn't going to do to much, if they have to catch them before hitting the last stage then it has some chance of succeeding.

[Borgholio]

The first week or two it is still being established. I imagine it is contagious as soon as enough virus builds up to be spread via fluid. I can find no hard numbers on how long that takes, but since it has no incubation period, I suppose theoretically it is contagious within a day or two.

[Ziggy Stardust]

The first week or two it is still being established. I imagine it is contagious as soon as enough virus builds up to be spread via fluid. I can find no hard numbers on how long that takes, but since it has no incubation period, I suppose theoretically it is contagious within a day or two.

Actually, ebolavirus DOES have an incubation period. Just a very short one. Nobody knows quite for certain, as you are right that the early stages of the virus' life cycle have yet to be definitively time-lined. Traditionally, it is assumed to be less than 21 days. The most recent study I know of on the subject estimated an average incubation time of approximately 13 days for the zaire subtype of the virus (as is this current outbreak). However, incubation period of as little as 2 days have been definitively confirmed.

With regards to Bedlam's question, ebola is not known to be contagious during this incubation period. That is, there is no evidence of it being spread by patients who are not exhibiting symptoms. The problem, of course, that early stage symptoms are largely indistinguishable from a number of diseases that are also common in the region: Marburg virus disease, malaria, typhoid, typhus, cholera, pretibial fever, not to mention other non-infectious conditions like leukemia or even some snake bites (the big sign they look for in a clinical- i.e. non-molecular- ebola diagnosis is a type of rash that develops about a week after infection). This is one of the reasons that outbreaks typically explode quickly, but then tend to fade away as subjects die too quickly to keep infecting people and awareness spreads so people are able to avoid getting infected.

Also of interest, many previous outbreaks have had mortality rates as high as 90%. While it isn't unusual for individual outbreaks to be highly variable, this current one is "only" 60%. Impossible to tell at this point whether this represents random change, improved treatment measures, or an extremely sneaky and unexpected mutation (this strain has already been sequenced and classified, which means any mutation would have to be at a location on the viral genome that isn't currently suspected to be of phenotypic import; that is, it could be years before anyone finds it, if ever).

[Purple]

How dangerous is this to us in Europe?

[Borgholio]

How dangerous is this to us in Europe?

If it makes it that far, not much of a problem. Europe has a much more advanced medical system than Africa, not to mention more highly educated populations and more effective governments that can actually coordinate and implement quarantines as well as backtrack cases. I can't see too many people dying in Europe.

[slebetman]

There have been around half a dozen Ebola cases outside Africa - in the US and Philippines. Zero deaths.

http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks

So yes, it will probably be nasty but manageable in Europe or anywhere with highly educated populations and good medical care.

[Fingolfin_Noldor]

There have been around half a dozen Ebola cases outside Africa - in the US and Philippines. Zero deaths.

http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks

So yes, it will probably be nasty but manageable in Europe or anywhere with highly educated populations and good medical care.

It should be pointed out that Taiwan, Hong Kong, Singapore and Malaysia were decently educated but that did not stop mass hysteria from setting in during the initial phase of the SARS outbreak.

[Imperial528]

There have been around half a dozen Ebola cases outside Africa - in the US and Philippines. Zero deaths.

http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks

So yes, it will probably be nasty but manageable in Europe or anywhere with highly educated populations and good medical care.

The strain in the US, Philippines and Italy outbreaks are all the Reston strain, which is not pathogenic in humans. It can be dangerous to monkeys but it has not been demonstrated to be harmful to humans.

That said, I am confident that developed nations with working medical systems and widespread education of medicine would fare far better, however we have only the data of outbreaks of similarly lethal and contagious diseases to base our assumptions on.

[slebetman]

There have been around half a dozen Ebola cases outside Africa - in the US and Philippines. Zero deaths.

http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks

So yes, it will probably be nasty but manageable in Europe or anywhere with highly educated populations and good medical care.

It should be pointed out that Taiwan, Hong Kong, Singapore and Malaysia were decently educated but that did not stop mass hysteria from setting in during the initial phase of the SARS outbreak.

On the one hand the reaction to SARS we had is the sort of reaction that would be useful - avoidance/phobia of human contact. On the other hand my first-hand account of the so-called hysteria looks to me more like a big "meh..".

[slebetman]

Could it be that the current outbreak is worse specifically because this strain is so bad at killing its victims? Previous strains had close to 90% mortality rate. This one is currently hovering around 60%. If a disease has survivors/carriers then it doesn't need an incubation period to spread.

[Fingolfin_Noldor]

On the one hand the reaction to SARS we had is the sort of reaction that would be useful - avoidance/phobia of human contact. On the other hand my first-hand account of the so-called hysteria looks to me more like a big "meh..".

Of course it was "meh". But that didn't stop people from not coming onto the streets. I know I took full advantage of this because I thought the entire affair was silly.

[Elheru Aran]

Could it be that the current outbreak is worse specifically because this strain is so bad at killing its victims? Previous strains had close to 90% mortality rate. This one is currently hovering around 60%. If a disease has survivors/carriers then it doesn't need an incubation period to spread.

This is definitely part of it. The most effective plagues aren't the ones that kill everybody right away. They're the ones that hide around for a while, don't kill too many people, get spread around, and THEN start kicking everybody's ass.

If everybody's dying off all around, people stay the fuck away (especially with something that ends in a fashion as messy and nasty as Ebola). If there's a chance people will survive the illness, then others are more likely to take care of them and be exposed to the pathogen. It then gets spread further.

[Steel]

Again, we could find that every ebola outbreak ever has a mortality rate of 20%, but we just don't get anyone but the sickest reported. The apparently lower mortality rate in this epidemic could be entirely due to better diagnosis. The next possibility is better care.

As far as the guy on the plane goes, given he died within 24 hours of landing, it is highly likely that he was infectious. We need to wait at least a month to see if an outbreak is going to occur in lagos. Of course we could see one earlier than that, but even if the disease has spread to hundreds within a couple of weeks it might not be visible in a city of 20 million, especially if people want to hide symptoms for fear of government quarantine.

[Ziggy Stardust]

The strain in the US, Philippines and Italy outbreaks are all the Reston strain, which is not pathogenic in humans. It can be dangerous to monkeys but it has not been demonstrated to be harmful to humans.

It may also be informative to look at the case of the zaire strain (as in, the one in the current outbreak) that made it to South Africa during the Gabon outbreak in the mid-1990s. It is the only comparatively modern country that has had a confirmed case of the disease (from a doctor traveling back from Gabon), and resulted in only a single death (interestingly, not the infected doctor, but a nurse taking care of him). Obviously, a sample size of one isn't anything to get excited over, but it should at least alleviate people's fears of one person on a plane landing in Frankfurt and causing an epidemic. As nasty as this disease is, it is actually relatively easy to prevent its spread if you are prepared and have proper medical facilities/practice at your disposal. It is only infectious while symptomatic, so you don't have the problem of carriers unwittingly spreading the disease.

Could it be that the current outbreak is worse specifically because this strain is so bad at killing its victims? Previous strains had close to 90% mortality rate. This one is currently hovering around 60%. If a disease has survivors/carriers then it doesn't need an incubation period to spread.

Other outbreaks have also had low mortality rates. The last big outbreak in Uganda was only 25%, but that was a newly identified strain. Other outbreaks of the current strain of interest have had mortality in the 40s or 50s. Ebola is just super unpredictable; as I mentioned in my previous post, it is hard to separate out random noise from any potential treatment effects.

Also, ebola doesn't have "carriers". It is not contagious during its incubation period. It is only contagious when symptomatic (and, unlike many other infectious diseases, CANNOT be spread via aerosol droplets as through sneezing/coughing).

Again, we could find that every ebola outbreak ever has a mortality rate of 20%, but we just don't get anyone but the sickest reported. The apparently lower mortality rate in this epidemic could be entirely due to better diagnosis. The next possibility is better care.

Too hard to tell. Other outbreaks, earlier outbreaks, in even more remote places of Africa with worse medical care then Sierra Leone have had lower mortality rates. Ebola is very unpredictable, in part because very little is known about how these outbreaks start. Once the outbreak starts, it pretty typically burns out quickly, because the disease doesn't really spread that easily compared to other infectious diseases. In MOST cases, there is a large initial surge of cases that were (somehow) exposed, then they either die off or recover and that's the end of it. Granted, this outbreak has displayed somewhat unusual behavior in that it appears to be coming in multiple small waves, but we just know so little about the vectors of ebola, the virus' life cycle, and why certain people respond differentially to it that it is impossible to correlate the current mortality rate with any specific factor.

As far as the guy on the plane goes, given he died within 24 hours of landing, it is highly likely that he was infectious.

Most likely. Given the time of death, he had likely contracted ebola at least 5-7 days prior to the flight. However, it is difficult to tell how infectious he was. As I have mentioned, ebola is ONLY contagious when the patient is symptomatic, not during the incubation period. It is possible, though admittedly unlikely, that this guy couldn't have spread it to anyone because the virus was still incubating, and the onset of symptoms was very sudden. Of course, it is also possible that he has had a light fever and minor symptoms for several days (not realizing it was ebola) and spread it to dozens of people. Without having any knowledge of this guy's medical history it is impossible to make a judgment; sometimes ebola CAN kill almost immediately after symptoms develop.

[Broomstick]

How dangerous is this to us in Europe?

If it makes it that far, not much of a problem. Europe has a much more advanced medical system than Africa, not to mention more highly educated populations and more effective governments that can actually coordinate and implement quarantines as well as backtrack cases. I can't see too many people dying in Europe.

Based on the 1967 Marburg outbreak in Germany (Marburg being a related virus that also causes hemorrhagic fever) Europe would probably be able to contain an outbreak fairly rapidly.

[Ziggy Stardust]

Based on the 1967 Marburg outbreak in Germany (Marburg being a related virus that also causes hemorrhagic fever) Europe would probably be able to contain an outbreak fairly rapidly.

I'd posit that Ebola spreading to Germany would be more easily controlled than the Marburg outbreak, even ignoring medical technology advancements. Marburg virus was essentially unknown to science until that outbreak (and a concurrent one somewhere in Eastern Europe, forget where). Hell, that's why it's CALLED Marburg, after the city in Germany. Even today, far more is known about Ebola than Marburg. At least with Ebola, we have some level of awareness and understanding of what to do about it. Not that it helps the poor people in Africa that don't have access to a lot of that understanding (and the practices/treatments that go along with it).

[Broomstick]

There are no specific treatments for Ebola, only what is known as "supportive" treatment. A lot of that is IV fluids to keep the ill person hydrated. The problem for Africa is not lack of elaborate infrastructure or fancy pharmaceuticals, it's lack of what is considered basic medical supplies in the first world. As usual, the problem is funding and transport.

[Grumman]

As usual, the problem is funding and transport.

...and idiots playing the role of "Zombie Infectee".

[PainRack]

There have been around half a dozen Ebola cases outside Africa - in the US and Philippines. Zero deaths.

http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks

So yes, it will probably be nasty but manageable in Europe or anywhere with highly educated populations and good medical care.

It should be pointed out that Taiwan, Hong Kong, Singapore and Malaysia were decently educated but that did not stop mass hysteria from setting in during the initial phase of the SARS outbreak.

....... Define mass hysteria........


If anything, response to some of it was retarded, with people breaking quarantine....

[PainRack]

Well, the real key in my opinion is to teach people not what to think but how to think. What are the proper ways to respond to a crisis? What tools are appropriate? Is doing research better than listening to a random friend you met in the marketplace?

To me that's part of education... but it's not part of any school curriculum I know of. I wish there were a series of classes all humans had to take on how to perform basic logic, on the structure of what a valid thought looks like regardless of its content.

Would that fix everything? No, but it'd help.

Define 'research'.
Research can mean picking up lousy information.
Like it or not, one of humanity traits is picking up information from the social mileu and authority figures, a characteristic that explains our social policies and evolutionary past. Its just that it can just as easily backfire in the modern age.

[Simon_Jester]

Well, my basic point is that teaching people to think critically and seek out appropriate cues from the social milieu and authority figures would help a lot with a lot of problems. Teaching them to screen out the inappropriate cues* would also help.

The tendency to seek out (and believe) information that one gets from taking inappropriate cues is a big part of the stance-that-is-ignorance. It's a big part of the reason ignorance becomes an entrenched thing, rather than a thing that evaporates when exposed to new information.

*The classic argument goes "If all your friends were jumping off a bridge, would you jump with them?"

[Broomstick]

Two infected American medical workers are being brought to the US. This is not without some controversy. The will be transported by private plane in isolation "pods" developed by the CDC and kept in isolation until recovered (or dead).