This is no longer true. We have no idea how many people are infected anymore because Liberia has too many patients to even keep track. They're literally thousands of beds short and it's actively doubling.
The CDC estimate is 100k-1.4m by the end of the year.
> * The vector of transmission is fluid exchange, so that reduces its ability to spread.
To some degree. It's still highly contagious, especially since it happens to cause people to tend to eject all kinds of different fluids. This is the largest spread of a BSL4 virus in history. It isn't casual.
> The chances of contracting the disease in AFRICA is fairly improbable too.
In places where it's not spreading, absolutely. In Monrovia or Freetown, there's actually a real risk and it's growing worse daily.
That's the scary part. This isn't even about what the risk is right now, though it's terrifying in comparison to where it was a month or two ago. It's about what happens two months from now.
The situation is bad now and rapidly deteriorating.
No no, you see, the world has seven billion people, so 100k-1.4m is still a tiny portion and therefore it's all sensationalism!
/s
The fact of the matter is that the current ebola outbreak is a disaster of epic proportions. Whether it becomes a pandemic is irrelevant: it's already devastating several countries in Africa and is likely to move to other underdeveloped nations if not kept in check. Can you imagine what would happen if it started spreading in India?
1) Scenario : some guy/girl lands in Florida, later that day goes for a swim in a big swimming pool with some 100+ people in it because it's a very hot day. Half of those people are on holiday and return to various places in the US before exhibiting symptoms.
2) Ebola is known for spreading fast in hospitals
3) Definitely diagnosing ebola takes several days
The problem with ebola (and all the MRSA variants, a number of which do spread through the air, and a few others) is that it can go from a few patients infected to turning hospitals into death traps in 2 weeks flat.
y' = y (1+p/100)^t
y = infected population % at time zero.
y' = infected population % at time t.
t = time in consistent units
p = percentage increase for one unit of time
So, if it takes a week for the infected population to increase by 1%, then:
http://i.imgur.com/TDPd7ug.png
IOW if after a week the infected population has increased by 1%, after a year (52 weeks) the infected population has increased by 67%. After 2 years (104 weeks) the infected population has increased to 281% of the original. And so forth.
This isn't true for car crashes, and the above is what is meant by an "exponential increase".
From the abstract of the report[0] you're citing. Essentially, it's rising exponentially (at smaller numbers) right now so of course if you extrapolate over long enough you're going to get a big scary number. The situation is bad, but we still haven't even engaged the outbreak with anything close to full force yet (a valid indictment on policy makers, not the situation). There's a difference between spreading caution and FUD, let's try and avoid the second.
[0] http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm?s_cid=... (cool read)
As you note, we still haven't even engaged the outbreak with anything close to full force yet. Until we see the effects of that engagement it makes complete sense to look at what is happening right now, not what countermeasures might or might not achieve.
We don't have a cure ... and won't have one in time to help (almost) anyone who's contaminated in this outbreak. There's really not much we can do except to contain the virus (if we can do that). I don't necessary want to be nuked from orbit, but if I were to contract this illness I'd also rather not linger towards an almost certain death.
I know it sounds a bit fatalistic, but why be an organ donor, draft a living will (etc) if you don't consider that one day you may perhaps die? And the truth is that most of us are unable to help the current situation in even the simplest way. Those of us who have a suitable belief system can only pray.
The WHO report as of Sept 24th estimates that Liberia alone is 1,550 short of what is needed for treating patients.
That was last week. What do you think it's going to look like in a month?
I think if you look at the numbers you'll see this massive scaling up the CDC is referencing isn't getting ahead of things, it's barely keeping up. The numbers are really quite bad and the CDC estimates shouldn't be taken lightly.
Basically the problem is with an epidemic that is growing exponentially, you have to scale your response exponentially just to keep your current rate of growth. To actually make it go down? You have to scale even faster.
And on top of that when the CDC (the experts in this shit) is trying to make projections, they are discounted as spreading FUD!
Is there a risk here? Yes, a small one.
I understand, but am frustrated by, the number of people who keep repeating "it's not airborne", as if this is some kind of definitive argument that a virus cannot spread here.
Something like 80% of cold/flu infections happen via "bodily fluids" -- people snot on a surface, someone else touches the surface, then touch their face, etc. This is an effective means of virus transmission. A virus doesn't need to be airborne for a pandemic to occur.
That said, we have a number of advantages over rural Africa in dealing with illnesses -- we have high standards of sanitation, good electricity, clean water, and our population is generally not afraid of physicians (with notable exceptions in some minority communities). But our biggest advantage, by far, is that Ebola isn't endemic here. Our best and most effective screen is "have you been to Africa recently?"
If that screen loses its effectiveness, you start to have to worry about every patient presenting with a fever and diarrhea, and the epidemiology becomes quite difficult. We're not really prepared for everyone with a fever and vomiting showing up at the emergency room...and it won't take many patients (a few thousand, say) for things to get tense.
Yes, a pandemic can occur even if the pathogen is not transmitted through there air - see HIV/AIDS.
Airborne and droplet spread make for fast spreading and hard to control epidemics. If something spreads through bodily fluids only, it's easier to do contact tracing and put the right measures in place. I think that's what people want to highlight if they say that Ebola is not airborne.
Actually, there was a study earlier this year[0] which showed, with better data and more rigorous treatement of the fluid dynamics, dropplets can travel much farther than previously thought. [1] has a summary of the research, in case the article is not available. But their basic conclusion is that, depending on the size, droplets can travel up to 200 times farther than previously thought, because they are carried along with the "cloud" associated with the sneeze.
[0] http://journals.cambridge.org/action/displayAbstract?fromPag...
[1] http://www.huffingtonpost.com/2014/04/09/sneeze-cloud_n_5110...
http://www.ncbi.nlm.nih.gov/pubmed/205151
In that study, 11 of 15 hand-contact exposures to a rhinovirus led to infection, which is not 80%, but it's within the margin of error. Notably, it was almost as good as large-particle aerosol exposure at spreading the virus.
But yes, the important point is that you don't need an airborne virus for a pandemic. Every virus is different, but there's this public fixation on "airborne" transmission that is a bit of a red herring. Ebola is doing just fine without it.
Considering that there are still regular flights from African countries to the US, that would be a large number of people.
Maybe that screen should be applied only if you have developed a symptom like a high fever...?
So at the moment, this "screen" is an easy way to rule out Ebola in a patient with potentially Ebola-like symptoms. Obviously we wouldn't expect everyone who has recently been to Africa has Ebola. I didn't downvote you, but I expect this is the reason why you're getting downvotes, not a misunderstanding about your question.
It’s still a disaster in the affected countries, with many knock-on effects. Also, it would have been better to spend more money earlier to prevent unnecessary deaths.
This Ebola epidemic is actually something people hardly care about. Hardly anyone is donating, for example.
Help is needed. Actually. For real. And with better support and a better reaction this could have turned out better.
Also, there may have been unique complications that make fighting the spread harder, though we don’t really know how widespread those are and were. They make for good stories, but are they the whole picture? I very much doubt that.
Additionally, it seems to me that even if those troubles were widespread it was possible to a) do something against them with more money (mostly in terms of improving communication about the virus) and b) make up for other deficiencies in resources (like a lack of space and beds and personal).
http://www.npr.org/blogs/money/2014/09/26/351515481/episode-...
The tl;dr is that people donate a lot more when they can tangibly understand that a disaster has happened and they make an emotional connection to the disaster (e.g. 9/11, Haitian Earthquake, etc).
When donors are asked to contribute money to prevent something, the emotional connection is a lot harder to make and funds are a lot harder to raise.
I don't mean to be callous, but compare that number to the number of total deaths to Malaria or even the flu, and that number pales in comparison. I am not callous to say that we shouldn't care about the Ebola outbreak, but if you look at the numbers, directing that money to buy more mosquito nets or Malaria vaccines will likely save more lives.
Malaria kills close to a million people a year. If you're looking for a cause for donation, the most value per dollar could be directed there.
The issue with Ebola isn't how many people it's killed so far (although the number is already tragic), but the number of deaths it can potentially cause. If left entirely unchecked at this point, it would kill over a million people in the next year. A half assed response limits it to hundreds of thousands, while a solid response limits it to tens of thousands (conceptually, numbers pulled out of ass but reasonable, I'd argue).
Outbreaks grow exponentially unless contained; the point of fast action is to prevent or curtail the exponential growth.
Of course, we should not fall into panic. Many factors will affect what ends up being the total effect of this outbreak in the mid to long term. But dismissing it as a non issue because "there are just a few thousand cases" misses the point completely.
According to Wikipedia, the total population of the 3 most affected countries - Liberia, Guinea and Sierra Leone - is roughly 20 millions. So there is at least that upper bound.
The real risk of pandemia comes from the fact that as the number of cases grows, the more likely it is that some of those cases travel through a porous border into other countries which lack the infrastructure and professional discipline to contain new outbreaks. If/when that is the case, each new region will start its own sigmoidal worth.
Regarding your original question... if you can identify individual regions where the model can be applied, maybe you could use Markov chains to model the transitions between states in each region. I am not qualified enough to do that, but I imagine that the result would be a few endemic nodes where the disease is always present (with different degrees of intensity over time) and from where outbreaks get sporadically "exported" to disease free nodes.
And note the WHO already did bend the curve down once before, back when there were only a couple hundred cases, and then they lost control again. Not confidence-inspiring.
More than 3,000 people dead, potentially more, and many of the affected places don’t have enough resources to deal with it in a satisfactory manner. That’s the situation here. This could have been controlled better, probably.
They raised over £1m in a few days.
> The blaze, which was tackled by more than 30 firefighters, killed about 60 animals.
> Within 24 hours, more than £1m pounds had been raised to help around 150 surviving dogs.
This happened while Ebola was happening.
What? It might not be surprising, but how is it not depressing?
It might be beneficial to provide a link to where people could/should donate.
Their US donation page is here: https://donate.doctorswithoutborders.org/onetime.cfm
Folks in other countries can find their local donation pages here: http://www.msf.org/donate
EDIT - To give you a sense of how involved MSF has been in the Ebola response: "Since March 2014, 14 MSF staff members have become ill, among whom 8 have sadly passed away." (Source: http://www.msf.org/article/ebola-workers-risk-tragic-reality...)
There's a comprehensive rundown of their efforts to date to help contain Ebola across West Africa here: http://www.msf.org/article/ebola-crisis-update-sept-25th
If you only care whether the disease is going to hit at home, or (even worse) only if it hits a "western country", then yeah.
Hundreds of thousands are dying, and it could hit millions.
I'm pretty certain it won't hit that bad "at home", maybe a few isolated cases, we have the infrastructure(s) to contain it adequately.
Not in Africa though. As you may recall, Africa is really really big (depending on map projection). May not literally count as a "pandemic", but this is a disaster of incredible proportions.
... and then there's people suggesting, only half-joking, to "nuke it from orbit". Would they suggest that if it was a "western country"?
It's fine to worry if you may get the disease yourself, personally. The answer is "no / highly improbable". But just because its wreaking havoc mainly in non-western countries, doesn't mean news about the terribleness and spread of this epidemic, that is going on right now (also it's not just some flu, it makes one bleed from their internal organs o_O), doesn't mean it's "hype" or "sensationalism". This is actual human drama and suffering at a massive scale. And it's probably going to get worse before it gets better.
3000 have died so far. 6500 have been infected. It certainly could grow much bigger, but it hasn't yet.
There are roughly three reasons this outbreak became so big: different location (West vs. Central Africa), it took a while for the differential diagnosis (the much less deadly Lasa Fever is endemic in the area, but doesn't cause hiccups), and when the foreigners arrived in force, the locals hid. The WHO et. al. actually thought it was under control, before it couldn't be hid anymore.
Educated guesses would put actual fatalities in the 10s of thousands; 100s is possible, but I don't get the impression it's quite there yet. But with exponential growth, 1 case infecting an average of 3 others by one estimate, there's no way it isn't going to get that bad in West Africa.
tl;dr: Blood samples were taken in villages, laboratory confirmed, but none of these deaths were counted unless the patient actually made it to a treatment center. Much needs revision, which is not a priority right now.
Doesn't take away from my main point, really, but apologies for the untrue and unnecessary hyperbole :)
The truth is also that we know fairly little about Ebola. It's fairly recent that we've known any animal vectors for it. It is very effective at killing but until now it has been very isolated. We know it requires fluid exchange but that's a somewhat vague concept to many, is a sneeze in an office a fluid exchange? I mean, that's good enough for flu... I'm not sure that it's known how bats (a vector) exchange or transmit it. Just a lot of unknowns, the idea that the North American bat population could start carrying it is a little scary.
We will stop it but it got a lot closer to home and if a dozen other contract it from this case, I'd say the sensationalism and paranoia are warranted.
I have long believed that some kind of bacteria or virus is going to take out all or a huge chunk of humanity at one point or another. Evolution is a heartless SOB. We could very well be one or two random mutations away from losing half the planet's human population. And, BTW, the mutations in question don't have to attack us. Imagine losing half the worldwide crops, cattle or fish.
Don't get me wrong, I don't lose any sleep over this and don't have a garage full of gas masks and HAZMAT materials. When/if it happens that stuff is likely to be absolutely useless.
I wonder if that's what might finally make the religious "get it". You go ahead and pray to your powerless imaginary intelligent creator. I'll choose science thank you.
You also missed my point about taking a scientific approach to something like ebola. Gas masks are utterly irrelevant and pointeless. We know how the virus is spread and we know that if caught reasonably early it is easy to kill. Even if your entire neighborhood consists of people with ebola you and your children are safe as long as you don't swap bodily fluids. I don't know about you, I can't remember the last time I swapped bodily fluids with my neighbors. So, yeah, others can pray --which is utter nonsense-- I'll stick with scientific knowlege --which is not.
Here's the difference with science: If tomorrow someone offered true evidence that ebola is now airborne and prayer kills it, I could not imagine a single scientist who, when presented with the evidence, would not accept these findings to have a high degree of probability of being true.
This is so ridiculous I had to separate it just to say:
ARE YOU FUCKING KIDDING! SURELY YOU MUST BE BECAUSE NO INTELLIGENT EDUCATED PERSON COULD POSSIBLY HOLD THIS RIDICULOUS BELIEF.
The fact that we have people on this planet in 2014 who can actually believe something like this is the root of many of our problems.
You are equating praying to medical treatement. That is utter nonsense on the face of it, regardless of whether or not an established and effective treatement course exists for an ailment. I'm sorry, it's just plain stupid. Would you pray to Thor, Apollo, the Tooth Fairy, Zeus? Why not? So, pray tell, why does your brain magically stop working when your favorite god is invoked?
I think the media has desensitized many people to the point where they can't recognize a significant and potential danger.
The CDC just issued instructions for U.S. funeral homes.
Further, this is a disease with a 50% mortality rate, and no verified treatment other than palliative care (even ZMAPP, the supposed magic bullet, did not save at least two patients who were treated).
I think we have good reason to be concerned.
It only looks like 50% at first glance because people are catching the disease so quickly that the number of deaths hasn't had time to catch up.
The CDC and other NGOs are trying to hype up its effects because people, and you are not in the minority, don't think it's a real problem. I know people who think it's corrupt African countries trying to get more aid money.
* 1 gets you 2, 2 gets you 4, 4 gets you 8, and 10 gets you 100. Exponential growth here. See, math is fun.
* How many times have you touched your face today? What else have you touched while outside. Victims don't have to physically bleed all over you. But imagine if just 1 infected person took the NY Subway.
* They become symptomatic and then what? Most people, when starting to feel sick, go to the supermarket and stock up on juice and vitamins. Possibly passing it along to coworkers, friends, and family. Only when they have overwhelming evidence that something is wrong do they head to the hospital. Meanwhile, the entire time, the virus is shedding.
[1] http://www.npr.org/blogs/money/2014/09/26/351515481/episode-...
That said, if there are rare issues where sensationalism might be justified, this might be one. This is one of those areas where preventative aid funding is incredibly hard to muster, even though money spent in containing the outbreak now could have an oversized impact.
More at Radiolab on this: http://www.npr.org/blogs/money/2014/09/26/351515481/episode-...
Famines are similar, apparently aid workers all know they're coming, but just no one cares enough to donate until it's far too late to prevent.
Elsewhere in this discussion, someone quotes a CDC estimate that by the end of the year the number of ebola cases could reach 100k to 1.4 million. Taking the lower end of the range, that's 100k new cases in 3 months, so the number of cases grows by a factor greater than 10 in 3 months.
This has the potential to make malaria look like a walk in the park.
Source: CDC.gov
Based on what, really ? It may be exponential in some area but not in another with different climate conditions and genetic pool. We have NO IDEA at this stage.
Malaria and ebola can't be compared, malaria and cars can. Malaria and ebola are transmitted in very different way. You get malaria if you live in areas where some species of mosquitos carry the malaria plasmodium. This means that it doesn't get you if you don't enter one of those areas. You can't get malaria in NYC. You can be hit by a car there because cars are definitely endemic in NYC as they are in most of the world.
I'm worried by malaria. I don't like the side effects of it prophylaxis and I don't want to risk getting sick (the prophylaxis are not completely effective) so I don't travel in areas where it's endemic. I sincerely hope we can make a vaccine against it.
I'm also worried by cars as anybody else and I take the usual measures (watch left and right before crossing a street, drive carefully) but there are few places to hide, right?
I'm much more worried by ebola because if it gets big enough there will be little we can do to stop it: it's going to overcome quarantines and get to us in our cities across the oceans and it kills with 50% efficiency. If we want to think about something that could send the human population back to 3 billion in a few years we shouldn't look at malaria or cars, but at ebola. That's why also to me this is "a far more dangerous pathogen." Let's concentrate on ebola now, we'll get back to malaria when we'll have fixed it.
https://en.wikipedia.org/wiki/Biosafety_level
So its "literally more dangerous".
Do you think it is worth considering whether a better response was and maybe still is possible to end this quickly (and be better prepared in the future)?
Malaria is a huge disaster. The Ebola epidemic is, too, in the affected countries. (I couldn’t care less about scared idiots in Europe and the US.) Both are.
But it's a bit strange to see all this American media FUD after years and years of not a word about all the destruction caused by malaria (apart from that Bill Gates project), no?
That's why this news is significant.
Well, besides media sensenationalism, the idea is that we should be fearful of a possible pandemic BEFORE it becomes a pandemic, and that that's how we take the measures and care we need to contain it. (Being fearful of something like that AFTER it becomes a pandemic goes without saying).
That said, in Nigeria there were abour 3,000 deaths and 6,000 cases. I wouldn't call that "fairly small". Plus stuff like that have a way of skyrocketing if they pass a certain threshold.
In Nigeria at least, they had very good reasons to be fearful, and with modern travel, a few stray travellers could have wiped out similar numbers in other places, or even more.
Let's take a lot at what we can agree on:
* The number of cases of infected patients is fairly small.
* The vector of transmission is fluid exchange, so that reduces its ability to spread.
* The virus doesn't appear to lie dormant, and is only contagious when the patient becomes symptomatic.
The chances of contracting the disease in a western country so far is near 0. The chances of contracting the disease in AFRICA is fairly improbable too.
It really sounds like sensationalism at its finest.