Not stopping this outbreak with all the resources we have is running a massive natural experiment in how well adapted Ebola can become for efficient human-to-human transmission. As a zoonotic virus Ebola in its wild state is very unlikely to be optimised for human-to-human transmission. Every new case is increasing the chance that a new strain will arise that will be efficiently transmitted between people. I am not too keen to see how well adapted Ebola can become to humans.
My total layman's impression of this has been that it doesn't matter if the virus mutates to something "worse" -- that, short of some currently politically impossible action several orders of magnitude beyond what is currently being done, there is no really solid, non-magical-thinking, reason to believe this outbreak won't kill tens/hundreds of millions of people and threaten world civilization as we know it, even with the virus as it currently is.
The way the narrative has shifted in the past week has done a really good job of discrediting any routes to denial I'd previously had.
I would love to hear some credibly informed people disabuse me of this notion, in some way beyond calling my impressions those of an ignorant, panicky fool.
While I am firmly on the side that believes that Ebola is very serious and we need to do everything we can to stop it [1], it is possible the R0 could drop below 1 via changes in behaviour of the people in west Africa. Since we really have a poor idea of what factors are driving the spread of Ebola, it is possible that these factors could change spontaneously. For example, people might get so scared of Ebola in the affected countries that people just stop caring for the sick and throw them out on the street to die. This might be enough to get the R0 below 1 and the disease will burns itself out.
The problem is hoping for a spontaneous change in behaviour that gets the R0 below 1 is like have a small fire that has started in the corner of your living room. Sure the fire might go out on its own, but is wise to sit there doing nothing just because it might go out?
"For example, people might get so scared of Ebola in the affected countries ... and throw them out on the street to die."
That might make it worse. In Africa, the distance between the gutter and the water supply isn't very far nor clearly defined (bad water causes a lot of deaths in Africa already). And given that the Ebola virus causes people to literately leak, dropping them in the street may containment local water supplies. Plus, the Ebola virus can probably survive in wet but dead tissue a lot longer than in the open area. So each one of these bodies would become a mini bio hazard, until the tissue decays to the point that the virus dies.
Of course. I was just trying to give a concrete example of a change that might cause the R0 to drop below 1. It would be great if the R0 did drop below 1 on its own, but planning on this is not any wiser than hoping the small fire in the corner will go out on its own.
In your piece, you advocate a military response. What do you want militaries to do to combat this problem? I'm terrified of this becoming a shooting war in which people suffering such horrible misery also become victims of violence intended to keep them "away."
I don't want tens of thousands in west Africa to die of ebola, but I certain don't want them to die lonely, thirsty, and ducking for cover. :-(
It seems like the most important tactic for reducing the R0 to <1 is building isolation treatment centers, yes?
I should write a follow up piece explaining why a military response, but the basic reasons are:
1. The scale of the problem is too large (both geographically and in the numbers of people affected) for any organisation (or group of organisations) other than the military to handle. Even if we moved to immediate mobilisation today it would still take months to get up and running on the ground by which time the problem will be vastly bigger.
2. We need to enforce a effective quarantine in the area and provide protection for the health care personnel. Only the military has the ability to do this.
3. I think we will have problems recruiting enough volunteer medical staff and may need to conscript them to get them to go.
4. Only full-scale mobilisation will stop the political games. Only if this problem is treated as war will we be able to get effective action out of the bickering political parties.
The military is quite good at operations 'other than war'. I was a minor cog in one effort, in 1991: Joint Task Force Sea Angel.
Details are searchable, but the upshot is that NGOs (I no longer recall if the term was used then) provided far more disaster relief assets and supplies, than the military did.
What the Marines brought to the party was command and control, and the ability to field, and support, a thousand guys in only days for delivering food, water, and medical aid.
And also, one shouldn't underestimate the ability of a brigade of disciplined troops to control masses of infected people. If they're told 'don't shoot' then they won't shoot.
Honestly I have been disappointed by how effective they have been. I would expect the Army to be able to build field hospitals faster than this. There have been a lot of setbacks, detailed in a recent NYTimes article: http://www.nytimes.com/2014/10/03/us/us-effort-in-liberia-ba...
" the local contractor announced that the crusher’s engine, needed to smash rocks, had broken" and "Hauling parts and equipment from the United States and Europe takes time, and then there are negotiations with local contractors for heavy equipment."
That's crazy. The Seebees and other military engineers have rock crushers, and construction equipment. They know how to break that stuff down and put it on airplanes. The Air Force is used to transporting that stuff.
Now, I was only a stupid jarhead, and there may be issues not called out in the article, but I'd expect a week, tops, could get engineers on site, working, with their own equipment.
replying to you since i can't reply to the child reply i wanted to address.
If they deployed the SeaBees this wouldn't be happening. The key word is 'contractor', by using companies to avoid the political taint of 'getting involved where they aren't wanted' or being accused of 'wasting money' we send the proverbial 'lowest bidder' instead of the trained experts. Sad but true.
I am bouncing back and forth between the positions you describe. At the end of the day, though, if the "R-naught" is less than 2 in uncontrolled situations, and something like 1 in a hospital, it seems like it can be reduced to <1 pretty easily.
As I understand it, the most dangerous type of "worse" is ebola becoming less deadly.
Very few articles about airborne mutation seem to bring up that ebola is an RNA-based virus, which means that it mutates at a faster rate and is less genetically stable than DNA-based viruses, bacteria, or most other pathogens. I wrote an explanation about the significance of RNA here: http://www.thinkhardly.com/think-hardly/ebola-for-entreprene...
There's already limited evidence that some transmission is occurring via atomized saliva/mucous. A truly airbone variant could cause a "get in your bunker and ride it out" kind of event.
Yes Ebola can be transmitted that way, but it is an unlikely route. The way Ebola is constructed it is very unlikely to become airborne [1], but it could increase in natural reproductive efficiency (R0). We really have no idea of the R0 for Ebola right now as we don’t have the people on the ground recording what is happening in the community.
Ebola does not have to become airborne for it to be a problem. Polio is not airborne and it has a very high R0 (5 − 7). The difference is polio is adapted for human-to-human transmission while Ebola is very unlikely to be. I don’t want to find out how well adapted Ebola can become.
[1] Something that I have noticed about the discussion here is many people are unclear about what it mean for a virus to be “airborne” (this is not surprising since most people are not virologists). What airborne mean is that the virus is adapted to spreading via small mucosal droplets. The classic virus for this is rhinovirus (the most common cold virus). Rhinovirus infects the mucosal cells of the upper respiratory tract, it causes you to produce lots of mucus, it makes you sneeze a lot releasing this mucus in small droplets into the air, the virus is hardy enough to survive in the small mucosal droplets, and it doesn’t make you that ill so you still go to work where you can spread it around your co-workers. Doing all the things required the evolution of many interlocking adaptations in the Rhinovirus genome.
Ebola's infection mechanism is nothing like Rhinovirus. While in theory it is possible that Ebola could acquire all the adaptions required to be spread efficiently by small mucosal droplets, it is really unlikely as there are so many changes required. This is why most experts think it is unlikely that Ebola will become “airborne”.
Spreading fear is a hobby for some people. Every single story on Ebola seems to be taken over by people who are:
a) ignorant of virology
b) enamoured of a multiply-debunked case "they've heard" that "might have" involved "airborne" transmission despite the massive unlikeliness of that
c) deeply, deeply fearful about the "possibility of Ebola becoming airborne"
and
d) have never once anywhere posted anything wittering fearfully about influenza becoming a deadly pandemic, which is so many orders of magnitude more likely it isn't funny.
The degree of cognitive failure exhibited by these fearful posters is saddening. There is no obvious reason for them posting their fears and disinformation.
I am far less concerned about fear being spread than ignorant “solutions” being spread. Things like proposing that closing the borders to people from west Africa will solve everything, that it is somehow's gods way of dealing with “overcrowding” and Ebola will only happen to “those people", etc. There is a real risk that we in the west will go into isolation mode and not do anything.
Some health workers have been infected even though they were equipped with significant protection.
Clearly infection rates in unprotected populations would be non-trivial, even without the kind of mutation that would make Ebola as infectious as a rhinovirus.
Given that many public spaces in Western cities are more densely populated than equivalent spaces in Africa, and there are much greater numbers passing through them, I'm genuinely concerned this has the potential to blow up in a vey bad way.
I'm not heading for the hills yet, but if case numbers begin increasing I'm going to consider it seriously.
I'm not a doctor or epidemiologist, but I think, as a matter of common sense, that there's a distinction between being an "airborne contagion" and being merely transmissible through saliva. We know that Ebola can be transmitted through saliva, but it does not cause any symptoms that would tend to aerosolize that saliva (coughing or sneezing).
This would mean that you're not at all likely to get Ebola if you just happen to stand near an infected person, but we will still occasionally hear of people who seem to have been infected "through the air." These, one would think, would tend to be healthcare workers since they see patients at their sickest and may be performing procedures (e.g. intubation) that aerosolize saliva.
The linked article is making a nuanced claim in general about aerosol transmission in general, not a specific change in the structure of the Ebola virus.
Wasn't there strong circumstantial evidence that the Ebola Reston strain was spreading without any bodily contact? It was discovered in lab monkeys in Virgina and spread from room to room of monkeys without any direct contact between the monkeys. It's possible caretakers were spreading it, but it seemed more likely that the strain had gone airborne.
As others have pointed out, Ebola lacks a large number of important features that rhinoviruses, for example, have. It is possible given sufficient time Ebola will mutate in ways that generate those features. It is also possible, given sufficient time, Ebola will mutate into flesh-eating flying monkeys (admittedly, this is marginally less likely than becoming airborne.)
Viruses--parasite and pathogens generally-are incredibly narrowly adapted to their preferred mode of attack. They have to be, because the chinks in the host's immune system are almost by definition incredibly narrow. If they weren't the host species would not have survived.
This gives pathogens and parasites very little room to maneuver. They can't just arbitrarily bolt on new capabilities. They have relatively little genetic material to work with: 19 kilobases in the case of Ebola, which is less than the coding length of the majority of human genes (which can run comfortably into the hundreds of kilobases).
So think of Ebola like an evil eight-bit micro-controller. It's only got 256 bytes to work with. It has been carefully programmed with a tiny attack program that depends on a very specific weakness in the target system that requires it be plugged into a USB port controlled by a particular chipset rev from a particular manufacturer. The claim "it might go airborne" is equivalent to the claim that such a chip, under millions of random mutations, might be able to infect systems via network ports while remaining the same in every other respect.
This is not (provably) impossible, but it is of such low probability that I'm pretty sure anyone concerned about it should be in a state of panic regarding cows, coconuts, coronal mass ejections, and other far-more-probable causes of death if they want to make any claims to intellectual consistency.
People here are so inclined toward numbers that I fear people are latching basic reproduction rate (R0) without proper context. The transmissibility of a disease is not some kind of invariant property of the pathogen.
It's not meaningful to talk about the R0 of Ebola in any kind of historic sense. Jungle/rural outbreaks are going completely different from urban ones, and this is a very different outbreak than previous ones. Very simply, if you have a 100% transmissible disease and are in a sealed room with 0 people until the pathogen is gone, your R0 is zero. If you're in a room with 100 people, it's 100.
I guess I'm saying that I'd love a reliable citation for your claim. Changes in R0 aren't necessarily evidence of that, and those claims (especially airborne transmission) is just needlessly and baselessly worrying people.
Usually the progression of most diseases is toward easier transmission but lower mortality rates. Viruses that kill their hosts have a hard time becoming endemic.
My prediction for Ebola is that it eventually becomes like norovirus (stomach flu): a common gastrointestinal ailment that is painful and inconvenient, but seldom lethal, and spreads easily through contaminated surfaces.
Firstly, this might happen over millions of years, but this is unlikely to occur anytime in the short term. Many viruses that have been in the human population for a long time have quite high death rates in immune naive populations (think of small pox as an example).
Secondly, the mechanism of transmission of Ebola is quite closely tied to the cause of death. To be transmitted it needs to turn you into a massive viral factory and then make you very “leaky” so the virus gets spilled out into the environment. Any mutations that decrease mortality are also likely to decrease the infectiousness of Ebola
Thirdly, Ebola is starting off from a very high death rate. Even if there was a major decrease in the mortality rate (say it only kill 5% instead of 50 to 75% people), it would still be a huge problem.
"The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy.[3] From this centre, the disease swept across Europe. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today."
It doesn't take millions of years for diseases to adapt.
Of course is doesn’t always take millions of years, but it can take millions of years and it is not something you should expect will happen quickly. Even in the case of syphilis it still took 50 years. The evolution of syphilis (to a slower disease course) is exactly what we should be most worried about happening with Ebola as it will then be more effectively spread - just because syphilis is not as quickly lethal as it once was it is not something that you want to catch and leave untreated.
