It's just a question of time before it reaches the US. We were lucky with Dallas. It likely will escape the next time into the general population since many people without health insurance are unlikely seek medical care in time and when they do at the last minute, it will spread.
Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic.
In Congo Kinshasa, it's just the chaos politically, there is no real government in many parts of this country, the real danger is that it is not a small country at all, 80+ millions of inhabitants, many can't be reach by the WHO because of the wars and infighting between the "government" and militias. So the crisis there has great chances of getting worse, not better.
Furthermore, many many many people locals despise foreigners and particularly white people, for historical reasons, or just ignorance, and the culture is extremely unsanitary (touching and living with the dead, consuming bush meat or worse, ritualistic cannibalism, and what not), some straight out think Ebola is a white conspiracy.
This isn't a problem only money can solve this time.
>Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic.
I would be careful of the use of the word 'civilized' in this context. You're implying DRC and/or other African countries are uncivilized. Which is just not true.
> I would be careful of the use of the word 'civilized' in this context. You're implying DRC and/or other African countries are uncivilized. Which is just not true.
No, I stand by what I said and by the following definitions of the word "civilized", and never talked about "other African countries":
> easy to manage or control; well organized or ordered:
> having an advanced or humane culture, society, etc.
Given the tragedy that has been going on for more than half a century in that part of the world, I couldn't care less about euphemisms and political correctness, they have not solved anything.
The culture absolutely needs to evolve if locals want to survive Ebola, there is absolutely no way around it, I'm not a cultural relativist. It's a matter of life and death.
Seems the "advanced cultures" tend to send their so called "civilized" companies into these regions and they historically have acted very uncivilized (in many cases worse than the local bush-people with no formal education).
Wouldn't be suprising if ebola is being spread in Congo for the same reasons that HIV was spread by the apartheid South African government.
Natural resources make our so called "civilized" do some almost subhuman things (remember many of the beneficiaries are US companies/shareholders).
Even if that specific example is false, there is a rich and well sourced history of African Americans (and other marginalized groups) being used in medical experimentation in the US or by US organizations.
Edit - my family (Cameroonian) almost 100% believes Ebola was either created or intentionally released by either Europe or the US as part of research or guerrilla warfare. There are no facts involved but it's a very common belief for people that grow up in the region.
> easy to manage or control; well organized or ordered:
> having an advanced or humane culture, society, etc.
So the US meets these characteristics by your logic but DRC does not? Have you traveled much in rural/poor US? Have you been to puerto rico? Are those areas equally uncivilized? Would you characterize south chicago as uncivilized as well?
In anthropology (maybe specifically american anthropology), the descriptor 'civilized' was pretty much thrown out during their reformation (I think it was 1970s?). At best, today it's pretty much considered a coded term for 'not conforming to my view of what a society should look like'(aka it's ethnocentrically viewed as inferior). At worst, you can tie the usages of the descriptors 'barbaric' and 'civilized' back to the biological determinism and eugenics movements.
>Given the tragedy that has been going on for more than half a century in that part of the world, I couldn't care less about euphemisms and political correctness, they have not solved anything.
What tragedy? and which part of the world? DRC is not near Liberia or Guinea where the other more recent highly publicized Ebola outbreaks have been. Are you referring to the civil war in DRC? It's really complicated and at the end of the day has root causes that tie back to neocolonialism and colonialism constructs created by so-called civilized societies.
I'm not trying to be politically correct. I wasn't even being all that critical of your original statement. I was trying to point out that word choice matters. While most of what you wrote originally is valid, my family (which is Cameroonian) would not listen to anything you had to say because you used the term 'civilized.' It would immediately shut down discourse.
What is the politically appropriate word instead of civilized to enumerate the difference between taking a public health first approach vs. killing first responders on conspiracy?
I would call them suspicious instead of uncivilized.
Europeans have tested harmful drugs on Africans without their knowledge for more than 2 centuries (including injecting live cancer cells and spreading HIV in very recent cases).
I don't think we can blame them for avoiding this treatment like the plague.
I'm empathetic to the idea that for entirely uneducated populations differentiating between legitimate treatment and experimentation is impossible, so their instinct is to avoid it.
I'd still be wary of making too many excuses for their wanton attack and murder on health-care workers as mere suspicion, as that gives off an impression of racism of lower expectations, in my humble opinion. Or, I mean, even if it doesn't, at a certain point we need to draw the line at acceptable behavior. Whether it's their upbringing, or they are justifiably suspicions, they are evil, or they are uneducated, in the end it sort of doesn't matter, right? It's still some other group trying to kill other people, where we have a belief on which one is correct and which one isn't.
I get your point - my issue was with the long history of cultures being called 'civilized' or 'advanced'. These terms are still too commonly used and mostly out of ignorance of their origins.
Just to throw it out there - I don't live there, I'm not a citizen of their community - why does my values judgement matter? Why am I judging what is acceptable for them to do in their neighborhoods and communities?
I'm a white american, married into an Cameroonian family, spend my time 90-10 split between US and Cameroon. If Cameroon was having a crisis over 'X', I'd ask my family and our friends what they think should be done in their cities about 'X.' I might ask questions or offer critiques but at the end of the day, they are the only ones that understand their communities, can solve their problems and judge a situation. Similarly, if my city was having an issue, I might be curious what they thought or how they solved similar issues, but I wouldn't expect them to dictate solutions or make a values judgement on my community.
> Why am I judging what is acceptable for them to do in their neighborhoods and communities?
There is a nihilistic rabbit hole this can take you down. Values are suspended in air, only there because we want them to be. Why is it unacceptable for people in their own neighborhoods and communities to murder others in cold blood?
Is it all relative? Is that a choice a community can take, that is equally valid as all other choices? Or should there be a preferred community, which all humans should strive towards. A civilized platonic ideal.
I'm okay with taking the more chauvinistic view that our way of living is better. Not the best. But better. I'm willing to claim that they would be better too if they became more educated, learned to understand it's best to not kill people based on witchcraft. This does involve me thinking that I am more civilized and above them on a hierarchy of values. I'm okay with that. I think you should be too.
Okay, first off, who has said these medical workers are being murdered in cold blood due to the locals beliefs in witchcraft. All that this link referenced is suspicion, they didn't say suspicion of what.
This region of the African continent is one of the most exploited regions in the world. Some of the historical tension/mistrust can be tied back to the same hutu and tutsi divide that fed into the Rwandan genocide. I agree education is a key factor but I suspect the geopolitics is a bigger factor in the violence than beliefs in voodoo. They might be suspicious of the motivation of any outsider coming in and telling them what to do. Which is a natural response. If that's coupled with historical fear or traumatic memories of a past where outsiders came into communities and murdered community members, I could logically see some of these conflicts turning violent.
I do believe my overall quality of life might be better than theirs, but I don't believe that has anything to do with my values or my way of living. I also believe that quality of life is more due to structural factors - factors that are mostly out of control of the individual and their local community. So am I lucky to have lived my life in regions where the controlling interests have created favorable conditions? Yes, I am very lucky. Do I judge others who have not? No I try not to.
Unless you're talking about some unknown evolved version, in a first world country the risk of spreading to a large scale is pretty low. Ebola is not very contagious / risky for the first world as it stands now.
Could it be? Yes but you could argue for any number of diseases that "if it changed" would create devastating consequences.
Note that the death rate of Ebola in developed countries in "only" about 10%, and all of those have been people that were severely ill before seeking medical attention. Ebola's one of those diseases that responds well to modern hospital care: sanitation, isolation, and IV rehydration are very effective at keeping patients alive while the disease runs its course.
When looking at death rates, it's important to remember that most Ebola outbreaks have occurred in countries with pre-modern sanitation & medical systems. It's like saying that cholera, scarlet fever, and bubonic plague are deadly diseases: true, but significantly less true in the developed world.
The fact this is going to spread worldwide is inevitable. I honestly think we need to prevent people from this area of the world from coming to the US until they get this under control, this is simply unacceptable from a global standpoint.
> I honestly think we need to prevent people from this area of the world from coming to the US...
...this is simply unacceptable from a global standpoint.
I’m guessing you’re in the US? What about the rest of us?
I believe that in times of outbreak it’s often the case that many countries, not just US, try to contain the spread within their own country by disallowing entrance to people from the offending geography.
What’s that to say of the people that are in the midst of it? Harder to tell but prevailing policy sure indicates that countries are self-interested first and foremost.
This is a knife that cuts through political issues. If your society has become so political that it can't even imagine the thought of restricting travel to prevent global pandemic, well, if nothing else consider that after the pandemic rages through a country it is fairly likely that said country's survivors are going to take a very dim view of open borders for a long time. If nothing else, consider that this is the sort of thing that will destroy any willingness to have free travel in the world.
Similarly, no matter how free a country may be, there are rules about quarantines. You can be involuntarily subjected to one, and that's that. Your Constitutional rights or whatever your country may have are gone for the duration.
This goes below politics and below the blustery winds of the day all the way down to one of the foundational principles of society, which is, you won't have a forum to argue about how open borders should be in your society if you don't have a society at all because it got sick and died. Despite superficial similarities, this isn't about immigration debates or open borders or xenophobia or any of those hot-button issues. This is just, can you take basic, "lizard-hindbrain of society" actions to protect yourself or not?
I don't know that this particular outbreak is there or not, but it's only a matter of time before some outbreak of something is.
So the answer is, everyone should prevent people from potentially affected areas from coming in to the country for the duration of the outbreak. If you fail at this task, no amount of rhetoric, no amount of voting, and no amount of mocking your political opponents with various epithets about how phobic they are will do so much as save a single life from the resulting outbreak, because those are all category errors. Epidemics are not political matters. They are way further down the societal Maslow hierarchy than that.
Why then are you entirely focused on a political solution to a non-political matter? Closing borders is a political solution.
I disagree because your situation disrespects the progress that technical solutions have made over thousands of years of human progress. As medicine, hygiene and diagnostic tests improve, the probability of the dramatic epidemic event you propose falls closer to zero.
We detect and quarantine individuals who are at high risk of being infected, without shutting down borders worldwide. We use better hygiene and sanitation to reduce the transmission of disease. We can educate the public when a disease is a risk and people can take measures to reduce the likelihood of transmission. Researchers can find cures and effective treatments to reduce the threat even if the disease spreads.
For all your talk of reality and rationality, you don't mention any actual technical solutions in your grandstanding that this isn't about politics, instead contradicting yourself by basically focusing on a single political solution.
The solutions you refer to don't exist, or can not be meaningfully deployed. I cite as evidence the article itself. Ebola isn't even all that contagious, really, and if those solutions were the solution to the problem, this article wouldn't have had to be written. Not everywhere is a first-world country. Most places aren't first-world country. Heck, even in the first world countries not everywhere is necessary "first-world country" status.
Secondly, as I sort of alluded to in my mention of quarantine, it's not about "borders". National borders are a relatively convenient cutting point in our world, but anything can be quarantined; a house, a state, Manhattan, a particular valley, a cross-country region, an airport, a hospital, whatever it takes. It's not about politics. It's not about any of the characteristics of the people on either side of the quarantine boundary beyond "are they contagious or not". It's about whether you can take the necessary steps to stop the spread of a pandemic or not.
I'll say it again, if you're sitting there standing on your rights and technology when something comes tearing through, then if nothing else you're going to filter out of the population all the people who are willing to trust technology and insist on free travel regardless, both because of changing attitudes and because of who ends up trusting in the assurances that everything's fine and doesn't take adequate steps themselves. If you value the believe in free travel, and you want a society to have an effective belief in free travel, then you must paradoxically be willing to handle cases like this very carefully, because if you stand on a 100% dogmatic "I don't care what diseases they have, free travel is literally more important than everyone's lives" stance you will create a society that does not value free travel at all once a highly-preventable epidemic sweeps through.
> The solutions you refer to don't exist, or can not be meaningfully deployed. I cite as evidence the article itself. Ebola isn't even all that contagious, really, and if those solutions were the solution to the problem, this article wouldn't have had to be written.
Did we read the same article? This article is about the Democratic Republic of the Congo, a nation which does not have closed borders with the rest of the world, and Ebola has not spread beyond it's borders. The DRC does not have adequate medical infrastructure, sanitation or education and therefore the outbreak is occurring there.
Europe and the United States do have effective technology, medicine and disease control, so there is almost no risk of a widespread Ebola outbreak here.
> once a highly-preventable epidemic sweeps through.
Until you present a pathogen with this quality that cannot be controlled in the western world this is science fiction. You might as well argue that xenophobia and authoritarianism will prevail once sentient androids revolt. Until you have evidence the threat actually exists you're arguing based on ideology.
To be fair, there is a vaccine (still experimental), and the disease is spread via contact with bodily fluids. It sounds like one of the major issues is there is conflict which is preventing people from either trusting people trying to help them, or preveting the logicstics required for medical staff to reach them to help them. In the US, while there is a group of people who don't trust vaccines, most normal people would both trust, and have access.
But who knows, maybe ebola could solve our anti vax issue for a few more decades.
Ebolla spreads and is endemic in countries with very poor health systems and emergency response. It's a very virulent disease that can be stopped in it's tracks with standard disinfection and quarantine rules observed in any first world hospital.
There is absolutely no need for fear mongering and international travel restrictions, border checks and short quarantine for people coming from affected countries is suficient.
Ebola as it is now isn't a very risky disease in the first world. It's ability to spread is pretty limited considering first world sanitation and medical care.
I suspect every first world country could handle an outbreak on their own and eliminate the disease in their own country in short order.
Basic healthcare practices that any hospital could handle are enough to deal with ebola.
We see it spread in places where there isn't basic healthcare and chaos that limits the ability for health workers to deal with it.
The internet was supposed to create an educated society with information at your fingertips, instead we got fake news and echo chambers spreading extreme thinking
We have huge groups of actively ignorant people supporting the growth of climate change, anti-vaccination, and a host of other dangerous actions.
Now those fighting Ebola outbreaks are getting attacked.
I hope I’m wrong, but it looks like rationality is fast disappearing from this world. It’s only a matter of time before we destroy ourselves.
I realize this type of gloom and doom stuff has always been predicted throughout history, it just seems “this time is different” for real with the intersection of technology and ignorance reaching levels we’ve never seen.
It really sounds like you're reading too much news. News is fear mongering most of the time. Try taking a short break, you might be surprised how much better you feel!
But passively reading the news and feeling like crap aren't going to stop anything either.
It seems more would be done if local news, or even just having a conversation with a friend were the primary way of obtaining information.
I would venture a guess that you're more likely to pursue a cause if it directly affects your community or someone you know and love thinks it's important, than you are just by reading something on the internet.
Measles outbreaks and hate crimes are very rare events that mostly shouldn't be in one's mind (with obvious exceptions if you are working on some related field).
Actually, for the most part, they do go away. In both cases, if you live in the USA, your probability of encountering either is vanishingly small, so if you don't have the news pumping up and amplifying these incredibly rare events, you can trundle along blissfully and deal with the local problems that actually impact you.
I would really love to know if this phenomenon is limited to Britain/Canada/USA and the rest of the world wonders if we have collectively gone insane, or if each demographic region is experiencing similar paranoia.
Honestly, as I've grown older, the more I've come to realize that "rationality" is such an energy intensive skill to cultivate and its payoff so long-term that humans have always been like this and that what we witness in modern times is just a clearer picture of that fact due to the scale of our populations and speed of information transfer.
Rationality is energy intensive and difficult to cultivate and is usually a socially learned or reinforced skill (similar to the fact that long-term research is usually only funded by public tax dollars and not corporations).
So I don't think now is any different, it's just at a different scale and behooves those of us who have had the privilege to cultivate the skill to not gloom and doom and to instead show the way up the ladder (if possible, not all people want to cultivate rationality).
> The internet was supposed to create an educated society with information at your fingertips, instead we got fake news and echo chambers spreading extreme thinking
We're talking about Congo Kinshasa here, I mean, most of you here, who are not from the region have absolutely no idea about the state of that country. It's a mess.
Internet is the least of the locals worries, many of whom are on a daily survival mode because of the war, can't even read and are strongly influenced by all sort of superstitions.
I'm not sure what point you are trying to make. A lot of them living in remote places controlled by militias never had access to the internet at first place.
Rationality never existed. Humans are fundamentally irrational actors, and the 'news' has always been about tribalism and fear-mongering. You are unknowingly falling victim to the age-old condition called "going-to-hell-in-a-handbasket-ism," where once you reach a certain age and level of experience with the world, you realize the world isn't how you want it to be and never will be; you become disillusioned; and you begin telling people that "this generation/the world is going to hell in a handbasket."
Every generation does this. It doesn't mean that actually, the world is a fine place. It just means that your rose-colored glasses are coming off.
You're correct. There are some painful ways to right our course, but it's unlikely we'll implement them.
- Take money out of politics and media, completely.
- Responsible reproduction policies.
not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find).
> not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find).
AIDS does not evolve variants. HIV, which is a virus, can evolve.
But the jury is still out on what evolutionary processes are ongoing. Is the virus adapting to its new host and consequently evolving more slowly, or is it quickly developing increased transmissibility? It's not quite clear.
I'd argue that there's no way to know such a thing in the moment, and the reason for that is because you're observing a living thing learn and discover facts about the best way to survive.
It's an open ended scenario. The organism could learn a robust survival method that helps it survive more efficiently, without making it more lethal. It could learn nothing at all. It could learn to be less lethal but more transmissible. It could learn to spread to other organisms, or whatever opportunity proves advantageous.
It's possible we could notice pathways that represent doomsday hazards long before it would be possible for an organism to naturally evolve into a new version of itself. With that, we might focus on adaptations that never appear, yet cannot be ignored. Like watching for a robber that never robs us.
It's probably only worth worrying about robberies when it looks like we have a robber on our hands. And right now, we're observing an awfully effective robber in action, right now.
The best evolutionary path from virus point of view is to reduce lethality so the host can spread it longer. I thought I read that HIV did something similar and used to be more deadly - even without modern treatment.
Problem with Ebola is that its transmission among humans is via the same thing that kills humans.
It depends on the environment. Mortality of cholera is high (~ 60 % if untreated), but by spreading abundantly the bacterium finds a supply of new victims.
I seem to remember a study from ages ago where they compared strains of HIV from South Africa and Japan. Condom usage in South Africa is low, so the virus evolved to develop a high viral load quickly. In Japan the opposite was true, condom usage was high, the strains that caused the victim to die early became extinct.
That is part of what the UN troops are attempting to do, but it's an impossibly difficult task. There are far too few troops for the size of the area and population size they need to defend, and that's before you take into account issues like logistics, the unwillingness of some national contingents to deploy far from bases, etc.
To provide some context, just the eastern provinces of the DRC, where most of the violence is concentrated, have a population of more than 20 million people and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has just 15 000 troops. A figure which shrinks annually as a result of US-forced budget cuts.
Those budget cuts (which the Trump administration has loudly boasted about, FWIW) have also severely depleted the aviation budget, preventing MONUSCO from being able to deploy as many attack helicopters as its commanders say it needs to go after armed groups and reducing its ability to transport troops by air. This forces them to take long, slow journeys on the country's dilapidated road network, even in cases of urgent responses. During the rainy season it can take hours to travel a few kilometres despite having specialised vehicles.
Add to that the fact that government troops are often corrupt and local commanders can be in league with some of the rebel groups, and it's a pretty difficult mission at the best of times.
I am amazed at the bravery of the medical staff, health professionals and volunteers who are trying to contain Ebola in the DRC.
Not only are they potentially exposed to the deadly disease, they have to content with violent attacks from the population they're trying to help.
It sounds incredibly complex - a mix of political mistrust, lack of education and difficult terrain making containment difficult.
While spreading to populous areas would be a major concern, I imagine that nations blessed with more resources may be in a better position to quarantine, contain and prevent the spread of Ebola.
Extremely unlikely, that it's not even an edge-case. I dare say that anybody who has seen directly or indirectly the effects of Ebola, would be more than aware of the risks and if anything, be more inclined to over-react (look at how leprosy was treated socially historically or even AIDS).
that's gotta be one the most presumptuous questions on hn I've ever seen. DRC has been dealing with Ebola outbreaks since the 60s. How do you imagine that they would be unable to comprehend? the clear implication is that they're too dumb.
The weather in Goma, the capital of North-Kivu province, is going to be ~75F (24C) and ~80% humidity tomorrow.
Imagine having to wear all that protective gear in 80% humidity, limiting your visibility and hearing, limiting your bathroom habits and ability to rehydrate and eat, for hours at a time, in potentially hostile social situations, while dealing with a person or a corpse that you have a very good suspicion could infect and kill you with literal Ebola, a disease that will liquify you from the inside, every day, for months at a time, with no end in sight, and the virus seemingly 'winning.'
Could someone explain the graph used in the article where the y-axis is labeled as "cumulative" -- does this mean that each bin includes the sums from the previous bins? If so, then this will always be a non-decreasing graph. Ebola outbreaks are horrible, but it doesn't do any good to use stupid graphs like this to make it look worse than it is.
If they're using the same data source I am at work it's because that is what the ministry of health for the DRC is releasing daily. They don't track active cases but rather cumulative cases in a health zone.
My apologies. I meant to say that the WHO reports are generally more informative and better presented to me. Nature's article is good, but I find the WHO reports better.
It's interesting to note how we can have consensus on 2,000 individual cases being called a true crisis, but we still cannot agree ~76,000 monthly border crossing[1] is a true crisis.
Perhaps it's because Ebola is deadly and it's easy to remain ignorant of the humanitarian crisis plaguing many of those 76,000 monthly refugee/asylum seekers... both before and after crossing. Perhaps it's because we all fear catching Ebola from an airport or shopping mall, but none of us fear catching "run-for-your-life-itus", or have to wonder how we'll feed, clothe, and shelter ourselves in a brand new country where we don't speak the dominant language or understand the culture, but we know it's safer than where we came from?
Or perhaps it's simply because it's not a political punching bag issue? ... that's probably the real truth neither "side" wants to admit.
Ebola isn't going to run rampant through the US - we have a great medical system that wouldn't be trying to treat patients in a field in the middle of a war zone. We should lend all the support we can to DRC to help prevent the spread of this terrible virus - not out of fear of it spreading to our home nation, but out of compassion to the people of the DRC.
At the same time, we should really step back from our trenches and objectively examine our own domestic problems - not through the lenses of political ideology, but through the lens of a decent human being.
(ya, this is a throwaway... advocating we stop being political about our own domestic crisis is sure to attract a lot of negativity, unfortunately).
The major factor in this Ebola outbreak in DRC is the civil war, which is making it very difficult to effectively treat patients. Ebola is spread through bodily fluids, which are far easier to contain and isolate in a controlled environment than in a field temporary hospital or simply a family member helping care for someone they think is just sick.
We don't have these problems here in the US at the present time. Say what you will about the US medical system and insurance, etc... but it is still a very good system that can handle a wide variety of cases and isn't hobbled by armed-conflict/civil war.
> Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents.
To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.
The doctors and medical staff are mostly white, while the people they are treating are mostly black. To the ignorant, this would appear like an attempt at a genocide or recolonization.
For one thing, some of the burial practices and rituals in the region pose significant risks of communicating Ebola. And, when health workers recommend suspending those practices, those recommendations are not well-received.
U.S. Army Medical Research Institute for Infectious Diseases is doing the important testing work, but the novel drug is GS-5734 / Remdesivir from Gilead Sciences.
I'm curious to learn more about how well we can ramp up production and distribution of such drugs in the event of a fast-moving pandemic. With Ebola you have 1-2 weeks after symptoms before death is likely. You have a few more weeks after exposure, but you might not know you're exposed and I would assume the treatment needs time and can't save you at the last minute. If everyone around was clamoring for treatment, could you get your hands on it that fast?
Sorry, I don’t know much about large-scale production of that type of compound, it’s not my field. But, I would question the premise, in that Ebola is not a likely candidate for a fast-moving pandemic.
... well now I'm curious to what the likely candidates are :) This is one of those topics I could just sit and learn about all day, I think it's fascinating. If you or someone else in your research group were willing to do an AMA, I would thoroughly enjoy that.
The june 2 WHO bulletin about the outbreak, which I believe is the source data for the article. It contains more data including a graph of number of cases by date of illness onset, which I think gives a better idea of the progression of the epidemic :
https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...
Figure 1 on Page 3 is a good-ish overall representation of the situation. Ebola is sustaining itself. It hasn't gone geometric yet, but it could at nearly any time, if not already.
One important thing to note is that though it may seem that in the last 3 weeks the epidemic has been tapering off, that is an artifact of the reporting situation there. There is a significant lag in identification of deaths and causes. Feel free to look back over the other reports to see this reporting lag effects.
Another thing to note is that North-Kivu province is about the same size as West Virginia with about 2.5X the population. Goma, the capital there, has a population of about that of San Jose proper.
Combined with other sources that other HNers have linked, the Nature article is correct to sound the alarm here. The Ebola fighters are trying their best (despite the complicated social situations, weather, gear, humidity, and resource limitations), but Ebola is not quitting either. This situation is not something to wave away and is very deserving of international attention.
As always when an Ebola discussion happens, I want to recommend people interested in the origins of the disease read Richard Preston's 'The Hot Zone.' It details the history of the disease (as well as some related filoviruses, like Marburg), specifically following several doctors and researchers as they track outbreaks and treat victims.
It was turned into a 6-episode miniseries on National Geographic (just aired last week), but the book is 100% worth the read if you're interested in the topic.
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In Congo Kinshasa, it's just the chaos politically, there is no real government in many parts of this country, the real danger is that it is not a small country at all, 80+ millions of inhabitants, many can't be reach by the WHO because of the wars and infighting between the "government" and militias. So the crisis there has great chances of getting worse, not better.
Furthermore, many many many people locals despise foreigners and particularly white people, for historical reasons, or just ignorance, and the culture is extremely unsanitary (touching and living with the dead, consuming bush meat or worse, ritualistic cannibalism, and what not), some straight out think Ebola is a white conspiracy.
This isn't a problem only money can solve this time.
I would be careful of the use of the word 'civilized' in this context. You're implying DRC and/or other African countries are uncivilized. Which is just not true.
No, I stand by what I said and by the following definitions of the word "civilized", and never talked about "other African countries":
> easy to manage or control; well organized or ordered:
> having an advanced or humane culture, society, etc.
Given the tragedy that has been going on for more than half a century in that part of the world, I couldn't care less about euphemisms and political correctness, they have not solved anything.
The culture absolutely needs to evolve if locals want to survive Ebola, there is absolutely no way around it, I'm not a cultural relativist. It's a matter of life and death.
Wouldn't be suprising if ebola is being spread in Congo for the same reasons that HIV was spread by the apartheid South African government.
Natural resources make our so called "civilized" do some almost subhuman things (remember many of the beneficiaries are US companies/shareholders).
[citation needed]
Edit - my family (Cameroonian) almost 100% believes Ebola was either created or intentionally released by either Europe or the US as part of research or guerrilla warfare. There are no facts involved but it's a very common belief for people that grow up in the region.
So the US meets these characteristics by your logic but DRC does not? Have you traveled much in rural/poor US? Have you been to puerto rico? Are those areas equally uncivilized? Would you characterize south chicago as uncivilized as well?
In anthropology (maybe specifically american anthropology), the descriptor 'civilized' was pretty much thrown out during their reformation (I think it was 1970s?). At best, today it's pretty much considered a coded term for 'not conforming to my view of what a society should look like'(aka it's ethnocentrically viewed as inferior). At worst, you can tie the usages of the descriptors 'barbaric' and 'civilized' back to the biological determinism and eugenics movements.
>Given the tragedy that has been going on for more than half a century in that part of the world, I couldn't care less about euphemisms and political correctness, they have not solved anything.
What tragedy? and which part of the world? DRC is not near Liberia or Guinea where the other more recent highly publicized Ebola outbreaks have been. Are you referring to the civil war in DRC? It's really complicated and at the end of the day has root causes that tie back to neocolonialism and colonialism constructs created by so-called civilized societies.
I'm not trying to be politically correct. I wasn't even being all that critical of your original statement. I was trying to point out that word choice matters. While most of what you wrote originally is valid, my family (which is Cameroonian) would not listen to anything you had to say because you used the term 'civilized.' It would immediately shut down discourse.
Europeans have tested harmful drugs on Africans without their knowledge for more than 2 centuries (including injecting live cancer cells and spreading HIV in very recent cases).
I don't think we can blame them for avoiding this treatment like the plague.
I'd still be wary of making too many excuses for their wanton attack and murder on health-care workers as mere suspicion, as that gives off an impression of racism of lower expectations, in my humble opinion. Or, I mean, even if it doesn't, at a certain point we need to draw the line at acceptable behavior. Whether it's their upbringing, or they are justifiably suspicions, they are evil, or they are uneducated, in the end it sort of doesn't matter, right? It's still some other group trying to kill other people, where we have a belief on which one is correct and which one isn't.
Just to throw it out there - I don't live there, I'm not a citizen of their community - why does my values judgement matter? Why am I judging what is acceptable for them to do in their neighborhoods and communities?
I'm a white american, married into an Cameroonian family, spend my time 90-10 split between US and Cameroon. If Cameroon was having a crisis over 'X', I'd ask my family and our friends what they think should be done in their cities about 'X.' I might ask questions or offer critiques but at the end of the day, they are the only ones that understand their communities, can solve their problems and judge a situation. Similarly, if my city was having an issue, I might be curious what they thought or how they solved similar issues, but I wouldn't expect them to dictate solutions or make a values judgement on my community.
There is a nihilistic rabbit hole this can take you down. Values are suspended in air, only there because we want them to be. Why is it unacceptable for people in their own neighborhoods and communities to murder others in cold blood?
Is it all relative? Is that a choice a community can take, that is equally valid as all other choices? Or should there be a preferred community, which all humans should strive towards. A civilized platonic ideal.
I'm okay with taking the more chauvinistic view that our way of living is better. Not the best. But better. I'm willing to claim that they would be better too if they became more educated, learned to understand it's best to not kill people based on witchcraft. This does involve me thinking that I am more civilized and above them on a hierarchy of values. I'm okay with that. I think you should be too.
This region of the African continent is one of the most exploited regions in the world. Some of the historical tension/mistrust can be tied back to the same hutu and tutsi divide that fed into the Rwandan genocide. I agree education is a key factor but I suspect the geopolitics is a bigger factor in the violence than beliefs in voodoo. They might be suspicious of the motivation of any outsider coming in and telling them what to do. Which is a natural response. If that's coupled with historical fear or traumatic memories of a past where outsiders came into communities and murdered community members, I could logically see some of these conflicts turning violent.
I do believe my overall quality of life might be better than theirs, but I don't believe that has anything to do with my values or my way of living. I also believe that quality of life is more due to structural factors - factors that are mostly out of control of the individual and their local community. So am I lucky to have lived my life in regions where the controlling interests have created favorable conditions? Yes, I am very lucky. Do I judge others who have not? No I try not to.
Could it be? Yes but you could argue for any number of diseases that "if it changed" would create devastating consequences.
When looking at death rates, it's important to remember that most Ebola outbreaks have occurred in countries with pre-modern sanitation & medical systems. It's like saying that cholera, scarlet fever, and bubonic plague are deadly diseases: true, but significantly less true in the developed world.
That said, any mechanism for checking travel will undoubtedly turn corrupt. So it comes with that cost.
Civil rights are all well and good. But 'everybody dies of Ebola' might take precedence.
I’m guessing you’re in the US? What about the rest of us?
What’s that to say of the people that are in the midst of it? Harder to tell but prevailing policy sure indicates that countries are self-interested first and foremost.
Similarly, no matter how free a country may be, there are rules about quarantines. You can be involuntarily subjected to one, and that's that. Your Constitutional rights or whatever your country may have are gone for the duration.
This goes below politics and below the blustery winds of the day all the way down to one of the foundational principles of society, which is, you won't have a forum to argue about how open borders should be in your society if you don't have a society at all because it got sick and died. Despite superficial similarities, this isn't about immigration debates or open borders or xenophobia or any of those hot-button issues. This is just, can you take basic, "lizard-hindbrain of society" actions to protect yourself or not?
I don't know that this particular outbreak is there or not, but it's only a matter of time before some outbreak of something is.
So the answer is, everyone should prevent people from potentially affected areas from coming in to the country for the duration of the outbreak. If you fail at this task, no amount of rhetoric, no amount of voting, and no amount of mocking your political opponents with various epithets about how phobic they are will do so much as save a single life from the resulting outbreak, because those are all category errors. Epidemics are not political matters. They are way further down the societal Maslow hierarchy than that.
Why then are you entirely focused on a political solution to a non-political matter? Closing borders is a political solution.
I disagree because your situation disrespects the progress that technical solutions have made over thousands of years of human progress. As medicine, hygiene and diagnostic tests improve, the probability of the dramatic epidemic event you propose falls closer to zero.
We detect and quarantine individuals who are at high risk of being infected, without shutting down borders worldwide. We use better hygiene and sanitation to reduce the transmission of disease. We can educate the public when a disease is a risk and people can take measures to reduce the likelihood of transmission. Researchers can find cures and effective treatments to reduce the threat even if the disease spreads.
For all your talk of reality and rationality, you don't mention any actual technical solutions in your grandstanding that this isn't about politics, instead contradicting yourself by basically focusing on a single political solution.
Secondly, as I sort of alluded to in my mention of quarantine, it's not about "borders". National borders are a relatively convenient cutting point in our world, but anything can be quarantined; a house, a state, Manhattan, a particular valley, a cross-country region, an airport, a hospital, whatever it takes. It's not about politics. It's not about any of the characteristics of the people on either side of the quarantine boundary beyond "are they contagious or not". It's about whether you can take the necessary steps to stop the spread of a pandemic or not.
I'll say it again, if you're sitting there standing on your rights and technology when something comes tearing through, then if nothing else you're going to filter out of the population all the people who are willing to trust technology and insist on free travel regardless, both because of changing attitudes and because of who ends up trusting in the assurances that everything's fine and doesn't take adequate steps themselves. If you value the believe in free travel, and you want a society to have an effective belief in free travel, then you must paradoxically be willing to handle cases like this very carefully, because if you stand on a 100% dogmatic "I don't care what diseases they have, free travel is literally more important than everyone's lives" stance you will create a society that does not value free travel at all once a highly-preventable epidemic sweeps through.
Did we read the same article? This article is about the Democratic Republic of the Congo, a nation which does not have closed borders with the rest of the world, and Ebola has not spread beyond it's borders. The DRC does not have adequate medical infrastructure, sanitation or education and therefore the outbreak is occurring there.
Europe and the United States do have effective technology, medicine and disease control, so there is almost no risk of a widespread Ebola outbreak here.
> once a highly-preventable epidemic sweeps through.
Until you present a pathogen with this quality that cannot be controlled in the western world this is science fiction. You might as well argue that xenophobia and authoritarianism will prevail once sentient androids revolt. Until you have evidence the threat actually exists you're arguing based on ideology.
Well right or wrong anyone in the first world is probabbly doesn't need to worry about ebola generally.
Still I get your point about just mentioning one country.
But who knows, maybe ebola could solve our anti vax issue for a few more decades.
There is absolutely no need for fear mongering and international travel restrictions, border checks and short quarantine for people coming from affected countries is suficient.
https://news.ycombinator.com/newsguidelines.html
I suspect every first world country could handle an outbreak on their own and eliminate the disease in their own country in short order.
Basic healthcare practices that any hospital could handle are enough to deal with ebola.
We see it spread in places where there isn't basic healthcare and chaos that limits the ability for health workers to deal with it.
We have huge groups of actively ignorant people supporting the growth of climate change, anti-vaccination, and a host of other dangerous actions.
Now those fighting Ebola outbreaks are getting attacked.
I hope I’m wrong, but it looks like rationality is fast disappearing from this world. It’s only a matter of time before we destroy ourselves.
I realize this type of gloom and doom stuff has always been predicted throughout history, it just seems “this time is different” for real with the intersection of technology and ignorance reaching levels we’ve never seen.
However, measles outbreaks and hate-crimes aren't going to stop because one does not pay attention to the news.
It seems more would be done if local news, or even just having a conversation with a friend were the primary way of obtaining information.
I would venture a guess that you're more likely to pursue a cause if it directly affects your community or someone you know and love thinks it's important, than you are just by reading something on the internet.
You'd like history, the masses of humans have always been like this.
This is more to do with being unlucky where the outbreak occurred in a country without order in that part, than fake news affecting anything.
A powerful entity conducting a controlled bio-attack to clear opposition to future mining operations is entirely plausable.
They may face other issues and we just aren’t aware of it.
Rationality is energy intensive and difficult to cultivate and is usually a socially learned or reinforced skill (similar to the fact that long-term research is usually only funded by public tax dollars and not corporations).
So I don't think now is any different, it's just at a different scale and behooves those of us who have had the privilege to cultivate the skill to not gloom and doom and to instead show the way up the ladder (if possible, not all people want to cultivate rationality).
We're talking about Congo Kinshasa here, I mean, most of you here, who are not from the region have absolutely no idea about the state of that country. It's a mess.
Internet is the least of the locals worries, many of whom are on a daily survival mode because of the war, can't even read and are strongly influenced by all sort of superstitions.
I'm not sure what point you are trying to make. A lot of them living in remote places controlled by militias never had access to the internet at first place.
Every generation does this. It doesn't mean that actually, the world is a fine place. It just means that your rose-colored glasses are coming off.
You cannot evaluate the actions taking place in that country and then apply them to the rest of the world.
AIDS does not evolve variants. HIV, which is a virus, can evolve.
There is neither a vaccine nor a cure for HIV.
But the jury is still out on what evolutionary processes are ongoing. Is the virus adapting to its new host and consequently evolving more slowly, or is it quickly developing increased transmissibility? It's not quite clear.
It's an open ended scenario. The organism could learn a robust survival method that helps it survive more efficiently, without making it more lethal. It could learn nothing at all. It could learn to be less lethal but more transmissible. It could learn to spread to other organisms, or whatever opportunity proves advantageous.
It's possible we could notice pathways that represent doomsday hazards long before it would be possible for an organism to naturally evolve into a new version of itself. With that, we might focus on adaptations that never appear, yet cannot be ignored. Like watching for a robber that never robs us.
It's probably only worth worrying about robberies when it looks like we have a robber on our hands. And right now, we're observing an awfully effective robber in action, right now.
Problem with Ebola is that its transmission among humans is via the same thing that kills humans.
I seem to remember a study from ages ago where they compared strains of HIV from South Africa and Japan. Condom usage in South Africa is low, so the virus evolved to develop a high viral load quickly. In Japan the opposite was true, condom usage was high, the strains that caused the victim to die early became extinct.
I don't have an answer for what should be done, but I can tell you that your suggestion is not it.
I suspect mass use of force would work (let's just assume we had unlimited troops or something crazy).... but only for a while.
For a health situation like this you need buy in from the locals to change how they handle things longer term or it might pop up again.
To provide some context, just the eastern provinces of the DRC, where most of the violence is concentrated, have a population of more than 20 million people and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has just 15 000 troops. A figure which shrinks annually as a result of US-forced budget cuts.
Those budget cuts (which the Trump administration has loudly boasted about, FWIW) have also severely depleted the aviation budget, preventing MONUSCO from being able to deploy as many attack helicopters as its commanders say it needs to go after armed groups and reducing its ability to transport troops by air. This forces them to take long, slow journeys on the country's dilapidated road network, even in cases of urgent responses. During the rainy season it can take hours to travel a few kilometres despite having specialised vehicles.
Add to that the fact that government troops are often corrupt and local commanders can be in league with some of the rebel groups, and it's a pretty difficult mission at the best of times.
Not only are they potentially exposed to the deadly disease, they have to content with violent attacks from the population they're trying to help.
It sounds incredibly complex - a mix of political mistrust, lack of education and difficult terrain making containment difficult.
While spreading to populous areas would be a major concern, I imagine that nations blessed with more resources may be in a better position to quarantine, contain and prevent the spread of Ebola.
Imagine having to wear all that protective gear in 80% humidity, limiting your visibility and hearing, limiting your bathroom habits and ability to rehydrate and eat, for hours at a time, in potentially hostile social situations, while dealing with a person or a corpse that you have a very good suspicion could infect and kill you with literal Ebola, a disease that will liquify you from the inside, every day, for months at a time, with no end in sight, and the virus seemingly 'winning.'
Absolute heroes.
Perhaps it's because Ebola is deadly and it's easy to remain ignorant of the humanitarian crisis plaguing many of those 76,000 monthly refugee/asylum seekers... both before and after crossing. Perhaps it's because we all fear catching Ebola from an airport or shopping mall, but none of us fear catching "run-for-your-life-itus", or have to wonder how we'll feed, clothe, and shelter ourselves in a brand new country where we don't speak the dominant language or understand the culture, but we know it's safer than where we came from?
Or perhaps it's simply because it's not a political punching bag issue? ... that's probably the real truth neither "side" wants to admit.
Ebola isn't going to run rampant through the US - we have a great medical system that wouldn't be trying to treat patients in a field in the middle of a war zone. We should lend all the support we can to DRC to help prevent the spread of this terrible virus - not out of fear of it spreading to our home nation, but out of compassion to the people of the DRC.
At the same time, we should really step back from our trenches and objectively examine our own domestic problems - not through the lenses of political ideology, but through the lens of a decent human being.
(ya, this is a throwaway... advocating we stop being political about our own domestic crisis is sure to attract a lot of negativity, unfortunately).
[1] https://www.nytimes.com/2019/03/05/us/border-crossing-increa...
This insular, isolationist attitude is precisely what is currently eroding the United States' soft power in the world today.
The major factor in this Ebola outbreak in DRC is the civil war, which is making it very difficult to effectively treat patients. Ebola is spread through bodily fluids, which are far easier to contain and isolate in a controlled environment than in a field temporary hospital or simply a family member helping care for someone they think is just sick.
We don't have these problems here in the US at the present time. Say what you will about the US medical system and insurance, etc... but it is still a very good system that can handle a wide variety of cases and isn't hobbled by armed-conflict/civil war.
https://news.ycombinator.com/newsguidelines.html
https://en.wikipedia.org/wiki/Remdesivir
But of course there's no guarantee, it's not really a great question when it comes to biology.
https://www.gilead.com/purpose/advancing-global-health/ebola
The latest report (4 June 2019): https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...
Figure 1 on Page 3 is a good-ish overall representation of the situation. Ebola is sustaining itself. It hasn't gone geometric yet, but it could at nearly any time, if not already.
One important thing to note is that though it may seem that in the last 3 weeks the epidemic has been tapering off, that is an artifact of the reporting situation there. There is a significant lag in identification of deaths and causes. Feel free to look back over the other reports to see this reporting lag effects.
Another thing to note is that North-Kivu province is about the same size as West Virginia with about 2.5X the population. Goma, the capital there, has a population of about that of San Jose proper.
Combined with other sources that other HNers have linked, the Nature article is correct to sound the alarm here. The Ebola fighters are trying their best (despite the complicated social situations, weather, gear, humidity, and resource limitations), but Ebola is not quitting either. This situation is not something to wave away and is very deserving of international attention.
It was turned into a 6-episode miniseries on National Geographic (just aired last week), but the book is 100% worth the read if you're interested in the topic.