The CDC's communication to the public about Ebola has been extremely one-sided: they seem to only care about reducing the likelihood of panic, to the point where they spread lies and falsehoods that will eventually cause panic! As the article says, the audacity of saying "At this point there is zero risk of transmission on the flight" is astounding. Expressing such confidence in something that is clearly unknowable (or worse, false) is dangerous.
There's no need to panic unless the authorities continue to downplay the seriousness of the disease, and continue to show their incompetence in handling contagious diseases.
I'm not sure how much room there is for "internet 'news' sources" to spread misinformation, at least in a populace who accepts the germ theory of disease, even if most are fuzzy on viri vs. bacteria.
Nigeria's recent Ebola experience gives us hope that the best supportive care can reduce the death rate to something below 50%, they had 20 cases, 19 lab confirmed, 8 deaths. But for the time being it's still inevitably going to be very deadly, although mutations to less severe forms would be advantageous. Whereas to truly airborne would take multiple ones, we're pretty sure, and is very unlikely. Although not 0%, but real close.
That's probably where there's harm that can be done, but as this article and discussion note, we don't really know the truth now. I suppose that the currently inept internal US response could lead to people giving credence to "it transmits like the flu!" (which per the above is neither true nor likely to become so). Certainly people including ones claiming to be doctors are saying that now in "internet 'news' sources" ... are people believing that? (I and my family know too much medicine and biology for that.)
When was the last time the American people panicked over a disease, vs. the always excitable media? I don't get the impression from my parents or my readings that "panic" resulted from polio in the '50s (although I gather a lot of swimming pools went empty at times), and I'm pretty sure not since then. But of course we haven't been stressed with something this bad since perhaps the days of yellow fever, e.g. the 1878 epidemic.
I seriously doubt we'll "panic" per se, but I wouldn't bet on idiots like Thomas Frieden remaining in charge of things like the CDC.
Don't forget the 1918 Spanish Flu epidemic. Or the 1957 Asian Flu pandemic. Or polio. Or the rest of these [0].
I was very aware of the Spanish Flu and Polio but no so much the rest.
And to say "this bad" when talking about 6,000 infections in Africa seems silly compared to most of these. 675,000 dead in USA (20 million across the globe) from Spanish Flu (my great grandfather included).
You mentioned polio of course but just because there aren't as many ready recordings doesn't mean people weren't stressed and/or panicked about these things.
Ah, yeah, the 1918 Spanish Flu was bad. But not 18th Century yellow fever or Ebola (potentially) bad (in the US). Using your figure of 675,000 dead, that's a fatality rate for the whole population of 0.6-0.7%, based on the 1920 and 1910 Census figures. Just now looking at Wikipedia, it's estimated that 28% of the population got it, so that would make a US Case Fatality Rate of 2.6% ... bad, but not hardly as bad as much of the rest of the world.
It was fantastic transmissible, plus its killing young healthy people is part of what made it so bad, a lot of older folk at least in the US appear to have had some immunity. However WWI wartime censorship kept a lid on greater recognition of how bad it was (it got its name because reporting on neutral Spain was allowed).
So I don't put it in the same league, and the late '50's Asian flu killed "only" around 69,800 Americans (per Wikipedia), so ... well, how many of us expect Ebola to kill that many in the country? I expect/hope sanity will prevail, that the Politically Correct will be shouted down or hounded out of office/their positions, and once we revert to the old fashioned quarantine methods the death toll will be small. But plenty will label that process as "panic" ... and if it doesn't happen, well, we may indeed see something close to well justified "panic".
So say the death toll in the U.S. ends up being ~2 people, are you going to revisit your assumptions and conclusions? Or would that outcome be easily dismissed as belonging to luck?
The CDC's responses are unsurprisingly politicized ("Nothing to see here, move along"), and miss the common sense point that unless a disease is 100% curable, nothing is certain about it. Transmission theories may be backed by significant data, but the data is still a sample subject to confidence and interpretation.
Another aspect of the CDC communication was the deliberate obtuse response that the CDC head had to suggestions of travel restrictions.
"Centers for Disease Control and Prevention Director Tom Frieden warned Saturday that imposing a travel ban to the countries known to be dealing with an Ebola outbreak could make the problem worse, as it would cut off the affected areas from receiving necessary medical aid."
But, of course, nobody anywhere has suggested a ban on travel into the affected countries. And he well knows that.
EDIT: Here is a change.org petition that I created today which I think addresses the issue of aid workers and medical transfer patients, etc.:
There's a zillion sane ways to handle that problem: for the not obviously infected, confine them for 21+ days of being nonsymptomatic. That would have caught our current index case (AKA Patient Zero). For the infected, send them straight to a hospital equipped for this, we've got 4 of them, our military is building one in Liberia right now, we could make more, and more beds in the ones we have, here and over there.
It never ceases to amaze me how much humanity clings to the feeling that they understand something, even when history tells us that surprises are far more common than predictability. It seems to me that planning for Ebola (or a battle, or climate change, or the economy, or anything vaguely important) wouldn't be something along the lines of "Ok, we know what's going on, no need to freak out or to spend any extra effort" but "Wow, these things go sideways all the time, let's assume our models are limited, in ways we don't even know yet, and throw everything we have at it; even then we will probably be lucky if we dodge a disaster."
I really don't have any more confidence because the CDC has been saying "it will be fine" than I did when the Japanese officials said Fukushima would be fine.
If you take the latter approach, it tends to manifest in the form of budget cuts. Because you just told the people handing out money that you don't know enough to be useful and there's no point in trying.
Before the nurse contamination in Spain, I was pretty optimistic. Now that someone got contaminated in a highly controlled environment with training and procedures, where people knew they were dealing with a Ebola patient, there is no way that "everything will be fine" in the coming months. And they only had 1 patient to deal with at once ! Now imagine with 10 or 100 patients in a given hospital.
Spain isn't exactly the first world country people assume it is, there are many commentators on other sites bemoaning the state of medicine there including links to articles describing the lack of proper protection for health care workers.
I think the problem many people are having is you have governments telling everyone to quit fear mongering while at the same time they are demonstrating they haven't got a real hand on this.
I think you're first sentence is a bit of rationalization. Because it is kind of slippery slope : "You know Alabama is not really well known for its hospitals", then "You can't really find a good clinic south of 8 Mile", etc. At this rate, it is going to end at your doorstep.
I remember plenty of recommendation and planning for H1N1, but currently I don't see anything really being implemented for Ebola in Western countries. Not sure it would have been really efficient in case of a full blown flu epidemic, but at least some things were organized.
Ebola is scarey, but really washing hands and quarantine are the most effective public health efforts. In the US with plenty of clean water and soap, the chances of an epidemic become small.
There are a very small number of places in the world that safely handle these types of pathogens. Most of them are military or off limits to the public.
Rates of hospital acquired infection show that you are perhaps a bit complacent.
These are people who know the risks; are trained to wash their hands; who have access to clean hot water and soap; who have gloves; and who face consequences when patients die.
And yet, even in these excellent hospital settings, on any one day about 1 in 25 people will have a hospital acquired infection.
Only 1 in 25? Considering how many people are immune suppressed or elderly or very sick from the start, that number seems low. That means 24 out of 25 people don't get a hospital acquired infection, or 96%. I was a little worried about Ebola before your comment, now I'm not worried at all.
Isn't it obvious that it spreads through air, if it causes coughing and sneezing? How could the virus have evolved to cause coughing and sneezing? Although, using this mechanism, the virus could just spread to other surfaces and liquids through air, but not directly (for some odd reason). Of course, it's possible that having another virus at the same time might enable this mechanism too.
The reason this virus is dangerous if because it didn't co-evolve with humans (it is a bat disease I think). Coughing and sneezing are mechanisms that humans have evolved in order to deal with various problems, not something that viruses have managed to program us to do.
No, they're mechanisms for completely different purposes than fighting viruses. Coughing, sneezing, running nose, diarrhea, etc. are vulnerabilities that infectious viruses exploit to be able to spread.
The critical distinction here is that Ebola doesn't seem to infect the outer part of the respiratory system like colds or influenza. There's not a huge mass of cells there to be shedding viri and getting into the air, and it would take more than a few mutations for that to change.
Ebola viri have been found in saliva, tears, can come from bleeding in the respiratory system, so it obviously can get airborne that way. Exactly what that means (how big are the droplets, how long do they stay in the air etc.), how significant that is as a mode of transmission (which includes iffy estimates of how many viri (virus particles) are required to make an infective dose) ... we just don't know. But with our current Ebola importation policy, it's very likely we will start to get answers to these questions....
Ebola is in the various fluids discharged by coughing and sneezing (its in the article). The problem for the urban areas is that ebola seems to persist (as long as its in a fluid) and its so infectious (small threshold exposure). The two may conspire to create an issue that 99.99% clean isn't clean enough. Thus, discharged fluids even in small amounts may very well transmit the virus in trace amounts (again, in the linked piece). From there its purely semantic about whther or not 'water vapour' or 'aerosolized liquids' are equal to "airborne". As you allude, eath pathogen may be airborne in various ways (the air has many pollutants and impurities).
A statement from the WHO, which I don't have a lot of respect for, but unlike the US CDC, I haven't yet caught them lying about Ebola (as opposed to arguably necessary optimism, they're not about to state they've written West Africa off, at least at this stage). Most of it is correct from my knowledge of things, and the statements about saliva, tears and sweat sound plausible:
The answer to that question is legitimately "because humans that coughed and sneezed survived longer than those who didn't". That's literally all there is to it.
"I really don't have any more confidence because the CDC has been saying "it will be fine" than I did when the Japanese officials said Fukushima would be fine."
As someone who has a small bit of background understanding of Ebola (that is, I read The Hot Zone, and then some follow-up texts related to it) and as someone who has an appreciation for the role that air travel would play in a pandemic, the lack of a proper travel quarantine procedure out of the affected west african countries is stupefying.
It is beyond all understanding that there is not a 21 day monitoring/quarantine period enforced for air travel out of these three affected countries.
EDIT: I have created this change.org petition which suggests what are, in my opinion, common sense travel guidelines that would avert a possible pandemic:
"Those monkeys were dying in a pattern that was certainly suggestive of coughing and sneezing — some sort of aerosol movement," Bailey said. "They were dying and spreading it so quickly from cage to cage. We finally came to the conclusion that the best action was to euthanize them all."
The money line. Caged primates spreading ebola. They would have been physically proscribed from direct contact.
My memory of the Reston chapters in Hot Zone is a little fuzzy, but I believe the virus spread not only from cage to cage, but from room to room throughout the facility. Of course there could have been some human vector, but it could have also been airborne in the ventilation system.
It's wise to prepare. Panicking and being prepared are two very different though overlapping behaviors. The part that 'bugs' (sorry) me the most lately is when someone claims certainty about Ebola's chances of spreading. It's un-scientific to speak with literal, absolute certainty in most contexts. The early guest on The Colbert Report last Thursday, for instance, was resolute in saying the chance of Ebola spreading in the United States is "zero." Attempting to balance against a flip-side of sensationalism is an inadequate excuse. Sure, memories of The Hot Zone panic are alive and well. That came and went. Too many factors are at play though. Anyone who states proof of "zero" seems to only play a fool or propagandist (unless the topic is mathematics).
Ebola is probably high on a list of threats in the form of plausible terrorism. I'll be glad to be wrong. There's no shortage of it to procure. It presumably can't be detected easily. It can survive numerous transatlantic mailings for cultivation. It has about a week delay in symptoms. Short bursts of it in dense populations where people eat/interact would cause huge catastrophe in panic alone. That's one factor. Hopefully, an increased response will thwart its growth altogether and we can again see it as "zero."
Frankly, I'd like to see some panic, a few closed borders, cancelled flights... This seems like the time when panic can still help.
BTW, I have a question for the people who are flagging the post, have you read it? It's pretty informative with past cases referenced, probability of transmission discussed based on real life observation, and so on. Good reporting overall.
He tells Colbert that he has a zero percent chance of getting infected (it's as a response to a question). I take your point that he is being somewhat dismissive, but he doesn't actually say that there is zero chance of it spreading. The rest of the discussion is quite a lot more measured:
Colbert: "What are the odds that I'm going to get Ebola?"
Sepkowitz: "Zero. Next question."
---
Thanks for posting the link. I wouldn't interpret what he said as only directed to Colbert. It's normal for an interviewer to place him/herself as the subject where it's understood that the implied subject is [any other person like me in this region/nation]. He's being far more than "somewhat dismissive." Even if he (oddly) were only specifically addressing Colbert by saying zero, that would be presumptuous. But that's my take.
I admit the possibility of a conversational zero. I don't see much point in arguing over it. Given current information, I don't expect to even change my behavior over Ebola (but I'm not in Dallas and I already didn't have plans to travel to west Africa). That meets my hand wavy, just invented definition of a conversational zero.
I posted the link because you said resolute in saying the chance of Ebola spreading in the United States is "zero.". I figured it was fair for people reading that to have an easy shot at interpreting the video themselves.
You're quite right to post it. It confirmed how I remembered it. He was resolute in that sense. To say that an arbitrary person (the implied subject) has a chance of "zero" is to effectively say it's "zero" for a whole. Anyway. Keep it easy. Get in the habit of bowing instead of shaking hands and you'll have already made inroads. :)
Prof. Peter Piot - scientist who discovered Ebola in 1976 had to say the following on Ebola becoming a pandemic [0]
There will certainly be Ebola patients from Africa who
come to us in the hopes of receiving treatment. And they
might even infect a few people here who may then die. But
an outbreak in Europe or North America would quickly be
brought under control. I am more worried about the many
people from India who work in trade or industry in west
Africa. It would only take one of them to become infected,
travel to India to visit relatives during the virus's
incubation period, and then, once he becomes sick, go to a
public hospital there. Doctors and nurses in India, too,
often don't wear protective gloves. They would immediately
become infected and spread the virus.
Experts said that the current outbreak would only be a couple of hundred people. Then they said it might be maybe 20,000. Now they're saying it could be one million.
It's frustratingly hard to steer the course of taking it seriously while not giving anything to the over-reactors.
So, while caution is always a good idea, there seems to be some practical evidence that supports the current sense of how easily (or not) ebola spreads.
At a minimum, we should quarantine travelers from that region when they arrive. We should require them wear a tracking device to be sure they are staying in place.
It would be expensive but worth it if it catches a few infected people.
As a result of the spanish nurse's infection, I think health care workers need to be quarantined too just in case the protections don't work as we expected.
BTW, did you read the article about the Canadian experimental medicine that is available but not being shipped because the US exclusive distributor doesn't yet know how to handle the distribution. It is scary that a company that stands to make a huge profit, if the disease spreads to a first world country, is holding back the distribution of a cure.
53 comments
[ 3.7 ms ] story [ 108 ms ] threadThere's no need to panic unless the authorities continue to downplay the seriousness of the disease, and continue to show their incompetence in handling contagious diseases.
Despite a few flare ups of panic, they did a pretty good job of getting the word out about HIV/AIDS when there was a lot of misinformation out there.
This is different for two very important reasons.
1. We just don't know how communicable Ebola is if people spend a lot of time in close proximity to an infected person.
2. Widespread access to internet "news" sources can spread misinformation extremely quickly.
They seem to be afraid to admit that there are things that they still don't know.
Honesty is the best policy.
There isn't yet any clear cause for panic, so start with that and go from there.
Nigeria's recent Ebola experience gives us hope that the best supportive care can reduce the death rate to something below 50%, they had 20 cases, 19 lab confirmed, 8 deaths. But for the time being it's still inevitably going to be very deadly, although mutations to less severe forms would be advantageous. Whereas to truly airborne would take multiple ones, we're pretty sure, and is very unlikely. Although not 0%, but real close.
That's probably where there's harm that can be done, but as this article and discussion note, we don't really know the truth now. I suppose that the currently inept internal US response could lead to people giving credence to "it transmits like the flu!" (which per the above is neither true nor likely to become so). Certainly people including ones claiming to be doctors are saying that now in "internet 'news' sources" ... are people believing that? (I and my family know too much medicine and biology for that.)
I seriously doubt we'll "panic" per se, but I wouldn't bet on idiots like Thomas Frieden remaining in charge of things like the CDC.
I was very aware of the Spanish Flu and Polio but no so much the rest.
And to say "this bad" when talking about 6,000 infections in Africa seems silly compared to most of these. 675,000 dead in USA (20 million across the globe) from Spanish Flu (my great grandfather included).
You mentioned polio of course but just because there aren't as many ready recordings doesn't mean people weren't stressed and/or panicked about these things.
[0] - http://www.healthline.com/health/worst-disease-outbreaks-his...
It was fantastic transmissible, plus its killing young healthy people is part of what made it so bad, a lot of older folk at least in the US appear to have had some immunity. However WWI wartime censorship kept a lid on greater recognition of how bad it was (it got its name because reporting on neutral Spain was allowed).
So I don't put it in the same league, and the late '50's Asian flu killed "only" around 69,800 Americans (per Wikipedia), so ... well, how many of us expect Ebola to kill that many in the country? I expect/hope sanity will prevail, that the Politically Correct will be shouted down or hounded out of office/their positions, and once we revert to the old fashioned quarantine methods the death toll will be small. But plenty will label that process as "panic" ... and if it doesn't happen, well, we may indeed see something close to well justified "panic".
"Centers for Disease Control and Prevention Director Tom Frieden warned Saturday that imposing a travel ban to the countries known to be dealing with an Ebola outbreak could make the problem worse, as it would cut off the affected areas from receiving necessary medical aid."
But, of course, nobody anywhere has suggested a ban on travel into the affected countries. And he well knows that.
EDIT: Here is a change.org petition that I created today which I think addresses the issue of aid workers and medical transfer patients, etc.:
https://www.change.org/p/barack-obama-and-u-s-senate-and-u-s...
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2010....
I really don't have any more confidence because the CDC has been saying "it will be fine" than I did when the Japanese officials said Fukushima would be fine.
Enough optimism for the morning...
I think the problem many people are having is you have governments telling everyone to quit fear mongering while at the same time they are demonstrating they haven't got a real hand on this.
http://www.reddit.com/r/worldnews/comments/2ignxj/nurse_infe...
I remember plenty of recommendation and planning for H1N1, but currently I don't see anything really being implemented for Ebola in Western countries. Not sure it would have been really efficient in case of a full blown flu epidemic, but at least some things were organized.
The point was, an epidemic requires a vector that easily passes the disease, plus a delay between infection and symptoms. Ebola has only one of those.
These are people who know the risks; are trained to wash their hands; who have access to clean hot water and soap; who have gloves; and who face consequences when patients die.
And yet, even in these excellent hospital settings, on any one day about 1 in 25 people will have a hospital acquired infection.
Ebola viri have been found in saliva, tears, can come from bleeding in the respiratory system, so it obviously can get airborne that way. Exactly what that means (how big are the droplets, how long do they stay in the air etc.), how significant that is as a mode of transmission (which includes iffy estimates of how many viri (virus particles) are required to make an infective dose) ... we just don't know. But with our current Ebola importation policy, it's very likely we will start to get answers to these questions....
http://who.int/mediacentre/news/ebola/06-october-2014/en/
As someone who has a small bit of background understanding of Ebola (that is, I read The Hot Zone, and then some follow-up texts related to it) and as someone who has an appreciation for the role that air travel would play in a pandemic, the lack of a proper travel quarantine procedure out of the affected west african countries is stupefying.
It is beyond all understanding that there is not a 21 day monitoring/quarantine period enforced for air travel out of these three affected countries.
EDIT: I have created this change.org petition which suggests what are, in my opinion, common sense travel guidelines that would avert a possible pandemic:
https://www.change.org/p/barack-obama-and-u-s-senate-and-u-s...
The money line. Caged primates spreading ebola. They would have been physically proscribed from direct contact.
Ebola is probably high on a list of threats in the form of plausible terrorism. I'll be glad to be wrong. There's no shortage of it to procure. It presumably can't be detected easily. It can survive numerous transatlantic mailings for cultivation. It has about a week delay in symptoms. Short bursts of it in dense populations where people eat/interact would cause huge catastrophe in panic alone. That's one factor. Hopefully, an increased response will thwart its growth altogether and we can again see it as "zero."
BTW, I have a question for the people who are flagging the post, have you read it? It's pretty informative with past cases referenced, probability of transmission discussed based on real life observation, and so on. Good reporting overall.
http://www.thedailybeast.com/articles/2014/10/03/dr-kent-goe...
Sepkowitz: "Zero. Next question."
---
Thanks for posting the link. I wouldn't interpret what he said as only directed to Colbert. It's normal for an interviewer to place him/herself as the subject where it's understood that the implied subject is [any other person like me in this region/nation]. He's being far more than "somewhat dismissive." Even if he (oddly) were only specifically addressing Colbert by saying zero, that would be presumptuous. But that's my take.
I posted the link because you said resolute in saying the chance of Ebola spreading in the United States is "zero.". I figured it was fair for people reading that to have an easy shot at interpreting the video themselves.
It's frustratingly hard to steer the course of taking it seriously while not giving anything to the over-reactors.
http://www.npr.org/blogs/goatsandsoda/2014/10/06/354054915/f...
http://www.csmonitor.com/World/Africa/2014/1006/Nigeria-cont...
So, while caution is always a good idea, there seems to be some practical evidence that supports the current sense of how easily (or not) ebola spreads.
edit: spelling
As a result of the spanish nurse's infection, I think health care workers need to be quarantined too just in case the protections don't work as we expected.
BTW, did you read the article about the Canadian experimental medicine that is available but not being shipped because the US exclusive distributor doesn't yet know how to handle the distribution. It is scary that a company that stands to make a huge profit, if the disease spreads to a first world country, is holding back the distribution of a cure.