Don't Freak Out About Ebola Coming to America

The disease is scary, but the risks are low.

I'm sure none of you would want to emulate Donald Trump, but just in case you're tempted to follow his lead and freak out about the Ebola patients coming to the U.S. for treatment, here's Danielle N. Lee to talk some sense into you:

Warner Bros.

It is a frightening prospect to have a disease with a 80-90 percent mortality rate so close to home. People are concerned that once Ebola arrives in the US, people here will get sick and the disease will spread.

There are two things, however, that are important for everyone to understand.

First, Ebola is already here in the US. Scientists have been studying the disease in well-secured laboratories for years, and there has been no trouble.

In other words, there have been no new cases or incidences of Ebola from these previous exposures to Ebola and related viral hemorrhagic fever diseases.

Second, Ebola is actually very hard to contract….[C]ontracting Ebola involves coming into direct contact with an infected person's body fluids, namely blood and feces. Caretakers such as relatives and medical staff are at high risk of becoming infected. Otherwise, the chances of anyone else in the community contracting Ebola is practically zero. Transmission can be avoided by wearing protective clothing and gloves, washing your hands, and avoiding physical contact with individuals who are sick.

Read the rest here. Reason's Ron Bailey discussed some related Ebola fears here.

Comments

[Pro Libertate]

Until Ebola mutates, becomes airborne, and most of us become living zombies.

[kinnath]

not to worry, Dustin Hoffman will save the day.

[EDG reppin' LBC]

Don't forget Morgan Freeman!

I saw that at the theater.

[Pro Libertate]

Crazy that one can't get refunds for bad movies. I mean, look, I wasted hours of my life, not to mention the cost of admission.

[DJK]

A former very high-ranking scientist in Biopreparat (the USSR's clandestie bioweapons program) reported that the USSR was running large-scale production of aerosolizable genetically modified versions of Ebola and Marbug as early as the mid-1980s. From what I understand, his accounts of the Soviet bioweapons program is considered accurate by Western intelligence agencies. The declassified parts are available in a book called Biohazard; try it for a truly terrifying read.

[Cytotoxic]

I heard about that. It was a useful lesson in the usefulness of the non-verifiable treaties i.e. they have none.

[DJK]

I'd highly recommend the book. I think it's somewhere between 300 and 400 pages and pretty well-written. The author would be engaging even if he weren't writing about such a profoundly interesting (and terrifying) topic.

[Francisco d'Anconia]

God, Trump is an idiot.

[Duke]

Idiot like a fox!

[kinnath]

Heaven forbid they should weaponize this evil . . . Trump that is.

[hamilton]

Ebola already in the US? I blame Bush. And corporations.

[Libertarian]

Obviously, it's the fault of this extremely libertarian society in which we live.

[MegaloMonocle]

Ya know, if you're trying to calm people down, obvious fallacies don't really help.

This:

Scientists have been studying the disease in well-secured laboratories for years, and there has been no trouble.

Does not lead to this:

In other words, there have been no new cases or incidences of Ebola from these previous exposures to Ebola and related viral hemorrhagic fever diseases.

Unless you believe that laboratory samples and conditions count as "previous exposures."

I was wondering, if this thing is basically a bloodborne pathogen like HIV, why is everybody all suited up in hazmats? Those hazmat suits are not usually brought out for bloodborne pathogens like HIV, after all. Then I discovered that people using the usual precautions against bloodborne pathogens were getting infected anyway.

If AIDS was an epidemic, then Ebola certainly has the possibility of being one if (when?) it escapes into the population. The window of transmissibility is shorter for Ebola, but it is apparently more infective as the usual precautions don't stop it.

[Sevo]

"If AIDS was an epidemic, then Ebola certainly has the possibility of being one if (when?) it escapes into the population."

Not sure this is analogous.
AIDs had been transmitted for quite a while before we knew how it was transmitted, and then the transmission involved things people do for pleasure and often when they are under the influence.

[MegaloMonocle]

It wasn't that long before it was identified, and it kept getting transmitted for quite awhile afterwards.

[Sevo]

..."available data suggest that the current pandemic started in the mid- to late 1970s. By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, spread was unchecked by awareness or any preventive action and approximately 100,000-300,000 persons may have been infected.
[...]
In June (1982) a report of a group of cases amongst gay men in Southern California suggested that the disease might be caused by an infectious agent that was sexually transmitted."
http://www.avert.org/history-aids-1986.htm

I'd say ~6 years and time enough to infect several hundred thousand people qualifies as "quite a while", wouldn't you?

[Tonio]

But the big difference here is awareness. They were slow to accept that AIDS (the terminal manifestation of the disease) was a real thing, and when they finally did so it took them a while to identify the cause of the disease. Even though there is no cure of vaccine, the progress and infectiousness of Ebola is well-known.

[MegaloMonocle]

And post-identification, how many were infected, Sevo?

There's lots of disconnects between Ebola and HIV, I know.

However, Ebola seems to be more transmissible than HIV, since nobody suits up for HIV, but everyone is suiting up for Ebola, based on reports that people using bloodborne pathogen precautions have contracted Ebola. That's really my main point here.

That, and the article seems misguided, if not misleading. The key thing limiting an Ebola epidemic isn't that there is no such thing as epidemics of bloodborne pathogens. Its that the window of transmissibility is small.

[Sevo]

MegaloMonocle|8.4.14 @ 1:31PM|#
"And post-identification, how many were infected, Sevo?"

Which is the reason I made the point about the transmission being associated with pleasurable activities and intoxicants.

[Agammamon]

The thing is, AIDS doesn't go from 'first contact' to 'infectuous' to 'kill you dead' in a month.

Ebola has a roughly 50% mortality rate in developed countries (vice the 90%+ in undeveloped) and would tend to be diagnosed earlier - limiting its spread.

Its a nasty disease to be sure, but its a subtle as a bomb explosion, unlike AIDS where you can be asymptomatic for years.

[Bill Dalasio]

Add in that, unlike ebola, AIDS took a long time to kill its host. That gave the host a long time to infect a lot of other people. Ebola, if I'm not mistaken, kills its host pretty quickly.

[DJK]

A big trouble with HIV is that you can have the virus and not give a positive test result for quite a long time (about 6 months for most of the duration of the HIV epidemic and about a month with modern rapid screening techniques). 6 months is a long time, during which one may have a few sexual partners, all of whom may be exposed without the carrier even knowing that they're a carrier.

That said, even HIV is not all that transmissible. It's estimated that being the receptive partner in UNPROTECTED anal sex WITH A KNOWN INFECTED PERSON (just about the riskiest kind of sex you could have) only carries a 1 in 1000 probability of transmission. Contrast that with the flu, which you'll get by just looking at someone wrong.

[np]

Then I discovered that people using the usual precautions against bloodborne pathogens were getting infected anyway.

That's because they didn't obey the precautions 100% of time when dealing with infected patients and the dead.

I was listening to the BBC on this issue recently and one of the researchers discussed how easy it is to slip up. It's already freaking hot in Africa without air conditioning and it's boiling inside those suits. If you just for a moment come into contact with body fluids of the infected, which could be through any means, including touching the outside of your suit before cleaning, and wipe the sweat off your eyes, you've now got it.

[DJK]

Yup. I worked on a research project that involved select bio-agents for a little while (never level 4 pathogens like Ebola, but occasionally some 3 pathogens like certain strains of F. tularensis). It takes constant thought to make sure that you're following safety protocols to the letter. It's difficult being in one of those suits for even two hours in an air-conditioned, well-stocked, organized lab which you're familiar with. Now go to an unfamiliar, environmentally hostile location which has barely begun to embrace modern medicine? I can understand why mistakes would be made.

[DJK]

Exactly. There are very few places in the country (just the CDC and Fort Derrick, IIRC) that are allowed to handle level 4 biohazards like Ebola. They're among the most secure facilities in the world. If Ebola were to come to the U.S., it would not take a detour through such a secure facility. What a ridiculous non-sequitor.

[Arkansaustrian Economics]

USRIID might be secure, but I've snuck onto Fort Detrick on too many drunken nights to count.

[Arkansaustrian Economics]

USAMRIID, I said.

[DJK]

I guess that I was using Fort Derrick as a stand-in from USAMRIID.

[Sevo]

This'll do every bit as good as the plain talk when AIDs was first recognized. Remember, we still have the Mc Carthy's of the world.

[Tonio]

When AIDS was first recognized it was as a group of symptoms; took them a while longer to figure out what was causing it.

[Sevo]

True, but even when the mechanism was identified, ol uncle Max ('he's gay, isn't he?') got the cold shoulder at the family get together.

[MegaloMonocle]

Just to keep kicking this comatose horse:

This:

Ebola is actually very hard to contract

Is not really consistent with this:

Transmission can be avoided by wearing protective clothing and gloves, washing your hands, and avoiding physical contact with individuals who are sick.

Turn it around: Unless you wear protective clothing and gloves, wash your hands (tricky to do while wearing gloves), and have no physical contact with people who are carrying the virus, you can get infected.

Does that really sound like a virus that's hard to contract?

[Francisco d'Anconia]

Yes. Compared to other diseases.

[MegaloMonocle]

Sounds easier to catch than most bloodborne pathogens.

[sarcasmic]

Being that this one is mostly fatal, it may be wise to err on the side of caution.

Seriously though, I wouldn't worry about an epidemic. A person isn't contagious until they're showing symptoms, and once they're showing symptoms they go down fast. So the window of opportunity is small, and you've got to try to get it. I mean, you've basically got to swap spit, semen or blood with a person who is obviously showing signs of an illness. Not the most attractive thing in the world if you ask me. I wouldn't fret. Unless you like to do nasty things with sick people.

[MegaloMonocle]

I think that's probably the limiting factor, sarc.

But, that is not really what the article is pushing. I guess "easier to catch than AIDs, but you really can only catch it from somebody who is visibly ill" was, for some reason, not the message they wanted to send. Dunno why.

[Pope Jimbo]

So get the hazmat suit to STEVE SMITH pronto?

Or would it be more merciful to kill STEVE SMITH than to force him to live in a world where he couldn't swap spit, semen or blood with the weak and incapacitated?

[Cytotoxic]

Not only that, but mortality levels will be much lower in first world countries with IV fluids that can be pumped into you and better yet, a whole bunch of serum from survivors. That serum contains antibodies to Ebola that are protective and can be passively transferred to an infected person by injecting the serum into that person. I think that is what they are doing with the infected American.

I don't know about Marburg though. It is deadlier.

[Cytotoxic]

It's not airborne so it's still really hard to contract.

[Tonio]

A lot of the transmissions in Africa have been to family members who prepare the bodies of the dead victims for burial. These family members don't use gloves for this, and are at best only vaguely aware of germ theory.

That handwashing thing sounds like standard precaution - you're supposed to wash your hands thoroughly after removing contaminated gloves, just in case. Yes, they have that removing contaminated gloves without touching the fluids thing down, already.

[Sudden]

The disease causes diarria, vomiting, and profuse sweating in its initial stages. The disease can be transmitted through contact with any of these.

[Tonio]

So, full "moonsuits" with positive pressure air supplies. We got that stuff down. The thing to NOT do is turn those warm, infectious bodies over to relatives for unhygenic, ebola-spreading burial preparation. Burn those bodies immediately.

This is not to be construed as an argument for bringing the patients here.

[MegaloMonocle]

Again, a strange disconnect.

Hazmats, especially with air, are typically used for airborne diseases. Which Ebola isn't (supposed to be, at least).

[Tonio]

True, dat, RC, but given the propensity of ebola patients towards diarrhea and vomiting the moonsuit is the best precaution in case you get spewed on

[Tonio]

And another key thing. HIV isn't supposed to be able to transmit through skin, even skin contact with infected fluids (this assumes no cuts, open wounds etc). If ebola can transmit through casual skin contact with infected fluids, that's a whole other level of danger.

[Cytotoxic]

Citation? I'm genuinely curious but skeptical of the sweat.

[JW]

I feel dirtier and more virulent from visiting a MSNBC site.

[DJF]

Don't worry says Reason Magazine, Top Men in Government are in charge.

Also these Ebola carriers are being treated in US hospitals and we know how good hospitals are at stopping the spread of infectious diseases inside hospitals.

[Homple]

"Scientists have been studying the disease in well-secured laboratories for years, and there has been no trouble."

I'm sure the CDC has the same safety procedures for Ebola research as it has for Smallpox, so I am comfort.

[Tonio]

^This.

[Swiss Servator, spare a franc?]

WALKER IS IN THE POCKET OF BIG DISEASE!!!!!! WHERE IS MY HAZMAT SUIT?!?!?!

/theorist of the conspiracy variety

[DJF]

No, Reason is in the pocket of BIG Vaccine. Once someone comes up with a Ebola Vaccine, Reason will get 10 cents for every shot given

[MOFO.]

Scientists have been studying the disease in well-secured laboratories for years, and there has been no trouble.

And nothing could go wrong there. No, sir, no possibility of a disease escaping a well-secured lab.

[Tonio]

Except the labs and samples are not as well-secured as they'd like us to believe.

[Duke]

I read in major news outlets that Ebola is present in sweat enough to infect. That sounds easy to spread unless you live in Antarctica.

[EDG reppin' LBC]

Ok Duke. We get it. You read in major news outlets that Ebola is present in sweat enough to infect. You don't have to keep repeating yourself. Jeez!

[Duke]

Now the comments are infected and replicating like the virus!

[Libertarian]

Imagine the horror of coming into contact with this menace while doing something as innocuous as walking down the street in NY. Life as you know it would be over, and your relatives wouldn't be able to help you. That, my friends, is why Donald Trump needs to be quarantined without delay.

[Libertarian]

I am not a totally heartless person, however. His hair could be allowed conjugal visits.

[Sevo]

That's not hair, that's a small, furry mammal!

[Peter]

Am I alone in finding these reassurances less than convincing?
We now know that deadly diseases have been mishandled, with some being forgotten about in file cabinets, not to mention dozens of workers accidentally exposed to Anthrax recently.
One of the Ebola victims supposedly followed all the protocols yet still contracted the disease.
While I would agree that the potential risk is small, the results could be catastrophic.

[Tony]

There is not a risk of an Ebola epidemic, at least in the US or other advanced countries. Symptoms manifest immediately, and it is not that easily transmissible as explained.

What should keep you up at night is the possibility of a nasty new flu, since it spreads by air and it's contagious before symptoms present, and thus is almost guaranteed to become pandemic.

[Pro Libertate]

To be sure, while I wouldn't worry too much about it, Ebola is a virus-caused disease, and viruses have a propensity to mutate frequently. Influenza is a great example of that.

[Jordan]

Ebola could easily mutate to be airborne, since it has an airborne cousin in the U.S. which only affects animals. In fact, the strain which killed all the lab monkeys in The Hot Zone did undergo just such a mutation.

[Tony]

That would suck. But the risk would be normal people taking airplanes, not suited doctors transporting patients, right?

[DJK]

Yup. That's the nightmare scenario. An airplane is probably the worst place for an airborne disease, given the recirculated air and small volume-to-person ratio. Then all those people go an catch connecting flights? It would be a nightmare. There's a reason that the Soviets worked so hard on producing an aerosolizable version of Ebola.

[DJK]

Wow. A nightmare scenario would be a nightmare. I clearly need to proofread my posts.

[Cytotoxic]

That mutant was incapable of infecting humans.

[avsteele]

Symptoms manifest immediately
This isn't true according to the wikipedia:
Symptoms typically start two days to three weeks after contracting the virus

Assuming you shed virus before you are symptomatic, that is a decent amount of potential for spreading it around.

[Tonio]

No, no, Tony's handy chart says there's nothing to worry about. And BoING BoING is the first place I turn to for medical advice.

[Cytotoxic]

But the transmissibility coincides with the symptoms, so it's easy to contain.

[Cytotoxic]

Your worries are completely misplaced. Ebola is only killing hundreds in west Africa. Stop making Tony look well-informed!

[Poppa Kilo]

So its very low risk.

Well, good.

Know what's lower risk?

Not bringing them here. And by the way, not exposing them to the stress of an intercontinental flight.

Because, you know, you could never fly the supplies and staff to treat them the other direction.

[Tonio]

I wouldn't want to be that staff. Lets say things turn nasty and someone imposes absolute quarantines and travel bans. Stuck for life in Ebolastan. Which is not to argue for bringing patients here; I'm just not sure what the right answer is.

[MegaloMonocle]

Hey, don't we have a nice off-shore property in Cuba that we could use for this?

[Tonio]

While the regime certainly deserves that, the people of Cuba do not. Don't hand the regime a PR victory.

[DJK]

I was thinking this as well. Why are they being treated at hospitals that are open to the public? Surely the CDC and Fort Derrick (you know, places that deal with these viruses every day) must have treatment facilities?

[Tonio]

I don't think the CDC actually has treatment facilities of their own; everything I read indicated that the patient was going to be at Emory University Hospital which is partially funded by the CDC.

[Hawk Spitui]

If it's all that difficult to contract, then why are people contracting it?

Something isn't adding up here.

[Tony]

Apparently local funeral traditions are a main cause of the spread in West Africa: the dead are thoroughly washed, exposing friends and family members. People are also refusing to seek treatment and running away from health workers.

[sarcasmic]

Did you just add something to the conversation that wasn't pure stupid? I'm shocked. Seriously. Shocked.

[Tony]

Your turn.

[Tonio]

He did, but he made up for it below with his idiotic chart link below.

[Sudden]

Yet here we have two aid workers who didn't participate in undertaker duties and were wearing full blown biohazard suits while tending to patients. And they've been infected.

[Tony]

I don't know precisely how they were exposed, but being healthcare workers in direct contact with Ebola patients does put them at risk of contracting Ebola.

Peter Piot, who helped discover Ebola, said, "I wouldn't be worried to sit next to someone with Ebola virus on the Tube as long as they don't vomit on you or something. This is an infection that requires very close contact."

[Sudden]

Of course, the primary early onset symptoms of Ebolavirus all manifest themselves in the expulsion of those very bodily fluids that can transmit the disease (sweat, vomit, watery fecal matter).

I don't know precisely how they were exposed, but being healthcare workers in direct contact with Ebola patients does put them at risk of contracting Ebola

Yes, therein lies the issue with bringing them back here. There was no Ebolavirus in the Western Hemisphere prior to this transport. But with them coming back to the states, now there will be other HC workers who run the risk of exposure to the virus. Any infection of them will mean even more people coming into contact with the virus via treatment.

I'm not prone to panics, but I do have a healthy skepticism concerning these assurances. Like I said below, I spoke with a friend of mine who works in this very field (an altogether pleasant and intelligent woman, even if a bit prog in her tendencies), and while she said it's unlikely that this will result in an outbreak, it's really a calculated risk that should be avoided.

[Tony]

I'm just saying, you're going to get hit by a car in your living room before you're going to contract Ebola in the US as a random person.

[Arkansaustrian Economics]

"I'm just saying, you're going to get hit by a car in your living room"

Boy, I hope not, I sure can't afford to get pregnant right now.

[Tonio]

There was no Ebolavirus in the Western Hemisphere prior to this transport.

There were lab samples, apparently. But, yeah, I hear what you're saying.

[Pope Jimbo]

Right. So don't sit next to Mr. Creosote on the Tube and for fuck's sake do NOT offer him a mint (even if it is wafer thin).

[Pro Libertate]

Oh, sir, it's only a tiny, little, thin one.

[Tonio]

Sudden, I'm really curious about the aid workers who contracted the disease while wearing "full blown biohazard suits". Is that in one of the articles?

[MegaloMonocle]

They were using standard bloodborne pathogen precautions.

Which failed. Which is why everyone is now wearing hazmats when they handle a known Ebola patient.

The trick is knowing they have it. "Sweating, vomiting, diarrhea" are not exactly uncommon.

[Tonio]

Thanks, RC. Yeah, big difference between basic BBP precautions (gloves, mask, glasses) and full moonsuit with air supply.

[Cytotoxic]

Because the locals are ignorant and have backwards traditions. The care workers are working under hard conditions.

The care workers should be given passive transfer of serum antibodies as a prophylaxis if there is enough supply.

[UnCivilServant]

It's been awfully hard to play Plague, Inc since this outbreak started. (Though I'd usually start the plague in India due to its large population, poor sanitation and significant transit links to other countries)

[Lord Humungus]

Madagascar ftw!

[Tonio]

Needs moar Phalanx(tm).

[Sudden]

In processing this news, I had to balance two countervailing instincts: 1. a healthy skepticism of anything the govt tells me and 2. a healthy resistence to fits of panic and paranoia.

So I decided to talk to a friend of mine who is an infectious disease specialist at UCLA, and who has worked on a number of more obscure epidemics in Africa and South America. She used the term "lunacy" to describe the govt's actions here and stated in plain language that any aid worker who goes into such countries to help is fully aware of the possibility of infection and the reality that they will not be returning while infected.

[Brett L]

Well, I guess we'll be retreating to the conveniently elevated beach house with excellent sight/firing lines from the balconies.

[Tonio]

Yeah, I'm really wondering what the push is to bring patients here. The best I can come up with is conspicuous, though misguided (as these things often are) sympathy.

We can't treat the disease. The only thing we can do is keep them clean, fed and comfortable which does improve their odds of survival slightly but at great cost and risk to ourselves. If the real goal is to keep infected corpses out of the hands of primitives, then it's a high cost we're paying.

[Tony]

What cost? There is pretty much zero risk here.

And here's a handy chart explaining this.

[MegaloMonocle]

"Zero risk" and "full hazmat/isolation" are not really consistent with each other, you know.

Apparently, one of the problems with Ebola is that its early onset is easily misdiagnosed. In Africa, apparently it looks a lot like cholera. In this country, it sounds really easy to confuse with the flu.

So, yeah, full hazmat will definitely reduce the risk, but by the time you know you need that, it may be too late.

[Cytotoxic]

Uh the patient is being brought in to a defined location and we know who will be working with him. It will be pretty easy to spot incipient Ebola. Tony is actually right there is basically no risk.

[Tonio]

Charter flights aren't free. Neither is bed space in an isolation unit. The infectious waste disposal costs. Disinfecting the plane. Disinfecting the ambulance. Etc, etc, etc.

[Sudden]

My understanding is that they did give him an innoculation with blood antibodies from a patient that had survived it.

[Cytotoxic]

There thank you. Technically, that's 'serum antibodies' because the blood serum, which is the cell-free portion, contains all of the antibodies. He is going to be just fine with those antibodies in him.

[PapayaSF]

I agree with the skeptics above. The "don't worry" brigade is not fully convincing for the reasons stated.

And here's another worry: does the virus need to mutate to become more of a threat? What if there's one asymptomatic carrier, a Typhoid Mary for Ebola? I am not a doctor, but it doesn't seem impossible that one person might have get infected and have a strong enough immune system to not immediately show symptoms. And for the full anxiety/paranoia effect, add that thought to the fact that dozens of people from Ebola countries have been caught sneaking into the US.

[Cytotoxic]

You and other other 'sceptics' are wrong and are not sceptics at all. There is no chance of a serious outbreak in America. This isn't West Africa savage-land.

The mutation scenario is also virtually impossible. Ebola's main strategy is to replicate so fast that it overwhelms the innate immune response before it can even spin up let alone initiate a humoral response that produces neutralizing antibodies. Pretty sure that this rapid replication is what's responsible for the pathology and mortality. That pathology-vomitting and bleeding and the like-is necessary for transmission. Typhoid Mary Ebola Emmy would be a dead-end host.

[RishJoMo]

Sounds like a very good plan to me man.

http://www.AnonWorld.tk

[Cytotoxic]

As a (puffs out chest) MASTER OF SCIENCE I can quite confidently state that all of the worrying above is unfounded. We'll be fine. This guy needs the care. Ebola isn't going to break out. MERS is what's going to kill us all.

[Cytotoxic]

Oh, and Outbreak sucked and Dustin Hoffman sucks.

[J_West]

Ebola: another example of the vibrancy with which immigration enriches the Homeland. Perhaps we can term it an "undocumented epidemic?"

[Henrycrapcakes]

I think it's interest and rarely (possibly never) mentioned that the virus still lives in semen 50 days after a person survives ebola and can be transmitted. I can't find anything about vaginal fluid or breast milk.