Perhaps the 4 most intelligent things you can read about Ebola today.
October 28, 2014 5:51 PM   Subscribe

The 4 most intelligent things you can read on Ebola today? 1) This week I received a "monograph" for review from an unlikely, politically removed scientist. It was plainly titled "Summary of Ebola Virus Disease," and written in exhaustive scientific detail. The author was Steven Hatfill. If the name rings a bell—I don’t want to dwell on this, but it's germane to the context of his perspective I'm sharing here—it’s because he was very publicly, very falsely accused of killing several people with anthrax in 2001... What he does know, at a depth that can rival any scientist’s knowledge, is Ebola. An interview, with Steven Hatfill and more: 21 Days.

2) [Professed] risk communication experts discuss how (and why) Ebola is stimulating simultaneous over-reaction and under-reaction in Ebola: Failure of Imaginations.

3) An ER doctor with 20 years experience let's us in on the "right question" that everyone "is pretending does not exist": "Dr. Profeta, will they – the staff, you, your partners – show up? " His honest answer in, of all places, a LinkedIn article.

4) Finally, hot off the presses: Assessing the Science of Ebola Transmission. The research (SCIENCE) on how the virus spreads is not as ambiguous as some have made it seem.
posted by spock (74 comments total) 46 users marked this as a favorite
 
I'm not afraid of Ebola. I know that if a couple dozen Americans got it, there would be a massive push to develop a vaccine and immunize everybody.

What I'm afraid of is the massive collective panic that will ensue. Airports, schools, and workplaces will close, anyone with any African connections will be ostracized, the stock market will crash. In this case it's reasonable to be afraid of fear itself.
posted by miyabo at 6:16 PM on October 28, 2014 [19 favorites]


I do not doubt his qualifications, but I don't believe he understands the realities of communicating these kinds of things with the public. When he says that they can't guarantee that Ebola doesn't spread airborne, the news and politicians take it and run with it. This is like everything else in life; you take prudent steps and mitigate what you can, but life is going to go on and we can't live in a bubble or in a constant panic. (As someone once told me, if you want to lose a few night's sleep, go talk with someone who specializes in infectious diseases.)
posted by azpenguin at 6:17 PM on October 28, 2014 [3 favorites]


The Ebola Wars [The New Yorker] is also very informative.
posted by Fizz at 6:20 PM on October 28, 2014 [4 favorites]


From Wikipedia:
Hatfill was enlisted as a private in the U.S. Army from 1975 to 1977.[3] (In 1999, he would tell a journalist during an interview that he had been a "captain in the U.S. Special Forces", but in a subsequent investigation the Army stated that he had never served with the Special Forces.[4])

...

Hatfill submitted his PhD thesis for examination to Rhodes in January 1995, but it was failed in November and no degree was ever granted.[6] Hatfill later claimed a Ph.D. degree in "molecular cell biology" from Rhodes, as well as completion of a post-doctoral fellowship (1994–95) at the University of Oxford in England and three master's degrees (in microbial genetics, medical biochemistry, and experimental pathology). Some of these credentials have been questioned. During a later investigation, officials at Rhodes insisted that he had never been awarded a Ph.D. from their institution.[7] (In 2007, Hatfill's lawyer Tom Connolly[8] — in his lawsuit against former U.S. Attorney General John Ashcroft and the FBI — admitted that his client had "Puffed on his resume. Absolutely. Forged a diploma. Yes, that's true."[9])
Uh, can we seriously not find someone else to listen to here? Even if what he's saying is true, giving him a platform seems like a net negative for the world.
posted by nicolas.bray at 6:24 PM on October 28, 2014 [18 favorites]


I'd like to add this to the reading list: Paul Farmer's diary.
I have just returned from Liberia with a group of physicians and health activists. We are heading back in a few days. The country is in the midst of the largest ever epidemic of Ebola haemorrhagic fever. ... What is to be done? The only formula we’ve come up with is the following: you can’t stop Ebola without staff, stuff, space and systems. ... First, we need to stop transmission. ... Second, we need to avoid pitting prevention against treatment. ... Third, the rebuilding of primary care must be informed by what has been learned from the response to this outbreak. ... Fourth, the knowledge gained from the response must be built on. ... Fifth, formal training programmes should be set up for Liberians, Guineans and Sierra Leoneans. ...

Less palaver, more action.
The snippets don't do it justice. Go and read the whole thing.
posted by MonkeyToes at 6:31 PM on October 28, 2014 [21 favorites]


As someone once told me, if you want to lose a few night's sleep, go talk with someone who specializes in infectious diseases.

Or crack open a pathology textbook with pictures. Yeesh.

I've gone up and down on this, freaked out and morose back to "nah, we'll get through this" and then back to "I don't want to die or watch my kids die, fuck."

I'm kind of glad that this guy is a chronic exaggerator bordering on pathological liar because he pretty much "promotes" for lack of a better word all of my buried / bubbling anxieties on the matter (it's a stretch to armchair diagnose of course, but I've dealt with so many including my former BIL that my instincts are intense and judgmental in fear of being ignored, and people who inflate entire years of their lives tend to lie, dissemble and story-tell almost reflexively).

What's with people lying about military service, so common...especially when it comes to Special Forces, Green Beret, Army Rangers, and Marines. In the case of my BIL he recently told a cop busting him for violating a TRO that he was an "Airborne Ranger" and the cop saw right through that (as if it would make a difference, the cop isn't doing a post TRO-violation psych analysis) because Army Rangers don't call themselves "Airborne Rangers."

I have to fly to Vegas Saturday. Back when Swine Flu was a big deal (2009?) it hadn't really broken out much in the country but I was going to Hawaii and when I arrived, the first Hawaii case was announced. I remember my aunt-in-law trying to practical coerce me to take "Airborne" supplements, which basically involve a huge toxic (IMHO) dose of vitamin A. No thanks. But it'll be a whole different ballgame if it's "first Vegas Ebola case announced" because Vegas is full of sick people who shouldn't have come to Vegas sick, who get sicker, and sick the shit out of everything while drinking, which suppresses their immune system and the efficacy of antibiotics (ask me how I know) while walking to exhaustion and making their bodies into infectious disease dream-houses. Boooo
posted by aydeejones at 6:44 PM on October 28, 2014


Also, when H1N1 / Swine Flu was all blown up into a big thing, there were no official cases in my state (Colorado) for some time, but I know a fellow who assured me that X amount of people were in a special quarantined floor of XYZ hospital that he had been working at for quite some time, i.e. most of his adult life, in a diagnostic / microbiologist /virologist technologist capacity. It was simply not worth panicking everyone about yet and similar situations could've been going on elsewhere while they waited for a hard diagnosis AND confirmation that the disease isn't as horrible as anticipated...the first cases were eventually announced within days but I get why it might be suppressed if only to figure out what is going to happen to these "live specimens." With Ebola we already know.

If we can whip up a vaccine as soon as enough white folks are affected, well...I think that's the beginning of a conspiracy theory that I don't buy into necessarily, I don't buy into anything because it's too lurid and the company you keep in the process aren't exactly convincing advocates with usable information. Because if "we" know "we" can do that, it would make no sense for some group of elites not to have prepared for it already, immunize those who "need" it, and then see exactly how things play out in a world that seems to be in global decline.
posted by aydeejones at 6:51 PM on October 28, 2014


5) The best thing that could have happened to African Ebola sufferers is that Americans contracted the disease.
posted by Renoroc at 6:52 PM on October 28, 2014 [14 favorites]


when H1N1 / Swine Flu was all blown up into a big thing

I think I had it. I had the flu quite badly that Spring, at a time when CDC was saying that H1N1 was almost the only active strain.

I called the County Health people to see if they wanted me to get tested. They said they weren't interested in anyone who was not sick enough to go to the hospital. How sick is that? I asked. She said, difficulty breathing, high fever that won't come down, or, I think, the sick person (sick with flu, not ebola) is disoriented or can't be roused to a state where they know what planet and year this is, but I am not sure about the third thing they told me.
posted by thelonius at 6:57 PM on October 28, 2014


5) The best thing that could have happened to African Ebola sufferers is that Americans contracted the disease.

Damn it. Decent stocks of trial vaccines should be available by mid-2015. Do you really think an American outbreak is going to make it more likely that those stocks will reach West Africa? Really?
posted by Leon at 7:00 PM on October 28, 2014 [4 favorites]


I do realize that is a leap, from "we have neglected it all of these years but figure we can handle it eventually" (human nature, but this is a deadly virus that is already here, not a comet that might hit the earth in 100 years, or climate change) to "some people are already vaccinated" and that it's possible that the elites know it doesn't spread all that terribly bad, so nothing has been done yet.

But if we were talking "2 weeks" to crank out a vaccine, it would seem crazy that someone hasn't made it happen, but they would have to have some seriously screwed-up scientists involved to keep it covered up. Not that there's a shortage of corruptible scientists or anything, lack of objectivity has become a requirement for "professionally paid" scientists a la Monsanto or, well...the military, DOD, etc.

We have the same problem with a decline in new antibiotics or developments in phage biology. There's not any demonstrable money in it yet, so we'll just deal with it when it threatens the global economy.
posted by aydeejones at 7:00 PM on October 28, 2014


I know that if a couple dozen Americans got it, there would be a massive push to develop a vaccine and immunize everybody.

Related idea from the NPR piece Jonas Salk's Polio Vaccine Trials Would Be Hard To Repeat Today: anti-vaxxers would make major vaccine trials like the Polio trial a lot harder, if not all-together unlikely. This is due, in large part, to the fact that no one in the US has had to deal with something as as visible, wide-spread and serious as polio in over 30 years, so the enormous good is largely forgotten, while the very rare bad cases are amplified, exaggerated, and blown up to a modern boogie man.
posted by filthy light thief at 7:32 PM on October 28, 2014 [9 favorites]


I honestly believe that a huge part of America's trouble in dealing rationally with ebola stems from the fact that American pop culture is soaked in zombie movies and shows. People are looking at the disease using 28 Days Later or The Walking Dead as their lens.
posted by tyllwin at 7:41 PM on October 28, 2014 [7 favorites]


Damn it. Decent stocks of trial vaccines should be available by mid-2015. Do you really think an American outbreak is going to make it more likely that those stocks will reach West Africa? Really?

Yes. That's pretty much what happened. Not an outbreak but a few westerners got sick and suddenly Amgen is trying to ramp up Zmapp production.
posted by rdr at 7:54 PM on October 28, 2014 [5 favorites]


I heard a great Ebola joke, you probably won't get it.
posted by T.D. Strange at 7:58 PM on October 28, 2014 [99 favorites]


Simply put modern medicine, funerary techniques, and sanitation combined with the lack of a natural reservoir in the US and other critical factors like mortality rate, incubation time, infection rate, etc make the chances of a significant outbreak of Ebola in the US exceedingly small.

At the end of the day it requires contact with bodily fluids and it's highly lethal nature actually work against it ever becoming a major public health threat to the US.

If you are going to adopt a sky is falling attitude be more concerned about Drug Resistant Bacteria or a Pandemic Flu as both of them are much more likely to result in the deaths of a lot of Americans.
posted by vuron at 8:00 PM on October 28, 2014 [7 favorites]


As I've probably made abundantly clear to the point that nobody wants to hear anymore, I work in Cote d'Ivoire, very close to the Liberian border. Since people tend to generically just know that I work in West Africa (and have a tenuous at best grasp of African geography), I've had about a zillion conversations about Ebola with people over the past few months. "Yes, I'm pleased to have left before Ebola arrived." "No, I don't think you need to be worried for your own safety." "Yes, you will certainly be fine if you go to Kenya in a few weeks. Kenya is very far away from Sierra Leone."

My field assistant, Frederic, gave me a call last week to make sure I'm still planning on coming back this summer. I told him I wasn't sure, it depended on the Ebola situation. He reminded me that there are more people in the US than in Cote d'Ivoire with Ebola - "You should come to Cote d'Ivoire - you'll be safer here!"

And this attitude is incredibly gross. Something doesn't have to kill lots of Americans to be worthy of concern!
posted by ChuraChura at 8:11 PM on October 28, 2014 [17 favorites]


I'd like to add this to the reading list: Paul Farmer's diary.

So good.
I’ve been asked more than once what the formula for effective action against Ebola might be. It’s often those reluctant to invest in a comprehensive model of prevention and care for the poor who ask for ready-made solutions.
posted by rtha at 8:13 PM on October 28, 2014 [17 favorites]


I don't think anyway is saying that it shouldn't be a concern for the appropriate public health specialists it's just that media fueled hysteria in the US is super common and it's being manipulated for political gain and it's ultimately got Americans more concerned about a very very unlikely event than a ton of risks that surround them every day.

If you plan on working an aid worker in the region I'd be concerned but otherwise it's just not something most Americans need to be getting anxious over.
posted by vuron at 8:24 PM on October 28, 2014 [1 favorite]


Hatfill: When the SARS epidemic happened, Singapore came very close to being wiped out. People don't realize this.

Uhhh, what? SARS has a 10% fatality rate. 33 people in Singapore died from it.
posted by justkevin at 8:35 PM on October 28, 2014 [9 favorites]


And this attitude is incredibly gross. Something doesn't have to kill lots of Americans to be worthy of concern!

I agree, but that appears to be the current political reality in the developed world.

Farmer is right. If we built and sustained equitable health care for everyone we would eliminate a whole set of diseases that rely on social marginalization, deprivation, and lack of access to basic care. But instead we are continuing in the opposite direction with no change of momentum that I can see.
posted by Dip Flash at 8:38 PM on October 28, 2014 [1 favorite]


Hatfill: When the SARS epidemic happened, Singapore came very close to being wiped out. People don't realize this.

This is a tremendous load of smelly bullshit. Why are we talking about this pompous moron fraud?
posted by His thoughts were red thoughts at 9:29 PM on October 28, 2014 [4 favorites]


Yeah, I know we should be talking about Ebola rather than Hatfill here but I just now clicked on that first link and discovered to my horror that it goes not to some random blog or something but rather to the Atlantic.

Hamblin's article was such a mind-blowing act of stupidity that if I were his employer, I would fire him on the spot. It will be very hard to take anything he says seriously after this. Actually, it's worse: to list Hatfill's supposed academic credentials without informing readers that he lied about having a PhD is absolutely journalistic malpractice.
posted by nicolas.bray at 9:39 PM on October 28, 2014 [10 favorites]


There is no chance Ebola is going to go airborne like this fellow says. It's not a respiratory disease.

The greatest threat is that Ebola will mutate to become less deadly. By killing fewer people the virus will survive longer and be able to infect more people.
posted by Nevin at 9:51 PM on October 28, 2014 [3 favorites]


Just chiming in to say that Paul Farmer is an (inter)national treasure and I'm very proud to be working in the same field that he is (global health.)

If you haven't read any of his books, I highly recommend you do so if you have any interest in health in a context of international inequality. They're very accessible even for non-academic readers.
posted by WidgetAlley at 10:08 PM on October 28, 2014 [6 favorites]


Do you really think an American outbreak is going to make it more likely that those stocks will reach West Africa?

Leon, I am really very near 100% confidence that we will never see Ebola cases in the U.S. beyond single digits at any one point during the current outbreak. I won't say that nobody will die here, but even with the missteps we've seen the transmission has been extremely limited -- none of Duncan's family contracted Ebola at all, for example.

A vaccine would be wonderful, a proven treatment that vastly increases survivability will (and apparently may be) superb, but the number one thing that stops an Ebola outbreak is diligent case follow-up by basic public health personnel, not some miracle cure.
posted by dhartung at 12:16 AM on October 29, 2014 [1 favorite]


I wish the media would talk about the fact that 10,000x as many people will die of influenza this year in the US as will die of ebola.
posted by persona au gratin at 2:02 AM on October 29, 2014 [2 favorites]


Hatfill: When the SARS epidemic happened, Singapore came very close to being wiped out. People don't realize this.

Yeah no. I was living in Hong Kong at the time (another epicentre of "atypical pneumonia" as it was known, due in no small part to the population density - the irony of the 'SARS' appellation that came about when the rest of the world started to pay attention was not lost on Hong Kongers) and it was nothing like the existential threat Hatfill makes it out to be. Not a nice disease to be sure, but nowhere was in any danger of being 'wiped out'.
posted by Dysk at 2:30 AM on October 29, 2014




I am really very near 100% confidence that we will never see Ebola cases in the U.S. beyond single digits at any one point during the current outbreak.

I agree completely, which is why the "evil drugs companies are only stepping in now the west is threatened" kneejerk is so frustrating.

There was a fantastic piece on Radio 4 a few days back about the ebola crisis. Really worth listening to.
posted by Leon at 2:55 AM on October 29, 2014 [1 favorite]


I've found this piece quite informative.
posted by hat_eater at 3:38 AM on October 29, 2014


Ivory Coast should be all the reassurance one needs that the current epidemic is more a result of poor infrastructure than virulence. Otherwise the whole entire area would be a mess and not just border-defined regions.
posted by From Bklyn at 4:33 AM on October 29, 2014 [1 favorite]


the current epidemic is more a result of poor infrastructure

West Africa needs what Cuba has: a well-trained, coordinated healthcare system. Anything less and Ebola wins
posted by Mister Bijou at 5:46 AM on October 29, 2014 [1 favorite]


Farmer is a hero.

Hatfill is a hack.

The science is clear, and yet many elected officials are making Ebola-response policies that are security theater instead of public health.
posted by entropone at 5:58 AM on October 29, 2014


Books that may interest people who want to know more about similar related topics:

Spillover by David Quammen
Ebola by David Quammen (recently released)
Rabid: A Cultural History of the World's Most Diabolical Virus by Bill Wasik & Monica Murphy
The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time by John Kelly
Rats: Observations on the History and Habitat of the City's Most Unwanted Inhabitants by Robert Sullivan
On Immunity: An Inoculation by Eula Biss
The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry
posted by Fizz at 6:01 AM on October 29, 2014 [7 favorites]


A teacher in Maine suspended because he traveled to Dallas for an educator's conference? Jesus wept.

At least there was Ebola in that area during his visit. A child in Milford, CT is being kept out of school for travelling to Nigeria, because , uh... it's right next to Liberia, right? If only there was a place where they could send their children to learn geography.
posted by dances with hamsters at 6:31 AM on October 29, 2014 [9 favorites]


I wish the media would talk about the fact that 10,000x as many people will die of influenza this year in the US as will die of ebola.

The other day, my 60-something mom was visiting and said, "You know, I'm really worried about this Ebola thi--" and my warning finger shot up into the air.

"MOM," I said. "Have you had your flu shot?"

"No, I don't believe in them."

I then gave my full and frank opinion on why she should get one, and reminded her how many people flu affects EVERY FREAKIN' YEAR, and told her that I am not going to hear one damn word about her Ebola worries until she has had her shot.
posted by MonkeyToes at 6:41 AM on October 29, 2014 [23 favorites]


5) The best thing that could have happened to African Ebola sufferers is that Americans contracted the disease.

Not really. I'm not a "when white people get it we'll release the vaccine" conspiracy theorist. But the reality is not much better, and it doesn't bode well for attacking the disease at its source.

The only reason we think of Ebola as an apocalyptic harbinger of human extinction - well besides Hollywood obviously - is because it is incredibly deadly in the West African settings where we've always encountered it. As it turns out, when you put Ebola in the first world with real hospitals and adequate supplies, etc., it isn't really all that dangerous. As that article notes, of the eight people who have now been treated for Ebola in the U.S., seven have recovered. Ebola's horrific mortality in West Africa says less about the intrinsic virulence of Ebola itself than it does about the horrible state of medical infrastructure in poor, third-world countries.

So no, it's not a case of "we're going to go ahead and fix it now that white Americans are getting it." But it's just about as bad. It's a case of "If white Americans get it, we can cure them." It's worse, really, because the only reasons Liberia doesn't have the same hospitals and trained personnel and drugs and equipment that the U.S. has are economic and social, not hard scientific barriers. If we aren't even going to make sure they have enough rubber gloves over there, what makes you think we'll flood the area with an ebola vaccine when we have one?
posted by Naberius at 6:48 AM on October 29, 2014 [3 favorites]


Not really. I'm not a "when white people get it we'll release the vaccine" conspiracy theorist. But the reality is not much better, and it doesn't bode well for attacking the disease at its source.

Kofi Anon is right though when he says that Americans weren't all that worried about helping West Africa tackle this disease until hit our shores. It's not so much that we'll finally create/release a vaccine is that something generally doesn't penetrate the US news cycle until it affects Americans in America.
posted by dances with hamsters at 6:56 AM on October 29, 2014 [1 favorite]


I can't control the way anybody evaluates information, or whether or not they even read the articles, but Hatfill is not saying a lot of things that others, like the Director of CIDRAP, Michael T. Osterholm, hasn't already said in public. I direct you to the John Hopkins forum on ebola (Part 6) earlier this month*
*I watched the video archive the same day when it was in only two parts. Osterholm was the keynote speaker and his part was dynamite. Now that it has been broken into chunks, I can't say whether parts were edited. There was also a Q&A from the audience after the speakers in which more was said by Osterholm.
People focusing only on the "When the SARS epidemic happened, Singapore came very close to being wiped out. People don't realize this." is also a little hilarious. (Ignorant comments also make his point for him.) First of all, he was not a talking about "wiped out" in terms of death toll. He was talking about how close to the brink they were from being isolated economically. It has been over a decade ago, so you might be forgiven for forgetting (and the whole story didn't come out for years) but for a nice review you might want to read Chapter 4 of Chinese National Security Decisionmaking Under Stress by Andrew Scobell, Larry M. Wortzel. The chapter is entitled "SARS 2002-2003: A CASE STUDY IN CRISIS MANAGEMENT".

Things I find it interesting that no one has commented on:
I went for a Department of Defense interview years ago. They wanted a scientist down at the Pentagon that could invent stuff that would support presidential policy. ... They just wanted a spokesperson that could kind of come up with a plausible explanation to explain a higher-up directive. And I think this is the same thing.
Another part that I found interesting:
Hamblin: Is there any other better screening measure that could be considered?

Hatfill: We have rapid PCR tests. Texas had them, but they're not allowed to use them because the FDA never certified it. We have a classified set of Department of Defense primers for PCR that work great.
That nurse and lab technician who handled the blood from the first guy, Duncan, I'm sure his blood went to the lab and he had a full blood count at his first admission. Well, Coulter counters [machines used to perform blood tests] are notorious for making little aerosols. And the fact that nobody in the laboratory came down with it is, yay.
Gee, I didn't know that the machines that test blood in hospitals make little aerosols. Either that is a fact or it isn't. That Hatfill said it doesn't automatically make it a non-fact, I'm sad to say. There is also a lot of confusion in the public between the words "airborne", aerosol-transmissible, and droplet. He sheds some light on that.

A whole 'nuther discussion could be had on how ebola illustrates the entire problem with having a healthcare system that is built on "for-profit" rather than what is best for the public good.
Hatfill: Depends on how much they practice. And if it's not mandated, hospital administrators aren't going to do it. They're stressed as it is.

Hamblin: It's a tough investment to justify until a threat is imminent.

Hatfill: Exactly. You want me to do what? Practice what? You know, that's going to cost the hospital. So I mean, this is for-profit medicine in this country, unfortunately.

Hamblin: Speaking of the for-profit: Pharmaceutical companies, they're not going to factor into development of vaccines and treatments of emerging infections diseases.

Hatfill: Well no, because the majority of [Ebola] patients don't have any money. These are businesses. Fair on them, it's a business, right? ... Do we have enough Tyvek suits? This was a thing that was brought up yesterday evening during a meeting. Dupont can make these things, we can crank them out and we can double our capacity, but if the epidemic ends we've just outlaid millions to ramp up capacity. Who's going to pay us? Because we're not going to do it on our own, we're a business.
posted by spock at 7:00 AM on October 29, 2014 [1 favorite]




Re. SARS and Singapore:

Of course it's wildly irresponsible of Hatfill to say, from this perspective, that 'Singapore almost got wiped out.'

But according to Paolo Bacigalupi, who was traveling in Thailand at the time, Thais at least were scared shitless.

This of course was irrational panic. The point is that they were pretty scared in some parts of the region, even if they approached the problem more realistically in others.
posted by lodurr at 7:48 AM on October 29, 2014


Rabid: A Cultural History of the World's Most Diabolical Virus

You think people, especially in the American northeast, would be much more worried about rabies than Ebola. Or car accidents, for that matter.
posted by Nevin at 7:53 AM on October 29, 2014 [1 favorite]


Kofi Anon is right though when he says that Americans weren't all that worried about helping West Africa tackle this disease until hit our shores

We still aren't. At the large scale, Americans' response to this isn't, "we need to build up medical infrastructure in West Africa to stop this thing." It's "we need to seal that place up and leave them to die so they don't infect us." This is a purely social problem, not a technological or scientific one. If we really wanted to solve it, we'd be doing it.
posted by Naberius at 7:59 AM on October 29, 2014 [5 favorites]


Thanks for this post.

I was also planning to post a Paul Farmer piece today. Just googling Paul Farmer Ebola will lead you to a number of articles he's been doing for the press (Slate, Washington Post, London Review of Books) about Ebola with an enormous emphasis on the need for building basic medical infrastructure to prevent disease transmission and save lives.

Ebola, like most deadly diseases, is a disease of poverty and inequality. Reducing inequality and poverty will reduce ebola, just as it will reduce almost every other killer from deadly diarrheal disease to diabetes. Although as Farmer points out, the “bush meat” issue is wildly overplayed, this is a simple example of a practice that is extensive because of poverty.

We won't get rid of epidemics until everyone has their basic needs met for food, shelter, and meaningful ways to engage in the world. Robust, local medical systems (instead of the current options of nothing with outsiders flying in for emergencies) are essential in the countries where Ebola is blossoming right now.

Besides the important messages about the politics of health, I found the Farmer diary moving for discussing the way Ebola attacks caregivers – from family members to doctors – and how tragic that is.
posted by latkes at 8:10 AM on October 29, 2014


Nurse Kaci Hickox says she won't obey Maine's Ebola quarantine: I won’t be 'bullied by politicians'

Good for her. It's not often that there is an issue where the NRA types and the ACLU types should be on the same page, but this house arrest nonsense needs to be reigned in.
posted by sparklemotion at 8:14 AM on October 29, 2014 [1 favorite]


The State of Maine is now basically stalking this woman to make sure she doesn't go out in public, and is seeking legal authority to enforce the quarantine. I just... I can't even. I don't know what to think.
posted by roomthreeseventeen at 8:17 AM on October 29, 2014




I thought the Hatfill article was pretty interesting. With a basic level of understanding of infectious disease, I think it's possible to read his ideas with a grain of salt and still learn a lot. My personal takeaway is that our country is not taking research into infectious disease seriously and that's pretty terrifying no matter how you slice it.

Working in a hospital, the second link from the ER doc resonates a lot, and, consistent with Hatfill’s critiques, I just don’t think we are prepared to prevent transmission of pathogens effectively, not because it’s impossible, but because our systems suck.

Yet again, I am deeply depressed by how a country with so much wealth uses it just to make rich assholes richer instead of enriching and protecting our communities as a whole. Please raise my taxes. And then use them for medical care and research and education and system improvements and pulling people out of poverty instead of for beefing up CEO pay.
posted by latkes at 8:45 AM on October 29, 2014 [5 favorites]


My wife's a nurse who has a lot of patients from West Africa. We are New Jersey residents. I'm more afraid of that sick fuck Chris Christie imprisoning her than from her getting sick from ebola.
posted by MisantropicPainforest at 8:46 AM on October 29, 2014 [2 favorites]


Besides the important messages about the politics of health, I found the Farmer diary moving for discussing the way Ebola attacks caregivers – from family members to doctors – and how tragic that is.

Paul Farmer is a gift to humanity. I'm glad his writing on Ebola is getting publicized and I hope his voice on this issue becomes the dominant one.
posted by MisantropicPainforest at 9:05 AM on October 29, 2014


While we've been all aquiver over Ebola, 1500 Americans have died of MRSA.

1500.

Americans.

Died. Died painful, agonizing, needless deaths from a manmade plague, made with the active connivance of the same politicians using Ebola for their own ends.

Some people should be jabbed with punji sticks made of Iowa pigshit.
posted by ocschwar at 9:29 AM on October 29, 2014 [5 favorites]


We still aren't. At the large scale, Americans' response to this isn't, "we need to build up medical infrastructure in West Africa to stop this thing." It's "we need to seal that place up and leave them to die so they don't infect us."

I think that's an unfair statement to make. The United States is leading the world's response to the ongoing crisis in west Africa. There's a lot of talk, but most of the 150+ members of the UN are offering words, and not, as the US is doing, any meaningful help.

While I am no expert, the Western response to the crisis does seem to have been slow, and we as a global community are behind the curve, that's for sure.

However, at this point the response is reactive. It seems to have little to do with focusing efforts on developing a vaccine as opposed to restoring what little health infrastructure there was in Liberia and other affected countries in the spring, at the start of the outbreak. The US troops who have deployed seem to be in the business of setting up regional treatment/triage centres, like what MSF has been doing.

I know it's fashionable to hate on the US for a variety of reasons, but while it is an imperfect response, the Americans are at least doing *something*.

(btw I am not an American)
posted by Nevin at 9:45 AM on October 29, 2014


I just received an email about ebola from the American Society of Tropical Medicine and Hygiene, whose conference I will be attending next week in New Orleans. As you might guess from the name, there are a lot of people who do their medical work in tropical setting, including west Africa.

The letter states, in part (bolding mine):
ASTMH Conference Attendees:

This is a notification for conference attendees of the 63rd Annual Meeting of the American Society of Tropical Medicine and Hygiene on November 2-6, 2014 in New Orleans, Louisiana from the Louisiana Department of Health and Hospitals to address concerns regarding the possible importation of Ebola Virus by attendees of the conference who may have been exposed in the current Ebola Virus Disease (EVD) epidemic in West African countries of Guinea, Liberia, and Sierra Leone.
...
From a medical perspective, asymptomatic individuals are not at risk of exposing others; however, the State is committed to preventing any unnecessary exposure of Ebola to the general public. As part of that commitment, we have requested that any individuals that will be traveling to Louisiana following a trip to the West African countries of Guinea, Liberia, and Sierra Leone or have had contact with an EVD-infected individual remain in a self-quarantine for the 21 days following their relevant travel history. In Louisiana, we love to welcome visitors, but we must balance that hospitality with the protection of Louisiana residents and other visitors.
...
Given that conference participants with a travel and exposure history for EVD are recommended not to participate in large group settings (such as this conference) or to utilize public transport, we see no utility in you traveling to New Orleans to simply be confined to your room.

These precautions are being taken out of an abundance of caution for the current situation, and certainly do not reflect a lack of appreciation for your service and sacrifice in efforts to treat and end the epidemic of EVD.
This type of response is politically responsible, but potentially problematic from a public health standpoint. These types of conferences allow researchers and clinicians to share information, strategies, and generate new ideas. It is yet another in a string of decisions that have the unforeseen consequence of reducing the desirability of conducting the difficult and necessary work that must take place in West Africa in order to stop the spread of this disease. If we, as a global research and medical community, cannot stop the disease in West Africa, there will continue to be these occasional cases in non-West African contexts. Quarantines are never 100% effective, and they often have unintended consequences as people attempt to hide their symptoms or travel history in order to go about their lives.

I had often wished that tropical disease epidemiology was more in the news - people don't give a damn about the diseases I work on - but the scare-mongering, disproportionate coverage of ebola has made me deeply irritated. Even people I know with science backgrounds are calling for travel bans and quarantines and isolation, in spite of lots of indicators that those measures are of, at best, limited utility.
posted by palindromic at 10:00 AM on October 29, 2014 [5 favorites]


Here's a slideshow of the US global health budget request for FY 2015; here's a more detailed fact sheet.

Please note: "Pandemic Preparedness funding through the GHP account totaled $50 million, a decrease of $22.5 million (-31%) below FY14. The decrease in pandemic preparedness funding was the second largest percentage decrease among all areas under the GHP account. Additional funding provided through other accounts, such as the ESF account, is not yet known." (from the linked fact sheet; emphasis mine)

I work for the place that produces the slideshow and the fact sheet, but I don't work on the policy side.
posted by rtha at 10:10 AM on October 29, 2014 [1 favorite]


Mistakes at our level four labs prompted closures recently. The facility that awfulizes existing mega predators has been shut down, hooray! Religion and pestilence meet regularly worldwide, and I worry religious ideologues might want to help God out with the end times. A little end time plague propaganda goes a long way, but weaponized viruses go even farther. We currently have a virus loose in the US which has paralyzed or partially paralyzed a whole lot more kids than Ebola has taken US victims. Not all the kids have antibodies to the virus, Maybe we should spend our money making sure bug spray, at the daycare didn't do this. The US has has several babies born without brains up in the Yakima area, many more than US Ebola patients, lets look after our own environment and the internal environment created by vaccination. Let us make more sure the whole process is safe for our nation, and our children and grandchildren do not act as guinea pigs for, for profit or prophet, big pharma / bio warfare. Hatfill didn't do it bit someone from our labs did, now they are more sophisticated. The sloppiness at the labs probably wasn't.
posted by Oyéah at 10:12 AM on October 29, 2014


My draw just drops at people who, when discussing this, show that their only concern or focus is on what affects "Americans". You could insert any other nationality there, as well, but it looks like "Americans" are the most vocal in exhibiting their complete and utter ignorance of how interconnected the world is today - transportation-wise, economically, etc.) and how pandemics work. It also really doesn't matter too much how many other diseases or things there are that kill people (even in greater numbers). I fear there are a lot of people who won't get it until they get it. See also: Metafilter, The Trouble with Ignorance is that it Feels So Much Like Expertise..
posted by spock at 10:26 AM on October 29, 2014 [2 favorites]


palindromic's comment is a good one (favorited) and I would like to make one other point. No question that there are media entities that are looking to sell papers, magazines, Nielson Ratings, and clicks. Fearmongering happens. But don't confuse that with the facts of the case. Remove the fearmongering and just look at the facts and, if you have a brain in your head, you see that serious concern is warranted. It is childish to say, fearmongering irritates me so much that, as a reaction, I'm going to poo-poo this as being a serious problem (or will until it is affecting "Americans" or is killing more people than "X" disease or virus does). Apples and oranges. Listen to the right people - not the fearmongers. See my 2nd link in the original post "Ebola: Failure of Imaginations "(which has yet to be commented on).and ask yourself why you are reacting the way you are.
posted by spock at 10:35 AM on October 29, 2014


I think some people in this thread are mistaking cynicism ("yeah, nothing's really gonna get done to address Ebola until white Americans start coming down with it") for approval ("and that's the way it should be!") What sounds like "fuck the rest of you, we're fine here in America" may be a weary agreement with the Médecins Sans Frontières coordinator who was "flabbergasted" at the lack of coordinated international response.
posted by Lexica at 11:11 AM on October 29, 2014 [2 favorites]


So no, it's not a case of "we're going to go ahead and fix it now that white Americans are getting it." But it's just about as bad. It's a case of "If white Americans get it, we can cure them."

Possibly coincidental, but the only American patient to have died was the black guy.
posted by T.D. Strange at 11:15 AM on October 29, 2014 [1 favorite]


In a good flu year thirty thousand Americans die. In a bad flu year seventy thousand Americans die. Tropical diseases are on the move into what were once cooler climates. The world is working out a response to this, while global warming deniers are shaking with fear over Ebola. Pathogens are a world problem, just like humans. How do we solve the bigger equations, since Ebola is the sum of just one of them?
posted by Oyéah at 12:11 PM on October 29, 2014 [1 favorite]


Possibly coincidental, but the only American patient to have died was the black guy.

You know, you know, I almost made that observation to address it, but then I didn't.

Duncan's problem was that he was diagnosed too late to save him. Part of that is just the bad luck of what happened to him, though I suspect a little of it can be laid at the feet of a private, for-profit medical system where the incentives weren't there to prepare them to deal with something like Ebola. That's also primarily to blame for the infections of nurses Nina Pham and Amber Vinson. (FWIW, Vinson is an African-American survivor.)
posted by Naberius at 12:45 PM on October 29, 2014 [1 favorite]


Duncan's problem was that he was diagnosed too late to save him. Part of that is just the bad luck of what happened to him, though I suspect a little of it can be laid at the feet of a private, for-profit medical system where the incentives weren't there to prepare them to deal with something like Ebola.

"On Friday, Sept. 25, 2014, my uncle Thomas Eric Duncan went to Texas Health Presbyterian Hospital Dallas. He had a high fever and stomach pains. He told the nurse he had recently been in Liberia. But he was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol."

Source: The Dallas Morning News
posted by Mister Bijou at 2:56 PM on October 29, 2014 [5 favorites]


There are all kinds of theories why Ebola hasn't arrived in Ivory Coast, despite the fact that it shares a long and very porous border with two Ebola-afflicted countries, Liberia and Guinea.

Some Ivory Coastians credit a beefed-up border patrol. The religious citizens in this Catholic country thank God. But Mumadou Traore, who works as a field coordinator for CARE International, has a third theory. He credits the legendarily infuriating Ivorian bureacracy.

French bureaucracy is a "blessing" for us, he says, because people here respect authority. Not like in Liberia and Sierra Leone, he says where people aren't obeying their own health officials.
posted by ChuraChura at 4:01 PM on October 29, 2014 [1 favorite]


In a good flu year thirty thousand Americans die. In a bad flu year seventy thousand Americans die.

I understand the need to keep things in perspective, but every time I hear this statistic the numbers are creeping upwards. For the record: "CDC estimates that from the 1976-1977 season to the 2006-2007 flu season, flu-associated deaths ranged from a low of about 3,000 to a high of about 49,000 people" with an overall average of 23,607 annually.
posted by peeedro at 6:18 PM on October 29, 2014 [3 favorites]


While your stat is accurate, it is misleading for two main reasons :
1) "Influenza encapsulates a whole host of different "bugs" (h1n1 is different from h7n9, for example, but would both be considered "flu". Ebola is ONE of the family of filoviruses).
2) most people on the planet have had, and survived, perhaps many of those influenza viruses over the course of their lives. Unless one has an "underlying medical condition" or is in a high-risk group (either the elderly or the very young) you don't fear dying from influenza, regardless of what the numbers say. Ebola? Not quite in the same (pedestrian) league, is it?
posted by spock at 6:52 PM on October 29, 2014 [1 favorite]


Another rather huge difference between influenza and ebola is that for influenza you can go and receive competent, life saving treatment at any hospital in the country. Isolation is not required even though transmissibility is "airborne". Meanwhile, Ebola is a "Level 4" pathogen that requires strict isolation and special treatment for both caregivers and lab samples. Only a handful of facilities in the COUNTRY reach that criteria. Pretending that they are in the same league, or that "by the numbers" influenza is something that deserves more attention is (in a word) whacked. Please reconsider your information evaluation process.
posted by spock at 7:07 PM on October 29, 2014 [1 favorite]


I have an appointment with a new doc tomorrow - a neurologist who's fairly new on the scene here in Spokane. Today his receptionist called to remind me of the appointment; she then said she had two questions for me "regarding travel":

1. Have you traveled to or from West Africa in the last 60 days?
2. Have you had contact with anyone who has traveled to or from West Africa in the last 60 days?


I answered no to both questions, so I guess I'm good to go.
posted by aryma at 11:13 PM on October 29, 2014



"On Friday, Sept. 25, 2014, my uncle Thomas Eric Duncan went to Texas Health Presbyterian Hospital Dallas. He had a high fever and stomach pains. He told the nurse he had recently been in Liberia. But he was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol."


Several years ago on a Wednesday evening a friend of mine, Curtis, (38 and white if it makes any difference) went to the hospital ER with agonizing pain in his hip, lower abdomen and back. He had no medical insurance and no cash to pay for his treatment, and he looked scruffy because he'd been in bed for two days, thrashing around in pain.They did an x-ray, told him he had some arthritis, and sent him home with ten Tylenol #3 pills.

On Friday morning, he was in such pain he called the EMTs who had him transported to the hospital (the same hospital). He died around 8:00 that evening from raging MRSA infection.

I'm still furious with the physician who sent him home that Weds night, but doctors can and do screw up; however, the doctor who sent this poor man home even knowing he'd just returned from Liberia should be in some deep trouble; I think he should lose his license because if Mr. Duncan had actually had an aggressively contagious deadly disease releasing him could have endangered hundreds of people. The problem with both cases, of course, is the fact that these men were poor and uninsured and sick enough that their appearance was down and out, and one of them was a man of color - another strike against him. Both were given substandard medical care because they were judged to be bums - or whatever the current term would be; in Curtis' case, they probably considered him a drug seeker since his primary complaint was that of pain.

It just struck me how similar the two cases are, one involving the most fearsome medical beast today - Ebola - and the other involving the most fearsome medical beast of yesterday - MRSA.
posted by aryma at 11:41 PM on October 29, 2014 [1 favorite]


Jina Moore has been doing good reporting about Ebola in Liberia.
posted by latkes at 7:29 AM on October 30, 2014


"The Louisiana Department of Health and Hospitals just ruled that anyone who's been in Sierra Leone, Liberia or Guinea in the past three weeks "should NOT travel to New Orleans to attend the conference." (That big "NOT" is in the original letter.)"

The conference is the The American Society of Tropical Medicine and Hygiene conference. But who needs reports or talks or input of any kind from people researchers and clinicians with recent on-the-ground experience? /headdesk
posted by rtha at 7:44 PM on October 30, 2014 [3 favorites]


The conference is the The American Society of Tropical Medicine and Hygiene conference.

Jesus. Ugh.
posted by latkes at 9:48 PM on October 30, 2014


My preferred news source for Ebola is a podcast called This Week in Virology.
posted by monkeys with typewriters at 11:44 AM on October 31, 2014 [1 favorite]


Maine quarantine struck down.

Maine governor says he doesn't trust Kaci Hickok.
posted by rdr at 1:12 PM on October 31, 2014


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