How Likely is a Worldwide Ebola Outbreak? (pt 2)

Back in March when we first began hearing about the current ebola outbreak, I posed the question [thread=719203]here[/thread] about the chances that such an outbreak could go worldwide. We all pretty much dismissed this nightmare scenario as improbable because ebola kills quickly, past outbreaks had been efficiently contained, etc.

However we are now moving into September. After six months the ebola outbreak is NOT contained. Today reports indicate that the disease has now spread to Senegal. A different strain of the disease is erupting in the Congo. There were 500 new reported ebola cases just in the past week in Africa. The total number of new cases is probably somewhat higher as many people are hiding the disease out of fear of the very health care system that is trying to contain it. The WHO is now forecasting we could have 20,000 infections over the next few months.

So far the disease is contained to Africa, but for how long? The potential for the virus to mutate with such a large outbreak seems suddenly very real. The virus could be used by terrorists who could easily carry it undetected on an airplane with the intention of infecting as many people as possible in the US or elsewhere before succumbing themselves to the disease. Its one thing for a modern hospital to contain a few cases of ebola, but if the number were greater than just a few, well what then?

So is the consensus answer on the widespread ebola outbreak danger different now, and if not —why not?

First world sanitation conditions are considerably better at containing such an outbreak than the jury-rigged situation where the virus is currently active. If you dig a little deeper, the worst outbreak areas are also those that are poorest, with the least infrastructure, and crappiest medical facilities.

Could we get a case walking off an airplane in Europe, Asia or the Americas? Yes, certainly. But I still don’t see it becoming widespread globally because it is not airborne. Avoid contact with anyone’s bodily fluids and you’re golden.

Yet.

DUN DUN DUUUUUUUUUUUUUUUUUUUUUUUUUUUN!!!

Ebola is actually kind of hard to spread. It requires bodily fluid transmission.

Africa has it bad because of very bad sanitation and low education in the affected areas.

The chance of it becoming a global infection are practically nil.

Even in the first world, we are plaqued by many diseases that require bodily fluid transmission. For example, nearly every diarrheal disease. EVERY blood-borne disease and STD (practically by definition), although these are not so comparable given long asymptomatic infectios periods. However, I feel that diarrheal diseases are directly comparable and these do occur in the first world. Ride any cruise ship.

Even the common cold is most frequently spread by hand-to-hand contact (rather than “airborne”).

I really object to some of the statements made by today’s “calm-mongers”. They say things like “If you don’t touch blood, puke, piss, or poop you have nothing to worry about.” The thing is, we all touch these things from time to time, often without our knowledge and often beyond our control. Never more so than when lot’s of sick people begin oozing various fluids from various orifices.

I’m not proposing that everyone panic, but some of the things i’ve heard sound a bit Pollyannish.

How many people do you know who have died of diarrhea? 1% of people you know? .05% of people you know?

I suspect it’s nobody.

5.4% of deaths in developing countries are due to diarrhea. That’s just under the percentage of people who die of lung cancer in the developed world.

Why don’t we die of diarrhea in droves? It’s easy to prevent, and once there is an outbreak it’s easy to contain (Yes, people on cruise ships can get norovirus, but it gets contained- we aren’t still fighting the aftermath.) And if people do get sick, we have good supportive care. Indeed, infectious disease is pretty much a blip on our radar. Even HIV, which is light years easier to spread than Ebola thanks to a decade long incubation period and being spread by something everyone does, is only at .06%-- tragic, but nothing compared to, say, Lesotho at 23%.

Non-airborne infectious disease just isn’t likely to become a general epidemic in the US, especially one with a short incubation period.

I’m not being sunshine and roses for the hell of it. These are strapped countries. Basically every dollar that goes into the economy is a matter of life and death. The economic damage caused by needlessly stopping flights kills people. The loss of tourism is killing people. The blocking of trade is killing people. The medical assistance that can’t fly in is killing people. An American just died because he had malaria and so many medical workers abandon post that he couldn’t get treatment.

So while it’s prudent to follow the advice of epidemiologists and major health organizations (who are certainly not painting a particularly optimistic picture), being overly cautious is not a neutral act. It is an act that causes pain, poverty and death. So as decent people, we need to make sure the shit we repeat is based on facts, not rumor and fear. And we need to do what we can to help these countries return to business as usual (or better) when the epidemic is contained.

I Don’t think diarrhea is a good comparison. Ebola is a disease that easily kills over half those that contact it.

We all agree the poor medical and sanitary conditions in the afflicted countries is enabling the outbreak. But isn’t the spread also somewhat inhibited by the lack of long distance travelling by people in those countries? A carrier in the developed world could carry the virus over a much larger area and thus the virus might be harder to contain.

We have a much better communication and information network in the developed world, but it is anybody’s guess how much better we’d be at avoiding panic should a few cases erupt in multiple areas.

Diarrheal diseases are pretty darn deadly when you don’t have access to rehydration materials and antibiotics. Ever read old novels where everyone is always dying if dysentery? That’s still the scene today in lots of places. Remember that Ebola is just one of many scary infectious diseases people in the area are worried about.

People in the developing world move around a surprising amount, and there are plenty of long distance overland routes (remember how HIV spread along trucking routes?). So Ebola is going to be spreading one way or another. And unlike modern air travel, these overland routes are largely unmonitored. And this is in actual reality what is spreading Ebola right now as we speak. Air travel hasn’t been a huge factor.

I wasn’t speaking to the lethality of diarrheal disease, merely the transmissibility. And it surely is transmitted, even though we are blessed with fancy plumbing and sewage.

It is worth noting that the lethality of Ebola in Africa is probably elevated in many cases due to baseline malnutrition and lack of medical care (just as is the lethality of diarrheal diseases).

Agree with Blue Barnacle, my take:

  1. We are told that it’s not really contagious at all (avoid body fluids and you’re fine)

  2. 1st world healthcare volunteers, like Kent Brantly (US doctor) and William Pooley (British nurse) have gotten the virus and been airlifted back for treatment.

  3. There are increased reports of the disease spreading this summer, despite that its been known for four decades!

Given 2 (factual) and 3 (likely factual), I am very suspicious of 1 and dismiss it as a “keep the people calm” piece of dis-information.

“Avoid bodily fluids” and “not really contagious” are NOT the same thing. The bodily fluids are, actually, pretty damn dangerous in this context. The point is that it is not airborne so being within 10 feet of a puddle of ooze will not kill you. The key is don’t panic, not don’t be cautious.

Obviously, you wouldn’t want to touch surfaces that have been in contact with contagious bodily fluids, either, at least not before rigorous decontamination. Sitting in a chair recently occupied by someone with an active ebola infection is not a good idea. Sitting across the room from such a person is a minor risk at best.

Now, obviously, if it did mutate to become airborne that’s a different situation - but it hasn’t and it’s not likely to. I don’t doubt that there are people watching for that, but until that’s discovered, if ever, there’s no reason to panic.

For experimental treatment in special facilities, basically they were used as lab rats. Yay, they got better but I can’t help but think that if they had died horribly someone would add that into the conspiracy theories.

Well, let’s see - like everywhere else, communications with the affected regions has improved over the years. The population is denser, making the spread of any disease easier. We probably have better reporting.

Do any research at all into ebola and you’ll find speculation that for a long, long time there have been outbreaks that were completely unreported, as an example and entire village wiped out without having communicated with the wider world, it’s just that later someone stumbles across a group of abandoned huts, maybe a skeleton or two inside if they weren’t all dragged off by scavengers.

On top of that, now that people are actively tracking and looking at the outbreak of course you’ll get more cases reported.

Holy crap, sure, 1500 or so people have died in this outbreak but in the average year in the US alone tens of thousands of people die from flu - realistically, which disease should you, personally, fear more?

How much exposure to bodily fluids is needed to contract Ebola? Do you have to ingest them for instance, or would skin exposure do it? What period of time can an infected individual spread the disease before symptoms appear? Are there carriers of this disease, human or otherwise, who could infect others for a long period of time before symptoms appear?

Again the comparison is weak. I get a flu shot every year that pretty much keeps me safe. I have had the flu and did not die. Most people who catch the flu do not die. If avian flu starts spreading human-to-human, I suspect we’ll see a thread or two here expressing some level of concern.

My understanding it is that the level of exposure is trivial- something as simple as wiping your forehead can lead to infection BUT, people are generally not particularly contagious until they are visibly ill and not likely to be very mobile-- so it would be pretty rare to contract it from incidental exposure unless you are working with sick people or bodies. The incubation period before symptoms is 2-21 days, and one is not contagious until symptomatic.

Current wisdom is that there are no asymptomatic carriers. You don’t spread it until you’re actively sick, and if you’re actively sick you won’t be moving around much.

As opposed to some other diseases where you have people spreading it while showing no symptoms.

The thing is, the flu is VASTLY MORE CONTAGIOUS and thus infects so many more individuals that even though the death rate is lower the total number of people killed is much, much higher. Even though an individual case of the flu is less likely to kill you than an individual case of ebola, you are so much more likely to catch the flu (even with an annual vaccination, which provides limited protection) that you are much more likely to die of flu than ebola. You probably won’t ever catch ebola, but you’ll probably have flu more than once in your lifetime.

Now, if you lived in a remote village of the Congo where flu was rare (due to little interaction with the outside world) and sited near a natural reservoir of ebola THEN you would be justified to worry more about ebola. I’m assuming you’re posting from somewhere other than the Congo, though.

Some of the fear seems to stem from people thinking that ebola is somehow as contagious as flu or the common cold. It’s not. That’s one reason health organizations fear a global flu pandemic more than a global ebola pandemic.

Add the important caveat - initial symptoms of ebola can be quite mild (for example headache with temperature less than 100F). There is every indication that a patient can be infectious at that early stage.

Common early symptoms include:
fever
headache
sore throat
general weakness
loss of appetite

Not all patients have all symptoms. Fever in particular can come and go.

True.

However, a “mild” case means fewer expelled body fluids to contaminate the local area and other people. It seems (based on my current knowledge which may change with more information) that there is a direct relationship between the severity of an infection and how contagious a person is.

This might also account for the disproportionate infections involving health care workers - an extremely mild case that never leaves home may not infect anyone else but doctors and nurses care for the most dramatic cases, which also have the most expelled fluids and are therefore the riskiest people to be around.

Who is responsible for this disinformation, and how have they gotten the entire worldwide press and the entire medical/virological community to go along with it?

There are few cases with the kind of published data that would be helpful to make such determination. In the only such case I could find published the viral titer loads were at the highest when he was first ill with mild symptoms. The patient was administered Immunoglobulin and viral loads fell even as his symptoms worsened. It;s not clear if viral loads fell because of this treatment or because his immune system was fighting off the infection (or a combination of the two).

Well, to be fair, some of the virology crowd I am familiar with are serious and logical but saying this is much worse than is being portrayed in the press.