To borrow an idea from math, "doing good" isn't a commutative, infections and diseases are. Have some respect for others and slow your roll before going out during the 21 day post exposure window.
It's a bit like saying, "Hey I've saved lives over here so I have earned the right to be irresponsible over here". Because you know, karma balances out. No, the world doesn't work like that. And you aren't doing any good propagating this idea either because it encourages this privileged way of thinking.
As much as this guy isn't being vilified (and say what you want about the government spinning its story of ebola being hard to transmit), lets think clearly and rationally. He knew the risks that he could possibly be infected and decided to endanger others when he could have easily stayed home or gone anywhere to a more isolated environment (upstate NY is calling). It is well known symptoms generally show up by the 10th day. Today is his day 10.
It's very interesting that the government has locked down this guys apartment, yet if you need contact with bodily fluids to contract the disease why quarantine the apartment and surroundings? Could it be that droplets are a transmission method as many people are starting to suspect. Sneezing and coughing may spread these droplets to the floors and walls? And if that is the case, what about other objects that come in contact with saliva and other fluids like utensils, door handles, glasses...
> He knew the risks that he could possibly be infected
> and decided to endanger others when he could have
> easily stayed home
That may be over stating things. Given that he is a doctor, and he is confident in his process with keeping clean, he might actually have a really hard time believing that he was infected. People have faith in their own abilities, that lets them do things which might put them at grave risk.
In the military service you will hear it as "trust in your training." Basically you believe you won't be the guy that gets shot or steps on a land mine or what ever because you trained really hard and you know you are implementing that training flawlessly.
It is entirely possible this person was so confident in their training, and their own competence in putting that training into action, that they believed it was impossible for them to be infected. They do the self monitoring because that is what you are supposed to do, but it never comes up positive because you did what you were supposed to do. This gets worse the more times you do something and the outcome is exactly as you expect it to be.
So I can believe this guy didn't believe he was at risk. Just like I have foolishly believed this small change I am checking in can't break anything[1]. One hopes he was asymptomatic when he went out. Unlike the guy in Texas who was showing symptoms and went home, or the nurse who had a fever and got on a plane anyway.
Sure you could put anyone coming back from West Africa in an airstream trailer [2] for 21 days but that is impractical if you want to support the process of fighting it in West Africa.
[1] I know, hugely different scale, but illustrative of my fight against my own assumptions in the pursuit of better process.
"Given that he is a doctor, and he is confident in his process with keeping clean, he might actually have a really hard time believing that he was infected."
Unless you are in proper (BSL-4) lab, the sad reality is there will always be risk. I hope that MSF doctors and volunteers are well protected. But it worries me that they would even contemplate believing that they have zero risk of exposure. That's simply not scientific or a professionally responsible. Although, to be fair, the CDC was guilty of making this same assumption up until about two weeks ago.
It makes more sense for them to spend 21 days self monitoring (in a secluded environmnet) locally in country. There is no need for a complete travel ban, but a staged ingress/egress process would make sense. And certainly we don't need to be issuing sight-seeing or tourist visas etc. Critical business travel could also be easily arranged for with a built in waiting period (most visas take 2-6 weeks anyway to issue).
You can fight the deleterious effects on support of quarantining by making the quarantining fun/enjoyable/pleasant. Choose a remote resort location, rent it out for the duration of the crisis, send everyone there to sit out their quarantine in comfort.
I wouldn't mind a 21 day quarantine on a beach or camping
I don't know much (well, anything really) about disease transmission, but should these health workers not quarantine themselves away from the immediate vicinity of the infection, but before taking a cross-Atlantic/Pacific flight where they could infect a number of other people in close proximity?
I would have through the health agencies they volunteer with would enforce these kind of quarantines to prevent international transmission of disease.
On one hand I can't help admire these people risking their lives to help people on the other side of the world. On the other hand some of them seem content to play Russian roulette with their neighbors and family back home, which makes no sense to me. Is it as the OP suggested that doctors make for bad patients?
I thought it was well known that ebola can be spread through any bodily fluids and that this includes droplets from coughing and sneezing. What they don't yet know is whether ebola is 'airborne' - i.e. dried droplets that can float in air as is the case with measles for example.
If you asked 10 average people what they think "airborne" means in this context, I doubt they'd say there is a difference between wet and dry transmission. I'd say for the purposes of argument, if a guy coughs violently on you because he's sick there is risk you could get Ebola. If a guy vomits in the subway car, apparently there is a risk of Ebola transmission. I've been on the subway cars and in taxi cabs it happens more than you think. Do you think they bleach all of those things adequately? No way, the financial incentives don't align to properly do it.
The government is using semantics and spin to their advantage by saying it isn't airborne via dried viral transmission. The WHO agrees[1] that it also isn't airborne, but also admits surfaces can transmit the virus.
Most officials omit this detailed explanation since they have no adequate explanation of how to decontaminate the urban environment en masse if an outbreak does occur.
In the end we all have to assess our own risk profiles. Will I stand or sit next to somebody coughing? I doubt it. Or will I take mass transit if I can easily walk to where I need to be by leaving a bit earlier? Nope.
> I thought it was well known that ebola can be spread through any bodily fluids and that this includes droplets from coughing and sneezing. What they don't yet know is whether ebola is 'airborne' - i.e. dried droplets that can float in air as is the case with measles for example.
I would suggest to everyone: Don't comment on questions like this one (how Ebola spreads) unless you know for certain what you are saying and can back it up. We have complete saturation of rumors and bad information; adding to it won't improve the situation.
I don't mean to criticize the commenter above; they just happened to have the top-most comment of this kind.
EDIT: What a strong signal of over-reaction when a post that says you should know what you are talking about, on HN, is modded down. (I don't care how it's modded, it's just depressing to see this response here.)
EDIT: The same applies to my other post, which asks serious, legitimate questions in a non-offensive way. How sad.
Ebola and Marburg viruses are the sole members of the genus Filovirus in the family Filoviridae. There has been considerable media attention and fear generated by outbreaks of filoviruses because they can cause a severe viral hemorrhagic fever (VHF) syndrome that has a rapid onset and high mortality. Although they are not naturally transmitted by aerosol, they are highly infectious as respirable particles under laboratory conditions. For these and other reasons, filoviruses are classified as category A biological weapons. However, there is very little data from animal studies with aerosolized filoviruses. Animal models of filovirus exposure are not well characterized, and there are discrepancies between these models and what has been observed in human outbreaks. Building on published results from aerosol studies, as well as a review of the history, epidemiology, and disease course of naturally occurring outbreaks, we offer an aerobiologist's perspective on the threat posed by aerosolized filoviruses."
or
Our study has shown that Lake Victoria marburgvirus (MARV) and Zaire ebolavirus (ZEBOV) can survive for long periods in different liquid media and can also be recovered from plastic and glass surfaces at low temperatures for over 3 weeks. The decay rates of ZEBOV and Reston ebolavirus (REBOV) plus MARV within a dynamic aerosol were calculated. ZEBOV and MARV had similar decay rates, whilst REBOV showed significantly better survival within an aerosol."
What you posted is from good sources and is interesting, but I'm not sure it's conclusive or helps. They are two studies/reports of possibly many and I don't know their credibility or if they represent consensus or fringe, good science or bad. Also, they require expertise to interpret and draw conclusions from.
We're not qualified to perform our own analysis; what we need are conclusive analyses from experts about the scientific consensus and range of possibilities.
So we should all be quiet and listen for the experts to give us guidance? Sounds like the antithesis of hacker culture to me. It also sounds like horribly bad advice based on large establishments' historical propensity (categorically) to act from what they know, fail to react to changing environments, and cover up what might make them look bad.
Yes, this is all dangerous thinking. Yes, this is acting from one's gut, rather than waiting on the data. But when it's my life on the line, I'm going to err on the side of caution. When death is on the other side of the decision, I'm going to be a little more skeptical of other people's certainty.
The risk to your life hasn't changed, unless you are writing from West Africa. I would be happy to make a bet with anyone on HN that they will not contract Ebola (assuming they are not posting from West Africa), and that the flu will kill far more Americans this year.
Let's be honest; people are acting on fear. It's very compelling to people in the moment, but I think we all know better and know that it's how people make dumb decisions for themselves and do very bad things to others. The person who stays calm when everyone else is panicking is much safer.
Fear is dangerous and contagious -- much more so than Ebola, because fear can spread over HN. Don't follow the herd; set the example for those around you.
I would argue that every time a case in the US turns up, my personal risk does change. Think of it in terms of a social graph, or the 6 degrees of separation. Each jump that is made, the potential to eventually link to me increases. I'm not worried about getting Ebola tomorrow. I'm worried about getting Ebola next year.
I'm not speaking specifically about the risk to my life, but in the effect that potential outcomes have on evaluating risk. The flu argument you make is a common example thrown around in this conversation, but it's not an accurate comparison. What is the mortality rate of the flu versus ebola? When I assess risks related to ebola, I tend to favor a more cautious approach, because the mortality rate is so high.
This is part of a popular meme that is showing up on the news. They ask questions like, "True or false, you are more likely to die from ebola than the flu." The mark replies "true", and a doctor (medical doctor, not a statistician) is quoted explaining that "You're actually more likely to die from the flu." This could not be more incorrect.
Mortality rates for diseases like the flu (or any disease) are not homogenous for all members of the population. It's not like a roll of the dice. You simply cannot extrapolate an individual's odds from the broad population mortality rate for the flu (or any disease). It is extremely unlikely that I will die from the flu. I am a middle-aged male in good health and fitness. My chances of dying from the flu are extremely low. The reason the flu kills so many americans is because it is so prevalent. It could be said that flu kills so many precisely because it is so non-lethal. This allows it to fly under our radar and infect people who are at risk. I'm not arguing that we shouldn't take action to prevent the spread of influenza, I'm arguing that the flu presents a different set of problems.
My chances of contracting ebola are also extremely low, but if I do, my chances of dying from it are very high. Across the board (all ages and classes), the mortality rate for ebola are much higher than the flu. Unfortunately, we don't have a strong grasp on ebola mortality rates in the west, because we haven't (thankfully) experienced an outbreak. Even in develping countries, the mortality rate varies widely [1].
I agree that we shouldn't let fear run away with our sensibility, but when dealing with a highly infectious disease [2] with a remarkably high mortality rate, we should be cautious. If not fully quarantined, a period of sensible precaution is a reasonable expectation. When the sun is at its strongest we're advised to wear sunscreen and limit our exposure. When an individual spends time with ebola patients, they should be advised to avoid situations where they would expose a large number of people to the pathogen. Flying, taking public transit, and participating in sports are all activities that put you in direct or indirect contact with large numbers of people. This seems like an unreasonble amount of risk to me.
> What is the mortality rate of the flu versus ebola? When I assess risks related to ebola, I tend to favor a more cautious approach, because the mortality rate is so high.
I think that raises a several good points. A few considerations:
1) The 'proper' way to evaluate risk, as I understand it, is (likelihood * cost). A 10% chance you'll lose $100 costs you $10 each time you take that risk, over time.
2) I agree that some costs are so high that the math works poorly even with low likelihoods. A 1% chance of death is far too high a risk to take, unless there is some high payoff such as saving someone else's life -- a risk the infected doctor and nurse took.
3) The cost of Ebola is that high, but the likelihood is so infinitesimally low that it's still not worth worrying about. You'll add more life years exercising or simply reducing other risks with the same time spent thinking about Ebola. It's a complete waste of time (I realize the irony of writing that! :) ).
4) There are many more equally deadly and far more likely risks for healthy middle-aged people: Lightening strikes, natural gas explosions, being shot in the head, carbon monoxide poisoning, food poisoning (of certain kinds), other contagious and non-contagious diseases, etc.
5)
> When an individual spends time with ebola patients, they should be advised to avoid situations where they would expose a large number of people to the pathogen ... This seems like an unreasonble amount of risk to me.
Generally I agree that we should minimize risks, but again I'm not sure there is one here:
* It's very possible that it's very safe. Nobody in the United States (in fairness, that we yet know of) has contracted Ebola in this manner from the infected 3, though two of them spent much time around others. Also, wouldn't Ebola be rampant in the hospital where the infected nurse worked, if this was a risk? Wouldn't it be rampant among medical staff in W. Africa, given the prevalence in their environment (higher than flu in those facilities)?
* HIV spreads via bodily fluids but we don't quarantine the infected or their caregivers. However when HIV first become known, people were afraid to be near the infected (resulting in a lot of discrimination). I think we should not repeat that mistake.
* I would guess that hospital workers encounter many contagious, deadly diseases, yet nobody worries about those spreading.
People want to treat Ebola differently despite many similar and much greater risks. That's why I believe it's fear and not real risk that drives it.
Anyway, I'm approaching redundancy. Good talking to you!
That's why I believe it's fear and not real risk that drives it.
What other BSL-4 pathogen are you referencing here? Or are you suggesting BSL-4 is an unappropriate classification? Maybe you think the scientific and biosafety community erred when they created the BSL-4 designation?
There is plenty of research out there that documents the objectibe risk.
There is very little research that documents supports a strategy of "see no evil, hear no evil, speak no evil".
People don't need to panic.
But that's entirely seperate from lack of comprehension of the actual risks involved. After all, you can't solve problems you don't admit to having.
Trying to deal with a BSL-4 pathogen with BSL-2 safety gear is a fools errand. We might not havy any better options, especially in backcountry settings, but lets not pretend its "not risky".
In densely populated urban areas those risks are simply not tolerable. They are not tolerable for two reasons: (1) we can do better; and (2) the technology that allows for (1) makes the risks of not doing (1) more problematic.
Technology allows us to isolate patients; but it also allows non-isolated patients to spread the pathogen further/faster. People with hemoraggic fever don't walk 1000Ks or cross continents on their own power. They only do so by using technology.
It makes sense that the appropriate technology be dedicated to helping contain these bio-hazards and to compassionately care for the afflicted.
But seriously, what do we have to gain by sticking our heads in the sand? It seems this is a cynical strategy by people who don't want to "get their hands dirty"? Mayb we can continue to provide false confidence to 'volunteers' to go to africa and do our dirty work for us?
Why do we need to play this charade? Lets just give these people the tools they need (including time, money , and gear) and properly de-brief them and the public about the risks and what is at stake from either mistakes or inaction.
I have to believe the US Government already knows that ebola is capable of this, they've been studying it for decades. If it can spread by aerosol, they're lying to prevent substantially more panic.
Downvoters should start by refuting the linked article - it's a pretty important article. The authors are guaranteed to know a lot more about ebola than anyone here.
Why not seal off the apartment? There's pretty much no downside, so I don't think it really says much (especially assuming ~2 people regularly use it...).
It's a bit like saying, "Hey I've saved lives over here so I have earned the right to be irresponsible over here". Because you know, karma balances out. No, the world doesn't work like that. And you aren't doing any good propagating this idea either because it encourages this privileged way of thinking.
As much as this guy isn't being vilified (and say what you want about the government spinning its story of ebola being hard to transmit), lets think clearly and rationally. He knew the risks that he could possibly be infected and decided to endanger others when he could have easily stayed home or gone anywhere to a more isolated environment (upstate NY is calling). It is well known symptoms generally show up by the 10th day. Today is his day 10.
It's very interesting that the government has locked down this guys apartment, yet if you need contact with bodily fluids to contract the disease why quarantine the apartment and surroundings? Could it be that droplets are a transmission method as many people are starting to suspect. Sneezing and coughing may spread these droplets to the floors and walls? And if that is the case, what about other objects that come in contact with saliva and other fluids like utensils, door handles, glasses...