The Coming Plague

Laurie Garret has an article out in the Washington Post.  She say that there’s no point in trying to block the spread of Ebola by travel bans.

The problem is, she’s full of crap.  Look, there are two possible scenarios.  In both of them, r, the number of new cases generated by each case, is greater than 1 in parts of West Africa – which is why you get exponential growth, why you have an epidemic.  If r < 1.0, the series converges – a case generates a few extra cases before dying out.

Everything we know so far suggests that even though it is greater than 1.0,  r in West Africa is not all that big (maybe around 2), mostly because of unfortunate local burial customs and incompetent medical personnel.

It seems highly likely that r in US conditions is well under 1.0 which means you can’t get an epidemic. However,  r is probably not zero.  It doesn’t mean that you can’t get a few cases per imported case, from immediate contact and hospital mistakes.  As an example, suppose that on average each case imported to the US generated a total of two other cases before dying out (counting secondary, tertiary, etc infections).  Then, on average, the number of US citizens infected would be twice the number of infected visitors.

Now suppose that a travel ban blocked 80% of sick people trying to fly here from Liberia.  We’d have 80% fewer cases in US citizens: and that would be a good thing. Really it would.  Does Laurie Garret understand this?  Obviously not. She is a senior fellow for global health at the Council on Foreign Relations, but she is incompetent.  Totally useless, like virtually everyone else in public life.

We hear people from the CDC saying that any travel restrictions would backfire, but that’s nonsense too.  One might wonder why they say such goofy things: I would guess that a major reason is that they were taught in school that quarantines are useless (and worse yet, old-fashioned), just as many biologists were taught that parasites are really harmless – have to be, because evolution!

In the other scenario, r > 1.0 in US conditions as well, or at least is greater than 1.0 in some subsets of the US population.  This is very unlikely- even more unlikely considering we can adjust our behavior to make transmission less likely.  But suppose it so, for the sake of argument.  Then you would want – need – to stop all travelers from the risky regions, because even one infected guy would pose a huge risk.  Some say that blocking that spread would be impossible. They’re wrong: it is possible*, although it wouldn’t happen, because we’re too crazy.  In fact, in that scenario, we’d be justified in shooting down every plane that _might_ carry an infected passenger.  This scenario is the one that fits Garrett’s remarks, but if she really believed it, she would be frantically buying canned goods and finding a cave in the Rockies to hide her family in.

*the Atlantic is pretty wide.

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218 Responses to The Coming Plague

  1. JayMan says:

    “She is a senior fellow for global health at the Council on Foreign Relations, but she is incompetent. Totally useless, like virtually everyone else in public life.”

    That by far is the saddest part….

    • pyrrhus99 says:

      Quite predictable, in fact. The CFR’s agenda is Globalism and therefore Open Borders (except in Israel), so no quarantines tolerated.

      • gothamette says:

        Yeah, they are all part of the same hive. Thomas Frieden (head of CDC) has a brother who is the Professor of Peace or something at an Ivy League U. These people are all so predictable.

        Frieden was good as the head of NYC’s Department of Health. But cutting smoking rates and containing TB is very different from containing Ebola.

    • dearieme says:

      What’s going to happen about all those boats full of sub-Saharan Africans who are truing to get ashore in Italy? Will they just be sunk?

    • Abelard Lindsey says:

      People in public life are incompetent because they are nearly all liberal arts majors in college. Realize that in college, 70% is passing, you get partial credit, and you even get credit for “effort”. In the real world, 95% is passing, there is no partial credit or credit for effort. Now ask yourself if it is rational to trust the competence of anyone in public life.

  2. I don’t think she’s incompetent–well, I don’t really know, but at least the more likely explanation is that she thinks the occasional death is cheap compared to any suggestion that we might be safer if we closed our borders, or even gave a passing thought to who we let in.

    • The fourth doorman of the apocalypse says:

      but at least the more likely explanation is that she thinks the occasional death is cheap

      She more likely thinks that the supposed occasional death of someone else’s children is cheap enough to justify her open-borders ideology.

    • Dale says:

      If you’re into Globalization, and so your funding sources are all multinational businesses, etc., then you’re likely to think that the occasional Ebola death is quite cheap compared to the disruption of international commerce that a travel ban like this would cause. After all, there’s a couple of million deaths in the US each year anyway, and we generally rate a death as costing between $100 thousand and $1 million. For comparison, there’s 30,000 motor vehicle deaths in the US each year and people basically don’t think anything of it.

      • gcochran9 says:

        You do know how economically insignificant West Africa is, right?

        • gothamette says:

          Chocolate is important to me.

          • Anthony says:

            The best chocolate comes from Colombia, with chocolate from Venezuela, the Caribbean, and Madagascar all being pretty good, and unlikely to be much affected by Ebola.

        • Dale says:

          It can still amount to some millions a year. The crucial question is to get a good estimate of what benefits a quarantine policy would bring vs. what it would cost.

        • Quarantining West Africa would set a precedent, establishing quarantine as a legitimate health measure. The next threat might come out of China.

          • Anonymous says:

            Not to mention several countries with Ebola outbreaks in their neighbors already HAVE flight bans from those countries to their own. It seems absurd that we have all these twits on the news proclaiming that keeping people from entering our country, such as that fool who was on vacation during an Ebola outbreak, is racist… Ugh. And that second nurse was flying around the U.S. Like, why in the hell was she allowed to leave the hospital she helped treat the first Ebola victim at??

    • IC says:

      “more likely explanation is that she thinks the occasional death is cheap compared to any suggestion that we might be safer if we closed our borders”

      You are really good at speculation – your trademark. You treat speculation as fact and act on it. Really not very smart.

  3. Influenza again. Garrett also assumes that the “jet age” is irreversible if lives are at stake. She confirms that shutting down air travel probably delayed the influenza season by two weeks. Sounds a good deal to me. So, shutting down air traffic for a few days would delay Ebola by two weeks? Deaths from Ebola per 100 are 65 versus 1 for Influenza. The delaying air travel for several weeks, and from Ebola prone places until the outbreak is contained, should have an effect. In fact, I think she is saying that people value air travel more than disease prevention, and will continue to do so until the costs of disease become too high, at which time it will be too late to do anything. This is different from saying that “viruses gain entry to populations regardless of what radical measures governments took to keep them out”. We probably differ as to what constitutes radical, but it is clear that really radical measures would deny entry, or at least very severely reduce it.

    It is up to the US to decide whether a visitor from Liberia must make his courtship visit to the US right now, or delay his ardour until West Africa has contained the outbreak.

    Say it with flowers.

    http://drjamesthompson.blogspot.co.uk/2014/10/ebola-and-availability-heuristic.html?showComment=1413102702293#c4921973188257615212

  4. John Harvey says:

    And what happens when continued air travel to and from tropical West Africa allows it to get out into the favelas of tropical South America or South East Asia or India?

    • gothamette says:

      I shudder to think. And further – if it becomes endemic to the favelas of S. America, and spreads north, how many people will come to El Norte for free treatment? There is no Atlantic between us and them.

  5. MawBTS says:

    Could be an issue of job security.

    I mean, if a plague is will inevitably happen, we can’t blame public servants for failing to stop it, right?

  6. István Nagy says:

    “MSNBC’s Melissa Harris-Perry Show this weekend, the absent host’s panel once again caused trouble, as they agreed that even proposing a ban on travel from Ebola outbreak nations is racist. Guests Laurie Garrett of the Council on Foreign Relations and Frankie Edozien, New York Times columnist and editor of The AFRican Magazine, first raised the specter of slavery before going straight for the racist label:
    GARRETT: “I was on Capitol Hill yesterday. I spoke to lot of the political leadership of the United States and I have to say I was stunned by how many felt the solution was to completely cut off Africa. no visas. no travel. Keep them out. And this is completely missing the point. The hysteria should not be about one person in Dallas. What the world should be hysterical about is that Africa is facing its greatest catastrophic crisis arguably since the days of slavery. This could turn into carnage across a whole region if the world does not assist immediately.”
    EDOZIEN: “That would never work. Keeping them out would not work. And the idea that you can keep out a whole group of people who are America’s partners, whether we like it our not, West African nations are partners with this country . . .”
    GARRETT: And trying to do that is racist. Let’s us be frank about it.
    EDOZIEN: Exactly. It’s borderline racism and fear”

    http://www.truthrevolt.org/news/msnbc-panel-even-proposing-ebola-travel-ban-racist

    • erica says:

      Over a week ago, Jehmu Green, one of the loony left’s spin doctors, appeared on a weekend business show on Fox. With practiced self-righteousness, she stiffened her spine and displayed her quills when a panelist suggested that travel bans should be in place for a time. She didn’t just play the race card; she played the personal race card: “My family is from Liberia and like other Liberians are the descendants of slaves. After what we have suffered through, you would do this to us again? It’s discrimination!”

      A panelist’s retort: “Yes! A travel ban would be discrimination–against the bug–and discriminating would be a smart thing, a very GOOD thing!”

      Funny how an event like this might remind Americans of the actual meaning, both denotative and connotative, of “discriminate.”

      First line of Wiki, on Jehmu: “Jehmu Greene (born June 22, 1972) is an American political commentator, and social justice organizer. Greene was born in Washington, D.C. and grew up in Austin, Texas. Greene is the daughter of Liberian immigrants.”

      Another “social justice organizer” just keepin’ it real and shaping public health policy. God.

      http://en.wikipedia.org/wiki/Jehmu_Greene

    • not too late says:

      She says, “since the days of slavery” but slavery is alive and well today in Africa. She either knows that and is a liar or doesn’t know that and probably doesn’t know much about Africa at all.

      • erica says:

        That was my second thought when she said that (my first was, “Effing bitch.”) She’s just a political hack who’ll say anything. I’ve seen her before, but didn’t expect to see her on a business show.

    • Exurban says:

      I spoke to lot of the political leadership of the United States and I have to say I was stunned by how many felt the solution was to completely cut off Africa. no visas. no travel. Keep them out.

      That’s too good to be true. She has to be BSing.

    • Anonymous says:

      That is such nonsense! It’s racist to prevent a deadly disease from reaching your country? Really??

  7. Michael Finfer, MD says:

    I would rather be more nuanced. Temporarily banning air travel from the affected area would reduce, or at least delay, the arrival of infected people in other parts of the world. What it would not do is prevent transmission to other parts of Africa because of the availability of ground travel. Internationally, when we speak of ground travel, we are speaking mostly of travel by sea, which is quite time consuming, even today. It would be easy enough to quarantine passengers and crew on those vessels until the incubation period has passed. Air travel is too rapid for any screening to be effective, and it is not practical to quarantine the large numbers of people that you would need to, the people from West Africa and possibly everyone else on those flights. I am not sure that would be politically feasible, in any event, unless significant numbers of infected people beginning arriving in developed countries. That may occur if the worst case scenarios come to pass. We will have to see.

    • gothamette says:

      Dr. Finfer,

      Have you seen this?

      http://www.usatoday.com/story/news/nation/2014/10/12/texas-health-care-worker-ebola/17147449/

      Look, my concern isn’t that the US is going to have a Liberia-style Ebola outbreak. Ain’t gonna happen. My concern is that due to the “let’s not panic”* attitudes of the PtB, we’ll be containing 50-100 cases that come here from the EZ – at what cost? Tell me, Dr. Finfer, at what cost? And of course you know that resources, being finite, that are devoted to containing Ebola, will not be used towards other health concerns? Of which there are thousands.

      This is terrible. And it will get worse. The West should put as many resources as it can afford to stomping out Ebola at the source – and banning travel from those countries. It won’t, so Ebola will slowly leak out to the rest of the world, for years to come. I don’t want to wait and see. I want to stop the process, now.

      Bizarrely, the only pol who has been talking truth about this is a liberal Democrat, Alan Grayson. Go figure.

      • gothamette says:

        *”Let’s not panic” really means, “let’s not think about the consequences.”

      • Michael Finfer, MD says:

        Yes, I’ve seen it. My first reaction was that she must have been sloppy in some way, and the artical seems to suggest that also. We’ll no more as things are looked into.

        My expectation is that each imported case of Enola will result in a handful of secondary cases among close contacts, including health care workers.

        Panicking is the last thing you want to do in a difficult situation such as this. We need to look dispassionately at each situation and learn from it going forward.

        It may eventually become necessary to ban flights out of a west Africa if our response fails to contain the epidemic. Are we at that point now? Possibly, but that is a political question as well as a medical one.

        So far, there are two known exported cases. That is not a large number. Personally, I am willing to wait and see.

        I work in a hospital not far from Newark Airport, so I may find myself on the front line at some point.

        • The fourth doorman of the apocalypse says:

          Well, Dr Finfer, up to now the CDC and lots of medical professionals have been telling us how hard it is to contract this virus, and yet two people in the West who where know to have been wearing serious protection have caught it, along with many health professionals in West Africa.

          Forgive us if we think you are full of it.

          • gothamette says:

            “My expectation is that each imported case of Enola will result in a handful of secondary cases among close contacts, including health care workers.”

            I assume that “Enola” was a true typo and not a Freudian slip!

            Seriously, how much are these secondary cases going to cost us? How many resources will be used on Ebola, when they could have gone somewhere else?

          • Michael Finfer, MD says:

            I think we need to put this in perspective, and this will be my last comment on the subject. According to the CDC, between 3000 and 49,000 people in the United States died each year from influenza. In most years, many of those deaths could have been be prevented if everyone got the influenza vaccine as now recommended. This year, the last report posted by the CDC shows that there have been 594 cases of measles in 18 outbreaks in the US, almost all of which could have been prevented if everyone had been vaccinated as recommended. Measles is not a benign disease.

            What about those costs? Many of those influenza deaths came at the end of very expensive hospitalization, not to mention so many potentially preventable, premature deaths.

            As I said, two cases of Ebola exported from Africa is not a large number. Also, both of the cases in health care workers sound like they are associated with a breach of infection control protocol. As I said, at this point, I think a wait and see attitude is appropriate.

            And yes, “Enola” is a typo. It is a town in Pennsylvania, not a virus. That’s what happens when I do this stuff too early in the morning.

          • melendwyr says:

            Flu vaccines are notably not very effective in the long term – preventing the spread of the most common strains simply opens up the niche for uncommon mutated versions. In addition, the people who die from the flu are often elderly with impaired immune systems, and would likely die of some other cause.

            When dealing with hundreds of millions of people, a few thousand deaths from a particular cause is nothing.

        • STALIN says:

          We’ll no more as things are looked into.

          I plan to NO a lot more as things are looked into. NO! NO! NO!
          Panicking is the last thing you want to do in a difficult situation such as this. NO!
          We need to look dispassionately at each situation and learn from it going forward. NO!
          It may eventually become necessary to ban flights out of a west Africa . No to eventually
          Possibly, but that is a political question as well as a medical one. NO! NO!.
          That is not a large number. Personally, I am willing to wait and see. NO!

          • gothamette says:

            Dr. Finfer,

            My joke was in reference to Enola Gay. I realized you wrote a typo.

            As to putting things in perspective, and influenza, and how much influenza costs, no dice. This is NOTHING like influenza. It’s MUCH more expensive. Tell me if the people who deal with flu victims have to put on full protective gear? Is flu a bio-safety level 4? Do people clearing out a flu corpse have to put on full hazmat gear?

            Wait and see what? We always wait and see – but for now, let’s stop travel from the hot zone. From, not to – we should be doing all we can to contain and destroy it where it is.

  8. pyrrhus99 says:

    It is patently obvious, as I was “taught in school”, that isolation of people with dangerous diseases is highly desirable. A friend in my 5th grade class spent a lengthy time confined to his house because of a contagious disease. Also, quarantines of the Black Plague were well known. The justifications for NOT quarantining West Africa are ludicrous, unless you are devoted to a political ideology in which sacrificing a few thousand or million Westerners is perfectly acceptable–which this woman obviously is.

  9. Greying Wanderer says:

    n1 * y1 > n2 * y2

    where y1 is a number representing offense and n1 is the number potentially offended and y2 is dying and n2 the number dying

    i wish they’d tell the truth about why though – even if they kept the same policy – because living with this constant PC lying is draining.

    • Greying Wanderer says:

      more accurate to say

      n1 is number of people offended at that particular time

      and

      n2 is number dying at that particular time

      so eventually n1y1 < n2y2 just not yet

  10. strongsloth says:

    All the West African countries are easy cases since the people there offer very little benefit from allowing travel. From a cost benefit perspective it would probably pay to deny entry to people from those areas even if Ebola didn’t exist. With luck the dilemma of blocking travel from more economically useful, Ebola infected countries will never arise.

    As for telling the truth and doing things in the interests of the American people. Try to think of recent cases where the US government has showen much interest in that. It’s hard to blame them since voters, the media and academia don’t seem to show a lot of interest either.

  11. gothamette says:

    Nigeria supposedly has stamped out its epidemic. Does anyone believe this? I don’t mean to sound like a conspiracy nut, but….if it sounds too good to be true, it is.

    • The fourth doorman of the apocalypse says:

      Heh, they have not been able to stamp out the other infection in the north of their country … so what chance that they have stamped out this one?

  12. NervousObserver says:

    I’ve been working on and off in epidemiology and related areas for a quarter century. My current job title is Epidemiologist in a state department of public health. Quarantines are still considered an effective method of epidemic control in the profession. The technique is still taught in schools of public health. A limited duration quarantine of Africa would protect the rest of the world, albeit imperfectly. It would have nugatory negative consequences. Garrett and all the other stuffed-shirt public health administrator/flacks we see pontificating in the MSM know this. It just goes against one strand in the current ruling elites’ narrative. Their lies will cause deaths.

    The whole analysis of r, the transmission rate, is spot on. But I do have one caveat and it is “alarmist”. The current epidemic in west central Africa has evinced more distinct strains of the virus than have ever before been seen in one outbreak, far more people from many different tribes have been infected, these people are often malnourished, and the populations have relatively high genetic loads. These are ideal conditions for mutation.

    Spontaneous mutation may have created an extremely virulent, airborne version of the Reston Virus, a simian version of Ebola. There’s no reason such a mutation couldn’t occur in some strain of the Ebola virus that is involved in the current African epidemic. If it does then r>>1 and all bets are off. It’s also worth remembering, now that our great leader is sending US troops into the “hot zone”, that the 1918 influenza pandemic came to the US via returning troops and spread into the general population from military bases.

    • The fourth doorman of the apocalypse says:

      <

      blockquote>Spontaneous mutation may have created an extremely virulent, airborne version of the Reston Virus, a simian version of Ebola. There’s no reason such a mutation couldn’t occur in some strain of the Ebola virus that is involved in the current African epidemic.

      <

      blockquote>

      Someone else posted this paper on what it takes to increase R in a virus (ie, the genetic changes, five in that case, I think):

      http://www.cell.com/cell/abstract/S0092-8674%2814%2900281-5

      So, what is the probability that such a small number of changes are possible?

      Or, since the flu season is approaching, could Ebola pick up some new genes along the way?

    • I have read the thread and find Nervous O’s and the Hungarian commenter Istvan’s thoughts excellent. The insertion of accusation of racism into the discussion is very troubling, as it will be an obstacle to doing anything with even a whiff of controversy attached to it. The subtext “I can’t say that, because then I would be thought racist,” with the known but unstated “and then my career would be over” is unavoidable. Deaths will come. We can reduce them fairly simply and cheaply – but the blow to the self-image of many in power is a cost too high.

    • Diana says:

      I just learned more from you than from every official source. Thank you.

      What do you make of the second Ebola case in Texas? She was a carer who observed strict HAZMAT protocol?

  13. The fourth doorman of the apocalypse says:

    It is not clear to me that we will not see an epidemic here in the US because time and again it seems to be being shown that dealing with Ebola, once there is an outbreak, is a test of the IQ and other characteristics of those dealing with it.

    For example, it seems that both the health worker in Spain and the one in Texas who now has Ebola both likely contracted Ebola because of a breach in disrobing protocol.

    It seems likely, because of affirmative action, that we will have lots of people dealing with the other instances of walking Ebola factories (that surely must have made their way here) who are very incapable of properly following the procedures.

    • The fourth doorman of the apocalypse says:

      Isn’t that the key problem here?

      A large enough percentage of our health care workers are unable to properly follow the procedures that the health care system will become the vector for any continuing any outbreak. And we are not allowed to nor do we have time to test their IQs for this sort of work.

      • gothamette says:

        “A large enough percentage of our health care workers are unable to properly follow the procedures that the health care system will become the vector for any continuing any outbreak.”

        Exactly. The protocols are so strict – necessarily so because the virus is so deadly – that one is bound to slip up, eventually.

        • Anthony says:

          The protocols are so strict – necessarily so because the virus is so deadly – that one is bound to slip up, eventually.

          This is true. Apparently, the nurse who caught Ebola from the guy in Dallas was the one who trained other nurses in the safety procedures. It takes not only a reasonably high IQ, but an unreasonably high level of conscientiousness, to not screw up ever.

      • Boris Bartlog says:

        It’s probably conscientiousness you’d want to test for first (not that IQ wouldn’t also be desirable). That African woman who managed to care for her family without getting sick (Fatu Kekula) is in all likelihood not over 110 IQ, but she followed her own improvised procedures with great rigor.

    • Denise says:

      Oh, so there’s a glut of brilliant people wanting to be nurses but prevented from doing so by affirmative action?

      • reiner Tor says:

        If affirmative action means anything, it means that some people from the preferred group will get the job ahead of some more able people from the non-preferred group. In the US, this means that for example some less able blacks or Hispanics will get the job ahead of some more able whites.

        So there must be some whites who are both willing and able to do the nursing jobs but are prevented from that by affirmative action.

        It was a pleasure helping you.

        • gcochran9 says:

          The difference can be big in higher-caliber professions: without affirmative action (which is a clumsy relabeling of racial favoritism) most black doctors would not have made the cut, most black college professors would not be professors, etc.

          • reiner Tor says:

            The problem I see is that it trickles down – some black people who would be more than capable of a nursing job get a doctor’s job, and then because there is AA in nursing as well, some less able blacks will get the nursing job… Since nursing doesn’t necessarily make big demands on IQ, they might actually do the job almost as well as a higher IQ white nurse would. Or at least they don’t make much trouble. However, they might have quite some difficulties when the job suddenly gets more demanding – like an ebola outbreak.

          • Jasper says:

            As a fund manager, I can’t help but notice a distinct under representation of non-Jewish minorities in my line of work. A disparate outcomes survey would conclude massive discrimination must be underway in the business. Actually, it is simply the fact that our results are laid bare every quarter and every year in the most transparent and comparable fashion possible and clients gravitate to success. It is a race-blind meritocracy if there ever will be such a thing. The results have been in for a while now, and they appear to mirror the composition of the far right tail of the IQ distribution.

          • little spoon says:

            Jasper, do you mind emailing me? Feministx99@gmail.com. your comment has piqued my interest…

  14. candid_observer says:

    Well I’d feel a lot more comfortable about the Ebola issue if I had read any sensible account as to why this particular outbreak is so much worse than any previous outbreak.

    It hardly inspires confidence that several American health care workers in Africa contracted the disease, despite presumably knowing both the risks and the standard “western” precautions.

    And today we hear that a health care worker at the Dallas hospital contracted Ebola, while supposedly taking all the right precautions.

    One can’t help but worry that this strain of Ebola is much more contagious than previous strains. I’m not sure why Mr. Cochran seems so convinced otherwise. You know, viruses do mutate.

    • The fourth doorman of the apocalypse says:

      One can’t help but worry that this strain of Ebola is much more contagious than previous strains.

      That is not necessarily the case, as I am coming to realize.

      It might simply be that average IQ people are unable to comprehend and follow the safety procedures required to deal with contact with infected individuals.

      In such a case you do not want the virus to ever get into your population.

    • gcochran9 says:

      People are running epidemiological models, and the models are apparently pretty much on track with what’s actually happening. In those models, the basic reproductive number is between 1.6 and 2.0, in West African conditions.

      If the current version of Ebola were a lot more infectious than before, those models would vastly underpredict the rate of spread. But they don’t.

      Capisce?

      • candid_observer says:

        And so, in these models, how does it get explained that this outbreak is so very much worse than anything we’ve seen so far?

        • gcochran9 says:

          With a basic reproductive number that low, an outbreak would often die off by chance at an early stage, and moderate countermeasures could probably stop it. That changes as the epidemic gets bigger: after a point you know it’s not going to die by chance, and applying countermeasures gets more and more difficult as the numbers get large.

          Look, it’s a lot like fighting forest fires. If the forest is soaked ( r < 1.0), you'll never have a forest fire. If it's dry, you can, but it depends how dry it is. If it's just barely dry enough for a forest fire, it will spread slowly and the fire fighters can likely stop it – although it would continue to spread if they made no effort. If the whole forest is tinder, and you have 70 mph winds, it's unstoppable.

          • candid_observer says:

            Well, I suppose these modelers actually do these things, but I’d like to see, say, a bazillion random initial conditions run with these models, and show that the sequence of outbreaks and their scale which we’ve actually experienced fits right into those simulations.

          • j says:

            http://www.geert.io/exponential-growth-of-ebola.html says that the number of cases is doubling every 24 days. The WHO says it is the most dangerous epidemy ever. Are they (a) dumb (b) want to create panic and receive more budgets or (c) the forest is very dry and the wind is blowing.

          • Anonymous says:

            Candid: THEY DO. Our old Postdoc dropped in and gave a talk on an Ebola model the NIG commissioned from him more than a year ago…
            This epidemic is worse than previous ones because Ebola’s made it to big city, and countries like Liberia don’t know how to run a quarantine. Some past Ebola outbreaks had mortality around 90%, this one is a mere 60-70%. It just seems bad because the media won’t stop getting people here in the U.S. excited…

        • The fourth doorman of the apocalypse says:

          In addition to what Greg said, think about the IQ requirements this virus demands of people in the health system and the average IQ of people in West Africa.

          • candid_observer says:

            Look, I don’t doubt that precautions and practices are a lot worse in West Africa than here.

            What bothers me is when Western health care workers seem to take all the right precautions, and nonetheless contract the disease — including, now, one in Texas, who certainly seemed to have been fully aware of the risk of Ebola, was presumably informed about the proper precautions, and nonetheless contracted the disease. I don’t know why every hospital in the US shouldn’t contain a worker who might also contract the disease, even in a case in which only one patient sufficed to do the trick. One isn’t a big sample, but it’s a lot bigger than zero.

          • The fourth doorman of the apocalypse says:

            I don’t know why every hospital in the US shouldn’t contain a worker who might also contract the disease, even in a case in which only one patient sufficed to do the trick. One isn’t a big sample, but it’s a lot bigger than zero.

            I think it is guaranteed that every hospital in the US contains several workers who will contact the disease.

            At this stage it seems you need an IQ of about 2SDs above the mean and a level of conscientiousness quite a bit above the mean as well.

            I wonder if we can estimate these requirements based on the number of infections among medical workers vs average people.

            Also, why have none of the people Duncan was living with in Dallas come down with Ebola?

          • Sam in Ivory Coast says:

            Look, the average IQ is West Africa is low – that’s a fact. But this can be all too easy explanation. As I write, the countries neighboring surrounding Guinea, Liberia and Sierra Leone are taking simple precaution that seem quite effective in limiting ebola’s spread despite the proximity and the ease of travel. The land borders in Ivory Coast, Ghana and Senegal all currently have screening measures (I just went through 2 of them). Direct commercial flights from the 3 affected countries have been banned by countries such as Senegal, Gambia, Ivory Coast and Nigeria. Despite the unfavorable conditions, Nigeria has managed to contain and stop the spread so far. Low West African IQ is a fact, but it can be a lazy form of analysis here.

          • ursiform says:

            “One isn’t a big sample, but it’s a lot bigger than zero.”

            One can be statistically equivalent to zero.

          • candid_observer says:

            “One can be statistically equivalent to zero.”

            Look, in a situation like this, one is a very uncomfortable number, and suggests risks far above those given it by the authorities, who presumably are basing their models on defective parameter settings.

            The hospital in Texas seems to be generally a respectable hospital, but not one specifically designed to handle cases like Ebola.

            We had been assured that the US is well prepared to handle Ebola cases as they arise. And the case in Texas was surely just the sort of typical case that might arise in the US, coming to a good hospital not specifically designed to handle Ebola cases. Presumably, everyone who handled this patient was instructed in the proper protocols, and followed them according to their abilities. Yet, despite this, a single patient was able to communicate Ebola to a health care worker.

            And that is not the most worrisome fact. Far more troubling is that the authorities were so certain that health care workers would not contract Ebola that they apparently did not even track them. The only thing that can mean is that they assigned a probability so close to zero to this risk that they felt these workers didn’t require tracking as a general procedure. Which can only mean that they judged the risk so low that even if there had been a very large number of hospitals and very large number of patients with Ebola, that this likelihood was exceedingly low.

            And yet here we have one patient in one typical hospital communicating Ebola to a health care worker.

            Even though it is only one case, it obviously puts the lie to their assumptions of risk.

        • Sam in Ivory Coast says:

          This outbreak in West Africa is far worse than the outbreak in Congo and Uganda for example because the area affected in those countries were quite isolated. Uganda is a densely populated country overall but not uniformly so. Congo (DRC) is very sparsely populated. The place in Guinea Conakry where the West African episode reportedly started is the second largest city in that country. An initial Ebola outbreak can burn itself out because the affected community is likely to be located far from other villages and towns. I have visited villages in Congo that are hours from the nearest big villages (with several streams, rivers, high hills and thick forest in between. West Africa is different. Absent a few mountainous areas in Futa highlands of Guinea, West Africa is flat, densely populated (relative to many parts of the continent) – with only few truly isolated places. Yesterday, I drove from Accra to Abidjan (350 miles) and I never went more than a few minutes without seeing some settlement. So movement of people is quite easy and therefore infected people can travel.

          • The fourth doorman of the apocalypse says:

            The land borders in Ivory Coast, Ghana and Senegal all currently have screening measures (I just went through 2 of them).

            Every meter of all of the land borders has effective screening or is impassable?

            I don’t believe it! The screening measures at airports in those countries is well known to be a joke and simple measures can be used to prevent elevated temperatures even if the staff doing the screening all knows how to use the meters.

        • Anonymous says:

          Oops, that should have said the model was commissioned by the NIH. Funny, as it was, 2 years ago the NSF declined to put money toward modeling Ebola epidemics because of “lack of interest.” Hopefully that changes soon enough…

    • Greying Wanderer says:

      PC is a form of insanity. West Africans seeing some guy wandering around with bleeding eyes probably do something sensible like run away or shoot him and burn the body. The PC elite in the West send hundreds of soldiers to get infected and then bring it back to their cities. If Ebola becomes big it will be more to do with PC than how contagious it is.

      • Gordo says:

        Long ago the village elders would have applied basic quarantine and contained this, not geniuses but they had learned by tradition. Now it is different and they have lost their power.

        As for us clever Whiteys, we have the concept of the precautionary principle and the demands on political correctness. Which will win?

        If asked I tend to say we should follow the lead of Israel, that way I can advocate strong solutions without becoming unemployed.

  15. Dale says:

    Are you proposing a particular policy, or just irritated at a particular commentator. If you are proposing a particular policy, what is it?

  16. The fourth doorman of the apocalypse says:

    It will be interesting to see how well the US military manages to avoid Ebola while in West Africa.

    There was this interesting comment in one news report:

    There are already more than 350 U.S. troops on the ground in West Africa, mostly in Liberia, including a handful from the 101st. That number is set to grow exponentially in the coming weeks as the military races to expand Liberia’s infrastructure so it can battle Ebola.

    Were they referring to soldiers or soldiers with Ebola?

  17. annoynamouse says:

    IQ may have some effect in reducing spread, but folks with sub-optimal IQs can protect themselves just fine from a number of other comparable hazards. It is the combination of low IQ and amoral orders from better endowed bureaucrats that is the hazard.

    Yes, cleanup crews are not selected from the best and brightest. But at least some of these actions are from direct CDC orders:




  18. Sean says:

    Daniel Dennett in ‘Darwin’s Dangerous Idea’:- “How could Three Mile Island have been a good thing? By being the near-catastrophe that sounded the alarm that led us away from paths that would encounter much worse misadventures – Chernobyls, for instance. Surely many people were fervently hoping for just such an event to happen, and might well have taken steps to ensure it, had they been in a position to act. The same moral reasoning that led Jane Fonda to create the film The China Syndrome (a fictional near-catastrophe at a nuclear plant) might lead someone rather differently situated to create Three Mile Island”.

  19. The fourth doorman of the apocalypse says:

    Does anyone have any credible info on the bio-hazard containment levels employed by the nurses in Dallas and Spain who have contracted Ebola?

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  21. The fourth doorman of the apocalypse says:

    Massive Decontamination Effort of Public Spaces as CDC Says Can’t Get Ebola from ‘Casual Contact’

    Isn’t there a contradiction there? Are they now, by their actions, admitting that casual contact can cause transmission?

    • Greying Wanderer says:

      The only certain thing is if the main source of anything bad is in anyway connected to any group or groups near the top of the PC hierarchy they won’t tell the truth – 100% guaranteed – even if most of the additional victims from not telling the truth are from the same groups.

    • Anonymous says:

      LOL! Of course people can get it from “casual contact.” Any contact with exposed skin is pretty risky…

  22. I understand why Laurie Garret is upset. Twenty years ago she wrote a book (which I read at the time) predicting terrible diseases were about to erupt. Alas nothing much happened. I wrote as much in an Amazon review about six months ago and got embroiled in a Web firestorm.

    Like the Climate Alarmists, the people who worry about mankind having to pay for our sins hold their beliefs strongly and resist any hint of good news. This is the theory of Ebola as Mother Nature’s Payback.

    I’m having trouble being alarmed about Ebola. I saw the Dustin Hoffman movie, but unlike many it seems, I don’t actually believe that movies are real. I’ve tried but I just don’t feel personally threatened. All the previous Godzilla movies had the big lizard in Tokyo or New York. The latest one had Godzilla stomp a lot of my own Bay Area neighborhood – but I refuse to be frightened. And I refuse to worry about Ebola.

    I might worry about a return of the 1918 Spanish Flu. But how would I get Ebola? The last Ebola outbreak was spread by nuns who used dirty needles. And I don’t dress or handle dead bodies. It’s just not a credible threat.

    The main effect of Ebola is likely to be political. Obama has rejected the Bill O’Reilly quarantine. At least a couple dozen Americans will inevitably get Ebola and die. O’Reilly no doubt has people taping interviews with their relatives right now. Other networks will struggle to compete. The whole thing is degenerating into farce.

    Farrakhan has already advanced the theory that Ebola was created by the white man to kill the black man. So we are, I supposed, doomed to endure analyses of Ebola deaths by race.

    I remember all the silly stuff said about AIDS. Deja vu.

    • Sean says:

      “I understand why Laurie Garret is upset. Twenty years ago she wrote a book (which I read at the time) predicting terrible diseases were about to erupt. Alas nothing much happened.”

      It’s almost like she thinks a near-catastrophe that sounded the alarm could lead us away from the path to the catastrophe she predicts. Surely she can’t be so fervently hoping for just such an event to happen, that she is taking steps to ensure it will happen?

  23. James Miller says:

    A Phd life scientist told me that the Ebola virus has an easier time surviving in cold than hot weather. If this is true and significant, we can’t necessarily assume that we will do much better than West Africa in controlling Ebola, although the scientists told me she thought there was little chance of Ebola killing a large number of Americans.

  24. The fourth doorman of the apocalypse says:

    Let me ask a question. Can that Dallas hospital now continue to treat normal patients?

    If not, how long before it can be decontaminated?

  25. AllenM says:

    While a ban on travel to and from West Africa would help contain the problem, all of Africa is now within the spread zone. http://www.news24.com/SouthAfrica/News/West-Africans-flee-Ebola-head-to-SA-20141012

    While SA is worried, the reality is they are two or three days drive away from Nigeria. So, in reality, all of Africa will be involved over time. The toughest part will be full interdiction at the Med, because Europe will freak at what is necessary to stop the human tide.

    Further worries about the US are kinda ridiculous- far greater worries should be expended on Brazil and India, either place could be far more dangerous for long term containment than America.

    Large urban concentrations of poor, living in crowded conditions are the perfect petri dish for this disease. The one week with no real symptoms means the entire world is within reach, so it simply becomes a matter of time.

    So, while we vilify the hospital in Dallas, the slums of Rio and Dehli are a wide open target. Even Shanghai and Jakarta are well within the zone of possibility and fear. Further, any real whiff of closing off West Africa to air travel will spark a panic of all foreign nationals, plus people with outside connections to the rest of the world.

    Panic what we are avoiding. Just think about someone being held in Lampedusa who happens to be shaking hands with his friends and one of them works on the food handling line in the detention camp.

    Now, imagine someone sitting in the railway station in Milan who gets sneezed on by someone who is now seriously sick. But northern Europe can handle it.

    With difficulty.

    Yet we worry about small numbers here.

    • Ebola Chan says:

      If or perhaps when Obola is introduced to Guatamala, Honduras, El Salvador, Costa Rica and/or Belize, I wonder what the government of Mexico will do? Perhaps they will not be so fond of letting their little brothers from the South pass through on the way to El Norte, because some of the slums of Mexico are not exactly hygenic.

      Yet we worry about small numbers here

      Do you understand how disease doubling works? Apparently not. First there’s one patient who infects another one or two. Those two infect others. There are areas in the US that are more 3rd world than 1st world, I’ve lived near some. How easy would it be for Obola to spread via homeless men across some parts of some cities? What would be the reaction if Obola became endemic in, say, Birmingham, Alabama or East St. Louis?

      Small numbers today may not necessarily lead to larger numbers 21 days from now, but that seems to be the way to bet.

    • Greying Wanderer says:

      “Yet we worry about small numbers here.”

      Worrying about small numbers is how you prevent big numbers.

  26. AllenM says:

    First problem is needlessly politicizing this disaster. The racism card is somewhat true, because we only began reacting the West African governments mostly failed at containment, until then, meh.

    Everyone assumes the mode will be like AIDS- the public health response is much more like typhus/cholera- complete with police powers to deal with it, including forcible isolation and treatment.

    Now, will people scream about it, sure- but it won’t matter. If you think otherwise, you should see the lawsuits people have tried about forcible treatment for drug resistant tb- and how the courts have utterly upheld the public health police powers.

    Now, countries that manage to do very badly on a typical governance day will react quite a bit more violently and forcefully to contain something like this.

    Our immigration problems are first world problems, but a police response can solve so many issues that politics can’t currently manage.

    Paranoia is going to run rampant, and that will be a bigger problem than most of the actual disease containment in America.

    • albatross says:

      When someone responds to the proposal to shut down travel from a heavily infected region to slow down spread of a contagious disease by screaming “racism,” I take that as a strong signal that they’re there to have an intelligent adult conversation.

      It’s quite possible that travel bans are bad policy–maybe they won’t help much and they’ll do a lot of collateral damage. But the adult way to deal with that is to discuss the costs and benefits.

  27. AllenM says:

    Here, see what we could do in just this one case: http://www.azcentral.com/12news/news/articles/1008TBguy-ON-CP.html

  28. gothamette says:

    I haven’t read all 1000+ comments, but the first few are remarkably intelligent. This is the NY Times; I expected total idiocy.

    http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?hp&target=comments#commentsContainer

    • The fourth doorman of the apocalypse says:

      The media seems to have lined up behind the idea that the nurse was stupid:

      http://shepherdofthegurneys.blogspot.com/2014/10/rape-rape.html

      • Greying Wanderer says:

        PC types are mostly bullies who get off on the bullying or people going along with it for their paycheck but there is a particular type of person who has a particular kind of morality program running in their head and if you feed that person distorted data all their life then you induce the PC form of insanity.

        A person like that in an NBC suit with a patient in isolation where the patient is from one of the top tier groups in the PC moral hierarchy (black or homosexual) will take their glove off to squeeze the guy’s hand (or something similar) to prove they’re not prejudiced – absolutely guaranteed.

        • BE Hardisty says:

          Funny you mention that… An NBC “doctor” has been severely reprimanded for breaking protocol to shake some Ebola-stricken person’s hand, and then came right back to America and went out to eat- instead of observing a “voluntary” quarantine.

  29. dave chamberlin says:

    I’m glad to see the Ebola boogeyman put in it’s place by Greg Cochran. It is a terrible disease killing a very high percentage of the people whom contact it in a particularly gruesome fashion. That apparently sticks in peoples mind far more at present than the stone cold facts laid out by Cochran that this disease will be quickly suppressed in countries other than places like Liberia which has an astounding one doctor per 100,000 people. And even in Liberia measures are now being taken to bring this disease under control by the mandatory cremation of anyone that has died.

    I worry a great deal about Africa in the 21st century. Runaway population growth on this continent in this century will result in horror that will make the number of deaths caused by this Ebola outbreak look like a hiccup. I’m sad to say most people do not grasp this what so ever and no real effort is being made to prevent the end game that is the inevitable result of continued over population of Africa. United Nations projections http://news.nationalgeographic.com/news/2014/09/140918-population-global-united-nations-2100-boom-africa/ aren’t all that accurate but still ain’t no way, no how, the continent of Africa is going to support the billions? that will be living there shortly. Pick your poison, disease, war, starvation, the Malthusian trap will limit the population of Africa one way or another.

    I’m guessing fear of disease will provoke the world to some sort of action. Will it be too little too late? Maybe it already is, I don’t know. I can’t foresee a food for birth control exchange program working. I can see a lot more boats impossibly crammed with Africans trying to escape. I can see large parts of he continent quarantined.

    all preventable
    sad
    very sad

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  31. Diana says:

    ZOMG. The NY Times has truly gone insane.

    http://www.nytimes.com/2014/10/13/opinion/how-to-quarantine-against-ebola.html?_r=0

    You really must read this to appreciate the full insanity of our chattering classes. He criticizes a travel ban because “An indiscriminate ban on travel would make it impossible for aid workers to reach the most widely affected areas, obviously deepening the medical and humanitarian crisis. It would also encourage subversion: Travelers might pass through other countries, confounding efforts to track their origin.”

    No dumbass, no one wants an “indiscriminate ban on travel.” We want a total ban on people coming OUT of the EZ. I am all in favor of facilitating massive international efforts to contain ebola in the zone – although it may be too late to do that already.

    I cannot understand how supposedly smart people can write things like this.

  32. Sisyphean says:

    An r of less than one makes it a lovely vector for profit expansion among the sick care set. It scares people into heightened consumption of the product without killing too many of the cattle… er… consumers. Maybe I’m too cynical.

  33. STALIN says:

    So we stop it this time with Africa’s population ~1 billion. In 2050 we stop it with Africa’s population ~2 billion. Will we stop it in 2100 with Africa’s population ~+4 billion? Of course Africa’s population will never be +4 billion. The East African drought(whenever it unpredictably but inevitably occurs, and the wars it inevitably engenders) and emigration will ensure that.

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  35. DrBill says:

    In the other scenario, r > 1.0 in US conditions as well, or at least is greater than 1.0 in some subsets of the US population. This is very unlikely- even more unlikely considering we can adjust our behavior to make transmission less likely.

    Seems like it could spread pretty quickly among injection drug users and homos if it got into those populations to start with.

  36. Jimbo Nobo says:

    with regards to the affirmative action discussion above – the dallas nurse who is infected was not an AA recipient, she’s an asian american (vietnamese). name is Nina Pham.

    http://www.dailymail.co.uk/news/article-2791089/first-picture-devoted-texas-nurse-fighting-life-catching-ebola-treating-man-brought-dreaded-virus-america-beloved-dog-s-quarantine.html

    • The fourth doorman of the apocalypse says:

      Doesn’t that make it worse? Should would seem to be, a priori, fairly intelligent and conscientious, and yet the big mouths in the Centers for Disease Confusion are blaming her for her condition.

  37. Ebola Chan says:

    70 different staff members treated Obola Patient Zero in Dallas

    So there could be others exposed, that we do not yet know about.

    And if this is the level of effort required for one patient, what will happen if the same hospital has to deal with ten? Or one hundred? What price in resources, in human lives, are we to expend because the US government will not do its job i.e. protecting the country from disease?

    • MawBTS says:

      Importantly, isolating countries won’t keep Ebola contained and away from American shores. Paradoxically, it will increase the risk that Ebola will spread in those countries and to other countries, and that we will have more patients who develop Ebola in the US. People will move between countries, even when governments restrict travel and trade. And that kind of travel becomes almost impossible to track.

      1) they’ll inevitably enter the country anyway. b) we might as well be able to track them.

      Sounds like an argument that could be used in favour of any immigrant or import, from nuclear weapons to terrorists to black tar heroin to Nazi war criminals.

    • Ebola Chan says:

      What else should we expect from an open-borders publication?

      “They’ll do it anyway” has been a standard argument about all sorts of things for years, I recall it was a mainstay in the 80’s for AIDS apologists.

      It’s at best an adolescent whine, something a 14 year old might say. The assumption behind it must be “USA is invulnerable”. Cargo cult thinking – Modern Medicine can beat any problme.
      No.

  38. j says:

    Stop the frivolous comments. The coming plague is coming. The number of days required to double the infected shortening, and 70% of the infected die. The question of air transmission is moot: this seems to follow the influenza model. Start hoarding survivor blood.

  39. The fourth doorman of the apocalypse says:

    I notice that the media thinks that transfusing blood from a survivor is going to magically jump-start the infected nurse’s immune system.

    How much real science is there showing that the presence of antibodies in a transfusion is going to get the patient’s immune system producing the same antibodies or instead produce antibodies against the antibodies?

  40. Rum says:

    In the entire US of A, there are 19 beds in the few facilities which are actually prepared to safely treat a level 4 biohazard – like Ebola. Not 19 hospitals, but 19 beds spread over 4 locations. None of the other multitudes of hospitals are really practiced at safety.
    Two points; semi-trained personnel simply will not come to work when Ebola is a threat. And many hospitals will be financially bankrupt long before Ebola spreads very far. Their employees will balk and paying, non-charity patients will run and hide. 90.999% of American hospitals are not prepared and everyone who works there knows this. Tell me again what the pay is for working in an Ebola care unit?
    You will not die of Ebola, most likely, under forseeable circumstances. But our Medical System will.

    • gothamette says:

      Yes, that’s exactly what I’ve been saying.

      The talking heads are spewing such bullshit. I heard on the PBS News Hour, which is supposedly a reputable news source, that we should build 50 Ebola hospitals, one in each state.

      Yeah, really – with whose money – China’s? Right! And who is going to work in these shiny Ebola Hospitals? Oh wait, we can get illegals to work in them, right. The nonsense never stops. Then the CDC says that all hospitals should “think Ebola.” (google it.) Ain’t gonna happen.

      We are left with praying that no more cases come our way. The spectacle of ineffectuality is shocking.

    • The fourth doorman of the apocalypse says:

      Actually, I think it is 23 beds. That’s almost 20% more than you mentioned. That’s huge!

    • dave chamberlin says:

      Calm down and educate yourselves. Carl Zimmer wrote this article http://news.nationalgeographic.com/news/2014/09/140918-population-global-united-nations-2100-boom-africa/

      Here is a quote form it.
      “You’ve got a fairly standard Ebola virus, it is just in the worst possible place.”
      Ebola is a virus that is NOT an airborne pathogen, it spreads through direct contact of bodily fluids. It is highly implausible that it could mutate so that it becomes an airborne pathogen. If it does than take to that Rocky Mountain cave Cochran talked about, until then, get a grip.

      • The fourth doorman of the apocalypse says:

        Hey Dave, that’s some pretty powerful stuff you been smoking. Who is your supplier?

        Carl Zimmer is one of those Anthropogenic Global Warming cultists. So I am not sure he is a credible authority on anything.

        Secondly, as posted above, when real scientists submit articles on what it takes to make influenza airborne/more airborne, it seems like it is not too far fetched to apply the same techniques to EBOV (especially as some of the vaccines and treatments started out being targeted at influenza.)

        Still, I am happy for you if you want to believe the pablum that they are feeding us.

        • dave chamberlin says:

          Well since I’m stoned and Carl Zimmer is a cultist you must be right. Good luck with guarding that door to the apocalypse, we are all depending on you.

  41. gothamette says:

    Please overlook the fact that this is a neocon site:

    http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-bankrupt-my-hospital-director-reacts-to-cdc-prep-call/

    The link embeds an interview with Betsy McCaughey, in which she discusses w/Piers Read the feasibility of 50 Ebola Hospitals. It’s pure fantasy. She points out that treating Ebola patients will bankrupt us.

    • gcochran9 says:

      No, Ebola won’t bankrupt us. Look, let me say it again: as long as r < 1.0, the number of cases in the US is linearly related to the number of infected people who enter the country. Twice as many infected visitors means twice as many Ebola deaths in the US, half as many infected visitors means half as many Ebola deaths in the US. So the people gabbling about how it's bound to get in anyhow, with the implication that one exposure is equivalent to 50 or 500 or 5,000, are just wrong.

      Suppose that 50 infected people show up, and generate 50 extra cases – many in hospital staff. That's unfortunate: more than unfortunate if it happens to you. Imagine that we end up spending 10 million dollars per case: that's a total of one billion dollars. Considering that the Feds spend 3500 times that per year, I don't think it will break us.

      Now why do I talk about 100 cases in the US? Couldn't it end up being a lot bigger than that? No, because if that number even hits 15, Congress will go ape shit and demand that flights from the hot zone be stopped.

      I'm not saying that wasting a billion dollars is a good thing. I'm not saying that exposing 50 US health workers to a very dangerous virus is a good thing. But there's a practical limit on the maximum impact. This is a big country: we can afford to be stupid.

      Up to a point.

      • gothamette says:

        What about 100 cases – coming over the border. Will Congress go ape shit? Yes, even they’ll have to respond, but at that point, will going ape shit matter?

        How do you trace 100 illegals? You can’t, at least, not the way you can trace hospital personnel, or Nancy Snyderman. (An MD, who insanely did not “follow protocol”.)

      • The fourth doorman of the apocalypse says:

        Is it possible that Congress will be too timid to demand that we stop flights from there because racism?

        I have heard it said that hospital staff do not even want to ask if someone has been to West Africa because that would be discriminatory.

        Of course, if someone who is vomiting Ebola laden vomitus turns up at admissions, then the staff have big problems.

      • reiner Tor says:

        as long as r < 1.0

        I know it’s not statistically significant, but a second health worker has just been found infected by the same Thomas Duncan in Texas. Let’s hope this was just an unlucky happenstance, and they won’t further infect more than 2 new people.

        • reiner Tor says:

          The other question is whether this strain of ebola is making apes especially intelligent at the same time. I’m wondering just who’s going to win after the Great Ebola Plague, when a small band of human survivors will get into conflict with a hunting-gathering band of intelligent, sign language using apes.

          • dave chamberlin says:

            Maybe this Ebola thing is an attack by aliens. I mean why show up in one hundred large ships to do battle with all of humanity when you can unleash a genetically designed plague, air born Ebola, to do all the heavy lifting for you. It worked great for Europeans after 1492, why not once again.

          • melendwyr says:

            I’m a little surprised no one has tried to do Ebola terrorism. Granted, it’s not extant in the locations where you expect terrorists to show up. But get a volunteer infected, get them into the States, then keep them in a private residence and farm them for the virus. Use their fluids to infect dozens of volunteers, who take off to every corner of the US.

          • melendwyr says:

            Since we don’t know what animals or insects spread Ebola (mosquitoes, perhaps?) I don’t know what ‘more effective’ methods you’d mean.
            I suppose aerosolizing Ebola-laden fluids might ‘force’ the virus to be airborne, but I have no idea how that could be effectively accomplished if it’s even possible.
            Actually, Dr. Cochran, do you have any thoughts on why we haven’t seen any infectious-disease terrorism to any great degree? The anthrax scare was a waste of effort – wouldn’t it have been more effective to try to infect livestock, and/or public locations, than sending it through the mail to politicians?

  42. Greying Wanderer says:

    So the million dollar question is if, for the sake of argument, r = 0.6 will PC increase it to 0.8 or 1.2?

    I’ve spent a lot of time in PC environments so i dunno – i could see it hitting 0.999.

  43. Bob says:

    So with the second caregiver case from Duncan it now seems that perhaps r>1 in the US as well.

  44. Paula Deen says:

    I might be an anthropologist at math, so I dunno what that r stuff is all about, but it sure looks to me like a couple new people are gonna catch that bug for everyone who gets it, just looking at that Texas fella.

    Honestly, I kinda favor a different brand of quarantine: euthanasia followed by incineration, or strike “followed” if time is pressing. “Hey, there’s a 30% chance you’ll live, lets kill 1.8 people trying to save ya” does not make a lot of sense to me

    • Anonymous says:

      No one caught it from the first two patients who were treated. “r” is a statistical factor, not a number that applies to each case individually.

      • Paula Deen says:

        The ones that were known cases transported there specifically for treatment? Yup, they should prove typical.
        Check your intertubes, looks like Duncan was shedding like July German Sheppard and they were short on lint rollers

        • Anonymous says:

          No one who was in contact with him before he was hospitalized has become sick, and as it has now been 17 days there is a good chance none of them will. The only people who have become sick were providing him medical care while he was very sick.

  45. Tolmides says:

    In Dallas area hospitals, r is currently 2.

    • Anonymous says:

      In Georgia, it’s 0.

      • Tolmides says:

        Maybe it’s a sign that we should keep the numbers of new cases arriving from outside of the country low enough that we can keep them all treated at Emory University Hospital level facilities instead of at Texas Health Pres. sorts of hospitals.

  46. Richard Sharpe says:

    The second infected nurse flew from Ohio the day before she experienced symptoms. The plane was used on five more flights before it was taken out of service.

    I hope that this thing cannot be transmitted before the victim shows symptoms.

    • Richard Sharpe says:

      What happens if a person has both Influenza and Ebola?

      There are reports that EBOV is sometimes found in bronchial epithelial tissues according to something above.

      • Anonymous says:

        “What happens if a person has both Influenza and Ebola?”

        They probably die pretty fast.

        • Richard Sharpe says:

          Do you have any evidence for that?

          • Anonymous says:

            A lot of people die pretty fast just from Ebola. Adding another serious–occasionally fatal–infection is not likely to make things better.

          • William Newman says:

            “Adding another serious–occasionally fatal–infection is not likely to make things better.”

            You’re probably right, but remember that living organisms are complex enough that they can easily have insanely nonlinear responses to things, and they are the end result of a long arms race which seems to select for more extreme nonlinearity than is usually seen in inanimate complex systems like meteorology or geology, which makes crude additivity less of a safe assumption than it usually is. So e.g. there are a bunch of antiviral response tricks in the human immune system, and successful viruses tend to have tricks of their own to circumvent them, but evolution has tailored those circumvention tricks to work in ordinary circumstances, not to work when some other virus is triggering some of the alarms. A high-security facility which happens to be targeted simultaneously by two extremely clever complicated capers (by independent actors who aren’t aware of the coincidence until they blindside each other) is probably worse off than once which is targeted by just one, but not necessarily, because there are various ways for the clever plans to be derailed by the strange coincidence.

        • The fourth doorman of the apocalypse says:

          So, what about if they have the common cold as well as Ebola?

          Who cares that the combination will also be mostly fatal. What will it do to the efficacy of the spread of EBOV?

    • Anonymous says:

      It’s not so much a question of “cannot” as it is a level of risk. Victims likely become much more contagious as the symptoms get worse. As they get sicker they will have more of the virus in their bodies, and they are excreting a lot more bodily fluids. Cleaning up a patient who is very sick with vomiting and diarrhea is probably orders of magnitude more dangerous than flying in a plane an infected but asymptomatic person was in on an earlier flight.

      • The fourth doorman of the apocalypse says:

        Cleaning up a patient who is very sick with vomiting and diarrhea is probably orders of magnitude more dangerous than flying in a plane an infected but asymptomatic person was in on an earlier flight.

        In other words, you are talking out of your ass.

        • ursiform says:

          If being in the vicinity of something someone who later came down with Ebola was in the vicinity of before showing symptoms carried a high risk of transmission there would be a lot more than a few thousand cases in West Africa. So no, I’m not.

    • Anonymous says:

      We don’t know, there are reports of people “cured” of Ebola later transmitting it through sex (e.g. weeks after they appeared symptomatic) but the WHO is trying to figure out if the phenomena is real. If so, we should be worrying.

      • Anonymous says:

        Ah ha! So I tried to track down where our Postdoc might have heard that particular bit, and it turns out that some percentage of patients can still transmit Ebola through their sperm for 35 days, and a very small percentage for up to 60 days. So. Wow.

  47. Deja Vu.

    All this has happened before – right here near where I live. It came from Hawaii and before that China. It was the Third Wave of Bubonic Plague. Just before 1900 Bubonic Plague got to Chinatown in Honolulu. After that it got to San Francisco and even Oakland.

    This disease episode was similar to the current one. It was full of political bloviating, ethnic sensitivities and governmental blundering. The good news is that despite all that humanity persevered. The race survived the politicians.

    In 1900 bubonic plague was like Ebola today. The microorganism had been identified but how it was spread was unclear. The authorities in Hawaii didn’t quite get the rat connection so in an effort to control the disease they burn down almost all of their Chinatown.

    The rats got on ships and came to San Francisco which also had a Chinatown. Again like today racial politics came into play. But on the mainland we also had politicians who simply denied that there was much of a problem at all. Henry Gage the California governor at the time claimed there was no plague. He tried to censor medical reports and ran a publicly funded campaign to promote the idea that it was not just a mistake but a conspiracy.

    The medical authorities of the day (The Marine Hospital Service) found clear evidence of the bacillus but Gage claimed that they had planted the pathogens in cadavers. He called it a federal plot. He kept any kind of quarantine from being effective.

    Yes, it does seem as if Obama has been channeling Governor Gage.

    Gage, who was apparently a tool of Southern Pacific and statewide business interests, collaborated with racially motivated Chinatown business interests and there was no effective quarantine. Fortune smiled on the City in 1906 after the earthquake when Chinatown burned to the ground.

    Obama’s stance on Ebola seems very odd to me. If Ebola catches on in America and kills more than a handful of people, he will have identified himself with the disease. He will be known as the man who allowed this nasty bug into our country. Why do it? The only thing I can think of is race. The victims from Africa are black and they gain by getting American medical care. The people endangered by the lack of quarantine are mostly white. Could that be it?

    • Anonymous says:

      I don’t think burning down Chinatown will stop Ebola …

      • The fourth doorman of the apocalypse says:

        I think he was alluding to the Chinese Fire Drill the Administration has been conducting.

    • Sean says:

      5 Jan 2010 – A 22-year ban on HIV-positive foreign nationals from moving to or visiting the United States has ended.”

      How many have contracted HIV because of that do you think? Nothing sticks to Obama.

  48. Anonymous says:

    One of the things that I find odd about this outbreak is that post-911 the U.S. government has ridiculously broad, vaguely defined emergency powers, including being able to detain people wherever they want, for basically however long they choose. In addition, the NSA have amazing data mining abilities, such as ability (supposedly) to catch people who habitually use “burner” phones, such as drug dealers. Seems like finding people listed on a flight manifest is a relatively simple use of government money. Why in the hell is the CDC asking for people who flew with the 2nd infected nurse to voluntarily call the CDC?? We have massive resources we can bring to bear, after all they catch terrorists all the time, outside the U.S. and in some pretty rural environments. Why are they not being used to find these people exposed to Ebola and quarantine them? If the government simply declares a national security risk, they can quarantine whoever they like.

    • Anonymous says:

      Also, preventing the few flights from West Africa per week from landing in the U.S. seems pretty easy as well. Seems like we’re just wasting time waiting for a bunch of people to get infected…
      And these people are not likely taking first class or business class seats, so we’re not losing much money by preventing them from flying here to begin with.

      • Greying Wanderer says:

        While the majority of carriers are West African TPTB will be incapable of any sensible response. If/when a large enough number of non West Africans are infected then they’ll suddenly switch to massive over-reaction instead and you’ll have the NSA coming out of your *** and shooting people for sweating too much in a public place.

        PC is a form of insanity.

  49. j says:

    The Yambuku (Zaire, 1976) ebola epidemy was stopped by closing down the hospital (after most medical workers had died), isolating the whole area and quarantine. Does CDC (2014) know that?

  50. The fourth doorman of the apocalypse says:
  51. Richard Sharpe says:

    Who says:

    Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.

    2% not characterized?

    http://www.who.int/mediacentre/news/ebola/14-october-2014/en/

  52. Rum says:

    I know that very few folks are going to see this, but what the hell.
    I just got back from a meeting of people who matter regarding this issue. There was an overwhelming consensus: No one thinks that their institution could have done better than the hospital In Dallas. Everyone understood that the problem is providing high quality care = more virus particles. Outside of a few level 4 centers, the geometrically increasing concentration of virii resulting from keeping patients alive will likely overcome ordinary protection for health care workers. No one is willing to require workers to care for Ebola as a condition of Employment. Since, you know, we cannot really protect them. In the future, it is going to be volunteers only.
    The more that the Dallas hospital is publically pilloried, the more the professionals in American Medicine are thinking” Fook the CDC. There is no reason to cooperate with them.”
    The CDC is Obama… Just looking for a way to blame someone else. He, they are about to get ignored.

    • Anonymous says:

      “I know that very few folks are going to see this, but what the hell.”

      I saw it and found it informative. Thanks for posting it.

    • melendwyr says:

      The CDC isn’t Obama – what it is, is political. The particular figurehead-in-chief isn’t significant.

      I am heartened by the suggestion that some people will behave sensibly. However, I will note that really matters little, if the key people in the positions responsible for making decisions on a certain scale don’t behave as reasonably. If there isn’t going to be a mutiny, then it doesn’t matter if the crew is sane, if the captain is mad. Everyone goes down with the ship.

  53. The fourth doorman of the apocalypse says:

    At this stage, I have to admit that the Affirmative Action problems are not in the hospitals.

    They are in the CDC and the Executive.

  54. Anonymous says:

    Has anyone mentioned that WHO closed Madagascar (ports and airports) when fewer than 100 were infected with plague?

    That was in 2013.

    Quite an INCONSISTENCY.

  55. Anonymous says:

    I’m sure someone has also mentioned that the immunity to HIV of some Western Europeans is explained by their ancestors’ having survived the plague.

  56. aramharrow says:

    If the r is smaller in the US than in Africa then each imported case will infect and kill fewer people here than they will there. So you have to value American lives more, possibly much more, than African lives to justify your conclusion.

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