The Advent of Cholera

Most of this is stolen from William MacNeill’s Plagues and Peoples.

Cholera seems to have existed in the Ganges delta for a long time, but it only spread to the rest of the world fairly recently.  An unusually severe epidemic broke out in 1817: it spread by ship to Sri Lanka, Indonesia, Southeast Asia, China, and Japan between 1820 and 1822.  A British expeditionary force brought it southern Arabia in 1821, and from there is filtered down the east coast of Africa.    It moved up into the Persian Gulf, reaching Iraq and Iran, then Syria, Anatolia, and the Caspian.

In 1826 a new epidemic moved even further, spread through Europe and North America.

It had been some time since the last outbreaks of bubonic plague, and most of the techniques for limiting its spread had lapsed. Some places still remembered: Marseilles, for example, had experienced a late outbreak of plague in 1721 and annually commemorated it.

Two main factors interfered with an effective policy response to cholera (not counting ever-present human stupidity and obstinacy): bad science and 19th century liberalism.

Scientists at the time had convinced themselves that the germ theory of disease was just wrong.  Yellow fever’s decimation of the French force in Haiti made it important, and when yellow fever hit Barcelona in 1822, French scientists were all over it. They concluded that there was no possibility of contact between yellow fever victims in Barcelona, and ruled out contagion.  Mosquito transmission didn’t occur to them.

Worse yet, they generalized their error: they concluded that contagion was never the answer, and accepted miasmas as the cause, a theory which is too stupid to be interesting. Sheesh, they taught the kids in medical school that measles wasn’t catching –  while ordinary people knew perfectly well that it was. You know, esoteric, non-intuitive truths have a certain appeal – once initiated, you’re no longer one of the rubes.  Of course, the simplest and most common way of producing an esoteric truth is to just make it up.

On the other hand, 19th century liberals (somewhat like modern libertarians, but way less crazy) knew that trade and individual freedom were always good things, by definition, so they also opposed quarantines –  worse than wrong, old-fashioned ! And more common in southern, Catholic, Europe: enough said! So,  between wrong science and classical liberalism, medical reformers spent many years trying to eliminate the reactionary quarantine rules that still existed in Mediterranean ports.

The intellectual tide turned: first heros like John Snow, and Peter Panum, later titans like Pasteur and Koch. Contagionism made a comeback.  I am not an expert on that history, but I think that the classical liberals didn’t argue that it would have been better for people to die than survive due to state-imposed public-health methods.

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117 Responses to The Advent of Cholera

  1. melendwyr says:

    I rather think you’re missing the point, there. A good monarch is a valuable and desirable role… but monarchy is a bad thing. Likewise, state-imposed health measures might be a good thing… but exerting the power of the state can still be a bad thing overall. It’s not a difficult concept.

    Although we could argue about the details, there are obviously times when state power is valuable, even necessary. It’s the anarcho-tyranny of the current system that bothers me. Like the people who insist that the state has coercive powers when dealing with infectious diseases, but which lets parents enroll their unvaccinated children in public schools with fraudulent certificates from sympathetic doctors. Or which legislates against fast food but can’t be bothered to cut off plane traffic from Ebola-infested countries.

    I think you need to make the state use its powers appropriately before trying to grant it more of them.

    • albatross says:

      But the state already has the power to refuse entry to some foreigners at the border for public health reasons, and to impose quarantines on contagious people, and a bunch of similar stuff. That’s not a new state power, it’s an old one.

      • melendwyr says:

        Yes, and the current system isn’t using the power it has to declare quarantines for known contagious diseases. Suggesting that it should be given the power to quarantine non-easily-contagious diseases, like HIV, as Dr. Cochran was retrosuggesting just a little while ago, seems inappropriate in that context.

  2. MawBTS says:

    Intredasting re: cholera being recent. When I read about Ancient Rome the diseases mentioned by Galen-era doctors are stuff like dysentery, malaria, and flu…I never noticed that “cholera” was always missing from the list.

    If India had remained isolated until the modern era (ie, assume we have modern testing and quarantine techniques at our disposal), would we have stood a chance at keeping cholera contained to the Ganges? Or would it have probably spread anyway?

  3. Sam says:

    “A British expeditionary force brought it southern Arabia in 1821, and from there is filtered down the east coast of Africa. It moved up into the Persian Gulf, reaching Iraq and Iran, then Syria, Anatolia, and the Caspian.”

    A British ship returning from India introduced it in The Gambia in 19th century, where it almost wiped out half of the island town of Banjul (now the capital). There is a still a neighborhood of that city called “half-die” due to that cholera outbreak.

  4. strongsloth says:

    Cholera appears to do best in places that are warm and wet, with a dense population, poor sanitation and lack of clean water sources. The fairly sudden propensity to spread might be a reflection of there being more places with dense populations, poor sanitation and lack of clean water sources as much as increased opportunities for transport.

    Cholera control is mostly about improved sanitation and clean water supply, not quarantine measures.

    • Toddy Cat says:

      Yes, cholera does best in warm, wet environments, but that didn’t stop it from killing tens of thousands in Britain, North America, and other temperate places. And yes, sanitation and clean water are why we don’t have cholera outbreaks today, but back them quarantines were an important part of controlling the epidemic.

      “The fairly sudden propensity to spread might be a reflection of there being more places with dense populations, poor sanitation and lack of clean water sources as much as increased opportunities for transport.”

      Yeah, and the current Ebola outbreak MIGHT be biowarfare directed against Earth from Mars – but that’s not the way to bet.

  5. You know, esoteric, non-intuitive truths have a certain appeal – once initiated, you’re no longer one of the rubes.  Of course, the simplest and most common way of producing an esoteric truth is to just make it up.

    Correct & that’s probably where there’s probably a negative correlation between IQ & HBD belief. Some facts are just so obvious that any idiot can see they’re true, but a certain amount of IQ & inventiveness is required to fool yourself into denial.

  6. Jim says:

    Cholera was brought to Haiti by UN-Indian troops.

  7. JayMan says:

    The most poignant case in recent history is the introduction of cholera to Haiti by UN aid workers from Nepal. A horrible irony of grand proportions. The disease persists there to this day. :\

  8. The fourth doorman of the apocalypse says:

    From that Science paper on Ebola in Sierra Leone:

    http://m.sciencemag.org/content/early/2014/08/27/science.1259657.full?explicitversion=true

    The observed substitution rate is roughly twice as high within the 2014 outbreak as between outbreaks (Fig. 4F). Mutations are also more frequently nonsynonymous during the outbreak (Fig. 4G). Similar findings have been seen previously (15) and are consistent with expectations from incomplete purifying selection (16–18). Determining whether individual mutations are deleterious, or even adaptive, would require functional analysis; however, the rate of nonsynonymous mutations suggests that continued progression of this epidemic could afford an opportunity for viral adaptation (Fig. 4H), underscoring the need for rapid containment.
    As in every EVD outbreak, the 2014 EBOV variant carries a number of genetic changes distinct to this lineage; our data do not address whether these differences are related to the severity of the outbreak. However, the catalog of 395 mutations, including 50 fixed nonsynonymous changes with 8 at positions with high levels of conservation across ebolaviruses, provide a starting point for such studies (table S4).

    Do I have this correct. With about 19,000 base pairs we have seen something like 2% change in its genome in 10 years (since 2004)? That seems fast, although admittedly only 50 were non synonymous.

    • Michael says:

      This mutation rate is typical of single stranded RNA viruses. For example, the flu (which has three to five million yearly cases of severe illness and about 250,000 to 500,000 deaths per year) has a 1.7% mutation rate per decade.

      The mutation rates are also usually high in viruses which jump between species (such as Influenza and Ebola) because rare survivors are quickly selected by avoiding a new type of immune system.

      • Richard Sharpe says:

        Should we really measure it per year or per decade. Shouldn’t we measure it per opportunity to infect?

        It seems to me that Ebola has had far fewer opportunities to infect than Influenza has had over the last 10 years. Maybe I am wrong. I sure hope so, because otherwise it suggests that Ebola has a higher mutation rate and can explore the lethal space much more quickly.

        • Michael says:

          Ebola has had just as many opportunities to infect as Influenza. Both viruses have non-human hosts, which serve as a reservoir for human infections. This is where the bulk of their evolution is occuring, and why vaccination of every person on the planet this year would not prevent people from getting the flu next year.

    • DK says:

      You have it right and it’s a reflection of a well-known biology: RNA viruses replicate with a lot of errors. See: influenza

  9. The fourth doorman of the apocalypse says:

    Possible R=3 or 4:

    http://belizean.com/belize-confirms-patient-with-ebola-symptoms-on-cruise-ship-off-its-coast-1814/

    I think most are saying Ebola-like symptoms so it is not confirmed.

    The lawsuits are going to be staggering.

  10. A local opera company was doing Traviata. I love Verdi but never cared much for Traviata – probably because it doesn’t have a good part for me. But the pay was good so I auditioned for one of the little baritone parts.

    The maestro told the cast to read the book. I was the only one who did. Very interesting.

    ‘La Dame Aux Camellias’ was written in 1848. Verdi wrote the opera in 1855. Murger wrote ‘La Vie de Boheme’ on which Puccini’s opera is based in 1851. But Koch published his paper on tuberculosis much later in 1882. That means that at the time of the first performance of Traviata and the composition of ‘La Boheme’ no one realized that the tuberculosis that Violetta and Mimi die from in the final acts, was contagious.

    So if they didn’t know about germ theory what did they think was the cause of ‘consumption’.? One popular theory was vampires. The neighbors would see a family in a house all slowly grow pale and weak. They figured that one of them was a vampire who was ‘consuming’ the blood of the others.

    This is why productions of Boheme and Traviata set in modern times make no sense. In both shows the tenors passionately kiss the sopranos. Modern people who know about infection generally won’t kiss a tubercular woman.

    Richard Feynman’s first wife had tuberculosis and they never kissed.

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  12. gothamette says:

    Doctors. Gotta love ’em.

    “Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis’s practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory…..”

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

  13. Riordan says:

    Dr. Cochran, what is your opinion regarding this argument and skepticism on how a flight ban from West Africa can be enforced?

    http://viewfromthewing.boardingarea.com/2014/10/16/ebola-travel-ban-shutting-travel-west-africa-even-work/

    • Richard Sharpe says:

      Well, I am not Dr Cochran but I pretend I am him in my dreams:

      You can stop people on entry into the U.S. But if they are infected with Ebola, they may have infected many others on the flights they took to the U.S. So the policy would keep them out, but not the people they infected.

      You can stop people from boarding flights into the U.S. in the first place, but since it’s specific people on specific flights from Europe, this gets harder to do than it might seem at first blush.

      Not even trying means that you deter no one.

      Having a policy of rejecting everyone on a passport issued by one of those countries and enforcing that policy reduces the problem to the number of people who have resources enough to evade the policy.

      Surely it comes down to limiting the problem to something we can handle and not overwhelming our medical system.

      Allowing thousands of people from that area to come here seeking to be cured is a recipe for disaster, it seems to me.

    • Richard Sharpe says:

      Also, people making that argument seem to be making a variant of the The Bomber Will Always Get Through argument.

    • gcochran9 says:

      It’s nonsense. As I pointed out, if r < 1.0 in US conditions, the number of cases is linearly proportional to the number of infected visitors. You don't have to stop every single one: stopping 75% of them decreases the US end of the problem by 75%. Is this too subtle for people to understand?

      Second, I don't give a crap if we inconvenience some expats with Liberian passports for the duration.

      Third, the author, and possibly the US government, may not be able to tell the difference between a Liberian and a Belgian just by looking, but I can.

      Fourth, I guarantee that most of those alternate routes through other countries are going to disappear, because they too are going to ban travelers from the hot zone.

      Greatly reducing the flow of infected people from the hot zone to the US is trivially easy. Anyone who says otherwise is addled.

      It is also easy as pie to block that flow without materially interfering with medical effort in the hot zone.

      The head of the CDC can say that charter flights don't do the same thing commercial airlines do, but that's nonsense. By the way, if I had to support some some of obviously stupid policy, possibly one that had a hidden reason (more likely no reason at all) I could sure as hell do a better job. Not only is he handing out bullshit, it's inferior bullshit.

      • ursiform says:

        By the way, some West African nations have imposed travel bans. They seem to get the concept …

      • AErickson says:

        Presumably the R value increases as a function of the number of total infected persons entering a country/region, since the ability to isolate cases properly and minimize secondary infections becomes more difficult with more patients. We aren’t likely to come close to a threshold number of infections wherein this becomes an issue, especially since political pressure would cause a travel ban/quarantine far before it did become an issue, but I don’t get the sense this is the sort of thing our officials are thinking of. Also, more important than minimizing infected persons entering the US is minimizing infected persons entering Calcutta, Shenzhen, Lagos (again), Cape Town, and on and on.

        • gcochran9 says:

          It might actually get smaller as the total number of patients increased, if you were scared into brutal realism.

          We can be sure that our officials are not thinking of exponential and subexponential regimes in parameter space.

          • AErickson says:

            Right, though the most likely way it would get smaller as the number of infected people increases is if the whole damned region shuts down and avoids one another, which would presumably cause at least a mild economic contraction. More reasonable still would be to shoot the infected and incinerate the bodies or something like that, but I doubt we would reach that level of brutal realism. So to amend my comment, I suppose the best idea is probably to keep the number of infected people entering low enough that we avoid either an increased R value or mass hysteria with meaningful negative impact. Or we go the Jerry Brown route of exponential ignorance you mentioned in a previous post concerning the med fly infestation in 1981, where we forego a small bit of realism/harm now for a guaranteed larger amount of harm later. Seems more likely if we ever find ourselves in such a situation, although I keep having to remind myself that I don’t have to imagine these types of epidemic scenarios, since the US lived through it with AIDS in the 1980s and there hasn’t been a whole lot of useful collective introspection since then.

    • Riordan says:

      I see. How about the argument that if such a travel ban is enforced, then any resident Liberians/Sierra Leonian/Guinean-Americans will then attempt to travel covertly anyways, and, once successfully in the U.S., will avoid medical care if they are infected and thus spread the disease further? I.e. you might get 5-10 infected people instead of 50-100, but then the travel ban will cause them to be so fearful that they will avoid medical care until the last stages when they might have infected even more people than if you brought the 50-100 infected persons without the travel ban.

      • ziel says:

        How are they going to manage that? Are they going to procure fake passports? How easy do you think that is? Are they going to go thru Central America? Do you think those countries want them? As Greg said, the Atlantic is awfully wide.

      • gcochran9 says:

        You know, I heard a lot of similar things during the early phase of the AIDS epidemic. We needed to keep the bathhouses open, because they made it easy to hand out educational flyers to the likely victims. Evidently educational flyers were thought to have an effect like that of saltpeter. We had to worry about AIDS patients ‘going underground’ if we tried quarantine, or compulsory testing, or even contact tracing, which had been routine for other, less dangerous venereal diseases. States and countries that were less tolerant of homosexual activity were bound to have more severe epidemics. AIDS was a big threat to the general population.

        All of those statements were false. We would have done better to listen to Fidel Castro than than the public-health bureaucrats.

        • thiscannotbethefuture says:

          Now this article is claiming studies show travel bans wouldn’t work. http://www.vox.com/2014/10/18/6994413/research-travel-bans-ebola-virus-outbreak

          The 2006 study seems to make some assumptions that might not be so relevant, but an interesting try regarding comparison to influenza nonetheless.

          • gcochran9 says:

            That article is nonsense. When you have a super-transmissible organism like influenza, any leak lets it get through and spread to everyone. Oh, you could stop it, but it would be difficult.

            With a pathogen like Ebola that had r less than 1 in US conditions, the situation is entirely different.

            The pinheads are really out in force in this one. I’ve been collected their ripest bits of nonsense. My recent favorite is Stephen Morrison, senior vice president and director of the Global Health Policy Center at CSIS, saying that you couldn’t use military and charter planes to insert health workers (while banning general air traffic) because it’s unaffordable. Unaffordable, for the country that ran the Berlin Airlift. I guess all those Air Force C-5As and C-17s are actually Christmas decorations.

            Morrison should be fired, of course. But then, maybe he’s doing just what he’s supposed to, supporting the Administration, the hand that feeds him. Anthony Cordesman works there, and when talking about US policy in Iraq, he refrained from continually pointing out that the people running the show ( Bush, Cheney, and Rumsfeld) were lying, incompetent assholes. I thought that Cordesman talked as realistically as he was allowed to, but still.

            Reminds me of some of the more hilarious examples of people being a true team player – like the time Michael Barone said that the Japanese invasion of Kiska and Attu in 1942 conferred foreign policy experience on Sarah Palin (born in 1964).

      • Greying Wanderer says:

        @Riordan

        As soon as the PC calculation flips (n1y1 > n2y2 -> n1y1 < n2y2) they'll say the exact opposite of what they're saying now.

        They'd say it today if someone suggested that Americans leaving for Liberia should be tested for Ebola first even in the same paragraph as they say the opposite for the reverse flow.

    • Greying Wanderer says:

      I betcha when it comes to using Ebola as the reason for controlling all movement within the US (but not into) they won’t be saying it’s too difficult.

  14. The fourth doorman of the apocalypse says:

    McNeill seems uninformed by such concepts as Selection and Evolution.

    I will have to get the book and read it in its entirety, though.

    • The fourth doorman of the apocalypse says:

      OK, just by reading further on Amazon I can see that this is not true.

    • gcochran9 says:

      There are aspects of that book that could benefit by revision by someone with a better understanding of the evolution of virulence, and also considering what we’ve learned about these questions since 1976: but it’s a damn good book.

  15. dave chamberlin says:

    The whole world is scared and transfixed by this Ebola outbreak. It might be all out of proportion to the death count and actual threat but I don’t mind. The government wont be sitting on it’s hands this time. It looks very probable that sufficient aid will be given to those areas in Africa that need it and travel will be severely limited, just as Greg Cochran has suggested.

    It sounds terribly cynical to say but it is mostly true, we don’t give a damn about Africa’s problems unless their problems can become our problems, same goes with the Middle East. So I’m optimistic this Ebola outbreak will be quickly squelched. But it feels like something is coming, doesn’t it? Just too many people crowded too close together with incredibly insufficient medical staffs in places like Liberia. So we can’t say extreme poverty isn’t our problem because we don’t suffer from it. A billion or two dirt poor people living across the globe is our problem because speaking germ wise that’s a lot of petri dishes running continuous experiments on communicable diseases. Sooner or later an outbreak will happen and modern medicine will be too late to react and then quickly overwhelmed.

    People typically don’t know how bad the 1918 Flu pandemic was. It infected 500 million people and killed 50 to 100 million. The world had 1.8 billion people back then so it is easy to project a four fold increase with today’s population. So while we are most afraid of the new exotic diseases like Ebola, the one that scares the medical professionals the most is a new variety of the flu which we have no resistance to. Even if effective flu shots are made guess who gets them last.

    • The fourth doorman of the apocalypse says:

      Why should we give a damn about Africa’s problems?

      • dave chamberlin says:

        Because extreme poverty breeds ignorance, violence, hatred, and diseases and they don’t stay put. You don’t have to be a wacko religious fundamentalist to become a terrorist. If your family back home is starving and you observe people in other countries feeding their dogs better than your family back home, you just might resort to action. It is a very connected world whether we want it to be or not.

        Ignoring the fact that they are people and can suffer let us just look at cause and effect.
        As long as poor parts of the world cant get their shit together and practice birth control we will remain threatened. Over population in other parts of the world causes us to spend billions to combat violence and disease. Isolationism might have been an answer a century ago but it isn’t anymore.

        • gothamette says:

          @dave,

          My guess is that the Africans in the EZ will handle the problem in a common sense way: quarantine. Severe quarantine. Leave the dead to die. It’s horrible and heartless, but it’s really the only way.

          MSF warned about this in March 2014 and no one listened. Where was Obama? Cameron? Blame THEM, and not the average Joe, for not caring. What the hell was I supposed to do about it? Our leadership has failed. But I repeat myself.

          Read today’s Times for a puff piece on how Obama’s aides have failed him. No – he failed them.

          http://www.nytimes.com/2014/10/18/us/amid-assurances-on-ebola-obama-is-said-to-seethe.html

          Oh wow, Obama is said to seethe. This is a total complete PR puff piece, not journalism! Obama should have known about the epidemic in March. He should have ordered a response. Instead the fire was allowed to rage out of control.

        • Jim says:

          No doubt Osama bin Laden’s dire poverty forced him into a life of terrorism.

        • ursiform says:

          Extreme poverty may lead people to steal. It may lead people to kill for food or items they or their family needs. But terrorism requires at least a desire for vengeance, as it has no, at least near term, value to the terrorist or his or her family.

        • TWS says:

          Nope still not my problem. My only problem is jackwads who want to let those problems into my country.

          • dave chamberlin says:

            I respect the fact that you are honest in your selfishness, I have a lot of liberal friends that lie about it. They pretend to care about everyone in the world they but don’t do jack shit for anybody. Places like the slum of Westpoint located in the city of Monrovia, capital of Liberia, are going to be your problem whether you want them to be or not. You see this disgusting place, population 100,000 people and four actual running toilets, is the epicenter of the latest Ebola outbreak. You can read a bit about this awful ghetto here ww.cbsnews.com/news/ebola-in-liberia-reporter-recounts-pockets-of-hope-amid-corridors-of-misery/.

            People are packed like sardines here, If it wasn’t for outside help then Ebola cases would double here every three weeks. But not everyone is desperately poor in the city of Monrovia Liberia, it is a city of one million people. Many of them would choose to get the hell out if Ebola were (maybe is going to, we don’t yet know) to keep on growing. People leave when they want no matter what the government dictates are. If you don’t believe me ask a wetback.

            So maybe Ebola gets contained because big bucks poor into shit hole places like Westpoint this time. But what happens when the population of Africa doubles and there are dozens of places like Westpoint and no more Bill Gates foundations willing to fork out 50 million bucks to contain the next outbreak. So it spreads and spreads and lots of lots of poor people die, not your problem…..

            Really? Is that how the world works, people can’t and don’t sneak across borders when they think life might be better elsewhere. I am not preaching about love your fellow man, I am talking stone cold cause and effect. Continued world over population will be your problem sooner or later. The shit will hit the fan and some of it will splatter on you.

          • melendwyr says:

            dave chamberlin, you make an excellent argument as to why we should care about Ebola in Africa.
            Unfortunately, you’ve demonstrated that we should hail it as population control rather than devoting resources to a fruitless attempt to stop it.

        • The fourth doorman of the apocalypse says:

          Extreme poverty is a relative thing.

          For example, compared with Mark Zuckerberg I am extremely poor. I cannot, for example, donate $30M (or whatever) to the CDC. Nor can I spend $100M buying up parts of Hawaii.

          However, I do not recall ever being compelled to commit mayhem because of that.

  16. Anonymous says:

    Assume you wished to give a damn about Africa. You are bound by a higher restriction: you cannot be a colonialist. So, if you send medical equipment and it stays unused on the quayside because bribes have not been paid, you cannot intervene. That would be colonialism. You cannot urge those governments to pay health workers substantial danger money. That would be colonialism. Sending money, however, would not be colonialism. It would be Aid.

  17. token_libertarian says:

    I’ll briefly present a bit of non-mainstream libertarian view on the subject of control, surveillance etc.

    So suppose Principality of Sealand acts as an example of a privately owned political system. Then quite simply the owner of that area could decide to block any individual from visiting the place and no reason would need to be given. The reason might be the fear of Ebola. It might even be the dislike of, say, a certain population or religion. To go further, this private society might install the most draconian surveillance system, and have the highest military spending (if the people renting or owning space under the system wished to contribute money into it). So in other words the private society could be more of a control freak than any conservative/military advocate in our current system, including on immigration. It would just mirror the values of its owners and residents.

    So the Libertarian mainstream view usually doesn’t take this position, rather it predicts that these private societies would be welcoming and open. Gated communities are seen as anti human-freedom when I think they are the expression of freedom of choice of the gated community.

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  19. The fourth doorman of the apocalypse says:

    Despite the people working to combat Ebola in West Africa having better standards than the CDC, they still have had lots of health worker deaths:

    http://thehill.com/policy/healthcare/220955-aid-group-leader-africas-ebola-standards-higher-than-cdcs

    MSF has had 9 dead doctors so far and 15 infected.

    I think we should be very afraid.

    • gcochran9 says:

      I suppose we should be, but not because of Ebola. We should be afraid because the people running the country are crazy.

      • The fourth doorman of the apocalypse says:

        I agree with that view, or rather, I think they are subjecting us to unnecessary risks.

      • The fourth doorman of the apocalypse says:

        Maybe they are not crazy from their point of view. Maybe they simply have a higher calling, one that does not include our interests.

      • The fourth doorman of the apocalypse says:

        John Derbyshire wrote something that seems relevant, although he was quoting/remembering Conquest:

        http://www.nationalreview.com/corner/65827/conquests-laws/john-derbyshire

        Several readers have asked me for Robert Conquest’s Three Laws of politics.
        As best I can remember, they are:

        1. Everyone is conservative about what he knows best.

        2. Any organization not explicitly and constitutionally right-wing will
        sooner or later become left-wing.

        3. The behavior of any bureaucratic organization can best be understood by
        assuming that it is controlled by a secret cabal of its enemies.

        Of the Second Law, Conquest gave the Church of England and Amnesty
        International as examples. Of the Third, he noted that a bureaucarcy
        sometimes actually IS controlled by a secret cabal of its enemies–e.g.
        the postwar British secret service
        . (Emphasis added.)

        Maybe the US really is controlled by a cabal of the enemies of the people of the US.

  20. gothamette says:

    http://www.bostonglobe.com/news/nation/2014/10/16/ebola-fear-spreads-ohio-and-texas-close-some-schools/JAec9k65EW6tmejLeCCwKL/story.html

    ““This isn’t flu or smallpox,” Offit said. “It’s not spread by droplet transmission. As long as nobody kissed the person on the plane, they’re safe.”

    Actually….Ebola is spread by droplet transmission. Not airborne, but droplets, yes.

    The man who said this is “Dr. Paul A. Offit, the chief of infectious diseases at the Children’s Hospital of Philadelphia, likened the response to the early days of the AIDS epidemic, “when people were afraid to walk into a grocery store and pick up a piece of fruit.”

    Yes, and in the early days of the AIDS epidemic, politicians who believed in informing mothers of HIV infected babies were accused of being Nazis. In addition to misspeaking like a real dope, Offit is caricaturing what the early days of the AIDs epidemic were.

    Oh yeah, there’s a lot of people who now think we should allow men who have sex with men (MSMs) to donate blood. More crazy.

  21. dave chamberlin says:

    Never mind logic, Obama is risking a couple of senate seats in the mid term elections coming up in under three weeks if he sticks with his position of no travel bans from Ebola infected countries. It is a very unpopular decision and republicans are already making hay by declaring the president inept and stupid. The attack ads will roll out soon enough declaring that Obama and the democrats are risking American lives to help out struggling African economies. I predict the “Ebola Czar” will reverse Obama’s decision and declare that no one can leave the source countries of Ebola unless they have passed a blood test proving they do not have Ebola. This includes a waiting period as people do not show signs of Ebola infection immediately. Basically a rational decision made for political reasons. But then again the president might stay stubborn and wave good bye to a couple of senate seats. But he will be getting extreme pressure from every democrat up for reelection to flip his decision by saying we still have no travel bans BUT everyone leaving has to pass this blood test proving they do not have Ebola.

    Yes it’s convoluted bullshit, but that’s how it’s done in Washington.

    • Enforcing a quarantine is very like shooting looters. Eventually looting always seems to be stopped when the guns come out. But the government, which theoretically has a monopoly on violence refuses to shoot. Therefore the private parties involved – particularly the store owners – get out their rifles – after which there is no more looting. In the Rodney King riots the storeowners lay on the roofs. In Ferguson they lined up out front.

      Similarly, quarantines need to be enforced with guns. But this requires political resolve. And at the very least political unanimity.

      In the attempted quarantine of Bubonic Plague in San Francisco in 1900, the Democrats wanted to contain the infection but the Republicans didn’t. Today it’s the Republicans who want a quarantine but the Democrats oppose it. The reason quarantines are so hard to manage is because of the politicians who represent some anti-quarantine faction.

      The Obama administration seems likely to sabotage any attempted quarantine. They seem unlikely to be willing to have white people round up all the sick, black illegal aliens. So if Ebola really is a dangerous as some claim we should expect an uncontrolled spread of infected aliens.

      Remember the Obama administration seems to have engineered the illegal influx of thousands of Central American children. The next batch they truck north may very well have Ebola. If so our heath system is likely to collapse.

      Our best hospitals struggle with just two Ebola patients. Some Ebola refugees in Africa may flee to Honduras or Guatemala. I doubt if the hospitals in those countries are better equipped and staffed than those in Texas. If this tropical African disease gets a foothold in tropical Central America we are in the deep doo-doo.

      Ebola treatment will change if the number of cases grows large. In Africa remote villages that get Ebola, it just burns out. Everyone dies and the virus is contained. If we get swamped with Ebola we will be forced into a similar treatment – just leave them where they lie. In Africa they call Ebola the ‘Nurse killer’. People who treat Ebola patients are at great risk. Currently we are putting Ebola patients in hospitals and exposing our medical people to the virus. That will stop if we get more cases. Our policy will probably evolve to putting the victims in a holding facility until they die.

      Ebola is still an easy disease to control but not if the government opposes control. We may see private citizens get out their guns as they did on the border this summer. If there are Ebola patients stumbling around sick in the streets, a lot of Americans may see it as a ‘Zombie Hunt’. Better to drop them in the street before they come to your door.

  22. Alex says:

    “that’s probably where there’s probably a negative correlation between IQ & HBD belief”
    This probably isn’t true.

  23. The fourth doorman of the apocalypse says:

    I managed to get a copy of Biology of Plagues.

    In the introduction it says:

    Olson et al. (1996) stated that a modern case definition of Ebola virus infection records sudden onset, fever, headache, pharyngitis followed by a cough, vomiting, …

    Wikipedia also reports a sore throat as a symptom.

    I find it hard to believe that the coughing does not aerosolise the virus droplets.

    • The fourth doorman of the apocalypse says:

      On page 22 of Biology of Plagues they say:

      The latent period of HIV is of the order of days to weeks whereas the median incubation period, before symptoms appear, is greater than 10 years, during which time a great many people may be infected (Halloran, 1998). We show in Chapter 5 that people in England infected with the plague were infectious for some 22 days before the symptoms appeared

  24. The fourth doorman of the apocalypse says:

    In this article:

    http://www.bloombergview.com/articles/2014-10-17/ebola-s-greatest-threat-a-third-world-pandemic

    Megan McArdle claims that HIV has an R0 of 4 (whoa, those homosexuals are randy) while Ebola has an R0 of 2.

    It would seem to me that HIV is restricted to a very small subset of all humans, while Ebola can infect all humans regardless of their sexual orientation or drug usage.)

    • Greying Wanderer says:

      I think sexual transmission will be a factor here as well – anyone with college age kids should be encouraging them to go Amish for a while in case the CDC somehow manage to create an epidemic.

      • The fourth doorman of the apocalypse says:

        Sure, but my point was that you need to be aware of both R0 and the susceptible population.

        If the disease only infects blue-eyed Namibians, then even though it has an R0 of 16, most people can rest easy. Conversely, if it can infect 90% of all people on the planet, having an R0 of only 2 is not much solace.

        • Greying Wanderer says:

          That’s my point – AIDS wasn’t just homosexuals. It was also heterosexual sub-populations who were very promiscuous so they had other STDs which allowed access to the blood stream – PC filtered that bit out as well.

          • Kilo4/11 says:

            It only allowed access to the bloodstream if they anally penetrated an infected person, which, in effect, since hardly any females had it, meant engaging in homosexual behavior.

    • dave chamberlin says:

      That article isn’t bad but it is very over simplified in it’s R value. The R value of HIV has been for a very long time under 1 in the developed world. If any disease was to stay over 1 than it would be a matter of time before everyone in the world would catch it. For HIV to become as widespread as it is some incredibly incompetent medical decisions were made. HIV went through three different stages of amplification that are mind boggling in how stupid they were. First vaccinations were made at ground zero in Africa using the same needle for hundreds of people. Second thousands of blood donations were collected and distributed to hospitals throughout the United States that were originally from Haiti, which had some workers sent to Africa. Thirdly we had the gay bath house thing happening in this country. A friend of mine who is a medical doctor was doing her medical internship at Bellevue hospital in New York City when almost all the beds were filled by young gay men suffering from diseases that healthy young men rarely got. It was the beginning of the Aids epidemic. It was her job to interview these men and find out their sexual history since there was some relationship, unknown at the time, between being gay and having these auto immune diseases. Good God these men would go to the bath houses and have sex with three men and let another dozen have sex with them. They didn’t just have Aids, they had up to a half dozen sexually transmitted diseases.

      These kinds of mistakes are no longer made, I would hope. I think Cochran is right about Ebola, there wont be but a very few cases in this country before it is snuffed out. But it appears a few really dumb mistakes have to be made before people learn the hard way with all these disease.

      • gothamette says:

        The thing is, AIDs really is difficult to get. You get it by sticking a needle in your veins, or getting poked up the anus by a guy with the virus. Also, to a degree it is quarantined by the fact that exclusive homosexuals don’t have sex with women. (Guys on the down low are a different matter.) Ebola may not be as communicable as flu but it is much more communicable than AIDs.

        Already there is the very American rosy glow of “we know how to do it”, see here:

        http://tinyurl.com/pavncps

        The author is gay and compares “Fearbola” to the early AIDs panic. Being a proud gay American and part of the ruling class, he thinks we do it better than anyone, including Cuba. The article is worth reading as a textbook example of CW in the making. Don’t quarantine, infect hemophiliacs with tainted blood, don’t tell moms their babies have AIDs, then conveniently forget about it.

      • The fourth doorman of the apocalypse says:

        These kinds of mistakes are no longer made, I would hope.

        The strongest message I am taking away from this posting of Greg’s is that: In the service of empire the elites have spread all sorts of really nasty diseases around the world in the past and killed so many people who did not need to die.

        Why is this time any different?

  25. The fourth doorman of the apocalypse says:

    An interesting nugget from Biology of Plagues on pages 77/78:

    Bubonic plague in India was primarily a disease of the smaller towns: the intensity of an outbreak in 1897-98 was inversely proportional to the size of the community, with the maximum mortality in the villages rather than towns (Hankin, 1905);

    A table is shown with the death rate (per 1,000) in Bombay, then with a population of 806,144, of 20.1 and in Ibrampur, then with a population of 1692, of 360.5.

    Now, clearly, many more died in Bombay, but it was surprising to me that the death rate differed like that.

    • The fourth doorman of the apocalypse says:

      This might be related to the available rodents or other small mammals as carriers of Yersinia pestis and their prevalence in different environments, since it was most effectively spread where small rodents were available that were immune to Y pestis. If the rodents died from the infection, the plague ended quickly. However, the authors seem not to comment on this.

      In the same paragraph as the above, the authors state:

      Furthermore, although the plague spread readily from village to village, Hankin observed that it did not appear to be carried great distances in the epidemic form. This is in complete contrast to the behavior of haemorrhagic plague in Europe (see section 13.9).

  26. The fourth doorman of the apocalypse says:

    Claims of identification of the index case of Ebola in West Africa:

    Emergence of Zaire Ebola Virus Disease in Guinea

  27. At the risk of sounding like a complete lunatic let me make an original suggestion for combating Ebola. We need robot nurses.

    We already have plenty of robots but they need to be adapted. Probably we only need some software modifications. The first useful free ranging multi-purpose robots were probably the little bomb disposal robots with tracks and stair climbing treads. These were quickly adapted for reconnaissance and later carrying arms. They became useful for retrieving wounded soldiers on the battlefield because they are relatively impervious to small arms fire. They are also impervious to microbes.

    One very serious problem with Ebola is that it tends to kill off medical personnel, especially nurses who handle the patients. In the last Ebola break out among the first victims were the Catholic missionaries – mostly females who did nursing. They also spread the disease by using dirty hypodermic needles but the nurses themselves were largely wiped out.

    Doctors are less hard hit with Ebola probably because they stand back from the infected patient and just issue orders. The nurses have to get ‘up close and personal’.

    Ebola doesn’t at this point seem to respond to any of our remedies. Nurses do not bring a cure with them to the bedside. The patients who survive (about 30%) do so because the nurses keep them clean and fed until their own immune system can strike back.

    So the solution for this particular disease now should be to isolate the infected and keep them alive but don’t let any human in the sick room. The main purpose of a robot nurse would be to drag the dead bodies out and provide bed pans for those still living. These tasks are needed but are hardly worth the life of human nurse. Injecting a human with a hypodermic needle into a vein may be beyond the abilities of any current robot but at present we have no effective drugs with which to inject them. I’m sure that medical research will soon develop drugs and serums that will need to be injected but right now the we just need nurses to change beds and move bodies. These are tasks for which robots seem appropriate.

    The Mobutu regime was effective in isolating Ebola for the last outbreak – they shot people breaking the quarantine. That’s still a good idea, but we also need a way to keep Ebola – the ‘Nurse Killer’ away from nurses.

    • Since I wrote this three days ago I saw a picture on the Web of four men in Hazmat suits carrying away a body of someone who had died of Ebola. We know that Ebola has spread from people handling dead bodies and we know that Hazmat suits are not perfect. Why do we allow these four guys to be exposed?

      There is already an operational robotic stretcher bearing robot. It is called BEAR ( Battlefield Extraction Assist Robot). It seems to work from the videos I see on YouTube. This seems like a no brainer – all bodies from Ebola should never again be touched by a human. Just send in the machines to take them to the incinerator or wherever.

      I worry about the thousands of American troops we are sending to Africa. It seems to me we should be looking for ways to increase the virus’s separation from people not sending more susceptible young men into “The Hot Zone”.

      Walter Reed had no difficulty getting volunteers to get bitten by infected mosquitoes. The troops had difficulty believing that a big strong man could be hurt by a tiny bug. My Army outfit was full of guys like that. If nurses in Hazmat suits are in danger, what can we expect from soldiers?

  28. gothamette says:

    “At the risk of sounding like a complete lunatic let me make an original suggestion for combating Ebola. We need robot nurses.”

    It’s an excellent idea.

    Re:Mobutu, he reportedly fled with his family to France, leaving Dr. William Close (father of Glenn) to deal with the epidemic.

  29. The fourth doorman of the apocalypse says:

    Shut up, The Economist explained.

  30. candid_observer says:

    I think it’s probably a mistake to think of “r” only as a fixed value for, say, an entire country or region across time.

    It’s far better to think of it as an expected value in various settings and circumstances — call this dynamic r.

    If a patient is treated relatively early in his symptomatic phase, but in a hospital as unprepared as Texas Christian, it may be that dynamic r is 2 or at least distinctly greater than 1. When such a patient is treated at a center up to highest standards, maybe dynamic r goes well below 1.

    The point is, we might well get to an average value of dynamic r across the US (which we might think of a snapshot of ordinary r at a given time) over 1 if our system gets overwhelmed with infected patients.

    We have real control over the values dynamic r takes in various settings — training, proper equipment, proper understanding will reduce it everywhere. Reducing the number of infected who get into our country reduces the average dynamic r values at any given time. And the reduction in average dynamic r at any given time creates a virtuous cycle, for we are better able to train, produce proper equipment, and understand the disease the longer we have to do so.

  31. The fourth doorman of the apocalypse says:

    On page 31 of Biology of Plagues they introduce the SEIR model. Susceptibles (X), exposed (I), infectives (H), recovered (Z).

    They use a system of what looks like four linear first order differential equations:

    N = X + H + Y + Z
    dX/dt = μN – μX – βXY
    dH/dt = βXY – (μ + σ)H
    dY/dt = σH – (μ + γ)Y
    dZ/dt = γY – μZ

    Later on on page 38 they then say that this system exhibits damped oscillation, which surprises me because I thought you needed something like a second-order differential equation to get damped oscillation. Does a system of first order DEs also display oscillation?

  32. Julian says:

    Wall Street Journal getting a hammering in the comments section for publishing this nonsense.
    http://online.wsj.com/articles/travel-ban-over-ebola-may-bring-other-troubles-1413748220

  33. The fourth doorman of the apocalypse says:

    On page 114 of Biology of Plagues it says:

    1479-80 Great Mortality reported in London and in many other parts of the country, which Shrewsbury (1970) suggested may have been a recurrence of cholera.

    Is it possible that Cholera had already reached England that early?

  34. STALIN says:

    Japan between 1820 and 1822.
    I thought Japan was a closed kingdom until ~1854 with only one ship(Dutch or Portuguese?) a year, no crew going ashore and only two or three Japanese officials directing the off-loading and loading of the vessel. That’s one contagious disease.

  35. Richard Sharpe says:

    Should we really measure it per year or per decade. Shouldn’t we measure it per opportunity to infect?

    It seems to me that Ebola has had far fewer opportunities to infect than Influenza has had over the last 10 years. Maybe I am wrong. I sure hope so, because otherwise it suggests that Ebola has a higher mutation rate and can explore the lethal space much more quickly.

    Michael said on October 18, 2014 at 9:05 pm
    Ebola has had just as many opportunities to infect as Influenza. Both viruses have non-human hosts, which serve as a reservoir for human infections. This is where the bulk of their evolution is occuring, and why vaccination of every person on the planet this year would not prevent people from getting the flu next year.

    Right. What I was groping towards was the difference in selection pressure.

    Right now, Ebola seems pretty well selected for existing within what ever animal reservoir it currently exists in, likely bats etc, where it is transmissable via saliva when multiple animals are feeding on the same fruit or mother to offspring.

    However, by our current behavior, haven’t we applied enormous selection pressure on Ebola to become more readily transmissable among humans.

    At the moment, virulence is not the problem for Ebola, transmissability is it’s number one issue.

    It seems we (the rest of us) would have been better off if we simply isolated those who initially contracted Ebola and let them and that Ebola outbreak die off.

    Instead, we seems to have applied plenty of selection pressure …

  36. gothamette says:

    This is interesting:

  37. baloocartoons says:

    Breath of fresh air. Reprinted and quibcagged with gratitude.
    http://ex-army.blogspot.com/2014/10/ebola-and-cholera-and-non-intuitive.html

  38. gothamette says:

    OT, but something that might interest both Drs. H&C:

    http://www.businessinsider.com/all-the-germs-and-viruses-in-nycs-subway-rats-2014-10

    “Even more disconcertingly, they discovered nearly 30 viral species, including almost 20 mammalian viruses, and 18 viruses that were previously unknown to science.”

    Ew.

    “Among the plethora of viral species they found in the creepy critters, a few stood out, including a new species related to the hepatitis C virus, and Seoul hantavirus, which causes hemorrhagic fever — a dangerous disease that causes excessive bleeding — which had never been found in New York before.”

    Double ew.

    Quarantine them!

  39. reiner Tor says:

    An interesting virus was found that slows brain activity. Nothing to see here, because the effects are “small”, according to the researcher. It’s not compared to anything. On average people with slower visual reaction times score lower on IQ tests. Does anyone know how much IQ difference there is between 100 IQ people and the ones with a 10% higher reaction time? Is it 1 point? 5 points? 10 points?

  40. reiner Tor says:

    I started reading Biology of Plagues. I checked the Wikipedia page on the Black Death, and apparently there is very strong counter-evidence against their argument.

    Does anybody here have a strong opinion on whether the Black Death and the subsequent plagues until the 18th century were caused by Y. pestis or if the controversy is even more or less settled at all?

    • reiner Tor says:

      there is very strong counter-evidence against their argument

      At least, to me having found Y. pestis DNA in mass graves of plague victims across different locations sounds like a strong evidence. It doesn’t necessarily invalidate their arguments about the spread of the disease, especially if it’s some previously unknown clades of the bacillus.

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