Though I haven't had a chance to write about this here, I have an article at Mic.com on Kent's experience with Ebola exposure in our area. Amber Vinson, the second Ebola-infected nurse in Texas, is a Kent State alumna and has relatives that work here. Our experience on campus so far is described here in this article.
Excellent work, Tara, keep it up. We need more of this: working scientists being willing to wade into the swamp of the media and provide accurate information and assurances.
Count on this: for every comment you get, like mine here or others' there, there are numerous people who read your stuff and just say "whew!, that's better!" and don't comment. Same case for other news articles with similar tone. Slowly but surely, facts catch up with rumors, and put the rumors out of business.
Nothing is gained by the optimistic, business-as-usual approach that the medical establishment and government are taking toward this disease.
By basing our responses on the prior known history of this disease, we are dooming millions to die if those assumptions turn out to be incorrect for this particular variant.
When dealing with natural systems which can enter a critical state and explode with exponential growth, the appropriate approach is to always plan for the improbable worst. Why? Because the alternative results in a cataclysm if, however improbable, assumptions turn out to be incorrect.
The collapse of the housing market was the result of failed assumptions based on historical facts which turned out to be false. Ditto for the the failed levees in New Orleans during Katrina. Ditto for the failed containment systems at Fukushima. Ditto with regard to the great fires of Yellowstone in 1988, and the collapse of the LTCM hedge fund in 1998.
With all due respect, all of the optimists out there (who are really more concerned with preventing panic than preventing calamity) need to get a much better understanding of what we are dealing with here (a complex system involving exponential growth), and what the consequences will be if they are wrong.
And what would you recommend, TJ? Ohio is already going beyond CDC recommendations for monitoring contacts and having people self-track fevers, etc. Of course it's biology and by nature somewhat unpredictable, but I'm not sure what you suggest for "planning for the worst" beyond what is already in place. Overpreparing and hyping the epidemic doesn't help either, and indeed makes people more cynical to the next emergency due to "crying wolf' perceptions.
In short, my argument is that we should be using the same protocols and procedures that we would use if Ebola was currently manifesting airborne transmission in Africa. I'm a systems theorist, not a virologist. So you probably have a much better idea as to what those procedures are. But I suspect that "planning for the worst" would encompass such precautions as: strict travel restrictions with affected countries; strict quarantines for anyone who comes in contact with an ebola victim; suspension of public transportation in affected areas; school closures; the use of BSL4 facilities (preferrably offshore) for all ebola cases, and so forth.
I completely agree that we should not be "hyping the epidemic." But let me ask you this question: if Ebola were to go airborne, with a transmission rate similar to the flu, how could we possibly avoid a mass loss of life if we were not already utilizing the most stringent protocols? With an incubation period of several weeks, wouldn't hundreds of thousands (if not millions) of people be infected by the time we even discovered that the virus had in fact become airborne (under current protocols)?
My intention is not to be argumentative. But I've seen this same movie play out numerous times before, across many different areas, and with many different experts optimistically predicting a best case outcome. But academics, scientists, and politicians have a terrible track record of forecasting the future, and protecting the public, when they venture into the area of complex systems. And unlike the 2008 financial crisis, where all that was at risk was money, we are now operating in a realm where hundreds of millions of people could die if our predictive abilities fail. That fact alone should be enough to warrant the most stringent protocols.
We do suck at forecasting the future. However, our "stringent protocols" all have advantages and disadvantages. Protecting against the theoretical possibility --and I'll say, quite remote-- of an airborne infection can put us at greater risk *now* of maintaining and even further spreading this outbreak. Public transportation restrictions will put people out of work and quite possibly drive up hunger and non-Ebola-related deaths and illnesses. There are consequences to every action, so they must be measured and evidence-based rather than done merely because of "an abundance of caution."
I recommend starting here for some background on why "overprotection isn't protection." http://haicontroversies.blogspot.com/2014/09/overprotection-does-not-eq… There are many similar analogies.
TJ @5: I believe that the only "offshore" BSL4 facility is on Galveston Island (and who though putting an BSL4 on a sandbar in a hurricane zone was a good idea I'll never know). But BSL4 facilites are generally set up for research, not patient care. If you want to know more about BSL4 facilites, there's a great video tour of the new BSL4 at Boston University up online. There are no toilets in the BSL4 part of the facility, which would make caring for a patient with Ebola pretty challenging.
Also, do you have an example of another existing diease that has changed transmission methods? Granted, some diseases have multiple transmission methods (plague is a great example), but I can't think of any that have gone from bloodborne to airborne. Thanks!
Hi Tara - Thanks for the thoughtful response. I'll investigate that link and reflect on your points.
Hi JustaTech - I think you might be missing my point. Until 2008, real estate prices had never declined across the entire Nation. Until Katrina, the levees protecting New Orleans had never been breached. Until 2011, a 9.0 magnitude earthquake had never struck the Fukushima region in Japan. Until 1987, stocks had never declined more than 20% in a single day (at the time, this probability was assessed at one in several billion years of trading history).
When operating in the area of complex systems, using historical data to estimate possible outcomes is extremely dangerous. Complex systems are not governed by normal statistical distributions, but by power law ratios that make accurate predications impossible.
Unfortunately, most politicians, academics, and scientists operate in specialized niches and do not understand the nature of complex systems, critical states, or even the very basic concept of exponential growth. Nor is the public generally aware of these concepts. As a result, mankind is continually blindsided by catastrophes which "should have never happened."
The basic point is that, under our current protocols, if our understanding of Ebola were ever to be proven wrong hundreds of millions of lives could be at risk by the time we were even aware of the error. I don't think this point is debatable.
I would direct your attention to a recent report by Peter Jahrling, who is one of the top authorities on Ebola. The report makes clear that Ebola is not static, and is in fact mutating at a fairly prodigious rate. Does it make sense to use static historical data for a virus which is not static and clearly undergoing evolutionary adaption?
In short, I'm not disputing the historical evidence of Ebola. I'm not disputing that we should not hype the disease. And I appreciate that we may not have all of the facilities and infrastructure to provide the optimal level of protection. What I am saying, however, is that when dealing with a viral pathogen that could lead to an extinction level event should our assumptions ever prove incorrect, we should utilize protocols that are as stringent as possible.
What concerns me is the pride fullness of the experts in vowing that the EBOV is not airborne and will not become airborne --- there is a wise old saying pride goeth before a fall. The numerous healthcare workers, the CDC and the 2 Texas nurses were all very confidant that the PPE being used was more then adequate, right up until the sickness developed.
I strongly believe that in the tropical areas of west Africa it is probably not airborne, due to the droplets being heavy enough to precipitate out within a short distance of being expired, however I have yet to see/read any articles/research that states the virus will not become airborne in a Temperate Zone --- hence the flu season from Nov. to Mar.
In 2007 there was research published, cite A.C. Lowen at www.plospathogens.org, that explains why the influenza virus is more transmittable during cold weather and very low humidity: Could the same thing happen to EBOV??
Also, could the climate of the Temperate Zone be one of the reasons the Plague was so virulent during the Middle Ages? Could this also be one of the reasons that the childhood illnesses of old were so transmittable during the school year?
In regards to what T.J. is saying, as a volunteer FF/AEMT and HAZMAT Technician, one of the instructions that we are constantly taught is to prepare for the worse case event; this is why acute chest pain is considered cardiac in origin until proven otherwise. Keeping EBOV isolated to the 3 countries involved should be paramount for the protection of all of us, along with getting a vaccine.
Thanks for all the information you have been disseminating and please allay my concerns.
Bill, we can only work with the evidence we have. That evidence says Ebola is not airborne--or the epidemic would be worse, probably by orders of magnitude. No one in Duncan's family became ill, despite being in close contact with him for days while displaying symptoms. It's just not that effective. And as you must know if you're a responder, it's not just that PPE is used and is adequate, but that people have received training and know how to use it correctly and regularly. From the sounds of things, that didn't happen and is probably how the nurses were exposed.
Flu and seasonality is complex--but Ebola simply is not a respiratory disease. It can be found in saliva but it is quickly inactivated there and that fluid is not as "hot' with viral particles as blood, stool, vomit etc. Even those infected are not coughing and sneezing massive amounts of it into the air like with influenza, so that's an apples and oranges comparison.
I agree that working to keep it isolated (and extinguished) in the 3 countries is paramount, and the way to do that is to expend necessary resources there but be on guard here.
Thanks for responding.
Does the virus quickly deactivate, in saliva at low temperatures?
Tara, in regards to all the valiant healthcare workers that are treating these patients: Their ability to provide basic human care, start IVs, intubate and provide other advance procedures while dressed in encapsulated suits is amazing!!! Starting IVs and intubating under normal conditions is tricky enough.
I do think PAPRs should be used over full face respirators, a greater protection factor and a lot more comfortable.
Again, thanks for all you do AND do you sleep much?
I don't know about saliva at low temps, but at body temps where the virus would be replicating it doesn't seem to survive long. So if it can't survive long enough to be expelled, that's kind of a non-starter to begin with.
And no, I don't sleep much. :)