The risk from Ebola is greater than it seems. Not only is it out of control in Africa, there is no reasonable chance it will be brought under control in Africa: it will have to burn itself out. This is because the countries simply do not have the administrative capacity to handle it: not enough beds, nurses, isolation suits, money, etc… The best plan I’ve seen for helping them is Vinay Gupta’s suggestion to use survivors are the primary care givers in community centers. (Note that community centers not run by survivors would likely increase the spread of Ebola, not decrease it.)
Fundamentally, however, the decision point for handling Ebola properly passed in the 70s and 80s, when neo-liberalism, the IMF and Western bankers conspired to reduce the growth rate of Africa from its post-colonial high to below its population growth rate. The governments in question do not have the capacity to handle Ebola, and no one is going to send over enough nurses, doctors and equipment to make a difference. Even if they did, the administrative problems of these countries, lack of infrastructure and distrust in Western medicine mean they would be less effective than you think.
Poor people with inadequate health care, nutrition and sanitation are resevoirs for disease to develop. They always have been. Attempts to explain this to the rich, both the global rich, and the American rich, have been in vain for the past half century or so. What happens in Africa, or India, can come back and kill you, just like what happens in the Middle East (half a million dead kids, and so on) can turn out to be very bad for Manhattan.
So much for Africa. But other nations are at risk as well. The widespread waves of austerity and the destruction of countries have left gaping holes in the medical infrastructure of the first world. Does anyone think Greece, for example, could handle Ebola? Spain already fumbled a case, leaving a nurse who said she probably had Ebola in a public waiting room for hours, while she was symptomatic.
Austerity, cheapness and incompetence kills. America has about 40 million uninsured. The initial symptoms of Ebola look a lot like the flu. Think about what most uninsured are going to do if they get a bad flu? Best case is a trip to the clinic to get some antibiotics. The same is true of many insured. Going to the hospital for a bad case of the flu is overkill, and hospital stays are expensive. Bankruptingly so.
And imagine you are poor, uninsured and have no paid vacation days, then come down what looks like a bad flu? I imagine you might still go wipe old people’s bums, or clean rich people’s houses, or go to work in retail. Sure, soon enough you’ll be too sick to continue, but for a few hours…
Many other countries are in no position to do the sort of contact tracking that is required to stop something like Ebola. Think of Mexico, America’s southern neighbor. Entire cities, indeed provinces, are beyond the writ of the government, essentially controlled by drug gangs.
I don’t see Ebola as an existential threat unless it mutates. It’s still fairly hard to pass it to another person; it isn’t communicable when it’s asymptomatic, and so on. But if it goes airborne, or if it becomes communicable during the incubation phase, it could turn into something truly horrible. And the more people who get it, the more likely a mutation is to occur.
There are some threats where we’re all in it together. Money and position may buy us some immunity, but they cannot buy us total immunity. Climate change is one of those threats; another is communicable diseases. We can only, so far, be grateful that this isn’t the super-flu many scientists have been worried about. Ebola may kill in a particularly nasty fashion, but the last great Flu Epidemic killed more people than World War I.
In the meantime, my sympathies go out to West Africans, who will largely suffer this without meaningful help. And I warn the Europeans that they are far more vulnerable than they think: the lack of internal borders, the near-failed or failed (Greece) States and austerity means that if Ebola gets a foothold it may be far harder to contain than they believe.
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Bill H
Back in the 1970’s when Ebola first appeared it was considered too lethal to be a serious threat. It killed too swiftly to be spread very far, and was therefor easily contained to small outbreaks. There was no need to develop vaccines or cures for it, and no concerted effort was made to do so. I kept asking the question, what if we are wrong? What if it gets into major population centers? I guess that question is being answered. Dammit.
Celsius 233
We’ve already witnessed both human and medical incompetence, in Africa and in the U.S.
There is a good chance that Thomas Eric Duncan (deceased) was sent home because he didn’t have insurance. This even though he informed the emergency staff he’d come from Liberia.
The deterioration of our entire infrastructure (medical, social, governmental, et al) will only contribute to the possibility the U.S. will not likely escape unscathed. Can you spell martial law?
What I do have faith in is our ability to screw things up.
Sam Adams
Let’s not forget to thank the Krazy kristian missionaries for transporting the virus from isolated village populations where the virus burned out to cities of large populations with multiple vectors to spread the virus
Tatanya
I am convinced that if the public were allowed to have all the information that the CDC has, we would all be a whiter shade of pale at this juncture. Why do I feel this way? Because, virologists are under an obvious (self-imposed) gag order not to say anything which might alarm the herd, at the risk of jeopardising their professional careers. Secondly, the PTB fear that were the public to grasp the complete gravity of the crisis, supply chains would be disrupted and the domino effect wouldn’t be far behind, e.g., crashing markets, bank runs, etcetera. Finally, if you spend enough time on the blogosphere, you get a sense that the few experts willing to break ranks under guise of anonymity are extremely ALARMED. And the alarm is not confined to west Africa. I am not writing this to inspire panic or fear in anyone. The notion that we shouldn’t express sincere and rational convictions, ideas, and theories because we might be called downers, doomers, conspiracy theorists, or fear mongers is a feature of western culture I find baffling. Count me among those who are seriously nervous and alarmed right now, if you will.
Celsius 233
@ Tatanya
October 9, 2014
~~~~~~~~~~~~~~~~~~~~~~
I find your whole rant to be utter bullshit!
It’s all there for all to see if they care to look.
The information is there.
The point is to be informed and act accordingly.
Panic is the absolute worst course…
Tatanya
Hit a raw nerve there? Your critique of my comment speaks for itself. Straw attacks, distortions, contortions, smears, and innuendo are a dime a dozen from the rattled. Your tinned “tweets,” are exactly why I don’t frequent social media.
Jeff Wegerson
Punishing people for hiding that they may be infected only makes matters worse. The incentives should encourage people to be forthcoming. If you might have it then you should get special care faster in places where the contagion has not yet spread. Of course, in places where it is out of control that is not possible. There the idea of utilizing the recovered is brilliant.
I see that now folks like the World Bank have are getting the “hey this is real” religion. They should fund a SWAT team to educate and initially oversee the health systems in newly infected cities. People pay a lot closer attention to details when the details are staring them in the face. The hospitals in Madrid would have paid quick attention to a properly trained nurse wielding a rhetorical gun to their heads. It so reminds me of the soon to be dead co-pilot who was too timid in the face of his cultural respect for “Authority” to forcefully tell the captain of his plane that they were out of fuel and needed to land NOW no matter that the control tower was saying to wait in line.
Medical wrist bands on every person who boards a plane leaving an infected region would not be that hard. The hard part would be to remove any stigma from wearing them for the required three weeks. Calling the wearers Ebola heroes would help.
And again placing a mark of potential infection on the forehead of every health worker tending the infected and calling them Ebola Super Heroes would have certainly increased the urgency surrounding the Spanish nurse. Like say a permanent marker id, capable of three weeks of wear, of a two or three characters would cover 600 to 12,000 people. It would warn everyone to be aware of their contact with those people. Then when you got the flu you call the hospital and give them the id. If that person is now currently infected then you get quick attention. Again works only in newly infected cities.
Look, I’m no doctor and I’m not particularly smart and if I can come up with these …
Viralchatter
Ok, let’s just ponder this…we have artificial intelligence based data mining scripts and tools to screen millions of molecules and their response rates to specific drugs in a matter of minutes….We can develop the cure in a matter of days if their was actually money to be made in this business.
Bill H
Yeah, Celsius, let’s stop the nasty tweets. You are driving people away from “social media,” where they are valuable and badly needed.
Jason Bonham
I think the US, aka the American Drug Companies, are welcoming Ebola into the US.
Gives them a chance to treat it with all sorts of ‘experimental’ drugs which can then be sold around the world. If they get it right – heroes. Just like firefighters who run into burning buildings. If they get it wrong, they can claim ‘we tried’.
Executives at the Drug Companies don’t consider deaths of Black American nurses and a few doctors to be important. As long as the CEOs don’t get Ebola, lets welcome it into Murica and attack the terrorist-virus head on with our Slave-Population.
shargash
I think Ian generally has it right. The virus in its current form probably won’t be as bad as the Spanish Flu. However, viruses are tricky little buggers. There would be a massive amount of money to be made for a vaccine or cure for the common cold, and we have neither. The current strain of ebola has accumulated several hundred mutations from its last appearance. It may not even be quite accurate to talk about a strain as if it were one thing rather than a cluster of related variants.
However, there is one area where I think we may be worse off than Africa — child care. Most mothers in our society cannot afford to take extended maternity leaves, so their children go into daycare as soon as possible, where they are clustered with lots of other very young children. I often make jokes about children being “disease viectors,” but the truth is that they are.
I have a one year old granddaughter in daycare. She caught a cold her first day of “school” and has been sniffling for a month, now with her second ear infection. She has gone to daycare while she is symptomatic, and I’m sure she is sneezing and drooling on all the other children and day care workers.
Can daycare workers afford to take time off if they’re sick? Can working mothers afford not to send their children to daycare? If ebola makes it into a daycare center, I suspect it will spread like wildfire.
I hear Obama has sent troops to combat the disease. Maybe we should send some support to more “moderate” hemorrhagic fevers so we don’t have to have boots on the ground in Africa. Or maybe we should have sent some money and doctors many months ago when MSF was begging for them. If this does blow up in our faces, there would be a certain amount of cosmic justice. I can’t help but thinking of Poe’s Masque of the Red Death.
BC Nurse Prof
Bad news:
http://www.motherjones.com/politics/2014/10/how-long-ebola-sperm
Joe
Hi Celsius 233.
Whats the point of your comment when your last line “Panic is the absolute worst course…” essentially agrees with Tatanya? Did you not read the post?
Synoia
Four points:
1. This is a new Ebola strain. It is slightly less virulent than the Ebola discovered in the ’70s. The time to death is longer, thus from the virus’ point of view its is a better infection, as the is a higher possibility of spreading the infection.
2. It is already considered both infections and contagious. Infection is that it can be spread by coughing and the droplets of liquid exhaled in the cough can spread the contamination. Infection because touch by an uninfected on infected bodily fluids, and then infection follows (probably through the mucus membranes).
3. Antibiotics do not work against virus borne disease. Because of the over use of antibiotics, both in humans and animals, they have become near useless.
4. Anyone who believes the statistics coming from Africa is deluded. There is a high probability (probably over one) the statistics are orders (plural) of magnitude too low. There is no effective Census or public heath system in any country in West Africa.
Nigeria could have build effective infrastructure, if its corrupt leadership had not stolen all the oil revenue over the last 45 years.
LorenzoStDuBois
Ian,
Poe already covered all this in his own post. He called it The Mask of the Red Death.
Ian Welsh
lol, lorenzo.
Yes, Synoia, I know antibiotics won’t work. But people will ask for them first in many cases.
Celsius 233
@ BC Nurse Prof
October 9, 2014
Bad news:
Indeed and likewise very interesting. Thanks for that.
@ Bill H
October 9, 2014
Yeah, Celsius, let’s stop the nasty tweets. You are driving people away from “social media,” where they are valuable and badly needed.
LOL, yeah, I’m a bad boy.
Cheers
Celsius 233
@ Synoia
October 9, 2014
#4 is most relevant, but there is a missing word regarding growth; exponential.
We’ll see…
Mary McCurnin
“3. Antibiotics do not work against virus borne disease. Because of the over use of antibiotics, both in humans and animals, they have become near useless.”
Synoia, I am confused. Antibiotics have never worked against virus borne disease. Antibiotics are compromised but are not near useless yet.
Everythings Jake
I made a similar observation about Prop 187 in California in 1994, when people lined up to deny illegal immigrants medical care. I wondered, politely in front of grocery stores, on street corners, and other places the believers congregated to gather signatures, had they ever heard of the plague or how it might have developed or spread? Based on the responses I received, contra Ernst Mayr (and others), it’s not human “intelligence” which assures the species self-destruction, it is a general majority level of sheer stupidity, narrow self-interest and greed.
Larry
Tatanya,
Ignore celsius. He has a superiority complex and poor social skills
Celsius 233
@ Larry
October 10, 2014
Tatanya,
Ignore celsius. He has a superiority complex and poor social skills
~~~~~~~~~~~~~
Larry, you pretty much nailed it; poor social skills is an understatement, really.
Superiority complex? Nah, inferiority is much closer to the truth. That’s why I overcompensate with my rotten social skills.
Do carry on… 😉
caia
“So much for Africa.”
Really? I concede that the situation of Guinea, Sierra Leone, and Liberia are very bad, and the epidemic is very serious. But these are three tiny countries on the coast of an enormous continent with vastly disparate cultures, economies, and health systems.
Writing off “Africa” because of events in these three countries makes about as much sense as would writing off “Asia” because of events in Vietnam, Cambodia, and Laos. i.e., none.
haelig
This post is EXACTLY on point, Ian and something that’s been on my mind for virtually the past 10 years. All along in this “War on Terrorism,” nobody has seemed to consider one of biggest chinks in our armor–the fact that the U.S. has the most overpriced and inefficient health care system of all 1st World countries, with massive numbers of uninsured and underinsured who can’t afford to go to the doctor and hospitals until it’s too late. Tens of thousands of U.S. citizens die needlessly every year due to lack of access/affordable medical care, and that number can explode exponentially if a lethal virus or virulent biological agent enters into communities.
By the way, Firedoglake reported just yesterday that come the new year, employees of one of the biggest retailers in the world will be cutting insurance for all those working less than *average* of 30 hours/week:
http://firedoglake.com/2014/10/09/we-cannot-afford-that/
And I know from a family member’s first-hand experience that the health insurance that Wal-Mart does offer is remarkably crappy. And I’m certain Wally World isn’t the only vampire squid corporation to contribute to society by upping the risk factors even more than ever before.
As Ian notes, the working poor, as well as most of the 99%, will drag themselves into work come hell or high water, and so the infections spread….
Ian Welsh
Exaggeration for effect. Of course all of Africa will not be badly hurt by Ebola.
Mark Gold
US is showing effects of Reagan still in its response to Ebola. The fact that CDC messed up in Texas & with nurse who travelled (not blaming her but rather what she was told by CDC), shows how badly the Reagan cuts hollowed out public institutions & many haven’t recovered.
Here is an email just got from my father, retired infectious disease specialist who had a good career (but was black balled himself from joining CDC in the 1960s by his Dad’s role in raising funds for Abraham Lincoln Brigade in ’30s & CP membership until Nazi-Soviet pact.)
“Who to blame? Clearly there was incompetence at the CDC. Clearly cuts in CDC budgets by almost every president since Reagan contribute to the incompetence by creating significant staff shortages and inability to recruit bright young doctors. The lack of doctor draft, which was a major source of recruitment to the CDC, means there is a much smaller pool of young doctors even willing to consider the CDC or a public health career at any level of government.
Elbola is not a new disease; nor are Marburg virus from Africa, or any number of hemorrhagic fever virus from South America, SARS-like viruses from Saudi Arabia and China have been around for many many years. Fear of air travelers bringing one of these viruses is also not new. But proper infection control is lacking is far to many hospitals in USA and Canada. So it goes.”
Public institutions matter, & tax cuts can kill. Only positive side is lack of airborne component so far to Ebola confines risks to health care workers & family members.