Patients’ Symptoms Raise Concern About Ebola in New York(nytimes.com)
nytimes.com
Patients’ Symptoms Raise Concern About Ebola in New York
http://www.nytimes.com/2014/08/05/health/patient-at-mount-sinai-has-ebola-like-symptoms-hospital-says.html?_r=1
3 comments
The HN title is linkbaity (and editorialized). The original is better:
"Patients’ Symptoms Raise Concern About Ebola in New York"
Which is true, and still interesting. At this point, I wouldn't bet against the disease showing up in an international city, and it's nice to know the state of things.
"Patients’ Symptoms Raise Concern About Ebola in New York"
Which is true, and still interesting. At this point, I wouldn't bet against the disease showing up in an international city, and it's nice to know the state of things.
It wasn't editorialized. The NYT changed their title. You can still see the original in the URL.
We've followed suit.
We've followed suit.
It is much more likely than not that the patient has something much more common like malaria, but until they are certain the authorities will only say it is unlikely even if they are pretty sure he has ebola. To do so would just generate panic while doing very little to help track down all the people who recently came in contact with the patient.
The [NYC] Health Department issued this statement on the Mount Sinai patient suspected of Ebola: "After consultation with CDC and Mount Sinai, the [NYC] Health Department has concluded that the patient is unlikely to have Ebola. Specimens are being tested for common causes of illness and to definitively exclude Ebola."
-- http://www.nyc.gov/html/doh/html/home/home.shtml
-- http://www.nyc.gov/html/doh/html/home/home.shtml
I understand the cause for concern. But I can not think of a single time i've had a virus that did not involve a fever, stomach problems, and or a headache.
But how many times have you had a flu where you bleed out of your orifices? Me.... none.
One child a minute dies from Malaria.
http://www.who.int/features/factfiles/malaria/malaria_facts/...
And that sucks, and we need to do more there... but that doesn't mean it doesn't make sense to pay additional attention to things that are more likely to present a direct threat to me.
http://www.cdc.gov/malaria/about/facts.html
You are far more likely to be infected by malaria than ebola. Ebola is scary and makes for great news that draws lots of attention -- but it is largely sensational and not truthfully something you need to rationally fear, unless you work with infected individuals.
You are far more likely to be infected by malaria than ebola. Ebola is scary and makes for great news that draws lots of attention -- but it is largely sensational and not truthfully something you need to rationally fear, unless you work with infected individuals.
No. Based solely on rates in the past, rather than any sort of projection into the future, I'm incredibly unlikely to be likely to be infected by either (note from your link, that of the <2k/yr of malaria in the US we see "almost all in recent travelers").
If I am infected by either, I am overwhelmingly more likely to survive a bout of malaria.
And during an unusual outbreak (which is the case for ebola at present), looking simply at past incidence will underestimate my risk.
It's still probably not a high risk, and there are higher risks (which I try to pay more attention), but I don't think it's wrong to say it poses a greater threat to me (or to the overwhelming majority on this site) than does malaria.
If I am infected by either, I am overwhelmingly more likely to survive a bout of malaria.
And during an unusual outbreak (which is the case for ebola at present), looking simply at past incidence will underestimate my risk.
It's still probably not a high risk, and there are higher risks (which I try to pay more attention), but I don't think it's wrong to say it poses a greater threat to me (or to the overwhelming majority on this site) than does malaria.
Actually it is very difficult to place any risk estimate on ebola (or any other new viral strain) as we don’t really know much about it.
Imagine that it is 1918 again and someone was trying to make a prediction of the likelihood of influenza becoming a deadly pandemic that would kill 100 million people over the next 18 months. They would look at the past history of influenza and say there is a negligible risk of this happening. Of course now since we know that influenza can become very serious we keep our eyes on it, but for something like ebola we really know very little.
Imagine that it is 1918 again and someone was trying to make a prediction of the likelihood of influenza becoming a deadly pandemic that would kill 100 million people over the next 18 months. They would look at the past history of influenza and say there is a negligible risk of this happening. Of course now since we know that influenza can become very serious we keep our eyes on it, but for something like ebola we really know very little.
Based on previous outbreaks of things generally I think it's most likely to be correct that this outbreak is also of low risk to the US population at large. Which is not to say that there's not a tremendously high value of information - the next thing we learn could change that (and again, probably won't, but...). I think it does make sense to be paying some attention as random individuals, and more attention as health workers or CDC employees, and I think it is probably still the case that my drive home is more likely to kill me (but I pay a lot of attention to my drive home!).
Humans tend to overestimate the danger of apparent low probability, high impact events (like pandemic ebola) and underestimate the risks involved in mundane events (like driving a car).
Given how infrequent pandemics occur, a better way to judge the risks involved would be to take a much long term view and try to measure the risk of a major pandemic occurring in your lifetime. When you look at the history of plagues over the last 2500 years they are infrequent, but common enough that we can get some handle on the risk. My very rough calculations based on past pandemic frequencies and death rates put the risk at around 1 in 1000 of being killed by a pandemic sometime during your lifetime. This is not huge, but at the same time it is not trivial.
Edit. I added the word apparent to the “…danger of…” as I realise that my wording is confusing without it.
Given how infrequent pandemics occur, a better way to judge the risks involved would be to take a much long term view and try to measure the risk of a major pandemic occurring in your lifetime. When you look at the history of plagues over the last 2500 years they are infrequent, but common enough that we can get some handle on the risk. My very rough calculations based on past pandemic frequencies and death rates put the risk at around 1 in 1000 of being killed by a pandemic sometime during your lifetime. This is not huge, but at the same time it is not trivial.
Edit. I added the word apparent to the “…danger of…” as I realise that my wording is confusing without it.
You seem to have approximately restated what I said. That's fine, but it's best to note that that's your intent...
Not really, well not by intent :)
I might have worded it better, but pandemics are actually one of those areas that people get the risks wrong for the opposite reason than usual. While pandemics are considered low frequency, high risk events and so over-worried about, they are actually relatively frequent events on a historical time scale and are not worried about as much as they should be. They are really more in the car crash category not the stuck by lightning category, but we get complacent because a big one has not happened in living memory (unless you count HIV).
I might have worded it better, but pandemics are actually one of those areas that people get the risks wrong for the opposite reason than usual. While pandemics are considered low frequency, high risk events and so over-worried about, they are actually relatively frequent events on a historical time scale and are not worried about as much as they should be. They are really more in the car crash category not the stuck by lightning category, but we get complacent because a big one has not happened in living memory (unless you count HIV).
Ah, yeah, that is a bit of a different angle on it. Truth be told, I'm not sure whether or not we're underrating the risk. On the one hand, increased travel and population density should see faster spread.
On the other hand we have a lot of changes in our favor: understanding how diseases are spread (starting with germ theory, all the way up through population models), understanding how many more diseases are treated, an astoundingly better ability to communicate, probably a better ability to coordinate...
I don't know how it nets out. The streak we've had should be taken as some evidence that it breaks in our favor. Certainly we should not succumb to the gambler's fallacy, there. However, I think we're well served to keep an eye on things.
On the other hand we have a lot of changes in our favor: understanding how diseases are spread (starting with germ theory, all the way up through population models), understanding how many more diseases are treated, an astoundingly better ability to communicate, probably a better ability to coordinate...
I don't know how it nets out. The streak we've had should be taken as some evidence that it breaks in our favor. Certainly we should not succumb to the gambler's fallacy, there. However, I think we're well served to keep an eye on things.
Yes it is really difficult to know how the two major forces are tipping the likelihood. We have a better understanding of how contagious disease is spread and on average much better immune systems because of better diets (the average person was starving when most plagues struck in the past). Balancing this is as you mention increased travel and much high population densities. You just have to see the spread of a contagious disease through a modern animal feedlot to know what this does. All of this makes it really hard to know which way the risk has changed.
My biggest fear is a pandemic Rhadinovirus since it is airborne, has a long incubation phase and leukaemia is the outcome [1]. Something like a human pathogenic Ateline or Saimiriine herpesvirus could spread through the human population without us knowing until it is too late.
Interestingly, Saimiriine herpesvirus has recently been linked to idiopathic pulmonary fibrosis [2]. All it would take is a more pathogenic strain of this virus and we would be in a lot of problems.
[1] http://en.wikipedia.org/wiki/Rhadinovirus
[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050527/
My biggest fear is a pandemic Rhadinovirus since it is airborne, has a long incubation phase and leukaemia is the outcome [1]. Something like a human pathogenic Ateline or Saimiriine herpesvirus could spread through the human population without us knowing until it is too late.
Interestingly, Saimiriine herpesvirus has recently been linked to idiopathic pulmonary fibrosis [2]. All it would take is a more pathogenic strain of this virus and we would be in a lot of problems.
[1] http://en.wikipedia.org/wiki/Rhadinovirus
[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050527/
Your chances of recovery from Malaria are far higher than recovering from Ebola. Malaria is more of a regional issue and does not necessarily have the ability to reach pandemic levels where Ebola, because of its communicability, does.
Edit: Though you are correct it is not necessarily something to be freaking-out over at the current moment. That said its a serious problem that we should not assume is benign. We should be working to contain it outside of the US.
Edit: Though you are correct it is not necessarily something to be freaking-out over at the current moment. That said its a serious problem that we should not assume is benign. We should be working to contain it outside of the US.
I've heard consistently that ebola is incapable of becoming a pandemic in first world countries. This is because it lacks the resiliency to survive outside of the human body for long periods of time.
The problem is a virus have a nasty habit of evolving - just because all the past ebola strains have had a particular property does not mean that any new strain will behave in the same way.
There does seem to be something about the strain in this latest outbreak that is different to past outbreaks.
There does seem to be something about the strain in this latest outbreak that is different to past outbreaks.
Do you similarly lose sleep over the idea of AIDS becoming airborne?
Don't waste your time worrying about such hypotheticals. If you want to worry for sport, there are better things to worry about.
Don't waste your time worrying about such hypotheticals. If you want to worry for sport, there are better things to worry about.
The odds of any particular mutation are small. The odds of any mutation are high. The odds of a meaningful mutation, somewhere between the two. The fact that we're seeing more spread than usual is already some evidence that this strain has some relevant mutation - though I don't know enough to quantify how much evidence.
No I don’t worry about AIDS becoming airbone, but when you look at the historical record of pandemics they are much more a problem than would appear of first glance. Pandemics that wipe out 1/3 to 1/2 the population and that appear out of nowhere are far too common over the last 2500 years for us to be complacent.
For roughly 2300 or more of those years we didn't understand how diseases spread or how to treat/prevent them.
But that doesn't mean we humans are "safe". Knowledge is power but its not a vaccine.
That is a total overstatement/generalization.
That would be the case if it were not for the fact that it is really good at surviving in the human body.... until the person is dead or until they have developed antibodies to fight it. Some people do survive Ebola (aka the plague or the black plague). But not many. Ebola spreads, and fast at that, in areas where there are high population densities, areas where people are in close contact (areas like NYC). Because of the symptoms, it is possible that someone may be infected, spreading the disease, but think they have the flu or some other common ailment. That is the reason why the hospital in the original article didn't take chances and put the person in involuntary quarantine (the article didn't say it but I can guarantee that is the case (and the patient may not know it because if you had Ebola you would have to be insane to decline care)). The only effective way to fight Ebola is quarantine. You section off an area, don't let anyone in or out, and wait out the sickness until it runs it course. After that you safely and securely destroy everything.
Plague refers to several types of bacterial infections. The Black Death is believed to involved bubonic plague because of the characteristic symptom described in all sorts of records:
http://en.wikipedia.org/wiki/Bubo
I guess a hemorrhagic fever can't be ruled out though.
Ebola, in the form that requires fluid transfer, won't spread all that quickly in the U.S., where people aren't all that skeptical of doctors and tend to react to disease threats by avoiding touching things (as I understand it, burial practices involving touching the bodies are a significant source of infection in the current outbreak).
http://en.wikipedia.org/wiki/Bubo
I guess a hemorrhagic fever can't be ruled out though.
Ebola, in the form that requires fluid transfer, won't spread all that quickly in the U.S., where people aren't all that skeptical of doctors and tend to react to disease threats by avoiding touching things (as I understand it, burial practices involving touching the bodies are a significant source of infection in the current outbreak).
I don't think that the thrust of this story has anything to do with the mortality of one person.
What is newsworthy is that there is potentially an Ebola patient zero in the most densely populated part of the United States. Worse, the patient was in contact with travelers who have likely fanned out throughout North America, South America, Europe, and Asia.
What is newsworthy is that there is potentially an Ebola patient zero in the most densely populated part of the United States. Worse, the patient was in contact with travelers who have likely fanned out throughout North America, South America, Europe, and Asia.
That's a horrible thing, but completely irrelevant to this topic. Should we stop paying attention to Gaza because things are worse in the Sudan?
"A New York City hospital is examining a sick patient who recently returned from a West African country where the deadly Ebola virus has been spreading, but authorities said it's unlikely that the man has Ebola."
http://www.nbcnewyork.com/news/local/New-York-City-Hospital-...