Ebola

A Big History topic on so many levels: the role of infectious disease in history in general; the current tragic and dangerous epidemic in Africa; changing course of the disease as it encounters urban centers; globalized world and spread far from the source, etc.

A few weeks ago I had a discussion with a friend who argued that were the disease to spread out of Africa to the US, we would see an epidemic here too. I demurred, arguing that Ebola, while deadly, spreads by direct contact. We have extensive experience in dealing with such infectious diseases, having dealt with more infectious conditions over long periods. Standard public health measures are effective: quarantine of infected or at-risk individuals, tracing contacts, decontamination of persons and equipment, etc.

But looking at the current Dallas case, I begin to wonder. There seems to be an almost Michael Crichton-like series of missteps going on. Maybe in comforting myself with rationality, I overlooked fear, error and randomness.

A man lies about contacts before getting on a plane in Monrovia. Ignorance, determination to pursue his travel plans, or a desperate attempt to get to where he can obtain treatment?

He is sent home by medical personnel after presenting with fever and recent residence in Liberia. Incompetence, inadequate training or communication foul up?

The apartment he occupied remains contaminated for days, apparently because of difficulty finding trained workers willing to do the job. There are photos of workers in civilian clothes powerwashing the sidewalk in front of the building. I hope they didn't think water alone would be adequate.

I'm not as confident as I was a month ago about safety in my own country. As far as west Africa, the situation is hard to comprehend, and in the end I fear the outcome will be staggering.

Infectious diseases can be contained and be stopped from spreading to other parts of the world. Effective vaccinations of the correct medications and care will prevent Ebola or any newly discovered bacteria strains from getting uncontrolled.

Have faith in the advancement of medical sciences in our present century.

>2 razzamajazz: I think the Dallas case demonstrates that we may indeed have measures to restrain spread, but it cannot in fact be stopped. Our world of global commerce and travel is an effective vehicle for the movement of men as well as microbes. I would be surprised if this were the last extra-African case of Ebola.

I'm by no means in panic mode on this. But wary, and not sanguine that things will go entirely smoothly.

By the way, Ebola is a virus, not a bacterium. There is currently no vaccine, and antibiotics are not effective against viruses. The few potential medications that may help are in the early uncertain and experimental stages. Isolation and supportive care seem to be effective for those already infected, provided it is available. It takes resources that are in very short supply in Africa. We can treat cases in the US this way, provided the system does not get overwhelmed.

As far as faith in modern medical science, I have as much as is deserved, which is a considerable amount. After all, I am a physician myself. But I am aware of the power of viruses, their miraculous mutability, their rapid reproduction, their potential for clever adaptation to conditions. And also of the human tendency to achieve less than ideal performance.

Of course, I hope you are right.

It may sounds ridiculous to stop the spread of Ebola, quarantine the countries where Ebola is originally being detected, restrict or ban the movement of exit and entrance of residents of these countries.

Very strict checks and medical scanning of all travellers at all exit/entrance checkpoints of the world - airports,harbours,railway stations, custom checkpoints and any types of exit/entrance points in all parts of the world. Vigilance is the best control of the Ebola's massive outbreaks to other parts of the world.

www.news.nationalgeographic.com

Click: Ebola Questions You Were Afraid To Ask

Can we stop or restrict all travellers from Western side of Africa coming into USA and other countries? Who has the right to sanction rightfully by law to restrict these movements?

World Health Organisation, an arm of United Nations!

Ok, whatever the merits of the proposal to make travel from affected areas more restrictive, that is not the case today. And the U.S. government has clearly indicated opposition to a travel ban, saying it would be counterproductive, impeding access to necessary outside help. Therefore, having faith that all will be well outside Africa seems something of a stretch. It goes without saying that such a strategy wouldn't help to get the epidemic under control within the affected African countries themselves.

Again, I hope your faith comes to pass.

Should we have faith that all bad things and bad times will pass away?

Well, from 30,000 Feet, all life on Earth comes to an end in a few billion years, so everything on Earth that is good or bad will pass away.

But I had in mind the immediate Ebola outbreak.

Top agenda to handle, to eradicate Ebola is Number One in the list of most world leaders - "Things to Do" lists besides IS's threat, I hopefully believe it to be.

Yes, you are politically and ethically correct on the spot.

:-)

Just watching some Ebola coverage. The one guy in Dallas is getting worse, but no one else so far, not even the people he was staying with, are showing any signs of illness.

I just don't see this being an epidemic in developed nations. Everyone is so freaked out the populace will do whatever the health authorities tell them to do. In West Africa, a lot of the populace doesn't trust authority, especially foreigners. They (reasonably enough, considering history) are wary of the imported health people having hidden agendas.

I see subtle threads of xenophobia and racism in so much of this. Africans are xenophobic because of the ways in which they have been exploited in the past, so they are not taking measures recommended to them by outsiders. Americans are freaking out about foreigners and illness. (There are memes going around Facebook and other social media claiming most of the unvaccinated kids in the US are illegal aliens, rather than white, middle class vaccine alarmist moms.) I wonder, if something like this was happening in France or Germany or Great Britain, would Americans be screaming for travel bans? Well, maybe for France.

I agree with you Phaedra. I'm not expected an epidemic here either, but I wouldn't be surprised at more cases, a few in Europe, and collateral damage causd by mistakes and fear.

On the other hand, if that mutation arises, the one that allows for airborne transmission....

The plague also is still around in the U.S. and yet the four horsemen of the Apocalypse have not emerged yet. Heck, even in the mid-14th century there were parts of Europe who have not been affected by Black Death at all, while the surrounding villages died out completely within a few weeks. The demiurge has other plans with us. There shall be weeping and gnashing of teeth eventually, but not because of Ebola.

Anyway, you can never go wrong if you go by the book:
"Heal the sick, raise the dead, cleanse the lepers, cast out devils: freely have you received, freely give." (Matthew 10:8)

>9 PhaedraB: I see subtle threads of xenophobia and racism in so much of this.

A timely read would be David Quammen's Spillover, which chronicles the outbreaks of a number of zoonotic infectious diseases, including a detailed chapter on ebola.

One thing that comes through very clearly in the book is that for people cognizant of the field, outbreaks are not a matter of "if" but of "when" and the most effective approach is not to "cure" but to "manage" them when they happen. If nothing else, the book made me feel more knowledgeable about the subject, more aware of the potential for danger, but also less inclined to panic over that danger.

Are we facing "pandemic" right now?

Control the "epidemic" of Ebola at its sources of origin.

Our advanced medical sciences will surely eradicate this virus.We have a string of pandemics through the centuries from 165-180 AD ,Antonine Plague (smallpox) to
Swine flu or SARS in 2009.

Can we stop Ebola becoming a pandemic?

www.medicalnewstoday.com/articles/148945.php

PRAY for the Ebola's infected hospital patient, Thomas Eric Duncan in Dallas,Texas to recover fast.His condition have become critical.

Ebola is nothing new, it has detected several years ago in Congo. The world leaders have to act fast, time is running out before Ebola becomes a "pandemic" when maybe millions of people will die and suffer. WHO must take the lead.

www.cid,oxfordjournals.org/content/42/11/1521.full

Note: Follow the internet's instruction to reach to the link.

The report is too technical for a layman to comprehend, but it is comprehensive and informative.

>12 southernbooklady:: Spillover looks intriguing but can I suggest as a fictional account The Pesthouse by Jim Crace as a dystopian plague-world. As far as Europe and England (as it then was) is concerned the nearest analogue must by the plague or "Black Death" mentioned by phlegaethon99 in #11 although it seems the nature of the disease has not been determined beyond all doubt. A couple of books I enjoyed were The Scourging Angel by Benedict Gummer and The Black Death https://www.librarything.com/work/5337707/book/31950161 by John Hatcher (Touchstones didn't work). The latter gives a much better idea of what it meant to live through those times although in part a work of imagination. I suppose the difference is that whereas the Black Death was spread between countries by sailing ships ebola can be spread by a person withn air ticket. And of course travel within a country is much faster now.

>14 PossMan: Black Death, as I recall, was spread through a vector, fleas on rats. Ebola requires direct contact with bodily fluids of an infected person who is actively showing symptoms. So, the travel difference is not as important.

This only applies to bubonic plague, not to pneumonic plague which - according to conservative estimates - killed a third of the population of Europe because it was transmitted by inhalation of aerosolised plague bacteria.

>16 Phlegethon99: Again, with Ebola, no evidence of airborne transmission. Although it is theoretically possible to contract Ebola from sneezes, as with AIDS, it's not so easily done.

>14 PossMan: My understanding is that there are not too many plausible alternatives any longer to the Yersinia pestis theory of the Black Death, cf:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951374/

Much more transmissible than Ebola, btw, as there are three modes of transmission -- direct contact, as with Ebola, infectious airborne droplets, and bites from infected fleas.

>15 PhaedraB:: >16 Phlegethon99:: I didn't intend to suggest that plague and ebola were transmitted in the same way. I was really thinking of what it meant to the inhabitants of England in the mid-1300s who must have been very fearful as are present populations in West Africa. Nor is it 100% certain how that outbreak compares with more recent outbreaks. The Gummer book does spend a few pages discussing the issue as to whether the "Black Death" was bubonic plague but I believe >18 stellarexplorer:: is right in thinking the Yersinia pestis theory is most likely.

>18 stellarexplorer:
Are there three modes of transmission, or three types of plague: bubonic (affecting the lymphatic system), septicemic (in the bloodstream), and pneumonic (in the lungs and able to be aerosolized)? I am confused.

Like many historical epidemics, plague was as much a problem of sanitation as anything. It was transmitted by fleas that fed off infected mammals; in other words, a zoonosis. The Black Death may have started in Central Asia, where even today people acquire the disease by hunting and eating marmots. Must be tasty.

Fortunately, the plague bacterium is susceptible to penicillin.

The rats are still here. My cat has brought live Norway rats inside the house for us to chase. She's a considerate animal. In our previous house one came up the toilet.

>19 PossMan:
People had various responses. Rich people packed up and hied off to their country estates, where they sat around telling stories (The Decameron). Other people became obsessively religious, to the point of wandering the countryside and whipping each other and themselves. Some people probably decided to party like there was no tomorrow, which was true for many of them. Others blamed the Jews for poisoning the wells.

>20 IreneF: Hi Irene -- that's an interesting question, and I'd suggest that it's a matter of how you want to classify things. There is one causative agent (Y. pestis), and three "forms". The forms describe clinical syndromes that tend to be associated with each type, each has characteristic modes of acquisition, but they are not entirely distinct either. For example, bubonic plague is most often acquired from a flea or rodent bite. Septicemic plague, the bacterium proliferating in the bloodstream, can be acquired either from a rodent or flea bite, or from untreated bubonic or pneumonic plague. The pneumonic form, where the bacterium proliferates in the lungs, can come from inhaled droplets, or from untreated bubonic or septicemic plague.

So to my way of thinking: one organism, three mode of transmission, three forms of the illness depending on which part of the body the organism is afflicting. Whether this constitutes one disease or three seems to me a matter of classificatory ambiguity. My personal preference is to call it one disease. Ymmv...

>22 stellarexplorer: Thank you for that nice succinct summation. Goodness knows I've read enough about the Plague and its various forms, but they're rarely explained so concisely.

>22 stellarexplorer:
I think it's one disease. I'm still just puzzled by it. I like diseases. Reading Rats, Lice and History for the first time was a great experience.

I believe strep throat and scarlet fever are caused by the same organism, but the later produces a toxin that effects the skin. Perhaps a plasmid (?)

I think influenza poses a greater potential threat than Ebola. We can't treat it very effectively, we can't prevent it very effectively, it's already demonstrated its lethality, and it strikes the young and healthy because of their strong immune responses.

>24 IreneF: I'm a fan of RL and H as well. And McNeill's Plagues and Peoples, if we're talking classics of the role of infectious disease in history.

Completely agree on influenza. All of what you said plus the potential for airborne transmission. It can be spread by birds which fly everywhere. During the 1918-1919 Spanish Flu there were precious few regions of the planet that went unaffected. It has an impressive track record. Not to be underestimated. Many virologists believe "it's not if but when". Not to be alarmist about it :)

"And Darkness and Decay and the Red Death held illimitable dominion over all."

new ebola case diagnosed in Madrid, acquired in Spain from patients being treated there.

>27 stellarexplorer:, Yes, now that's a concern...

Slightly disturbing that all the doctors/nurses that treated the original patient brought back from Sierra Leone didn't seem to get much follow up or supervision (but what I've read in press or seen on BBC seems very sketchy so perhaps I'm being unfair)

Would it have been a breach of human rights (or sensible) to quarantine them during the treatment of the original patient and then later until it was clear none had been infected?

edited to add "(or sensible)"

>30 PossMan: The people with whom the Dallas patient was staying have been put in quarantine for 21 days. In the US, the government's right to quarantine is quite sweeping.

>30 PossMan: regardless of the issue of human rights, I can only imagine how hard it would be to get health care workers to provide care if the work was so risky that it required 21 days of quarantine afterwards.

I think the answer here is that this shouldn't have happened, adequate precautions exist to allow stricken individuals to be safely treated, so something went wrong. It's imperative to figure out how this happened, but clearly something fell through the cracks procedurally.

This isn't an issue of quarantining the sick, btw. They are already being treated under ostensibly secure conditions until they are recovered and not infectious. It's a matter of health care workers contracting the disease when they should have been able to work safely.

The true pandemic:

http://www.newyorker.com/humor/borowitz-report/man-infected-ebola-misinformation...

Latest situation about Ebola in the world from

International SOS

http://www.internationalsos.com

Spanish nurse reportedly thinks she may have mistakenly touched her her face while removing her protective suit after treating ebola patient.

Liberian Thomas Duncan died in Texas where he was being treated for ebola infection.

That makes this nurse a pretty sub-standard nurse. Now they are going to put down her dog because they don't want to quarantine him. ¡Salvemos Excalibur!

http://www.bbc.co.uk/newsbeat/29535230

I had thought the procedure was to disinfect the suit with a spray-down before removal, but I guess the virus was still viable.

Apparently, it's protocol not to touch anything above your neck until the decontamination procedure is complete.

Training. Training. Training. And you'll still have human error. The silver lining is we'll learn more from the mistake.

>39 PhaedraB: I wouldn't touch anything below my neck prior to decontamination either.

>41 stellarexplorer: I imagine it gets tricky getting out of coveralls without touching anything.

I think the idea a thorough spraydown with a chemical decontaminant before beginning removal. But as pmackey says, human error is always a possibility.

The extra protection by having all health workers, doctors and nurses to wear the hazmat suits is extra precaution against infectious diseases beside chemical decontaminant and quarantine zoning wards in hospitals. The suit protects from head to toe with a pair of goggles for the wearer's eyes.

Human error is not totally zero error, anything can happen due to carelessness.

The suit is the protection for the health worker from the ill person's infectious bodily products: blood, vomit, diarrhea, etc. Chemical decontaminent is protection of the worker from the contaminated suit after it has been used.

Two different procedures of protection on a health worker, initial and closing stages. Misunderstanding on my part.

>37 Phlegethon99:: Perhaps an insufficiently trained nurse? It seems one of the problems with the dog is that some scientists believe dogs can carry the virus but without showing symptons. I'm not a dog lover myself but clearly we can't afford to be too gung-ho in dealing with this dreadful disease. There's an article here:-

http://theconversation.com/ebola-how-did-a-spanish-nurse-become-infected-with-vi...

It doesn't come up with any definite answers but I did learn how even though not very contagious the disease is highly infectious - a distinctinction I hadn't previously been aware of.

>47 PossMan: She was a nurse's assistant, not an RN. And she said she thought she did touch her face while getting out of the gear.

My dog breeder friends tell me that yes, dogs and other animals can carry Ebola without showing symptoms. What's not clear is if they can transmit it. A human is only contagious when showing symptoms, so if the critter shows no symptoms, is it contagious?

http://wwwnc.cdc.gov/eid/article/11/3/pdfs/04-0981.pdf

Asymptomatic dogs exposed to ebola in Gabon 2001-2002 by eating infected dead animals were shown to have antibodies against the virus, suggesting infection but not illness. They are therefore thought to be capable of carrying the virus.

>48 PhaedraB:: I don't know her status in the Spanish nursing hierarchy or what 'RN' means but I would have thought that ALL people in contact with the patient from cleaners to top-notchers would have been given suitable training. In fact I think responsible or well-qualified doctors/nurses have a duty of care to those working under them. My remark that she was possibly insufficiently trained was because today's (London) Times had a report which included this comment from a Spanish doctor:-
" A senior doctor at the hospital where Ms Romero and five other quarantined patients were being treated attacked a lack of training. Dr Santiago Yus, a specialist in intensive care, said: “Tomorrow or the day after tomorrow I will be expected to treat the ebola patient and nobody has even taught me to put on the protective suit... I am not ready, I am not trained. And it’s the same with my colleagues.” and the article added "Ms Romero was part of a team treating a Spanish missionary who died on September 25. After developing a fever, she was treated by staff without protective suits and told to take paracetamol. Days later she was kept waiting in a busy emergency ward despite telling staff: “I am worried I have ebola.”

I would have given a link to the full (and much longer) article but it's behind a pay-wall.
In the case of the UK the media are stressing the excellent facilities at the hospital where the last patient was treated but I can't help wondering what happens if several patients come forward at the same time..

>48 PhaedraB:: For all I know quite possibly not - but should we take the risk that it might be? Dog lovers may say "yes" and I'm afraid that's where I have to differ.

>50 PossMan: An RN in the US is a Registered Nurse, one with a particular level of education and licensing. There are other levels, including Nurse Practitioner (more education and training, can prescribe, works under supervision of an MD), Licensed Practical Nurse (less education and training), and the all-round catch-all "nurse's aid," which doesn't signify much of anything. All categories have things they can or cannot do.

Here in the US, nurses and other medical personnel have been complaining that they are not being given training. It's easy to think, just go online, but just because we have the time to do that, doesn't mean everyone else does. If you're at a hospital all day working your butt off, you're not watching cable news or seeing the crazy stuff online.

Quarantine the dog, wait for two weeks, draw blood, look through a miscroscope, find out that all the hysteria is unfounded and set the dog free. Not too much of an issue, costs close to zero. And if a dog really produces antibodies it would be a good idea to figure out how and apply that knowledge accordingly.

Even though I never developed measles, I was exposed to it as a child and developed antibodies to the virus. I didn't know this until about three years ago.

During the time after exposure, I don't think I was able to give anyone the disease. However, other diseases can be transmitted by an asymptomatic host, e.g. Typhoid Mary.

Herpes simplex and Clostridium difficile are also notorious for an asymptomatic infectious carrier state.

Some diseases do come once in your lifetime, I am not sure whether some people are resistant to them, eg measles,chicken pox, small pox, mumps.

http://www.sharecare.com/health/chicken-pox/people-diseases-chicken-pox-once

Smallpox comes never.

Smallpox is very contagious, a childhood disease.

>59 razzamajazz:. It used to be yes. (although liek most things its not actually restricted to childhood). But it remains the WHO's greatest success and so far the only disease to be eradicated in the wild. There are no (zer0, zip, 0, nought, none) smallpox cases in the world anywhere and haven't been since 1980.

You can catch chicken pox more than once if you're unlucky. Adult chickenpox can be very serious. (Cf the mirror crack'd)

>53 Phlegethon99: - quarantine the dog?! Who feeds it? exercises it? in full HazMat gear? This is neither cheap nor easy to do. Humanely killing it was definitely the right thing to do, although as part of a victim blaming exercise the PR could have been handled much better.

> reading_fox

Thanks. Smallpox is totally eradicated .

I believe the next task is to eradicate HIV , and the total eradication will be possible in a matter of a decade's time( I am very confident it will be a reality) with the rapid and progressive advancement of medical sciences for making better and effective vaccination.

No, the next one will be Guinea worm (dracunculiasis).
http://en.m.wikipedia.org/wiki/Dracunculiasis

The next one after that could be polio, except for suspicions about gov't (and even NGO workers) and chronic violence in some parts of the world that makes sending health workers over there too dangerous.

In the developed world many parents are overly frightened of immunizations, so we are experiencing resurgences of dangerous diseases such as measles.

Eradicating HIV is going to be difficult, because offering an immunization is like asking someone, "Do you inject illegal drugs? Are you a whore? Do you frequent whores, or even have sex with people you don't know very well? Do you have anal sex with men?" It will be a hard sell.

>63 IreneF: I don't think so. People are so freaked out about AIDS that if someone said "Do this and you are never going to get AIDS from anything," they would jump at it.

So far we do not even have eradicated malaria and leprosy, both of which have been around for thousands of years, claiming tens of millions of lives.

>64 PhaedraB: But it is reminiscent of what is going on with the Gardasil HPV vaccine, which prevents cervical cancer. A lot of parents are not getting their kids vaccinated because they are uncomfortable with the idea that this prevents a sexually transmitted disease. Girls WILL get cervical cancers that could have been prevented.

The fact is that the means of infection is irrelevant. Lethal disease can be prevented. But ever notice that people are not always completely rational? ;-)

"An estimated 3.4 million children were living with HIV at the end of 2011, 91% of them in sub-Saharan Africa. Most of these children acquire HIV from their HIV-infected mothers during pregnancy, birth or breastfeeding. With efficacious interventions the risk of mother-to-child HIV transmission can be reduced to 2%."

All children of whores (includes persons of either gender who have sex with people they-don't-know-that-well), and gay men.

There is good reason to suspect that AIDS is a consequence of colonization of Africa by the so-called Great Powers.

...

>68 IreneF: Please explain.

The European colonizers uprooted Africans, in some places forcing men to work far from home (e.g. as miners). People also left villages to go to the cities. The upshot was an increase in "social vices", esp. prostitution and casual sex. Combined with the lack of health care, many people developed chronic STDs that formed genital sores. The sores made transmission of HIV much more likely, especially to and from women, which is why HIV infection in Africa are more equally distributed between the sexes.

Do you want to know more about facts,fallacies and conspiracy theories about AIDS or HIV?

There is a misconception that the virus originated from the African green monkeys being transmitted to the male black population in the African continent by sexual contacts with the animals.Can it be a truth, and not proven at all?

http://www.newdawnmagazine.com/articles/the-secret-origins-of-aids-facts-fallaci...

http://www.nhs.uk
Search: HIV and Aids

http://www.biblebelievers.org.au/46a.htm

Yesterday at school, my daughter received her hepatitis B and meningitis vaccinations. Afterwards she and I looked over her entire vaccination record. After reading the names of all the diseases she has been vaccinated for, she said to me, "I've never heard of these." I thought that was a pretty good tribute to the effectiveness of the vaccination program.

The trouble is, as those diseases fade from memory, parents are becoming complacent, and deciding that vaccinations are unnecessary, or even harmful.

>68 IreneF: "There is good reason to suspect that AIDS is a consequence of colonization of Africa by the so-called Great Powers." That seems a bit of a long bow to draw.

The first known case of HIV appears from 1959, pretty much when colonialism was dying out. That exploration and development of natural resources leads to movement of the population is undeniable but this would have eventually happened anyway regardless whether by the native African population or by foreign investment.

I don't think that casual sex and the world's oldest profession are just confined to the "Great Powers" or their colonies either, the need for contact of this kind is fairly universal. The increase in social vices isn't a direct result of having European colonizers in your backyard.

My feeling is that this HIV pandemic was inevitable but due to Globalization not Colonization. The virus had already jumped from simians to humans and it is just the increased world population and greater accessibility to travel that has propagated it, much the same way that a Liberian man can die in Texas due to Ebola.

I strongly believe and trusted vaccination against some diseases made in the course from a baby (a toddler) to adulthood.

To protect against influenza. a different vaccination for a different seasonal flu applicable in different parts of the world.I do receive a yearly vaccination against influenza, and I believe it is advisable to have some kinds of vaccination before travelling or going overseas work stint against certain diseases depending where you are heading to.

http://www.historyofvaccines.org

Search: top 20 questions about vaccination

A very information FAQ website.

I think WHO are having medical missions to the remote areas of the world supplying and giving vaccinations for their widespread diseases existed in their areas, and at the same time giving self-help training and education to the villagers' chiefs or leaders.

>74 bernsad:
Well, I didn't invent the theory, and I'm not claiming that it's 100% true, but the scientific work behind it looks pretty solid.

There are known cases dating before 1959, diagnosed from old tissue samples.

Here is more info:
http://en.m.wikipedia.org/wiki/History_of_HIV/AIDS#Origin_and_epidemic_emergence

Reading through that Wikipedia entry, I find myself drawn to what each of you is saying. In other words, it's hard not to believe that colonialism introduced and fostered conditions that promoted the spread of HIV. On the other hand, as HIV appears to have been introduced into the human population through the bushmeat practice, it seems to me likely -- though admittedly speculative -- that as populations increased in Africa, the virus would have entered the population anyway. It's a prominent mechanism for the development of emerging infectious diseases in general: people expand into areas previously thinly occupied, and contact organism that are reservoirs for new viral or bacterial pathogens. Maybe the time course would have been slower, who knows what the pattern of the spread would have been; the efficiency of spread through global travel was coming one way or another.

Anyway, another alarming feature in the case of HIV is its further adaptation to its new human hosts via mutation once it got into the population. The Ebola virus is currently simmering in the brand new nutrient-rich Petri dishes of ten thousand human blood streams, replicating billions of times a day, each replication a roulette wheel that may land on a new variant of the Ebola we thought we knew....

Thanks for the updates.

>76 IreneF: That's an interesting article you linked to, thanks.

It still seems to me though that this might have happened with time anyway. I thought one of the interesting points was that widespread immunisation programs, unfortunately reusing unsterilized equipment, probably accelerated the problem.

>80 bernsad:
Yes, that's terribly sad. I don't know whether it even occurred to anyone that reusing needles was dangerous. I remember that at the beginning of the AIDS epidemic people who got blood transfusions, especially hemophiliacs, were getting AIDS and then being shunned because of it.

I think the combination of factors that seem to have come into play created a perfect storm situation. If it had happened later, perhaps some of the most severe manifestations would have been averted.

Vaccines have eradicated smallpox (100%) and to some degree of eradicating diphtheria,tetanus,yellow fever(malaria), whooping cough,polio and measles. T B , tubercuolosis to a very small degree of eradication.

http://www.unicef.org

Search: Vaccination

Influenza vaccinations are a complete scam though if you live in the First World. We also should not forget that with every vaccination something can go wrong like with every general anesthetic, so to a certain degree I can understand the motivation of the anti-vaccination lobby. The pharmaceutic industry isn't the International Red Cross, Caritas or Médecins Sans Frontières but it is bound to make a profit and compulsory vaccinations are one of the safest and quickest ways to make a massive profit. May are the scandals stemming from the collusion of the state with multinational pharmaceutical corporations.

Corruption between the country's Ministry of Health and the major multinational pharmaceutical corporations is a common knowledge, but how transparent can the business deals with these corporations be, and frauds can only be controlled and not totally eradicated.I believe that there are clinical tests on patients and healthy volunteers before the purchase of new drugs being distributed and procured in large bulks for patients in hospitals and clinics,public and private

I'll take my chances with vaccinations. I trust the scientific/medical community more than the vaccination naysayers. I had mumps as a kid. My children did not because of immunizations.

As long as you have it as a kid everything's fine. It only gets problematic when you catch it as an adult. The best cure is natural immunization.

Vaccination is different from immunisation.

This website is useful with FAQs and answers.

www.health.gov.au/internet/immunise/publishing.nsf/content/faq

>86 Phlegethon99: As long as you have it as a kid everything's fine.

No, not fine. Those childhood diseases are worst if you get them as adults but they still killed plenty of kids.

>83 Phlegethon99: Then why has it been so hard to get pharmaceutical companies to make vaccines? The truth is that they make very little money off vaccines.

A constantly growing number of customers for a constantly growing number of comparatively useless vaccinations with no need for any active marketing or promotion = every capitalist's wet dream.

I had tons of those diseases as a child, because they didn't have as many vaccinations then. Believe me, they are no fun.

I had measles. It's most dangerous if you are under 5 or over 20. From the CDC: "Before measles vaccine, nearly all children got measles by the time they were 15 years of age. Each year in the United States about 450-500 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness." It's super dangerous for infants who are too young to receive the vaccination. Those are the kids who are most likely to die, and who benefit most from herd immunity. Other than supportive care, there is no treatment for measles.

I had German measles (rubella, three-day measles). It's dangerous for pregnant women. Again, from the CDC: "Birth defects if acquired by a pregnant woman: deafness, cataracts, heart defects, mental retardation, and liver and spleen damage (at least a 20% chance of damage to the fetus if a woman is infected early in pregnancy)." Vaccines and herd immunity help. There is no treatment.

I had mumps. Miserable, but in children, not so many complications. But if an infected child passes it to an adult without immunity, it's more of a problem. The CDC says: "Complications of mumps can include
- Inflammation of the testicles (orchitis) in males who have reached puberty, which rarely leads to sterility
- Inflammation of the brain (encephalitis) and/or tissue covering the brain and spinal cord (meningitis)
- Inflammation of the ovaries (oophoritis) and/or breasts (mastitis) in females who have reached puberty
- Temporary or permanent deafness"

Guess what? No treatment.

I had chickenpox. Again, worse if you are under 5 or over 20, or have a suppressed immune system from things like AIDS, cancer, steroid use, the usual suspects. From the CDC:

"Serious complications from chickenpox include
- dehydration
- pneumonia
- bleeding problems
- infection or inflammation of the brain (encephalitis, cerebellar ataxia)
- bacterial infections of the skin and soft tissues in children including Group A streptococcal infections
- blood stream infections (sepsis)
- toxic shock syndrome
- bone infections
- joint infections

"Some people with serious complications from chickenpox can become so sick that they need to be hospitalized. Chickenpox can also cause death.

"Some deaths from chickenpox continue to occur in healthy, unvaccinated children and adults. Many of the healthy adults who died from chickenpox contracted the disease from their unvaccinated children."

There are some anti-virals that can be used to treat chickenpox. But not aspirin. "The use of aspirin in children with chickenpox has been associated with Reye’s syndrome, a severe disease that affects the liver and brain and can cause death."

All of these illnesses are much more dangerous for people who are malnourished or in ill health. Thinking they are no big deal is a first-world attitude. Those kids without vaccinations, what happens if they travel? What happens if they get these diseases as adults? Heck, what happens when they go to college? When I went to grad school in my 40s, they wanted proof of immunizations if you wanted to attend day classes.

And kids who get these diseases because their parents chose not to have them immunized can pass them along to other people who are perhaps immunosuppressed or otherwise susceptible.

>92 IreneF: Exactly.

>83 Phlegethon99: I don't understand why you are comparing the risk of general anesthesia to the risk of vaccination. The two topics are unrelated, and it just obscures the issues to connect them.

Following up on the points of Phaedra and Irene, in the US we are experiencing significant increases in vaccine-preventable diseases due to the small but increased number of unvaccinated children. In 1990, before the flourishing of the anti-vaccine movement, there were ~4500 cases of pertussis aka whooping cough. This is a disease that kills a certain percentage of young kids. It was on the verge of eradication in the US. IN 2012, there were 48,000 cases. You don't get it if you are vaccinated.

In 2000, US health officials declared measles eradicated in the US. There have been numerous outbreaks in then US since that time, and new cases brought from abroad are finding susceptible individuals among the unvaccinated. This is a highly infectious disease; see >91 PhaedraB:
It may be hard to know whom to believe on a lot of things, but vaccination is a deadly place to take a stand against expert opinion.

>82 razzamajazz: Yellow fever is not malaria. There is no vaccine for malaria.

Enjoying my free time. I just watched Contagion.

>96 stellarexplorer: Contagion is technically very accurate, unlike most Hollywood movies. The last time Ian Lipkin gave a seminar at the lab where I work, he also gave a public seminar about his work on Contagion.

http://www.mailman.columbia.edu/news/media/professor-ian-lipkin-brings-science-h...

>97 streamsong: It was, and I had read before seeing it that the CDC had also made a similar comment. Of course, that didn't immunize it from the rest of the script :)
It was ok, held my interest, but the script was nothing special. The technical dealings and the conflicted position of the head of the CDC effort were the best aspects to me.

>97 streamsong: just read that link to Dr Lipkin's interview. Very interesting just having seen the movie. Thanks streamsong.

Laurie Garrett and Larry Brilliant were also consultants to the filmmakers.

I seem to remember Outbreak with Dustin Hoffman (1995), about an Ebola-like airborne virus, was fun to watch. Might have been based on a novel. Or I might just have bad taste in movies.

I remember enjoying that too. So last night, I was choosing between Outbreak and Contagion, and decided because I hadn't seen Contagion, and it was praised for its technical attention to detail.

Last night I watched some old news footage of the Marburg outbreak in the small German university town Marburg (hence the name) in 1967. And lo and behold, the Marburg virus is still around in Uganda these days.

http://www.newsweek.com/health-officials-respond-ebola-marburg-virus-276621

I liked this quote: “Now, Marburg is a lot like Ebola, except it didn’t have a movie made about it.”

Marburg, along with ebola, figures prominently in Richard Preston's The Hot Zone. Which was pretty gripping and terrifying reading.

And on another topic, now that we have another health care worker diagnosed with ebola (the Dallas case), one has to wonder: is it another case of human error? Equipment failure? Poor training? Or is there more to the transmission of the disease than we have previously understood? Personally, I'd be more comfortable with a biohazard spacesuit than with gown, gloves, mask and shield.

>104 stellarexplorer: You echo my sentiments after reading the news http://www.washingtonpost.com/news/post-nation/wp/2014/10/12/dallas-health-care-.... I'm also waiting to see what happens to the pet mentioned in the article.

> 103 Oh, I remember reading The Hot Zone. I couldn't remember the name.

> 104 The nurse in question said (as did the one in Spain) that she remembered touching her face while she still had the contaminated gloves on. There isn't a procedure in the world that can't be breached by a single unthinking moment.

Better to wear a whole-face mask.

>106 PhaedraB: I hadn't heard that about the nurse and the glove. It's good to get an explanation, though that's pretty awful. That may well be less likely in an isolation unit that trains regularly to deal with such infections.

Nonetheless, this bug must be darn easy to transmit. I read today something I'd been thinking about: apparently the virus is not only present in the bodily products of symptomatic individuals, but also on their skin.

>108 stellarexplorer: You're assuming that the nurse only touched his skin, not bodily fluids. With gloves and a whole hazmat outfit on, she could have and is likely to have handled all sorts of bodily discharges.

>107 IreneF: A whole-face mask won't help if you touch your face during the undressing/decontamination procedure, which is what she said she did.

I wonder if there's a device for patients like the hoods (not for the head, more like an oven hood) that chemistry labs use to keep dangerous fumes away from people. So you could put a person with Ebola in a special bed that would waft viral particles away.

Re the gloves, touching one's face: human error is the hardest to control. Better to make a dangerous action impossible to perform.

Even though medical personnel know their jobs could be dangerous, killing them off is counterproductive. As is making the job so dangerous that they decide it's not worth it.

> streamsong

Thanks. Malaria and yellow fever are two different illinesses.

>110 IreneF: There's no evidence it's airborne, so airflow wouldn't do much.

I read it could be airborne within a close distance, such as a meter. Sorry, I don't recall where I read that. Or maybe I'm confusing it with something else.

How dangerous is Ebola .

A good BBC report.

http://www.bbc.com/news/world-africa-26835233

Deaths To Date: 3,850 persons

>109 PhaedraB: No, I'm not assuming that. I'm just mentioning a newly announced source of viral particles that may be relevant to transmission.

>110 IreneF: The four US special medical biocontainment units (at Emory University Hospital in Atlanta; Nebraska Medical Center in Omaha; the National Institutes of Health in Bethesda, Md.; and St. Patrick Hospital in Missoula, Mont.) have just such air flow systems. Patients are completely isolated, with air entering a closed system around the patient from outside, and air exiting through dedicated ductwork that releases air eight feet or so above the roof. Postive air pressure is maintained, so exhaled air from the patient is forced to flow away safely.

Here is an interesting article about the Nebraska unit, which has stood empty for ten years, staff conducting regular drills in preparation. They treated their first ebola patient recently, successfully, and are currently treating an American journalist who contracted the disease in west Africa:

http://www.nytimes.com/2014/10/10/us/ashoka-mukpo-ebola-nebraska-hospital.html

It's my understanding that in those four units, it's the room that is isolated and not the individual patient bed.

Those four hospitals are close to the four government research labs with BSL4 facilities and so were funded by government money in case of an incident in a BSL4 lab. Because of that, they are equipped to handle all sorts of pathogens, not just Ebola. To put it in perspective, laboratory work on AIDS is 'only' BL3.

I think it's premature to say either nurse violated protocol. Both nurses denied doing so. To me, it's like when the FAA immediately calls the crash 'pilot error' before the investigation is even begun.

>117 streamsong: agree with you on not jumping to conclusions. The infection of two nurses in the west puts the difficulty in addressing the disease in Africa in perspective.

I don't know the full history of all 4 specialized medical units in the US, but I do not believe the U of Nebraska unit has anything to do with a government BSL4 unit. It was set up by a motivated doctor with the backing of the president of the college using government funds made available to states following 911. I don't think there is a BSL4 lab in the vicinity.

And, yes, it's the rooms that are isolated, and the staff wears protective gear. My mentioning that was mostly to reinforce that Irene's idea of isolating the patient to protect others from airborne viruses they might give off was in fact part of the plan. It's also built into the highest level protective suits. These have a positive air pressure system built within the suit so that even if there is a puncture, air is forced from within the suit out, and not outside air into the suit, giving the wearing another layer of protection.

>118 stellarexplorer: - Ah, you're right. I was thinking there was a military BSL4 in the Midwest, but it looks like they are all in Fort Detrich, Maryland.

>119 stellarexplorer: Yes, even the BSL 2.5 (BSL 2 with BSL 3 practices) lab that I work in has the lab at a lower air pressure and multiple doors to gain entrance so air flow is only into the lab. The air then travels through special filter units before going back into general circulation.

Another Dallas health care worker has been diagnosed with Ebola: http://www.cbc.ca/news/world/ebola-outbreak-2nd-health-care-worker-in-dallas-tes...

Disturbing of course, and also that it's getting less surprising.

Dr S Murkeejee in the NY Times yesterday had an interesting idea: instead of measuring fever at the airports, which is not specific and not always a reliable indicator, have each passenger boarding a plane in west Africa give a drop of blood. The blood can be tested during the flight, and anyone who tests positive can be quarantined immediately upon arrival. It would significantly reduce guesswork.

Are there enough virus in the blood to detect before symptoms develop? I always thought that was the limiting factor on blood tests.

Has any one questioned the durability and reliability of the protective gear being used? The companies that make them have ramped up production to meet demand. Is it possible their quality control is suffering?

>123 TLCrawford: according to Dr Mukherjee, while problems will need to be worked out, using PCR technology and a teaspoon of blood, you can get an answer within a few hours. He cites the use of the method in asymptomatic ebola cases previously, but does not pretend it's ready to be implemented tomorrow in airports. But it may be worth putting effort into.

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

In the article it states that 3 infected subjects were not caught. It looks great for getting most of the people exposed into early treatment but not so great at containing the infection.

The original US patient has been shown to have infected two health care workers so far. I am concerned about the people he was in contact with in the days outside the hospital. No news is not always good news.

Edit to add, the airline passengers that flew with patient #3 are also a subject of concern.

>125 TLCrawford: true. Here is the relevant paragraph:

"A 2000 study in The Lancet illustrates the power of this approach. Twenty-four “asymptomatic” individuals exposed to Ebola were tested using P.C.R. Eleven of the exposed patients eventually developed the infection. Seven of the 11 tested positive for the P.C.R. assay; none of the other 13 did. In 2004, virologists at the Centers for Disease Control and Prevention further refined this method to increase its sensitivity. The test now requires only a teaspoon of blood. The sample is transported, on ice, to a centralized lab. Results are back in a few hours."

So the technique was improved since that time. I'd like to see other virologists weigh in on the viability of the method.

A couple of random comments. I agree with whoever said that guinea worm infestation will probably be the next to be eradicated; we have one of the last outposts of it here in South Sudan. The Carter Center is in the forefront of this particular campaign. Polio should also be eradicated fairly soon, except that armed conflict and the opposition of some armed groups to the vaccine is causing a bit of a setback.

I saw a figure the other day that 800,000 people a year die of malaria. Puts it all in perspective, rather, and that's a disease where there are existing preventative and curative measures available.

I saw a BBC article recently which sets the beginning of HIV/AIDS rather earlier than the 1950s: Aids: Origin of pandemic 'was 1920s Kinshasa'

An ebola cartoon from the Grauniad:

Yes, very much who. Ebola outbreaks in the past haven't attracted anywhere near this level of paranoia. But the Gods forbid an American (or European) should get it while on American or European soil.

>128 John5918:: Agree totally with your comments but the trouble is that neither media response or public response is always logical. I remember polio being quite an issue when I started student life in the late 1950s (in UK) and getting some sort of vaccine but like diphtheria (remember those library bookmarks) and whooping cough polio is no longer much of an issue in the minds of people here. And I'm afraid people have got "used to" living (or dying from) malaria. (I'm sorry, I haven't expressed that well and it sounds horrid - I don't think we should be complacent). Ebola is relatively new and as I suggested as far back >14 PossMan:: our responses (in Africa & UK perhaps) seem a bit like the way people in mid-1300s responded to the Black Death although as others quickly pointed there's no medical links between the two. A new virulent disease to which there is no obvious defence - especially if you don't trust the state/scientists/doctors which seems to be case in some communities.
PS love the graphic cartoon.
PPS When I was a young boy there was a san(itorium) just along the road which I later learnt was for TB patients but by then it was closed. Another disease of no consequence. Seem to be hearing more of it now.

"The Kardashian of Viruses"--love it!

>131 Marissa_Doyle: Believe it or not I had never heard of the Kardashians until a year or two ago when I happened to be staying in a guest house with some young US aid workers who were watching it on satellite TV. I was completely baffled and they had to explain it to me, but I still don't really understand why these people are famous enough to have a TV show made about them. Later I learned that there's a Kardashian sex tape floating around the internet somewhere. Maybe that's why they're famous?

The Kardashians are famous for the same reason that Paris Hilton is; nothing. They have simply promoted themselves appropriately and the sheep in society have gone "Oooh look, famous."

At one time malaria was a big concern in the United States. But then we drained swamps, killed mosquitoes, and controlled the disease. Now it is forgotten. Unfortunately West Africa is to big, to wet, and to poor to accomplish the same thing. (not to mention here we have a helping had from occasional frost) Polio scared us so badly that we are still fighting to eliminate it, sending money and people to dangerous parts of the world to vaccinate people in areas of active infections.

The cartoon is funny, but off-base. Tb isn't unheard of in the US.

At one time TB was considered, in the US, to be a fashionable disease. It was seen as the disease of artists and poets. Now, after first having a cure and now we are loosing it to resistant strains it is getting scarey again but still it is seldom in the news.

Ebola is a lead headline here in a large part because of the election November 4.

>136 TLCrawford: At one time TB was considered, in the US, to be a fashionable disease. It was seen as the disease of artists and poets.

I don't think "fashionable" is the word you are looking for. It was romanticized, partly because it was so ubiquitous it couldn't be associated with any class of people, or any particular "sin."

And when the cartoon refers to "a very specific demographic", it may not just be referring to non-westerners or non-Americans, but rather to the fact the TB is mostly in the news for its multi-drug-resistant form, which in the west generally is associated with poverty, and with individuals who fail to follow instructions on taking medication, taking partial courses of antibiotics or not taking them at all. There are people who others often prefer to keep invisible.

TB today is mainly a Third World and poverty disease. Without asylum seekers and illegal immigration TB would have long disappeared in western Europe.

Just reading an article in print edition of The 'The Times' (London) (today 2014-10-20) by a Will Pavia from New York. He gives several examples of "ebola fear"
1. In Arizona a missionary just back from Liberia had put himself in voluntary quarantine but complained of a 'lynch-mob' mentality. One person wanted his house burnt down. (Hope that doesn't mean with him in it).
2. In Maine a teacher was sent home because she had been to Dallas and stayed in a hotel just 10 miles from the hospital where America's first ebola patient (Thomas Eric Duncan) was treated before he died.
3. In Mississippis parents withdrew their children froma middle school after learning that the principal had visited Zambia - a country over 1500 miles from the nearest affected country.
4. Ahmed Kargbo from Staten Island (originally from Sierra Leone) says his accent caused fellow travellers to move on a New York subway. His whole row was suddenly empty.
5. Navarro College 60 miles south of Dallas has started rejecting Nigerian applicants.

I can't answer for the veracity of these claims but it confirms me in my opinion that responses to this disease are sometimes fear-led rather than science-led. And remember that these examples if true, come from an advanced country where we might expect science responses to predominate. So hardly surprising if the rural populations of these countries do not behave as western scientists would expect. And of course I'm not suggesting that these examples are typical of all Americans - I'm sure that is not so.

>140 PossMan: But it is reminiscent of the HIV transmissable in the swimming pool legend.

>140 PossMan: Navarro College 60 miles south of Dallas has started rejecting Nigerian applicants

The World Health Organisation has just declared Nigeria officially ebola-free after six weeks with no new cases - http://www.bbc.com/news/world-africa-29685127

They have the Marburg virus instead. Not much of an improvement.

>140 PossMan: There are people in Oklahoma who are pulling their kids out of school because some folks connected with the school were on a cruise ship with a lab worker from the Texas hospital who may have handled lab specimens from the Ebola patient. They're not sure that this person had any contact with the specimens, merely that the person worked in the lab.

A mom in that school district posted the email she received on Facebook:

Good Evening,

Moore Schools has been made aware that there were staff members, as well as, students on the same cruise as the lab technician who worked with the Ebola patient in Texas.

Erring on the side of caution, those employees will not report to work until the District can confirm that the lab technician has been cleared and there is no medical threat.

We have been able to identify some of our students who were on the cruise. They will also be kept out of school and not allowed to attend school activities until there is no medical threat as determined by the CDC. Tonight I am asking that that If you have a student who was on the cruise, please keep him or her out of school until further notice and notify your school’s attendance office.

Our hope is that we will have the “all clear” by late afternoon on Tuesday, October 21st.

Other parents on the same comment thread are saying they will keep their kids out of school because "you can't be too careful," and because "there's something they're not telling us." Someone else was lamenting that people from Oklahoma visit Dallas all the time, so the whole state is in danger.

What can one say? This is just plain hysteria and very reminiscent of reactions to AIDS back in the '80s.

Ebola has exposed America's fear, and Barack Obama's vulnerability

http://www.theguardian.com/commentisfree/2014/oct/19/ebola-america-fear-barack-o...

Many people in Texas are afraid to get out of bed in the morning. It's the politics of fear that pollutes some parts of America. Seems to be the same in the northeast, too. I don't remember which state it was (maybe Vermont? New Hampshire?) that suspended a teacher because she had gotten within ten miles of Presbyterian Dallas. This kind of silly fear is everywhere and instead of bowing down to it we should be facing it down, but alas we live in a country drenched in fear.

Home of the brave? Puh-lease!

>143 Phlegethon99: I have not heard of any recent cases of Marburg in Nigeria. Can you give us a source? There have been recent cases of Marburg in Uganda, which is over 3,000 kms away.

Marburg has been around in Nigeria as well for the last thirty years or so, but no recent outbreaks have been reported. Uganda would not even have made it into the news without the recent Ebola hysteria, as already back in 1977 under Idi Amin there was a major outbreak of Marburg and it was hardly reported even with the background of the European outbreak ten years before. The media today seem to be split on which has the higher fatality rate. At least in 1967 the Marburg outbreak in Marburg and Belgrade was under control with a low mortality rate within weeks. Marburg seems to have come and gone in Africa for decades without ever reaching the state of a real epidemy. And even today with international travel to and from Africa soaring I guess neither Marburg nor Ebola will justify all the mass hysteria in the end.

>149 Phlegethon99: Marburg seems to have come and gone in Africa for decades without ever reaching the state of a real epidemy

That's also true of ebola until this most recent outbreak. We had it in (South) Sudan about 40 years ago and it has popped up on and off in the region since then, but usually in fairly isolated rural areas where it has been contained fairly quickly, by natural factors as much as by human intervention. The difference seems to be that this recent outbreak has found its way into large towns.

>142 John5918:: "The World Health Organisation has just declared Nigeria officially ebola-free after six weeks with no new cases"

Yes John, the Times article did say that Nigeria was free of ebola and I suppose that was the point which makes the Navarro college action a bit illogical. I should have added that in my post.

#137, Thanks, that is a much better word.

I took this class last year, it is free and all online if anyone is interested. It is in progress but you can start late or sign up for future sessions.

https://www.coursera.org/course/epidemics

>152 TLCrawford: When responding from a post so far back it would be a great service to those reading your post to put a >137 southernbooklady:, that is a greater sign followed by the number of the post you are replying to, somewhere in your post.

The current issue of "The Economist" magazine (October 18-24) has a long and (to my layman mind) very informative article on the ebola crisis. It claims that much worse is to come saying that WHO fears 5000 to 10000 cases per week by early December, a figure comparable with total cases so far. I'm beginning to wonder how we can cope. And also beginning to think that our anti-ebola measures in UK are based on assuming a small number of people flying in from Africa. If infected people ended up at large in a densely populated city what then? After all this is what seems to have happened in West Africa - outbreaks were often in isolated villages but now in urban areas.

PS >136 TLCrawford:: TB is one of the diseases covered in The Sick Rose which is mostly medical graphics from the collection of the Wellcome Foundation but there are watercolours of the "White Death" and old posters. So I can see why some would see it as romanticized.

Just a few random comments. I'll pre-qualify that I am married to an Emergency Doctor (Consultant/Specialist level) who has been in the same room as many people with H1N1 (and has done a stint in ICU looking after one of the patients that was essentially turned into a vegetable by H1N1) and - more recently in the room with one person suspected of having Ebola (that fortunately turned out not to have it). This is not in the United States, by the way.

>83 Phlegethon99:

Influenza vaccinations are a complete scam though if you live in the First World. We also should not forget that with every vaccination something can go wrong like with every general anesthetic, so to a certain degree I can understand the motivation of the anti-vaccination lobby. The pharmaceutic industry isn't the International Red Cross, Caritas or Médecins Sans Frontières but it is bound to make a profit and compulsory vaccinations are one of the safest and quickest ways to make a massive profit. May are the scandals stemming from the collusion of the state with multinational pharmaceutical corporations.

This is mostly ill-informed nonsense. Influenza vaccinations are very useful for certain segments of the population, including the elderly, immune compromised or healthcare workers. H1N1 was a good example of an influenza that was killing people that otherwise would have been unlikely to die from the flu (teenagers, for example). Vaccination plays a role in protecting the most vulnerable and in controlling spread (through infected doctors). My wife was immunised and exposed to plenty of H1N1 -- she didn't get it. Does a vaccination guarantee protection? No. Would you want to work in a hospital with a bunch of infected patients without it? With the H1N1 vaccine, a lot of doctors started out skeptical as to whether they would have the vaccine (including my wife), but most ended up weighing the risks and going with the vaccine.

The anti-vaccination crowd are extremely vocal, but most of their arguments against vaccination have been proven to be completely without merit (such as the link of MMR with autism). The instance of preventable disease in communities in Australia where the anti-vac crowd are strong is on the rise. This puts the weak (such as newborns) at risk of death. Yep, children and the elderly *will die* for no good reason because some idiot parents with no critical thinking skills read something on the internet about vaccines being bad.

On the subject of Ebola, if it actually breaks out in meaningful numbers in the west it will not be containable. Most hospitals have a single room that would suffice for containment. What do you do when you have multiple possibly-infected patients in the ED (or ER of you are in America)? Remember, you don't know which ones have it and which don't, so where do you put them? Remember that EDs are already overcrowded (think 5 hour waiting times in typical operation). The healthcare workers will catch it because of mistakes following PPE protocols (insufficient supply, incorrect usage, careless removal, disposal, etc). If you think overstretched nurses always follow correct procedure with their PPE when they are rushing from patient to patient, think again. They certainly didn't with H1N1, and they probably won't with Ebola.

Ebola is one of those things - like a nasty influenza variant - isn't much of a problem when only a handful of people have it, but can easily escalate right out of control. The deciding factor is probably just going to be how easy or hard the current Ebola variant is to transmit. The jury seems to be out on that one at the moment (albeit I'm still tending to think it is relatively difficult to accidentally transmit when proper protocols are followed).

>155 Studedoo: couldn't agree more on vaccination, including annual influenza. As for a major ebola outbreak in the west, it would be hard to deal with. I just have trouble imagining how that will realistically happen. But if it does -- panic and overwhelmed hospitals.

On the Times (London) website there is a report that a French laboratory has developed a test for diagnosing suspected that will give results in 15 minutes. It says the tool, which has yet to be approved by regulators, works by monoclonal antibodies reacting to the presence of the virus in a tiny sample, which can be a drop of blood, plasma or urine, France’s Atomic Energy Commission (CEA) said. Prototype kits for clinical trials should be available by the end of the month and a pharmaceutical company is developing kits that will be user friendly and can be used in the field. A bit like a DIY pregnancy test. This sound as if it could be a huge help. “Current tests are highly sensitive but need special equipment, take between two and a quarter and two and a half hours and can only be carried out in a lab,” the CEA explained.

One should keep in mind that the WHO hardly is neutral in the Ebola story. Recent reports here have brought to light the massive collusion of the WHO with the pharmaceutical industry. This became blatantly obvious during the swine flu hysteria.

“The relentless note of incipient hysteria, the invitation to panic, the ungrounded scenarios--the overwhelming and underlying desire for something truly terrible to happen so that you could have something really hot to talk about--was still startling. We call disasters unimaginable, but all we do is imagine such things. That, you could conclude mordantly, is the real soundtrack of our time: the amplification of the self-evident toward the creation of paralyzing, preëmptive paranoia.”

― Adam Gopnik

“Fear is the main source of superstition, and one of the main sources of cruelty. To conquer fear is the beginning of wisdom.”

― Bertrand Russell, Unpopular Essays

>158 Phlegethon99: I think you should read Outbreak by David Quammen for a full account of the swine flu and why an influenza with mixed components from several host species is a major concern.

I had H1N1 at the same time I was undergoing breast cancer treatment. Brutal.

>157 PossMan: That's very interesting PossMan. I work at a US NIH lab with four independent labs within the complex. One of the labs is run by Heinz Feldmann, one of the major Ebola researchers with both one of the top two vaccine candidates under consideration as well as a therapeutic in the works. Currently his lab fields three teams of 5 people rotating through Liberian labs in three week shifts. They are doing the more common PCR tests, although they are doing a slightly different (and they believe better) version of it.

>155 Studedoo:, you are right that there are only a few hospital rooms with full isolation beds, but in a full out outbreak, wards with multiple patients and limited access would certainly work as long as clinicians have sufficient PPE. African Ebola treatment centers are currently tents without any air handling filtration since Ebola is not airborne. As a rule they are not within the established hospitals, which are left for other patients.

I think the news out of Dallas is hopeful. The Dallas hospital with no hands on training for nurses in using PPE, no buddy system to make sure they got in and out of suits correctly, and sub-standard PPE only had 2 workers infected. There were no infections from the first botched presentation with the patient kept in the regular ER and waiting room and then sent home. And according to news reports, it took a week for hazmat workers to get to the man's apartment and remove towels, bedding and personal items while other family members still lived there.

I do not work with any BSL 4 organism or in a BSL 4 lab but I get to hear wonderful seminars from brilliant people on the forefront.

I am not opposed to vaccinations per se. Got some myself as a child, where it was medically indicated instead of just being available. But the way vaccinations are praised as the be-all end-all for everyone, regardless of physical constitution, age, profession and residence (especially compulsory vaccinations of schoolchildren) by politicians, lobbyists and also parts of the medical profession - most of them with ulterior motives, some of them speaking out of ignorance - is a dangerous path to tread.

Anti-vaccers also speak out of ignorance and tread a dangerous path.

#157 PossMan Have you have a chance to visit the Wellcome Museum and Library? The museum is small but interesting and their library is a national treasure.

Seeing that all healthy children in a population are vaccinated is the best way to protect the children who are not healthy enough to be vaccinated or to survive what most of us older citizens consider "childhood" diseases. I was more than willing to accept a tiny risk to my children to protect my neighbors less fortunate children. But then I am a liberal.

>160 Phlegethon99: You don't seem to understand that vaccines are as much about protecting other people as about protecting yourself. If there isn't near universal vaccination then vaccines are fulfilling only a small part of their purpose.

Following that logic we'd have massive internment camps for those carrying contagious diseases for which there isn't a vaccination. For Germany alone that would mean 2.5 million carriers of Hepatitis C, not to mention AIDS and tuberculosis. Obviously the protection of others is limited by basic human rights of those infected.

Don't you have quarantine laws in Germany? But they generally only apply to highly contagious diseases, not Hepatitis.

>162 TLCrawford:: I'm afraid not. I live in Inverness (also known as Dystopia) in the Scottish Highlands which is about as far away from the Wellcome Library as is possible and still be in the same (for now) country. I have recently learnt something of the Wellcome from The Sick Rose a book I bought which contains images from the library. Some pretty horrendous and reminders of life in the not too distant past.

Apparently Hepatitis C seems to much much more of an issue in Europe than Ebola in Africa. And it has to be contagious because it is the most underreported disease. Experts assume that there are a whole lot more carriers than the official statistics suggest. And only a negligible percentage of them got tainted blood conserves or donor organs.

There's no logic to it. People are having a visceral, emotional reaction to the idea of Ebola, when there are a zillion other things much more likely to kill you.

It's like people who are insane about "stranger danger" with their kids, when in fact most child injuries and deaths happen in cars when the child is within arms reach of a parent.

>158 Phlegethon99:

One should keep in mind that the WHO hardly is neutral in the Ebola story. Recent reports here have brought to light the massive collusion of the WHO with the pharmaceutical industry. This became blatantly obvious during the swine flu hysteria.

“The relentless note of incipient hysteria, the invitation to panic, the ungrounded scenarios--the overwhelming and underlying desire for something truly terrible to happen so that you could have something really hot to talk about--was still startling. We call disasters unimaginable, but all we do is imagine such things. That, you could conclude mordantly, is the real soundtrack of our time: the amplification of the self-evident toward the creation of paralyzing, preëmptive paranoia.”

― Adam Gopnik

“Fear is the main source of superstition, and one of the main sources of cruelty. To conquer fear is the beginning of wisdom.”

― Bertrand Russell, Unpopular Essays

I'd hardly say that your two quotes are evidence of the collusion between the WHO and big pharma, that you state in the first paragraph. To have your assertions taken seriously, you need to cite specific evidence, not generic statements about human behaviour (both of which are indeed clearly true). You mention "Recent reports" -- could you elaborate?

(Edit: I don't think media hype about scenarios of doom, coupled with the population's clear desire to revel in that media hype implies anything much about the WHO or the pharmaceutical industry. That said, if big pharma can make a whole lot of coin out of it, they will. It is up to governments to take independent advice on where they spend their money. Doesn't matter what the product or sector, any vendor is going to try and sell you as much of their product as they can. That's capitalism. It is up to the buyer not to buy it. Don't get angry with Big Pharma, get angry with the thoroughly corrupt nature of government spending).

>164 Phlegethon99:

Following that logic we'd have massive internment camps for those carrying contagious diseases for which there isn't a vaccination. For Germany alone that would mean 2.5 million carriers of Hepatitis C, not to mention AIDS and tuberculosis. Obviously the protection of others is limited by basic human rights of those infected.

No one stated or implied anything of the kind! I've said it before and I'll say it again, the straw man argument is the lazy tool of those who know their own arguments are weak. Wanting to have a population that is as well vaccinated as possible *does not infer* locking those up those who are diseased in NAZI-esque style camps. Of the three diseases you mention, none of them have ever required require the incarceration of carriers, except in the small handful of cases where there has been deliberate and wilful spread of disease.

By mentioning incarceration camps, you were mixing a straw man and a reductio ad-Hitlerum. Double points.

I used the term "internment camp". Internment as a synonym for confinement, like in a psychiatric ward. A quarantine is used to separate and restrict the movement of persons; it is a 'state of enforced isolation'. Thus it is a variation of internment. The Nazi allusion was yours, thus you prove Godwin's law here. Nice try in Eristic dialectics, though.

Regarding the WHO not doing any independent research but almost exclusively relying on questiomable medical studies financed by the pharmaceutical industry a simple Google search will trigger a lot of hits. As this is LibraryThing

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

will give a rather general overview on the problem.

The particular report I referred to can be found here:

http://www.zdf.de/ZDFmediathek/beitrag/video/2265900/WHO-versagt-bei-Ebola#/beit...

It is in German, though. Your IP address may also not have access to German public TV.

>171 Phlegethon99:

I understand what "Internment" means. However, the term "Internment Camp" is used almost exclusively to refer to the Nazi and Japanese camps of Word War 2 (and I still think you were engaging in ad-hitlerum, but accept I could be wrong). However, forgetting that little diversion, your suggestion that a desire for herd vaccination implies internment camps for those with disease is complete tripe.

Your "Bad Pharma" article is a Wikipedia entry about a book (There is SO much wrong about citing that as evidence). That said, the infractions listed therein are all fairly well known (and somewhat obvious). But they don't imply that herd vaccination is a bad thing -- which was where I came into this, responding to your straw man.

Incidentally, the problems of regulatory oversight (particularly the revolving door between industry and regulator) exist in almost every field that is regulated. The US Nuclear Regulatory Commission is notorious, and we see the same problems in the financial industry. The behaviour of the Marketing side of things parallels the food industry. The bad science and statistical manipulation parallels pretty much any industry trying to peddle a product. Big business is ALL shady in some areas -- but it doesn't mean that some what they do is not useful. It also doesn't mean everyone involved in the industry is evil or greedy or not doing a good job.

I've met a handful of bad doctors, but the vast majority of doctors in the public health system are trying to do their best by their patients, based on the evidence they have seen throughout their careers, not just based on what the drug rep told them. Those good doctors all seem to think most vaccination is probably a good thing. Most doctors in the public health system aren't out to hurt people, funnily enough.

When I was a kid there were entire weeks, multiple weeks during the summers that I was not allowed outdoors because someone in the area came down with polio. The polio vaccine changed all that. I'll continue to receive vaccinations (smallpox was about it in 1950), because I was raised in a world without vaccines for most things. It was not a pretty place. I caught American measles which nearly killed me. It screwed up my ears pretty bad and left me a music lover of the first order, the first person people beg not to sing. I know that's minor, but not if you are me. I think part of this anti-vac stuff is caused by ignorant people who don't know what a world without vaccines looks like. I hope, for their children's sake they don't have to find out when one of their children dies from a preventable disease.

The case of Hepatitis C is very different, and that example obscures the issue in ebola and other infectious diseases where quarantine may be a reasonable measure. Quarantine always involves a balance between risk to the public and curtailment of individual rights when it is forced. It should be noted that most people who place others at risk by their proximity will voluntarily limit contact with others, and quarantine can be voluntary or involuntarily, ie it is not necessarily coercive.

For quarantine to be warranted, two conditions must be met: it must be justified and it must be effective. Justification means there must be demonstrable risk of harm and it must be the least restrictive viable means of risk abatement. In addition, quarantine functions under the principle that the restriction of the civil rights of the infectious individual is permissible because following a period of restricted activity, the quarantined individual will no longer be infectious. It applies to non-sick individuals who are at risk for developing a highly dangerous and communicable disease.

In the case of Hep C, there is no demonstrable risk of harm to the public by allowing people to go about their business as usual. They are also chronic carriers, and a period of isolation or quarantine will have no effective long-term benefit to the public. In Ebola, measles and many other diseases, quarantining the potentially infected will reduce the risk to the public.

Finally, the alternative to vaccination is not internment camps for the sick: it is the exposure of far more people to the sickness. We don't confine vaccine refusers despite the risk they represent to others.

Looking at it Hep C globally is a much bigger issue than Ebola and - at least in western Europe - also bigger than AIDS. The difference here is that Ebola symptoms appear much sooner and although fatality rates are lower death comes much quicker. This ultimately is an advantage though. When bubonic plague turned into pneumonic plague folks died much quicker and their being quarantined (in many cases being buried alive) was the harshest but most effective way of containment by mid-14th century standards. Hep C is often dormant, mostly fatal in the long run and seriously underdiagnosed. If you don't know you have Hep C you can spread it. If your GP does not test for it (not part of any standard tests when blood is drawn) and you're not a blood or organ donor you may be kind of a time bomb.

The problem we are facing today is that hardly anyone will accept the fact that even today some people will have to die. My problem with vaccinations - and the accompanying propaganda - is the pretense of safety. This is where things have changed. When I got my training as an army paramedic when the Cold War logic controlled what would have been ground zero in an ABC attack scenario we had to carry an atropine syringe 24/7. Back then we were told how pretty useless a 2 mg Atropin injection would have been in a real nerve gas attack, though. And this is exactly where I see the problem with vaccinations today. They have side effects and often - mostly in the case of the flu vaccines which do not even cover a majority of the several strains circulating through Europe - provide a false sense of security. Everyone seems to be happy when nobody reads the fine print. It is security theatre similar to some asinine regulations which are being sold to us as 'airport security'. It is this government paternalism I am opposed to. Tell them the full story and let people decide for themselves.

Anyone who is modestly educated about flu vaccines understands that the antigens in the vaccine is an educated guess about the next year's as-yet-unknown flu strains. Flu strains mutate wildly and unpredictably. No one should believe that the vaccine is a guarantee against flu. That is not a reason not to get the protection it offers; it's just a reason not place absolute confidence in it.

To disavow vaccines because they are imperfect reminds me of a favorite aphorism: The perfect is the enemy of the good.

>175 Phlegethon99:

The problem we are facing today is that hardly anyone will accept the fact that even today some people will have to die. My problem with vaccinations - and the accompanying propaganda - is the pretense of safety.

So you are saying people need to be OK with dying, even when it isn't actually necessary for them to do so? (I'll leave any overpopulation arguments out of this so as not to muddy the waters). What "prestense of safety" are you referring to? If a vaccination demonstrably reduces infection rates, it isn't a "pretense" of safety, it is an "increase" in safety. It isn't necessary for something to be 100% effective to still be worthwhile. For example, would you turn down a cancer treatment that had only a 50% chance of saving you, if the alternative (do nothing) was, say, 10% or 0%? It is probably also worth mentioning that people being preventably sick (or dying) incurs a cost to society as a whole and puts a huge drain on the public healthcare system.

This is where things have changed. When I got my training as an army paramedic when the Cold War logic controlled what would have been ground zero in an ABC attack scenario we had to carry an atropine syringe 24/7. Back then we were told how pretty useless a 2 mg Atropin injection would have been in a real nerve gas attack, though. And this is exactly where I see the problem with vaccinations today. They have side effects and often - mostly in the case of the flu vaccines which do not even cover a majority of the several strains circulating through Europe - provide a false sense of security.

I have genuinely never seen/heard anyone claim that the flu vaccine provides any kind of guarantee of protection. Due to the multiple strains and "in advance guesswork" as to which strains are likely to be prolific, that would be impossible. The side-effects of the flu vaccination (where there are any) tend to be fairly benign, such a short lasting fever (although the risk of even this is pretty low). People need to make their own minds up about whether they prefer the potential side-effect vs the benefit. In Australia (for example), the vaccination is only available for free to segments of the population that are considered "at risk". No one is forced to take it, and no one is told it will guarantee them safety. I personally haven't bothered, but if I was a healthcare worker or a different age demographic, I probably would.

Still, you say your problem is the "false sense of security". Presumably your issue with this is that people will feel so unbelievably secure that they don't bother washing their hands and practicing basic hygiene -- because that is about all you can do wrong in the case of flu.

Everyone seems to be happy when nobody reads the fine print.

Who is "Everyone"?

It is security theatre similar to some asinine regulations which are being sold to us as 'airport security'. It is this government paternalism I am opposed to. Tell them the full story and let people decide for themselves.

It is nothing at all like security theatre in airports. Vaccinations (and flu is probably one of the less important ones, to be honest) *demonstrably* prevent illness and death. Security theatre *arguably* does not achieve anything. I fail to see the link.

If you don't like being given the option to have a flu vaccination (and it is just an option, no one is forcing you) because of state paternalism, do you also object to the government paternalism that spends your taxes on providing Emergency Departments, Ambulances, etc. Or would you rather just try and figure that out for yourself when you get sick? The state is there to provide services that benefit the whole, and that would potentially be beyond the reach of an individual. Sure, sometimes it goes too far, but making vaccinations available and recommending that certain people avail themselves of them does not seem unreasonable use of taxes.

Roundup of newest ebola news in scientific journals:

http://www.sciencemag.org/site/extra/ebola/?utm_source=newssidebar&utm_mediu...

And a recent quote from the AD of the lab where I work:

“When I give my talks, the first question I get is ‘We have Ebola virus in the U.S. – what’s the most important thing to do?’ ” (Marshall) Bloom said. “And I say, ‘Get a flu shot.’ Because the initial symptoms of Ebola and influenza are exactly the same: High fever and muscle aches. If you can rule out the flu, you alleviate a strain on public health systems from false positives. And it’s astonishing that 10,000 people die in the United States from flu every year. It’s not as glamorous as the Ebola virus, but it’s certainly a big problem.”

>178 streamsong: Fantastic resource on current research and events, streamsong. Thank you. This outbreak really brings home the risks involved in scaling back support for biomedical research.

>164 Phlegethon99:
My grandfather survived a labor camp in either Germany and Poland, and then an internment camp in Italy. He did not survive long, but after he got to the US he was under the guardianship of my grandmother because he was a disease carrier (typhoid? typhus?) Certainly better than quarantine or "internment".

And I am in favor of compulsory immunizations. Lots of people these days are immunosuppressed. I was for about 18 months.

Would you rather have a vaccine or cool your heels in what is essentially a jail because you caught a preventable disease?

Cuba calling: what this small island can teach the world about disease control (Guardian)

Your link doesn't work, John. Hopefully it pointed out that the Cuban teams were trained by US personnel headed by local doctor George Risi, recently back from West Africa.

And that the US soldiers deployed aren't guys with guns, but engineers and construction workers building hospitals, as well as medics and doctors.

I haven't heard what the African countries are doing to help their neighbors out. Any links you can provide would be much appreciated.

>182 streamsong: Apologies - link now fixed (I hope!)

It doesn't mention him by name, but refers to "biosecurity experts from the United States".

Thanks - the grassroots approach is interesting.

I tried looking for the article you had linked to and found several of the sort 'Cuba sending doctors, US sending soldiers' which triggered my rant about the engineers and hospital builders. I apologize for my grumpiness.

#178 streamsong I never get the flu vax. I am not in a high risk group and I feel that like my muscles and my brain, my immune system needs exercise. Reading the last bit of your post made me decide that this year I will go ahead and get the shot.

"“When I give my talks, the first question I get is ‘We have Ebola virus in the U.S. – what’s the most important thing to do?’ ” (Marshall) Bloom said. “And I say, ‘Get a flu shot.’ Because the initial symptoms of Ebola and influenza are exactly the same: High fever and muscle aches. If you can rule out the flu, you alleviate a strain on public health systems from false positives. And it’s astonishing that 10,000 people die in the United States from flu every year. It’s not as glamorous as the Ebola virus, but it’s certainly a big problem.”"

Except that the you can still get a different strain of flu than the ones in the vaccine and there are also a myriad of other bugs that present with flu-like symptoms, so getting the flu shot won't really help to alleviate the false positives very much.

>186 jjwilson61: "very much" or not we don't know. As with everything else in health, nothing is completely certain. It certainly will reduce some confusion.

Thinking about it a bit more, it depends on your point of view. From an individual or their doctors point of view a flu shot doesn't change much since if you come down with a fever and some sniffles, ebola is probably not the first thing you'd expect. But from the point of view of the health system as a whole, the fewer people who get flu-like symptoms due to the flu the easier it will be to spot the ones that are really ebola.

Fears that Ebola crisis will set back malaria fight (BBC)

Resolved: Nurse Kaci Hickox should respect governmental quarantine requests.

UN chief defends returning Ebola aid workers

UN chief Ban Ki-moon has said discrimination against aid workers who return home from the Ebola crisis in West Africa is "unacceptable". Strict quarantine rules are hampering aid efforts when more health workers are needed in order to deal with the crisis...

Charity MSF warns US on quarantine

The medical charity Doctors Without Borders has warned some mandatory US state Ebola quarantine measures are having a "chilling effect" on its work...

Both from BBC

Well, the poll may be obsolete, at least as regards Ms. Hickox. The Maine court has taken a stand based on science, not panic, and has cast down the quarantine order as not based on rational grounds. "She has no symptoms and therefore is not infectious."

http://www.nytimes.com/2014/11/01/us/ebola-maine-nurse-kaci-hickox.html?_r=0

>192 stellarexplorer:

Doesn't necessarily mean the judge is correct. We had a nurse come back to Australia and self-quarantine at home. She ended up going into hospital after developing an elevated temperature. She tested negative, and all was well. However, if the situation had been reversed (and she had been positive), the use of home quarantine would have been fundamental. It is probably overkill, but I don't have a problem with home quarantine at this stage. It is for a relatively short period and the potential advantages outweigh the short-term disadvantages.

>193 Studedoo: Isn't the judge right if the medical science is right? The medical science says you can only convey the disease once you are symptomatic. There is no reason to limit the activity of individuals who are not symptomatic. Monitoring for symptoms, usually fever initially, allows for isolation before there is risk to others.

In your case, the nurse went to the hospital when she developed a fever. If she had the disease, this would have been the safe and appropriate thing to do. Prior to the fever, and even later before the onset of high fever, vomiting, diarrhea, etc, she would not have been a threat to anyone. Home quarantine would not have helped or been needed.

I understand the fear; it's a horrible illness. But the policy should be based on medical knowledge, not fear. Unnecessary restrictions promote fear, as these measure convey to the public that there is a danger when there is not.

Are we asking the wrong questions about Ebola? (BBC)

Studies of viral mutation during the west African Ebola outbreak suggests adaptation to the human host, affording the virus easier entry into human cells:

http://www.nytimes.com/2016/11/04/science/ebola-evolution-african-epidemic.html

I love the conclusion: "But it was also possible these changes didn’t mean anything at all."

It really is disturbing, though, just how fast viruses can mutate. But if Ebola becomes even more deadly, wouldn't it also become more self-limiting, as it kills off its hosts more efficiently before they can pass it on to as many new victims?

Yes, that often happens, but an increase in ease of spread, if of sufficient magnitude, might compensate for that. The other possibility seen in other viruses could be additional adaptation that retains the increased ease of entering cells but lowers the lethality. Then you have a less deadly but more contagious virus.