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Comment by danieltillett | Hacker News Reader

What I want to know is why anyone think this outbreak is going to be brought under controls anytime soon. Looking at the size of the outbreak and with with the R0 well over 2 since August there is nothing that makes me think it is not going to hit the predicted 1.5 million infections by January. Then what?

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I think we will see an infected person make it out of West Africa at a rate of one per month to one per week. We have one case in Dallas and a case earlier this summer in Nigeria. Both were contained but as the number of infected people goes up in West Africa the pressure to leave is going to be greater.

On July 20 Patrick Sawyer entered Nigeria in an infected state and infected at least 20 people, 8 of whom died. See http://www.washingtonpost.com/news/to-your-health/wp/2014/09...

On Sept 20 Thomas Duncan arrived in Dallas, and was subsequently diagnosed with Ebola. At least 15 people are at high risk for contracting the disease and another 100 had some risk of exposure.

If you take two cases in two months it's not an unreasonable estimate that at least one person a month will escape the quarantine protocols. The protocols are likely to get better but the number of infected people trying to leave is likely to be substantially higher in each month going forward for at least three to six months. If the numbers hit the upper end the current CDC estimate (1.5 million infected) then it's likely the "escape rate" will be much higher, hence an estimate of one per week.

>Both were contained but as the number of infected people goes up in West Africa the pressure to leave is going to be greater.

It sure is. The problem is there are already 10,000s of people in Liberia and surrounding countries that are infected right now. How are the surrounding country going to keep out the ten to hundreds of thousands of people fleeing if the case numbers reach 1.5 million since the borders between these countries are completely porous? We need to get really serious about controlling this outbreak (full scale mobilisation) and not just hope everything is going to turn out OK.

Right now the protocols aren't nearly strong enough, hopefully we will close air travel for anybody who has been in west africa, which should prevent people from escaping.

Right now the excuse is that they can't infect anybody while one the flights, but that is not really the concern - the concern is that they end up infecting others after they land.

" hopefully we will close air travel for anybody who has been in west africa" - CDC advises against this. It does more harm than good, and makes it difficult for supplies, and medical staff to travel in/out of the area. Also, once you put in travel restrictions, you enter an adversarial rather than cooperative phase, and people start to fight you, rather than work with you.

http://www.politico.com/story/2014/10/ebola-us-border-111581...

What I don't understand, is why don't we enhance screening for anyone who has travelled recently in West Africa? I get pulled into secondary every time I note I've visited a "Farm" - you would think the impact on the system wouldn't be that great to just ask a few questions (and take a temperature) of people who've visited ebola impacted regions.

I read the story and they don't get the problem - the problem isn't saving people in Africa, but making sure the disease doesn't spread via people who travel on airplanes.

Speaking from a US centric view, the only way to protect America is to control the disease at it's source. If you prevent air travel, you make it difficult, if not possible to control the disease.

By putting on travel restrictions, you will lose control of the disease and jeopardize the United States.

So, in effect, if you wanted to spread the disease and put the United States in grave danger, you would put travel restrictions in place.

I would say/hope closing air travel is not necessary - what is necessary is strict quarantine procedures for anyone who travels via an infected country.

The problem with both of these approaches, however, is that if that is the response of the international community, then countries will avoid reporting Ebola cases until it is unavoidable. Perhaps they already are doing this.

Containment is unlikely to work all that well when Ebola reaches millions of victims, imho. The panic that will be happening at that moment will also ensure that every one of hundreds of millions of people living in Africa (or any other seriously infected continent) will be doing their best to figure out a way to get out. Many inevitably will.

It might burn itself out, which is as bad as it sounds - it will kill so many people there will be no one left to infect.

There will probably be mandatory quarantine as well, and everyone inside the zone will either die or become immune.

Or we might figure out how to manufacture the 2 or 3 known cures in great enough quantity.

Or a vaccine - seems to me this should not be a huge challenge to develop a vaccine for because (unlike HIV) people become immune after exposure, which is half the battle already.

A vaccine is defiantly the way to go, but do we have the infrastructure (or will) to produce a vaccine in the quantities required? The progress towards a vaccine seems to be rather lackadaisical given the scale of the problem.

I bet we will see things speeding up as we get more "patient zero" episodes in developed countries, putting pressure on Western governments who will, in turn, pressure the pharmaceutical industry.

I'd go out on a limb and say that this would have happened already, if it weren't for the fact that the "avian flu" fiasco / profiteering is still very fresh in people's minds.

The problem is you can’t just click your fingers and suddenly have a new vaccine on demand. We have yet to have even stage 1 testing of any candidate vaccine for Ebola. Once we have a vaccine we need to produce millions of doses and then distribute it in countries with no functioning health infrastructure. And we need to get all this done in a couple of months!

There is already a functional system for distributing basic vaccines across the world, reaching 80% of babies.

It would not be difficult to distribute the vaccine, and we don't have to get everyone - we just have to get the viral rate below 1.

This system was not set up from scratch in a couple of months. I think you are underestimating the difficult of distributing a vaccine we don't have in west Africa once the case numbers there reaches into the millions.

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