So, every few years, there's some kind of epidemic, and people panic.
"OMG it aer teh new black death!!1!"
Riiiiiiiight.
One disease tends to get the lion's share of the serious scares, because it's rare, extremely deadly, and frankly really scary, mostly because we know very very little about it.
Thaaaat would be Ebola.
The Ebola virus is unique in a lot of ways. The virus particle itself is odd; it has a distinct shape that makes it recognizable on sight, which is, well, highly unusual, because most viruses look pretty similar in physical structure.
It's unique because we have, frankly, no frigging idea where it comes from. We know monkeys and fruit bats can act as carriers, and we know it's transmissible to humans, but if we knew what monkeys had it, we'd kill them all and then boom! No more Ebola. We can't actually do that, because *incomprehensible noises of ignorance, wide-spread hands, and an innocent face.*
It's also unique because it's one of the three or four most deadly and incurable diseases (mad cow and other prions, hemorrhagic smallpox, inhalational anthrax, and Ebola) known to have occurred in nature. There are deadlier viruses in existence, but those by and large have been engineered and exist only in laboratories. Ebola, on the other hand, kills on average - and I want to emphasize that word "average" for reasons that will become evident - 50% of the people that contract it.
Why is that relevant? Untreated, it goes to around 85-90%.
For relevance, if you discount the diseases (of which there are several) which are equivalently deadly but curable, or at least with more effective treatments than "here's some water, don't die, ok?" then you're left with mad cow and its relatives at 100% case fatality rate (CFR,) hemorrhagic smallpox at 95%, inhalational anthrax at 93%, Ebola at 83-90%, and well... Compare that to, say, pneumonic plague at 50%, malaria at 20%, the Spanish flu at 2.5%...
Yeah, Ebola is a relative badass.
Well, no worries for us, right? The good ol' USA has all the medical care required by law and even more.
...Um, about that...
See, the trick is that there is no effective "treatment" for Ebola. The only thing doctors can do is keep you hydrated and isolated from everyone else. And doing so is ridiculously resource-intensive, requiring a hospital bed (from which we are enthusiastically kicking patients the day after major surgery. Good thing there's no shortage,) medical staff to watch and monitor you, a staggering quantity of intravenous fluids, and safe, hygienic disposal of the inevitable tidal flood of medical waste coming from you, impregnated with simply trillions of infectious viruses.
So, Ebola kills you because your body goes into catastrophic organ failure. It's a hemorrhagic fever, which means (effectively) that it makes your circulatory system break down and leak from simply everywhere, while raising your body temperature until your systems simply stop working. The blood that leaks out is hugely contagious, as this is the virus' primary means of transmission.
Ebola - at this time, and thankfully - isn't airborne, by which I mean to say you can't get infected just by standing ten feet from someone who has it.
It is possible, however, to spread by aerosol, which is slightly different and relevant for reasons I will make clear shortly.
Incubation can take as long as three weeks, which means you can be infected and totally oblivious until holy shit, Ebola, almost a month later. For bonus fun points, men who survive the illness can carry the virus in their semen for as long as an additional seven weeks. (So, ladies, steer clear of those pesky hot-looking Ebola survivors, because even if they have dayum they also have OMG I'M MELTING... MELTINNNNGGGGGGG.)
So, the WHO happily informs you that people exposed to Ebola aren't contagious until they display symptoms.
Yaaaaaaaaaaaayyyyyy waaaait, which symptoms?
I mean, if they weren't contagious until they were staggering drunkenly and leaking blood from the surface of their skin, NOBODY would go near them and it wouldn't even be a thing. "Holy shit, dude, what's wrong with you? No, get the hell away from me."
So which symptoms mark the onset of the contagious stage?
Wellll...
Look at that list again.
Fever.
Muscle pain.
Headache.
Sore throat.
Errrr... So, the common cold?
It's just that a cold lingers and annoys you, and then goes away. Ebola makes you start vomiting blood, and then you die.
So, you're perfectly safe, as long as you stay away from everyone who shows symptoms of Ebola, which you can't actually tell apart from any other minor ailment until it's way, way too fucking late.
A relevant fact in the veracity of which we're getting an object lesson right now.
Meet Thomas Eric Duncan. Mr. Duncan is from Liberia, where you may have noticed in the news they are having an outbreak of - and I know this comes as a surprise given the article so far - Ebola.
Mr. Duncan holds the distinction of being the United States' "patient zero."
Now, we've had people in the States with Ebola before, specifically several of the doctors and nurses who have been helping out in Liberia.
Those people are a little different from Mr. Duncan, for reasons I will explain directly, before embarking on the previously-offset explanations which are, frankly, becoming increasingly overdue.
See, they knew they were infected before coming back to the States.
So, we were ready. They were transported in quarantine, to quarantine, in a secure facility prepared for their specific arrival and set up for treatment.
Awesome!
Mr. Duncan, however, helped a sick pregnant woman in the weeks before traveling; a woman who later died. He was symptomatic before he got on the plane to the States, but he filled out a form when exiting Liberia in which he promised he really, really wasn't sick, hadn't had any contact with sick people, didn't know what all the fuss was about, and no, this sore throat is because the dry air in the airport made me cough.
Or something.
Liberia - and you may find this satisfying rather than ridiculous, based on what happened next - is considering suing him for falsifying his exit documents, in large part because...
Well, at best he's killed a bunch of people. "At worst" is something I don't really want to talk about.
So, Mr. Duncan flew. In a plane. A plane in which he was symptomatic, and therefore contagious; and this is the first of the delayed explanations, that being the relevance of the distinction between "airborne" and "aerosol."
See, a plane is an enclosed environment. Particularly so, since the lack of exterior air pressure means that the cabin air is recycled.
An "airborne" virus can survive on its own in the air; people contract it after being within yards of infected people, like some kind of sinister sorcery. Ebola can't do that.
An "aerosol," however, is when, for example, you clear your throat, and the microscopic water droplets you expel in doing so contain, surprise, Ebola! And then you die.
Ebola can totally do that.
Which is super awesome when the contagious person with a sore throat is enclosed in a tiny space for 12 hours with hundreds of other people all breathing in his air.
You might think the airlines would be outright panicking right now...
...But I'm getting ahead of myself. (Spoiler; they totally are.)
So, Mr. Duncan decided to travel. And did. Now in context, after the doctors had been brought to the States, the CDC rushed to assure everyone that this wasn't a huge, stupid risk, because now that there was "an awareness" of Ebola and its risks, hospitals around the country were set up to recognize, isolate, and treat it, to reduce if not outright eliminate the danger.
So, no worries, it was totally ok for the first - note that word - hospital Mr. Duncan visited in Dallas to tell him it was a cold, pat him on the head, and send him on his merry way with some antibiotics. Even after he told them he had specifically been in the country that specifically has an Ebola outbreak they're supposed to be specifically looking for. Because we're prepared to identify the disease.
We're ready.
We're also caught flat-footed when he vomits blood and collapses a couple of days later, and then goes back to the hospital, where it's "Surprise, Ebola!"
So, let me digress a bit before I scare the shit out of you.
See, earlier, I was talking about how medical treatment reduces mortality significantly, and how it's a good thing there's no shortage of medical care in the USA.
For some values of the phrase, "no shortage."
There are two factors that are relevant to that phrase.
See, each individual under treatment represents a staggering drain on the resources of an individual hospital. Ebola isn't cheap, or easy, to treat, and each person suffering from it is a massive use of hospital staff, supplies, and care. This is why the African outbreaks typically are so deadly; the healthcare system in Africa by and large deserves the finger quotes you saw in your head when I said that, and is almost immediately overwhelmed.
Well, good thing this is the USA.
We can handle dozens of patients with Ebola, all at once!
So it's a good thing Mr. Duncan may have infected as many as 400 people.
Secondly, we have healthcare insurance in this country, but most people are like me - there's a deductible. Go to the doctor, it can cost you. A minor cold, to most lower-income people, is not doctor-worthy simply because they can't pay for it; they have to prioritize their trips to see the doctor according to the severity of their illness, which means that when your common cold turns into "Surprise, Ebola!" it's too late and you're fucked, and so is everyone you've coughed on in the days prior to your very own vomit collapse.
Awesome! Glad, again, that's only maybe 400 people.
Because - and here's the fun part - even if the government and the airline can notify all of those people, and they all come in, and only a few of them actually have it, by the time it's detectable, they will have been symptomatic, and thus contagious, for a while.
During which time they could potentially have infected everyone they came in contact with.
Which means - assuming that the average incubation period is roughly 10 days, 50% of the people he infected will be contagious hmmmmmm, let's see, he became infectious the 24th, today's the 2nd, so... Saturday?
Want to place bets the airline can't catch them all?
I really, really hope they can.
The Dallas County HHS Department pulled three schoolkids out of Richardson Elementary today because they are thought to have been in contact with Mr. Duncan while he was symptomatic.
Want to place bets he talked to, and coughed on, someone else?
Some rando is in the hospital being tested for it in Hawaii right now, because planes. And readiness.
An NBC correspondent in Liberia is infected, as well. Because despite precautions... "Surprise, Ebola!"
So, here's the CDC.
We're ready.
Then, Mr. Duncan shows; he was maybe in contact with five schoolkids.
Errr... Maybe 12 to 18 people.
Well... 80. 80 people, that's it, that's all.
Good to know it was only 400.
Good to know we're ready.
Good to know we have a plan for disposing of that pesky medical waste, like Mr. Duncan's bloody vomit.
Your government is in charge and prepared, citizen.
I wonder what will happen when they have this much trouble dealing with each of several hundred people at once?
Because as I recall saying, once the hospitals get swamped, things go south pretty fast.
This might be a better time to wear the plague masks than during the swine flu scare, guys.
