Friday, October 17, 2014

Weekend Links: The Don't Panic Edition

One of my more stereotypically geeky attributes is that I love Douglas Adam's Hitchhiker's Guide to the Galaxy series. I even programmed my very first cell phone (one of those StarTAC flip phones) to say "Don't Panic" on its tiny little screen when I first opened it up.

The "Don't Panic" line, for those who don't know the series, comes from the guide itself, which has the words printed "in large, friendly letters" on its cover.

I put the phrase on my phone because I, like most people, can get myself worked up over things, and it was actually useful to have my phone remind me to calm the eff down.

Which is all to say that I am very sympathetic to the people who are freaking out over Ebola right now, but think it would be better if we all heeded the advice on the cover of the Hitchhiker's Guide to the Galaxy and calmed down.

I wasn't going to write a post about this, because I am not a virologist or an epidemiologist or really in any way the sort of scientist whose expertise gives her reason to write about this outbreak. But then I came across a post from another scientist who is also not a virologist, epidemiologist, or even, apparently, someone who has bothered to read some basic science about Ebola and apply some common logic to the facts we have. I will not link to that post because it is bad, and full of things that are not true. But it made me want to write this post, just to link to some resources that are more useful, and to say: a scientist speaking outside his or her own realm of expertise is no more believable than anyone else blathering on the internet. That includes me. Check the sources and make sure the information tracks back to someone who is speaking within their realm of expertise.

What little specialized knowledge I have about Ebola comes from having once worked on a biodefense project, back in the early 2000s when those projects were all the rage. I was involved in the database design (since that is my area of expertise), but I also helped explain the biology to a lot of people whose backgrounds were more on the defense part of biodefense. As part of that project, I read a lot of papers about a lot of infectious diseases and for awhile, I was on the mailing list that sent out notices about reportable diseases. I learned a lot about Listeria from those notices, which perhaps made me a little more paranoid than strictly necessary about that particular risk during my pregnancies.

It was a fascinating project for a lot of reasons, but one of the things that stuck with me the most was the glimpse it gave me into the inner workings of government. Every few months or so, we would all fly to DC to have a meeting with the people assigned to this project from all the various governmental agencies- CDC, Homeland Security, the State department, various branches of the military, the Post Office (remember the Anthrax attacks?), and on and on. There was even a guy who we were pretty sure was there representing some part of the intelligence community, although officially he was there in some other capacity. His knowledge and his official capacity were greatly mismatched- i.e., he knew far too much about far too many obscure diseases for the title he supposedly held.

Anyway, at the second or third such meeting, it dawned on me that my entire project was a bit of a cover. Oh, we would turn in a fairly decent work product and perhaps the system we were working to specify would even eventually get built, but the real benefit of the project was that it forced all of the government people from all those different branches to sit in a room and talk to each other. This was good because it made them learn how their counterparts in other branches saw similar issues and gave them an inkling of the different constraints everyone operated under. It was also good because it meant that they developed some personal relationships, which would come in handy if there ever was really a crisis and they needed to get something through a bunch of inter-departmental bureaucracy quickly.

I came away from the project impressed with the intelligence and diligence of the governmental officials I'd met (with one notable exception), and absolutely in awe of the bureaucracy under which they had to try to get things done.

That is a very long preamble to my first link, which is a post from Ezra Klein about why a bureaucrat with a reputation for being good at navigating through inter-departmental morasses is actually a really great pick for an Ebola czar.

Assuming that not much has changed in government since my brief stint interacting with it, I'd guess that we have plenty of really smart people who know what we need to do, and what we want the czar to do is help them get it done. The best response to the Ebola outbreak undoubtedly will require involvement from a wide range of agencies across several departments- not to mention various state and local health departments. I know that a lot of people are upset that the Ebola czar is not someone with a scientific or medical background, but personally, I'm glad Obama seems to have picked someone who knows how to get things done in our bureaucracy.

OK, on to some information about the disease itself.

This article from USA Today provides a good overview of why the people most at risk of getting Ebola are the ones treating late-stage patients.

This also matches what we saw happen in Dallas: no one who was in the apartment with Mr. Duncan between his first and second trips to the ER has gotten sick. None of the doctors who treated Mr. Duncan have so far gotten sick. The people who got sick are the nurses, who were the ones getting exposed to large amounts of infected fluids. Really, if you read no other article I link to here, read the USA Today one above to get an understanding for the difference between a patient in the early days of symptoms and a late stage patient.

If you want to really dig into what we know about how Ebola is transmitted, this post from some Australian virologists is full of information.

One of the egregiously false statements in the post that set off this rant/link list was that people infected with Ebola almost always die. That is just not true. Even in the current outbreak in West Africa, mortality is somewhere between 50 and 70%. That is still a very high percentage, but it is not "almost always." Also, good "supportive care" (e.g., rehydration- Ebola patients lose a lot of fluids) is known to improve survival. One of the challenges in West Africa is the lack of hospital beds and trained personnel to care for patients and provide that supportive care. That is not a problem in developed nations like the US. Here in the US, we have lost one patient, had four recover completely, and have another two who seem to be doing well under treatment (update: there is one more patient being treated at Emory: a WHO doctor flown in from Sierra Leone. I don't know anything about his condition). I came across this Megan McArdle article, which has a quote from Paul Farmer (a well-known and well-respected figure in public health in the developing world) stating that he thinks the mortality rate in a developed country is more likely to be about 10%.  I've also seen estimates of 20% mortality with proper supportive care, but I can't find a link for that right now. Sadly, we don't have any actual data on this because the world has never cared enough about an Ebola outbreak to send sufficient resources to the effected areas to provide good supportive care to all of the people who get sick.

That McArdle article is a bit alarmist about the risk of an Ebola patient using a public bathroom- Emory tested surfaces in the rooms of the Ebola patients it treated and found no contamination. The article describing this testing is quite clinical (but worth a read!) so I'll extract the key phrase:

"Environmental testing in the patient rooms had no detection of viral RNA and included many high touch surfaces such as bed rails and surfaces in the bathroom."

The evidence we have indicates that this virus- like most viruses- does not live long on surfaces. McArdle is a smart journalist with a lot of experience covering health issues. I am disappointed she didn't do better in this regard.

The McArdle article does a good job, however, of explaining why the people in the know are focusing more on West Africa than here. The best way to keep the US safe isn't to issue travel bans- we know that does not really work. It is to help the West African countries contain their outbreaks, which is why the CDC has people deployed there and why we have our armed forces there building treatment centers.

My statement about the weaknesses of the McArdle article leads to my final point in this post: a lot of what you read in the media is unnecessarily alarmist. McArdle's bit about the bathroom is mild compared to the nonsense that has been spewed by Fox and CNN.

In fact, Media Matters found that the more Ebola coverage you watch, the less you know.

The case of "clipboard man" is another example of some people in the media not taking the time to get the facts before they speculate and freak out... and freak a bunch of other people out, too.

In closing, I fully understand why people are a little freaked out about Ebola, but the reality here is a lot less scary than many of the media reports will lead you to believe. I think hospital nurses have every right to be screaming at their management for better gear and training. The rest of us should take the advice of the Hitchhiker's Guide. Don't Panic.

But maybe donate to Doctors without Borders or UNICEF, who are on the ground in West Africa trying to help the people who are really at risk.


  1. Anonymous7:12 PM

    Great post!

  2. Zenmoo9:32 PM

    Working in the government/semi-government space, I really appreciate the value of policy/political people who have good networks and can get stuff done. I've just watched a hilarious comedy series called Utopia which is set in a 'nation building authority ' doing infrastructure projects. The guy running the agency is perpetually harassed by politicians who want to launch stuff and media people. As I said to my Dad (who I was watching it with) it's funny because it's true. If you google 'utopia working dog YouTube ' you can see trailers. It's definitely worth watching .

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