The Ineffectiveness of Sealing the Border Against Ebola (and Other Viruses)

Good analysis.

Posted on October 24, 2014 at 12:31 PM • 44 Comments

Comments

AnuraOctober 24, 2014 1:01 PM

The whole thing is being blown out of proportion anyway. Containing Ebola is an issue of education and procedures, and the main failure in Sierra Leone is a distrust of authority which makes it hard to get the job done. Nigeria, on the other hand had no issue preventing a serious outbreak in their country, despite people entering the country with the disease.

The fear-mongering in the media is just sick, but not unexpected.

HowardOctober 24, 2014 1:44 PM

Education + a community of trust ... no substitute. It also helps to have as small of a tradition of corruption as is possible, which goes along with the previous two values.

That's a big part of why the Firestone Rubber Company has been so successful, with imperfect equipment re-purposed to the situation, in keeping Ebola at bay:

http://www.npr.org/blogs/goatsandsoda/2014/10/06/354054915/firestone-did-what-governments-have-not-stopped-ebola-in-its-tracks/

Regarding the fear-mongering, I agree it's not unexpected. The media like ratings, plus there's the well-worn saying "Never let a crisis go to waste; you'll be able to do things and acquire new powers you'd never get away with in normal times." I don't remember who said it ... rahm emanuel, saul alinsky, barry soetoro ... one of those.

Gerard van VoorenOctober 24, 2014 1:49 PM

Ebola.

I am not a doctor so I could and probably am wrong. I am also not questioning Ebola. It is a terrible and deadly virus.

But...

It also has all the signs of yet another "big scare" with all the extraordinary countermeasures taken place. The (not so funny) thing however is that Cuba did send the most doctors to Africa to actually deal with it on the spot...

Each time I see this kind of news, I wonder what racket is being cooked.

parrotOctober 24, 2014 1:57 PM

@Anura

Distrust in authority is precisely why I'm afraid of Ebola. The United States has done some horrible things to innocent and even unwitting people (see Guatemala syphilis experiments for an example). The United States has lied through its teeth about its mistakes, about its ignorance, about its negligence, and about its outright malevolence--to be proven wrong later. So, when the CDC comes out and says Ebola is not airborne or that it's doing the best it can to prevent the disease, I'm not taking them at their word.

Granted, I'm not going to run around like a chicken with its head cut off either. I just re-audit my emergency supplies, make sure I'm up to date on current news, and take every day cautiously.

However, I could see how this distrust in authority that the government sows can cause people to be extremely fearful and act irrationally. And therefore I can see why the media plays it up.

BJPOctober 24, 2014 2:21 PM

@Gerard van Vooren

What countermeasures?

At least in the US we've done essentially nothing. Unlike so many manufactured crises where we had pre-written laws ready to go at a moment's notice when nobody will read them, we seem to have nothing at the ready right now. Our response seems so incompetent, disorganized and anarchic that it gives me more a feeling of the powers that be getting caught off guard and hoping it will just simmer quietly until we finish our election in a week and a half.

We've invoked no extraordinary quarantine measures, not even any half-hearted ones. We've mandated no new immunizations, we've gone out of our way not to limit travel, and the establishment media response seems much more "don't worry, be happy" than does the response to "we should have panicked a decade ago" articles about (for example) carbon emissions.

keinerOctober 24, 2014 2:50 PM

Sorry, but the first argument in the article is poor nonsense, as the flu is already in the country, while Ebola is (mostly) not. This has nothing to do with science, it's Voodoo. And deaths from flu have to do with the seasonal starin, not with the speed of spreading.

This is at the best disinformtion...

Gerard van VoorenOctober 24, 2014 2:50 PM

@ BJP

Elections. I am from the Netherlands so I wasn't aware of that.

All I have to say is don't worry. After the elections it will probably dissolve like you said. Keep me informed about who won.

Looking from a global threat, I don't think Ebola isn't the one. It is, pick one, over population, smoking, alcohol, famine, the environment (and the three western designed: the nukes, global warming and getting fat). Note that I don't mention war.

Gerard van VoorenOctober 24, 2014 2:53 PM

Typo.

It should be: "Looking from a global threat, I don't think Ebola is the one."

keinerOctober 24, 2014 2:54 PM

Arguent 3 poor nonsense, too, as Westafrice is one of the riches regions, thanks to oil, gold, coltan etc. But its also the most corrupt region world-wide with money and healthcare available for only a handful of families.

Stopping all air travel would successfully stop the chain of infection. Everything else is a lie.

Frank Ch. EiglerOctober 24, 2014 2:56 PM

Surely there exists higher quality analysis.

e.g., "Closing borders would be a disaster" is justified by red herrings (closing borders would not guarantee our safety) then misdirection (closing borders might be a disaster -to west africa-, not to us).

etc.

SkepticalOctober 24, 2014 3:34 PM


The article makes three arguments:

(1) Closing borders is ineffective because people would travel anyway;
(2) Closing borders is ineffective because it renders disease outbreak in West Africa worse by impeding flow of assistance;
(3) Closing borders would devastate West Africa's economies and societies.

The first two arguments aren't very persuasive.

How many people buying airline tickets from West Africa are going to smuggle themselves into the US if temporarily banned from flying here? I'd guess a pretty low number.

How hard is it for doctors and aid workers to coordinate with the military and/or DHS for flights into an area when ordinary civilian air travel is restricted? It might be more difficult, but it's been done and there's no reason to suppose it couldn't be done here.

The third argument is persuasive, but it's a humanitarian argument against closing borders, not an argument that closing borders would fail to achieve additional safety.

I'd hasten to add that I'm not in the least worried about ebola, and I don't think closing the borders is necessary or advisable.

vas pupOctober 24, 2014 3:38 PM

Sorry, but disagree for the following reasons:
- as security interested bloggers, you know that there is no 100% security at all regardless of the nature of the threat, but taking measures to decrease 'window of opportunity' of the threat will decrease the probability of harm (number of security breach cases as well as consequences in the case of security breach).
Conclusion: less potential infected people let in less cases inside US, again not 100% - no such case at all.
- travel ban + visa suspension from infected countries.
In this (not so often) case Republicans are on the side of reason and logic. It will prevent bypassing travel ban by travelling through other countries, not directly to US.

-quarantine centralized facility in US should be set up by DoD ASAP at remote military base for prospective of return military guys being sent to West Africa. That is measure towards prevention and shrink 'window of opportunity' for virus spread. Ebola should be real test to all security preparedness to fight biological threats (by terrorist or foreign agents).

Last, but not least, many times on this blog it was stated that people not only to be secure (objective risks) but feel secure (psychological risk).
Politicians (election coming in particular) should address both, and travel restrictions works both ends.

Gajma DOctober 24, 2014 3:56 PM

It sounds like a straw man arguments to me. Rather than address the actual concerns and propositions (like quarantine upon reentry), the authors argue about sending aid workers TO the affected countries and against theatrical airport screenings.

Additionally, the bold faced statement "The best way to protect Americans is by protecting West Africans" is a ludicrous sound-bite, perhaps the product of some political focus group. No, the best way to protect Americans is to actually protect Americans in America from exposure and to help the African countries contain infection at the source at the same time.

How many times do security experts argue for layered security? Why, when threatened with epidemic, would anyone argue for single point, all eggs in one basket security?

ParallelPortOctober 24, 2014 4:05 PM

There's something about claiming it's all blown out of proportion, and "What me? Worry?" that is exceedingly arrogant. If you knew what the hell you were talking about you would have predicted the outbreak. You get your news from the same place as everyone else super genius.

AdjuvantOctober 24, 2014 4:18 PM

Regarding Ebola, from a layperson who reads:

1. At this juncture, I see no reason to question the official line that worries of significant outbreaks in countries with functioning public health systems are misplaced.

2a. Ebola is not likely to go airborne, at least not in the popularly-understood sense. Read this for a brief explanation of why.

2b. It does, however, have the potential to be droplet-borne. See this from Reuters for the distinction.

3a. A complication: perhaps the hard distinction made in 2a and 2b is a false one, and we are looking at something more closely resembling a spectrum of aerosol transmissibility. Here is an attempt to overturn the 2a/2b model in a recommendations from U of MN CIDRAP: via ZeroHedge.

Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data.... The current paradigm also assumes that only "small" particles (less than 5 micrometers [mcm]) can be inhaled and deposited in the respiratory tract. This is not true. Particles as large as 100 mcm (and perhaps even larger) can be inhaled into the mouth and nose. Larger particles are deposited in the nasal passages, pharynx, and upper regions of the lungs, while smaller particles are more likely to deposit in the lower, alveolar regions. And for many pathogens, infection is possible regardless of the particle size or deposition site.It's time to abandon the old paradigm of three mutually exclusive transmission routes for a new one that considers the full range of particle sizes both near and far from a source. In addition, we need to factor in other important features of infectivity.... We recommend using "aerosol transmissible" rather than the outmoded terms "droplet" or "airborne" to describe pathogens that can transmit disease via infectious particles suspended in air.

To my layman's eyes, their recommendations look to be made out of an abundance of caution and are probably not unreasonable protocol for directly-exposed healthcare workers. Of course, the ever-cynical ZH editors sum up certain other implications succinctly: "And now the search for the next LAKE, i.e., a public company maker of powered air-purifying respirator (PAPR), begins."

3b. Nonetheless: CIDRAP's recommendations are specifically directed at high-risk healthcare workers, not the general public. Panic would be foolish.


Sancho_POctober 24, 2014 4:27 PM

It’s all about encryption here, so when “0” was to encrypt now it’s “1” :

“Bad story / essay / analysis” ==> “Good story / essay / analysis”

... No, the encryption point is nonsense.
Bruce means “Good story to discuss, let me read why you don’t like it” ;-)

I don’t like it because an outbreak in densely populated areas would be fatal.
Hygienic standards are not sufficient to contain the disease.
Stop of all travel activities would be inevitable, with unpredictable consequences.
Let's face problems, not ignore them.

Spike "Oops" BowmanOctober 24, 2014 4:51 PM

So, USAMRIID seems to have a little trouble dotting i's and crossing t's. Big deal. They're busy keeping you safe. Silly Germans, fretting that critical dual-use goods might somehow fall into the hands of the nasty old lone mad scientists who gave ATCC strain 14578 to Saddam Hussein. They retired years ago. Nowadays, nobody gives those ebola genomes a thought. The military will protect you, we've got everything under contr ... .

AdjuvantOctober 24, 2014 5:24 PM

Having now actually read the article:

@Skeptical To your assessment of the three arguments,

1. How many people buying airline tickets from West Africa are going to smuggle themselves into the US if temporarily banned from flying here? I'd guess a pretty low number.
a. You conflate restricting flights to e.g. US from West African countries with the sealing of the borders and ports of West African countries. I've got a bridge to sell anybody who thinks it's effectively feasible to seal, for instance, Liberia's land borders. As for circumventing bans on certain air travel routes, that's easy: travel by any means possible to the nearest unbanned international travel hub, then fly to the US. And if you argue that countermeasures can be put in place against that sort of thing based on e.g. passport stamps, I'd ask you to remember that we're talking about Sub-Saharan Africa here: good luck! Your assessment of this CDC spokesperson's argument as unconvincing is, itself, unconvincing.

2. How hard is it for doctors and aid workers to coordinate with the military and/or DHS for flights into an area when ordinary civilian air travel is restricted? It might be more difficult, but it's been done and there's no reason to suppose it couldn't be done here.Any increase in friction will reduce the available pool of personnel and supplies to some degree. How much is debatable.

3. The third argument is persuasive, but it's a humanitarian argument against closing borders, not an argument that closing borders would fail to achieve additional safety. Not at all. The argument is not only that devastating the economies of West Africa is a "bad thing" per se; the corollary is that the comcomitant degradation of what little public health infrastructure exists in those countries would worsen the epidemic, quite overwhelming any benefits that might be gained by the restriction of population movement and contributing to the deepening and broadening of the epidemic.

OT, Further Reading in Public Health: A Plague Upon Your Houses

Just as a tangent: for anyone interested in the deep ties between issues of public health, public policy, and social justice; or in the history of New York City's urban geography in the late 20th century; or -- more boldly -- how misguided and/or manipulated public policy, justified by scandalously faulty research from the RAND Corporation, directly fostered a literal firestorm that consumed vast swathes of NYC in the 1970s and permanentently eviscerated their social fabric): I would strongly urge a read of Deborah and Roderick Wallace'sA Plague Upon Your Houses: How New York Was Burned Down and National Public Health Crumbled . One of the finest interdisciplinary works I've ever come across, providing conundrums to think upon in many directions. Enthralling work, and deserves to be universally read.

Via some Amazon-ian who transcribed the JAMA review:

JAMA, Jan 26, 2000, p 538, Vol 283, Those who live and work far from New York City may be tempted to ignore this book, thinking it deals only with the problems of one large metropolitan area with unique circumstances that don't affect the places where most Americans live and work. As the title indicates, this book is an attempt to convince readers otherwise. It takes a very broad view of public health, connecting neglect and withdrawal of services from poor urban communities with epidemics of tuberculosis, AIDS, substance abuse, and violence.

Bob S.October 24, 2014 5:37 PM

Turns out the touchless thermal scanners are practically useless, because they are inaccurate.

Fine. There are only 150 people per day leaving the impacted countries. For god sakes use a real thermometer to take their temp.

Turns out a lot of travelers take aspirin if they feel a bit feverish.

That's actually tougher...at least ask them if they have taken any medications and why...of the 150.

The concept of of "sealing the border" is political/media hype. Simply say "it's impossible and it's hype".

It would be common sense to closely scrutinize medical personnel arriving from the impacted countries: they are definitely high risk.

I think the fear is not so much about contracting Ebola personally. The fear is our government will continue to drop the ball and act irresponsibly as exemplified by the Dallas fiasco.

I think current precautions and procedures seem reasonable by the way, e.g. in the case of the doctor in NY.

However, why don't they use real thermometers on travelers from impacted countries? Seems penny wise, pound foolish to me.

Is this blog about border security now, too?

Anonimous CowOctober 24, 2014 5:48 PM

...We've invoked no extraordinary quarantine measures, not even any half-hearted ones. We've mandated no new immunizations, we've gone out of our way not to limit travel, and the establishment media response seems much more "don't worry, be happy" than does the response to "we should have panicked a decade ago" articles...


AFAIK the US has (thus far) seen only 3 cases, and they were isolated upon discovery. A few false alarms, though.

Also AFAIK there is NO immunization for Ebola. If there is, why haven't we heard about it by now?

And you might think the media's attitude is "don't worry be happy" but at least they are putting the word out. Would you rather they not say anything at all?

Incontinuously ContagiousOctober 24, 2014 6:08 PM

I stopped reading right where it compares ebola to effects of post-911 syndrome on seasonal flu.
Travel ban and closing border seem to work pretty well for East Africa. Having that said, it is much harder for virus to spread outside Africa, given the vectors.

AdjuvantOctober 24, 2014 6:14 PM

@Anonimous Cow:
Re: Ebola vaccines, there are none approved, but there are several experimental ones and more on the way -- with all the usual corporate pharma jockeying. See this roundup.

BOBOctober 24, 2014 9:31 PM

I tend to agree with Parrot. The Boy Who Cried Wolf looks good compared to the United States government and its mostly controlled media.

Anura makes the common mistake of believing most Americans are like him and some of the other commenters here. Back in 1873 when there was much more independence and honesty in news media than there is now, Mark Twain wrote this: "The trouble is that the stupid people--who constitute the grand overwhelming majority of this and all other nations--do believe and are moulded and convinced by what they get out of a newspaper." Add in the strongly controlled and manipulated news media (96% of which in the western world is controlled by six monster corporations)and the controlled, duplicitous, lying and manipulative government, and there is no reason to believe the country is safe from ebola, much less safe for democracy (whatever that is supposed to be).

And nowadays the majority of the people are not just stupid in the way Mark Twain though of them. They have been deliberately dumbed down and distracted by sports, reality TV, computer games, smart phones, etc. There is probably a significant percentage of them even now that know nothing about the ebola epidemic in Africa. Big chunks of them do not know who we fought in the Revolutionary War or in WW1 or WW2, who was president during the Civil War, etc. If they think about it at all, probably most of them believe the propaganda that our military personnel have died "to protect our freedom" in multiple wars.

While the approval ratings of Congress and the president are very low, still huge numbers of people are willing to re-elect them. Why? Look at the following quote:

"According to the Survey of Income and Program Participation conducted by the U.S. Census, well over 100 million Americans are enrolled in at least one welfare program run by the federal government. Many are enrolled in more than one. That is about a third of the entire population of the country. Sadly, that figure does not even include Social Security or Medicare. Today the federal government runs almost 80 different “means-tested welfare programs”, and almost all of those programs have experienced substantial growth in recent years."

For every job created by the Obama administration, 75 people have gone on foodstamps. How's that for progress?

They are willing to elect the scoundrels because the scoundrels give them freebies. It has always been that way, and it has always been the cause of governments collapsing and becoming dictatorships.

Does all of this have anything to do with ebola? Yes, I believe it does. People have grown to assume that the government will take care of them. They have no idea that the government CAN'T take care of over 300 million people or that everything the government does has to be paid for by the people who pay the taxes. Only around 30% of the population even pays net income taxes. But the people above the pay grade of the president who really run things push their own agenda, and the people be damned. David Rockefeller, Ted Turner, Henry Kissinger and others have openly spoken of the need to reduce worldwide population very drastically. Look the Georgia Guidestones and what is written on them. When it is positively known that stopping people entering the U.S. from the West African nations affected by ebola would cut the risks of the U.S. essentially to zero, our high government officials speak of how it would hurt the economies in West Africa and how it would impede assistance to them. But their economies are not as important to the U.S. as preventing an ebola epidemic. And medical and other aid could be supplied via charter aircraft. That whole thing is a red herring.

When you go to a magic show, you need to watch the "other" hand of the magician when he is making fancy flourishes with the one he wants you to watch. You need to watch governments the same way.

Laird WilcoxOctober 25, 2014 9:33 AM

This whole Ebola thing will probably look a lot different in just a few weeks. It's so easy to jump to conclusions early on in an emotional issue such as this. I'm reminded of one of my favorite quotations:

"You can prove almost anything with the evidence of a small enough segment of time. How often, in any search for truth, the answer of the minute is positive, the answer of the hour qualified, and the answers of the year contradictory."
Edwin Way Teale (1889-1980), Circle of the Seasons, 1953.

someoneOctober 25, 2014 1:33 PM

Good analysis? Adopting the pose of cool-headed rationalists, the authors soothingly understand the fear, but proceed to associate a reasonable proposal with conspiracy theories and their concomitant wackos, calling it irrational, crazy, nuts, panic.

That present airport screening methods are ineffective is irrelevant. The comparison to the flu and SARS is invalid, as the latter are much more infectious.

Tom Frieden himself admitted that 95% of all travelers from West Africa arrive in the States through those five airports. A complete travel ban against such travelers at all ports would necessarily, substantially reduce the probability of an infected person crossing our borders.

That tracking people of concern may become more difficult is a nonsensical line of argument. The authors deride airport screening as theater: how then do they propose identifying subjects for monitoring? Through the same inefficient and ineffective process?

To transport aid workers, the government can step in. An international emergency requires a governmental response from concerned nations.

It would be helpful to know how a travel ban would devastate the affected countries' economies. Will it cut down on Ebola tourism? Do we import a lot of West African goods?

ChrisOctober 25, 2014 3:02 PM

I for one am tired of these silly arguments that sealing borders and stopping flights won't stop Ebola. Of course it will (or dramatically slow it). No antivirus software is 100% effective, should I stop using that? No network security will keep out all hackers, so I guess there's no reason to set up a firewall. This is pure silliness. Everyone else who's fed up, go out and vote Nov. 4th.

SkepticalOctober 25, 2014 4:53 PM


@Adjuvant: You conflate restricting flights to e.g. US from West African countries with the sealing of the borders and ports of West African countries. I've got a bridge to sell anybody who thinks it's effectively feasible to seal, for instance, Liberia's land borders. As for circumventing bans on certain air travel routes, that's easy: travel by any means possible to the nearest unbanned international travel hub, then fly to the US. And if you argue that countermeasures can be put in place against that sort of thing based on e.g. passport stamps, I'd ask you to remember that we're talking about Sub-Saharan Africa here: good luck! Your assessment of this CDC spokesperson's argument as unconvincing is, itself, unconvincing.

As many people have noted, and as I thought my own criticism of the article explicitly indicated, you don't need to achieve 100% success for a travel ban to reduce risk. No doubt some people who would have flown will have a passport from an ebola-free country (or at least one that is not the subject of the ban), will elude or defeat border controls, and will board a flight from a non-banned country.

But how many of those 150/day passengers are going to do that successfully? I'd guess not many, and in any event a very reduced number.

Moreover, the substantial additional travel time will mean greater probability that an infected person will progress to a symptomatic, or even incapacitating, stage before being able to get on a flight. This raises the probability that the person will be stopped or detected as a carrier of the virus before exiting border controls in the United States.

.Any increase in friction will reduce the available pool of personnel and supplies to some degree. How much is debatable.

I don't agree. First, I reject the assumption of increased friction: mandatory coordination with the military and DHS may actually increase the number of personnel and supplies able to travel to West Africa to help by reducing costs for NGOs and by increasing the perceived security of personnel volunteering. Second, I reject that any increase in friction reduces available supply: a doctor intent on volunteering in West Africa is not going to be deterred by some additional paperwork. "Friction" is a metaphor that only goes so far; people and bureaucratic hoops are not actually exactly like objects in a physics problem.

Not at all. The argument is not only that devastating the economies of West Africa is a "bad thing" per se; the corollary is that the comcomitant degradation of what little public health infrastructure exists in those countries would worsen the epidemic, quite overwhelming any benefits that might be gained by the restriction of population movement and contributing to the deepening and broadening of the epidemic.

This is not the argument made in the article however. The argument in the article includes a brief mention of a deleterious effect on public health resources, but focuses entirely on the impact to West Africa. The further argument you make here - that the worsening of the epidemic in West Africa will therefore lead to increased risk of exposure in the US - is not stated in the article. I don't agree with the further argument here either, incidentally.

Apart from all of the above, try your intuition on a counterfactual. Suppose ebola has mutated and can now be transmitted as readily as influenza. Would you agree that a travel ban would just make things worse for the US, or would the arguments in the article appear somewhat weaker than they do to you currently?

RonKOctober 26, 2014 2:43 AM

@ Skeptical

Apart from all of the above, try your intuition on a counterfactual. Suppose ebola has mutated and can now be transmitted as readily as influenza. Would you agree that a travel ban would just make things worse for the US, or would the arguments in the article appear somewhat weaker than they do to you currently?
Is this a trick question? The arguments in the article would appear to then be even stronger, since you'd certainly just be wasting time and resources trying to keep your finger in the dyke. These resources would be much better spent on trying to organize the public, the health system, develop countermeasures like vaccines, etc.


If, somehow, you think an "argument from panic" is going to help you, let me one-up you: in your hypothetical scenario, what exact behavior do you expect from... (pregnant pause)... terrorists?

Tal Be'eryOctober 26, 2014 2:53 AM

@Chris I think that an AntiVirus is the perfect analogy. Using a somewhat effective security tool increases the overall security, but only if the needed resources to use it are not too high. So if even the best Antivirus is only somewhat effective, maybe spending a high fee per license is too much and a free/cheaper option is better? that way the security budget can re-balanced to include more efficient/supplementary security controls.

Same goes for "sealing borders". If the "thermal scanner" are proved to be useless why do we keep using them? if screening did not catch a single sickness case in the past why do we keep doing it? Probably for the very same reason thatwe keep investing in Antivirus in a post Target, Staples, Home Depot, etc. breaches world.
Because "That's what we always did!"

So it's time to rethink our procedures and re-balance our security portfolios.

Clive RobinsonOctober 26, 2014 7:09 AM

The problem with Ebola and many other African and Asian diseases is that untill recently they have not effected the Western and other affluent countries where the Big Pharma companies are. So they don't see a profit and thus have not developed the drugs needed.

Which causes a problem, to get approval for drugs etc can even when optimized take considerably longer than it would for any epidemic to overwhelm us.

In the UK prior to the Ebola outbreak discussions had started about reduced drug testing protocols for use with those facing a terminal illness. That is if the choice is be dead in a year or use a drug that's not yet fully approved but is likely to increase your life expectancy by six months should it be offered to you?

It's these sorts of questions that also reflect into contagious diseases, after all Ebola was isolated and identified back in 1976, and in essence little has been done about it untill recently, and what is now being done is "to little to late" and won't clear even basic testing before either the current out break has died down or it becomes a major intercontinental issue effecting the first world nations sufficient to cause justified alarm.

So the question is, if currently approved drugs are not going to cure the majority of people who contract Ebola should new effectivly untested drugs be offered / used?

And if so what protocols should be in place?

Because there are secondary questions such as should patients be offered euthanasia as an option? And what liability should a supplier of a drug be under if say a drug cures ebola but gives you say liver cancer?

It's long past time that we started asking these questions and actually took more than a rose tinted view. Because as other parts of the world become more affluent allmost the first thing that will happen is that migration to other places will occur, thus diseases will become more mobile, and many we will have absolutely no immunity to.

Oh and trying to stop people migrating is a joke, afterall what's the current estimate on the number of "illegals" who have come in from the Mexican side of the US? You might contain legal travel but as long as money is to be made people will pay to travel illegal and you won't be able to stop them. For those in the US who think otherwise have a look at what has recently been occuring in Europe.

Technical and legislative measures won't realy stop people trying to get in as long as they think the risk / reward is worth it. The real solution is give them reason not to leave in the first place which means adressing issues there not here.

SkepticalOctober 26, 2014 8:16 AM


@RonK: Not a trick question. I think the Vox article is a bit breezy in its arguments; they're easy to accept if you're not worried and are genuinely concerned about victims of the disease. I happen to fall into that category. But if I were genuinely concerned about ebola becoming epidemic in the US or other countries, I'd take a much harder look at those arguments.

In my scenario, there'd be a full response across the spectrum and in every space. It would include a travel ban.

Thank God, ebola is not so contagious that such a response is necessary.

The real reason not to institute a travel ban is that there's little threat to the US from ebola and it would make things more difficult in affected countries. Whether this remains politically viable depends on how quickly this can be contained in West Africa, because it will not take many cases of ebola travelling on an international flight for the public to demand a travel ban. Tick tock.

f43893uf92fh4398hOctober 26, 2014 11:37 AM

It's not "exaggerated". If a person goes out into a populace with an almost incurable disease that rapidly causes death in each person and continues to spread through almost all forms of contact; it's kind of a problem.. Especially on a continent of almost 400,000,000 that is dense and efficiently interconnected..

One door knob contact in NYC will spread the virus exponentially inside a twenty-four hour period nationwide..

This isn't computer security where you can afford to make mistakes or illogical observations. Like the infamous "secure coding" and "virus signature" philosophy and model that keep the industry redundant yet profitable..

Karl SchmidtOctober 26, 2014 1:14 PM

The error in logic here is that they are responding in a linear manner to a exponential problem. Chances are good that this will just blow over, but there is a real non zero chance that we could have a black swan that could overwhelm the system. (this disease has a gain of over 2).

My biggest concern is that it will arrive in Latin America - where they just can't deal with it - and the rush to come to the USA for treatment will overwhelm the border and our facilities.

This line from the story is just a straw-man":

"To completely seal off and don't let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can't get supplies in, you can't get help in, you can't get the kinds of things in there that we need to contain the epidemic."

Closing commercial flights and limiting the only path in and out were military transports - with screening/quarantine would be the sane response. One of the few legitimate functions of government in a free society is public health - and they have failed.

Ignoring the problem in Africa is also insane.

Karl SchmidtOctober 26, 2014 6:40 PM

One last point -

What is known about Ebola is limited - less than influenza. What is known about this new stain is even less - could be it has just a little bit higher gain than the last strain - but again there is a real - non zero risk that this one has new tricks up it's sleeve.

Should we really just assuming that this strain will simply die out like previous ones?

Karl SchmidtOctober 26, 2014 6:42 PM

What is known about Ebola is limited - less than influenza. What is known about this new stain is even less - could be it has just a little bit higher gain than the last strain - but again there is a real - non zero risk that this one has new tricks up it's sleeve.

Should we really just assuming that this strain will simply die out like previous ones?

Wesley ParishOctober 27, 2014 12:49 AM

@Karl Schmidt

Actually, this current strain of Ebola may be worse than the original strains. Strains of infections that incapacitate initially then kill later, infect more people than ones that kill from the start of infection. And thus have a greater chance of spreading, thus a greater chance of "surviving", thus a greater chance of "succeeding".

Making education and public health a top priority in West Africa, and recognizing the IMF's and World Bank's psychopathic insistence on "austerity" as a crime against humanity and thus ending it, would set the best foundations for ending it as thoroughly - one hopes - as smallpox was ended.

WinterOctober 27, 2014 2:50 AM

@Clive
"Oh and trying to stop people migrating is a joke, afterall what's the current estimate on the number of "illegals" who have come in from the Mexican side of the US?"

You see, the voice of reason is one of the first causalities of an epidemic. And deep down, we all know that diseases are brought to us by foreigners.

Remember the French disease as it is called in the UK, which is called the Italian disease in France, and the Spanish diseases in Italy, and is claimed by the Spanish to have been originated in South America?

And the solution is always the same: Clean the country of foreigners.

WaelOctober 27, 2014 3:07 AM

@Nick P,

France, and the Spanish diseases in Italy, and is claimed by the Spanish to have been originated in South America?

Theory of "Attraction" again! @Winter writes about "Spanish", just about the time I pressed submit with my "Spanish" joke. Wadda ya think @Nick P? Coincidence?

Frank Ch. EiglerOctober 27, 2014 11:18 AM

"@Winter

@Clive
"Oh and trying to stop people migrating is a joke, afterall what's the current estimate on the number of "illegals" who have come in from the Mexican side of the US?"

You see, the voice of reason is one of the first causalities of an epidemic. And deep down, we all know that diseases are brought to us by foreigners. "


Your sarcasm betrays an uncomfortable truth. Some diseases *are* brought to us by foreigners, as of course is the case for Ebola, and maybe the recent lethal strain of D68. Should the de facto open south border be associated with an influx of serious disease, there will be a terrible price to pay by those supporting said open borders. They've put themselves between a rock (being seen to protecting public health) and a hard place (hoping to manufacture more D voters).

Wesley ParishOctober 29, 2014 7:14 PM

@Frank Ch. Eigler

If you read Guns, Germs and Steel by Jared Diamond, you realize the uncomfortable truth of that. The wide, wide spaces of North America would not have seemed anywhere near as wide or as empty to the European settlers, if the inhabitants had not first encountered Europe's long-gestation diseases like the common cold and influenza to which they had no immunity ...

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