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In which John discusses the ebola outbreaks in the United States, Nigeria, Sierra Leone, Guinea, and Liberia, and how best to deal with them. Sources and resources below:

This Economist story is a great introduction to where we stand with the epidemic: http://www.economist.com/news/international/21625813-ebola-epidemic-west-africa-poses-catastrophic-threat-region-and-could-yet

The WHO's weekly situation report update: http://apps.who.int/iris/bitstream/10665/136645/1/roadmapupdate17Oct14_eng.pdf?ua=1

Interview with Bill Gates I paraphrased: http://www.theguardian.com/world/2014/oct/03/bill-gates-ebola-shutting-down-healthcare-system-african-countries

Oxfam expresses concern that ebola could be "the definitive humanitarian disaster of our generation." http://www.theguardian.com/world/2014/oct/18/oxfam-call-for-troops-ebola--west-africa-world-health-organisation-accused


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Good morning Hank; it's Tuesday.

So in the 20th century about as many people died from smallpox as currently live in the United States of America. I bring this up because I don't think it's irrational to be terrified of infectious diseases - they are terrifying. But then again, for the rest of human history, no one will die from smallpox because we eradicated it. Like the beginning of the Wikipedia page for smallpox is "Smallpox WAS an infectious disease." So don't underestimate humans when it comes to kicking microbial butt.

Today I want to talk about Ebola and what shouldn't terrify us about it and also what should.

So quick update: currently three people have contracted Ebola in the U.S. Nigeria, which had twenty infections, was just declared Ebola free by the World Health Organization. Good work Nigeria! But there have been about ten thousand total reported cases in Guinea, Liberia, and Sierra Leone. Also we know that number is low because there is a lot of under-reporting. And as this graph indicates, the rate of infection is not even beginning to level off - and that is terrifying.

The current outbreak here in the United States is-is not terrifying. For one thing infection controls are good enough that the disease won't spread widely. And for another, the survival rate so far is over 80% thanks to excellent supportive care, whereas in West Africa it's closer to 30%.

But Hank as long as the outbreak is worsening in West Africa, there will be other outbreaks around the world regardless of whether we revoke the visas of people traveling from affected countries and regardless of whether every nation on Earth checks every international traveler for fever.

Hank, microorganisms just aren't very well informed when it comes to the borders of nation states. And if we're going to enjoy the many benefits of globalization - inexpensive Argentinian beef in our Big Macs, West African chocolate in our Hershey's Kisses, roses from Kenya, clothes from Bangladesh - if we're going to have all that stuff we're also going to live in a global health community.

We like to imagine that deadly infectious diseases like cholera or malaria happen to other people, to like poor people who live far away from us. But Ebola reminds us just how false that us/them dichotomy is. Like better health care infrastructure in Liberia is not just good for the health and productivity of Liberians, it's also good for the health and productivity of all humans. And then there's the non-Ebola effects of Ebola, like as Bill Gates has pointed out, the collapse of public health care systems in Sierra Leone and Liberia and Guinea has probably led to more deaths from non-Ebola causes than from Ebola. Harvests are being affected as is every segment of these countries' economies, and we're probably at the beginning of the outbreak. I mean the World Health Organization is estimating that by December, there could be between five and ten thousand new cases of Ebola per WEEK.

Now Hank I understand the impulse to try to cut these countries off from the rest of the world. But experts agree that will lead to more Ebola around the world, not less, as we've already seen from the insufficiently robust international response to the initial outbreak. So what are we going to do? Well, the World Health Organization's current plan is 70-70-60. Although grammatically I would say that it's more sixty, seventy, seventy. The idea is that within sixty days, seventy percent of Ebola patients will be isolated and seventy percent of burials will be safe. That's going to require tremendous community outreach and lots more hospital beds which is going to be very expensive, like up to a billion dollars a month and also will require a lot of staff.

The heroes of this story will be the people who build and run those clinics, and they will be American and Cuban and Botswanan, and there will be many, many West Africans who work together to isolate and treat Ebola patients. That is hugely courageous work, and it is done on behalf of all humans. It will eventually be effective, and the Ebola outbreak will eventually be contained but at a very high cost.

But Hank, I hope that we might learn from this disaster than when it comes to communicable diseases in today's world, threats to the health of any humans are threats to the health of all humans. I'll see you on Friday.