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The return to The Hot Zone

Ian A. York iayork at panix.com
Thu Jan 18 20:36:51 EST 1996


I'm replying to Frank Eldredge's followup to Andersson's article, since
the original hasn't hit my news spool - baffling since we're both on the
same ISP.  (I checked to see if Hans had cancelled his article, but didn't
see his name in 'control', so I guess it's just Panix weirdness.  Unless
Andersson is using the mailing list instead of the Usenet groups for this
discussion?)

Frank says that both Hans and I have overstated our arguments.  To be 
entirely honest, I don't know what Andersson's argument is.  I went back 
and reread this thread (thanks to alta vista and dejanews) and, frankly, 
I'm not much further ahead - although I gather Andersson is a 
professional journalist, I'm quite honestly unclear on what he's trying 
to say here. So let me first explain my interpretation of Andersson's 
point, and then explain where I disagree with him. 

HA says that the filoviruses are deadly viruses on an individual basis. 
Nobody here has disagreed with that, so we have no argument there.  If 
you get it, it's bad news for you.

Where we do seem to disagree is two other points:  (1)  The present 
public-health risk of Ebola; (2)  The risk of Ebola mutating to become a 
public-health risk at some time in the future.

I maintain that Ebola *as it is now* is not a major public health risk. 
It certainly is of some concern, but our present knowledge of Ebola, and
the Kikwit outbreak (and I repeat, that was the worst-case scenario)
assure us that an Ebola outbreak is not going to destroy civilization;
it's not going to destroy a city, even.  The reason is that Ebola is
simply not a particularly infectious virus, and the reason for that is
that it kills people - and causes symptoms in people - too quickly.  There
is not a long contagious period during which the victims get around and
spread the disease. 

HA doesn't address this, as far as I can see.  He keeps repeating that
Ebola is deadly, which is true but irrelevant.  He says, "It's only in a
world of theories that the lethality of a virus has little or nothing to
do with the potential public health problem."  But this isn't just theory,
it's theory that's been confirmed by observation; Ebola burnt itself out
in Kikwit, as predicted.  All the 'theory' is coming from Hans.

Let's look next at his concern about mutation.  He seems to feel that
because Ebola has been shown to spread by aerosol then it might mutate to
become as infectious as flu - or something like that. 

Well, let's look at a virus that's not as exciting right now as Ebola. 
And let's take HA's two main arguments: That a lethal virus is a major
public health concern, and that things that have been shown to spread by
aerosol are likely to mutate to spread like influenza. 

There are quite a few articles demonstrating that rabies virus can be
spread by inhalation, and rabies is vastly more lethal than Ebola (see,
Hans, I read quite a bit later than Jane Austen; you might actually try to
read a little more yourself, to get a real understanding of the
situation). 

Furthermore, there are tens of thousands of cases of rabies in North
America each year (in animals - I put this in so that Hans won't be able
to misinterpret as he did with my CJD example) - providing plenty of
opportunities for mutation to respiratory spread.  In case you missed it,
it hasn't happened.  Should we put the CDC on alert and throw money at the
problem for fear that it will mutate to respiratory spread?  -Or mutate so
the vaccine doesn't neutralize it (more likely, since there's some
selection pressure there)?  I can come up with rabies scenarios all day
that more more plausible than any of your Ebola scenarios. 

Of course, Richard Preston hasn't written any scary books about rabies;
perhaps he doesn't care about the 50,000 people (and their families) who
die of it, in excruciating pain, every year? 

In other words, I don't think anyone says that Ebola cannot possibly
mutate to become a threat.  (Read that carefully.) But the likelihood of
that is the same as any of a thousand other viruses mutating to become
threat.  

What if human cytomegalovirus incorporates a mutant p53 in its genome,
Hans?  Shouldn't we be preparing for that possibility?  It's at least as
likely as an airborne Ebola - Richard Preston's claim that "Ebola is a
virus trying to break out - out of the jungle, out of the monkey species,
and out of Africa" notwithstanding, Ebola is a virus: it doesn't have
goals or intentions. 

But I do think (I won't speak for Ed here, my wrist is still sore from the
last slap he gave it) that we have to assign our non-infinite resources -
money, time, and manpower - rationally.  That means assessing where the
most likely risks are, and addressing them. 

If the only virus you know anything about is Ebola, then it's going to
look like the biggest threat.  But if you look at some of the established
killers like TB (and yes, Hans, I know you said "*This* discussion just
happens to be about Ebola", but you're wrong; this discussion is about
public health risks, of which Ebola is one), measles, and polio, then it's
hard to argue that resources should be withdrawn from them in order to
cover the hypothetical risk of a hypothetical mutation.  And if you do
want to cover that hypothetical mutation scenario, than you should also
cover the risk of rabies mutating, polio mutating, TB mutating, measles
mutating ... 

Let me say it again:  We KNOW that TB kills millions of people per year. 
We KNOW that measles kills another couple of million people per year. 
Ebola has killed about 400 people in the time these two diseases have
killed some 40,000,000. There's no theory here, Hans, just facts.

I'll tell you what I, personally, would like to see done.  I'd like to 
see funding of a much better infectious disease surveillance program, 
worldwide - probably heavily based on the CDC, since they seem to have 
the most experience at it. Basically, an expansion of the programs the 
WHO is already working on.

I do not want to see journalists advocating research on the latest flavour
on the month. I do not want to see money being thrown at Ebola, because
that money will come from somewhere else - and it will probably come from
somewhere in the health care/research system, and people will die because
they didn't get the measles vaccine that money was originally going to
cover. 

And, as long as we're dreaming here, I wish that the CDC didn't have to
use scare tactics based on the latest mobies in order to get some funding. 

I think this will be my last post on the subject of Ebola, so feel free to
insult me some more, Hans; you'll have the last word. 

Ian
-- 
                      Ian York   (iayork at panix.com)
      "-but as he was a York, I am rather inclined to suppose him a
       very respectable Man." -Jane Austen, The History of England



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