Related to: Forty Days , Low Hanging Poop
From professor Gregory Cochran's blog West Hunters.
Laurie Garret has an article out in the Washington Post. She say that there’s no point in trying to block the spread of Ebola by travel bans.
The problem is, she’s full of crap. Look, there are two possible scenarios. In both of them, r, the number of new cases generated by each case, is greater than 1 in parts of West Africa – which is why you get exponential growth, why you have an epidemic. If r < 1.0, the series converges – a case generates a few extra cases before dying out.
Everything we know so far suggests that even though it is greater than 1.0, r in West Africa is not all that big (maybe around 2), mostly because of unfortunate local burial customs and incompetent medical personnel.
It seems highly likely that r in US conditions is well under 1.0 which means you can’t get an epidemic. However, r is probably not zero. It doesn’t mean that you can’t get a few cases per imported case, from immediate contact and hospital mistakes. As an example, suppose that on average each case imported to the US generated a total of two other cases before dying out (counting secondary, tertiary, etc infections). Then, on average, the number of US citizens infected would be twice the number of infected visitors.
Now suppose that a travel ban blocked 80% of sick people trying to fly here from Liberia. We’d have 80% fewer cases in US citizens: and that would be a good thing. Really it would. Does Laurie Garret understand this? Obviously not. She is a senior fellow for global health at the Council on Foreign Relations, but she is incompetent. Totally useless, like virtually everyone else in public life.
We hear people from the CDC saying that any travel restrictions would backfire, but that’s nonsense too. One might wonder why they say such goofy things: I would guess that a major reason is that they were taught in school that quarantines are useless (and worse yet, old-fashioned), just as many biologists were taught that parasites are really harmless – have to be, because evolution!
In the other scenario, r > 1.0 in US conditions as well, or at least is greater than 1.0 in some subsets of the US population. This is very unlikely- even more unlikely considering we can adjust our behavior to make transmission less likely. But suppose it so, for the sake of argument. Then you would want – need – to stop all travelers from the risky regions, because even one infected guy would pose a huge risk. Some say that blocking that spread would be impossible. They’re wrong: it is possible*, although it wouldn’t happen, because we’re too crazy. In fact, in that scenario, we’d be justified in shooting down every plane that _might_ carry an infected passenger. This scenario is the one that fits Garrett’s remarks, but if she really believed it, she would be frantically buying canned goods and finding a cave in the Rockies to hide her family in.
*the Atlantic is pretty wide.
Yes! Thanks for pointing me at that paper, I hadn't seen it before.
Enveloped viruses are in general much more fragile than non-enveloped viruses. They contain the genetic material of the virus and viral proteins surrounded by a lipid membrane derived from the membrane of a host cell, which they then fuse with the membrane of another host cell to get the genome in. Easier entry to the host cell at the expense of fragility. If the membrane is broken the virus is dead, and a bubble of membrane is a lot more fragile than a protein/RNA crystal (which is basically the entire structure of non-enveloped viruses which need to somehow pass through the cell membrane without killing the cell which is more difficult). In particular, dessication tends to kill enveloped viruses fairly quickly meaning they need to be wet from host to host. Ebola viruses are filamentous viruses, meaning their genome is stretched out in a long ribonucleoprotein fiber which is surrounded by a big tube of membrane (those long funny shapes we have all been seeing), so they have a lot more membrane per particle than most viruses and are particularly vulnerable.
One might note that the flu virus is also membrane-bound but goes through the air. Sort of. It empirically requires droplets of several microns in size to move through the air in natural conditions, which only make it so far (a few feet) before drying out or settling to the ground. In real-world conditions smaller droplets or dry particles don't seem to be important for its spread, though you can set up experiments where a few manage to make it through that way. Also, any flu virus that gets breathed in or on a mucous membrane is already in its perfect environment - epithelial cells - so a very small viral dose is required to make it in, whereas in living organisms ebolaviruses seem to have a much lower affinity for epithelial cells than blood vessel or connective tissue cells from research I've been able to look up, so you need more viruses to get into and infect a surface.
In the above-linked experiment, monkeys had their heads put in a sealed 8-liter box inches away from a nebulizer that produced aerosols from a liquid containing ebolaviruses, kicking up single-micron-sized droplets. They found that in this circumstance as few as 400 functional virus particles delivered this way to the respiratory tract/face was enough to cause a lethal infection (as compared to <10 functional virions via injection, though they did not try lower viral levels for inhalation), showing that a smallish number of freshly-aerosolized viruses landing on a respiratory surface can cause disease.
However, that you can set up an experiment in which you give enough viruses through the air to cause infection does not mean that under normal conditions that circumstance is likely to happen - the latter being the usual definition of 'airborne'. There's also a difference between 'airborne' and 'screwed if someone sneezes on your face' which is more akin to what's happening here.
They note this. Quotes from the paper:
"Epidemiology studies of human disease outbreaks in sub-Saharan Africa did not suggest that aerosol transmission of filoviruses was likely in that setting [emphasis mine]. Virus did not spread easily from person to person during the Ebola virus epidemics in Africa, and attack rates were highest in individuals who were in direct physical contact with a primary case... no cases occurred in children whose only known exposure to the virus was sleeping in the huts occupied by their fatally ill parents."
"It is possible that the quantity and distribution of virus within most patients' respiratory tracts may have been below the level needed to establish effective aerosol transmission."
The structural factors that make Ebola more fragile in the air are not ones that are likely to change much via mutation - that's things like cell affinity, how obvious it is to the immune system, replication speed, or toxicity to infected cells. There's reasons that viruses generally don't change their modes of spread during evolution.
On the other hand, there's this:
"Both elevated temperature and relative humidity (RH) have been shown to reduce the aerosol stability of viruses... Our experiments were conducted at 24C and < 40% RH, conditions which are known to favour the aerosol stability of at least two other African haemorrhagic fever viruses... If the same holds true for filoviruses, aerosol transmission is a greater threat in modern hospital or laboratory settings than it is in the natural climatic ranges of viruses... As previously stated, aerosol spread was implicated in the spread of disease among the monkeys at Reston [an accidental 1990s outbreak of ebolavirus among monkeys in a laboratory of a strain that could not infect/cause disease in humans, after work I may look up more about it to see what they mean about 'implicated']"
And this:
"While both parenteral [injected] and aerosol exposure to Ebola virus cause a systemic disease involving all organs, monkeys exposed to viral aerosols during our study developed strong immunoreactivity for Ebola virus antigen in airway epithelium, in oral and nasal secretions, and in bronchial and tracheobronchial lymphoid tissue. By electron microscopy, viral replication after aerosol exposure occurred in the lungs and tracheobronchial lymph nodes, and extracellular virus accumulated in alveoli of the lung." The monkeys exposed via fresh aerosol developed much more shedding virus in the lungs than their needle-exposed counterparts which you could imagine affecting infectivity.
You may find another paper making the rounds about aerosol transmission between monkeys and pigs; these were in a cage separated by bars and space and scientists make note that in that circumstance they can't necessarily tell the difference between respiratory aerosols, splashed liquid, and liquid kicked up during periodic cage cleaning.
In cold air droplets could live much longer. This is why we have flu outbreaks in winter. Ebola was never "tested" in winter conditions but it could become more contagious in winter in Europe and Norther US. Anyway, the question will it become airborne or not is not important as it already has doubling period 1 month and it is enough to infect almost all human population to 2016. To be airborne is only an option. The main question is how and when exponential growth will be stopped? What is your opinion?