Tuesday, November 4, 2014

Ripley Was Right: Ebola, Science, and the Precautionary Principle

In my previous post on the Ebola outbreak, I focused on how the treatment of Ebola patients highlights the shortcomings of private healthcare in the US, and the need for a comprehensive public system.  I also mentioned that American media coverage has been limited, as we might expect, to a spectrum running from Republican/Fox fear-mongering to Democratic/MSNBC ass-covering. I avoided, and had formed no opinion about, the question of how dangerous this strain of Ebola is, or of any question about what preventive measures are called for.

Since that post, the subsequent brouhahas about who should and shouldn’t be quarantined have only exacerbated the ridiculous media paradigm in which what’s really at stake in Ebola is Obama’s presidential reputation or Chris Christie’s presidential prospects or which party will win the mid-term elections. At the same time, a lot of evidence has become available regarding the lethality and transmissibility of the Ebola strain we are dealing with. In this post, I want to look at some of that evidence, teasing out the issues of scientific knowledge and ethico-political authority that are raised by the Ebola crisis, and which are confused by the impulse to read them through the lens of American liberal/conservative categories, with which they have nothing to do.


Superbug

How lethal and how transmissible is the current (Zaire) strain of the Ebola virus?

Here’s a two-minute clip of Dr. Michael Osterholm, head of the Center for Infectious Disease Research and Policy at the University of Minnesota, speaking at Johns Hopkins:

(2 minutes)

And here’s Peter Jahrling, chief scientist at the National Institute of Allergy and Infectious Diseases, who’s been studying hemorrhagic fevers for 25 years, and helped discover the Reston strain of Ebola, in an interview with Vox:
We are using tests now that [we] weren't using in the past, but there seems to be a belief that the virus load is higher in these patients [today] than what we have seen before. If true, that's a very different bug. …
JB (Vox): A higher viral load means this Ebola virus can spread faster and further? 
PJ: Yes. I have a field team in Monrovia. They are running [tests]. They are telling me that viral loads are coming up very quickly and really high, higher than they are used to seeing.
As Vox points out (using statistics that have already been surpassed), the current Ebola outbreak is “remarkable” because “the virus has spread to six countries in Africa plus America, and has already infected more than 13,000 people. It has killed nearly 5,000 people. That is more than six times the sum total of all previous outbreaks combined.” It has a 50-70% mortality rate.

In short, unprecedented lethality:



A Joke In November



On the way home from his successful fund-raising meeting, a powerful US Senator drives his car into a tree and dies. His soul arrives at the Pearly Gates, and is met by St. Peter. 

"Welcome to heaven," says St. Peter. "Before you settle in, we have a special protocol for a person of your stature, to make sure that you are given appropriate accommodations.“

"No problem, says the Senator. “Just let me in and we’ll work it out."

"Actually,” St. Pete says, “our process requires that you spend one day in hell and one in heaven. Then you can choose where to spend eternity."

"Not necessary. No need to waste my time. I've made up my mind. I want to be in heaven," says the Senator.

"I'm sorry, but those are our rules, and there can be no exception," says St. Peter, who escorts the Senator to the elevator and hits the “Down” button. The Senator gets anxious as the elevator wooshes waaaay dooooown.

The elevator stops abruptly, the doors open, and the Senator steps out into the middle of a lush resort. The sun is shining, there’s a beautiful beach, tennis courts, golf courses, yoga studios. At the main lounge, he finds all of his old friend and colleagues who greet him enthusiastically—everyone as healthy and charming as the day he met them. Also present is the devil, who turns out to be a very friendly guy, and who welcomes the Senator warmly. The Senator passes the day with the lot of them, frolicking in the sun and surf, and in the evening he joins his companions in a gourmet dinner, followed by drinks and dancing.

Before he realizes it, the day has passed, and he finds himself in the elevator, going up, up, up. When it stops, the door opens, and St. Peter greets him, saying: "Now it's time to visit heaven." So the Senator passes the next 24 hours with a small group of contented souls, going from cloud to cloud, playing the harp and singing his favorite Beatles’ songs.  He has a good enough time, which passes quickly, and before he realizes it, another day has gone by, and St. Peter returns.

"Well, then, Senator you've now spent a day in hell and another in heaven. Choose your eternity."

The Senator thinks for a minute, then answers: "Well, I never thought I would say this, but, although heaven has been delightful, I think I would rather be in hell."

So St. Peter puts him in the elevator and he goes back down to hell.

Now, when the elevator opens, the Senator is in the middle of a barren land covered with waste and garbage, reeking of the foulest odors. He sees all his friends, covered in shredded rags, scrounging in the muck for offal. The devil himself comes over to him, puts his arm around his shoulders, and says: “Welcome to eternity.”

"I don't understand," stammers the Senator. "Yesterday I was here and there was a beautiful beach, and beautiful people, and great food, and fun and dancing. Now there's just a horrid wasteland full of miserable, tortured souls. What happened?"

The devil smiles at him and says: "Yesterday we were campaigning.  Today, you voted."



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