First we were assured that Ebola would never come to the US. Comforting if reality doesn’t interfere. Seriously, we prepare for bird flu which we expect to travel from Asia. West Africa is closer. Attempts to quarantine an entire country or 2 or 3, that will only slow things. Perhaps a quarantine of Texas would make us feel better, but wouldn’t be effective either.
So sooner or later, there will be an outbreak in the US, but we can rely on our superior health care system. We have a wonderful tiered health care system that gives excellent results for the top tier. While the US leads the wealthy nations in medically preventable deaths with an estimated 100,000 per year, this does not effect the excellent care delivered to the top tier consumers. If your housekeeper, nanny, restaurant worker, farm worker, or employees drop dead from thyroid disease, appendicitis, tetanus infections, abdominal hernia, colon cancer, measles and epilepsy, leukemia, cervical cancer, diabetes or heart disease they are replaceable without any noticeable disruption. A rate we can live with unless they begin passing around a communicable disease.
In Texas we saw an Ebola patient sent home to infect more people. We now know both the patients travel history was available to both nurses and doctor who ignored it. This isn’t appendicitis. The uninsured and underinsured can transmit the disease to those who have top tier insurance. Thomas Duncan’s family was quarantined in the apartment where the virus was believed to be present for a week before being moved and workers in hazmat suits moved in to clean up. Duncan’s stepdaughter and husband who helped the sick Duncan into the ambulance have self quarantined, but are not receiving any support in their efforts, like someone to bring meals. This does not inspire confidence.
We shouldn’t put too much faith in our superior medical technology to produce better outcomes for those who contract the disease. Although the first American’s with Ebola were successfully treated with ZMapp, the supply is gone. A spokeperson on the weekend news repeated faith in our healthcare and then related the major treatment available was fluids. Replenishing fluids, IV fluids and lots of fluids.
It just seems with all of our available technology that we might have engineered something more effective to combat a disease that first appeared in the 70’s. Google had a link to a vaccine which is owned by the Canadian government and licensed to an American company in 2010, but as with the Zmapp there hasn’t been a profit motive to mass produce either the vaccine or the cure.
A few days after it was reported the Ebola vaccine delay may be due to an intellectual property dispute, Canada has acted and is moving forward with testing and production.
I get the whole free market system. But if the US is going to send troops, (human beings), into danger, shouldn’t we send them with the best available weapons and protective gear? In the case of fighting Ebola it might consist of a vaccine and ZMapp.
How many people are we willing to sacrifice to protect corporate profits? Or is a for profit healthcare model the most effective means of saving lives?
In the USA, our “health care” is just another market for CEO’s to deliver profits to shareholders. It has nothing to do with health.
While it’s true that Ebola has been known for a long time, it is not necessarily true that our relatively low-key response to it is a sign of racism.
When considering the spread of ANY virus, there is a race between between competing factors including the contagiousness (how easy is it to spread) and the virulence (how much harm does it do to its victim and how fast).
Ebola is a virus that, while very contagious, is also very virulent. In the rural settings of Africa where it languished for decades, it killed its victims so quickly that it did not actually spread very rapidly.
Those same constraints are still true now, even after it has spread to urban areas in Africa. From a public health perspective, especially in the US, the primary large-scale risk from Ebola is the risk that it will mutate into a form that, for example, allows its victims to live much longer. A similarly dangerous mutation would generate a form that made its victims symptom-free and still contagious for a longer period. These are truly nightmarish scenarios.
Still, even if we RADICALLY change the amount and funding of research in the US (and the first world, for that matter), it is not clear that an Ebola vaccine should come first or even near the top of the list of targets.
For example, the threat presented by disease-resistant bacteria is much more immediate and is arguably a much better target for research. The scientific task of creating an effective anti-bacterial agent is MUCH more manageable than creating an effective vaccine — especially when the contemplated virus is relatively rare, kills its victims quickly, and kills almost all its victims.
If research funds are even moderately constrained, I think it might well be mistaken to invest in high-risk long-term vaccine research if that investment means that we continue to starve research into far more mundane but far more achievable antibiotic agents.
It was not that long ago that children commonly died or suffered serious life-long impairments from “simple” staph infections of the ear, eye, nose, and throat.
I wholeheartedly agree that the profit motive is causing our drug research efforts to be targeted in ways that are likely to be devastating to our society in the relatively near future. Sadly, I think there is a relatively long list of targets that should come before Ebola when we make the needed change.
its the profit driven model is not conducive to successful health outcomes.
During the last few days spokespeople have been spewing the same tired explanation that research dollars are better spent on finding drugs that will prevent and cure more prevalent diseases. Sounds like a solid logical approach, except it isn’t true. Experts have been sounding the alarm for years that big pharma has chosen to bypass research in developing new antibiotics even as the old ones are becoming less effective due to overuse by commercial agriculture. Big pharma is not interested in developing new drugs that will be taken by a few people for a short time – limits their profit. Larger profits are made by drugs that are taken every day for the rest of your life.
I enthusiastically agree that the profit-driven model is, in fact, leading to awful health outcomes.
Big pharma cannot do anything different — not because they are evil, per se (they may be!), but because as publicly traded corporations it is illegal for them to do anything else.
The new antibiotics and vaccines that we need simply are not profitable. So long as we depend on the profit-driven model to guide new drug development, we will not solve this problem.
I find myself agreeing with you a lot lately.
I would add other factors to the problem with the development of new antibiotics. First is that they picked off the low hanging fruit during the first few decades that antibiotics existed. It is harder to find new ones now.
Second is that the existing antibiotics are way over-used, both in agriculture and in medicine, which exacerbates the need for new antibiotics, without solving any of the challenges that makes finding those new antibiotics hard.
Third is that in the US, it is extremely difficult and expensive to get new drugs approved, which creates something of a feedback loop with the economic problem you have already identified. You don’t get a new drug approved for treatment of “infection” but rather for only one thing, say strep throat. If you want to have your new antibiotic also approved for UTI, then you have to run new tests and apply anew. So if you want your new drug to be widely available in the marketplace for the things it is good for, then the cost of developing a new antibiotic is relatively high compared to developing a new drug for cholesterol, hypertension, depression, or imptence. It takes years and a huge amount of money to get a drug approved, and so the incentive to focus on chronic rather than acute illnesses is all the greater.
Ebola is not transmitted airborne; it requires physical contact with an infected person or their fluids.
Given that, it’s not likely that we’re going to see an epidemic.
If there is a slight outbreak and the public health message is to stop touching other people, Americans will all too happily oblige. In the areas where Ebola has spread, the public health message has been met with skepticism or outright distrust by many people.
We seem so eager to dismiss those Africans as ignorant and/or apt to mistrust science, and here we are in the USA with global warming, health care dispensing, and so many more area where many of us are as foolish as they are.
Then I think the answer is unfortunately no. For every person who gets ebola, they’ll spread it to an average of two people. That’s far less than, say, the flu… but about the same as HIV.
Hospitals and our larger health care infrastructure are woefully unprepared, with few institutions relaying any kind of policy or providing necessary education on ebola.
This is reflected in how terrible the Texas response has been on so many levels. I hope we’d fair better in Ma, but we shouldn’t assume it. Our hospitals and the state government better be taking Texas as a wake up call.
It sure seems to me that the mechanism of transmission– physical contact with blood, poop, or saliva– is a pretty sharp limit on the threat of this particular virus in places like North America, Europe, and Japan compared with the rural areas of sub-Saharan Africa, from which it comes, for cultural and economic reasons alone.
If it mutates along the way here and becomes airborne like the flu, then all bets are off. I am not sure any health care system could cope effectively with that.
I am far more worried about the new biolab slated for downtown Boston (what INSANITY!) than about an Ebola outbreak from any of our hospitals.
As epidemics go, Ebola (at least in its current form) is not as large a threat as a multitude of others. I grant you it has great shock value and fits well into the media news cycle, but it really isn’t high on the list of things we need to worry about.
The new biolab, handling a variety of agents far more dangerous than Ebola, is a different story. Sadly, that seems to be yesterday’s news.
Seriously? If the researcher’s homes are in Boston, would you rather place the lab in the Berkshires?
If I’m not mistaken, the place is still under-used. It’s securable, is somewhat isolated, and is within commuting distance from Boston. There’s even a commuter rail stop in nearby Ayer.
Siting something as potentially dangerous as an infectious disease lab in the middle of a city is not smart.
I don’t know about Berkshires, but I do know that downtown Boston is NOT the place for it.
There is no shortage of researchers, and it will not be hard to staff wherever it is located in MA.
Two answers: in terms of research capabilities and finding a vaccine, a resounding yes; and we’d have the trillion dollar investments into for-profit health care research at the expense of a single payer universal healthcare system to thank for that.
Single payer is still my first choice for keeping costs down and making health benefits universal, but you have to give the devil his due in terms of our for-profit research capacities.
The 2nd part of the answer: in terms of taking care of the population, should it break out in here, probably yes, we are ready also, but better hope we don’t have to find out.
I don’t think the Ebola response would be a good measuring stick for our ills in American healthcare. That does not mean, should an outbreak actually occur, that the experience gained treating the outbreak would not be transformational for the system.
Are attractive to corporations looking to sell drugs to a large affluent population (think Viagra). Ebola? Not so much, at least not now. Remember that the AIDS virus was discovered by an American scientist working for the federal government along with French scientists working for their government.
True, but the know-how exists, even if right now directed to other goals.
Here’s an example of those goals:
Note that Gilead purchased the company that developed the drug. Alton says his company will not cut the price even after it has recouped its investment.
Ebola, by itself, is a pretty bad disease. However, the specific problems seen in Africa result not solely from the disease but from the particularly tight fit between the diseases strengths and the populations vulnerabilities: illiteracy, superstition, distrust of government and long held funeral customs, in the context of a patchwork healthcare infrastructure, have contributed to a greater death toll than Ebola could have done on its own. So I don’t think that just plopping Ebola into America is going to see the same sort of problems seen in Africa and so I think we could handle it. Or, put another way, when was the last time that you either, A) touched a dead body? or 2) nursed a truly sick person on your own? Yeah, the one Ebola case in the US was wrongfully discharged from the hospital, but he was (and presently is again) in the hospital being cared for by professionals who practice contact hygiene as part of their jobs that is, even on itself, far and away better than anything seen in in Africa. So, are we prepared? I think so.
I think, for America, the closest analogy to Ebola in Africa, where the strengths of the disease work directly against our vulnerabilities in the same manner is something we’ve already seen: AIDS. I think we’re at stasis with AIDS: we can more or less treat early enough that it becomes a condition people live with rather than a disease that kills them eventually. Is this another version of your pharma heroics masking a mercenary bottom line? Perhaps. But there are a lot of people alive today who otherwise would not be, who might have a different perspective. That’s some of the mechanics of our healthcare system (payment and subsidies mechanisms notwithstanding). But, no, that doesn’t do much for the people of Africa.