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0 pointsbradleyland11y ago0 comments

I'm not speaking specifically about the risk to my life, but in the effect that potential outcomes have on evaluating risk. The flu argument you make is a common example thrown around in this conversation, but it's not an accurate comparison. What is the mortality rate of the flu versus ebola? When I assess risks related to ebola, I tend to favor a more cautious approach, because the mortality rate is so high.

This is part of a popular meme that is showing up on the news. They ask questions like, "True or false, you are more likely to die from ebola than the flu." The mark replies "true", and a doctor (medical doctor, not a statistician) is quoted explaining that "You're actually more likely to die from the flu." This could not be more incorrect.

Mortality rates for diseases like the flu (or any disease) are not homogenous for all members of the population. It's not like a roll of the dice. You simply cannot extrapolate an individual's odds from the broad population mortality rate for the flu (or any disease). It is extremely unlikely that I will die from the flu. I am a middle-aged male in good health and fitness. My chances of dying from the flu are extremely low. The reason the flu kills so many americans is because it is so prevalent. It could be said that flu kills so many precisely because it is so non-lethal. This allows it to fly under our radar and infect people who are at risk. I'm not arguing that we shouldn't take action to prevent the spread of influenza, I'm arguing that the flu presents a different set of problems.

My chances of contracting ebola are also extremely low, but if I do, my chances of dying from it are very high. Across the board (all ages and classes), the mortality rate for ebola are much higher than the flu. Unfortunately, we don't have a strong grasp on ebola mortality rates in the west, because we haven't (thankfully) experienced an outbreak. Even in develping countries, the mortality rate varies widely [1].

I agree that we shouldn't let fear run away with our sensibility, but when dealing with a highly infectious disease [2] with a remarkably high mortality rate, we should be cautious. If not fully quarantined, a period of sensible precaution is a reasonable expectation. When the sun is at its strongest we're advised to wear sunscreen and limit our exposure. When an individual spends time with ebola patients, they should be advised to avoid situations where they would expose a large number of people to the pathogen. Flying, taking public transit, and participating in sports are all activities that put you in direct or indirect contact with large numbers of people. This seems like an unreasonble amount of risk to me.

1: http://www.npr.org/2014/10/23/358363535/why-do-ebola-mortali...

2: Even though ebola must spread through bodily fluids, it is extremely infectious. A small amount of the virus can infect you.

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hackuser11y ago

> What is the mortality rate of the flu versus ebola? When I assess risks related to ebola, I tend to favor a more cautious approach, because the mortality rate is so high.

I think that raises a several good points. A few considerations:

1) The 'proper' way to evaluate risk, as I understand it, is (likelihood * cost). A 10% chance you'll lose $100 costs you $10 each time you take that risk, over time.

2) I agree that some costs are so high that the math works poorly even with low likelihoods. A 1% chance of death is far too high a risk to take, unless there is some high payoff such as saving someone else's life -- a risk the infected doctor and nurse took.

3) The cost of Ebola is that high, but the likelihood is so infinitesimally low that it's still not worth worrying about. You'll add more life years exercising or simply reducing other risks with the same time spent thinking about Ebola. It's a complete waste of time (I realize the irony of writing that! :) ).

4) There are many more equally deadly and far more likely risks for healthy middle-aged people: Lightening strikes, natural gas explosions, being shot in the head, carbon monoxide poisoning, food poisoning (of certain kinds), other contagious and non-contagious diseases, etc.

5) > When an individual spends time with ebola patients, they should be advised to avoid situations where they would expose a large number of people to the pathogen ... This seems like an unreasonble amount of risk to me.

Generally I agree that we should minimize risks, but again I'm not sure there is one here:

* It's very possible that it's very safe. Nobody in the United States (in fairness, that we yet know of) has contracted Ebola in this manner from the infected 3, though two of them spent much time around others. Also, wouldn't Ebola be rampant in the hospital where the infected nurse worked, if this was a risk? Wouldn't it be rampant among medical staff in W. Africa, given the prevalence in their environment (higher than flu in those facilities)? * HIV spreads via bodily fluids but we don't quarantine the infected or their caregivers. However when HIV first become known, people were afraid to be near the infected (resulting in a lot of discrimination). I think we should not repeat that mistake. * I would guess that hospital workers encounter many contagious, deadly diseases, yet nobody worries about those spreading.

People want to treat Ebola differently despite many similar and much greater risks. That's why I believe it's fear and not real risk that drives it.

Anyway, I'm approaching redundancy. Good talking to you!

001sky11y ago

That's why I believe it's fear and not real risk that drives it.

What other BSL-4 pathogen are you referencing here? Or are you suggesting BSL-4 is an unappropriate classification? Maybe you think the scientific and biosafety community erred when they created the BSL-4 designation?

There is plenty of research out there that documents the objectibe risk.

There is very little research that documents supports a strategy of "see no evil, hear no evil, speak no evil".

People don't need to panic.

But that's entirely seperate from lack of comprehension of the actual risks involved. After all, you can't solve problems you don't admit to having.

Trying to deal with a BSL-4 pathogen with BSL-2 safety gear is a fools errand. We might not havy any better options, especially in backcountry settings, but lets not pretend its "not risky".

In densely populated urban areas those risks are simply not tolerable. They are not tolerable for two reasons: (1) we can do better; and (2) the technology that allows for (1) makes the risks of not doing (1) more problematic.

Technology allows us to isolate patients; but it also allows non-isolated patients to spread the pathogen further/faster. People with hemoraggic fever don't walk 1000Ks or cross continents on their own power. They only do so by using technology.

It makes sense that the appropriate technology be dedicated to helping contain these bio-hazards and to compassionately care for the afflicted.

But seriously, what do we have to gain by sticking our heads in the sand? It seems this is a cynical strategy by people who don't want to "get their hands dirty"? Mayb we can continue to provide false confidence to 'volunteers' to go to africa and do our dirty work for us?

Why do we need to play this charade? Lets just give these people the tools they need (including time, money , and gear) and properly de-brief them and the public about the risks and what is at stake from either mistakes or inaction.

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