Ebola! Panic! - or not

The bottom line here is to head the advice from "The Hitchhiker's Guide to the Galaxy" by Douglas Adams.  The advice is simple:  Don't Panic.  For the last several weeks we have been getting the opposite advice.  We have been told by many august personages on many occasions not only to Panic!  But to PANIC!!!  But in the last day or so I have detected indications that things are about to change.  I have even seen some indications it is already starting.  The new message is the proper one, namely don't panic.  It would be nice if the "don't panic" message is given prominence equal to that of the old "panic" message.  Instead, if the past is any indication, the message on Ebola will instead change to silence.  Rather than rehash what has already been hashed (i.e. "don't panic" was always the correct message) I am going to delve into two subjects.  The first is why we have been hearing "panic" so loudly and from so many quarters.  Ebola has only actually affected a few people in the U.S. to date.  It's hard to justify all the outcry.  But what if an epidemic eventually developed?  Then it might be not unreasonable to panic.  Rather than debate the issue I am instead going to look at how an epidemic could be handled to see if even this scenario justifies any of the hype.  Proceeding . . .

There is a sophisticated and powerful entity at work in our culture.  I am going to call it Fear, Inc.  If you check with the Securities and Exchange Commission you will not find a company of that name listed.  That's because it is an informal group acting in concert rather than an actual company.  The name is an homage to Murder, Inc., another organization that was never incorporated.  In the case of Murder, Inc. there was an actual group of specific people who identified with the name.  It was the nickname used by a group of contract killers that worked for the mob in the '30s and '40s.  Together they were purported to be responsible for between 100 and 500 murders.  The group was ultimately broken up by a concerted effort by the federal government.  Thomas E. Dewey was one of the government men who was part of the effort.  He parlayed the notoriety he gained from busting up Murder, Inc. into a run for President as the candidate of the a Republican party.

With Murder Inc. were specific people you could point to.  If you asked them and got an honest answer they would admit to being members of Murder, Inc.  In some cases they would even see it as a source of pride.  The membership in Fear, Inc. is much more widespread.  And, like Murder, Inc. it is possible to identify members or the organization.  But the members of Fear Inc. would vehemently deny being a member.  In some cases they would go so far at to accuse others of being members.  So while no one is willing to admit to being a part of Fear, Inc.there is definitely a fear industry.  And while they might wish to decline the offer, I am willing to call people who do the work of the fear industry members of Fear, Inc.  They deserve the accolade as much or more as the members of Murder, Inc. did.  So who are these people?  They are politicians and members of the news media.  Let me start with an explanation of how this works when it comes to politicians.

At least theoretically in the old days politics was a "may the best man (it used to be all men) win" competition.  On the other hand, Finley Peter Dunne in an 1895 newspaper column observed that "politics ain't beanbag".  But for a long time afterward there still seemed to be an agreed on set of rules to the game.  And one rule required everybody to at least pretended that political campaigns were about the great issues of the day and not trivia.  That is manifestly no longer true today.  In the past few days there has been a tornado of coverage concerning the fact that one candidate for the governorship of Florida likes to use a small fan to keep cool at political events.  Coverage of the issues this contest should be about is conspicuous by its absence.  And that's just one example of dozens I could point to.  A lot of political coverage is about trivia and not about the great issues of the day. There is a new book out by Matt Bai called "All the Truth is Out:  The Week Politics Went Tabloid".  I have not read the book but I have heard good things about it.  Bei contends that a substantial shift away from issues and toward trivia happened in a single specific week.  I am not interested in the how or the when of this shift.  I am only interested in the fact that it has happened.

With that as background consider two candidates:  Smith and Jones.  Both of them are vying for some political position.  Both are human so both have flaws.  Let's say you are Smith and Jones seems to be the better candidate when viewed through the lens of "the great issues of the day".  What do you do?  Most people do not put a lot of effort into picking a candidate to vote for.  And if a candidate does a lot of "right" things but does one thing you think is very wrong what do you do?  Well, in election after election in my experience, you vote for the other guy.  You do this in spite of the fact that the other guy does a lot of wrong things.  All that is necessary for things to work this way is for you to not have your nose rubbed in the wrong things the other guy does.  This observation leads to the solution to Smith's problem.

Let's say you can pin something on your opponent.  Let's say you can make that thing sound like a "terrible, horrible, no good, very bad" (to steal from a movie title) thing.  And let's say your opponent fails to do the same thing back to you.  Then you have the election in the bag.  So is my analysis correct?  It doesn't matter because political consultants believe it's true.  So they advise candidates to "go negative", to find something that you can be pined on your opponent and make him or her sound "terrible, . . .".  As just one example of this let me go all the way back to 1960 and the Kennedy/Nixon race for President.  The conventional wisdom is that Kennedy won the TV version of the first debate because Nixon looked like he had a 5 o'clock shadow.  The conventional wisdom also says that people listening to the same debate on the radio thought Nixon won it.  That election was close and conventional wisdom says that the "5 o'clock shadow" debate tipped it to Kennedy.  Once an idea like this gets established then people behave like it's true and whether it is actually true or not is longer important.

Now let's also say that voters think a particular election is not very important.  They might think "there's not a dime's worth of difference between my two choices", for instance.  What do voters who think like this do?  Well, a lot of them stay home.  It doesn't do a candidate any good to convince a voter she is the right candidate if that voter doesn't actually vote.  But let's say that in a particular race one candidate is a bland nonentity but the other candidate is a "terrible, horrible, no good, very bad" candidate.  Then voters who think like this will show up at the polls and vote reliably for the bland candidate.  Why?  Fear!  They are afraid the "terrible, . . ." candidate will win and this, of course, will result in "terrible, . . ." things happening.  If you want someone to actually do something specific then fear of a bad thing happening is a much more effective motivator than something where one of two things can happen and neither thing is very bad.  This is true even if one of the things is much better than the other.  Politicians, or more importantly their consultants, have figured this out.  And this is why elections are so negative.  Scaring voters into being afraid of your opponent is much more effective than convincing them of your wonderfulness.

And this is why political campaigns have become so horrible.  Everyone hates them.  Voters would much rather vote for some positive good thing than otherwise.  Campaigns are designed to convince voters that one candidate is wonderful and the other candidate is horrible.  But the efforts of each campaign to convince voters that the other guy is horrible are more effective than their campaign to convince voters that their guy is wonderful.  This results an voters deciding both candidates are horrible, becoming disgusted with the whole business, and in many cases staying home.  "A pox on both their houses."  Nobody has figured out how to get out of this box.  So all candidates are merchants of fear.  They feel they have to do it to win elections.  And if they can convince voters that the other candidate is to be feared and they are not to be feared then they are right.  They will win the election.

A case can be made that some candidates or parties rely more heavily on fear than others.  But everyone does it.  And, of course, what works as an election strategy unfortunately is also applied to governance.  Once a candidate is elected she wants to be seen as effective.  Again there are tons of good things she can do.  But voters don't remember.  What they do remember is when you saved them from that "terrible, horrible, no good, very bad" thing happening.  Again, it doesn't matter if it is actually "terrible, . . .".  It only maters if you can sell the story that it is "terrible, . . .".  So in the little time not devoted to fund raising for the next election, and there is almost always a next election, politicians search for and try to exploit whatever "terrible, . . ." thing comes their way.  So that's why politicians carry water for Fear, Inc.  Why does the news media?

Well, in a lot of ways the news media has the same problem politicians have.  With politicians it's black and white.  Either you win the election or you lose it.  With the media it is shades of grey.  But it ends up the same.  You see the news media's job is not to tell you as clearly and as well as they can what's going on with an accent on the important stuff.  The news media's job is to attract eyeballs so that their endeavors will result in high ad rates.  The news media is in a continuous election situation.  They win or lose not based on how many votes they get but on what their Neilson numbers are, or their subscription numbers are, or how many "click throughs" they get.  And here too fear works.  You have your choice of TV shows to watch or Internet channels to follow or newspapers to read.  And in each case you also have the chance of "staying home" by not watching or following or reading the paper.

Again, harkening to a previous era, if you see a newspaper on a news stand and there is a three inch headline that says "WAR" are you going to buy the paper?  Of course you are.  Similarly, if you see a "WAR" banner on a web site you are certainly going to click through.  War is a very frightening event.  Now what happens if you see a much smaller headline saying "GDP up for fifth straight quarter" (definitely good news) or "talks stretch into third straight week" (neutral news), then what?  You might decide to check in later or skip it altogether.  And a decision like that, if repeated by many others, results in depressed ratings, clicks, or circulation.  News organizations don't like that.

The history of CNN's rating bears this out.  If there is a big story like a war their ratings go up.  If it is a "slow news day" their ratings go down.  And people are attracted to bad news more strongly than good.  So it is in the economic interest of news organizations to convince the public that something bad has just happened or is about to happen.  And, as with politicians, it doesn't much matter what the actual importance of the bad news is.  It is only important that the public can be convinced that whatever it is, it's bad, very bad.  The importance of finding "important" bad news has long since filtered down to front line reporters.  They all know their job is to make "it", whatever "it" is, sound very bad.  The reporters that don't "get the memo" either don't last long or they end up at news organizations no one has heard of.

Ebola falls squarely into this category.  As I write this exactly one person has died in the U.S. and only a handful have contracted the disease.  For comparison I checked out the "Around the Northwest" section of The Seattle Times, my local newspaper, for one day.  I picked Saturday October 18 because nothing particular was going on.  This feature is a collection of short items of interest (in the opinion of the editorial staff) to readers but which are not sufficiently important to rate a stand alone story.  To give you an idea of what I'm talking about the feature takes up less than a whole page and appeared on page B-4 that day.  However, this one selection from an unimportant part of the paper for one ordinary day gave details on three deaths.  So the death of one person on one day across the entire United States should not be that big a deal.  But vast amounts of coverage have been devoted to Ebola in the U.S.  Currently there are a small number (less than ten) of other people in the U.S. who have been diagnosed with Ebola.  But there is a good chance that all of them will live.

So the "Ebola in the U.S." story has been massively over-covered.  And it has all been heavily laden with a "be afraid, be very afraid" subtext.  In fact, in a lot of cases the "text" has been less than "sub".  It has been blatant.  And every wing and branch of the media has been guilty of fear mongering.  Some outlets have been more guilty (Fox and other right wing outlets) but everybody has been doing it.  One trick a lot of TV news uses is to have the talking head say the right things while video of ambulances and other scary stuff runs in the background.  Another piece of conventional wisdom holds that pictures, particularly moving pictures (and the video they use always has a lot of movement in it) trump whatever the talking head is saying.  So these other less-blatant outlets are just using a more subtle technique to scare us to death.  And they can pull the trick off of getting the ratings while maintaining the fiction that they are responsible journalists.  "Nice work, if you can get it, and you can get it if you try."

So politicians and the media are selling us fear.  Why is it working?  At some level everyone knows that one death and a handful of sick people are not that scary.  Sure, there is great video of emergency vehicles running around with lots of lights flashing and people walking around in moon suits.  I admit that's "compelling", as in "good for ratings" video.  But it's not enough.  So why did it work?  In a word, epidemic.

If one person can die and a bunch of people can get sick what happens if a whole lot of people get sick?  If we ignore the experts who claim it won't happen and assume it happens anyhow, what happens?  "We're all going to die!", that's what happens.  This is the fear mother load.  "Responsible" journalists don't go there.  Instead they drum up every tiny nugget of "some expert got it wrong" they can find and let people fill in the blanks.  I am not going to rehash all the reasons why an epidemic is not going to happen.  Instead I am just going to cut to the chase.  I am going to assume that somehow an Ebola epidemic breaks out.  We have thousands of people getting sick all over the place.  What then?

Now that I have you on the edge of your seat I am going to make a digression.  Early in my career I worked with a lot of IBM equipment and people.  I got to know how IBM operated.  The IBM of that period was a classic "not invented here" organization.  To IBM's way of thinking if it wasn't invented or developed inside IBM it was no good.  IBM was very successful for a long time with "not invented here".  It was finally forced to change in the early '80s when it brought out the IBM PC, which was composed of parts (both hardware and software) that were, in fact, invented somewhere else.  And those same Fear, Inc. yahoos, politicians and the media are now fierce proponents of "not invented here".  Ebola was beneath notice as long as it was happening in Africa.  Hundreds then thousands of deaths - not a problem.  It's happening way over there.  Ebola only became worthy of notice when it washed up on our shores.

That's bad.  But what is worse is that our response to Ebola has suffered, and badly, from a serious case of "not invented here".  Africa has been dealing with Ebola for decades.  There have been dozens of outbreaks.  They have all been contained.  Is this current outbreak somehow different than the previous ones?  Yes!  But the differences are ones of scale rather than kind.  This time Ebola broke out in countries that had non-existent medical systems.  They also had poor to non-existent communications, roads, etc.  So Ebola could break out and spread widely before anyone even knew anything was going on.  When they did recognize they had a problem they lacked the resources to deal with it.  Ebola is a problem in Africa not because no one knows what to do.  It is a problem because no one has the resources to do what needs to be done.  But that is all happening over there.  So we flounder around trying to figure out what to do without making a serious effort to find out what they did over there that worked.  A polite version of what we did instead goes by the phrase "reinventing the wheel".  Why? Because judging by our actions we believe we are smart and special and everyone else is dumb and ordinary.

So let's say a large epidemic of Ebola broke out in the U.S.  What should we do?  Well, there's U.S. Ebola response, version 1.  This is what Texas Health Presbyterian Hospital did.  That resulted in patient zero dying and two health workers getting infected.  So let's not do that.  Then there's U.S. Ebola response version 2. The virtue of version 2 is that it's working.  We have a small number of facilities that are set up to handle the most contagious diseases.  So far no one treated at one of these facilities has died.  And so far no one has caught Ebola at one of these facilities from the patients they are treating.  These are both good things.  The problem is that there are only four of these facilities and they can only handle about ten patients between them.  If we have hundreds or thousands of infected people that's not going to work either.  So we now move on to what I think a successful system for dealing with large numbers of Ebola patients would look like.  Call it version 3.

And version 3 is based on what worked in Africa.  Two countries in Africa have successfully eliminated Ebola after having had at least one case.  If they can do it, we should be able to.  Both of these countries are third world countries.  What separates them from the countries where Ebola is endemic is that they both have primitive but functioning health care systems.  All the countries where Ebola is raging are countries that recently emerged from civil war.  Whatever health care system they had was wiped out by the war.  The fact that there was no health care system to build on is what has made it so hard for these countries to get a handle on Ebola.  But if you talk to the right people in Africa you can find out how to successfully defeat Ebola.

And it turns out that you don't really have to go to Africa.  Doctors Without Borders is the U.S. branch of an international organization headquartered in France.  Doctors Without Borders knows how to successfully deal with Ebola patients.  Then there's the Bill and Melinda Gates foundation.  An operation funded and organized by the Gates Foundation was the key to wiping Ebola out in Nigeria.  So "who are you going to call?"  Call the Gates Foundation or Doctors Without Borders.  Pick whichever one you want or call both of them.

I have not actually called either of them.  But if you poke around enough you can find out what they would say if you did call them.  And here's the formula:

Step 1 - diagnosis.  People who are not actively symptomatic are not dangerous.  If a person is not running a temperature they are safe.  So monitor people's temperature.  There has been an argument about what the critical temperature is and people have said that the CDC screwed up by letting one of the current patients fly.  She had a temperature but it was below the threshold.  And at the time she had that temperature she probably was not dangerous.  Her temperature later rose quite a bit and she came down with the disease.  But so far none of the people on the plane with her have come down with the disease.  (It is too soon to be 100% sure no one will come down but I'm betting none of them will.)  The other thing to remember is there is a test for Ebola.  The test doesn't take very long to get a result.  But a person in early stages tests negative.  Of course, at that point they are also not dangerous.  I don't know if we have a lot of test kits.  If we don't this could be a serious problem in an epidemic situation.

Step 2 - Isolation.  We are currently using high end isolation units.  That works but we only have a few.  The "isolation" Texas Health Presbyterian Hospital used was ineffective.  As is common, the media provides few in any details.  But I suspect that the nurses that got infected had the wrong kind of protective gear or used it incorrectly.  I do not fault them.  As far as I can tell both of them followed directions.  But what the Africa experience tells us is that all skin must be covered.  The disease is transmitted by skin contact with infected bodily fluids (sweat, diarrhea, vomit, etc.).  Some reports indicate their necks were exposed.  The Africa experience also tells us that it is very difficult to properly disrobe.  If infected bodily fluid on the outside of the protective gear ends up in contact with your skin you can get infected.  The Africa experience recommends training and a buddy system.  Your buddy verifies that you have donned and most importantly doffed your protective gear properly.  My understanding is that the nurses were not using the buddy system.  The gloves, moon suits, etc. are broadly available and can be procured in large numbers.  The proper technique can be taught and adopting the buddy system is a matter of procedure.  So all this can be easily scaled up to large numbers.

Step 3 - Disinfection part 1.  It turns out that the virus is easy to kill.  A chlorine solution works pretty well.  So is a chlorine solution hard to come by?  No!  It's what you find in every swimming pool and hot tub.  You can go to any Home and Garden store or Spa store and buy large bags of the proper chemical.  And a single bag of the chemical goes a long way.  You also need a sprayer.  A bug sprayer from any Home and Garden story will do just fine.  Part of the Isolation/Disinfection problem is where do you put all these sick people?  Initially all the infected people of Texas Health Presbyterian were put in standard isolation rooms.  That didn't work.  So do we need to go all high tech like the units we are currently using?  No!  Tents in a field will work fine.  That makes it easy to physically separate each patient and provide paths the care givers can use to go about their business while being physically separated from the source of the infection most of the time.  We have lots of fields.  And we have lots of tents.  The Africa experience also recommends gravel.  Why?  Because they recommend a lot of sluicing people and things down with the chlorinated water.  If the ground is gravel then everything drains away where no one can step on it.

Step 4 - disinfection part 2.  People who get really sick with Ebola generate a large volume of bodily fluids.  They can get a bad case of diarrhea.  They can vomit a lot.  They can sweat a lot.  They can toss and turn a lot.  So there is a lot of dangerous material generated.  And this can get smeared around a lot.  It can get on the clothes of the patient, the bed linen, the moon suit, anything else in the vicinity of the patient.  You take all this together and there is a large volume of contaminated stuff to deal with.  Texan health Presbyterian is rumored to have filled a room completely full of contaminated stuff.  The Africa experience recommends burning all of it.  This is harder to do than it would seem.  You need to make sure no contaminated surface comes into contact with anything it's not supposed to. If you get all the contaminated material safely into the "burn box" of the incinerator (a high tech fire place) and you burn it all up then everything is fine.

One of our high tech isolation facilities uses a different solution.  They autoclave everything.  So what's an autoclave?  It is a high tech pressure cooker that was invented about 150 years ago.  It turns out there are some viruses (Ebola is not one of them) that can survive normal steam at 212 degrees Fahrenheit.  An autoclave is a pressure container.  You put some water and whatever you want to sterilize inside and fire it up.  It heats the water under pressure.  This lets the temperature rise to well over 212 thus killing everything.  This idea of autoclaving everything works just fine.  And there are a lot of autoclaves around if you look hard enough.  But is there a third option that is less drastic than burning everything and easier to do than autoclaving everything?  I think so.  Get a back yard type inflatable swimming pool.  Inflate it and fill it with chlorinated water.  Then dump stuff in it like bed clothes, moon suits, whatever.  Stir everything around thoroughly, say for 20 minutes.  I think this would work fine.  But if anybody has tested this I don't know about it.  So this technique should only be tried if it turns out you can't burn everything or autoclave everything.  But I bet it would work.  It has the virtue of being a simple, cheap, high volume solution.

We are now done if all we want to do is stop the epidemic.  Of course, a lot of our patients will die.  So how about actually treating out patients and trying to save their lives?  This is not necessary to stop the epidemic but it seems like a good idea if we can pull it off.  Based on what we now know it may not be possible to save everyone.  In the primitive conditions in Africa they are able to keep most medical personnel safe and save the lives of about half the patients.  Of the patients treated in the U.S. however, only one has died and he was not properly treated in the early stages and perhaps not properly treated in the later stages either.  But several people who received treatment elsewhere in the U.S. are alive and fully cured.  And the prospects are good for the several people who are in treatment now.  So let's see what can be done in an epidemic situation.

Step 5 - Mitigation.  Ebola is a standard infectious disease.  The virus is introduced into the body.  It finds a cell and attacks it.  It then seizes control of the cellular machinery and reprograms it so it starts making lots of copies of the virus.  Eventually the cell can't take it any more.  It explodes and the many copies of the virus escape and start searching out other cells to infect.  This goes on for a while.  Then the surveillance systems of the body figure out something is wrong.  They start formulating a defense and attacking the viruses.  Things soon start looking like two armies engaged in total war.  Each side appropriates whatever resources it needs to take the fight to a new level.  Eventually one side wins.  If it is the virus the patient dies.  If it is the defenses the patient lives.  But like total war both armies wreck havoc.  This havoc is what makes people sick.  If the defenses kick into action early and are quickly successful the patient doesn't get very sick.  If the defenses are slow or respond poorly then the havoc caused by the warring forces overwhelm the body and the patient dies.  So the secret of success is twofold.  First, keep the patient alive long enough for the defenses to overcome the virus.  Second, do what you can to give the defenses what they need to be effective and to operate quickly.

Step 6 - Sharps.  This isn't really a step.  It's a problem.  What if you have done everything well with your moon suit and it gets a hole poked in it?  Now bad things can happen.  In Africa, they are short on resources.  So they put minimal effort into keeping patients alive.  Their priority is keeping health workers safe.  So they ban anything with a sharp edge.  This means knives (scalpel anyone), needles (including IV needles), and even pretty much anything metal, like a bracket on a piece of furniture.  If there is nothing around that can tear the moon suit it won't get torn.  Remember in Africa they are very resource constrained.  They have to stretch what they have as far as they can.  Hopefully, even in an epidemic situation we will not be forced to take such drastic actions.  So . . .

Step 7 - Basic support.  If we can avoid the situation where the patient gets horribly sick then all kinds of good things happen.  The body does not have to put up with nearly as much abuse while its defenses are dealing with the Ebola virus.  This means more resources can be directed to the defense without putting the patient's life in danger.  This also means the defense can work more quickly and effectively because it can use more resources without putting the body in danger.  This improves the chances of the defense winning the race and the patient surviving.  It also means a lot less contaminated material to deal with.  Support can be very low tech.  A lot of children in the third world die of dehydration.  They get sick.  They can't keep anything down.  They get dehydrated.  They die not of the sickness but dehydration.  There is a simple and inexpensive solution that can literally be a lifesaver.  It is a mixture of water and salt and sugar.  The formula can be found on the internet and it is extremely cheap.  The formula is designed to provide liquid to directly fight the dehydration and basic nutrition in the form of the sugar to keep the body strong.  And the formula has been carefully designed to be easy on the digestive system.  Kids that can't keep anything else down can often keep this solution down.  So you feed the Ebola patient as long as they can keep anything down then switch to the solution.  This keeps the patient in good shape further into the progression of the disease.  This can make a great deal of difference.

Step 8 - Aggressive support.  The standard hospital procedure for sick people is to start an IV and then push saline, nutrients, etc.  The problem is that the end of the IV is a needle.  This is a problem because of the whole "sharps" thing.  But it is also a problem because of the fact that some Ebola patients in an advanced stage suffer a general deterioration of their blood vessels.  This means it is hard to start an IV, keep the IV working, and avoid problems.  Patients can bleed at the IV site because their blood vessels are in such bad shape.  Apparently the top tier facilities can deal with this sort of thing at least some of the time.  Certainly, if you can get the IV to work and you can avoid moon suit punctures then this should help the patient through the worst of the disease progression.

So let's review where we are at.  We should be able to handle a large number of simultaneous patients as far as controlling the spread of infection.  We can also keep the people caring for the patients safe.  The only possible problem I see up to this level is whether there is a sufficient quantity of the materials to do Ebola tests.  I think there probably is but I am not sure.  Beyond that we can do some things for sure that improve the patient's chances of survival.  This is not necessary to stop the epidemic but it is a good thing to do.  I am not sure there are aggressive support measures that can be broadly deployed.  If there are, so much the better.  That leaves one more item:

Step 9 - Counterattack.  So far I haven't covered anything having to do with going after the virus.  There is one definitely feasible thing that can be done.  As the body mounts a defense it creates antibodies.  These assist the defense to get going more quickly and be more effective.  Any patient that has had Ebola and survived has antibodies in their blood.  In several cases matched blood from a survivor has been transfused into sick patients.  It seems to help for pretty obvious and well understood reasons.  This is a technique that is easy to ramp up.  If you have lots of patients you should end up with a lesser number but still a substantial number of survivors.  This should give you a pool that is large enough so that matching should be possible and the amount of blood should be significant.  And as the epidemic ramps up the number of blood donors should also ramp up.  Beyond that there are a number of booster drugs that have been developed.  The problem is that none of them have been tested enough to determine if they help or not.  And beyond that there are a number of vaccines that might prevent people from getting Ebola in the first place.  Here too no one has been able to do enough testing to tell if they help or not.

So that's it.  I have laid out how it is easily possible to deal with a widespread epidemic.  So the unspoken great fear is not so fearsome.  And let me finish with some more fear busting.  Something like 50 people were on a tracking list due to their possible exposure to patient zero.  This includes people who were cooped up in a small apartment with patient zero while he was very sick and therefore very contagious.  Many of them have now cleared quarantine.  They didn't catch Ebola.  The rest of them will clear quarantine within a few days.  So far none of them have caught the disease.  In other words, what the experts have been saying all along is true.  Ebola is fairly hard to catch.  Of all the people who were exposed to patient zero only two nurses have caught the disease.  And this group now includes lots of other medical professionals at Texas Health Presbyterian Hospital who presumably also had lots of chances to catch the disease from patient zero.

I expect this news to filter out to the general public over the next few days.  It will allay a lot of fears.  It also looks likely that everyone in the U.S. who now has the disease will survive.  This will also allay a lot of fears.  Ebola goes from an "it kills everyone" disease to an "a lot of people survive it" disease.  It would be nice if the news media super saturation coverage that has characterized the Ebola story to date would continue long enough to get this good news out.  Instead I expect this news to disappear quickly.  It just won't be able to compete with whatever we are supposed to be afraid of next.