Chris Blattman

“Yes you dolt, diseases can expand exponentially and Ebola just may”

That is the general tenor of some (only some) of the Twitter responses to my posts on whether or not the Ebola crisis is overhyped or not, including that from some experts who know more than I do. Some comments were less kind. Others sympathetic. Either way, it’s a fair point.

More importantly, there has been actual information coming in which is interesting. So this is a last Ebola post (I hope)—hurried, apologetically, because I’m conferencing the rest of today and this week.

First, a clarification: yesterday’s post was actually agreeing with the people pushing back (Kim Yi Dionne and Stéphane Helleringer in that case) saying “this crisis is actually, by the numbers, more serious than you think.”

My main response, which apparently I garbled a bit, was supposed to be simple: The chicken littles (I singled out and tarred an MSF post with that brush) are absolutely right about Liberia if the conditions are there for the Ebola epidemic to spiral out of control. That is the question on which many, many lives are staked.

There seem to be some partial answers, but let me get back to that in a moment.

I also wanted to make a second point: In responding, we must make sure the cure is not worse than the disease. All the negative hype will hinder, and might even destroy, Liberia’s economy for the next 5 or 10 years. Maybe the optimal response to a disease outbreak is overhype, to get the most resources possible. I’m worried about the aftershock. The cost to everyone who survives the disease looks to be very, very high in terms of lost growth, jobs, social programs, and the like.

What might be the consequences of hype? Here’s a US survey that suggests 40% of Americans are concerned about an outbreak at home and that a quarter think their family might get it. And that was two weeks ago. Frankly that smells like it might be a poorly worded question or interpretation, but either way, I think “large scale irrational fears” adequately sums up the situation.

At the same time, people like me who urge caution on the hype have a responsibility not to diminish a truly serious crisis—in this instance, the potential for the Liberia epidemic to go out of control.

Readers have made some good points and sent some useful links.

Three claims that were made, that I’m not sure are true, but are worrying if they are:

  • The recorded numbers of the disease well vastly underestimate the actual numbers
  • The people who are responding to the disease are leaving the country or dying
  • The organizations responding to the disease (the government, the WHO, etc) are doing a poor job

These seem like the right claims for researchers and the media to investigate.

Here are the models and science that I’ve been sent (please let me know if I missed some). It’s hard for me to say, but I think they paint a picture of a deadly serious outbreak, but one where it’s very unclear if it will leave Liberia or even grow exponentially for long:

Surely I am missing research. Suggestions?

One comment: having spent a lot of time running forecasting models of violence, I can tell you that extrapolating history is a reasonable but seldom reliable method. You have to factor in the response, things that interrupt the vector, etc. I can only assume epidemiological models do this.

The sad thing is that I haven’t seen the media identify these as the main questions and seek answers that are not simply speculative. Surely this is out there.

20 Responses

  1. Hansdieter, the model seems to look at the environment as homogeneous, while the environment is clearly is not homogeneous. So it could be expected that when Ebola arrives in an urban environment, the exponential function takes on a totally different form (higher: more people, more communication, more transport; lower: better health services, better education, better information.)

  2. Me too, I write about Ebola without any real expertise in the matter.

    What I read on Ebola makes me afraid:
    – yes, diseases can – and do expand exponentially.
    – In DRC, most outbreaks were in sparsely populated areas and the disease just petered out. A lack of wood to burn.
    – The treatment options don’t convince. Essentially, if you get Ebola, you die. Fleeing the region seems on an individual level a good option.
    In the DRC this meant waiting it out in the forest. In other countries, there is not a less forest to go to, and less a culture that makes forest life a valid option. The exponential growth coefficient doubles.
    – Ebola spreads through very basic human reflexes: Touching a fellow human being not feeling well.
    – Ebola starts with taking out the health care system. What is in it for the nurses? Flee while you can.
    I think the illness will peter out, because behaviour change, stop caring for the sick and weak, is enforced in a quite drastic way. But it could go in a totally different direction if it finds itself in an urban setting, with lots of people living together and lots of interactions, and the contamination spreads before it is contained.
    Humanity has a strong incentive to overreact.

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