donderdag 16 oktober 2014

Concerned about Ebola? You’re worrying about the wrong disease.!

Despite the terrifying headlines, almost none of us will get sick from Ebola – our fears often bear little relation to reality


Villagers in Liberia are made aware of the dos and don'ts when faced with an Ebola outbreak
Villagers in Liberia are made aware of the dos and don’ts when faced with an Ebola outbreak. Photograph: Eyepress/Sipa/Rex
A deadly disease is set to hit the shores of the US, UK and much of the rest of the northern hemisphere in the coming months. It will swamp our hospitals, lay millions low and by this time next year between 250,000 and 500,000 worldwide will be dead, thousands of them in the US and Britain.
Despite the best efforts of the medical profession, there’s no reliable cure, and no available vaccine offers effective protection for longer than a few months at a time.
If you’ve been paying attention to recent, terrifying headlines, you may assume the illness is the Ebola virus.

Instead, the above description refers to seasonal flu – not swine or bird flu, but regular garden variety influenza.
Our fears about illness often bear little relation to our chances of falling victim to it, a phenomenon not helped by media coverage, which tends towards the novel and lurid rather than the particularly dangerous.
Ebola has become the stuff of hypochondriacs’ nightmares across the world. In the UK, the Daily Mirror had “Ebola terror as passenger dies at Gatwick” (the patient didn’t have Ebola), while New York’s news outlets (and prominent tweeters) experienced their own Ebola scare.
Even intellectual powerhouses such as Donald Trump have fallen into panic, with the mogul calling for the US to shut off all travel to west Africa and revoke citizens’ right to return to the country – who cares about fundamental rights during an outbreak?

Not to be outdone, the endlessly asinine “explanatory journalism” site Vox informed us that “If the supercontinent Pangaea spontaneously reunited, the US would border the Ebola epidemic”.
Ebola is a horrific disease that kills more than half of people infected by it, though with specialist western treatment that death rate would likely fall a little. It’s unsurprising that the prospect of catching it is a scary one.

The relief is that it’s not all that infectious: direct contact with bodily fluids of a visibly infected person is required, meaning that, compared with many illnesses, it’s easily contained.
Even in the midst of the current outbreak – the worst ever – the spread of the disease has not been rapid in west Africa: around 400 new cases were reported in June, and a further 500 or so in July.

This is a linear spread, meaning each person at present is infecting on average around (actually just over) one additional person.
Far more worrying are diseases that spread exponentially: if one infected person spreads the disease to two or more on average, the illness spreads far quicker and is a much more worrying prospect, even if mortality is considerably lower.
The 800-plus deaths from Ebola in Africa so far this year are indisputably tragic, but it is important to keep a sense of proportion – other infectious diseases are far, far deadlier.
Since the Ebola outbreak began in February, around 300,000 people have died from malaria, while tuberculosis has likely claimed over 600,000 lives.

Ebola might have our attention, but it’s not even close to being the biggest problem in Africa right now.

Even Lassa fever, which shares many of the terrifying symptoms of Ebola (including bleeding from the eyelids), kills many more than Ebola – and frequently finds its way to the US.
The most real effect for millions of people reading about Ebola will be fear and stigma. During the Sars outbreak of 2003, Asian-Americans became the targets of just that, with public health hotlines inundated with calls from Americans worried about “buying Asian merchandise”, “living near Asians”, “going to school with Asians”, and more.
Similarly, during the H1N1 “swine flu” outbreak, which had almost identical spread and mortality to seasonal flu, patients reported extreme fear, prompted largely by the hysterical coverage.
In the coming months, almost none of us will catch the Ebola virus. Many of us, though, will get fevers, headaches, shivers and more.
As planes get grounded, communities are stigmatised, and mildly sick people fear for their lives, it’s worth reflecting what the biggest threat to our collective wellbeing is: rare tropical diseases, or our terrible coverage of them.

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Ebola is highly contagious … plus seven other myths about the virus


The Ebola outbreak is serious, but the nature of the epidemic is often misunderstood – and inappropriate measures suggested
German Red Cross trains Ebola volunteers
A volunteer doctor travelling to west Africa to help care for Ebola patients takes off an isolation suit during during training offered by the German Red Cross. Photograph: Timm Schamberger/Getty Images
The Ebola outbreak has been claiming lives in Africa for many months now, but following the first Ebola death from a case diagnosed outside the continent, coverage – and concern – in the west has stepped up yet another notch.
The outbreak is certainly a grave issue for west Africa, a public health priority, and has been exacerbated by a slow response from international bodies and rich nations. It has already claimed more than 3,800 lives, and could claim far more without an appropriate international response.
But it is also not the species-ending disaster some fear it could be. Below are eight Ebola myths, and an attempt to set out the real position.

1. Ebola is highly contagious

Compared with most common diseases, Ebola is not particularly infectious. The primary risk of catching Ebola comes from the bodily fluids of people who are visibly infected – primarily their blood, saliva, vomit and (possibly) sweat. These can transmit the disease if they make contact with the mucus membranes (lining of your nose, mouth, and similar areas).
Each patient in the current Ebola outbreak is infecting on average two healthy people (this figure, known as the R0 value, can be reduced with appropriate precautions). The Sars outbreak of 2002-03 had an R0 of five, mumps 10 and measles a huge 18. Ebola could be much more infectious than it is.

2. You can catch Ebola from someone who looks perfectly healthy

You almost certainly can’t. Ebola has an incubation period of up to 21 days between infection and showing symptoms (though it’s generally shorter). This is part of the fuel behind fears people could travel from west Africa then spread the disease.
However, in general, people who display no Ebola symptoms are not yet infectious – and in any case, casual social contact (being nearby, or even shaking hands) generally doesn’t spread the virus.
The exception actually lies with those who have had Ebola and recovered: studies suggest the virus can linger in semen for up to three months after recovery – so you may wish to think twice before having sex. Or at the very least, use a condom.

3. If you catch Ebola, you’ll almost certainly die

The most widely cited figure about Ebola is that its death rate is “up to 90%”. The history of Ebola, prior to this year, is a series of short-lived and very isolated outbreaks of different strains of the disease, and it is true that one of these outbreaks had a fatality rate of 90%.
Thankfully, this outbreak has a lower death rate. At present, about 8,000 people have been confirmed as diagnosed with Ebola, and of those 3,865 have, sadly, died. This is a fatality rate of 48% (though it could increase as some of those still ill die) – tragically high, but not nearly as bad as it could be.
Given the rudimentary and overloaded conditions in many of the hospitals in affected areas, it is likely this rate could be lower still for patients with access to top-tier medical care.

4. We should quarantine anyone with ‘Ebola-like symptoms’

This would lead to a lot of people being quarantined: if you want an accurate list of symptoms for early-stage Ebola, simply imagine the last time you (or someone you know) had flu – the two are almost indistinguishable at first.
This set of symptoms, shared among many common ailments, is behind the flurry of incidents at airports of “possible Ebola cases” causing so much coverage and disruption. It’s likely to keep happening, though there should be many more false alarms than real cases.

5. We should screen everyone for Ebola at our airports

Airports take in a lot of people, the overwhelming majority of whom have travelled nowhere near west Africa. Using measures like temperature sensors or similar en masse in western airports would trigger a vast number of false alarms.
The most effective measure, public health officials have repeatedly stated, is to make sure there is effective and comprehensive screening in place for people exiting countries with Ebola outbreaks – though some nations (notably the US) have implemented screening for airports with particularly high numbers of travellers from west Africa.

6. We are not ready for Ebola in the west

We’re about as ready as we can be. The Sars outbreak and pandemic flu scares mean hospitals and public health officials in most countries are required to have contingency plans for both local, small-scale outbreaks and major events.
Rich countries have much more ability to track and isolate those who have been in contact with anyone diagnosed with Ebola, and much better abilities to treat those who have been affected in hospital.
That’s not to say the risk is zero, but generally speaking public health officials are confident of their ability to limit the direct harm Ebola could do to countries like the US or UK.

7. Ebola has brought Africa to its knees

It is important to stress the three nations currently most affected by Ebola – Guinea, Liberia and Sierra Leone – face a public health emergency, social unrest, and economic issues caused by the protracted outbreak. Dealing with this is a humanitarian priority, and more help is needed.
But it is an oversimplification to suggest Ebola is a disaster for “Africa”, a continent of more than 50 countries and a land mass more than twice the size of Europe. The countries currently battling Ebola make up less than 1% of the continent’s economy – for much of Africa, like the rest of the world, it is largely business as usual.
It’s also worth noting that Ebola is far from Africa’s number one infectious killer: malaria, tuberculosis and HIV have each claimed hundreds of thousands of lives – many, many times more than Ebola – already this year, with none of the horrified coverage of the latter.

8. Ebola is the biggest public health disaster imaginable

Ebola is a real issue for the world’s governments, and one they’ve been slow to respond to. But there are many things epidemiologists (and others) think we should worry about far more.
Top of the list is a repeat of a deadly pandemic flu. Despite a few near misses, we’ve yet to see a repeat of the Spanish flu outbreak of 1918, which devastated nations already barely recovered from war, killing the youngest and healthiest.
There are extensive measures in place for such a situation, but officials agree they all leave much to be desired. If you must fear a pandemic, it’s a much better candidate than Ebola.
Ebola is a serious problem, which anyone with a degree of compassion should be concerned about. But if you’re in the west, it is astonishingly unlikely it will affect you, or anyone you know, personally.
Perhaps, though, it’s only that fear that’s making us pay the virus any attention at all.



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These Are the Emails Snowden Sent to First Introduce His Epic NSA Leaks


Unknown
 courtesy Laura Poitras
Six months before the world knew the National Security Agency’s most prolific leaker of secrets as Edward Joseph Snowden, Laura Poitras knew him as Citizenfour. For months, Poitras communicated with an unknown “senior government employee” under that pseudonym via encrypted emails, as he prepared her to receive an unprecedented leak of classified documents that he would ask her to expose to the world.
Poitras’ remarkable new film, Citizenfour, premiered Friday at the New York Film Festival, and opens in theaters on October 24. It is a haunting, historic document of Snowden’s motivations and personality, the sort of revelatory filmmaking that could only have been achieved by a director who was herself at the center of the story; Poitras lived out the NSA drama almost as completely as Snowden.
When Citizenfour begins, the camera is speeding through a traffic tunnel in Hong Kong, as dark as the secure channel that connects Poitras and her anonymous source. The film’s first words come from that source’s emails, read by Poitras. And throughout the film, she reads aloud more of Snowden’s encrypted correspondence, which serves as much of the story’s narration.
Those emails stand apart from Poitras’ film as a preamble to Snowden’s epic disclosures. They are a piece of history in themselves. With Poitras’ permission, WIRED reveals excerpts from them below. The formatting may not be the same as the originals, as the messages were transcribed from Citizenfour‘s audio. They are presented in the order they appear in the film, which may not be chronological.
The Text:
Laura,
At this stage I can offer nothing more than my word. I am a senior government employee in the intelligence community. I hope you understand that contacting you is extremely high risk and you are willing to agree to the following precautions before I share more. This will not be a waste of your time.
The following sounds complex, but should only take minutes to complete for someone technical. I would like to confirm out of email that the keys we exchanged were not intercepted and replaced by your surveillants. Please confirm that no one has ever had a copy of your private key and that it uses a strong passphrase. Assume your adversary is capable of one trillion guesses per second. If the device you store the private key and enter your passphrase on has been hacked, it is trivial to decrypt our communications.
Understand that the above steps are not bullet proof, and are intended only to give us breathing room. In the end if you publish the source material, I will likely be immediately implicated. This must not deter you from releasing the information I will provide.
Thank you, and be careful.
Citizen Four
…
You ask why I picked you. I didn’t. You did. The surveillance you’ve experienced means you’ve been selected, a term which will mean more to you as you learn about how the modern sigint system works.
From now, know that every border you cross, every purchase you make, every call you dial, every cell phone tower you pass, friend you keep, article you write, site you visit, subject line you type, and packet you route, is in the hands of a system whose reach is unlimited but whose safeguards are not. Your victimization by the NSA system means that you are well aware of the threat that unrestricted, secret abilities pose for democracies. This is a story that few but you can tell.
…
Laura,
I will answer what I remember of your questions as best I can. Forgive the lack of structure…I am not a writer, and I have to draft this in a great hurry.
What you know as Stellar Wind has grown. SSO, the expanded special source operations that took over Stellar Wind’s share of the pie has spread all over the world to practically include comprehensive coverage of the United States. Disturbingly, the amount of US communications ingested by the NSA is still increasing.
Unknown-1
 courtesy Laura Poitras
Publicly, we complain that things are going dark, but in fact, their accesses are improving. The truth is that the NSA in its history has never collected more than it does now. I know the location of most domestic interception points, and that the largest telecommunication companies in the US are betraying the trust of their customers, which I can prove.
We are building the greatest weapon for oppression in the history of man, yet its directors exempt themselves from accountability. NSA director Keith Alexander lied to congress, which I can prove.
Billions of US communications are being intercepted. To gather evidence of wrongdoing, I focused on the wronging of the American people. But believe me when I say that the surveillance we live under is the highest privilege compared to how we treat the rest of the world. This I can also prove.
On cyber operations, the government’s public position is that we still lack a policy framework. This too is a lie. There is a detailed policy framework, a kind of marshall law for cyber operations, created by the White House. It’s called presidential policy 20 and was finalized at the end of last year. This I can also prove.
I appreciate your concern for my safety, but I already know how this will end for me and I accept the risk. If I have luck, and you are careful, you will have everything you need. I ask only that you ensure this information makes it home to the American public.
…
The encrypted archive should be available to you within seven days. The key will follow when everything else is done. The material provided and the investigative effort required will be too much for any one person. I recommend that at the very minimum you involve Glenn Greenwald. I believe you know him.
The plaintext of the payload will include my true name details for the record, though it will be your decision as to whether or how to declare my involvement. My personal desire is that you paint the target directly on my back. No one, not even my most trusted confidant, is aware of my intentions and it would not be fair for them to fall under suspicion for my actions. You may be the only one who can prevent that, and that is by immediately nailing me to the cross rather than trying to protect me as a source.
On timing, regarding meeting up in Hong Kong, the first rendezvous attempt will be at 10 A.M. local time on Monday. We will meet in the hallway outside of the restaurant in the Mira Hotel. I will be working on a Rubik’s cube so that you can identify me. Approach me and ask if I know the hours of the restaurant. I’ll respond by stating that I’m not sure and suggest you try the lounge instead. I’ll offer to show you where it is, and at that point we’re good. You simply need to follow naturally.
…
Let’s disassociate your metadata one last time, so we don’t have a clue or record of your true name in your file communication chain. This is obviously not to say you can’t claim your involvement, but as every trick in the book is likely to be used in looking into this, I believe it’s better that that particular disclosure come under your own terms. Thank you again for all you’ve done. …
If all ends well, perhaps the demonstration that our methods work will embolden more to come forward.
Citizen
 Here’s the first trailer for Citizenfour  :



http://www.wired.com/2014/10/snowdens-first-emails-to-poitras/
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