Puplic Service Announcement

Why You Shouldn’t Worry About Catching Ebola From Dr. Kent Brantly and Nancy Writebol, and Should Instead Worry About Influenza, Mumps, AIDS, Cancer, MRSA, Tuberculosis, Other Antibiotic Resistant Germs, Getting Hit by Cars, Being Struck by Lightning, Being Killed by an Escalator, Dying in an Elevator, or Any of the Many, Many, Many Ways of Dying that are All Much More Probable than an Ebola Outbreak Being Caused by Treating Two Ebola Patients in the United States

Posted on August 4, 2014. Filed under: Puplic Service Announcement |

As you are hopefully aware, West Africa is dealing with an Ebola crisis. This is the single worst outbreak of the disease in history, and two American aid workers, Kent Brantly and Nancy Writebol, have been infected. They are being moved to the United States for treatment, and this has sparked a bunch of people on social media to do what scared, ill-informed people on social media always do.

I get it, I really do. People are scared. Ebola is a terrible, terrible virus; the method in which it kills is literally what horror movies are based on. You’d be insane to NOT be scared of Ebola. But there is a difference between being scared of Ebola in the academic sense of it being a really horrendously painful and awful way to die, and being actively terrified of being infected with Ebola to the point of using that fear to demand that we don’t give our fellow Americans – people who put themselves in harm’s way to save the lives of people they don’t know who desperately need help fighting this virus – the best possible chance at beating this illness.

Does Ebola suck? Hell yes. If you’re living in America, are you likely to contract it from Kent Brantly or Nancy Writebol? No. You are not.

This is going to be a long one folks, but I hope you’ll stick with it because there is too much ignorance floating around about this, and I would really appreciate it if we could lessen the fear that comes from the unknown. Knowledge is the greatest weapon available to us.

(Before you whine, no, a vaccine wouldn’t be the greatest weapon. That’s a preventative measure. That would be a shield, not a weapon. And not a Captain America shield that is in fact the most terrifying weapon of mass destruction next to Mjolnir, either.)

I’m going to explain why I’m slightly better qualified to talk about this than your average CNN anchor, what Ebola is and what the different strains are, what we know about this outbreak, why this outbreak has been so severe, why you don’t need to worry – seriously, at ALL – about the two infected Americans being brought here causing an outbreak, why you should instead be aware of the much larger but still pretty insignificant risk of Ebola spreading to America by other means, why the situation in America makes it EXTREMELY unlikely that even if Ebola does somehow spread here (again, insignificant risk) that it will spread very far, why (despite the stupid, stupid things the CDC has done that have been recently discovered) you can trust the CDC to handle this situation, go over some horrible diseases you can catch and die from in the United States that you should be more concerned about than Ebola, and that we all need to relax, realize that the odds are that we will probably be alright, and pray/send good thoughts to the people of West Africa, who are the people ACTUALLY IN DANGER OF GETTING EBOLA.

I will also address in another article (because I’ve been working on this for 10 hours and I’m ready to be done) some specific conspiracy theories and erroneous claims about Ebola and why they are wrong, despite the fact that you personally have a much better chance of getting infected by Ebola from the aids workers than I do of changing a conspiracy theorist’s mind with logic and facts.

If you have questions about the virus or outbreak, comment or email me and I will do my best to find the answer and update the post with the question and answer.

What makes you think you’re qualified to talk about this?

Short answer: I am an elitist academic.

Long answer: I am a second year Bioinformatics and Computational Biology Ph.D. student with a bachelor’s degree in biochemistry. I am NOT a virologist (although I have assisted in research on the HIV envelope glycoprotein GP120 as well as influenza hemagglutinin proteins) or an epidemiologist. I won’t actually have a doctorate for at least another three years. I can, however, read scientific, peer-reviewed literature and think critically, which makes me 100% better qualified to talk about this than every single person on Twitter or Facebook demanding we leave those two aid workers in Africa. There are many, many, many, many, many people better qualified to talk about this than I am. But they are talking about it and a substantial number of people either haven’t heard them or are ignoring them, so one more voice of reason probably won’t hurt and can maybe help.

I will also be doing this new thing called “citing respectable sources.” I will occasionally cite Wikipedia elsewhere on this blog. Wikipedia is usually a pretty reliable source for scientific information, because the only people who care about editing Wikipedia articles are usually scientists and the people who enjoy screwing up Wikipedia articles usually don’t care enough about science to target the pages in the first place or make them believable. I will NOT be doing that in this article, because Ebola has become a hot topic recently which increases the chance that well-meaning but ill-informed people will edit the page or that jerks will trash the page and I have no idea how accurate the Ebola page currently is. All of the sources I cite in this post (regarding characteristic facts about the virus) will be from either academic, peer-reviewed journals, a website from Stanford that summarizes an academic, peer-reviewed journal article that I don’t have access to, or from agencies like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). I have chosen to only cite open-source academic peer-reviewed journals (except that one website), which means that you will be able to read the articles I’m citing without having to pay for them – they’re freely available online. I will occasionally cite news sources for public responses, but NOT for information regarding virus specifics, like transmission, infectivity, death rates, etc. Occasionally the news gets those right, but frequently the media picks out one unimportant aspect of a scientific report and then incorrectly parrot that sound byte until an incorrect statement is accepted as fact. The FACTS I am reporting about this disease come from either the CDC, the WHO, or an academic peer-reviewed journal. I encourage all of you to try to find the sources of whatever “fact” the media starts spouting off about, because FREQUENTLY it will not, in fact, possess a particularly strong working relationship with reality.

What is Ebola virus?

When people refer to the Ebola virus, they’re actually referring to one of five strains of viruses in the Ebola genus. The genus Ebolavirus encompasses 5 species, which, along with the Marburg virus genus*, and Cueva virus** makes up the Filoviridae virus family.

*MARV, short for Marburgvirus, named for the city of Marburg in western Germany where it was first discovered; in certain literature it’s also known as Lake Victoria marburgvirus, but the name was changed back to marburgvirus in 2010 so that’s the one I’m using

**genus Cuevavirus, and has one member called Lloviu cuevavirus (LLOV), named for the Cueva del Lloviu, the Spanish cave where it was first discovered

The name “filovirus” comes from the filament-like structure of the viruses, which look like this:

The members of the Filoviridae family cause hemorrhagic fever, which means that the infected experience “petechiae, ecchymoses, uncontrolled oozing from venepuncture sites, mucosal haemorrhages, and post-mortem evidence of visceral haemorrhagic effusions.”

In English: hemorrhagic fever causes you to bleed into your skin on a small scale (petechiae), on a much larger scale (ecchymoses) , continually ooze blood and other fluids from the injection site of an IV or shot (oozing from venepuncture sites), uncontrollably bleed from mucous membranes like the eyes, mouth, nose, anus, etc. (mucosal haemorrhages), and uncontrollably bleed from the internal organs (visceral haemorrhagic effusions).

Oh dear God. There’s more than one kind of Ebola?

Yep. There is. There are five identified species of Ebolavirus – Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Côte d’Ivoire ebolavirus (also known as Taï Forest ebolavirus, TAFV), Reston ebolavirus (RESTV), and Bundibugyo ebolavirus (BDBV).

The first hemorrhagic virus discovered was MARV in Marburg, Germany, in 1967, although there were two other outbreaks that occurred simultaneously in Frankfurt and Belgrade, Serbia. In Germany, 29 were infected and 7 died, while only 2 were infected in what is now Serbia; neither died. Ebola first struck in 1976 simultaneously in two locations – what was eventually identified as EBOV in what was then northern Zaire (which is now the DRC), and what was eventually identified as SUDV in southern Sudan.  In Zaire, 318 were infected; 280 died. In Sudan, 284 were infected; 151 died. The first and only case of TAFV occurred in Côte d’Ivoire in 1994, and was not fatal. BDBV first reared its ugly head in 2007 in the town of Budibugyo in Uganda; 149 were infected, and 37 died. In case you were wondering, yes, all of the filoviridae members are cleverly named after the place they were found.

You may have noticed that I didn’t mention RESTV. That is because there have been no confirmed pathogenic cases of RESTV in humans. RESTV has been doing a fine job, however, of killing pigs and monkeys in the Philippines and is named for Reston, Virginia, which was the site of an outbreak among monkeys quarantined in a research facility. (Those monkeys came from the Philippines.) This page (from Stanford) does a great job of summarizing the Reston-type outbreaks, if you’re interested. It is a summary of an article from The Lancet on Reston outbreaks; the article is locked behind a $35 paywall. The abridged version: RESTV can and does infect humans, but humans don’t develop filovirus symptoms (or any symptoms, actually) from infection. Workers exposed to the monkeys infected with RESTV (who DO develop and die from filovirus symptoms) had antibodies against RESTV, which means the virus did get into their systems and proliferate long enough for them to develop an immune response, so they were infected, but again, they did not develop symptoms. So while you can be infected with RESTV, you won’t get sick from it. (Currently. It could mutate, and then who knows.)

Prior to the 2013-14 outbreak, there had been a total of 2,387 confirmed Ebola cases. 1,590 of those cases ended in death. For those of you not keeping score at home, that’s an overall mortality rate of 66.6%, which I’m sure is coincidence. In individual outbreaks (excluding those where a single person was infected), the mortality rate has ranged from 25-90%. The big three – EBOV, SUDV, and BDBV – are responsible for all of those deaths. The current outbreak is an outbreak of EBOV, which has had mortality rates ranging from 44% in the DRC in 2008 to 90% in the DRC in 2003.

That’s terrifying. Why do outbreaks keep occurring? How are these people being infected?

Ebola pops up every couple of years or so in the southern and western parts of Africa. It is believed to have a natural host in the African bush (currently believed to be fruitbats). Basically, the virus is constantly present in animals in Africa, and occasionally a human comes into contact with an infected or dead infected animal and contracts the virus, and then spreads it to others. Essentially, until we come up with a vaccine, Ebola will ALWAYS come back sooner or later.

What are the symptoms of Ebola?

After exposure to the illness, people can take anywhere from 2-21 days to display symptoms (although usually it’s 4-10 days.)

Ebola generally starts off with sudden-flu like symptoms, like general muscle aches, headaches, sore throat, malaise or weakness, and a high fever. The patient can start developing multi-organ system symptoms, like impaired liver or kidney function, respiratory issues including coughing, chest pain, and a runny nose, gastrointestinal issues including abdominal pain, nausea, vomiting, and diarrhea, and neurological issues like comas. The hemorrhagic (bleeding) symptoms don’t develop in all cases, but when they do, they are severe and painful. A side effect of the hemorrhaging is abnormal blood coagulation, which can cause its own problems. As the severity of the case escalates, patients can go into shock and experience seizures.

How is it spread from person to person?

The virus can be transmitted through tissues and fluids of an infected patient- fluids like blood, saliva, mucus, semen, vomit, etc. Skin tissue and feces can also carry the virus. Unfortunately, victims of hemorrhagic illnesses tend to ooze. A lot. The fluids they ooze can then infect the people taking care of them. HOWEVER, infection generally requires open-wound or mucus membrane content with infected material to actually infect a new host. So you could stick your hand in a pool of infected blood, and provided that you did not then lick your hand or have any open wounds on your hand, and also immediately disinfected your hand, you would probably be fine. (Please note that I do not recommend this under basically any circumstances.) You should also avoid being sneezed or coughed on by infected patients; like the flu, the virus can be transmitted through the fluid droplets of a sneeze or cough. Unlike the flu, Ebola doesn’t survive outside a host for very long, so it doesn’t linger on door handles or phones like influenza does.

Additionally, guys who have been infected shouldn’t do the horizontal (or vertical – however you have your fun) tango for a good seven weeks after infection – there was a guy who had the virus present in his semen 61 days after he started showing symptoms.

Patients also aren’t particularly contagious before they start showing symptoms, so unless the person is displaying flu-like symptoms or actively oozing, you will again be fine.

What’s been going on in West Africa?

Read this.  And read this.

The Reader’s Digest Condensed version: This whole mess started in December 2013 in forested areas of Guinea. Between December 2013 and April 2014, there were ~240 suspected cases. That number, as you may have noticed, has increased somewhat with the spread of the virus to Sierra Leone and Liberia.

As of July 30, 2014, the virus is probably present in Nigeria, with a suspected fatality and two suspected cases. The CDC reports 1440 suspected and confirmed cases in the Guinea, Liberia, Nigeria, and Sierra Leone. Of those 1440 cases, there have been 826 fatalities so far, at least 60 of them health workers.

This makes this outbreak by far and away the worst in history.

Why has this outbreak been so bad?

A combination of things. First, it’s very widely geographically distributed.

Prior outbreaks have usually been confined to a smaller area, usually in just one country. This means that there is a shortage of educated, qualified health workers to take care of the infected. It also means that infections are occurring in rural and urban areas. In the rural areas, poverty and lack of education make it impossible or difficult for people taking care of the infected to take the proper preventative measures necessary to prevent the virus from spreading to them. The urban areas don’t have it so great, either; the high density of people allows the virus to spread rapidly, and they can’t really afford proper protective equipment either.

Second, there’s a general suspicion of hospitals and aid workers – sick, frightened people keep leaving quarantine and hospitals and spread the virus further.

Third, air travel and relatively easy travel between country borders allows sick people to spread the virus further.

Fourth, people are pretty ill-educated about Ebola infection, and rely on homeopathic remedies for protection. Currently, there is no cure or vaccine for Ebola. This doesn’t stop people from believing that herbal bracelets, for instance, will protect them..

Basically, higher mobility of populations combined with disinformation and a mistrust of hospitals and health workers combines to make an epidemic.

BUT THAT WILL HAPPEN HERE WHEN THOSE AID WORKERS ARE BROUGHT BACK AND WE’RE ALL GOING TO DIE!!!!1!!!

Take a deep breath. Let it out. Okay. I’m not going to say that there is a 0% chance that the aid workers coming back to the US will spark an epidemic. The fact that Ebola exists and that the aid workers are coming back and that the universe occasionally throws a wrench into the best laid plans of mice and men mean that, theoretically, this could cause an epidemic. There is also a non-zero chance that you will be hit by a meteorite tomorrow. From a statistical standpoint, if you’re American, that’s actually more likely since that’s actually happened to an American before.

Dr. Kent Brantley is currently at Emory University Hospital in Atlanta (the city which is not coincidentally home to the CDC). Nancy Writebol, the other infected aid worker, will be coming to Emory sometime this week.

There is basically no chance of the transportation of the individuals causing infection. The plane used to transport them has a special containment unit designed EXACTLY for cases like this. The reason Writebol isn’t in the US already is because the containment unit only holds one person.

“But what if the plane crashes?” you might ask. Well, in that case the chance of the disease spreading is actually zero, because the virus doesn’t survive violent holocausty fireballs. That, and the second that plane went down we’d be up to our eyeballs in hazmat teams.

“But there have been 60 aid workers infected and killed in Africa! What’s to stop that happening here, in the US, allowing those aid workers to spread it to the rest of us?” you might ask. I’m going to once again cite the US being one of the richest countries ever, which means the hospital can afford BSL-4 PPE (which you may remember me discussing here), and point out that the patients are being housed in the isolation wing of Emory University Hospital, which is one of four hospitals in the country designed SPECIFICALLY TO HOUSE INFECTIOUS DISEASE CASES LIKE EBOLA. This is LITERALLY what the hospital wing was made for. The people working in that wing have been training for over a decade to be handling cases like this. And they have two. They have exactly two cases to deal with, so they can afford to take their time, follow all the protocols and procedures that are in place for exactly situations like this, and not make a mistake like the 60 dead aid workers made (which was almost certainly the mistake of being a caring human being working in a country too poor to afford proper protective equipment. Although I don’t think they would characterize it as a mistake at all.)

“But what if it DOES get out?” you might ask. Okay, let’s say for a minute that one of the doctors caring for our two fellow infected Americans somehow gets infected through their BSL4 PPE. Let’s say that hypothetically, the highly trained doctor who knows more about Ebola than you or me, who knows exactly how scared to be of the disease (he isn’t), somehow exposes themselves to the virus. A) If it doesn’t occur through negligence, the doctor will probably know about it – ie, there is a tear in the PPE and the doctor comes into contact with infected material. The doctor will know about it, and be put into quarantine. B) The highly trained doctor who knows more about Ebola than you or me, who knows exactly how scared to be of the disease, is negligent in some fashion, despite the several people who check and double-check that equipment before it’s used and check and double-check that the protocols and procedures are being properly followed. Let’s assume that somehow that all happens, and one of the doctors gets infected. It’s a shame that nobody is smart enough to regularly test those workers who are coming into contact with the infected for the presence of the virus and that we don’t have fast, reliable methods of detecting the virus quick- oh, wait, nope, we TOTALLY HAVE THOSE THINGS.

To summarize: it’s not like we’re throwing Brantly and Writebol in with the general population; they’re behind BSL4 protective measures cared for by doctors who have been training for a significant portion of their lives to combat this very sort of thing in a nation wealthy enough to equip and maintain the hospital and doctors caring for them. We can monitor those doctors for infection and throw their butts in quarantine if they’re exposed. Those doctors know what they’re dealing with, they are in the absolute perfect environment to deal with it, and there are so many people watching like hawks that there is a minimal risk of screw-ups. So on the incredibly small chance that one of the aid workers gets infected, we’ll know about it, and deal accordingly. There won’t be an epidemic.

But you mentioned something about Ebola spreading here anyway. You were joking, right?

Eh. Sort of. Not really. I mean, theoretically an infected person could get on an airplane and fly here and then the virus would be in the US. It’s just extremely unlikely that a person with a full-blown Ebola infection getting off an airplane in the US would blossom into an epidemic, for a variety of reasons.

1) If the infected person doesn’t have symptoms, they are almost definitely not going to infect anyone else (remember from earlier?) until they show symptoms.

2) If the infected person DOES have symptoms, they a) most likely won’t be allowed on a plane, and b) will probably be too sick to travel anyway.

3) Let’s assume somebody gets on a plane before they develop symptoms and then comes here, and then develops symptoms. Are we screwed? No, because Americans are f***ing terrified of Ebola right now and are also hypochondriacs – a combination meaning that if someone actually gets into the country and is infected, they will very likely get to a medical professional before they spread it to anyone else. Remember, Ebola is not actually all that easy to transmit between people until symptoms show up, and I would hope you’d go to the hospital if you were throwing up or crapping blood regardless of the state of Ebola in the world. So right now, if anybody displays Ebola symptoms they’re going to the doctor; the doctor will test for Ebola, everybody that person ever came in contact will be in quarantine, and we’re good to go. No epidemic.

“But Carla,” you might say, “In real life things never go that smoothly. The Universe, as you’ve said, likes to throw a wrench into the works. What happens then?” Do you remember that massive Marburg outbreak in Colorado in 2008? All the people who got sick, and puppies wept and the music died and no one ever smiled again? You don’t? That’s weird, because we totally had a hemorrhagic fever virus patient in Colorado in 2008. A woman infected with the Marburg virus while she was on a trip to Africa came to the US – again, infected with Marburg – and eventually went to the hospital when she got a rash and was sick (no pun intended) of the diarrhea and vomiting. While she was there, the tests they had at the time for viral hemorrhagic fevers came back negative (which won’t happen today unless the viruses mutate, because we have better tests), and so the doctors thought she had some weird variant of hepatitis. She was treated and released; the doctors took the precautions they’d take for hepatitis – NOT BSL4 precautions. Nobody realized she had Marburg until she insisted on further testing 6 months later, after she heard a guy on the same tour she’d been on in Africa had died of Marburg. She was fine, by the way. Not a single other soul was infected. To emphasize – a woman infected with a disease that has basically identical symptoms and modes of transmission as Ebola was in the United States, went to a hospital, was treated there in normal conditions without all the safety gear because the doctors didn’t know she had Marburg, and survived the virus without a problem (although she spent a year recovering) and didn’t spread it to anyone else. This is what happened when we didn’t take proper precautions and know what we were dealing with.

Today, we’re paranoid about Ebola. People are paying more attention to this than to Orlando Bloom punching Justin Beiber in the face. We will absolutely catch any potential outbreak quickly. We don’t have the same fear of hospitals and doctors like in West Africa, and if the Jenny McCarthys of America shut their stupid faceholes for the duration of the crisis, we won’t have people being misinformed about what will and won’t prevent spread of the illness. When we weren’t prepared and ready, we didn’t have an epidemic. We’re on the alert now. We won’t have an epidemic. Don’t believe me? This situation played out in Britain today.  Unfortunately, the woman died. Fortunately, the Ebola tests have come back negative. But the response to this was the important thing. If she HAD Ebola, it would have stopped in that airport.

But hasn’t the CDC screwed up a bunch of times recently in hilariously close to apocalyptic scenarios? I mean, they’ve been acting like the fictional CDC in that show you were talking about awhile ago.

Yeah, the CDC has dropped the ball a couple of times recently. And let’s not forget the National Institutes of Health (NIH) and their assist in the dropping of said balls.

So why am I so sure they’re not going to drop the ball now? Mostly because the ball HAS been dropped so recently. The CDC and NIH are fresh off of some major grade-A SNAFUs. There are a whole messload of people doing their very best to make sure there is no further droppage of balls. Nobody wants to be the jerkhole who is responsible for releasing Ebola into the wild, and since the eyes of the nation are side-eyeing the crap out of them, they are being extremely paranoid and careful. Yes, accidents happen. And they can be tragic – the Soviet Union lost at least one researcher working on weaponizing Marburg. (Tragic for the Soviets, I mean. I personally am okay with how that situation worked out.)  The Russians again lost another researcher, this time to Ebola, when she accidentally stuck herself with a contaminated needle.  Accidents happen, yes. And I hope you noticed that in both of those cases, there was no outbreak.

But even though there is basically no chance of an Ebola outbreak in the US, I’m still worried about it!

Let me take your mind off that. Instead of worrying about a disease that will probably never, ever, ever affect you, let’s talk about some of the horrifying diseases and maladies in the US that you have a non-zero chance of catching! (There will be some Wikipedia citations here, mostly because these are probably reliable (although no, I haven’t checked) and also because I’ve been working on this for ten hours and I’m ready to be done. I may update with more later.)

MRSA – MRSA stands for methicillin-resistant staphylococcus aureus. Staph is one of the bacteria responsible for acne. It can occasionally cause severe infections characterized by pus and oozing and general nastiness. The methicillin family of antibiotics is used to treat staph. Methicillin-resistant staph does not respond to methicillin antibiotics. MRSA can kill you. It does kill lots of people every year. The ones it doesn’t kill can take months to recover. 2% of the US population carries MRSA. MRSA can survive for DAYS on dry surfaces and can spread quickly through hospitals that don’t properly disinfect surfaces that the bacterium contacts.

Vibrio vulnificus – You may have heard of this one on the news recently. This is the flesh-eating bacteria that has been found in Florida, because Florida is the Australia of the United States in that if something terrifying or bizarre happens in the US, there is a 93.657% chance that it occurred in Florida. There were 41 cases of this thing in 2013. There were 12 Ebola outbreaks with fewer infected than that. There have been 20 Ebola outbreaks (not counting this one) with more than one infectee. Eight of those cases have had fewer than 65 infectees.

Between 1992 and 2007, there have been 459 recorded cases. 237 of those people died. Don’t eat raw oysters.

And you might want to avoid swimming in Florida.

Primary Amebic Meningoencephalitis (PAM) – Or you just might want to avoid swimming ever, period, because the so-called “brain-eating ameba” (so-called because it turns grey matter into Swiss-cheese), naegleria folweri, resides in fresh water. Fortunately, you can’t be infected by drinking contaminated water. Unfortunately, you can catch it by having water go up your nose. There were 132 of those cases between 1962 and 2013. Three people survived infection. The parasite likes warm water, by the way.

That didn’t stop it from killing someone in Minnesota.

To sum up: If you are in America, you have a technically non-zero but basically still zero chance of getting Ebola. You have a much better chance of dying from horrible terrible things that are already in the United States. The aid workers being moved to the United States present a technically non-zero but basically still zero chance of starting an epidemic. I get that people are scared. But I don’t see people calling for the ban of cars, despite the fact that more people die in car accidents in the United States every year than in every Ebola and Marburg epidemic combined (including the current one.)

Instead of being worried about a situation that presents a technically non-zero but basically still zero chance of affecting you in any way, please send your thoughts, prayers, and warm fuzzy feelings to the people of West Africa. They need your worry a lot more than you do.

Is there any way I can contribute positively to this situation?

This is the transcript of an address by the leader of the WHO. Read it, and get a better idea of the situation West Africa is facing. This blog post is merely a long-winded explanation of why Americans need to calm the frick down. It is not an explanation of the situation in Africa, which IS DIRE. The virus is spreading more quickly than the WHO can contain.

If you want to actually help the people who are ACTUALLY affected in this situation, consider tweeting or otherwise posting to social media about these groups and/or donating to them, instead of co-opting somebody else’s crisis and making it all about America.

Samaritan’s Purse

Doctors Without Borders

Finally, a friendly reminder from the Barenaked Ladies:

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