The Truth About Ebola

Any time a relatively obscure topic becomes front page news overnight, people become overwhelmed with information pouring in from all sides: TV, newspapers, the Internet etc. And as usual, right along with all the credible information, folks start being inundated with conspiracy theories and people spreading misinformation or information they have misunderstood. As we have seen, this has created a kind of communal national anxiety attack. 

In the light of all that has happened, I want to take you through the basics and hopefully ease any anxiety and clear up some confusion.  

Introduction

Ebola is a hemorrhagic fever caused by an Ebola virus. There are 5 species of Ebola virus, with the most common being the Zaire ebolavirus. Ebola was first discovered in 1976 and is named after the Ebola River in the Democratic Republic of Congo (formally known as Zaire). Since 1976 there have been 27 individual outbreaks; however, 4 of them were laboratory accidents and the disease did not spread beyond the first patients.

A computer model of the virus.

The various natural outbreaks have had mortality rates ranging from 25% to 90%. The current outbreak, which began in December 2013, has a case fatality rate of 71%. There have been over 9,600 reported cases and 4,800 deaths. (The discrepancy between the reported cases/deaths and the fatality rate is that the fatality rate is based off of proven Ebola cases/deaths vs. those suspected of being Ebola.) It is very likely that in the primary affected countries, the number of cases and deaths have been under reported. This outbreak is by far the largest in history, with more cases than all the others combined. In August 2014, the World Health Organization estimated that 20,000 people are expected to contract the disease. That estimate is likely to be greatly surpassed. 

The current West Africa epidemic began in Guinea and then spread to Liberia, Sierra Leone, Nigeria, Senegal, Spain, and the United States. The outbreaks in Nigeria and Senegal were stopped. Liberia, with a population of 4.3 million, has the greatest number of cases, followed by Sierra Leone, and then Guinea. There's also a separate (unrelated) outbreak in the Dem. Rep. of Congo which began in August 2014 and has claimed 68 lives. 

Ebola symptoms can begin 2-3 days after exposure, all the way up to 3 weeks after, with a small number of cases not experiencing symptoms until a month after. The first symptoms are often fever followed by a sore throat, muscle pain and headaches. Further symptoms include a rash, diarrhea, nausea & vomiting, shortness of breath, swelling, confusion, bleeding from the eyes, nose, and other openings, and internal hemorrhaging. Death typically occurs 6 to 16 days after the start of symptoms. Ebola is NOT airborne. It is only spread through contact with bodily fluids like vomit, diarrhea, blood, sweat, breast milk etc. or by objects contaminated with body fluids.

Transmission

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There has been no change in the way Ebola is transmitted, but since people have been confused about its transmission through sweat or through the air from things like coughing, I’m going to explain a bit more on this. Different body fluids can contain different levels of a virus or bacteria; this has always been the case. Viral infections occur when a person is exposed to the necessary viral load (a certain number of viral particles) and the virus survives in the body, and then begins reproducing. For some diseases that can happen with a single viral particle (known as a viron), for others it requires thousands. And so, the risk of getting Ebola from sweat is less than the risk of getting it from blood. In a 2007 study of Ebola transmission from various fluid types (including sweat), saliva, stool, blood, and breast milk were most likely to contain virons; the single sweat sample did not have any viral particles. It needs to be stressed that doctors can't say "yes this happens" or "no this is impossible" unless there's real evidence to support the claim. As more and more studies are done, it's obvious that we will learn more and things may change. Until then, we can only go by what has actually been proven.   

Different viruses can also live on surfaces for different lengths of times. In the case of Ebola, once the body fluid has dried on a surface, the virus dies within hours. Ebola is a very weak organism outside of a body and cannot survive long outside of a host, and it is easily killed by chemicals like household bleach.

On the issue of airborne transmission. Airborne transmission is basically when a virus (or bacteria) can survive in the air for extended periods of time and is then picked up by other people which can then make them sick. When someone has an infection, their body contains billions (or trillions) of germs, and so when they sneeze or cough, they expel large numbers of germs into the air which can then be breathed in by another person. Respiratory droplets from sneezing & coughing are a form of bodily fluid & that has always been the case. HOWEVER, Ebola cannot survive outside of the body for long, and once those droplets dry the virus dies. Because of this, because Ebola can’t live in the air, Ebola is not an airborne disease.  Also, coughing & sneezing are not common symptoms of Ebola.

The jump to become an airborne disease takes more than a single "switch" flip, it takes multiple mutations in the right way. While Ebola could theoretically become airborne, there's no evidence that is has become airborne or is nearly there. Any disease could theoretically become airborne, but until it actually does, the only thing that exists is speculation. If people really are afraid of this, then all the more reason for us to do all we can to stop this outbreak in Africa. 

To stress the point: unless you have had physical contact with the skin, blood, vomit, stool, saliva, or other fluids of an Ebola patient, or of their corpse; or if you have had physical contact with sheets or other objects which have liquid matter on them from an Ebola patient; or if an Ebola patient has projected their fluids onto you.... then you do not have Ebola. 

Infectious vs. Contagious

I also want to try and clear up some questions about infection and contagion. Ebola is very infectious. That means that it only takes a small amount of virons to infect a person. Infection means that the virus is able to survive in the body and successfully replicate. Contagious on the other hand describes how easily a disease can spread from person to person. Ebola is highly infectious, but it is not highly contagious under normal circumstances.

The contagiousness of a disease boils down to something called the reproduction number (shown as "R0" or "R nought"). R0 is a mathematical term that tells you how contagious an infectious disease is. Specifically, it's the average number of people who catch the disease from a single sick person during an outbreak. If a disease's R0 is less than 1 an outbreak will die out, if it's greater than 1 then the outbreak is likely to grow. 

A good example to use is measles, which is one of the most contagious diseases known. Its R0 is around 18. In other words, one person with measles will infect 18 others (on average) when no one is vaccinated. On the lower end of the R0 spectrum are viruses like HIV and hepatitis C. Their R0's tend to fall somewhere between 2 and 4. They still manage to infect large numbers of people, but compared to the measles their contagiousness is relatively low (leading them to spread more slowly).

For Ebola, the virus's R0 is around 1 to 2, which less than the common flu. 

For some context: up to 50,000 Americans die from the flu each year (or 0.015% of the population), as of today 0.000001% of the American population have been diagnosed with Ebola (including those who worked in West Africa). Likewise in West Africa, Ebola hasn't reached the level of malaria or even deaths due to hunger. This isn't to suggest that Ebola is harmless, on the contrary it has the potential to kill hundreds of thousands in West Africa. But, I wanted to show that while the media may be consumed with Ebola reporting, currently the spread of the disease hasn't reached the levels of more common illnesses that kill just as many (and more) each year. 

Treatment and Prevention

Currently there is no cure for Ebola, and the only treatment is to try and keep people hydrated and comfortable until they either die or until their immune systems are able to fight it off and recover. Normally, medications take 10 years to go from an idea to an approved drug and can cost billions in R&D and government fees. In the case of severe diseases this can be sped up, but it still takes time to create enough of the drug and to make sure that it will help and not harm patients. The ZMAPP experimental vaccine given to the two American healthcare workers is still being studied, as are two other potential vaccines. It’s going to take time though before anything is approved for wide-spread use, if they’re proven effective.

The best way to protect yourself from an infected person is to be covered from head to toe in protective equipment, with no skin showing at all. There are several kinds of personal protective equipment and there are various protocols for putting them on and taking them off, and it takes practice to get it right. The most recent CDC guidelines stress that repeated practice in "donning and doffing" is required to help ensure that people don't make mistakes. 

Preventing the spread of Ebola hinges on containment. Once an infected person is found, the next step is to identify all those who may have had contact with the patient and then to narrow that list down to those who actually did have contact either directly with the patient or with their bodily fluids. Those people will then need to be monitored and isolated from others. A criticism of this protocol has been that it relies, in part, on potential patients being honest about their travel history and symptoms. As noted earlier, in the overwhelming majority of cases the first symptom is fever. While a low grade fever can be masked by things like Tylenol, higher fevers aren't so easily hidden, and once a person begins having a fever other symptoms quickly follow, and those cannot be hidden. Since people are not contagious until symptomatic, once you identify the potential patient(s) and isolate them, and follow the proven Ebola protocol which has been in place for 40 years, then transmission stops and the outbreak comes to an end. 

Since Ebola spread to the capital of Liberia, it was able to infect far more people than previous outbreaks which had happened in isolated communities. When you combine a dense population center with the poor level of medical infrastructure, the level of mistrust of modern medicine by the average person in these regions, and the level of pervasive superstition, it is easy to see how it spread so rapidly. To help understand the dreadful state of medicine in the affected countries, in Liberia for example, there is 1 doctor for every 90,000 people. In the United States, there’s 1 doctor for every 400 Americans.

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When trying to grasp all the things that have happened recently in the US, a dose of reality is always helpful. Healthcare workers are human beings and they can make mistakes, especially when stressed. It is completely unreasonable to expect that there will not be mistakes, or that somehow they’re supposed to know everything. For 38 years Ebola was an “African” disease, and a disease that was fairly easily contained. Most American healthcare workers have never given it a thought. And now that it has reached the US, we are having to educate literally millions of doctors, nurses, and other medical professionals – from the major hospitals all the way down to small walk-in clinics, on the dangers of the disease, its symptoms, and on the protocols on how to deal with potential Ebola patients. This will take time and mistakes are bound to happen. In the end, the real problems and breakdowns have been shown to come from human error. The science and protocols have all been tested in the real world and proven effective time and time again. Unfortunately, people make mistakes and do things they shouldn't (like failing to properly protect themselves, lie, or use mass transit when they've been exposed).

Travel Restrictions

The CDC and National Institutes of Health have generally been opposed to travel restrictions. Commentators, particularly those on the right, have pushed this issue and seem to be ignoring the actual reasoning the government has been giving regarding why they're opposed to travel bans. On Oct. 16, 2014, CDC director Dr. Tom Frieden and National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci testified before Congress and were grilled multiple times on the issue of preventing people from the affected countries from coming to the US as a means of stopping the spread of Ebola in America.

Having watched the testimony this is my understanding of why they don't support such a ban. NOTE: I am not saying I personally support or oppose a travel ban, I'm simply trying to explain the reasoning behind why the CDC opposes one. 

Currently, people are free to travel to the United States from the affected countries. Of the roughly 150 West Africans a day who come here, 94% enter through five specific airports. At these five airports, passengers from those countries will undergo enhanced screening procedures: having their temperature taken, asked about people they've been in contact with, checked for other symptoms, asked about where they've been and where they're going, etc. And if they have symptoms they will immediately be quarantined. Other airports and border security locations had also been given a set of guidelines as well. Should persons from the affected countries come through their facilities, those travelers would also undergo a screening process. 

However, as of Oct. 21, the government is requiring that all passengers from the affected countries now arrive at one of those five primary airports. 

The benefits of this are multiple: they know who exactly they area, where they have come from, where they are going, their contact information, the contact information of friends & family, etc. And that information can then be passed on to local hospitals and the authorities in the event that they become sick. This gives them the added benefit that if someone gets sick, they can then initiate the tracking, screening, and monitoring procedures for anyone inside the US who may have been in contact with the patient so that they can then contain a potential outbreak.

The primary criticism of this is that if we don't let them come to the US in the first place, we won't have to worry about an outbreak to begin with. 

Something to remember is that there are no direct flights from western Africa to the United States, all of these passengers have to go through other countries first. The worry about a travel ban is that while we may stop 145 visitors from coming here openly, for the other 5 people (or just 1), a ban may potentially force a frightened person to come to the US through other or illegal means. If they did indeed have Ebola, this would lead to a situation where we don't know who they are, where they came in from, who they came in contact with, or where all they may have traveled. That could mean an outbreak could occur anywhere in the country and lead to dozens, or even hundreds of other potential patients by the time the west African patient was finally located. In that case, the amount of work required to do contact tracing, monitoring people, etc. would be far more and more difficult than the work required to watch those who came here openly. 

Another problem with any travel ban is the fact that people move around. They don't necessarily have to be a Liberian citizen for example, they could be English, or French, or from Nigeria (the most populous country in Africa), or from someplace else. To effectively enforce such a ban we would necessarily have to block people from coming to America from many other countries. 

Anything we do (ban, no ban, something else) necessitates a level of risk. In the eyes of many experts, the risks of a travel ban is greater than the risk of tracking people who are moving around openly as opposed to moving around in the shadows. Of course as time goes on, things may change.

Last Thoughts

In the case of the CDC, or any governmental scientific organization, they are going to try very hard to only talk about the things that are currently known; those things shown in peer-reviewed scientific reports. Talking about theories and speculations in front of millions of people who may not fully understand the science isn't going to help anything and will only lead to more confusion. So, they’re going side step certain questions and answer others only in the context of what has actually been proven. This doesn't mean they’re hiding things. The only boogieman is the disease itself. 

It’s also very important to understand that medicine, and indeed the bulk of all sciences, are a matter of probabilities, and our understandings are subject to change when new information is learned. This is the largest outbreak ever, we are going to learn things we didn't know before because now more people have the disease. It’s also important to remember that medical terms like “airborne” have very specific definitions and those definitions may be different from what most people understand them to be. Getting caught up in fear; or listening to people who have misunderstood the facts; or mistaking an opinion for fact; all of these things serve to hamper efforts to putting an end to this outbreak. 

I also find it rather disingenuous to blame the government for the actions of free people. The nurses who contracted Ebola from Thomas Duncan were not federal employees, they were just average nurses from a hospital in Texas. While we don't exactly know how they were exposed to Ebola, it could be as simple as improperly suiting up (while the nurses may have been confident they covered themselves correctly, they could have been wrong), and there's very little anyone can do in those types of cases; of cases of honest human error. It's easy to blame the government, and there's plenty to blame them for. That said, they're not to blame every time someone somewhere does something bad. 

As of today only two people out of 315 million have contracted Ebola while in the United States. The sky is not falling. 


--Jacob Bogle, 10/21/14
Facebook.com/JacobBogle
Twitter.com/jacobbogle

Looking at the World Today

As we approach the 13th anniversary of the first September 11th terrorist attack and the 2nd anniversary of the Benghazi attack, I thought it would be worth taking a brief look at eight issues facing millions around the world today.

Scottish Independence

The Scottish people have a long history of being independent. Whether it was the thousand year existence of the Kingdom of Scotland, or their struggles to maintain a separate identity after the final union of Scotland and England in 1707 and the travails of the Highland Clearances, the Scots have always sought to keep some level of independence, be it cultural or political. Since the 1850s, the "Home rule" movement tried to re-assert Scottish control over Scotland, and between the 1930s and 50s Scotland won several concessions including the moving of the Scottish Office to Edinburgh and the return of the Stone of Scone - which had been in English control for 700 years.

Then, in 1997, the Scottish devolution referendum led to the creation (or re-establishment) of the Scottish Parliament, granting Scotland a devolved government. However, the desire by many for a fully independent Scotland has only deepened over the years and on Sept. 18, 2014, the people of Scotland will have a chance to vote to either remain in the UK or to become an independent nation.

The issues facing Scotland as it pertains to independence are numerous and there remains a very large segment of the population who desires to keep the status quo, but no matter which way this new referendum swings, it is absolute proof that peaceful self-determination is possible and that the spirit of William Wallace is alive and well, even 709 years after his death. This will be one vote for the history books.

US Border crisis

The US has had a large illegal immigration problem for decades and since the 1990s the number of illegals coming into the country has outnumbered the number of legal immigrants. This has led to 11 to 15 million illegal immigrants now living in the country, which costs tens of billions each year in services, law enforcement, loss tax revenue etc.

Starting in 2008, the country extended the rights and protections given to unaccompanied children (UAC) who cross the border, and we saw an increase in the number of these children each year. Indeed, the number of apprehensions of unaccompanied children coming to the US from El Salvador, Guatemala, and Honduras increased 430% between 2011 and 2013, while the number of UACs (from all of Central & S. America) entering the US rose literally 1,000% in 2014 compared to 2013. This explosion of refugees reached crisis level in 2014, when tens of thousands of refugees and illegal migrants from these countries crossed into the United States; primarily into Texas.

This has overwhelmed our immigration system and prompted President Obama to ask for $3.7 billion in emergency funds. According to Texas Gov. Rick Perry, crime rates have also surged and he ordered 1,000 Texas National Guard troops to the border to help stem the tide in the absence of federal assistance. Many of these children (which include teenagers) have been sent to facilities across the country, at times without the knowledge of the governors of affected states.

With little in the way of meaningful legislation or promises to enforce federal law, and with Obama announcing that he would not use executive actions (which aren't the same as an executive order) to address the issue of illegal immigrants already here, only time will tell if this crisis will get worse before it gets better.

Ebola outbreak

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Ebola is by far one of the most horrific diseases known to man. Historically it has had a death rate of around 90% and the deaths themselves can be incredibly painful and graphic. Ebola has been known since 1976 and the few outbreaks that occurred prior to the current West Africa epidemic were, thankfully, short and contained. This latest outbreak however has been anything but short and contained.

What began as a single case in Dec. 2013 in a small Guinean village has morphed into a regional epidemic with potential global ramifications. Unlike the flu or SARS, Ebola isn't an airborne disease, it can only be spread through contact with the bodily fluids of infected persons. That said, with this outbreak moving rapidly into its eleventh month and 4,030th case, like the evolution of SARS, it is possible that the virus could mutate and become more virulent. The longer any outbreak lasts, the greater likelihood of the virus hoping onto an international flight (since a person can be infected for several days before showing symptoms) and causing the worst case scenario.

Of course it would be very difficult for an Ebola outbreak to occur in the United States or Europe since our medical facilities and protocols are geared to contain such things - and are far better than anything in West Africa. Still, the risk is there for it to spread within Africa and possibly the Middle East, creating a situation that would require the full weight of global medicine to stop it. 

Presently, the outbreak is the worst in Guinea, Liberia, and Sierra Leone, with cases also present in Nigeria (the most populated country in Africa) and Senegal - there's also a separate outbreak happening in the Democratic Republic of Congo (Zaire). There have been 4,026 cases and 2,137 deaths due to the virus, a death rate of 53%. The death rate has so far been considerably lower than in previous outbreaks, but with little in the way of treatment, anyone who becomes ill is going to be in for a very rough time. Back in August, the UN estimated that upwards of 20,000 people would contract the disease, unfortunately, the infection rate has increased; meaning that estimate could well be surpassed. 

This outbreak is unlike any other in a number of ways. Only a strong and concerted effort will win the day. To quote CDC Director Dr. Tom Frieden, “The bottom line with Ebola is we know how to stop it: traditional public health. Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away.”

Ukraine-Russia Conflict

Russia has a penchant for invading countries and stealing land. This is abundantly evident from their history. Their most recent conquest was Ukraine's Crimean Peninsula in February of this year. Under the pretense of protecting ethnic Russians from persecution (this from the ones who committed genocide in Ukraine) the Russian military, ever so subtly (sarcasm), built up a mass of thousands of soldiers, tanks, and aircraft along the Russia-Ukraine border in Ukraine's Donbas region (the area embroiled in a regional civil war, with pro-Russian militants seeking secession). After months of troop build ups and partial withdrawals, over a thousand Russian soldiers marched into Ukraine in late August and bombed the area around Novoazovsk.

At first, Russia denied they had invaded the country, but when faced with clear satellite imagery and other evidence (like captured soldiers), they said the men had accidentally entered Ukraine. 

The proposed reason for the invasion has been to give Russia a land bridge to Crimea, since the only way to get to it via land is to go through Ukraine. To accomplish this, the Russians would need to carve out a strip of land roughly 180 miles long, and in doing so, would take away Ukraine's access to the shallow Sea of Azov. Of course official Russian territory is a mere 3 miles from the eastern edge of Crimea at the Strait of Kerch. My advice to Russia? Build a bridge instead of plunging Europe into war just to steal one! 

At the moment there is a ceasefire under the "Minsk Agreement." In part, the agreement lays out that all Russian troops are to leave the Donbas region, as well as the illegal militias, and the areas in question are to receive a greater level of autonomy. With respect to autonomy, in my mind this only pushes the eventuality of Russian annexation down the road, it won't prevent it. 

On a side note, there has been an increase in the number of Russian nuclear bombers violating the air-defense perimeter of the United States. While this isn't technically violating sovereign airspace, it's not something countries take lightly. And it's just another provocation by Russia which shows their disregard for the rule of law and the notion of a "community" of nations. 

North Korea

The situation on the Korean Peninsula continues to be a ticking time bomb, particularly due to the actions and provocations of North Korea (more properly, the Democratic People's Republic of Korea). In a continuation of its 2013 activities, North Korea has fired several rounds of short and medium range missiles, and they have announced the trial of yet another American. However, unlike Jeffery Fowle and Kenneth Bae (who are being held for being Christian missionaries), or Merrill Newman (held for being a Korean War vet and then released after "apologizing"), Matthew Miller reportedly tore up his passport at the Pyongyang Airport and shouted that he was seeking asylum in North Korea. He was arrested for "rash behavior" and will be placed on trial on Sept. 14.   

The most recent barrage of missiles came on Sept. 9, when the North fired three short-range missiles into the Sea of Japan. Previously, the DPRK fired missiles during Pope Francis' visit to Seoul, South Korea (which DPRK officials deny there being any relation to the two events), and there were several other tests earlier in the year. It is believed that the most recent launches were an attempt to test a new, slightly longer range tactical missile similar to the KN-2. 

Since coming to power in 2011, Kim Jong-un has been very provocative, with multiple missile tests, a nuclear test, and a satellite launch; not to mention the major 2013 crisis. Some of this behavior has been, no doubt, to help him consolidate power and gain legitimacy. (He has no formal military training and is still fairly young at the age of 31 - a leader in a heavily militarized society and one in which age and wisdom go hand-in-hand.) I also feel it's an attempt by North Korea to try to close the technology gap with South Korea, especially since Kim Jong-un is keenly aware of how disadvantaged his country is in every way. 

These reasons and more can add up to a potentially very dangerous young man. A man eager to prove himself, to fulfill the promises of his father and grandfather, and to retain absolute control in country whose populace is no longer as docile and obedient as it once was.

Islamic State of Iraq and Syria

The Islamic State of Iraq and Syria (also known as the Islamic State of Iraq and the Levant) began in 1999 as 'Al-Qaeda in Iraq'. Thanks to the completely inept leadership of former Iraqi Prime Minister Nouri al-Maliki, the withdrawal of American troops from Iraq, and the Syrian Civil War, ISIS began to flourish and forge its own identity outside of Al-Qaeda, with the two organizations officially splitting in 2014 (reportedly ISIS was too cruel and brutal, even to Al-Qaeda). Though it was established in Iraq, many of their fighters went to Syria and becoming battle hardened, and then burst onto the scene in Iraq as a more invigorated group.

Unlike other terrorist organizations, ISIS has a clear goal that includes the establishment of a new country - the Islamic State, also known as a caliphate. They have been able to seize large tracts of territory in both Iraq and Syria and in the process they have stolen hundreds of millions in cash, gold, and natural resources like oil. They are largely self-financed because of this (which is very unusual for terrorist groups and creates additional difficulties as we attempt to deal with them) and earn an estimated $2 million a day from selling oil on the black market. 

Beginning in June 2014, the US has been carrying out targeted airstrikes against ISIS and has sent nearly 2,000 troops into Iraq as advisers and embassy security. The UK and other countries have begun to send personnel to Iraq as well in a growing coalition against ISIS. With the murder of two American journalists, the domestic support for intervention has grown dramatically. Although President Obama's initial rhetoric toward ISIS was fairly weak and indecisive, the Obama administration has now been calling for the complete destruction of ISIS, and they have proposed that to achieve that goal, we will need a three-year military operation. 

Congress has likewise had a mixed reaction to the ISIS threat, and with mid-term elections right around the corner, it's difficult to say what, if anything, Congress will do to thwart ISIS in the short-term. One thing is very clear, the President does not have the authority to go after ISIS unilaterally as they do not yet pose an immediate threat to the American Homeland (despite the tragic deaths of James Foley and Steven Sotloff); he must get Congressional approval, not merely "advise" them. That said, even if ISIS were a direct threat, any conflict longer than six months would still require a Congressional vote. Though, given the self-inflicted 
emasculated state of Congress, if Obama wants to do something I'm pretty sure he'll get it - even at the expense of law (and even if the motives are well-intentioned). These things notwithstanding, it is clear that ISIS must be dealt with, and we will need all of our allies to step up to the plate, especially those in the region.

Syrian Civil War

Despite no longer being on the front page news each day, the Syrian Civil War is still raging. What began as protests in 2011 quickly turned into a devastating civil war that has cost 200,000 lives and created millions of refugees. Early on it seemed like the opposition might win, especially after Syrian President Bashar al-Assad used chemical weapons; an action that promptly saw many Western nations recognizing the opposition Syrian National Coalition as the sole legitimate representative of the Syrian people. Unfortunately, lack luster international support in terms of financing, arming, and training the Free Syrian Army helped to slow momentum. The growing divisions within the opposition itself (moderates against Islamic extremists) and renewed government offensives have led to what may be an irreversible tide change in favor of Assad's regime, 

With ISIS having a stronghold in Syria and recently helping to push the opposition out of Aleppo, a key opposition city which the anti-Assad forces have mostly held since 2013, a new dynamic may arise in which Western forces must align themselves with Assad in order to defeat ISIS. And while President Obama has said that we will work with the Free Syrian Army (and provide greater support to them), you cannot hope to destroy ISIS without Assad's help. And that may create a situation in which the opposition is further weakened because we are also, by default, helping Assad. 

If Aleppo is re-taken by Assad, he can cut the last supply lines from Turkey to the opposition. And coupled with the recent deaths of dozens of top opposition leaders in Idlib, we may yet see Assad triumph, with the United States and the West having the major headache of being forced to deal with an Assad Syria after marking out so many red lines. 

Israel-Gaza Conflict

A factory burns after rocket attack.

Israel has been in conflict with Hamas since 1987, and Israel has practically been in a constant state of war (be it against invasions or terrorists) since gaining independence in 1948. The current conflict (aka "Operation Protective Edge") against Hamas in the Gaza Strip roughly began on May 1, 2014 when Hamas started firing rockets into Israel in retaliation for "Operation Brother's Keeper." The conflict has resulted in 72 Israeli deaths (66 soldiers and 6 civilians) and 530 injuries, as well as around 2,150 Gazan's killed and 11,000 injured. 

Hamas has built up a collection of tens of thousands of rockets, including the Qassam (which cost less than $1,500 each and are easily produced), Khaibar, and Fajr rockets. The Khaibar and Fajr rockets can both reach Jerusalem and Tel Aviv. After enduring years of sporadic (thought at times very intense) rocket attacks, Israel developed the Iron Dome missile defense system, and during this latest conflict it has been successful in intercepting 90% of the rockets it targeted. However, Hamas also built a very 
sophisticated network of tunnels to reach into Israeli territory to launch attacks, engage in smuggling, etc.

After launching several air offensives and sending in waves of soldiers to deal with the threats, the tunnels have been destroyed and there were a number of brief ceasefires (primarily for humanitarian reasons). The current ceasefire seems to be holding, but there are a number of issues placing strain on it coming from within and outside of Israel and the Palestinian areas. This uneasy momentary peace could hold, but it could easily be shattered as we have seen before. As we watch and wait there remains little real hope of a lasting peace.