We all need to STOP and think about Ebola with the science of transmission in our minds eye.
With 21 day quarantines all the rage these days ( it reminds me of the post 9|11 security theater that we still deal with at airports and big buildings ), I thought it important to discuss how the Ebola virus actually spreads. When you understand how difficult it is, and what it requires, perhaps you will share this page with a few friends so we can move away from hysteria and focus on helping the people in West Africa tamp this thing out.
First let’s all acknowledge Ebola is a horrible disease. Traditionally it has a mortality rate in the 50 percent or more range. Ironically, thanks to an increase in both wealth and mobility coupled with social customs and political factors, things are making the spread more difficult to control in western Africa than in places like the US or even Nigeria.
In epidemiology there is a statistic called the R naught which helps us understand how contagious a disease is. This number tells us how many people, on average, a sick patient will infect. For example, a person with measles infects 18 additional people on average (in an unvaccinated population – thanks Jenny McCarthy!). Each patient with Ebola only infects 1.5 to 2.
Ok, so how does the Ebola virus move from one person into another?
The Ebola virus, it requires direct contact. This means you have to get it not just on your intact skin, which can be a pretty effective barrier, but you have to get it onto one of your mucous membranes (nose, eyes, mouth, etc.), or in a cut.
Ebola can’t stay alive outside the body for a long time if it gets dried out or exposed to sunlight. Dry is not good for Ebola and sunlight is not good for Ebola. It’s one of the easiest to kill of all pathogens. If you spray it with rubbing alcohol or a regular disinfectant like Lysol, it will die. Sufficient sunlight will kill it. So that’s the good news.
Ebola is not spread through the air like measles or chickenpox. However, if you are standing nearby when someone coughs, sneezes, or vomits, you could get droplets of these bodily fluids into your mouth, nose, or eyes. This is what is considered direct contact. It should be pointed out that is the most conservative view of possible transmission mode, most of the Ebola virus spread which has occurred in West Africa seems to be related to much more direct methods. In West Africa, people are becoming ill after contact with blood or vomit, urine or feces.
Once the virus enters the body, it targets several types of immune cells that represent your first line of defense against invasion. It infects your dendritic cells, which normally display signals of an infection on their surfaces to activate T lymphocytes—the white blood cells that could destroy other infected cells before the virus replicates further. With defective dendritic cells failing to give the right alarm, the T cells don’t respond to your infection, and neither do your antibodies that depend on them for activation. From there, Ebola can start replicating immediately and very quickly.
Ebola, like many other viruses, works in part by inhibiting interferon—a molecule that cells use to hinder further viral reproduction. In a new study published in Cell Host & Microbe, researchers found that one of Ebola’s proteins, called VP24, binds to and blocks a transport protein on the surface of immune cells that plays an important role in the interferon pathway.
Interestingly, your lymphocytes themselves don’t become infected with the virus, but a series of other factors—a lack of stimulation from some cells and toxic signals from others—prevent them from putting up a fight.
So, as you can clearly see, because of the Ebola viruses’ method of transmission and infection, we can be very reassured that a person with Ebola can’t really spread the disease until they are pretty sick. You can be exposed to influenza and pass it on to your family within two or three days—before you develop symptoms. With Ebola that takes about two weeks and symptoms MUST be present for a day or two before it’s highly contagious.
If you stop and think about it, the very first patient to become symptomatic in the United States, Thomas Eric Duncan, stayed with relatives prior to developing symptoms. Even after he spiked a fever, he was unable to infect those around him even though they were all sharing a small apartment. The people Mr. Duncan did infect, were two nurses who were not adequately covered when dealing with his blood, vomit, urine and feces.
The bottom line is that you are not going to catch Ebola from a person who has even a fever but is otherwise symptom free. So, the policy of beginning a quarantine of an individual who has (a) been exposed to the Ebola virus; and (b) spiked a temperature of >= 100.4 BEFORE they have ANY other symptoms is THE BEST POLICY. Everything else, like these silly 21 day quarantines for symptom free people, is just an attempt to pacify all those people who cannot, for whatever reason, grok the science.
Before you get going, you need to have a clear understanding of what it is you are trying to achieve and how you intend to do that. For most of you this means understanding your business model.
It is certainly something much more than “having a great app” or “lots of people installing our app”. A clear business objective is going to be a specific measurable outcome. Things that generally make good measurable outcomes include: a revenue target, a target number of engaged users who use the application for 6 months on a daily basis, or it may even be a metric measured outside the app. In each case it is essential to understand what your objective is and work towards it, rather than just waiting for things to happen.
Take the revenue target as an example. Revenue is the result of purchases, and in any digital environment purchases do not just “happen”. A great deal of thoughtful design, both of the application and of the business model, is required to make purchases happen.
We can only go through this process if we understand our business objectives clearly. If you are unsure about the right business model for you app (or you business for that matter), consider working through the results of Business Model Generation: A Handbook for Visionaries, Game Changers, and Challengers. If you spend the time to get the business model right, you’ll be more likely to create something of value rather than wondering why your wonderful app isn’t actually able to achieve your measurable outcomes.
Whatever you do, you must create an app that looks and feels perfectly natural. When your users pick it up, smiles should light up their faces as they involuntarily nod their heads in approval. When you do that, you will have succeeded.
People crave clarity and respond positively to its presentation. Most all of us live in a world of continuously increasing complexity where simplicity isn’t all that easy to find. It boils down to basic supply and demand: As simplicity of design in apps becomes more rare, it also becomes more valuable. So your ability to keep your application simple, and protect things from becoming more complicated, becomes more valuable as well.
To do this you need to understand the “Laws of Simplicity” which Ken Segall has so graciously spelled out for us in his book Insanely Simple: The Obsession That Drives Apple’s Success. But creating the perfect app for your users and business model is more than that. It is also figuring out what you need for a very first version, no more and no less.
This requires focus. Consider what Apple’s Jonathan Ive says about focus:
If you sit down and really focus on building the best possible 1.0 version of your app, you should be able to do it quickly; in 10 to 12 weeks with the right small group of smart people. Concentrating on building the best possible 1.0 version of your app gives you a number of advantages beyond scheduling. It normally allows you to create a app that’s not only revolutionary, but also illuminates an even more exciting path ahead.
If you are lucky you might be looking at about 30%-50% of your installs still using your app after one week. And things tend to go downhill from there.
Of course, in any digital business some attrition is inevitable. But too much of the wrong kind of attrition will kill you. All your acquisition and development spend is for nothing: because you can’t keep people in your app. And a prime cause of bad attrition is a poor initial experience.
What do I mean by poor initial experience? Well, firstly it’s not necessarily a ‘tutorial’ in the conventional, rigid, sense of the word. But rather a method of answering the questions that – if you fail to answer them effectively – will end up causing your users to give up:
Far too many apps ignore this requirement. They launch the user straight into the core experience and leave them to their own devices. No wonder so many fail to engage beyond the first session.
So first of all, start thinking about initial user experience, and build out a smart initial experience process that stops your users getting confused or frustrated. Look to create (dismissible) screens that answer the questions above and ensure users understand what to do and how to do it.
Look to create some form of funnel analysis in order to understand exactly where you are losing users, and take steps to remedy those issues. Great initial experience is designed and simple. Apply the lessons from (#2) to your design efforts and take great pains to be empathetic to the brand new user of your app; after all, not everyone is able to read minds.
You must do everything in your power to create word-of-mouth and bring people to your app without paying for them. If you repeatedly have to pay for acquisition chances are you are ignoring the brutal honesty of the market place. Simply put, your app is considered by the users to be irrelevant. Either you have failed at design (#2), or your business model (#1) won’t fly.
Your app should consider the role of social sharing and ratings in organic acquisition from the very start.
When it comes to the social sharing, you should be doing everything in your power to make it as easy as possible to make social sharing happen. Encourage your users to share achievements (and if you don’t have natural ‘achievements’ in your app – create them).
In fact, if appropriate, pit users against each other. This is one area where apps can learn from the games industry, where ‘competitive’ social techniques drive user engagement.
App store ratings will also have a significant effect on organic acquisition. They help convert browsing users, and good ratings improve chart position. They matter enough that simply asking users to rate your app would be a mistake. Instead, develop a plan for driving higher ratings rather than any ratings.
Central to your efforts would be targeting and in-app messaging. The goal is to only have users who love your app to rate it. That’s relatively easily achieved by, for example, presenting an in-app message asking for feedback to you before then asking those who give positive feedback to rate. Simple – but are you doing it?