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Ebola Patients Brought to the United States


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#1 Egann

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Posted 08 August 2014 - 11:17 AM

This topic will likely bleed over into Contro territory.

 

So, as of now there are two people with Ebola in the United States, and six unidentified people from undisclosed locations have been tested and come back negative

 

The CDC director here in Atlanta recently said that the Ebola patients pose no public threat. That's really quite comforting until you remember that only last month the head of the CDC's Rapid Response and Advanced Technology Bioterrorism Lab resigned after lapses in procedure exposed a dozen CDC workers to Anthrax. It's also really telling he also says an outbreak here in the states is inevitable.

 

"It is certainly possible that we could have ill people in the US who develop Ebola after having been exposed elsewhere," Frieden told a hearing of the House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations.

 

"We are all connected and inevitably there will be travelers, American citizens and others who go from these three countries -- or from Lagos if it doesn't get it under control -- and are here with symptoms," he said.

 

"But we are confident that there will not be a large Ebola outbreak in the US."

 

Well, that's comforting.

 

I have more to say, but this is very much not good. Let's talk Ebola.



#2 Delphi

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Posted 08 August 2014 - 02:18 PM

Seems like I have to do this in every site I post lately...

The reason the outbreak in West Africa is so bad has more to do with the countries it's been ravaging than anything else.

Sierra Leone hasnt really been stable since the end of the empires in the middle if last century. Additionally Sierra Leone and the areas around it are terribly poor. Health care is all but nonexistent. Sierra Leone if what I was reading is correct also has the highest infant and maternal mortality rates in the world.

The entire area is already ravaged by endemic diseases like malaria and its own hemmoragic disease, Lassa Fever.

This is a weakened population that has issues with getting clean water to their citizens, much less proper medical treatment.

Now Ebola comes to the area and it really couldn't be a more perfect breeding ground. Despite only being infectious after symptoms begin and spreading through contact with bodily fluids, there was no doubt in my mind that it'd be a perfect storm if it reached this area.

Lassa fever, while milder, has many of the same symptoms of Ebola including the nausea, vomiting, body aches, sore throat and eventually bleeding. It's also spread by contact with body fluids but has the additional vector of having mice as a vector. The good news is that Lassa fever can be easily treated with ribavirin in the early stages. We've know this for decades now. It ribavirin is expensive and the poor can't afford it. There used to be programs in place to reduce the mice infestation in food storages.

Then the civil war happened and lasted twelve years and the CDC and WHO couldn't get into the country to provide the ribavirin. Lassa went right back to killing and disabling people and getting it's foothold back.

Now if Sierra Leone can't even fight off Ebola's weaker younger brother that they're familiar with, then an Ebola outbreak is going to be a perfect storm of an epidemic. And ribavirin doesn't work on Ebola.

Most hospitals in rural Africa are very poorly stocked. Things we take for granted like IV fluid support being readily available in any ER here in the States is a precious comodedy there. Sure large hospitals like Mama Yemo have first world treatments and supplies but it doesn't help when it's 500 miles away.

Unless brought in from better off countries in Africa like Egypt and South Africa or from completely foreign aid, these countries don't have access to the basics to keep something like this from spreading. No masks, no eye protection, limited gloves, limited needles that inevitably get reused without sterilization, and lack of biohazard materials containment all spells one thing: no containment.

This is why the virus is now out of control there.

But over here, I'm more worried about a zombie apocalypse than Ebola. I have a tongue in cheek zombie plan but not an Ebola plan. That's how much of a non issue this would be to me.

Ebola can only truely take hold in countries lacking in basic health care. The second you introduce barrier nursing, a standard practice in first world medicine with any suspected contagious illness, Ebola cases start to drop.

We've actually already had a case of Lassa fever make it back to the States and into a Chicago hospital where he bled out and died in the operating room. There were no secondary cases.

Our ability to keep a unit clean and patients separated and triaged appropriately is what will cause Ebola to stop dead in its tracks in a first world country after the initial infectees present.

Ebola is spread by bodily fluids and Ebola causes severe vomiting and diarrhea along with the famous bleeding. Where the outbreaks happen this is not easily cleaned up even in medical settings. And with the lack of protective clothing you can imagine what happens if someone projectile vomits into someone else's face or the filth gets into an open wound.

On top of that people in rural Africa don't have a lot of faith in hospitals. Some for superstitious reasons but more often it's from simple observation. They send a sick person to a hospital and half the time a persons lives and the other half they die. I wouldn't take my chances there either.

Funeral rights in the area also involve cleasening and purging the body, usually done by the family. Now the family is potentially infected. The actual funeral involves family and friends kissing the corpse. Now even more people.

And then us mighty whiteys come in and tell them they can't practice their funeral rites anymore or they'll die. The same people who have a bad habit of destroying a culture and replacing it with their own over many centuries. Yeah I wouldn't want to listen to them either. And people are still dying.

And interesting thing I observed when it comes to Ebola and Lassa fever and the like is if you could overlay a map of where epidemics like this happen over a map of the countries labeled with the average family's yearly revenue per region, you'd see the regions with the poorest families are the ones being ravaged by these diseases.

That leads you to the real problems.

I'm at work so I don't have access to my books but I've been following and reading about Ebola including peer reviewed studies since I first heard of it during the 2000 outbreak.

My favorite is co-written by the former director of the CDC's level 4 hot labs Joseph B. McCormick and was in Africa as a young doctor during the first recognized outbreak called Level 4: Virus Hunters of the CDC. Very good true story with references to back up the facts. Slightly outdated now but the actual search to find a cure for Ebola also crosses into the stories of trying to contain Lassa Fever and the emergence of HIV as a modern pandemic.

#3 Selena

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Posted 08 August 2014 - 09:43 PM

Yeah, the "Ebola Scare" is just media sensationalism -- at least for developed countries. There are a grand total of two US cases, they are both under strict quarantine, and the only acquired the disease because they were working with the infected in less-than-ideal medical circumstances.

 

This is immensely dangerous for developing countries in and near Africa, along with any densely populated areas in the vicinity, but the likelihood of it spreading like wildfire throughout the rest of the world, especially the US, is slim.

 

There's no cure, and fatality rates among the infected are staggeringly high, so it sounds terrifying. But so long as people are kept quarantined, it's unlikely to be a major issue. Now, if it were suddenly like 100 people over here, and they didn't know for a while, then it might spread a bit. Even then, the danger element only comes into play if patient numbers exceed the max number of people hospitals can keep in isolation at a time.

 

People will forget about it in a month.



#4 Egann

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Posted 09 August 2014 - 10:47 AM

Let's start by being honest. Ebola in Africa will kill people, but unless the outbreak in the US is absolutely outrageous it's more likely to cost money more than kill.

 

I don't think the two patients in the US is a major danger. The likelihood it will cause problems are really quite small; the only real way anything could happen is a protocol breech. Heck, I don't even think they're the first Americans to come down with the disease this outbreak. The reason they were brought to the US? Because a doctor and nurse are ideal patients; they've seen the symptoms in others and likely know more about it than any of the US doctors. This isn't about humanitarian aid to our own (which 90% of the articles focus on) but about controlled research.

 

I mean, seriously. The CDC is literally walking range from Emory--a three minute drive according to google maps: walking to the car and parking take longer than the drive--and yet the news articles are all about how humanitarian this is. Get quotes from the CDC? Sure. Mention the CDC is right down the street? Never. I confess, that was half the reason for this thread; what kind of driveling moron do these news places take me for? To say this stinks of disinformation and distraction would be an understatement. If they're not willing to tell me the reason they wanted the patients was to help the CDC, then what else have they left out? Why?

 

 

The major problem I have is that on reading the material...Ebola should be an easy disease to quarantine. It's not airborne (yet) and it shows symptoms quite quickly, at least for being a retrovirus. HIV is a retrovirus, too, and it can remain dormant so long quarantining it was effectively impossible. And there's really not that much traffic in and out of this part of Africa, in part because it is dirt poor.

 

So why is the CDC director saying Ebola in the states is inevitable when even sensible quarantine should be effective? Because the CDC thinks it is about to go airborne, or at least that enough people are infected in Africa that it could go airborne. That is a completely different proposition because if that happens, quarantine just became much harder.

 

Of course that's also essentially guesswork. It's also possible the CDC just wanted to keep a close eye on the effects of their experimental serum. 



#5 Delphi

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Posted 09 August 2014 - 04:27 PM

Ebola is an extremely slow virus when it comes to mutation. The Zaire strain has just barely shown a minor change in its genetic coding since it was discovered back in the 70s and the 70s samples sequenced when the technology is available.

Let's be honest, viruses don't work like the pandemic game where it just decides to go airborn one day. There's no way to look at a virus's code and go "Ayup. That there's the airborn gene." We barely even know how our own genetic code works and we've been focused on that since the ability to unravel DNA was produced.

HIV and Influenza had a ridiculous rate of mutation. That's why an HIV vaccine that works indefinitely is the holy grail of HIV research. Also the reason you need a new flu shot each year.

Ebola doesn't have that rapid mutation factor.

Besides, going by your logic of it's only a matter of time before it becomes airborn through mutation then why hasn't the more rapidly mutating HIV virus done it yet? It'd provide an easier infection vector which is clearly beneficial. But it hasn't and we don't really understand why because we really still don't understand viruses all that well when you get down to it.

Can you link me the article where he said an outbreak is inevitable? With all the bullshit stories floating around the web right now it's a total mess so I doubt I'll trip across the one you're referencing. I ask because I'm seeing statements proclaiming the opposite, that an Ebola outbreak in the states us highly unlikely.

Also I did hear about issues at the CDC labs regarding The anthrax issue and that is quite an embarrassment. However, anthrax is a biosafety level 3 pathogen while Ebola is biosafety level 4. The facilities that work on each level are different as night and day really.

Level 3 facilities just require safety clothing and respirators to be used with the containment cabinets and hoods. The air has to be filtered before being released. It's considered a neutral/warm zone.

Level 4 is freaking intense. All facilities have to be under negative pressure so if there is a breach in containment, air is sucked in first rather than out to buy time. Usually that means they're separated from other research facilities. This is where you see the "space suit" work being done. That actually requires a segregated air supply and the suits are under constant positive pressure. The entrance and exits include multiple shower stations, a vacuum room, and ultra violet room along with any other safety methods deemed necessary. Then the lab workers work inside the same hoods used in level 3 as extra precaution. This is the infamous hot zone.


Multiple airlocks are used which use electronic systems to make sure no two doors are open at the same time. All tools enter the lab and exit via autoclave. All water used in these labs is decontaminated and held for a certain period of time. Most methods use superheating the water. Some places that superheat the water actually have to wait to dump until it cools back down or it will crack the pipes.

The Laboratoire P4 Jean Mérieux lab in France is a rather impressive level 4 lab with some cool pics.

Anthrax getting loose from a level 3 containment? More likely than you'd think. Ebola getting loose from a level 4 lab? That'd be the day. As so few people are authorized to work level 4, it's also a point of professional pride to uphold those standards. It's impressive what humans will do when pride is on the line. It'd also be a kick in the face for the CDC especially after what happened. They're not going to let it get loose and have their reputation really go down the toilet.

Also just an FYI. Ebola has an incubation period of about three to twenty one days. This is not the same as an infectious carrier period. Ebola actually isn't contagious until symptoms appear.

I really, really recommend reading information from Joseph B. McCormick and William Close (yes Glenn Close's dad). These guys were in the bush and chasing Ebola from the first days.

It's actually quite tragic that he died in 2009. He was instrumental in getting the first outbreak under control. He had a lot of friends in high places around all parts of Africa but especially Zaire.

Interestingly enough from what I've been reading the mortality rate for the current outbreak is around 60%. While still staggeringly high compared to most diseases, this strain of Ebola is know to have up to a 90% mortality rate. I wonder if the comparatively lower death rate is partially to blame. In the epidemics with 90% mortality, the virus tends to go through victims too fast to spread efficiently and perpetuate infection rates. But with a 60% mortality rate it might just be low enough to chew through people but not so fast it that it doesn't have any more victims to infect...

Just musing.

#6 Egann

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Posted 11 August 2014 - 11:39 AM

Ebola is an extremely slow virus when it comes to mutation. The Zaire strain has just barely shown a minor change in its genetic coding since it was discovered back in the 70s and the 70s samples sequenced when the technology is available.

Let's be honest, viruses don't work like the pandemic game where it just decides to go airborn one day. There's no way to look at a virus's code and go "Ayup. That there's the airborn gene." We barely even know how our own genetic code works and we've been focused on that since the ability to unravel DNA was produced.

HIV and Influenza had a ridiculous rate of mutation. That's why an HIV vaccine that works indefinitely is the holy grail of HIV research. Also the reason you need a new flu shot each year.

Ebola doesn't have that rapid mutation factor.

Besides, going by your logic of it's only a matter of time before it becomes airborn through mutation then why hasn't the more rapidly mutating HIV virus done it yet? It'd provide an easier infection vector which is clearly beneficial. But it hasn't and we don't really understand why because we really still don't understand viruses all that well when you get down to it.

 

Ebola actually appears to be pretty close to going airborne, already. While it hasn't done it in an actual outbreak, lab tests indicate that it already can go airborne.

 

Airborne transmission has not been documented during previous EVD outbreaks.[3] They are, however, infectious as breathable 0.8–1.2 micrometre laboratory generated droplets;[25] because of this potential route of infection, these viruses have been classified as Category A biological weapons.[26] Recently the virus has been shown to travel without contact from pigs to non-human primates.[27]

 

The phrase "uncomfortably close" comes to mind, especially as that last one (the pigs to primates) was published after the outbreak before this one. This could be a very recent change.

 

Can you link me the article where he said an outbreak is inevitable?

 

That was a sparknotes from the AP. It isn't exactly what he said, which was why I quoted him in the original post. The link is right here. What he actually said suggests that globally there's not much will to quarantine any disease.

 

Also I did hear about issues at the CDC labs regarding The anthrax issue and that is quite an embarrassment. However, anthrax is a biosafety level 3 pathogen while Ebola is biosafety level 4. The facilities that work on each level are different as night and day really.

Level 3 facilities just require safety clothing and respirators to be used with the containment cabinets and hoods. The air has to be filtered before being released. It's considered a neutral/warm zone.

Level 4 is freaking intense. All facilities have to be under negative pressure so if there is a breach in containment, air is sucked in first rather than out to buy time. Usually that means they're separated from other research facilities. This is where you see the "space suit" work being done. That actually requires a segregated air supply and the suits are under constant positive pressure. The entrance and exits include multiple shower stations, a vacuum room, and ultra violet room along with any other safety methods deemed necessary. Then the lab workers work inside the same hoods used in level 3 as extra precaution. This is the infamous hot zone. 


Multiple airlocks are used which use electronic systems to make sure no two doors are open at the same time. All tools enter the lab and exit via autoclave. All water used in these labs is decontaminated and held for a certain period of time. Most methods use superheating the water. Some places that superheat the water actually have to wait to dump until it cools back down or it will crack the pipes.

The Laboratoire P4 Jean Mérieux lab in France is a rather impressive level 4 lab with some cool pics.

 

It probably won't cause a problem, but I seriously doubt that the lab in Emory is actually a level 4 lab.I went through a half dozen articles online and not one of them described the facility beyond the word "safe." Not one described the safety procedures or codified them in a safety level. The most I found was a news article with the floor plan of the facility (no description of safety proceedures) and another with a picture of a facility like the one the CDC had set up in the airplane.

 

I am sure the people at the CDC and Emory understand this word "Biosafety Level" and would normally throw this around as workplace jargon. Not seeing it is a notable omission.

 

I can only conclude the CDC disagrees with WHO on Ebola's biosafety classification and if we're lucky the patient ward they set up is level 3. All of these articles reinforce that Ebola is not airborne and can't be spread by casual contact...and like I pointed out earlier, I don't think that's a sure bet because there is some research which says otherwise.

 

If they did set up a level 3 lab. of course they wouldn't describe the ward's safety procedures in detail. Anyone could fact-check what biosafety level it was and find out it isn't actually up to World Health standards.

 

That's my little theory, anyway.

 

Interestingly enough from what I've been reading the mortality rate for the current outbreak is around 60%. While still staggeringly high compared to most diseases, this strain of Ebola is know to have up to a 90% mortality rate. I wonder if the comparatively lower death rate is partially to blame. In the epidemics with 90% mortality, the virus tends to go through victims too fast to spread efficiently and perpetuate infection rates. But with a 60% mortality rate it might just be low enough to chew through people but not so fast it that it doesn't have any more victims to infect...

 

That strikes me as uniquely plausible. It's hard to assess what the old Bubonic Plague's mortality rate was, but most of the resources I've found put it in the 30-70% range, which is surprisingly low. There's probably an optimum mortality rate which depends on a disease's incubation and infectiousness periods, but between 60 and 70% strikes me as a butter zone of optimum killage.  



#7 Delphi

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Posted 11 August 2014 - 07:42 PM

I read the article and study about Ebola supposedly being airborn.

Airborn in epidemiology sense and the way we use it isn't the same.

Airborn in epidemiology means that the disease can spread without requiring a liquid medium to survive. Airborn as we think means if we breathe and it gets in the it's airborn. The distinction can mean the difference between spreading on commercial airliners or not so it's not just semantics.

However in the study they believe that the virus was spread from the pigs via aerosolized water droplets. The study also mentions that pigs are very unique in the situation as they shed more virus particles via aerosol than other species.

But they're still not sure if it traveled this way. Is also likely the monkey cages were contaminated by a fine spray of water when the pig pens were being cleaned. It's also possible that pigs are unique in spreading the viruses by air as multiple studies have been done with several monkeys being infected and then in close enough contact with another cage of monkeys to spread the disease by air and not fluids and there hasn't ever been a case where it's spread.

Plus you can basically make anything aerosolize in the right lab setting. However conditions in the lab aren't even close to what happens in real life.

The strain they were using is Ebola Reston, known not to infect humans. It's commonly found in pigs in the Philippines. But Ebola Zaire, source of the current outbreak hasn't been found in pigs. They're not even sure Ebola Zaire infects pigs.

So, no. That doesn't alude that the virus is on the cusp of going airborn. It only shows a small possibility in one animal with one Ebola strain of maybe being aerosolized in small droplets.

Basically we don't know nearly enough to start drawing conclusions that it's about to go airborn. The behavior of this outbreak doesn't support it anyhow. Many of the richer citizens of these countries flee by airline to large European cities. If even a few of the virus particles had the ability to go airborn, we'd certainly hear about people dropping dead from Ebola in say France.

But the pattern of infection isn't there. It's almost everything to do with sanitation.

Now that my desktop is back up and running I'll see if can superimpose the Ebola outbreaks with rates of poverty to illustrate what I mean.

This is the article I was reading btw about a second opinion of the 2012 pigs and monkeys study.

https://www.sciencen...key-study-shows

#8 Crimson Lego

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Posted 01 October 2014 - 09:24 PM

Coming from an uneducated 19 year-old, should I be worried about the spread of ebola in North America after the report in Texas?



#9 Selena

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Posted 01 October 2014 - 09:39 PM

In a word: No.

 

 

 

There will be rare cases here and there -- simply due to global travel. There are cases of other rare diseases that crop from time to time. Hell, some people still get Black Death. But ebola is relatively easy to isolate and lock down when we have confirmed cases. See: the other ebola patients who were successfully cured and didn't cause a zombie like plague.



#10 Crimson Lego

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Posted 01 October 2014 - 10:22 PM

Oh, they found a cure? :o

#11 Selena

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Posted 01 October 2014 - 11:03 PM

No, but it runs its course. After it's out of your system, you're fine. Like the flu from hell. I guess me saying "cured" was the wrong choice of words. "Successfully treated."

#12 Crimson Lego

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Posted 13 October 2014 - 01:54 PM

Possible vaccine for Ebola being tested?: http://www.cbc.ca/ne...n-u-s-1.2796859






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