War on Ebola

[TreeA10]

Including the military folks deployed to Africa to help?

No. We know where they've been, they know what to look for. The best treatment facilities in the U.S. are limited but here for a reason so, if a military member contracts ebola, they have to come back to the U.S.

Great guidance from the Expert, Mr. Frieden. He has actually said both of the following sets of statements.

"Amanda Vinson shouldn't have flown on an airplane.

But passengers on that airplane are at no risk.

You can't get Ebola on a bus.

But people with Ebola shouldn't ride on one.

Cutting off all flights to W. Africa is a bad idea.

But we're now recommending that all non-essential travel there be cancelled.

Any hospital can treat Ebola patients.

But maybe special Ebola hospitals are a better idea.

We know how to handle Ebola.

We just can't seem to figure it out when it's for real.

Our protocols will stop the disease.

But maybe we need to take another look at our protocols.

[Clark Griswold]

There is a reason why Ebola is classified as Biosafety Level 4 hazzard.

https://en.wikipedia.org/wiki/Biosafety_level#Biosafety_level_4

The longer we screw around and not stop this in its place, the more chances it has to mutate and become airborne, head for the bunker at that point. Or alternatively, it will find a natural reservoir here in the Western Hemisphere, as it is suspected it is in Fruit Bats in Africa, at that point it is endemic.

https://www.theguardian.com/society/2014/aug/23/ebola-outbreak-blamed-on-fruit-bats-africa

[Fuzz]

Including the military folks deployed to Africa to help?

No healthcare workers/military/NGO orginizations etc. should all be allowed to enter and leave under controlled circumstances. Otherwise no one, except the military who has no choice, would ever accept to a one way trip to those areas; its hard enough to get people to go help as it is right now.

[jcj]

1. The estimated mortality of Ebola infection in the US (with our modern health care facilities & aggressive supportive care) is about 20%. Of course with just a handful of cases and one death (in a case that was mishandled) that's still pretty much a WAG - but clearly the mortality is much less than overseas where modern care isn't available. That also doesn't factor in experimental drugs (there are a few being used when they are available) and transfusion of antibody-containing blood products from Ebola survivors when compatible type blood is available. It's thought that these treatments may be somewhat effective, but no one knows for sure.

2. What's required to care for Ebola patients is standard isolation, contact isolation & droplet isolation. Theoretically, any hospital can do this. As a practical matter, these patients get very sick with projectile vomiting, explosive diarrhea and lots of other unpleasantness. All of these fluids are quite infectious in Ebola patients. Hence the staff caring for them must wear a very complex ensemble of PPE when caring for the patient, and (this is really important) must be able to decontaminate and safely remove the PPE when they go off duty. And essentially, they have to do it right without error every time around the clock. This is really complex and exhausting for staff to do repeatedly, especially if they're not extensively trained and practice (drill) regularly. This is probably why the nurses at Texas Presbyterian were infected - caring for the patient (who eventually died) at the height of his illness with at best "rushed up" training, no practice or experience with Ebola or other high-level infectious diseases and (some media reports) incomplete PPE ensembles and incomplete training in use and safe removal. In short this hospital (Texas Presbyterian) decided they could care for this patient there - they quickly got in over their heads & got in deep trouble really fast. Hindsight being 20/20, this was a bad decision and those paying the price are the two front-line nurses who were doing the best they could to care for this patient in an environment that just wasn't up to speed.

3. You'll notice that there have been no occupational exposures at the three national biocontainment centers that have cared for Ebola patients - NIH, Emory and Nebraska Medical Center (the fourth biocontainment center at St. Patrick in Missoula, Montana hasn't yet cared for any Ebola patients). That's because the staff of these centers regularly train, teach and drill in caring for patients who require this strict isolation on an ongoing basis. Their staff is qualified & current in use of these PPE ensembles and other things necessary to care for these patients. Right now there are 11 such beds in all of the U.S (2 currently occupied). It seems to make sense to move these patients to one of these four centers although it makes sense to stand up additional resources to care for Ebola patients if more are encountered - there are other hospitals that with help of CDC experts can stand up to the same level of competence with some advance warning, and there are several that are working on that now.

4. If you're interested in the air transport of Ebola patients back to the U.S. check here https://abcnews.go.com/Health/video/ebola-us-walkthrough-inside-ebola-transport-jet-26226918 - it's pretty interesting.

5. I think the CDC has also made some missteps early in this event but they are rapidly correcting and I have confidence in what they are telling us.

6. What's been written that makes sense is that travel bans don't make sense, but screening & individualized monitoring does. Apparently there's a very small number (<200/day) persons who come into the US from the West African areas where the outbreak is centered - indirectly because there are no direct flights - and DHS knows in advance who these individuals are co they can be closely monitored. I think you'll see that this plus screening of overseas PAX will be effective at keeping this situation under control domestically while teh world humanitarian effort gets it under control overseas.

6. Am I overly worried? No. Do we need to take this very seriously - especially while we are still learning the nuances of this disease in the U.S.? Absolutely. I'm old enough to remember when HIV/AIDS was first discovered & not well understood (I was a medical student at the time). This seems very similar - except internet and 24 hour cable communication is more prevalant - and I'm sure we'll get a good handle on it quickly.

Edited October 18, 2014 by jcj

[Clark Griswold]

21 days may not be enough time now to tell if someone is infected.

New Study Suggests 21-Day Ebola Quarantine Is Dangerously Short

I don't think it's time for Code Red 28 Weeks Later lock down but we need to really err to the side of caution.

Edited October 18, 2014 by Clark Griswold

[TreeA10]

21 days may not be enough time now to tell if someone is infected.

New Study Suggests 21-Day Ebola Quarantine Is Dangerously Short

I don't think it's time for Code Red 28 Weeks Later lock down but we need to really err to the side of caution.

The study was done by an engineer, not a medical professional, so he is wrong.

[DC]

the more chances it has to mutate and become airborne

That doesn't happen.

No virus we've ever studied has ever changed its mode of transmission.

[jcj]

That doesn't happen.

No virus we've ever studied has ever changed its mode of transmission.

This

Sometimes people talk about it being airborne transmissible (because HCW's are wearing N95 masks, etc) - it's not. But it is droplet transmissible, meaning if a patient sneezes and those droplets hit the mucus membranes of another person, transmission is possible. But that's just a characteristic of the virus not a mutation.

Here's a longer explanation that's quite good if anyone is interested. https://answers.yahoo.com/question/index?qid=20071110152456AAPomKI

[pintail21]

I'm not ready to panic yet but tempting fate with this potential wildfire of a disease is just plain stupid. Good article on why this should raise more paranoia. I like the people who listen to experts and parrot the "this disease is not easily transmitted". Two experts caught it in Dallas. This article details a report by 58 epidemiologists regarding Ebola and 5 of them died of ebola before it was published. IF experts are being killed off, the rest of us are screwed if this gets a foot hold.

https://www.weeklystandard.com/articles/six-reasons-panic_816387.html

The "experts" who got sick in africa weren't wearing their biohazard suits because it was too hot, and the "experts" in the US were nurses who had no experience dealing with biosafety level 4 agents. If you don't follow african funeral rites and don't give hands on medical care to ebola patients there is zero chance of getting sick. Statistically speaking more americans have been killed by toasters, cows and elevators than ebola this year, hell the common cold has probably offed over 3000 americans this year but nobody bats an eye at that.

[jcj]

The "experts" who got sick in africa weren't wearing their biohazard suits because it was too hot, and the "experts" in the US were nurses who had no experience dealing with biosafety level 4 agents. If you don't follow african funeral rites and don't give hands on medical care to ebola patients there is zero chance of getting sick. Statistically speaking more americans have been killed by toasters, cows and elevators than ebola this year, hell the common cold has probably offed over 3000 americans this year but nobody bats an eye at that.

In fact over a recent 30-year period we've averaged about 24,000 influenza-related deaths in the US annually (the variation is wide = from 12,000/yr to 48,000/yr over the last 10 years) even though we have a very effective vaccine and somewhat effective treatments for influenza.

One other thing I've noticed - the US medical community has ramped up like I've never seen before in response to this outbreak - even more so than I remember when HIV was first identified. I am optimistic that we will see a both a vaccine and effective treatment very soon. But we (in the medical community) are still learning more about this outbreak as we work through it. In the next 24 hours or so you will see some revised recommendations from the CDC released - in large part from lessons learned from the Texas Presbyterian cases. And I think the consistent opinion of pretty much everyone credible is that the most effective way to fight this outbreak is to put it down in Africa.

My concern with the Weekly Standard article above is it's using good primary medical evidence and spinning it to support an agenda. We just don't need that right now.

Edited October 19, 2014 by jcj

[Clark Griswold]

That doesn't happen.

No virus we've ever studied has ever changed its mode of transmission.

This

Sometimes people talk about it being airborne transmissible (because HCW's are wearing N95 masks, etc) - it's not. But it is droplet transmissible, meaning if a patient sneezes and those droplets hit the mucus membranes of another person, transmission is possible. But that's just a characteristic of the virus not a mutation.

Here's a longer explanation that's quite good if anyone is interested. https://answers.yahoo.com/question/index?qid=20071110152456AAPomKI

Knowledge acquired - thank you. Further Google post-football research, good article on probability of Ebola evolving to an airborne virus: Fact or Fiction?: The Ebola Virus Will Go Airborne

What I think is most worrisome is that as human infections rise, is that Ebola will jump from primates to another species and find a new reservoir from which to infect us. The flu will commonly go from species to species and raise hell, so why not Ebola?

The study was done by an engineer, not a medical professional, so he is wrong.

2

[zrooster99]

That doesn't happen.

No virus we've ever studied has ever changed its mode of transmission.

Bullshit, I heard it has already mutated and is now causing zombism... Execute zombi apocalypse plan 0!

[hispeed7721]

Sent from my iPhone using Tapatalk

[TreeA10]

While not inflicting fatalities, I will agree her music has made more people sick that Ebola.

[pawnman]

This

Sometimes people talk about it being airborne transmissible (because HCW's are wearing N95 masks, etc) - it's not. But it is droplet transmissible, meaning if a patient sneezes and those droplets hit the mucus membranes of another person, transmission is possible. But that's just a characteristic of the virus not a mutation.

Here's a longer explanation that's quite good if anyone is interested. https://answers.yahoo.com/question/index?qid=20071110152456AAPomKI

Unfortunately, if those droplets hit a surface, then the virus can survive on that surface, albeit for a limited amount of time. Now put that surface somewhere thousands of people will come into contact with it...like, say, an airplane? Like I said, I'm not panicking, but I am slowly inching my level of concern upwards.

[TreeA10]

Exactly. "It's not communicable unless you are in a confined area with a person exhibiting symptoms so don't worry. Uh, unless you were on that flight from Cleveland to Dallas, we really need to talk to you."

[HossHarris]

How often do you touch airplane surfaces with your mucous membranes?

[TreeA10]

If you are this guy, maybe too often:

[snoopyeast]

[Clark Griswold]

If you are this guy, maybe too often:

LMFAO

Sent from my iPhone using Tapatalk

[busdriver]

How often do you touch airplane surfaces with your mucous membranes?

While I agree not to panic, the issue is touching said surface then rubbing your eyes or eating, etc. I doubt Africans are rubbing their mucous membranes on dead relatives.

The issue in West Africa from what I can tell based on some Vice reporting and whatnot is overload of medical facilities. Sick people sent away rely on their friends and family, who are at risk based on no barrier protection. Seems to me that we could boost the medical capability as well as pass out free barrier protection capability. Let's be honest some tyvec suits, gloves and face masks aren't expensive.

[SurelySerious]

Let's be honest some tyvec suits, gloves and face masks aren't expensive.

Who set the requirements, and who designed/built it? I'm sure LM could make it worthwhile to the shareholders on a gov't contract.

But seriously, we've sent some and need to send more.

[Jughead]

Am I alone...?

[StoleIt]

Bullshit, I heard it has already mutated and is now causing zombism... Execute zombi apocalypse plan 0!

[pintail21]

There is a reason why Ebola is classified as Biosafety Level 4 hazzard.

https://en.wikipedia.org/wiki/Biosafety_level#Biosafety_level_4

The longer we screw around and not stop this in its place, the more chances it has to mutate and become airborne, head for the bunker at that point. Or alternatively, it will find a natural reservoir here in the Western Hemisphere, as it is suspected it is in Fruit Bats in Africa, at that point it is endemic.

https://www.theguardian.com/society/2014/aug/23/ebola-outbreak-blamed-on-fruit-bats-africa

So should we do the same thing with AIDS? I mean that has an equal chance of mutating and finding a natural reservoir in the Western Hemisphere right (as in pretty much zero).