Ebola: Is the end really here?

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Ebola: Is the end really here?

Postby GreenDay » Thu Oct 02, 2014 1:46 pm

Questions that should be asked:

Why doesn’t the United States have a mandatory quarantine period of 28 days before allowing any traveler who has visited West Africa in the past 90 days, to enter our country?

As Ebola cases continue to crop up in America, what actions are planned so that the virus will not enter the animal population of antelopes, porcupines, rodents, dogs, and pigs, and thus become a untreatable and unreachable reservoir of the virus that will never disappear?

When will the State Department cancel the 13,500 visitors visas from the three West African countries that currently have Ebola epidemics? What is the State Department waiting for?

The search for an Ebola virus vaccine is proceeding rapidly. Who in the government will actually decide those patients that would become beta- testers and receive this scarce commodity?

Canadian Ebola studies indicate that aerosolized Ebola is “strongly suspected” to be infectious through droplets in the air. When will the CDC required all medical caregivers to use full-face masks and P100 filters in dealing with infected patients?

How many hospital beds in the United States have negative air pressure enclosures plus air exhaust handling systems that meets the criteria for Bio Safety Level (BSL) 3 or 4?

If an outbreak of Ebola occurs in a major US city such as New York, Chicago, or Los Angeles, is this government prepared to quarantine five to eight million citizens from land, sea and air travel to stop the spread of the virus? How many deaths from such an outbreak would trigger such quarantine? Would US troops be ordered to fire upon US citizens attempting to evade the quarantine?

How many Ebola deaths nationally would trigger a Presidential Executive Order declaring martial law, nationalizing the distribution of food, energy, healthcare and information? Would this Executive Order also limit the duration of martial law and the circumstances for it being lifted?

Will American troops serving in West Africa and infected with Ebola, be returned to the United States for treatment, or will they remain in Africa to lessen the chance of contagion here at home? Were the troops notified of this decision before they shipped out?

Ebola makes global warming, Iranian nukes, and terrorism as insignificant as a McDonalds hamburger wrapper. Ebola knows no racial, economic or political boundaries. Ebola’s lethality (50%) is higher than the 14th century’s Black Death (30% to 40%) or the 1918 influenza pandemic’s (15%); a viral infection that killed 3% to 6% of entire human population living on the planet in 18 months.

Last question. Why are so few of us raising our voices --- screaming at the top of our lungs--- demanding that our government begin implementing common-sense epidemiological safeguards against Ebola unnecessarily infecting more Americans?



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Re: Ebola: Is the end really here?

Postby GreenDay » Thu Oct 02, 2014 1:54 pm

I'm not usually freaked out by stuff like this, but this is pretty serious. Ebola is an R2 disease, meaning one person gives it to 2. Exponential growth. No vaccine, no ready treatment, 50% lethality even with good treatment. Our hospital systems are totally unprepared to deal with thousands of patients who all should have isolation and biosafety level 3 or 4 containment.

I'm going to spend at least part of this weekend getting supplies together, including medical supplies from relatives in the healthcare field. I'd recommend being prepared to be isolated for stretches of time, and possibly also be prepared to vomit and bleed to death.

In retrospect, we've known about Ebola for decades - this would have been a pretty basic problem for the UN to fund and solve, if they actually had reasonable priorities.
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Re: Ebola: Is the end really here?

Postby dsr » Thu Oct 02, 2014 4:13 pm

"Affected countries have encountered many difficulties in their control efforts. In some areas, people have become suspicious of both the government and hospitals; some hospitals have been attacked by angry protestors who believe that the disease is a hoax or that the hospitals are responsible for the disease. Many of the areas that have been infected are areas of extreme poverty with limited access to soap or running water to help control the spread of disease. Other factors include belief in traditional folk remedies, and cultural practices that predispose to physical contact with the deceased, especially death customs such as washing the body of the deceased. Some hospitals lack basic supplies and are understaffed. This has increased the chance of staff catching the virus themselves."

These are the conditions that create 50% lethality, so far. I reckon America can do better. Don't you?

Tropical diseases traditionally flourish better in the tropics than outside. And a disease that killed 1,200 in August and the same number in September isn't likely to become a worldwide pandemic. If it can't spread faster than that in an African city, it's not going to do well in the cleaner, more spacious, better protected western world.
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Re: Ebola: Is the end really here?

Postby get louder at lambeau » Thu Oct 02, 2014 4:36 pm

Ebola is definitely a scary disease. I'm not ready to get all worked up about it just yet.

If you are concerned about it, I'd say focus on getting yourself as healthy as possible. Survival of the fittest is particularly pertinent with disease. If ebola flames out, worst case scenario is that you got yourself all healthy just in time for your body to fight off flu season. No downside at all.

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Re: Ebola: Is the end really here?

Postby GreenDay » Thu Oct 02, 2014 6:06 pm

^^^ both points above are important, but a bit off the mark. Yes, being healthy can help you better ward off an infection, but it just slightly lessens your risk - healthy people get infected all the time.

Yes, the US is far better in dealing with disease than third world countries. But Ebola is a highly lethal infection. The mortality rate is just a lot, lot higher than your garden variety virus, even with great medical care.

The real question is what is it's actual transmission rate. It's supposed to be R=2, but I've read research papers that show direct evidence that it's far higher - but those are in monkey controls. 1-1/R is supposed to be the fraction of the population that needs to be immune (vaccinated) to prevent continual spread. Obviously, as the R gets closer to 1, the easier it is to stop the epidemic. Smallpox and Measles have R's in the 5-15 range for comparison. HIV is close to Ebola, but 'immunization' is essentially a cessation of sexual contact or needle sharing with people infected/suspected to be infected - no immunization is required. If a similar type of physical barrier (even if it's distance or timely isolation) works for Ebola, it shouldn't be a huge problem.

Still, I'm concerned
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Re: Ebola: Is the end really here?

Postby Lord Ben » Sun Oct 05, 2014 1:41 am

dsr wrote:These are the conditions that create 50% lethality, so far. I reckon America can do better. Don't you?


Up to a certain point, yes. But we don't have unlimited capacity. Guy in Dallas gets sick and CDC sends a quick team there to track down his contacts, etc and place them all under quarantine. It's all good so far but what happens when a few more people see that the difference between living and dying might be whether or not they can get a plane ticket to America? Get the same thing happening in a half dozen more cities a month from now, etc. Everything is going to be stretched and then soon there aren't any more beds or nurses available anymore.

Stories like this one below are already starting. Anyone who thinks they were exposed or gets a fever with the $1500 for a ticket from Monrovia to USA is going to be coming. Does anyone think all the sick people are going to take one for the team and stay in Liberia when they can come to the USA and be given better medical care just for showing up? This guy in Dallas isn't the last (I pray he's the first) guy with Ebola to come to the USA. At some point Americans will start getting sick, if it gets bad enough we'll run out of space and it's going to be hard to contain.

http://nypost.com/2014/10/04/sick-passe ... k-airport/

It is unclear how many Liberians had been on the plane. Brussels airlines had a Friday night flight out of Monrovia, Liberia’s capital; that flight connected to United Airlines, according to online records.

“The crew reported (during the flight) that a person was vomiting, and that Liberians were aboard the plane,” a law enforcement source told The Post.

“The person throwing up is believed to be Liberian,” the source said.

The jet had just completed a seven-hour flight across the Atlantic, and as it sat at Gate 53, Terminal B, the five-hour wait once the plane landed seemed to be an eternity to family members at the airport.

“It’s a concern not only for me but for every one of us,” Liberian Jah Zauyan, 44, said as he waited for three friends, who are also Liberian, to deplane.

“You hope it’s nothing. This is scary for the sick one,” Zauyan added.

“Someone comes to a strange land and they have to grab them and take them somewhere.”

Better here than in Africa, noted Liberian native Joshua Brown, as he waited for friends at Gate 53.

“I’m not worried for them,” he told The Post. ‘Because they are coming from Africa, and America is a better place to be” if you have Ebola, he noted.

“All the people brought here are cured from Ebola but there they die. America is a great country.”
Last edited by Lord Ben on Sun Oct 05, 2014 1:44 am, edited 1 time in total.
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Re: Ebola: Is the end really here?

Postby Lord Ben » Sun Oct 05, 2014 1:44 am

dsr wrote:Tropical diseases traditionally flourish better in the tropics than outside. And a disease that killed 1,200 in August and the same number in September isn't likely to become a worldwide pandemic. If it can't spread faster than that in an African city, it's not going to do well in the cleaner, more spacious, better protected western world.


Do we have any actual data that it spreads less well in the USA? I know they've been telling us lately that it's hard to spread and it'll be under control "any day now" for a few months.

Also, those death tolls are probably under reported to avoid panic. For the same reason our own government keeps saying "Oh, it'll never come here."
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Re: Ebola: Is the end really here?

Postby get louder at lambeau » Sun Oct 05, 2014 4:41 pm

Here is an interview with the doctor who discovered and named Ebola, back in 1976. A couple blurbs -

About what has enabled it's spread -

In their hospital they regularly gave pregnant women vitamin injections using unsterilised needles. By doing so, they infected many young women in Yambuku with the virus. We told the nuns about the terrible mistake they had made, but looking back I would say that we were much too careful in our choice of words. Clinics that failed to observe this and other rules of hygiene functioned as catalysts in all additional Ebola outbreaks. They drastically sped up the spread of the virus or made the spread possible in the first place. Even in the current Ebola outbreak in west Africa, hospitals unfortunately played this ignominious role in the beginning.


Do you think we might be facing the beginnings of a pandemic?

There will certainly be Ebola patients from Africa who come to us in the hopes of receiving treatment. And they might even infect a few people here who may then die. But an outbreak in Europe or North America would quickly be brought under control. I am more worried about the many people from India who work in trade or industry in west Africa. It would only take one of them to become infected, travel to India to visit relatives during the virus's incubation period, and then, once he becomes sick, go to a public hospital there. Doctors and nurses in India, too, often don't wear protective gloves. They would immediately become infected and spread the virus.


Sounds like it is likely to spread like wildfire where medical hygiene standards are NOT properly followed, but is unlikely to spread quickly where they are.

The whole thing -

http://www.theguardian.com/world/2014/o ... t-outbreak
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Re: Ebola: Is the end really here?

Postby Beagle » Mon Oct 06, 2014 8:16 pm

Ebola just popped up in Spain. It is starting to spread outside of Africa now.

" A nurse's assistant in Spain is the first person known to have contracted Ebola outside of Africa in the current outbreak. Spanish Health Minister Ana Mato announced Monday that a test confirmed the assistant has the virus.
She had helped treat a Spanish missionary who contracted Ebola in West Africa."


http://www.cnn.com/2014/10/06/health/eb ... ?hpt=hp_t2
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Re: Ebola: Is the end really here?

Postby Pckfn23 » Mon Oct 06, 2014 8:45 pm

If transmission is not aerosol then the threat of world wide pandemic is very very minimal. That is unless the host turns into a flesh craving zombie, hell bent on biting other humans.
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Re: Ebola: Is the end really here?

Postby Beagle » Tue Oct 07, 2014 5:49 pm

Ebola is much easier transmitted than HIV and look at how many people are infected with that.

While Ebola is not an airborne disease and cannot be transmitted by water, you can get the virus by being coughed on or sneezed on. IMO, Ebola is something that needs to be contained and kept away at all costs.

With that said, 3rd world countries are where Ebola will really do it's damage. Countries, like the US, can stop it well it before it really starts to take a hold. We have the capabilities and the facilities that a lot of those countries do not have.
Last edited by Beagle on Tue Oct 07, 2014 7:35 pm, edited 1 time in total.
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Re: Ebola: Is the end really here?

Postby BF004 » Tue Oct 07, 2014 5:58 pm

From what I've read, there are a lot of unkowns about the exact communicability (pretty sure thats not a word) because it is so dangerous to handle and they just can't test it and there isn't an extensive history to analyze.

Much like pregnancy factors. Many things are not recommended while someone is pregnant, but most were not tested to have negative impacts, just unknown impacts because you really can't test it for ethical/health reasons.

This does have the possiblity to be absolutely devastating on a global scale. India has tens of thousands of contract workds in Africa including Liberia and have a terrible medical system, doctors and nurses regularly don't use gloves, sanitation is sub par, needles are cleaned and reused, if it spreads to a few cities in countries like India, Indo-China, rural parts of China, this won't be able to be contained.
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Re: Ebola: Is the end really here?

Postby Pckfn23 » Tue Oct 07, 2014 8:05 pm

Beagle wrote:Ebola is much easier transmitted than HIV and look at how many people are infected with that.

While Ebola is not an airborne disease and cannot be transmitted by water, you can get the virus by being coughed on or sneezed on. IMO, Ebola is something that needs to be contained and kept away at all costs.

With that said, 3rd world countries are where Ebola will really do it's damage. Countries, like the US, can stop it well it before it really starts to take a hold. We have the capabilities and the facilities that a lot of those countries do not have.


The main difference is that Ebola symptoms start to show at latest 3 weeks after infection, most of the time within days, AND (BIG AND HERE), patients are not contagious until they start showing signs of infection. HIV infects many people because people can infect others and not show signs for years. MAJOR difference. And actually Ebola and HIV/AIDS are transmitted pretty much in the same manner, bodily fluids.

The R0 value for Ebola is pretty low, meaning an infected person is only likely to infect 2 others before they die or get better.

As you said, it has little to no chance of spreading outside of the third world countries.

Again, being only transmitted through bodily fluids it has little to no chance of spreading in first or second world countries.

http://www.geek.com/science/so-just-how ... y-1606117/

We know it is not airborne, that is about all we need to know.
http://www.who.int/mediacentre/news/ebo ... r-2014/en/
http://news.sciencemag.org/africa/2014/ ... ey-studies

The exact ways of transmission, while not completely verified, the modes of are fairly nailed down. While it might take years to get it in check in Africa and Asia, this is not a risk to become a global pandemic, at this time.
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Re: Ebola: Is the end really here?

Postby Beagle » Tue Oct 07, 2014 8:30 pm

Pckfn23 wrote:The exact ways of transmission, while not completely verified, the modes of are fairly nailed down. While it might take years to get it in check in Africa and Asia, this is not a risk to become a global pandemic, at this time.


True. They think sweat, saliva and other fluids can transmit it, even from a dead body. As of right now, all of the factors are unknown because it needs to be studied further. Studying it carries it's own risks. But right now, it is a lot easier to get than HIV, without a doubt!

I think they might find, just my own unverified opinion, is that Ebola can spread a lot faster than what is currently known.

If fruit bats in Africa have it, how long will it be before one is transported over here, released and then all bats have it?
Last edited by Beagle on Tue Oct 07, 2014 11:19 pm, edited 1 time in total.
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Re: Ebola: Is the end really here?

Postby GreenDay » Tue Oct 07, 2014 10:07 pm

"And actually Ebola and HIV/AIDS are transmitted pretty much in the same manner, bodily fluids."

Not even close. HIV is a lot harder to infect someone with - you pretty much have to get their blood in your blood stream. If an ebola patient sneezes on you , you can get it. And the experts treating it are not exactly sure how they are contracting it either.

IN DEPTH
INFECTIOUS DISEASES
When Ebola protection fails
Jon Cohen
In July, as Ebola was exploding in Liberia, Senga Omeonga worked as a doctor at St. Joseph's Catholic Hospital in Monrovia. Among the patients he cared for was the hospital's director, who had diarrhea and was vomiting repeatedly, but tested negative for the Ebola virus. “I was exposed to that patient day by day,” says Omeonga, who originally is from the Democratic Republic of the Congo. When the director didn't respond to treatment, a second test was done, which came back positive. That was 10 days after his first test.

Omeonga wore what he calls “light” personal protective equipment (PPE) after he learned the man was infected, which included a surgical gown as opposed to a heavy plastic apron, gloves that he thought were too short, and a face shield and mask. By the last few days of the patient's life, he says, the staff was keeping its distance. “Everyone was afraid to touch him,” Omeonga says. “He was screaming. I removed his nasogastric tube and he was fighting.” On 2 August, the hospital director died and Omeonga himself came down with Ebola.

Omeonga, along with two other health care workers infected in Liberia, Kent Brantly and Nancy Writebol, has received widespread media attention for receiving an experimental cocktail of antibodies called ZMapp. All three survived; none of them knows if the treatment helped. But all three wonder about another question that has important implications for other health care workers: How did they become infected?

Surprisingly, no one has a firm answer. “Every day I'm still thinking, When was I contaminated?” Omeonga says, although he suspects the hospital director was the source. Writebol, a clinical nurse associate who worked for a missionary group called SIM at the ELWA 2 Ebola Treatment Center in Monrovia and helped health care workers don and doff PPEs, is similarly stumped. “Nobody is really sure, least of all me,” she says. Brantly, a doctor in the same center, also has only hunches but says, “I am fully convinced that I did not contract Ebola in my work in the treatment unit.” (Read Q&A's with Ebola survivors at http://scim.ag/ebola14.)

As of 23 September, the outbreak had sickened 375 health care workers and killed 211, according to the World Health Organization. A clearer understanding of the risks could lead to better precautions and ease the minds of those thinking of joining the fight. But few studies have analyzed the relative risks of blood, urine, vomit, and other bodily fluids that health care workers encounter. And doctors and nurses rarely can pinpoint risky lapses in their behavior, says epidemiologist Daniel Bausch of Tulane University in New Orleans, Louisiana, who worked in Ebola units in Guinea and Sierra Leone when this outbreak surfaced.

“Very few people have anything specific to say,” Bausch says, although many, like Brantly, doubt that they got infected in the Ebola unit itself, where precautions are most stringent. “There's a tendency to want to believe people get infected outside the ward because it makes us feel better. It's probably a mixed bag.”

Brantly, Writebol, and Omeonga say they had ample training about how to protect themselves. “Our process was very safe,” says Brantly, who worked for the Christian relief group Samaritan's Purse. “It is my opinion that during an Ebola outbreak, the safest health care job is working in the Ebola treatment unit.” The hidden danger, they say, lies in patients whose status isn't known.

Brantly suspects he was infected while working in the emergency room, outside the treatment unit, and saw a patient who was diagnosed with Ebola only after she died. He wasn't wearing PPE at the time. “It is in clinics and emergency rooms and hospitals where you have to look at every patient and ask yourself ‘Should I be concerned that this patient might have Ebola?’” he says. But it's a risk that is, in practicality, impossible to eliminate.

Omeonga, too, says new patients present a serious risk. “A lot of them were lying when they came to the hospital,” he says. “They didn't even tell you they're having fevers. They'd say they fell down or were on a motorbike or someone pushed them or they went to work and passed out.” He was one of 15 who became infected at his hospital, presumably all by the ailing director. Nine of them died. The hospital closed.

When helping staffers doff PPEs, Writebol says she wore gloves and a disposable apron; she was separated from workers exiting the treatment unit by a line that she never crossed. Thinking back, she believes a co-worker who did the same job may have infected her. He became ill with what he thought was typhoid; he died from Ebola. “I never remember touching him,” she says—but it's possible she picked up a sprayer he had used.

When Writebol first developed a fever on 22 July, she thought she had malaria, which a test confirmed. Her husband, David, cared for her while they continued sharing a bedroom. But she could not shake the fever, and 4 days later, a doctor gave her an Ebola test “to relieve everyone.” After the results came back positive, she was isolated, and David began speaking to her through a window near her bed. He did not develop Ebola.....
http://www.sciencemag.org/content/346/6205/17.full




More:
Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak
Stephen K. Gire, et et. Science

In memoriam: Tragically, five co-authors, who contributed greatly to public health and research efforts in Sierra Leone, contracted EVD and lost their battle with the disease before this manuscript could be published: Mohamed Fullah, Mbalu Fonnie, Alex Moigboi, Alice Kovoma, and S. Humarr Khan. We wish to honor their memory.
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