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What We're Afraid to Say About Ebola
New York Times ^ | 9/11/2014 | MICHAEL T. OSTERHOLM

Posted on 09/11/2014 11:23:51 PM PDT by DouglasKC

THE Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.

There have been more than 4,300 cases and 2,300 deaths over the past six months. Last week, the World Health Organization warned that, by early October, there may be thousands of new cases per week in Liberia, Sierra Leone, Guinea and Nigeria. What is not getting said publicly, despite briefings and discussions in the inner circles of the world’s public health agencies, is that we are in totally uncharted waters and that Mother Nature is the only force in charge of the crisis at this time.

There are two possible future chapters to this story that should keep us up at night.

The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. This outbreak is very different from the 19 that have occurred in Africa over the past 40 years. It is much easier to control Ebola infections in isolated villages. But there has been a 300 percent increase in Africa’s population over the last four decades, much of it in large city slums. What happens when an infected person yet to become ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu — or even Karachi, Jakarta, Mexico City or Dhaka?

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented...

(Excerpt) Read more at nytimes.com ...


TOPICS: Culture/Society; Foreign Affairs; Miscellaneous; News/Current Events
KEYWORDS: airbourneebola; ebola; ebolaoutbreak; ladyalqaeda; pandemic
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To: Black Agnes; Lazamataz

Please note the difference between this and CDC Ebola PPE reccomendations —

http://www.pbs.org/wgbh/pages/frontline/health-science-technology/ebola-outbreak/msf-on-ebola-this-is-the-biggest-outbreak-weve-ever-known/


“When we go into the [isolation] ward, we’re wearing full personal protective equipment, which means a Tyvek hazmat suit with a hood on top of it.

The suit has a hood that comes with it, but we use another hood that covers the full head, the face, and has a mask, but we wear a mask underneath that as well.

And then we have goggles on top of that, double or triple gloves, and boots, and an apron on top of that.”


IOW, multi-layer protection againt fomite migration or penetration to mucus/eye/mouth/fingernail beds/ear membranes.

They don’t even want fomite contamination on top of their N-100 particle masks!


161 posted on 09/12/2014 7:17:38 PM PDT by Dark Wing
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To: Dark Wing
The CDC recommendations for prevention of transmission in hospitals are detailed here: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Please note that these are recommendations for general hospital behavior where Ebola patients are on site in the hospital (not necessarily in situ), not for isolation wards themselves. I understand that the protocols, being medical protocols in general and not specific to any one organization, are roundly followed by all groups: ECDC, WHO, CDC, MSF, MHW (the Chinese counterpart to the CDC).

Everyone will (with exceptions for the foolish, or perhaps early in the crisis) be in bunny suits in actual Ebola patient wards. There are not different protocols followed by different groups. These are all professionals.

162 posted on 09/12/2014 7:29:23 PM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: DouglasKC; 3D-JOY; abner; Abundy; AGreatPer; Albion Wilde; AliVeritas; alisasny; ...

PING!


163 posted on 09/12/2014 8:21:51 PM PDT by Tolerance Sucks Rocks (The mods stole my tagline.)
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To: Smokin' Joe

Thanks for the ping!


164 posted on 09/12/2014 8:28:46 PM PDT by Alamo-Girl
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To: DouglasKC

Dr Brantley, in his interview, speculated that he caught ebola when diagnosing a patient while not suited up.


165 posted on 09/12/2014 11:25:37 PM PDT by Selene
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To: Lazamataz
Droplet precautions only require masks, gloves and sometimes gowns; AIRBORNE precautions require negative-pressure ventilation to ensure no/little transmission to others via a very infective route.

***********************************************
Then how come it's classified as a level 4, and the people working in the labs have spacesuits and oxygen/negative pressure ventilation? Why aren't they just wearing masks, gloves, and gowns?

And the pics of the docs that I've seen have more than masks, gloves and gowns, yet the docs are getting sick too?
Better safe than sorry I say.

As to the distinction between airborne and droplets, the general public makes no distinction. To them droplets might as well be airborne, because if they don't touch the person, and get the disease when they were only in the room, they are going to feel like it was airborne.

Even though they may have simply stepped on the droplet and then taken off their shoe and got in on their hands and rubbed their eyes, they are exposed, and their story will be, I was only in the room. I never touched them, and I had nothing to do with their care, so it must be airborne.

At any rate, once they have the disease, I don't suppose they care whether it was truly airborne or not. They just want to get well, and are scared that they have been handed a death sentence.

Sloppy reporting is par for the course. You don't really expect reporters to do their jobs effectively do you? I haven't seen many if any for a long long time that do a good job.

Well, that's just me though. I wouldn't want to be in a room with an Ebola patient without the suit and negative ventilation, and oxygen etc. etc. An ounce of prevention is worth a pound of cure. Guess I'm just a nervous Nellie.

166 posted on 09/13/2014 12:15:59 AM PDT by greeneyes (Moderation in defense of your country is NO virtue. Let Freedom Ring.)
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To: Black Agnes

I don’t know about the CDC, but the people who have been treating Ebola patients here had more than mask, gown, and gloves, and the rooms had negative pressure too.


167 posted on 09/13/2014 12:30:04 AM PDT by greeneyes (Moderation in defense of your country is NO virtue. Let Freedom Ring.)
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To: PapaBear3625

“Now, think about the datum about recovered Ebola patients still being able to transmit Ebola in semen for weeks afterward, and consider the effect of just one recovered gay man going back to work as a trucker and making the rounds of gay bars around all the truck stops across the country he may visit over those weeks.”

One thing I never want to think about is those disgusting homos in truck stop bathrooms and gay bars. But, that is what happened in 1981 or so. The CDC refused to quarantine the homos and an AIDS epidemic was born.


168 posted on 09/13/2014 5:03:31 AM PDT by anton
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To: DouglasKC; Black Agnes; greeneyes; UCANSEE2
Ok folks, you want something you SHOULD be worrying about?

Glad to oblige!


This is an official
CDC HEALTH ADVISORY
 
Distributed via the CDC Health Alert Network 
September 12, 2014, 17:00 ET (5:00 pm ET)
CDCHAN-00369
 
Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014 
 
 
Summary: The Centers for Disease Control and Prevention (CDC) is working closely with hospitals and local and state health departments to investigate recent increases in hospitalizations of patients with severe respiratory illness. Enterovirus D68 (EV-D68) has been detected in specimens from children with severe illness in Missouri and Illinois. Investigations into suspected clusters in other jurisdictions are ongoing. The purpose of this HAN Advisory is to provide awareness of EV-D68 as a possible cause of acute unexplained respiratory illness, and to provide guidance to state health departments and health care providers. Please disseminate this information to infectious disease specialists, intensive care physicians, pediatricians, internists, infection preventionists, and primary care providers, as well as to emergency departments and microbiology laboratories.
 
 
Background
Enteroviruses are associated with various clinical symptoms, from mild to severe. EV-D68 causes primarily respiratory illness, although the full spectrum of disease remains unclear. EV-D68 was originally isolated in 1962 and, since then, has been reported rarely in the United States. Small clusters of EV-D68 associated with respiratory illness were reported in the United States during 2009–2010.There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive.
 
In August 2014, a children’s hospital in Kansas City, Missouri, and one in Chicago, Illinois, notified CDC of increases in pediatric patients examined and hospitalized with severe respiratory illness, including some admitted to pediatric intensive care units. Both hospitals also reported recent increases in detection of rhinovirus/enterovirus, in initial screening with a respiratory virus panel. Nasopharyngeal specimens from patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. EV-D68 was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. CDC has been notified by various states of similar clusters of respiratory illness, though confirmation of EV-D68 in these potential clusters is still under way.
Of these severely ill patients who were confirmed positive for EV-D68 from both hospitals, all presented with difficulty breathing and hypoxemia, and some with wheezing. Notably, most patients were afebrile at presentation and throughout the hospital course. Approximately two thirds of cases had a previous medical history of asthma or wheezing, but both hospitals reported some patients with no known underlying respiratory illness. Ages ranged from 6 weeks through 16 years, with median ages of 4 and 5 years in Kansas City and Chicago, respectively. Most patients were admitted to the pediatric intensive care unit. Of the 30 patients who were positive for EV-D68, two required mechanical ventilation (one of whom also received extracorporeal membrane oxygenation) and six required bilevel positive airway pressure ventilation. It should be noted that specimens from only the most severe cases have been typed at this time, and so these findings may not reflect the full spectrum of disease.
Additional details about these EV-D68 clusters can be found in the September 8, 2014, MMWR Early Release:
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0908a1.htm?s_cid=mm63e0908a1_e)
Recommendations
 
Clinical Care: 
•	Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever.
•	Although the findings to date have been in children, EV-D68 may also affect adults.
 
Laboratory Testing:
•	Providers should consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory infection in severely ill patients is unclear.
•	Confirmation of the presence of EV-D68 requires typing by molecular sequencing.
•	Providers may contact state or local health departments for further enterovirus typing. CDC is available for consultation.
•	Health departments may contact CDC for further enterovirus typing.
•	CDC is currently prioritizing respiratory specimens from patients with severe respiratory illness who are known to be positive for rhinovirus/enterovirus from initial screening assays.
•	Please visit the CDC EV-D68 website (http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html) for information on specimen submission. Completion of a brief patient summary form is required with each specimen submission to CDC.
Infection Control:
•	Routes of transmission for EV-D68 are not fully understood.
•	Infection control guidelines for hospitalized patients with EV-D68 infection should include standard precautions, and contact precautions in certain situations, as is recommended for all enteroviruses (http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf).
•	As EV-D68 is a cause of clusters of respiratory illness, similar to rhinoviruses, droplet precautions also should be considered as an interim recommendation until there is more definitive information available on appropriate infection control.
•	As EV-D68 is a non-enveloped virus, environmental disinfection of surfaces in healthcare settings should be performed using a hospital-grade disinfectant with an EPA label claim for any of several non-enveloped viruses (e.g. norovirus, poliovirus, rhinovirus). Disinfectant products should be used in accordance with the manufacturer’s instructions for the specific label claim and in a manner consistent with environmental infection control recommendations (http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf).
Reporting:
•	Providers should report suspected clusters of severe respiratory illness to local and state health departments.
•	EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
•	Health departments may contact CDC for epidemiologic support. Please contact Dr. Claire Midgley (cmidgley@cdc.gov) with brief descriptions of possible clusters.
 
For more information: 
For additional information, please consult the CDC enterovirus D68 website:
(http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html)
 
 
The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.
 
____________________________________________________________________________________
 
Categories of Health Alert Network messages: 
Health Alert         Requires immediate action or attention; highest level of importance
Health Advisory   May not require immediate action; provides important information for a specific incident or situation
Health Update    Unlikely to require immediate action; provides updated information regarding an incident or situation
HAN Info Service                Does not require immediate action; provides general public health information
 
##This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations##
 

169 posted on 09/13/2014 5:55:47 AM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: greeneyes

I just posted what someone else posted. Once I started digging, I discovered everyone uses the same protocols. Not sure why the MSF guy was braggin’ on it, but maybe he was tryin’ to score some hot chick reporter.


170 posted on 09/13/2014 5:58:01 AM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: Lazamataz

How many deaths from this so far?


171 posted on 09/13/2014 6:05:32 AM PDT by Black Agnes
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To: Black Agnes

Fortunately, none. However, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0908a1.htm?s_cid=mm63e0908a1_e indicates that they were categorized as ‘severe’ and in quite a few cases, bi-level oxygenation was required. They’d have died but for our current medical system.


172 posted on 09/13/2014 6:23:32 AM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: Lazamataz

Ok. Thousands infected. None dead.

Clearly that’s much more dangerous than Thousands infected, thousands dead, including hundreds of healthcare workers.

Right?


173 posted on 09/13/2014 6:26:35 AM PDT by Black Agnes
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To: Black Agnes
EV-D68 is in America, actually happening, so we should disregard it.

Ebola is in Africa, and the very few actual cases of it in America were imported patients, who were cured at 100% rate. So that is what we should be concerned about.

Right?

174 posted on 09/13/2014 6:36:00 AM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: Lazamataz

If that’s the case, why is the CDC sending all those people to Africa now? If ebola is in Africa...and e68 is here.

Are they doing as extensive contact tracing with the e68 as they are with ebola? You know, so they can find out where the e68 came from?

Let me know if they ever manage to trace how this particular enterovirus entered this country.

Because THAT will be a radioactive topic.

I guarantee you anyone who fingers the immigrant invasion will be fired. F. I. R. E. D. fired.

By the way, have they decided that the immigrant kids will have to be vaccinated to attend school yet? So far they’re not required to have any proof of vaccination.


175 posted on 09/13/2014 7:05:41 AM PDT by Black Agnes
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To: Black Agnes
If that’s the case, why is the CDC sending all those people to Africa now?

Vacations, probably.

176 posted on 09/13/2014 7:22:19 AM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: Tolerance Sucks Rocks

Before we started importing Ebola cases, there was virtually zero risk of any Ebola epidemic in the US. Now, there is a nonzero risk. Some say it’s major, some downplay it, but no one will say it’s still zero. So already, it’s increased — which is VERY bad policy.


177 posted on 09/13/2014 9:35:32 AM PDT by TBP (Obama lies, Granny dies.)
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To: Lazamataz

There are several threads on the EVD-68.

I posted maps of the NAFTA SUPERHIGHWAY and noted how the outbreaks of EVD-68 are all along that path.

I also noted that with all these kids getting sick, the health care system (ins. companies) and the government stand to profit off it, due to those new LARGE DEDUCTIBLES in OBAMACARE.

I mean, most of us would just suffer the disease, but when it comes to our children....


178 posted on 09/13/2014 4:36:29 PM PDT by UCANSEE2 (Lost my tagline on Flight MH370. Sorry for the inconvenience.)
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To: UCANSEE2
I posted maps of the NAFTA SUPERHIGHWAY and noted how the outbreaks of EVD-68 are all along that path.

That's interesting. Freepmail follows.

179 posted on 09/13/2014 4:58:50 PM PDT by Lazamataz (First we beat the Soviet Union. Then we became them.)
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To: Lazamataz
Here, for instance, is one depiction of the superhighway. Immigrants, legal or not, usually go straight from the border to Kansas City. They either stay , or disperse along the branches out of the Kansas City Hub to other states.

Missouri was one of the first publicized outbreaks, iirc. From there it has spread to

And here's a simpler map that very closely matches the Map with Rush.


180 posted on 09/13/2014 6:55:07 PM PDT by UCANSEE2 (Lost my tagline on Flight MH370. Sorry for the inconvenience.)
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