Posted on 08/10/2014 12:46:23 AM PDT by Smokin' Joe
I have spent a little time compiling links to threads about the Ebola outbreak in the interest of having all the links in one thread for future reference.
Please add links to new threads and articles of interest as the situation develops.
Thank You all for you participation.
Snips from
http://www.bbc.com/news/health-29060239
Dr Christopher Dye, the director of strategy in the office of the director general at the World Health Organization, has the difficult challenge of predicting what will happen next.
He told the BBC: “We’re quite worried, I have to say, about the latest data we’ve just gathered.”
Up until a couple of weeks ago the outbreak was raging in Liberia especially close to the epicentre of the outbreak in Lofa County and in the capital Monrovia.
However, the two other countries primarily hit by the outbreak, Sierra Leone and Guinea, had been relatively stable. Numbers of new cases were not falling, but they were not soaring either.
That is no longer true, with a surge in cases everywhere except some parts of rural Sierra Leone in the districts of Kenema and Kailahun.
“In most other areas, cases and deaths appear to rising, that came as a shock to me,” said Dr Dye.
Snip
The charity Medecins Sans Frontieres has an isolation facility with 160 beds in Monrovia. But it says the queues are growing and they need another 800 beds to deal with the number of people who are already sick.
This is not a scenario for containing an epidemic, but fuelling one.
Dr Dye’s tentative forecasts are grim: “At the moment we’re seeing about 500 new cases each week, those numbers appear to be increasing.
“I’ve just projected about five weeks into the future and if current trends persist we would be seeing not hundreds of cases per week, but thousands of cases per week and that is terribly disturbing.
“The situation is bad and we have to prepare for it getting worse”
Snip
But it has spread significantly with the WHO reporting that “for the first time since the outbreak began” that the majority of cases in the past week were outside of that epicentre with the capital cities becoming major centres of Ebola.
Additionally one person took the infection to Nigeria, where it has since spread in a small cluster and there has been an isolated case in Senegal.
Prof Simon Hay, from the University of Oxford, will publish his scientific analysis of the changing face of Ebola outbreaks in the next week.
He warns that as the total number of cases increases, so does the risk of international spread.
He told me: “I think you’re going to have more and more of these individual cases seeding into new areas, continued flows into Senegal, Cote d’Ivoire, and all the countries in between, so I’m not very optimistic at the moment that we’re containing this epidemic.”
There is always the risk that one of these cases could arrive in Europe or north America.
Snip
Prof Neil Ferguson, the director of the UK Medical Research Council’s centre for outbreak analysis and modelling at Imperial College London is providing data analysis for the World Health Organization.
He is convinced that the three countries will eventually get on top of the outbreak, but not without help from the rest of the world.
“The authorities are completely overwhelmed, all the trends are the epidemic is increasing, it’s still growing exponentially, so there’s certainly no reason for optimism.
“It is hard to make a long-term prognosis, but this is certainly something we’ll be dealing with in 2015.
“I can well imagine that unless there is a ramp-up of the response on the ground, we’ll have flair ups of cases for several months and possibly years.”
It is certainly a time-frame which could see an experimental Ebola vaccine, which began safety testing this week, being used on the front line.
If the early trials are successful then healthcare workers could be vaccinated in November this year.
Here forever
But there are is also a fear being raised by some virologists that Ebola may never be contained.
Prof Jonathan Ball, a virologist at the University of Nottingham, describes the situation as “desperate”.
His concern is that the virus is being given its first major opportunity to adapt to thrive in people, due to the large number of human to human transmission of the virus during this outbreak of unprecedented scale.
Ebola is thought to come from fruit bats, humans are not its preferred host.
But like HIV and influenza, Ebola’s genetic code is a strand of RNA. Think of RNA as the less stable cousin of DNA, which is where we keep out genetic information.
It means Ebola virus has a high rate of mutation and with mutation comes the possibility of adapting.
Prof Ball argues: “It is increasing exponentially and the fatality rate seems to be decreasing, but why?
“Is it better medical care, earlier intervention or is the virus adapting to humans and becoming less pathogenic? As a virologist that’s what I think is happening.”
There is a relationship between how deadly a virus is and how easily it spreads. Generally speaking if a virus is less likely to kill you, then you are more likely to spread it - although smallpox was a notable exemption.
Prof Ball said “it really wouldn’t surprise me” if Ebola adapted, the death rate fell to around 5% and the outbreak never really ended.
“It is like HIV, which has been knocking away at human to human transmission for hundreds of years before eventually finding the right combo of beneficial mutations to spread through human populations.”
It is also easy to focus just on Ebola when the outbreak is having a much wider impact on these countries.
The malaria season, which is generally in September and October in West Africa, is now starting.
This will present a number of issues. Will there be capacity to treat patients with malaria? Will people infected with malaria seek treatment if the nearest hospital is rammed with suspected Ebola cases? How will healthcare workers cope when malaria and Ebola both present with similar symptoms.
And that nervousness about the safety of Ebola-rife hospitals could damage care yet further. Will pregnant women go to hospital to give birth or stay at home where any complications could be more deadly.
The collateral damage from Ebola is unlikely to be assessed until after the outbreak.
No matter where you look there is not much cause for optimism.
Could that be because they are comparing today's infected numbers against today's dead count, instead of the infected numbers form 2-3 weeks ago (when the dead were infected) against the dead count?
To know the survival rate, You need solid data on how many have recovered.
You also need to know how many were infected.
Keep in mind that a 'mere' 30% death rate (about half to a third of anticipated) has the potential to more severely impact human population numbers than the Black Death, both in terms of raw numbers and in terms of percentage.
Yet they find virus in the saliva of three-fourths of acute-phase patients using assay, and only one positive for the culture of those same patients.
Looking at this chart it's obvious that the experimental design is lacking an important component. I'm surprised they published given the very odd results.
Later, in the conclusions, they state:
There was a significant discrepancy between the results of virus culture and RT-PCR testing in our study, with many more frequent positive results from RT-PCR. Possible explanations for this finding include virus degradation from breaks in the cold chain during sample collection, storage, and shipping; the greater sensitivity of RT-PCR relative to culture; and, in the case of the saliva specimens, possible virus inactivation by salivary enzymes. The less-than-ideal storage conditions of the specimens in the isolation ward immediately after acquisition and the fact that even the nasal blood from 1 patient was culture negative suggest that some virus degradation indeed occurred. Nevertheless, we cannot exclude the possibility of a true absence of viable virus in the original samples. We hope to be able to repeat this study in the future with better maintenance of the cold chain to resolve this question.
In light of this serious problem and the oddity of their clinical sample results, I take with several grains of salt the following:
Other than in samples grossly contaminated with blood, EBOV was not found by any method on environmental surfaces and by RT-PCR on the skin of only 1 patient. These results suggest that environmental contamination and fomites are not frequent modes of transmission, at least in an isolation ward. However, the infectious dose of EBOV is thought to be low, and neither cell culture nor the RT-PCR assay used for EBOV in this study have not been extensively validated for use in %^ detection. Hence, the sensitivity and specificity are unknown. It is possible that EBOV was present in the environment below the threshold of detection or that environmental surfaces in the isolation ward were, at times, initially contaminated by EBOV but then decontaminated through the daily cleaning routine. However, many of the inanimate objects tested, such as bed frames and bedside chairs, would not routinely be specifically decontaminated with bleach solutions under existing guidelines unless they happened to be visibly contaminated [3], suggesting that environmental contamination did not occur. Taken together with empirical epidemiological observations during outbreaks, our results suggest that current recommendations for the decontamination of filoviruses in isolation wards [3] are effective. The risk from environmental contamination and fomites might vary in the household or other settings where decontamination would be less frequent and thorough, especially if linens or other household materials were to become visibly soiled by blood.
One more thing about that study:
If their procedures on clinical samples produce such inexplicable results, what degree of confidence is warranted their results on environmental samples?
CDC's last update was August 28 (9 days ago), after multiple, multiple updates in August. Interpreting anything the Obama administration does is a bit like Kremlinology in the old days, but I imagine that there is quite an internal battle going on about whether or not to release data (they must know on some level that they have to) and how to spin it to support their messaging.
This was released by WHO Geneva HQ late Friday afternoon/evening. CDC seems to consistently lag behind WHO data releases
Ebola Toll Tops 2,000, Cases Near 4,000
2014-09-05 22:28
Geneva - More than 2,000 people have died in the Ebola outbreak in West Africa, the World Health Organisation said on Friday, out of about 4,000 patients thought to have been infected in the three countries worst hit by the disease.
The death toll in Guinea, Liberia and Sierra Leone totalled 2,097 as at 5 Sept, out of 3,944 cases, a WHO document said.
The data did not include patients in Nigeria or Senegal, which have also been affected, nor Democratic Republic of Congo, which has been hit by an unrelated outbreak of the disease.
(End)
“nterpreting anything the Obama administration does is a bit like Kremlinology in the old days, but I imagine that there is quite an internal battle going on about whether or not to release data (they must know on some level that they have to) and how to spin it to support their messaging.”
Thoroughly agree that CDC has become fully political under this regime.
Just heard over the radio that NIH (IIRC) uncovered an unsecured and hidden Ricin stash. Hard to believe that MDs and research scientists can be so cavalier about such.
It turned out that safety data sheet linked to in the Chicago Boyz article was written poorly.
The “(23)” in that sentence was not for “23 days.” It was a _foot note reference_ which, when looked up, said Ebola survived outside the body for “Several days” which in contexts meant from one to as many as five days.
Someone posted in the Ebola Surveillance topic here a 2007 article from the Journal of Infectious Disease titled —
“Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites”
...that said there wasn’t much risk of Ebola slime infection unless their was blood involved, however, see the following admission from that article —
“There was a significant discrepancy between the results of
virus culture and RT-PCR testing in our study, with many more frequent positive results from RT-PCR. Possible explanations for this finding include virus degradation from breaks in the cold chain during sample collection, storage, and shipping; the greater sensitivity of RT-PCR relative to culture; and, in the case of the saliva specimens, possible virus inactivation by salivary enzymes. The less-than-ideal storage conditions of the specimens in the isolation ward immediately after acquisition and the fact that even the nasal blood from 1 patient was culture negative suggest that some virus degradation indeed occurred.
Nevertheless, we cannot exclude the possibility of a true absence of viable virus in the original samples. We hope to be able to repeat this study in the future with better maintenance of the cold chain to resolve this question.”
The 2007 test team’s samples ran out of liquid nitrogen cooling for their Ebola samples between Africa and its virus culture testing by the CDC in Atlanta. Which, given the infection rates we are seeing in Liberia and elsewhere, means the samples went bad in transit.
The bottom line is we still don’t know the human infection rate from non-blood human body fluids in the environment.
At this point — given how Patrick Sawyer infected the ECOWAS diplomat sitting next to him on the flight from Togo to Lagos — I’d bet that fresh Ebola contaminated saliva and mucus getting into your eyes, nose and mouth from a Ebola infected person’s sneeze will suffice to infect you.
It's obvious that dissemination through the air (as opposed to "airborne") is happening. There must be transcutaneous infection with a low ID50.
I am having a hard time reconciling simple "droplet+contact+standard" precautions with the existence of the four biocontainment units in the US.
I think CDC would love it to be true that "rule out Ebola" cases could be managed with less stringent precautions than proven cases, but this cannot happen, given the mortality of HCWs in Africa with seemingly incidental contact. There will be dozens or hundreds of rule out cases in the US if arrivals from West Africa are not stopped (and they won't be stopped until it's too late).
The effect is that while positive results can be believed, at least in a qualitative sense, negatives have not been conclusively proven.
What if “dissemination through the air” had a little help?
I’m talking about mosquitoes. Can some of you very learned folks on this thread explain to a layman like me why mosquitoes can spread malaria but can’t spread Ebola?
I for one can't explain it, except to say that some organisms are well adapted to vectorborne transmission and others aren't.
The guys on the ground in West Africa have done a good job showing chains of transmission involving physical or close personal contact, and with mosquitoes involved there would be hundreds of thousands of cases by now.
Which would make sweat and fomites particularly dangerous. (How often have you been jostled by someone who is sweating in a crowd?)
If an individual is sweating (just from the heat), can they be more susceptible to picking up the virus from a contaminated surface? Are open pores sufficient for viral entry and infection?
Someone sweating is also more likely to rub their eyes (sweat in their eyes). All these factors may apply.
I have more questions than answers at this point, but chances are that whatever is causing (at least some of) the infections is a gesture, behavioural quirk, or unconscious action on the part of the infected which places the virus in contact with a mucous membrane. Still, other means of contamination cannot be ruled out at this point.
>>According to Dark Wing, 1000 new cases PER DAY
>>starting around Sept. 16. Just 11 days away.
It turns out I am over estimating by WHO data rates of disease progression.
See post 1,671 on this topic for a better (not much) rate of disease growth.
With Ebola, the mosquito would have to bite a human to pick it up, then bite another to transfer it. Usually, they fill up with the first bite, so the likelihood of transferring the disease from one human to another is less.
Theoretically, if interrupted while biting, they could bite someone else, but many interruptions are fatal to the mosquito...
One of my major “Expected Flaming Datums” for Ebola in Nigeria has just exploded.
Foreign oil workers are leaving Nigeria over Ebola.
While none of the big multi-national oil companies have officially announced they are leaving Port Harcourt Nigeria. The whole economic ecology of lower level, predominantly 3rd world, oil service workers is now on the move and bugging out of Nigeria.
This seems to be a side effect of the panic induced partial shut down in the Nigerian Health Care system.
The Nigerian Rivers State local government is now acting a lot like Kevin Bacon screaming “Remain Calm. All is well!” in the movie “Animal House,” with roughly the same level of effectiveness.
Since a lot of these oil workers are Chinese, the Chinese government just announced tightened inspections of all incoming flights and people from infected countries in Africa.
See the Chinese link and the Nigerian article and link below:
English.news.cn 2014-09-05 22:03:05
http://news.xinhuanet.com/english/china/2014-09/05/c_133624431.htm?
Foreigners flee Rivers over Ebola
SEPTEMBER 6, 2014 BY CHUKWUDI AKASIKE AND FISAYO FALODI
http://www.punchng.com/news/foreigners-flee-rivers-over-ebola/?
Foreigners have been fleeing Rivers State following the outbreak of the deadly Ebola virus that recently hit Port Harcourt, the state capital, Saturday PUNCH has authoritatively learnt.
The foreigners fled the state in droves out of the fear of contracting the Ebola virus.
The foreigners, with their fully-loaded bags and members of their families, stormed the Port Harcourt International Airport to board flights to their various countries.
One of our correspondents, who saw them while arriving at the airport in chartered vehicles, noticed that they were filling some forms whose contents were only known to them.
Before the foreigners decided to flee Port Harcourt, they had been seen wearing face masks to prevent being affected by the virus.
One of the foreigners, who declined to give his name, told Saturday PUNCH that the spread of the Ebola virus informed the decision to return to their countries.
“I am afraid here. I want to go to my country because there is no cure for Ebola,” he said.
The Minister of Health, Prof. Onyebuchi Chukwu, said during the week said that a total number of 255 were currently under surveillance in Port Harcourt for signs of Ebola.
The minister’s claim, one of our correspondents learnt, might have heightened the foreigners’ fears thus necessitating their decision to flee the city.
The World Health Organisation also warned that the Ebola virus could spread wider and faster in Port Harcourt than that of Lagos State where the virus claimed its first victim.
The United Nations health body said the arrival of the virus in Port Harcourt, which is 435 kilometres (270 miles) east of Lagos, showed “multiple high-risk opportunities for transmission of the virus to others.”
This, according to experts, could have also heightened the fears of the foreigners who decided to flee the city.
A virologist, Dr. Akinjogunla Olajide, in an interview with one of our correspondents, also foresaw a backlash to the outbreak of Ebola in Port Harcourt while expressing the fear that many expatriates in the city might flee due to the level of contagion associated with EVD.
Olajide had said, “The Ebola disease may spread in Port Harcourt within days after the outbreak following the death of a doctor who treated a diplomat who contracted Ebola from Sawyer, the index case. This is because the victim must have interacted with many people before he succumbed to the disease.”
The foreigners’ decision to flee Port Harcourt, however, shocked the Rivers State Government as it described the action as needless.
The state Commissioner for Health, Dr. Sampson Parker, said that the action of the foreigners was unnecessary.
Parker said the fear expressed by the foreigners was unfounded, adding that the state was doing everything to contain the spread of the Ebola virus.
He said, “My advice is that people should not panic. We are doing everything to safeguard the people in Rivers State. We have 98 per cent coverage of the contacts, which is a good pass mark so far and by now, as I am speaking, the people who are on the field may have covered everybody.
“So, nobody should panic. Those leaving Rivers State out of panic should know that it is unnecessary. I don’t know who they are; I don’t know where they are coming from or where they are going.”
He expressed surprise that the foreigners were wearing face and surgical masks when the state and the country had sensitised the people that the Ebola virus was not an airborne disease.
Saw that one yesterday. This is a worst case scenario for Nigeria.
I haven’t seen this mentioned so far but does surviving
Ebola infection result in immunity?
I would expect some to invoke "force majeure" clauses in their contracts and leave.
Under the circumstances, no one would fault a hired hand for quitting if they had to, and they'd likely find work elsewhere if they lost their job with their present outfit.
http://www.nytimes.com/2014/09/06/world/africa/ebola-vaccine-could-be-ready-by-november-who-says.html?_r=0
"Two potential vaccines against the deadly Ebola virus ravaging West Africa could be available as soon as November and would first be given to health care workers most at risk of exposure to the disease there, the World Health Organization announced on Friday.The organization also announced that blood from recovered Ebola patients and serums derived from that blood should be used to treat the sick, and it said treatment centers should quickly begin testing other experimental therapies to combat the viral disease, which has escalated into a devastating health crisis.
“We have to change the sense there is no hope in this situation to a realistic hope,” Dr. Marie-Paule Kieny, an assistant director general, told a telephone news conference at the conclusion of a two-day meeting at the organization’s Geneva headquarters aimed at expediting the prevention and cure of Ebola. The disease has now killed nearly 2,100 people over the past six months. Nearly all the deaths have been in three West African countries — Guinea, Liberia and Sierra Leone — but clusters of Ebola patients have recently been found in Nigeria, Africa’s most populous country.
Dr. Kieny said nearly 200 scientists, ethicists and clinicians from around the world had reached a consensus in identifying the most promising vaccines and potential treatments and developing strategies for testing them. The two vaccines, which have not yet been studied in humans, are set to undergo initial tests of their safety and immune system effects beginning this month in a small number of volunteers in Britain, the United States and Mali, which borders Guinea, where the outbreak emerged."
I’ve seen discussions about it. There isn’t any real immunity to *other* strains of ebola but they may be immune to zebola for 10-12 years.
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