Posted on 08/10/2014 12:46:23 AM PDT by Smokin' Joe
Ping to 2,340 “Doctors Without Borders chief: World losing battle with Ebola now”
5843 (probable, confirmed and suspected; see Annex 2) cases and 2803 deaths have been reported in the current outbreak of EVD as at 20 September 2014...
There is no precedent for this and so no means of presently determining what the natural R.O. is for Ebola in such a densely populated urban area, particularly one with the endemic horrendous sanitation problems of Monrovia.
It is simply too soon to make claims about the role of fomite infections here. Lab work is at present the only realistic means of determining the threat of fomite transmissibility of Ebola.
Short form —
1. There is an inflection point in Ebola health care where it is all a matter of being a hospice for the dying.
2. Too few health care workers (HCW) move you from providing real health care to warehousing the dying and risk avoidance for HCW.
3. When there are not enough HCW per infected, you give PPE to families, tell them to stay home an use it, and hope only 3 out of 5 rather than all five become Ebola victims.
4. Ebola is now so wide spread in Liberia and eastern parts of Sierra Leone that “contact tracing” is useless and 1-thru-3 above is all that can be done.
5. Middle and Western Sierra Leone are close to being what Liberia is now in terms of exponential Ebola spread.
6. Bausch has lots of regrets for “being too late” — as if he were responsible — and doesn't think Ebola is airborne, and it does not need to be to do what it is doing. The fomite threat of Ebola infected human fluids in an urban area is enough.
See full text at the link below.
by NPR STAFF
September 22, 201411:36 AM ET
http://www.npr.org/blogs/goatsandsoda/2014/09/22/349882298/dr-daniel-bausch-knows-the-ebola-virus-all-too-well?utm_medium=RSS&utm_campaign=news
The Ebola crisis in West Africa has been a “very personal outbreak for me,” says Dr. Daniel Bausch. The virologist spent “quite a few years” working on hemorrhagic fevers at the Centers for Disease Control and Prevention: Ebola as well as Marburg and Lassa fever. He knows the Ebola virus all too well, and he knows many of the people who've been deeply involved in fighting the current outbreak, including Dr. Sheik Umar Khan, a virologist in Sierra Leone who contracted Ebola himself and died this spring.
>snip<
Ebola projection from 8 Sept 2014 (post in 1650-ish range) vs 22 Sept 2014 Reality.
The WHO Ebola case data previously supported a monthly doubling trend (AKA an ~RO=3 per the Foreign Policy Ebola article from Early Sept 2012).
In black and white numbers, from May thru Sept 2014.
May 1 = 180 cases (actual reported was 243),
June 1 = 375 cases,
July 1 = 750 cases,
Aug 1 = 1500 cases (After FP article reported July RO of 2.83 for Sierra Leone),
Sept 1 = 3000 cases.
Projection for the rest of 2014 based on monthly doubling (AKA RO stays at 3.0) —
Oct 1 = 6000
Nov 1 = 12,000
Dec 1 = 24,000
We are currently at 5843 Ebola cases on 22 Sept 2014, with eight days left in Sept, and Liberia four days behind in reporting.
The Ebola case doubling time is now three weeks, and accelerating.
And MSF has just stated — officially theough its head officer — that the WHO Ebola case undercount in West Africa is now 1/5, not 1/3 or 1/4, of total Ebola case load.
Saudi Arabia: Pilgrims Being Tested For Ebola At Jeddah Airport
September 22, 2014
Pilgrims arriving at Saudi Arabia’s King Abdulaziz International Airport (KAIA) are being screened, tested and given preventive medication against the Ebola virus.
Fahd Al-Ghazwi, supervisor of the preventive center at the airport, told a local newspaper that a medical team wearing protective clothing “examines pilgrims who have flown in for Haj, especially pilgrims coming from West Africa.”
Passengers are required to fill out medical forms and are administered medication as soon as they disembark from their flights.
Excerpted
Saudi Arabia: Pilgrims Being Tested For Ebola At Jeddah Airport
"How long can the virus exist outside a human host?
The viruses can only replicate in living tissue, they commandeer certain proteins and functions of a living cell for their replication. So once any organism dies, there can be no more replication of a virus. Bacterium is different, right? If you leave the food out bacteria will grow. But a virus can't do that. And so in this virus, Ebola virus, it's not kind of an Andromeda strain-type thing where we can't kill the virus; we can kill the virus pretty easily through bleach and Lysol and alcohol, and a host of different things. And so once it gets out in the environment, it's not particularly hardy.
You can't give an exact number of hours or days because there's not been a lot of research; we need more research, and it also depends upon the conditions.
Viruses don't like heat and light, and that will inactivate what they call a lipid membrane of this virus. And so if that virus is out in an area where there's a lot of heat and light, then it's going to be inactivated relatively soon. If that virus is in a place where it's dark and cool, it'll last longer.
If you put it in a test tube and you put the test tube on the table in a cool, dark place, it'll probably last for, I don't know, weeks, maybe. But if a drop of blood on this table that dries and is out in the light and heat, we're probably talking hours to days of this virus surviving."
The Freep's HTML formatting codes have problems. Blockquote does not work at all, and the italics command must be repeated for each paragraph.
Thoroughly depressing.
Holy cow.
I wonder if ultra-violet light kills the Ebola virus on fomites. This should be checked out in a lab.
They’re doubling every 3 weeks currently.
>>Is there potential for transmission in public transit; if someone with Ebola were to shed blood or sweat and another passenger came in contact with the blood or sweat?
So is there the potential? What often happens is people come with scenarios that are, say, like this. So you're in a taxi and they say, well, what if the person who was in the taxi before me was a sick person who was bleeding or had vomiting, and then [the taxi driver] dropped them off at the hospital. And the passenger had contaminated the seats with vomitus or stool. And then I get into the taxi and I put my hand on the seat, and then I touch my eye. Could I get Ebola like that? Yes, you could get Ebola like that.
Is that really what our major concern is? Those things are probably very [rare].
>>How much do we in fact know about transmission?
We don't really have lots of sound data of what period people start shedding virus and from what tissues. And so that would be incredibly valuable data. What we do have is the epidemiological data, and when we put that together from past outbreaks, it really appears that most infections occur from very sick people late in the course of their illness.
One thing that happens, and it's very clear from both human as well as non-human primate data, that in Ebola, the sicker you are, the higher your viremia — the level of virus in your blood. Conversely, if you're not very sick, you have a very low level of virus in your blood, you're not particularly infectious.
And when you think about it, the virus, it's not jumping off the wall, it has to get from one person to another. And so if I have Ebola right now – which I don't, by the way, I haven't been in West Africa for over a month. But if I had Ebola right now, even if I said, “OK, I have a fever and a headache, but I still feel well enough to have this conversation,” your risk of getting Ebola from being around me and probably even shaking my hand, is extremely low to nil, because I just don't have very much virus.
It's clearly not transmitted from casual contacts. Going and shaking hands with a person who's not sick does not transmit Ebola. And then someone will ask: Well, what if they had a sick family member at home and they didn't wash their hands? So you can always come up with something where you say, “Yeah, that could do that.” And the example I use is, OK, there's a plane that's flying overhead, and could that plane crash now into this building and kill us? It could, but it's probably not the most likely thing we need to worry about.
So we know how this is spread. This is spread from direct contact with sick people, and that's where we need to focus. And is there somebody somewhere who had indirect contact through one of those things, from being in the wrong taxi or kind of the wrong situation? It probably happens and we don't know it, but it doesn't happen very often, and it's not where we need to focus our public health approach..
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This sure looks like a case of "Yes, But...I don't want to consider vehicular Ebola fomite infection" to me..
As in, "We don't want the public to think about it for fear of what the public's fear will do to out international public health logistics."
This is very much a case of needing "public trust" to function and the international public health authorities treating the 'irrational public' as something to be despised and lied to in order to maintain control...
...which is the surest way to lose public trust in the "smart phone Internet" era. It isn't irrational to fear something that will kill you and your loved ones horribly.
All major health organizations value ‘public trust’ over the public.
It’s how they roll.
>>They’re doubling every 3 weeks currently.
The “official double” from 3Kto 6K in WHO data has not happened yet.
It likely will happen by the next WHO report on Thursday of this week.
I think both Liberian and Sierra Leone data is getting increasigly...unreliable.
IMO, there will be no real operating civilian public infrastructure in West Africa by the time the US Military arrives in force in late October.
Agree on all counts.
Basically stay the hell away from people who are visibly ill, bleeding, puking, s*****ting, coughing, etc. and don't go where they've been if you can avoid it. We knew this. If they're not doing those yet, they're not shedding much of a viral load.
There are no absolutes here. It is not possible to avoid all risk save by avoiding all people.
Once Ebola appears in your area, wear nitrile gloves, waterproof shoes or booties and N95 masks, and cover your eye area with goggles to keep you from rubbing your eyes with your hands when outside your home. Then spray a bleach solution on your gloves and rinse the footwear off in a bleach solution before re-entering your house, take off the gloves and the goggles, spritz the goggles ditto, take off the footwear and enter your house. And don't let the kids outside save for vaccination.
Dr. Bausch just said the fomite contamination threat forms a continuum rather than being a pure yes/no issue, just as the PPE manufacturer said last week that the non-exhalation airborne transmission threat forms a continuum based on distance. People can certainly contract Ebola at distances greater than three feet from large droplets emitted from the mouth, trachea and esophagus of victims by coughing and sneezing, but the danger of that drops off dramatically after three feet. It just doesn’t end entirely at three feet. The stuff can waft around for dozens of feet and 10-15 minutes, but its viral load will be going off-scale very fast.
What I got from Dr. Bausch’s statement was his reiteration of the viral load issue. The greater and denser the Ebola viral load is in anything, the more dangerous it is. Sure the LD/50 load is only 10 whatevers. More is more, and less is less. You might contract Ebola from a small viral load in dried saliva secretions on a doorknob 4-5 days after the emitter touched it, but the odds of that are low. But if the dude hawked up a clot of mucus onto the doorknob 20 minutes ago, you are in big trouble from touching it unless you are wearing glove and goggle PPE.
Living with uncertainty is hard. That is no reason to despair or worse, refuse to do what you can to protect your family and yourself.
I’m searching for short-term stop-gap solutions short of quarantine pending availability of vaccines, and things are looking better.
Consider things like a younger set of Wal-Mart greeters outside their stores, using remote thermometer sensors on prospective customers and accompanied by armed guards. No one with a detectible above-normal temperature will get inside. And dark glasses will be required inside due to all the U/V lamps. Ditto for grocery stores, public access buildings, etc.
There hasn't been much research done into fomite transmission (nor, for that matter, transdermal infection).
Simply put, the reason is that those infected have some other vector which can be blamed.
We are where it took Kimberly Bergalis' infection with AIDS via a dentist's drill to admit AIDS could be caught from fomites, too.
Rare? Sure, because other vectors or behaviours could be blamed for the infection.
The bottom line is that we do not know how many people were initially infected by fomite contact and then went on to become more infected by other means already known to be effective.
Without knowing that, we cannot assess the risk, only acknowledge it.
Needless to say, there is economic (and other) pressure to downplay the threat of fomites.
While Dr. Bausch’s replies seem very informed and “to the best of his extensive knowledge” kind of answers, I am reminded of the principles of failure analysis (fault trees) that were employed by NASA during the early Apollo development. While a NASA engineer could honestly state that the likelihood of failure of a given component was “1 in a million”, that was the wrong question to ask.
The proper way to look at the Apollo situation was to look at the overall Apollo system, and how all the parts depended on the other parts. This meant that a unit’s failure rate could not be considered in isolation, because its actual likelihood of failure depended on what was happening “upstream” from it. The net result was that an aggregate rate of failure might end up as 1 per 100 missions, because some $2 part that no one gave a second thought to was actually the weak link in a long chain (the chain only being as strong as its weakest link).
Relating that to Dr. Bausch’s answers, the question isn’t what are the odds that I will sit in a taxi that the previous occupant vomited in who had ebola. I’m sure that from our current vantage point, the odds are trivially small. But, the proper question is a very complex fault tree comprising what are the odds that the disease will work its ways to our borders (by intention or by accident) and then what are the odds that (not I but) some hapless American will be in the wrong place at the wrong time to unintentionally contract the disease. And if that happens, what are the odds that a typical American, or maybe an American at the fringes of society can be truly contact-traced in the proper manner, given that many people I know meet thousands of strange people per week as they traverse airports, downtown attractions, restaurants, etc.
The key to the problem is statistics, which is not the way a doctor is going to generally be thinking about the problem. In fact, I’m thinking that the fact that ebola only needs 1 to 10 virions to infect a person is in some significant measure causing the confusion on “how did this infection occur?” How many microparticles are exhaled during a sick sneeze? What are the odds that just one of those thousands stay afloat long enough to land on someone else? And what are the odds that it contains several virions? Asked that way, the perception of the transmission process gets revised quickly.
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