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.
Not good; thanks for posting.
http://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=articl
(The New England Journal of Medicine— WHO Ebola Response Team)
Very interesting article with graphs and data that clearly show the 70% CFR and not the 50% (or under) WHO has been releasing.
This sentence is a little concerning—
“To curtail transmission in the community, the period from symptom onset to hospitalization (a mean of 5 days but a maximum of >40 days) clearly needs to be reduced.”
A person can be symptomatic for 40 days before he or she is hospitalized?? Yikes.
Hi guys, is there a ping list?
>>A person can be symptomatic for 40 days before he
>>or she is hospitalized?? Yikes.
There is our big difference with past Ebola outbreaks.
This outbreak isn’t airborne.
We have slow developing Ebola “super spreaders.”
Hi, GRRRRR!
I think Smokin’ Joe has a ping list for articles of interest, and then he generally posts them to this big “Ebola Surveillance Thread”.
Thank you!
Hi Joe, please add me to the ping list!
This was her behavior with the pH1N1 virus in 2009 in declaring a “public health emergency of international concern,” or PHEIC —
http://en.wikipedia.org/wiki/2009_flu_pandemic
The 2009 flu pandemic or swine flu was an influenza pandemic, and the second of the two pandemics involving H1N1 influenza virus (the first of them being the 1918 flu pandemic), albeit in a new version. First described in April 2009, the virus appeared to be a new strain of H1N1 which resulted when a previous triple reassortment of bird, swine and human flu viruses further combined with a Eurasian pig flu virus,[2] leading to the term “swine flu”.[3] Unlike most strains of influenza, H1N1 does not disproportionately infect adults older than 60 years; this was an unusual and characteristic feature of the H1N1 pandemic.[4] Even in the case of previously very healthy people, a small percentage will develop pneumonia or acute respiratory distress syndrome (ARDS). This manifests itself as increased breathing difficulty and typically occurs 3–6 days after initial onset of flu symptoms.[5][6] The pneumonia caused by flu can be either direct viral pneumonia or a secondary bacterial pneumonia. In fact, a November 2009 New England Journal of Medicine article recommends that flu patients whose chest X-ray indicates pneumonia receive both antivirals and antibiotics.[7] In particular, it is a warning sign if a child (and presumably an adult) seems to be getting better and then relapses with high fever, as this relapse may be bacterial pneumonia.[8]
Initially coined an “outbreak”, the stint began in the state of Veracruz, Mexico, with evidence that there had been an ongoing epidemic for months before it was officially recognized as such.[9] The Mexican government closed most of Mexico City's public and private facilities in an attempt to contain the spread of the virus; however, it continued to spread globally, and clinics in some areas were overwhelmed by infected people. In late April the World Health Organization (WHO) declared its first ever “public health emergency of international concern,” or PHEIC,[10] and in June the WHO and the U.S. CDC stopped counting cases and declared the outbreak a pandemic.[11]
Despite being informally called “swine flu”, the H1N1 flu virus cannot be spread by eating pork or pork products;[12][13] similar to other influenza viruses, it is typically contracted by person to person transmission through respiratory droplets.[14] Symptoms usually last 4–6 days.[15] Antivirals (oseltamivir or zanamivir) were recommended for those with more severe symptoms or those in an at-risk group.[16]
The pandemic began to taper off in November 2009,[17] and by May 2010, the number of cases was in steep decline.[18][19][20][21] On 10 August 2010, the Director-General of the WHO, Margaret Chan, announced the end of the H1N1 pandemic,[22] and announced that the H1N1 influenza event has moved into the post-pandemic period.[23] According to the latest WHO statistics (July 2010), the virus has killed more than 18,000 people since it appeared in April 2009, however they state that the total mortality (including deaths unconfirmed or unreported) from the H1N1 strain is “unquestionably higher”.[18][24] Critics claimed the WHO had exaggerated the danger, spreading “fear and confusion” rather than “immediate information”.[25] The WHO began an investigation to determine[26] whether it had “frightened people unnecessarily”.[27] A flu followup study done in September 2010, found that “the risk of most serious complications was not elevated in adults or children.”[28] In an 5 August 2011 PLoS ONE article, researchers estimated that the 2009 H1N1 global infection rate was 11% to 21%, lower than what was previously expected.[29] However, by 2012, research showed that as many as 579,000 people could have been killed by the disease, as only those fatalities confirmed by laboratory testing were included in the original number, and meant that many of those without access to health facilities went uncounted. The majority of these deaths occurred in Africa and Southeast Asia. Experts, including the WHO, have agreed that an estimated 284,500 people were killed by the disease, much higher than the initial death toll.[30][31][32]
And this was her behavior with Ebola according to Wikipedia here —
http://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa
1. The current Ebola (styled EVD) outbreak began in Guinea in December 2013.
2. Ebola is recognized as such in on 25 March 2014, when the World Health Organization (WHO) repeated a Guinea Ministry of Health report of outbreak of Ebola virus disease in four southeastern districts, with suspected cases in the neighboring countries of Liberia and Sierra Leone being investigated.
3. A “public health emergency of international concern,” or PHEIC was declared 8 August 2014 after a 6 August 2014 report of infected countries reported 1 779 cases (1 134 confirmed, 452 probable, 193 suspect), including 961 deaths
The WHO response difference —
Three weeks for pH1N1 virus PHEIC in 2009
Four and a half months for an Ebola PHEIC in 2014.
If the WHO had declared the PHIC in April 2014 the world would be a much safer place today and millions who are going to die would have lived.
And the WHO is tell telling the world not to shut down commercial air travel to and from EVD infected nations.
G-d help us all.
http://pissinontheroses.blogspot.com/2014/09/us-army-says-ebola-flu-in-airborne.html
Tuesday, September 16, 2014
US ARMY Says EBOLA = FLU in Airborne Stability, Needs Winter Weather To Go Airborne
According to the Center for Aerobiological Sciences, U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Maryland:
(1) Ebola has an aerosol stability that is comparable to Influenza-A
(2) Much like Flu, Airborne Ebola transmissions need Winter type conditions to maximize Aerosol infection
“Filoviruses, which are classified as Category A Bioterrorism Agents by the Centers for Disease Control and Prevention (Atlanta, GA), have stability in aerosol form comparable to other lipid containing viruses such as influenza A virus, a low infectious dose by the aerosol route (less than 10 PFU) in NHPs, and case fatality rates as high as ~90% .”
“The mode of acquisition of viral infection in index cases is usually unknown. Secondary transmission of filovirus infection is typically thought to occur by direct contact with infected persons or infected blood or tissues. There is no strong evidence of secondary transmission by the aerosol route in African filovirus outbreaks. However, aerosol transmission is thought to be possible and may occur in conditions of lower temperature and humidity which may not have been factors in outbreaks in warmer climates [13]. At the very least, the potential exists for aerosol transmission, given that virus is detected in bodily secretions, the pulmonary alveolar interstitial cells, and within lung spaces”
Analysis:
Its clear that when Ebola is in the air it is at least as hardy as Influenza. Its also clear that coughing and sneezing is what makes Influenza airborne; the same should be expected of Ebola.
Moreover, just as sun, heat, and humidity along the Earths’ Equatorial regions serve to ‘burn’ Influenza out of the air, the same should be expected of Ebola. The difference with Ebola is that physical contact with even the tiniest amounts of infected bodily fluid can cause infection, hence unlike flu it also readily spreads in equatorial regions. When Ebola spreads to the regions of the Earth which experience Fall and Winter Flu seasons, airborne Ebola infectious routes are to be expected in conjunction with direct contact infection.
Ebola has the capability to infect pretty much every cell in the entire human respiratory tract. Similarly, our skin offers little resistance to even the smallest amounts of Ebola. How much airborne transmission will occur will be a function of how well Ebola induces coughing and sneezing in its victims in cold weather climates. Coughing and nasal bleeding are both reported symptoms in Africa, so the worst should be expected. In that regard, co-infections with Flu, Cold, or even seasonal Allergies will readily transform Ebola victims into biowarefare factories.
Unlike Flu, a person need not inhale airborne Ebola to be infected via airborne transmission. Merely walking through an airspace (or touching the objects therein) where an Ebola victim has coughed or sneezed is potentially enough for a cold weather infection to occur. As such, all indicators are that Ebola’s potential rate of infectious spread in cold weather climates is EXPLOSIVELY greater than what is occurring in Equatorial Africa
In that regard, the government's Filovirus Animal Nonclinical Group [FANG] is standardizing on a Airborne Ebola Infectious “challenge” of 1000 PFU that all proposed medical countermeasures must defeat in order to gain acceptance.
Mutation:
Given that the experts are keenly aware that most mutations lead to viral dead ends and given the ARMY’s public research documents make such a clear case that the Ebola airborne risk is here and now, the question remains: why are the experts pushing a “future mutation”fear on the public?
The primary benefits of the media mutation gambit are:
1) When the public becomes aware Ebola is airborne, the public will default to blaming a mutation rather blaming the experts for having prior knowledge of Ebola’s transmissability
2) A scary future fear makes for great immediate fund raising from a public seeking to avoid it.
3) The expert clique comes down hard on experts that do anything which is perceived to immediately raise public fear, an accurate warning to the public can immediately negatively affect a forthright expert's budget and prestige
4) Public knowledge of imminent Public Health threats negatively affects supply chains and the logistics planned responses
The next time some expert pushes the Ebola mutation risk ask them to specify exactly what mutations would be required to do as they claim. When they refuse, ask why experts spelled out the mutation steps of Avian Influenza and why they won't for Ebola. The answer is: Ebola can already infect pretty much every cell in the human respiratory system.
Sources:
http://www.mdpi.com/1999-4915/4/10/2115/pdf
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041918
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997182/
I doubt they are being so careful with Ebola-contaminated waste in West African medical facilities. Just decontaminating walls, floors and ceilings is hard enough.
http://news.yahoo.com/u-hospitals-unprepared-handle-ebola-waste-051112265--sector.html
2014-09-24 By Julie Steenhuysen CHICAGO (Reuters) - U.S. hospitals may be unprepared to safely dispose of the infectious waste generated by any Ebola virus disease patient to arrive unannounced in the country, potentially putting the wider community at risk, biosafety experts said. Waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training, infectious disease and biosafety experts told Reuters. Many U.S. hospitals are unaware of the regulatory snafu, which experts say could threaten their ability to treat any person who develops Ebola in the U.S. after coming from an infected region. It can take as long as 21 days to develop Ebola symptoms after exposure. The issue created problems for Emory University Hospital in Atlanta, the first institution to care for Ebola patients here. As Emory was treating two U.S. missionaries who were evacuated from West Africa in August, their waste hauler, Stericycle, initially refused to handle it. Stericycle declined comment. Ebola symptoms can include copious amounts of vomiting and diarrhoea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up. "At its peak, we were up to 40 bags a day of medical waste, which took a huge tax on our waste management system," Emory's Dr. Aneesh Mehta told colleagues at a medical meeting earlier this month. Emory sent staff to Home Depot to buy as many 32-gallon rubber waste containers with lids that they could get their hands on. Emory kept the waste in a special containment area for six days until its Atlanta neighbor, the U.S. Centers for Disease Control and Prevention, helped broker an agreement with Stericycle. While U.S. hospitals may be prepared clinically to care for a patient with Ebola, Emory's experience shows that logistically they are far from ready, biosafety experts said. "Our waste management obstacles and the logistics we had to put in place were amazing," Patricia Olinger, director of environmental health and safety at Emory, said in an interview. NOT IF, BUT WHEN The worst Ebola outbreak on record is now projected to infect as many as 20,000 people in West Africa by November, while U.S. officials have said that number could rise above 550,000 by mid-January without an international intervention to contain its spread. Experts say it is only a matter of time before at least some infected patients are diagnosed in U.S. hospitals, most likely walking into the emergency department seeking treatment. Already there have been several scares. As of Sept. 8, as many as 10 patients have been tested by U.S. hospitals for suspected Ebola cases, Dr. Barbara Knust, team leader for the CDC's Ebola response, said at a medical meeting this month. All tested negative. The CDC has issued detailed guidelines on how hospitals can care for such patients, but their recommendations for handling Ebola waste differs from the U.S. Department of Transportation, which regulates the transportation of infectious waste. CDC advises hospitals to place Ebola-infected items in leak-proof containers and discard them as they would other biohazards that fall into the category of "regulated medical waste." According to DOT guidelines, items in this category can't be in a form that can cause human harm. The DOT classifies Ebola as a Category A agent, or one that is potentially life-threatening. DOT regulations say transporting Category A items requires special packaging and hazmat training. CDC spokesman Tom Skinner said the agency isn't aware of any packaging that is approved for handling Ebola waste. As a result, conventional waste management contractors believe they can't legally haul Ebola waste, said Thomas Metzger, communication director for the National Waste & Recycling Association trade group. A TEMPORARY FIX Part of Emory's solution was to bring in one of the university's large-capacity sterilizers called an autoclave, which uses pressurized steam to neutralize infectious agents, before handing the waste off to its disposal contractor for incineration. Few hospitals have the ability to autoclave medical waste from Ebola patients on site. "For this reason, it would be very difficult for a hospital to agree to care for Ebola cases - this desperately needs a fix," said Dr Jeffrey Duchin, chair of the Infectious Diseases Society of America's Public Health Committee. Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, said there's "no way in the world" that U.S. hospitals are ready to treat patients with highly infectious diseases like Ebola. "Where they come undone every time is the management of their liquid and solid waste," said Macgregor-Skinner, who recently trained healthcare workers in Nigeria on behalf of the Elizabeth R. Griffin Research Foundation. Skinner said the CDC is working with DOT to resolve the issue. He said the CDC views its disposal guidelines as appropriate, and that they have been proven to prevent infection in the handling of waste from HIV, hepatitis, and tuberculosis patients. Joe Delcambre, a spokesman for DOT's Pipeline and Hazardous Materials Safety Administration, could not say whether requiring hospitals to first sterilize Ebola waste would resolve the issue for waste haulers. He did confirm that DOT is meeting with CDC. Metzger said his members are also meeting with officials from the DOT, the CDC and the Environmental Protection Agency to sort out the issue. Until the matter is resolved, however, "We're bound by those regulations," he said. (Reporting by Julie Steenhuysen; Editing by Michele Gershberg and John Pickering)U.S. hospitals unprepared to handle Ebola waste
Groundbreaking post. It explains quite a bit.
The pest vector is still an open question - can you get it from a mosquito, lice, fleas, or bedbugs, given so little virus is needed to become infected?
Are there old steam engines still viable for generating steam? Seems an entrepreneur out there would make the connections to manufacture large autoclaves for sale around the US ...
All American (who makes pressure cookers) also makes pressure ‘cooker’ autoclave units.
Could ostensibly even be used on a wood cookstove.
http://www.allamericancanner.com/nonelecsterilizer.htm
You have been added!
Being in a relatively primitive situation doesn't necessarily mean you can't take care of things, but sometimes 'civilization' trips over its own feet.
Ebola symptoms can include copious amounts of vomiting and diarrhoea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up.
"At its peak, we were up to 40 bags a day of medical waste, which took a huge tax on our waste management system," Emory's Dr. Aneesh Mehta told colleagues at a medical meeting earlier this month.
,In the context of the article can one assume that the mentioned waste is solely from the two Ebola patients? If so, raises serious doubts of CDC claims that our modern 21st century hospitals are up to the challenge of an Ebola outbreak here.
While U.S. hospitals may be prepared clinically to care for a patient with Ebola, Emory's experience shows that logistically they are far from ready, biosafety experts said.
"Our waste management obstacles and the logistics we had to put in place were amazing," Patricia Olinger, director of environmental health and safety at Emory, said in an interview.
FR Jim Noble and I came to the same conclusion a while back that the sheer logistical problems of one or two patients presenting Ebola symptoms plus their immediate contacts would overwhelm the average hospital quickly. Emory had their Level-4 in place before the arrival of Brantley and Writebol and had days to prepare and yet this critical detail evaaded them.
Yes - that is why I posted the whole thing. There is no way the US medical system can handle even a minor Ebola outbreak here using existing standards. Any significant outbreak can only be dealt with by mass quarantine to reduce new infections plus isolation of the already infected.
Hospitals won't be places of treatment. They will become charnel houses where the infected are isolated and left to die, along with the hospital staff and anyone in the immediate vicinity of hospitals, like me. I can't hole up in my house to protect my family. It's simply too close to the local hospital. Any infected taken there can just walk down the street to my home. Plus they'll be burning Ebola-laden medical waste on site. We'll have to move in with relatives a lot farther from the hospital.
Get ready for a poo-poo response from the quick scanning lady who has seen no evidence of the Ebola symptoms including coughing and sneezing, and dammit, no evidence of EV in alvelar tissue or in the lungs. She gets all the journals, doncha know.
;>)
I had more than one occasion to visit NYC Bellevue Hospital years ago. Huge complex in mid-town Manhattan. On a regular Fri-Sun weekend summer or winter ambulance admittance ER patients were stacked in corridors, unattended for hours at times. So conditions aren’t much better in that regard then in Liberia.
My local suburban hospital is part of a very large med office research park with heli-pad and has excellent ambulance response times. When considering the work flow from ambulance to prelim intake work, triage, etc. One case would cause chaos, two or more and breakdown would start if all CDC level-4 procedures were implemented. Logistics of supply and disposal become a big problem very quickly.
You situation becomes more complex for you because of delay of confirming EVD and hosp/local and regional politics. How long before you and your community are informed? We all face that nasty problem. Seems like my tagline is and will remain “au coutrant” as J f’en Kerry would say.
Yes, that was what the Morbidity and Mortality Weekly Report (MMWR) Ebola article by the Center for Disease Control strongly implied.
Warehousing Ebola victims with suspected Ebola victims means exactly that.
It goes hand in glove with the “smothering a fire with logs” PPE approach the CDC reccommended several weeks ago with health care worker's lives.
I’m surprised that they’ve taken the “every hospital must prepare to treat suspected EHF cases” approach.
The logical stance to take is 1) Do everything possible to prevent outflow, 2) Screen arrivals actively in our airports (no, I don’t count the passport screeners’ checkups they’re promoting now, 3) Four week waiting period in quarantine for any arrivals from the big 3 + Nigeria, 4) Centralized care for anybody with symptoms and the right geographic background.
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