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.
See:
http://www.theguardian.com/world/2014/oct/07/ebola-crisis-substandard-equipment-nurse-positive-spain
Staff at the hospital where she worked told El País that the protective suits they were given did not meet World Health Organisation (WHO) standards, which specify that suits must be impermeable and include breathing apparatus. Staff also pointed to latex gloves secured with adhesive tape as an example of how the suits were not impermeable and noted that they did not have their own breathing equipment.
The nurse was part of a team attending to missionary Manuel García Viejo, 69, who died four days after being brought to Carlos III hospital on 20 September. The same team, including the nurse, also treated missionary Miguel Pajares, 75, who was repatriated from Liberia in August and died five days later.
Staff at the hospital said waste from the rooms of both patients was carried out in the same elevator used by all personnel and, in the case of the second patient, the hospital was not evacuated.
The European commission said on Tuesday it had written to the Spanish health minister “to obtain some clarification” on how the nurse had become infected when all EU member states were supposed to have taken measures to prevent transmission.
“There is obviously a problem somewhere,” the commission spokesman Frédéric Vincent said.
The nurse had alerted the ministry of a slight fever on 30 September and been checked into a hospital in Alcorcón, on the outskirts of Madrid, with a high fever on Monday. She was transferred to Carlos III hospital early on Tuesday morning.
El Mundo reported that it was the nurse who asked to be tested for Ebola, having to insist repeatedly on being tested before it was done on Monday.
While staff at the Alcorcón hospital were waiting for the test results, the nurse remained in a bed in the emergency room, separated only by curtains from other patients, hospital staff told El Mundo. Their version of events clashes with that of health authorities, who have said the patient was isolated from the first moment.
In August, Spain became the first European country in the current, fast-spreading outbreak to evacuate patients for treatment. The decision prompted concern among health professionals, who said Spanish hospitals were not adequately equipped to handle Ebola.
The easiest explanation here is that this nurse assistant got Ebola fomite sh*t from the dead priest's diapers on the adhesive tape sealing her latex gloves to her gown, and that is what infected her.
Whether that is true or not will require further investigation.
I sure hope the Spanish health authorities are video recording this treatment protocol as executed. We won't know for certain otherwise.
The TFMetalsreport Ebola thread here:
Ebola in CONUS (Ebola #3 thread)
http://www.tfmetalsreport.com/comment/437256#comment-437256
Reports the following:
“There appear to be multiple variants of the same strain in this epidemic. Some victims are actually infected with multiple variants and therefore the clinical behavior of the epidemic varies by the predominant variant.”
Basicly, we not only need a very fast and effective Ebola test. We need one that can tell us which genetic variants are in the sample to know what the likely symptom presentation will be!
See the following science report on Ebola mutation as the related cite.
Ability to mutate
Viral dynamics during the 2014 outbreak.
(A) Mutations, one patient sample per row; beige blocks indicate identity with the Kissidougou Guinean sequence (GenBank accession KJ660346). The top row shows the type of mutation (green, synonymous; pink, nonsynonymous; gray, intergenic), with genomic locations indicated above. Cluster assignments are shown at the left. (B) Number of EVD-confirmed patients per day, colored by cluster. Arrow indicates the first appearance of the derived allele at position 10,218, distinguishing clusters 2 and 3. (C) Intrahost frequency of SNP 10,218 in all 78 patients (absent in 28 patients, polymorphic in 12, fixed in 38). (D and E) Twelve patients carrying iSNV 10,218 cluster geographically and temporally (HCW-A = unsequenced health care worker; Driver drove HCW-A from Kissi Teng to Jawie, then continued alone to Mambolo; HCW-B treated HCW-A). KGH = location of Kenema Government Hospital. (F) Substitution rates within the 2014 outbreak and between all EVD outbreaks. (G) Proportion of nonsynonymous changes observed on different time scales (green, synonymous; pink, nonsynonymous). (H) Acquisition of genetic variation over time. Fifty mutational events (short dashes) and 29 new viral lineages (long dashes) were observed (intrahost variants not included).
Patterns in observed intrahost and interhost variation provide important insight about transmission and epidemiology. Groups of patients with identical viruses or with shared intrahost variation show temporal patterns suggesting transmission links (fig. S10). One iSNV (position 10,218) shared by 12 patients is later observed as fixed within 38 patients, becoming the majority allele in the population (Fig. 4C) and defining a third Sierra Leone cluster (Fig. 4, A and D, and fig. S8). Repeated propagation at intermediate frequency suggests that transmission of multiple viral haplotypes may be common. Geographic, temporal, and epidemiological metadata support the transmission clustering inferred from genetic data (Fig. 4, D and E, and fig. S11) (6).
The observed substitution rate is roughly twice as high within the 2014 outbreak as between outbreaks (Fig. 4F). Mutations are also more frequently nonsynonymous during the outbreak (Fig. 4G). Similar findings have been seen previously (15) and are consistent with expectations from incomplete purifying selection (16–18). Determining whether individual mutations are deleterious, or even adaptive, would require functional analysis; however, the rate of nonsynonymous mutations suggests that continued progression of this epidemic could afford an opportunity for viral adaptation (Fig. 4H), underscoring the need for rapid containment.
As in every EVD outbreak, the 2014 EBOV variant carries a number of genetic changes distinct to this lineage; our data do not address whether these differences are related to the severity of the outbreak. However, the catalog of 395 mutations, including 50 fixed nonsynonymous changes with 8 at positions with high levels of conservation across ebolaviruses, provides a starting point for such studies (table S4).
To aid in relief efforts and facilitate rapid global research, we have immediately released all sequence data as it is generated. Ongoing epidemiological and genomic surveillance is imperative to identify viral determinants of transmission dynamics, monitor viral changes and adaptation, ensure accurate diagnosis, guide research on therapeutic targets, and refine public health strategies. It is our hope that this work will aid the multidisciplinary international efforts to understand and contain this expanding epidemic.
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.
You are correct, but it will take a nurses union strike under pressure of an Ebola outbreak to make the CDC change it’s pointy haired bureaucratic mind.
Neither Ebola nor Health Care Worker’s strikes will await the November elections.
A HCW union local in Las Vegas has already staged a “Die In” over lack of BHL-4 PPE.
A wildcat HCW strike for BHL-4 PPE for the next Ebola outbreak is a distinct and growing possibility.
The only thing that has prevented one at Texas Health Presby in Dallas is the lack of a HCW union in the first instance.
Can you see Pres Obama laying a 60-day cooling of fperiod for such a strike? </sarc>
I've been reluctant to post this since it's completely personal experience but it seems to be more relevant as time passes.
I first heard about Ebola during a microbiology lab in 1998. Our lab instructor was working on a PhD in epidemiology. Since the lab work rarely extended the full three hours allotted, and the lecture professor insisted we remain in lab the entire allotted time, the lab instructor started playing "what if" games with pathogens. He was the first person I heard describe Ebola as a "molecular shark," and he was the first I heard admit that most of what is claimed "known" about Ebola is derived from incomplete/suspect epidemiological data. As a result of that lab, I became fascinated with Ebola (yeah, I know) and have followed every outbreak since. Not in a professional venue but as an interested and reasonably educated observer.
During a few Ebola "what if" games, he listed various assumptions about transmission vectors and we students debated whether or not Ebola could escape rural central Africa and threaten the world based on those assumptions. I tended to side with the "it can't happen here" contingent as long as the only transmission vector was direct contact with copious amounts of bodily fluids. When the assumption was aerosol, airborne, and/or fomites, I vacillated between the camps.
The one thing none of us on either side of the debates ever imagined was the complete ineptitude of the CDC and WHO. It was never stated outright but everyone, even the instructor, assumed that those two entities would function appropriately. It was a given, never questioned.
As I watch this play out I can't help but recall those "what if" games and shudder. I wonder if my former classmates are also recalling those games and if so, how they are responding.
Anyway, it's good to see my assertions regarding the multitude of unknowns verified by recognized experts but I sure wish we'd made more progress between '98 and 2014. And I really wish the CDC/WHO were at least minimally competent. Watching the "risk communications" is driving me up a wall.
In viewing youtube videos of the MSF in the Ebola treatment centers, it appears that all of the HCW PPE are sprayed with a bleach solution prior to removal, thereby limiting the potential of transmission of the virus via fomites. I wonder if hospital staff in Spain were following this protocol.
That study was posted a thousand or so comments back but it’s well worth reposting.
There are at least two variants at work in this outbreak, possibly three. That really complicated matters. I think the plethora of false negatives we’re seeing is due to that fact.
Please check http://www.dcclothesline.com/2014/10/05/80-penn-state-students-monitored-ebola/
Penn State University officials have identified 80 international students on various campuses who may have been exposed to the Ebola virus while visiting the infected countries of West Africa. In compliance with the guidelines issued by the U.S. Center for Disease Control and Prevention, these students are being monitored for symptoms of the Ebola virus.
I already have some full-face masks with P100 respirators, along with the other PPE items, for use in our back-yard shed ETU when the time comes.
Congress will give the hospitals retroactive immunity to civil liability for the Ebola deaths of health care workers, and make Medicare plus possibly some form of federal death benefit (likely the Social Security death benefit) the sole source of compensation for all Ebola victims. I am certain of this.
Doubtful.
This is the protocol to be followed in OUR hospitals.
Compare/contrast with the MSF one.
http://www.al.com/news/mobile/index.ssf/2014/10/us_hospitals_ready_to_treat_eb.html
This new bit is chilling news> The designated parrot Dr. Frieden's spin should be interesting.
Study: Growing Guinea outbreak caused by new Ebola strain
Filed Under: Ebola; VHF
Lisa Schnirring | Staff Writer | CIDRAP News |
Apr 17, 2014
http://www.cidrap.umn.edu/news-perspective/2014/04/study-growing-guinea-outbreak-caused-new-ebola-strain
The Ebola virus strain responsible for Guinea's outbreak—now at 197 suspected or confirmed cases—is a new strain that has been sickening and killing people at least as far back as December, researchers reported yesterday.
The results of full genetic sequencing suggest that the outbreak in Guinea isn't related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM).
The report is also the first detailed look at the epidemiologic features among the patients sickened in the early days of the outbreak in the forested region of Guinea, sketching out transmission chains that start with a 2-year-old girl who died in December.
[section on WHO data of April 2014 deleted]
Clinical features, genetic analysis
In the NEJM report, researchers said Guinea's health ministry first learned of clusters of a highly fatal mysterious disease that had been occurring in two cities in the forested region on Mar 10. The finding triggered an epidemiologic investigation by a European team from Doctors without Borders (Medecins Sans Frontieres) and prompted the collection of blood samples and clinical data from 20 patients, which were sent to biosafety level 4 labs for analysis in Lyon, France, and Hamburg, Germany.
Fifteen of the patients tested positive for the virus using conventional filovirus tests, and electron microscopy identified the Ebola virus in the serum of one patient. Researchers isolated the virus from cell culture in samples from five patients.
The team's genetic analysis found a high degree of similarity among 15 partial and 3 full-length sequences. Meanwhile, their full-length sequence analysis revealed that the Ebola clade is separate from other known viruses of its kind.
Clinical investigation found that the most common symptoms among confirmed case-patients were fever, severe diarrhea, and vomiting, but hemorrhage was less common. The case-fatality rate (CFR) of initial cases was 86% and for suspected cases was 71%, consistent with EVD.
Three fruit bat species that are thought to harbor Ebola viruses are found in large parts of West Africa, and the first outbreak in Guinea serves as a warning that the whole West African region is at risk for the disease, the team concluded.
Evidence of single introduction
The group's look back at the transmission chains found that the first suspected case was a 2-year-old girl from Gueckedou prefecture who died in early December. They also found that an infected health worker from the same part of Guinea appears to have spread the virus to Macenta, Nzerekore, and Kissidougou in February. As the outbreak grew, 13 of the confirmed cases could be linked to four clusters.
Researchers concluded that genetic evidence and epidemiologic links between the cases suggests a single introduction of the virus from animals to humans, which could have occurred in early December or before. They wrote that they suspect the virus was transmitted for months before clusters of cases in Gueckedou and Macenta signaled that an outbreak was under way.
Hemorrhage wasn't documented for most of the patients when blood samples were obtained, but could have occurred later, the team noted. They said, however, that the term "Ebola virus disease" was developed to emphasize that hemorrhage isn't seen in all patients. The researchers said the CFR is consistent with previous Ebola outbreaks.
That the Guinea Ebola strain is a separate clade suggests that the pathogen that sparked the outbreak evolved parallel with those seen in the Democratic Republic of Congo and Gabon and was not introduced into Guinea—the first West African nation to experience an Ebola outbreak—from those countries.
"And what our customers have seen and reported in the medical literature is reduction in these infections in the rate of up to 50 percent," he said.
50% reduction of Ebola in hospital setting with a full viral load might not be good enough.
And I;m guessing the 50% is a result of virus pools hiding in the shadows and hidden nooks and crannies, light traveling in a straight path and all.
Speechless.
Well, that is just wonderful. *smh*
5:56 Minutes
Residents claim discrimination that they can’t purchase food
Ebola - Residents Who Live Near Duncan Tx Say They Are Being Discriminated Against - Stuart Varney
https://www.youtube.com/watch?v=v1spIumQwmY
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