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.
Oops. One mistake gets you dead or nearly dead.
I guess what I'm saying is it seems to need “cells” to attach to and pierce through.....so once it doesn't have that access what happens to it as it does, does the air destroy it, does it basically suffocate...or just shrivel up on itself?
The virus, in the case of Ebola is a tiny machine made up of a strand of RNA complexed with various viral proteins, enclosed by a lipid layer which is also studded with proteins. Please excuse the fact that this diagram is on a Russian website, but it simply is the best depiction of an Ebola virus that I have seen.
UV light damages the RNA. Desiccation and pH changes disrupt the structure, and these processes occur faster in warm temperatures. The virus is not very stable outside of the body, and is best preserved in controlled conditions.
In order to infect, the virus must be present in fluids from the patient, and someone must touch those fluids. At that point, the virus can enter through mucus membranes or any cut in the skin, find a compatible cell to attach to, and begin the infectious cycle.
About the compatible cell: only some cells in the body have receptors--proteins on their surfaces--that are the right size, shape, charge, etc., for the virus to attach to (it's like a key fitting into a lock). Once the virus attaches, the cell must have proteins inside that the virus can co-opt to its own use; not every cell type has those proteins. So there are only a few cell types (out of hundreds of cell types present in the body) that Ebola can infect. Unfortunately, they are really important cell types. And some of them are blood cells, so the virus travels throughout the body.
Exactly. That is why the training to work as a researcher with level 4 agents is so rigorous.
We now,officially, have an “Ebola outbreak” in Texas.
The timing off the infection makes me think this was one of the emergency room workers in Duncan’s first Emergency room visit, where they thought he had Malaria.
If it is not, we would then also have real world confirmation inside America’s health care sys that the two tier PPE-2/PPE-4 guide lines for front line HCW versus lab HCW worker PPE regime simply gets front line HCW infected with Ebola and, 33% to 70% of the time, dead.
2nd Ebola Case Confirmed in Texas
by
Rick Moran
Bio
October 12, 2014 - 5:02 am
A Texas health care worker who was part of the team that treated America’s first Ebola case has tested positive for the virus a state health official said today.
Reuters:
A Texas health worker who provided care for the first person diagnosed with Ebola in the United States has tested positive for the deadly virus in a preliminary examination, a state health official said on Sunday.
The health care worker at the Texas Health Presbyterian Hospital reported a low-grade fever Friday night and was isolated and referred for testing, the Texas Department of State Health Services said in a statement.
“We knew a second case could be a reality, and we’ve been preparing for this possibility,” said Dr. David Lakey, commissioner of the health service.
The first person in the United States diagnosed with Ebola, Liberia citizen Thomas Eric Duncan, died in an isolation ward of the Dallas hospital on Oct. 8, 11 days after being admitted.
The U.S. government has since ordered five airports to start screening passengers from West Africa for fever.
No word on how the worker contracted the virus, although it’s remarkable that with all the precautions, all the protective gear, the worker was still exposed.
AFP is reporting:
“Health officials have interviewed the patient and are identifying any contacts or potential exposures. People who had contact with the health care worker after symptoms emerged will be monitored based on the nature of their interactions and the potential they were exposed to the virus.”
Health care workers see a lot of patients every day so you would hope that part of the monitoring that went on following the death of Thomas Duncan was limiting the number of hospital patients seen by the people who treated him.
Dare we point out that this wasn’t supposed to happen? That we were told that all the protective clothing, isolation wards, and hi tech care would make the spread of the disease unlikely?
It may be unlikely, but it’s happened.
I hope that the confirmatory testing comes back negative.
However, if it is positive, this is exactly how Ebola keeps spreading in Africa. The care-givers who have direct and often prolonged contact with the patients get the virus. In this case, the exposure will probably be tracked down to some lapse in infection control protocol, just like the case in Spain was.
You could very well be correct. If so, then this would be a consequence of the hospital's original failure to put him in isolation immediately when he showed up with symptoms and reported a travel history of recently leaving Liberia. CDC issued the guidelines; the hospital did not follow them.
If they thought he had malaria when he showed up at the emergency room the first time, that supports the idea that he did not himself know he had been exposed. The family of the young woman he helped to take to the hospital thought she had malaria. So he would have told the staff at the hospital that he had contact with a malaria patient--which isn't contagious, but he could have been bitten by infected mosquitoes since he lived in the same building. However, whether or not he had malaria, the CDC protocol is clear: treat any symptomatic patient from the affected country who might have been exposed as a potential Ebola patient until Ebola is ruled out through testing. And the testing must be done: malaria is very common, and people can have both malaria and Ebola. Or malaria, Ebola, and HIV. Treating the other diseases improves the chances of surviving the Ebola.
Oops, I should have commented on this. The control measures DO make spread unlikely. They DO work to limit and stop outbreaks. But they have to be used properly and appropriately, which was not necessarily the case here.
The weak part of any control system is the human operator.
But how does it die or cease to be able to infect a host?
From PFIF, It wad a HCW in the 28 SEPT visit who was in PPE-2.
Health care worker was “self-monitoring based on involvement in caring for the patient Thomas Eric Duncan during his care that started on September 28th.”
So this is indeed a health care worker who likely was caring for Mr. Duncan after they realized he had Ebola.
Presbyterian is on diversion. No ambulances are coming to Presbyterian.
“We are also continuing to monitor all staff who had some relation to Mr. Duncan’s care even if they are not assumed to be at significant risk of infection.”
There is a pool of “monitoring” staff (48 people) and a pool of “self-monitoring” staff. Now the self-monitoring group will become a monitored group. So this HCW may have been one of those asked to only self-monitor who they did not believe was at significant risk of infection.
The Judge opened with remarks about how Ebola cannot be contracted by walking by a person with Ebola, etc. He looked like he was reassuring himself as well as others. And he didn’t look like a happy camper.
Dallas hazmat team has decontaminated open areas of apartment complex in “37th area of Marquita.” “Police are standing by to make sure no one enters that apartment.” They are going door to door explaining what has happened.
{I wonder if this health care worker’s possessions and pets will be destroyed.}
Yes, they now say they believe there is a pet inside that apartment.
Hazmat team has moved to Presbyterian and has decontaminated car patient arrived in. They are decontaminating handrails, etc. (So they did not get transported by ambulance!!!).
Questions for doctor:
?: Did HCW come in contact on first or second visit of Duncan?
A: Involved in care during second visit.
?: Was involved in care in high risk pool?
A: No, low risk.
?: Gear?
A: “All of our workers are following CDC prescribed precautions.”
?: Support staff or medical provider?
A: Won’t say due to privacy.
?: Protective gear?
A: “Full CDC precautions which are barrier and droplet. Gown, glove, mask, and shield.”
?: How disturbing that even after those precautions this person has still contracted the disease?
A: We’re very concerned.
{Frieden’s Grand Experiment, the thesis that we can treat Ebola patients in the U.S. with standard droplet protection in a standard hospital environment, is in tatters}
?: Got to be scary for workers who have followed the CDC guidelines..
A: We’re still confident the precautions we have in place will protect our workers.
?: This person self-quarantined?
A: The HCW has been doing self-monitoring and did not work the last two days.
?: How many contacts of Duncan have been doing self-monitoring?
A: Can’t give you the full details of all of the contacts. TX Health Resourcs is currently tracking 18 employees.
?: Timeline?
A: From time self-monintoring indicated need for contact to time patient entered isolation was less than 90 minutes.
?: Area of hospital closed off?
A: 24 bed ICU is cordoned off.
?: Treatment?
A: Can’t comment on the care.
We are not just dealing with droplets created by coughing and sneezing, but those from violent vomiting, and from cleaning up bodily fluids by people who tend to confuse pressure washing with decontamination, the former creating suspended droplets, the latter trying to avoid the same creation.
While no attribution of infection to droplets may have been documented, that does not mean that infection in the wild has not been attributed to other causes when in fact the droplet exposure would have been sufficient to infect. Nor, for that matter do we know no one has been infected by the fine mists carried over distances greater than three feet, when many of those people were in situations where attribution may be given to other mean of infection.
As I have said from the onset of this, we know how much exposure will result in infection, we know the obvious means of transmission, but we do not know how little can infect in the wild, and less obvious mean of infection may be overlooked when there are so many more easily attributable means of infection in the environment.
I would point out that hantavirus isn't considered 'airborne' either, but the finely crystallized rodent urine which carries the virus can blow out of the heating ducts in forced air heating systems common in the Poplar, Montana area and caused an outbreak there. To the layman, infection occurred from breathing in the virus, therefore it is airborne, despite technical definitions.
As a practical matter, the arbitrary three foot range is entirely dependent on drafts, cross winds, and airflow in general, and outside of a laboratory controlled environment, that is highly variable.
Settling is entirely dependent on updrafts and localized airflow, and as I have noted, droplets, even sizable ones by the 5nm cutoff, can travel considerable distances outside of controlled environments.
With Ebola, considering the low ID50, and considering the severe penalty for being wrong, opting for a level of protection that may be excessive would be far better than risking one which is insufficient.
It may be that we, as a nation, and a host of individuals have dodged the proverbial bullet in Texas, and no further infections will result. Considering the tremendous pressure from a liability standpoint and a political one, I would hope the information coming from the area is indeed accurate.
A non-trivial bit of information ...
Full Press conference
Dallas County Ebola press conference
http://www.myfoxdfw.com/clip/10648879/dallas-co-ebola-presser
The site admin for the PFIF, Pixie, commented on the Dallas Press conference as follows —
Standard CDC-recommended droplet precautions can lead to HCW infection.
By Ebola.
Health care workers thought to be at “low risk” for infection can become infected.
Go BSL4 or get sick.
We did not dodge the proverbial bullet.
We now have one confirmed secondary case, and may soon have two. (Local reports say an additional person is hospitalized, awaiting test results.)
According to the news conference this morning, the confirmed case is a health care worker who cared for Duncan AFTER he was known to have Ebola.
The implications are enormous. The scaled down level of protection the CDC insisted was adequate failed. The CDC attempt to treat this as something nearly every hospital is equipped to handle has failed.
The official response is that they "authorities" still have complete confidence in the protection provided to health care workers. The claim is certain to be made that the cause of the infection is human error.
But human error is a fact of life. If human error occurred in this case then the steps taken to protect the lives of the health care workers were inadequate. Based on the "confidence" expressed in this morning's press conference, they still are.
Another comment from Pixie over on the PFIF —
worrywart wrote:
“infected HCW was wearing full protective gear.”
Only as defined by Frieden at CDC.
They were wearing only standard droplet precaution PPE (mask/gown/gloves/shield).
The health care workers caring for the Ebola patient were not wearing head-to-toe Tyvek PPE. Only the hazmat teams who clean the environments that an Ebola patient has been in — outside of a hospital setting — have been using the appropriate BSL4 PPE.
Everybody within the hospital has been stuck with being forced to wear standard infection control, droplet protocol, PPE which is *not* appropriate for potential contact with a BSL4 pathogen.
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