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.
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.