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Posted on 05/04/2005 12:42:04 AM PDT by Judith Anne
Welcome to the Marburg Surveillance Project.
This thread will be used for all of the latest Marburg Outbreak News and comments. This is the place to post all comments about the Marburg outbreak, all articles and links to articles about the Marburg outbreak.
We're going to use just one thread instead of having to go from article to article as we have in the past. We'll use this thread as long as we can.
It could, but with less than 500 cases this implies a low morbidity statistic.
Maybe I'm mistaken, but I thought there was a shortage of gloves and Spain(?) flew in an emergency supply? I don't remember where or what thread it was that I read it, perhaps somebody else can help out on that.
That was my thought, too. The two aspects should be uncorrelated. However, I know nothing about viruses so I wanted to ask.
We expect to see a higher morbidity statistic as transmission is more likely, in other
Kelly, that comment confuses me. It seems to indicate that there is a positive correlation between morbidity and transmissability. Yet, your earlier comments seemed to imply an anti-correlation.
The Reston Ebola outbreak described in The Hot Zone seemed to indicate airborne transmission and 100% fatality for the Ebola infection of monkeys (the strongest data was that monkeys in different rooms became infected).
So the question remains. Is it possible to have a Marburg variant that is 100% lethal (the present observation) and airborne transmissable???
If possible, then how likely. The only argument I can make (and it is as a physicicst not a virologist) is the following. Given a finite amount of genetic material, then there is a possibility that the specific genetic sequence that controls transmissability (i.e. airbone, UV resistant), might also control lethality. That would indicate a modest anti-correlation, depending on the likelihood that the same genetic sequence controls both.
Speaking from clinical experience, if the medical caregiver were not wearing a spacesuit, sweat contamination is very likely.
Think of lifting a person's head to give a drink of water--think of moving the patient to clean them after diarrhea--I can attest that doing the most basic and routine of nursing chores will get body fluids on my scrubs, including sweat. Gloves protect only one small area: the hands. Getting a patient into a sitting position, managing a patient who is siezing, changing soiled linens--moving a patient to a bedpan--all are opportunities to come into contact with sweat.
"Maybe I'm mistaken, but I thought there was a shortage of gloves and Spain(?) flew in an emergency supply?2
Maybe I am just being naive here, surely they would not be that unequipped in this situation? Surely seasoned practitioners would take precautions and observe protocol? if this is not the case I am stunned
To answer your question, I have almost no information about where the infected medical personnel were working.
The only thing I recall on this topic was early in the outbreak when it was noted that medical personnel were reluctant to come to work in hospitals relatively far from Uige. The government and WHO were trying to calm their fears.
The reason people were reluctant to come to work at the hospitals was said to be the deaths of medical workers in the Uige hospital, and at a hospital relatively near to Uige. The article was not primarily about hospital workers, and I do not have the link. (Another example of why this thread is a good idea.)
There is a finite amount of genetic material, but it is plenty long enough for lethal variations that are airborne, the only question is, is there opportunity in nature for that to take place, and the answer for me is "yes."
Yes, they are that unequipped. Wish you had been with us from the beginning. They were so ill-equipped that needles were being re-sharpened and re-used. Supposedly the needles were also disinfected, but who knows?
China and Spain have both contributed things like gloves, disposable gowns, masks, syringes, IV sets, plastic sheeting, etc. At least in the case of China, I know that the plane just dropped the stuff off at the Luanda airport--and left it up to Angola to distribute. It's my opinion that no Chinese left the plane, that they literally just dropped it.
I don't mean to sound like a scold, but it's only been since last week that WHO, MSF, and the Angolan health authorities have even mutually decided on a treatment protocol in hospital.
Everyone was doing what they thought was right, no one was in agreement, patients with Marburg were housed on general wards--Kelly--you're going to have to read some of these linked articles, there's not time enough to tell everything.
Assume the most primitive conditions--you probably have a first aid kit at home, it is likely better stocked than the rural Angolan clinics. Hospitals are not much better.
Please...assume the worst. I've read the articles, I'm telling you the truth.
Yes I also agree this does not affect mortality at all but the following caveat is important, there has been a lot of research into viral lode in various bodily fluid (fecal matter, blood, semen, saliva etc) Viral lode is significant factor in infection and transmission. VHF viral lode is highest in the lumina of the sweat gland as well as the major organs undergoing massive haemorrhage
"So the question remains. Is it possible to have a Marburg variant that is 100% lethal (the present observation) and airborne transmissible???"
yes it is possible
That was my sense too. Then the issue is only that there is a slight statistical anti-correlation between airborne transmission and lethality, based on the statistical likelihood that the same genetic sequence controls both. An unlikely event.
Moreover, we have the Reston outbreak which indicates airborne transmission in at least one variant (not lethal to humans fortunately).
Therefore it is possible. At issue then is the apparently contradictory observations that:
1. Medical personal have become infected, and
2. This thing is NOT spreading like wildfire, but has apparently been slowed.
that is a shame it is significant :-)
"The reason people were reluctant to come to work at the hospitals was said to be the deaths of medical workers in the Uige hospital, and at a hospital relatively near to Uige. The article was not primarily about hospital workers, and I do not have the link. (Another example of why this thread is a good idea.)"
yes I saw that too, interesting...
Kelly, is this you? Or is someone else posting under your name? On this thread is a lot of circumstantial evidence that Angolan authorities, having "administratively reclassified" an unknown number of cases, are hiding the true numbers, and in my opinion, the numbers are FAR higher.
In China, when SARS broke out, it turned out that the true numbers (after the news leaked) were approximately 10 times higher than reported. Do you think Angola is better (more honest) than China in this respect? Angola has far more to lose than China did, and China lost a LOT.
I am certain that known cases are three times higher than reported. Unknown, unseen rural cases, cases where whole villages have died, may double even my pessimistic assessment. There are millions of people in Angola's Uige province, and they live in extremely primitive conditions.
Hi Judith, yes I wish I was here then too, it is just amazing how bad this is on the ground. The situation is looking more and more like a mess
Throughout Africa, governments and the private sector are spending less than $50 per person per year, on average. Even in South Africa, one of Sub-Saharan Africa's richest and best developed nations, only $206 is spent on health services from public and private coffers.
As you are well aware PPE is expensive, add into that number ($50) medicine, doctors fee, etc. and there isn't much left to be prepared for a major outbreak. It is very sad indeed that brave professionals find themselves in these types of situations. It also is indicative to how blind the rest of the world can be and how much we truly take for granted.
Then the high fatality statistic amongst the medical and hospital practitioners is starting to look "normal". It is OK I don't view this as a scold, my ivory tower impressions are being challenged that is all. That is healthy
"Assume the most primitive conditions--you probably have a first aid kit at home, it is likely better stocked than the rural Angolan clinics. Hospitals are not much better."
they haven't got a prayer of containing and stopping the outbreak in that case
"Kelly, is this you? Or is someone else posting under your name?"
This is all very hard for me to swallow that is all, sorry yes I agree the misreporting and reclassification will show a very different distribution and imply a very different morbidity statistic. Could the CDC know this and remain quiet? the WHO maybe but CDC? this is big really big nothing like this has ever happened in VHF history before. The scope of this infection and the implications for transmission are everyone's worst case scenario and extrapolation of the ebola reston strain. they could never keep the lid on this for long, there would be cases showing up in the west by now, I am sure of it
bump
We agree that Angola can't do it. Can they do it with the help of WHO and MSF? We don't know. Are the neighbors of Angola worried? Yep. And taking measures. Will they be effective in keeping it out of their countries? Probably not.
Truthfully, I am not personally worried about catching Marburg, but I can see many many scenarios where it could get to this country from Angola, primary one being an infected AlQaeda terrorist posing as an Angolan (or Zimbabwean) UN worker flying, asymptomatic into New York and getting sick, and going to a NYC ER with it. PS, Al Qaeda is making inroads into largely Christian Angola. One of the linked articles somewhere above said that.
Before anyone knew what was happening, it could easily overtake a hospital here.
That's the reason for the existence of this thread. To surveil the situation in Angola and contiguous countries, to assess the likelihood of America being affected.
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