Posted on 09/04/2014 12:43:46 AM PDT by nickcarraway
A study in the journal Science, released last week, shows that the Ebola strain spreading across Western Africa has undergone a surprisingly high amount of genetic drift during the current outbreak. Experts say the mutations could eventually make the virus harder to diagnose and perhaps treat with a new therapeutic, should one come along.
In yesterday’s Wall Street Journal, I wrote that in response to the crisis, the Obama administration has stressed that the disease is unlikely to spread inside America. We will certainly see cases diagnosed here, and perhaps even experience some isolated clusters of disease. For now, though, the administration’s assurances are generally correct: Health-care workers in advanced Western nations maintain infection controls that can curtail the spread of non-airborne diseases like Ebola.
But our relative comfort in the U.S. is based on our belief that our public health tools could easily contain a virus spread only through direct contact. That would change radically if Ebola were to alter its mode of spread. We know the virus is mutating. Could it adapt in a way that makes it airborne?
(Excerpt) Read more at forbes.com ...
Most definitely. Few remember the time around the Spanish flu epidemic.
Every summer there were epidemics of typhus, typhoid fever, German measles, measles, mumps, whooping cough, chicken pox, polio, tuberculosis, etc.
Every doctor carried around quarantine signs in their black bags. Upper middle class homes had small closet-like “sick rooms” for family members who were taken down.
Summer vacation camps for children came about as a way to get them to cooler places in summer and escape the epidemics. The smell of Carbolic acid (phenol) soap sanitizer was heavy around hospitals.
Around that time was when the US Public Health Service came into its own, as a normally benign agency that in time of a public health menace could turn entirely authoritarian, even dictatorial. A big job of theirs was to inspect ships from other countries arriving in ports, so they were issued naval officer uniforms and ranks, that sailors were more inclined to respect.
One of the better sources of the time was the writer Berton Roueché, who wrote on medical issues for The New Yorker magazine for about 50 years. He catapulted many public health stories into public view, and wrote several popular books that were compilations of his stories. They are very entertaining reads, even today, and are still in print.
http://en.wikipedia.org/wiki/Berton_Rouech%C3%A9
You agreed with the layman's definition of "airborne" and despite knowing that droplet infection is absolutely possible, you continue to claim that Ebola isn't "airborne"--the general public's definition of "airborne." If the "man on the street" were asked, "what do you call it when a sick person coughs or sneezes infected droplets near a healthy person and the healthy person becomes ill?" That "man on the street" is going to say, "it's airborne."
Coughing and sneezing are not common Ebola symptoms but we are moving into cold and flu season. Do the authorities assume that Ebola is kept at bay by an adenovirus? I doubt that. Coinfection is an issue.
I do not know what these supposed "lies by omission" are.
Fomites. That's the greatest omission to date. The authorities never list environmental contamination as a vector. Why is that? It's not amenable to the parsing done with the droplet vector. Then there is the droplet vector, which is parsed to be technically correct but still misleading in light of the general public's definition of the term.
Commission: telling people they are perfectly safe unless an Ebola patient is vomiting blood all over their shirts. That's so wildly inaccurate, one can only conclude that the authorities have something other than infection control as a focus. What that is I can only guess but none of the guesses are flattering.
Ebola is spread by droplets, fomites, and direct contact with infected bodily fluids, none of which are airborne transmission. While it is true that someone could be in the path of a droplet (for instance, from a patient vomiting blood) and be exposed that way, that is not airborne transmission. It is transmission through direct contact with infectious fluid.
Okay, we'll play it your way. By your own assertion you've laid out the authorities' dishonesy. I've yet to see, hear or read anyone talking about fomites or droplets. Not a single word. According to official pronouncements one must be vomited or bled upon by an infected individual to become ill. Is that not a lie by ommision?
Second, I think most people try to avoid those who are coughing and sneezing. Third, it is very unusual to be within 3 feet of someone who is vomiting blood or is having diarrhea. I don't think I would approach anyone vomiting blood--would you?
So you're asserting that viral particles are not shed until the patient is in the last stage of illness. That is inaccurate. Viral shedding, according to the authorities, begins when the patient becomes febrile. One develops the fever days, in some cases many days, before the gastrointestinal lining begins to slough off.
My scenarios are those people who are unaware of their exposure, develop a fever, toss down some Tylenol and go on about their day. The next day they're nauseated but assume it's a stomach bug so take some more Tylenol and go about their day. Those people are the ticking time bombs, unknowingly spreading viral particles everywhere they go and exposing everyone they encounter--on mass transit, in the restaurant, at the office, etc. etc.
Earlier you wrote:
There are many things that are not known about Ebola, and of course, it is impossible to make statements about what is not known. I see no problem with the MSF statement or the WHO pamphlet.
Which of your facts are known and which are assumptions? Recall that this is an entirely new strain that hasn't been studied like Zaire, Congo, Reston, etc. How much of what you're writing do you know is fact based on data? How much is assumption based upon the characteristics of Zaire?
Authorities have never once told the public, "there is much we don't know about how this new strain of Ebola spreads and behaves in the human body." That is an obscene lie by ommision. That's why I linked to the WHO communication document. Throughout that document they insist that the public be told that unknowns exist and officials should avoid making statemnts of fact that are not known to be fact. Once a "fact" has been disproven the effect upon the public's trust is severe.
I think viral shedding is occuring before the onset of fever. How long before I don't know.
In another twist, the third US physician infected believes he was exposed while performing a cesearean on an HIV+ woman who was not febrile.
WebMD: Third American With Ebola Evacuated to Nebraska
Sacra told his wife he thought he might have been infected by a patient with HIV who had also contracted Ebola, according to Doug Sacra.
One of the ways ELWA hospital tests patients for Ebola is by checking their temperature before they’re admitted. If they’re not running a fever, they’re treated as being free of the disease, he explained.
A fever is one of the first symptoms of Ebola infection. It’s the body’s way of beginning to mount a defense against the virus.
A patient with HIV, who has a weakened immune system, may not have been able to run a fever in response to the infection, and thus would have mistakenly been thought to be Ebola-free.
Sacra believes he may have performed a C-section on such a patient, his brother said.
I couldn't bring up the video you linked to, my firewall doesn't like it, but in the text it is noted that the patient was in shorts and a t-shirt. It isn't clear in the text but it seems the crowd developed when the PPE-clad followers were chasing the patient down. It's good that the people in the market have learned to keep their distance from someone known to be infected. That does nothing to stop the spread, however, since it's the unknown infected that are most dangerous.
Time will tell who among us is right and who is wrong. I think there will be an unbelievable amount of pain, suffering and death beforehand, though, and I'm not looking forward to it.
I think the motivation is pretty clear, almost transparently so.
On August 16, 2014, the CDC sent out a health alert message that contained the following language:
NEW Stigma Key Messages
West Africans in the United States and elsewhere may face stigmatization (stigma) during the current Ebola outbreak because the outbreak is associated with a region of the world.
Stigma involves stereotyping and discriminating against an identifiable group of people, a product, an animal, a place, or a nation.
Stigma can occur when people associate an infectious disease, such as Ebola, with a population, even though not everyone in that population or from that region is specifically at risk for the disease (for example, West Africans living in the United States).
Stigma occurred among Asian Americans in the United States during the SARS pandemic in 2003.
Communicators and public health officials can help counter stigma during the Ebola response.
Communicate early the risk or lack of risk from associations with products, people, and places.
Raise awareness of the potential problem.
Counter stigmatization with accurate risk information about how the virus spreads.
Speak out against negative behaviors.
Be cautious about the images that are shared. Make sure they do not reinforce stereotypes.
Model good behaviors; engage with stigmatized groups in person and through social media.
In April 2003, when SARS was spreading in North America and 166 suspect cases were under investigation in the US, Julie Gerberding, Bush's CDC chief, said the following:
"There are some very specific issues that are of concern to CDC right now. One is that we are hearing reports, internationally, about some stigmatization that's occurring among people in the Asian community.
It's very important that people appreciate that this is a respiratory illness caused by a virus, probably a new virus, and is a disease that is an infection of great medical consequence but it is not a disease that is in any way related to being Asian or to the fact that Asia happened to be the place where we first recognized cases.
So we want to ask people's support and help in appreciating how difficult this is for the affected people and how we really need to take the high road here and recognize that this is a time when all of our communities need support and empathy, not stigma or bias or shunning that has been reported in some international press.
In part to address that, CDC has established a community outreach team and we are working with various communities, in particular the Asian community, to understand what are the issues, what are the best ways of providing information to the community and languages, and formats that are accessible to the individuals who are concerned or affected by this problem, and we will be continuing to work aggressively to provide factual information and hopefully reduce some of the stigma that could evolve."
So, consistently over 11 years (actually much longer), a major concern of the premier disease control entity on the planet has been avoiding discrimination.
Isn't that interesting. We're discussing the intentional deception involved in transmission vector communication, yet the authorities have abandoned their own advice.
The notion of stigma during disease outbreaks as a bad thing is ridiculous. Of course people are going to take known facts (the virus is widespread in three specific countries, emerging in another, and all those countries' populations are the same demographic) and use those facts to protect themselves. It's called rational thought.
It's true that populations of Liberian/Guinean/Sierra Leon expats residing in the US are not likely to have the virus in their populations yet but after the Patrick Sawyer episode it's obvious those expat populations are at great risk of having the virus introduced via the Sawyer plan. Hence some caution when dealing with those populations are warranted. It goes without saying that the populations of Liberia, Guinea, Sierra Leon and to a lesser degree Nigeria warrant extreme stigma at this point.
So, consistently over 11 years (actually much longer), a major concern of the premier disease control entity on the planet has been avoiding discrimination.
Why am I not surprised. Little wonder the CDC and WHO have been wholly ineffective over the last months. Standard epidemiological actions have been pushed aside in favor of politically correct nonsense.
The complaints by WHO and CDC over airlines ceasing service to infectious areas strikes me as irrational. Maintaining control over populations both currently infected and extremely susceptible to infection is step one to control an outbreak of infectious disease, especially viral disease. Allowing asymptomatic infected people to fly around the world gives the pathogen an unnatural advantage and guarantees a much greater body count while hindering control efforts.
The UN and WHO take in billions of dollars a year. Can they not rent a dozen C130s to move materials and medical personnel into the area while forbidding unauthorized people from return flights? For that matter, why don't they have their own planes, helicopters, etc. to move material and personnel?
I am absolutely against the US military being used for anything other than, perhaps, flights into and out of the infected areas with total authority to deny anyone access to the planes to prevent infected and potentially infected people trying to leave by hiding in the planes.There is no reason to expose US military personnel to this virus, and the statements that MSF et al don't want the military to use standard crowd control procedures tells me that MSF has no concern for the health of our people.
Americans are so used to the magic bullet they have no sense of hygiene like they did even in the '50s.
Complacency, instilled in a population by telling them "this is hard to get", coupled with normalcy bias, the hook-up culture of youth, the incredible potential for transmission via fomites, and sheer mobility will make this population low hanging fruit,indeed.
Aside from contact tracing being the equivalent of seeing what the bullet hit after it was fired (instead of stopping the shot), they have been trying to perform contact tracing there in Africa, and they seem to be having some trouble. People skip out there, they will here. How are you going to perform contact tracing in a major urban environment in the US?
Are you going to round up everyone who was on the subway or the bus with them?
Follow them around?
Where are you going to get the staff? Just a few confirmed cases could overwhelm that.
The saw about how much 'more advanced we are' won't carry the day.
A virus doesn't care about technology, about religious beliefs, about any of the social trimmings, it will infect the high or low of society with equal vigour given an opportunity.
Even closer to home, what is the lead time on manufacturing (importing?) sufficient PPE for even a few of the hospitals in the country--not just for the Ebola patients, but every patient who comes in the door--especially the ER--because you just don't know.
How about for EMS? (Was that car wreck because they were texting or because the fever was too high?--you see it all.)
Human nature is what it is.
Will the US close schools if cases start appearing? Likely that will be all too slow to happen, but could be a wonderful vector for the virus. People won't keep their sick kids home now.
I really wish I could be as sure this wasn't going to be a problem, and I seriously hope I prove wrong in this, but if this gets in the wild here in the US, it will be a plague of biblical proportions--not just because of the virus, but because of the fragile supply mechanisms that keep food on the shelves at the grocery stores, gas at the gas station, and the lights on, not to mention medical supplies distributed.
If that supply chain breaks, there will be a loss of civility or order imposed by force.
Neither is a pleasant prospect.
Consider that the very people who can prevent this in government are taking their marching orders from and serve at the behest of others who would jump at the chance to declare martial law and rule by fiat, and then consider the best way to defend against the disease is to not let it in, then why aren't we closing our borders to traffic from the affected countries at a minimum?
You and me, both!
Okay, at this point, it looks like you have a mental block against understanding the difference between airborne and droplet transmission.
Airborne is something that infects by particles suspended in the air. It is like smoke, but invisible. Think about how smoke fills a room and stays in the air until you open a window and let it out. If that smoke were an airborne virus like measles, anyone walking into that smoky room would get sick. If someone outside were close to the window when you opened it, that person could get sick.
Droplets are like a spritz of Windex from a spray bottle. You can stand at one end of the room and spritz Windex into the air all day long, and the most that will happen is that a big wet spot appears on the floor a short distance from where you are spritzing.
In the case of Ebola, the patient isn't even sneezing (analogous to spritzing the Windex). Since the virus is in the blood, not the epithelial cells of the respiratory system, even if the patient developed another illness (unlikely, given that he/she is in isolation where no exposure to a respiratory virus will happen), a sneeze or cough can't aerosolize virus or expel it into droplets. I've seen some reports that Ebola is highly susceptible to drying, meaning that even if it were shed into aerosols, it would not survive to infect someone else.
Almost all cases of Ebola can be traced to direct contact with a sick person. The few remaining cases either do not remember touching a sick person, or may have been infected through fomites. The transmissibility of Ebola in fomites, although recognized as a potential, has not been established through rigorous research.
Coughing and sneezing are not common Ebola symptoms but we are moving into cold and flu season. Do the authorities assume that Ebola is kept at bay by an adenovirus? I doubt that. Coinfection is an issue.
Colds and flus are not seasonal on the equator.
Fomites. That's the greatest omission to date. The authorities never list environmental contamination as a vector. Why is that? It's not amenable to the parsing done with the droplet vector. Then there is the droplet vector, which is parsed to be technically correct but still misleading in light of the general public's definition of the term.
Fomites are routinely mentioned as a potential vector, despite the fact that fomite transmission has not been established through rigorous research. Even if fomites exist, one reason that researchers won't find them is that surfaces in patient treatment areas are routinely sprayed with bleach. When a patient is removed from a house, the house is sprayed with bleach. No one is taking chances. It's pretty hard to establish that fomites can be vectors when everything is disinfected daily, if not more often.
I should point out that Africans refuse to enter houses where someone has had Ebola. They're refusing to pick up dead bodies. Not much of a chance of them getting Ebola like that, but they are subjected to the stench of rotting flesh.
Commission: telling people they are perfectly safe unless an Ebola patient is vomiting blood all over their shirts. That's so wildly inaccurate, one can only conclude that the authorities have something other than infection control as a focus. What that is I can only guess but none of the guesses are flattering.
You won't get Ebola by being in the same room or next room as an Ebola patient. You have to be within a few feet, or actually physically touch that patient.
Are you aware that there have been at least 25 outbreaks of Ebola prior to the two current outbreaks?
Think smoke. If Ebola were airborne, we would have seen a pandemic starting in 1976, at the time of the first outbreak. We cannot stop airborne viruses--have you never noticed that every year, influenza sweeps around the world in a few months, and we've never been able to prevent its spread?
Okay, we'll play it your way. By your own assertion you've laid out the authorities' dishonesy. I've yet to see, hear or read anyone talking about fomites or droplets. Not a single word. According to official pronouncements one must be vomited or bled upon by an infected individual to become ill. Is that not a lie by ommision?
I am utterly amazed that you know more about the spread of Ebola than the researchers and health care providers who work with it every day. I'm amazed that you know more about it than even the experts and authorities who read the medical literature about Ebola every day. How do you know so much that the experts don't?
So you're asserting that viral particles are not shed until the patient is in the last stage of illness. That is inaccurate. Viral shedding, according to the authorities, begins when the patient becomes febrile. One develops the fever days, in some cases many days, before the gastrointestinal lining begins to slough off.
The virus is shed in contaminated bodily fluids--blood, fluids derived from blood, and fluids which are contaminated with blood (for instance, sweat from an area next to a minor cut). Symptoms include vomiting and diarrhea--all it takes is for a little blood to get mixed in with those fluids for them to become contagious. BTW, not all patients become hemorrhagic, not even all those who die. They die of multiple organ failure.
My scenarios are those people who are unaware of their exposure, develop a fever, toss down some Tylenol and go on about their day. The next day they're nauseated but assume it's a stomach bug so take some more Tylenol and go about their day. Those people are the ticking time bombs, unknowingly spreading viral particles everywhere they go and exposing everyone they encounter--on mass transit, in the restaurant, at the office, etc. etc.
Highly unlikely. When symptoms appear, they hit hard. And if a person has a mild case, no vomiting, no diarrhea, they are unlikely to be shedding.
Which of your facts are known and which are assumptions? Recall that this is an entirely new strain that hasn't been studied like Zaire, Congo, Reston, etc. How much of what you're writing do you know is fact based on data? How much is assumption based upon the characteristics of Zaire?
My facts and statements are based entirely on extensive reading of the relevant medical literature about Ebola. This outbreak is Zaire, which is the most thoroughly characterized of all Ebola viruses.
Authorities have never once told the public, "there is much we don't know about how this new strain of Ebola spreads and behaves in the human body." That is an obscene lie by ommision. That's why I linked to the WHO communication document. Throughout that document they insist that the public be told that unknowns exist and officials should avoid making statemnts of fact that are not known to be fact. Once a "fact" has been disproven the effect upon the public's trust is severe.
Really? I watched a panel discussion of Ebola on CSpan yesterday. Everyone on that panel was very careful about what he said about Ebola. They stuck to what is known. One even referred obliquely to Donald Rumsfeld's "unknown unknowns." I have not seen a single instance in that panel or anywhere else of experts claiming that everything is known, or omitting to mention known facts.
I couldn't bring up the video you linked to, my firewall doesn't like it, but in the text it is noted that the patient was in shorts and a t-shirt. It isn't clear in the text but it seems the crowd developed when the PPE-clad followers were chasing the patient down. It's good that the people in the market have learned to keep their distance from someone known to be infected. That does nothing to stop the spread, however, since it's the unknown infected that are most dangerous.
Here is the youtube video. In case you cannot watch the youtube video, I will describe the scene. The man is clad only in t-shirt and shorts, no shoes. Any cuts on his feet can contaminate soil. There are a LOT of people at that market. Remember smoke, and how it penetrates everywhere? If that man were aerosolizing virus through the respiratory route, everyone in that sizeable crowd that gathered to watch would have been exposed, and there would already be a few cases. He is trying to escape four heavily clad health care workers, while another man in scrubs is following them, spraying the ground where the man walked with bleach. They finally corner him, talk to him, and wrestle him into a pick-up, while the crowd cheers.
The spread of Ebola is almost always through direct contact. The reason this outbreak continues is because we haven't managed to spread the message to everyone in the area about avoiding contact. Many of those people STILL do not believe Ebola is a real disease. We have to get on top of those two issues to stop the outbreak, and that is where we are having difficulty.
No, you are missing the distinction between the technical definition and layman's definition, and ignoring the misuse of the technical definition when communicating with laymen. When speaking among virologists or MDs, using the term "airborne" to mean individual viral particles independent of droplets (aka droplet nuclei) is fine since everyone understands the intended meaning. Using the term "airborne" among laymen, or rather using the phrase "it's not airborne" among laymen, is dishonest because you are intentionally misleading the audience. It's not a vague distinction.
Intelligent non-medical people are asking, "if it isn't airborne why are the doctors and nurses wearing positive-pressure spacesuits with protected air supplies?" How would you answer them?
You won't get Ebola by being in the same room or next room as an Ebola patient. You have to be within a few feet, or actually physically touch that patient.
Really? That's news to the CDC.
Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease ExposureSome Risk of Exposure
-- Household contact with an EVD patient
-- Other close contact with an EVD patient in health care facilities or community settings
Close contact
Close contact is defined as
a. being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations); or
b. having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.
Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact.
Also news to the WHO, which has reversed course considerably.
Ebola situation in Liberia: non-conventional interventions needed 8 SeptIn Monrovia, taxis filled with entire families, of whom some members are thought to be infected with the Ebola virus, crisscross the city, searching for a treatment bed. There are none. As WHO staff in Liberia confirm, no free beds for Ebola treatment exist anywhere in the country.
According to a WHO staff member who has been in Liberia for the past several weeks, motorbike-taxis and regular taxis are a hot source of potential Ebola virus transmission, as these vehicles are not disinfected at all, much less before new passengers are taken on board.
When patients are turned away at Ebola treatment centres, they have no choice but to return to their communities and homes, where they inevitably infect others, perpetuating constantly higher flare-ups in the number of cases.
This outbreak is Zaire, which is the most thoroughly characterized of all Ebola viruses.
Incorrect. There are three distinct Ebola clades at work right now, all of which derived from an ancestor virus in or about 2004.
Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak, Page 2In more pedestrian language:This suggests that the lineages of the three most recent outbreaks all diverged from a common ancestor at roughly the same time c. 2004 ( Fig. 2C and Fig. 3A ), supporting the hypothesis that each outbreak represents an independent zoonotic event from the same genetically diverse viral population in its natural reservoir.
Samples from 12 of the first EVD patients in Sierra Leone, all believed to have attended the funeral of an EVD case from Guinea, fall into two distinct clusters (clusters 1 and 2) ( Fig. 4A and fig. S8). Molecular dating places the divergence of these two lineages in late April ( Fig. 3B ), pre-dating their co-appearance in Sierra Leone in late May ( Fig. 4B ), suggesting the funeral attendees were most likely infected by two lineages then circulating in Guinea, possibly at the funeral (fig. S9).
(snip)
One iSNV (position 10,218) shared by twelve 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.
AAAS: Genomes reveal start of Ebola outbreakLook, I maintain that using a technically correct definition to mislead the general public regarding transmission vectors and risks is a gross injustice. It serves no good purpose, except perhaps to delay a public panic that will inevitably erupt if/when Ebola arrives in the continental US. I think it's when, not if, but I could be wrong. Even you, while denying it, admit that no physical contact is required because droplets are in fact a transmission vector. Why are you struggling so hard to deny your self-contradiction?The analysis reveals that the outbreak in Sierra Leone was sparked by at least two distinct viruses, introduced from Guinea at about the same time. It is unclear whether the herbalist was infected with both variants, or whether perhaps another funeral attendee was independently infected. One Ebola virus lineage disappears from patient samples taken later in the outbreak, while a third lineage appears. That lineage—tied to a nurse who was traveling to reach a hospital but died along the way—seems to have originated when one of the lineages present at the funeral gained a new mutation. This third lineage was spread, Garry says, via a truck driver who transported the nurse, as well as others who cared for her in the town where she died.
How do you know so much that the experts don't?
I know what the experts know because I get my information from research journals, not CSPAN. Perhaps you should expand your reading. Where are you getting your information, other than CSPAN? I note you post no links.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.