Much like Smallpox I suppose. You will find Ebola and Smallpox reservoirs in US and Russian Government Military Bio weapons research establishments.

There is some good science (at least, it looks good to my layman's eyes) suggesting that fruit bats are immune carriers. Pigs and non-human primates have also been infected in the past.

I hope this is not too much of a silly question, but here it is.

I have read several reports that one of the Doctors who survived Ebola donated his blood so that the plasma (which contains anti-Ebola antibodies) can be extracted and was used to treat other patients. I have been wondering about this for the past week or so.

If this is actually an effective treatment (is it?), then would it not make sense to collect blood from Ebola survivors in Africa (perhaps paying for it as is done in many blood donation centers), extract the plasma, and use it to treat the Ebola patients?

I expect there would be many practical problems in implementing such a plan, but IMO it seems a potentially useful treatment resource is being ignored. What am I missing or not understanding?

A very good question. The short answer is that it is not known if the use of convalescent antibodies (or convalescent serum) is effective with Ebola. But since there is no effective treatment for Ebola, doctors have resorted to still-experimental treatment, but that is at their discretion. Zmapp or the drug by Tekmira would be other examples of still experimental treatments that have been tried.

This case series from a prior Ebola outbreak indicates that a transfusion of convalescent serum shows promise. However, the article does mention that animal experiments did not show effectiveness.

Another mainstream article about this topic is this one.

Donors must meet a number of criteria according to the WHO guidelines. Age 18-60, must wait 4 weeks since discharge and have two negative RT-PCR tests for Ebola, plus be screened for a number of diseases like HIV and hepatitis. The usual blood typing rules between donors and recipients also applies. Anyway, all these criteria limits the donor pool even further.

But putting aside the effectiveness question, I'm not sure that there are enough trained personnel or equipment to do this procedure properly in most of the regions in West Africa where Ebola is raging. There aren't enough resources to give people even basic nursing and supportive care. You also need survivors of Ebola to get the antibodies from and unfortunately, there aren't that many in this outbreak.

It seems that Dr Kent Brantly is giving a lot more transfusions than guidelines would recommend. Kudos to him for his generosity, but that's likely not going to be feasible among most West Africans donors either.

I think there are only four facilities in the US equipped to handle patients at level 4 (Max) isolation. I'll try to source this tonight, but it may be if that you need to move patients, EMU is one of few places available with highest-grade isolation.


I doubt the patients have a choice. Time there probably makes ICU look cheap.


There are a lot of hospitals in the US. I'd wonder just how many had such Ebola-specific training prior to Mr. Duncan, especially those not regional facilities.


Texas Health Presbyterian Hospital is set up to handle three cases at once at Ebola-class isolation, not more. When transferring Nina Pham they specifically stated that the problem was that there might be more cases in the Dallas area and they needed to clear space to be ready, just in case.

Without an effective treatment, the cornerstone of the fight against Ebola is isolation and contact tracing. Despite the mistakes and disorganization in Dallas, the contact tracing part of the response seems to have worked as intended. However, in West Africa, it seems that contact tracing is becoming increasingly rare.

This article discusses the issue directly.


A different article focuses on how thinly stretched healthcare workers are and how patients enter the medical system and just disappear. Patients may die, be transferred, or be recovering, but many/most are not accounted for. If they can't keep track of patients in their care, finding and keeping track of contacts is a daunting task. Family members often have no idea what condition or even where their family members are.


It does not seem that recent pledges of aid from Western countries has made any sort of dent over there yet.

A couple of thoughts about the current Ebola.
I have been following pretty closely.
These are offered in the vein of promoting common sense, rather than fear.

A number of infected travelers have gone thru intl. airports and flown on airplanes. As far as we can tell, NO-ONE in those airports or planes was infected by the traveler. The only secondary infections have been to health care workers in direct contact with the infected people. So this piece of news should be reassuring. The current strain of ebola, while serious, cannot be said to be highly transmissible through very casual contact.

Next, this ebola is NOT airborne in the sense that it is being carried by coughs and sneezes. If it was, most of Africa would have it by now. And probably a lot of other places. If Ebola ever gets to that stage - the world has got a serious problem.

However, there is some medical research that the virus can stay alive on dust and other fine contaminants for a few days. Hence it would not be good to be caring for a patient (in close proximity) and not have breathing protection.

It seems to me that the West is getting its act together now ... the initial response was certainly fraught with problems. The big concern remains about how far ebola will spread in West Africa. And THAT is a real concern. We should be praying - or expressing concern - for the US troops that have been sent there. And also all the health care workers who are active down there. That is a much higher risk zone.

Just my $0.02

Pete

Ebola isn't very contagious:

http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola

I have heard (randomly) that Ebola can be present in peoples' sweat, for example. But during the incubation process, the viral load in someone's body is fairly low. So the chances of getting it from a glancing contact from the perspiration of an infected person ... is pretty small. And by the time the viral load becomes high in an infected person - they fell like "death warmed over" anyway. They are not going to be walking around, or going down to the local fitness clinic. They will be desperately seeking medical attention.

The Ebola virus seems to be "tougher" than the AIDS virus, for example. AIDS really cannot survive outside the warm moist confines of the human body - it dies rapidly. Ebola seems to be able to last for a few days on some surfaces. But more info is needed on this.

If Ebola mutates so that it can survive for longer times in the environment - that would not be helpful. The risk would be that if, for example, you picked up a plastic water bottle that was held by an Ebola patient, and then wiped your eyes, some real risk of infection would exist.

I think they are trying to stop Ebola now in West Africa. The last thing the world needs is a huge expansion in the numbers of people infected with this illness (which would happen if the virus got out of control in places like Ghana and the Ivory Coast). The concern would be that eventually new mutations of ebola could develop.

Pete

Back to the convalescent serum issue. This article is skimpy on details, but the WHO is reporting that there are plans to start using convalescent serum more widely in West Africa.

It's an experimental treatment, so we will see how it goes. Once a larger number of patients start getting it, we may get a clearer idea of its effectiveness. The article doesn't say if any clinical trials will be conducted at the same time, although it does mention vaccine trials. I think the popular perception is that blood transfusions can help, so the political pressure may be too great to deny the treatment to Ebola patients in the form of a placebo.

One side story to this new strategy is that there do appear to be asymptomatic survivors of Ebola, too, who also have antibodies to the virus. I referred to it in another post but there's no telling how small or large that number is. That may expand the pool of potential donors, but that's just conjecture for the time being.