EBOV versus Pandemic Flu Preparedness

Posted by: Meadowlark

EBOV versus Pandemic Flu Preparedness - 08/12/14 07:07 PM

Hello all --

Seeing as there are now four West African countries battling to contain the latest Ebola virus outbreak, I was wondering: what, if anything, would an individual do differently to prepare for EBOV versus pandemic flu?

While EBOV is highly unlikely to spread like wildfire in developed countries (so-called) due to improved infrastructure, medical care and contact tracing, it's still a good idea to consider scenarios that involve weaker, lesser-known pathogens.

As for me: I'm not doing anything specifically different, as I already live near a research lab containing stuff that makes EBOV look like the common cold by comparison, but I am checking to make sure our general med supplies are up to date and re-reading my 20 year old copy of The Hot Zone by Richard Preston.



--M

Posted by: hikermor

Re: EBOV versus Pandemic Flu Preparedness - 08/12/14 07:26 PM

I wash my hands once a week, whether I need to or not; I would probably increase the frequency in case of an Ebola outbreak. I would also avoid contact with other's body fluids, which is evidently the means of transmission.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 08/12/14 11:41 PM


The last time we had such disease such as a pneumonic form of hemorrhagic fever in the town, I think more than half died and were buried in a mass grave under/near Debenhams at the Overgate Shopping Centre. frown
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 08/13/14 12:03 AM

I was reading a blog I follow and found the following quote:
Quote:
The Ebola manifestation is causing alarm bells all over the world where the CDC just called the alert a Category 1 (the highest). The virus is now in 5 countries.
The virus is airborne and there is no cure. If a person has been hit with it, the only way he can survive is to be kept alive for 5 to 6 weeks, allowing for one's own antibodies to be produced to kill the virus. The death toll is now over 1000 people.

I went to the article on Ebola he quoted in his blog and didn't find a statement of it being airborne (?) so don't know about that. However, given that the Spanish Priest recently given ZMapp has died, that experimental drug probably has limitations (ie., wait too long and it won't work?) Way too much is unknown.

Ebola is a bad illness and until now has never travelled much because the victims die. Now we have people traveling with the disease -- not good. Isolation seems to be the thing to do. Stop it from traveling. Until they get a cure that's tested and reliable and for which the side effects are significantly better than death, isolation is the go-to plan. Seems to be anyway. Even having taken ZMapp, isolation is still required. Testing is far from complete, barely started actually. It may keep people alive longer, which may make them contagious longer. Lots of testing...

Isolation.
Posted by: Phaedrus

Re: EBOV versus Pandemic Flu Preparedness - 08/13/14 07:48 AM

I don't think the Ebola strain that affects humans is airborne. It's blood born and passed by bodily fluids.
Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 08/13/14 09:13 AM

The virus is in body fluids. A person produces water vapor into the air with every breath, cough, & sneeze. The CDC is now stating that a person can catch the virus being within 3 ft of an infected person.

BTW: airliners have very efficient cabin air recirculation systems.
Posted by: Meadowlark

Re: EBOV versus Pandemic Flu Preparedness - 08/13/14 09:35 PM

Wildman800: You're correct; it looks like the CDC has updated their website to clarify what they mean by "casual contact":

Casual contact is defined as a) being within approximately 3 feet (1 meter) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations); or b) having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations). At this time, brief interactions, such as walking by a person or moving through a hospital, do not constitute casual contact.

(from http://www.cdc.gov/vhf/ebola/hcp/case-definition.html)

Side note -- I thought the abbreviation for the current Ebola virus was EBOV (Ebolavirus), but it looks as if EVD (Ebola Virus Disease) ZEBOV (Zaire Ebolavirus) and EHF (Ebola Hemorrhagic Fever) are also being bandied about. The fact that there's at least five species under the proposed "Ebolavirus" genus makes it even more confusing:

http://www.virology.ws/2012/08/07/is-it-ebolavirus-or-ebola-virus/

Whatever the name, it certainly is a nasty bug.

Thoughts and prayers going out to the victims and healthcare workers in the trenches.


--M

Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 08/13/14 10:49 PM

As of yesterday, the infection rate was increased from a 1.86 to 1.92%.
Posted by: Meadowlark

Re: EBOV versus Pandemic Flu Preparedness - 08/14/14 06:36 PM

Wildman: Yeah, I'd heard that, too. frown


So I've been giving some more thought as to what one might do differently in regards to an outbreak of Ebola virus compared to pandemic flu.

In the event that a local clinic or hospital becomes overwhelmed, one might be required to stay home for lesser medical issues, as well as face the possibility of having to home quarantine oneself or family members for several weeks' time.

Home care for EBOV would be a near-impossible endeavor, as high amounts of the virus can be present in the patient's body fluids -- blood, vomit, diarrhea, sweat, tears, mucus, urine, etc. Even semen and breastmilk are affected.

Pathogen fact sheet from the Public Health Agency of Canada:
http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

And then there are the post-mortem issues. The remains of a deceased Ebola virus victim are exeedingly contagious. Their bodies are either cremated immediately or buried very deeply. In many villages, homes that had contained the deceased are thoroughly sprayed down by decontamination teams or else abandoned. In cities, this is not as tenable; which is why aid organizations are hoping the situation in heavily populated Lagos becomes contained ASAP.

From the WHO regarding interim infection prevention and control: http://www.who.int/csr/resources/who-ipc-guidance-ebolafinal-09082014.pdf

Currently isolation tents are being shipped to Nigeria in order to help with the overflow, which made me think: if someone in that situation couldn't get to a hospital, or if the hospital was overwhelmed or abandoned, would it be best to place someone who's starting to show symptoms in a provisioned shed, tent or other temporary shelter? That way, if (heaven forbid) they passed away, one wouldn't be faced with further risk while waiting on assistance to prepare/transport them?


From the Red Cross regarding their burial management teams: https://www.ifrc.org/en/news-and-media/n...ra-leone-66528/


Those working in the affected areas are facing a very grim situation, indeed.


--M



Posted by: Mark_F

Re: EBOV versus Pandemic Flu Preparedness - 08/15/14 03:55 PM

This is a scary situation to say the least, and considering DW works at a local hospital makes it even more so. I'm wondering if she could be exposed and come home without even knowing it? Hoping it would be some time before it would make it's way this far anyway, but it's still awful to think about.
Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 08/15/14 09:02 PM

The CDC & WHO are now recommending Hibiclens for deconning gloves and skin.

As far as I know, pre & post surgery cleaning should be done with Dial Antibacterial Liquid Soap, as always.
Posted by: chaosmagnet

Re: EBOV versus Pandemic Flu Preparedness - 08/15/14 09:12 PM

My surgeon instructed me to use hibiclens before my shoulder surgery.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 08/15/14 09:24 PM

I came back from Eastern Europe just a few days ago. I had no worries where I was. But International airlines and airports scared me. Anyone can be, and usually is, from anyplace in the world, and within a few hours. I met a couple from Eastern Africa in a less traveled Eastern European Airport lounge. Not what I would have expected. Then there was the mass of people at JFK Airport Customs and Immigration, all lined up in one huge room waiting to get into the US. Anything airborne and we all can and will take it with us, wherever we go.

IMHO, the genie is out of the bottle.
Posted by: Meadowlark

Re: EBOV versus Pandemic Flu Preparedness - 08/19/14 09:32 PM

Hibiclens contains the biocide chlorhexidine. Great for killing off most pathogens, even enveloped viruses such as EBOV.


Came across this paper on the estimated reproduction rate of the current outbreak, which shows 1.52 for Guinea, 2.42 for Sierra Leone and 1.65 for Liberia: http://arxiv.org/abs/1408.3505 So yeah, numbers like this are quite serious, especially given the low level of available medical help and protective gear.

Also an interview with photojournalist John Moore on the situation in Liberia: http://lightbox.time.com/2014/08/19/ebola-outbreak-liberia-john-moore-photographs/#1

On the bright side, there might be a better chance of containment now in Lagos, even though I just heard that another doctor who treated their "patient zero" has not recovered as was reported earlier, but passed away from the disease.


--M
Posted by: Mark_F

Re: EBOV versus Pandemic Flu Preparedness - 08/22/14 04:19 PM

DW works at the local hospital here, and just thought you might be interested what precautions they are taking in light of the outbreak.

Universal precautions have, of course, been in place for many years, but in addition to those, the hospital has been conducting training sessions, per CDC recommendations, to all employees regarding what symptoms a patient infected with the virus may present with, and what additional precautions need to be taken if a patient presents with said symptoms, including:

- reduce exposure time to patient
- disposable gown, shoe and leg coverings (i.e. so that they can be easily and properly disposed of after contact with the patient)
- full face shield (additional protection from any bodily fluids such as projectile vomit or spurting blood)
- double gloves (although gloves are part of universal precautions and would already be worn by nurses and other personnel coming in direct contact with said patient, gloves are something that ALL other support employees such as social workers, supervisors and janitorial staff would also be required to wear)
- all equipment used for the patient is dedicated and not to be used elsewhere
- limited use of sharps and other aerosol treatments (such as breathing treatments)

I'm sure this is just scratching the surface of other precautions they may be taking, such as any emergency planning in case of a widespread area outbreak with multiple cases, or planning for isolation units in case of said outbreak.

If i find out about any additional precautions they are taking I'll be sure to let you know.
Posted by: Meadowlark

Re: EBOV versus Pandemic Flu Preparedness - 08/25/14 03:26 AM

Good to know all that's in place, Mark. Thanks for sharing. smile
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/01/14 03:56 PM

The thought hadn't occurred to me until I just read a news article, but as the new school year starts up, colleges and universities have had to think about how to deal with the sudden influx of foreign students from Ebola-impacted countries.

Mostly the preparations seem to involve familiarizing campus health staff with the symptoms of Ebola and having emergency plans in place. A number of schools are implementing temperature checks of arriving students from affected countries to check for fever.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/02/14 06:31 PM

Interesting but chilling read from Newsweek. I was just in NYC, too.

Smuggled Bushmeat Is Ebola's Back Door to America
Posted by: LesSnyder

Re: EBOV versus Pandemic Flu Preparedness - 09/02/14 11:54 PM

Hibiclens' active ingredient, chlorhexidine gluconate 4% solution is available in generic form, at a savings... no affiliation

Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/15/14 08:37 PM

Over the weekend, the CDC has posted an official reminder to health care administrators to review their procedures in case a suspected Ebola case comes into their facility. It's very matter-of-fact, like reminding people to make sure their earthquake preparations are in place. But just the fact that they're officially notifying people does seem to indicate the level of concern is rising beyond merely thinking of Ebola as an "African" concern way over on the other side of the planet.
Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 09/16/14 09:42 PM

I am thinking, based on what the CDC & WHO are stating, that it is now time to make anew evaluation of the Ebola situation.

I think it is time to update preps for a pandemic.

1. Food and water supplies, N95 or N100 (better) (or gas) masks, gloves (nitrile, vinyl, or latex), rain gear (slicker suit), duct tape, extra meds, extra consumables of all kinds, Chlorox bleach.

2. Curtailment of travel via commercial transportation (especially aircraft & air terminals).

3. Perhaps it is time to avoid events where large groups of people attend (sports arenas, festivals, public govt meetings, etc.

4. Time to make plans to homeschool one's children?

I'd like to hear everyone's thoughts on when such precautions would be prudent to put into action in order to minimize potential infection of one's family unit. What triggers would one look for?
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 09/16/14 10:22 PM


Here are my thoughts "by the numbers"

#1: "Stock up"; now is the time. If there is a domestic outbreak, these things will disappear.

#2: Curtail travel, especially international. I would do this now also. I mentioned in this tread earlier my concerns/experiences during my mid-August trip to/from Eastern Europe. International Air Terminals are mixing bowls for the world's population. You usually can't control who is standing or sitting next to you (and coughing). Don't go unless you have to.

#3: Public Gatherings: Right now, I think a judgment call based on where you live. Big cities, maybe not; small rural town, much less concern.

#4: Plan to Home School; good idea to do the planning now. When to start the home schooling will need to be driven by local developments. School size and location (e.g. big city school vs. small town school) would play a big part.

And I would also suggest implementing frequent hand washing/sanitizing and, if possible, a no handshaking policy.
Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 09/16/14 10:49 PM

I hadn't thought about a no handshaking policy. At this time I think it would be a good idea to start getting in the groove and start putting that idea out to others as well.
Posted by: chaosmagnet

Re: EBOV versus Pandemic Flu Preparedness - 09/16/14 10:57 PM

I'm flying (domestic) tomorrow. I really have no concern about Ebola or pandemic flu from tomorrow's travels. I did get a flu shot, but that wasn't about flying, it was about getting my doctor off my case about it.

If some pandemic comes to the US, my family will be in very good shape for a couple of weeks, possibly a month. If utilities stay operable possibly far longer.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/17/14 07:09 PM

Now that the President has committed 3,000 military personnel to help contain Ebola in West Africa, it's possible we will hear about more Americans becoming infected and Ebola becoming more visible in the news (not to take anything away from any of the foreigners already on the ground there who deserve a lot of credit). I'm assuming that any service members infected over there will be airlifted back to the US.

It will be interesting to see how the military performs because this is a unique mission. The US military has plenty of experience with humanitarian missions and moving personnel and materiel long distances, but now we're combining that with an almost biowarfare aspect to everything they do over there. Security might become an issue as the epidemic spreads and the fear level rises, and you need security forces that can perform while being protected from infection. Paper surgical masks just aren't going to cut it in this case.

Although it would be wonderful if we had a civilian response rather than a military one, the US military is probably the only organization that could do all of this on such a scale on short notice. I just don't see the UN or WHO being able to organize and recruit a similar roster and size of civilian people and assets for such a difficult working environment in a similar time frame. And which would remain on the ground for an extended length of time necessary to try and slow or halt the spread.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/22/14 05:18 PM

Sierra Leone has just completed a three day lockdown of the entire country over the weekend in an attempt to slow down the spread of Ebola. No one except authorized personnel were allowed out on the street during this time.

Teams of healthcare workers and volunteers attempted to visit every household, to educate them about the disease, look for more people with Ebola or for bodies that need proper burial, and to pass out some basic hygiene supplies. The government claims that 80% of households were contacted.

Not sure if we'll ever really know if the lockdown had any real effect on the spread but we may know in the coming weeks. I can't imagine the entire US experiencing something similar, although I could imagine a lockdown happening at the local level here if people or politicians ever became scared enough to demand such drastic measures.

Anyway, a real life example of another reason to be able to survive for at least 72 hours without any outside help. The government did give the people advanced warning of the lockdown, like warning the public about a hurricane coming. However, markets there are already very low on supplies due to the disruption already caused by the disease. And people are very poor and prices are very high for what is still available, so this lockdown was very difficult to comply with for many people.

In other news, US military personnel have started arriving in Monrovia, the capital of Liberia. Liberia is the country most in need of help dealing with the outbreak. Some infectious disease experts say the outbreak is basically out of control within Liberia so this military effort may mostly be seen as damage control rather than an effective effort to actually halt the epidemic there. Ebola outbreaks tend to subside on their own, and not because of human intervention, unfortunately.

Supposedly the US military personnel there right now will not have any direct patient contact, but once you're in the hot zone, it's pretty hard to be confident that you won't have any second-hand exposure to the disease if you're there to train local healthcare workers. We'll see how the people back home react if service members start contracting the disease.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 12:56 PM


Quote:
Ebola outbreaks tend to subside on their own, and not because of human intervention, unfortunately.


I would tend to treat the Ebola Outbreak as potentially the equivalent to the medieval Black Death. There is lots of information on how the Black Death spread and its effects.
The current Ebola out break appears to have an incubation time of around 3-6 weeks and the rate of eventual death is around 70% with an airborne vector. If isolation from the vector is a means of protection or survival from the Ebola virus then this would probably require 6 months to a year in a very isolated region of the world.
I would begin to look into the kit and stores requirements of early Antarctic expeditions for your preps. Then find a really inhospitable location (mountainous and sub arctic regions) where the unprepared would have difficulty surviving for a few days.

It may also prove difficult escaping quarantined areas such as high density populations. EOs have apparently already been signed where those with the Ebola infection can be disappeared.

The US military in these West African Countries are not there for Medical needs but for Security requirements as the secondary effects of the Ebola virus take hold in the break down of civil law and order, where the local security forces may begin to refuse to carry out the required public order shootings. i.e.

http://www.youtube.com/watch?v=bwKSJQI3tco
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 01:35 PM

I travel frequently. If Ebola goes airborne, the biggest thing you have to fear is not catching Ebola, it's global economic collapse and the attendant hardships that come with that.

Here's why. In Western societies, for the most part, we get the idea behind germs and airborne transmission of disease, so we can and will take radical steps to prevent transmission to the degree we can. We have better science, infrastructure, communications and (to a degree) a population with a better understanding of disease prevention (well maybe not the anti-vax crowd, but like the Shakers, that's a self-limiting population).

But one of the necessary radical steps needed may be to shut down virtually all international travel for a period of time ranging from weeks to months to allow the virus to "burn out" where it is strongest. That would be bad in the short term. Very bad.

Consider that just a few days of European air travel closure from the volcanic eruptions was enough to roil global markets. Now consider more than a regional shutdown of transport, imagine a nearly global shutdown. This would certainly push the world into a depression, or at least a severe recession. Interestingly, the United States, with our newfound energy independence, would likely not suffer as much as other places, if for some reason we had to cut off incoming oil tankers, but then again, it's not as hard to isolate a crew of an oil tanker as it is to isolate the passengers of an Airbus A340-600. In the United States, we are, for the most part, independent for the things we need (energy, food, water, beer) and highly dependent on China and other countries for the things we want (cheap electronics, clothing, Pokemon cards and so on).

I'm not worried about North America in all of this, I am worried about the 4th world - the parts of the world where young, uneducated, and underemployed people are accumulating in vast numbers without much in the way of economic prospects or political power. These are people who can (and are) easily swayed into violent means of attaining what feels like power and direction, and charismatic leaders emerge in crisis to leverage their cult of personality to attain their own vision of how the world should work - from IS to Boku Haram, the flavor of the 2000's is radical Islamists stepping in to provide what feels like social order, economic stability and, most of all, power to a powerless class.

Ebola may, along with wiping out thousands of people, wipe out the remains of the semblance of progress towards a pluralistic, secular democratic culture that had been attained in West Africa and the Middle East during the cold war and slightly beyond.

As an aside: remember that Iran was once pretty much like Austin Texas (OK, with a dictator running things...but....)

http://www.pagef30.com/2009/04/iran-in-1970s-before-islamic-revolution.html

So my concern isn't about the disease itself, I'm convinced that it can be contained to a great degree to the parts of the world where ignorance and fear allow it to thrive. I'm concerned about the socio-political effects of the disease and the tactics needed to contain it.
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 01:38 PM

It is possible - with today's technology - to scan the temperature of people as they enter a building. Be assured that this technology WILL be deployed rapidly if needed.
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 01:42 PM

The customs halls coming into the USA are mind-blowingly poorly thought out. Basically, no matter where you're coming from, you go into this one vast room, stand in line for a long time staring at the walls (because you're not allowed to use your phone for some insane reason) and all around you are people who have come from everywhere. There's no air curtains to keep whatever's in there in there, there's no protocols for presorting people into groups from "high risk" areas into a semi-isolated area, there's zero in the way of medical staff, there's no hand sanitizer available, the fingerprint machines are sort of cleaned between each use, but not really that well. It's not a great thing.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 05:30 PM

Originally Posted By: Meadowlark
I am...re-reading my 20 year old copy of The Hot Zone by Richard Preston.

It's been a long time since I read The Hot Zone but the thought just occurred to me that Preston described another Ebola outbreak that really was airborne. The Reston strain spread through an animal facility in Reston, Virginia through the airborne route. Fortunately, that strain did not make people sick, just the primates.

Anyway, so we have already seen a truly airborne (as opposed to droplet/aerosol spread) strain of Ebola already. Let's hope the current outbreak doesn't lead to a similar mutation.
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 05:54 PM

Todays Scary News:

CDC Predicts As Many As 1.4 Million Ebola Cases by Early 2015
http://www.thewire.com/global/2014/09/of...ly-2015/380654/
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 07:08 PM

Originally Posted By: Arney
Ebola outbreaks tend to subside on their own, and not because of human intervention, unfortunately.

I don't mean to imply that people are powerless in the face of Ebola. But there is no effective vaccine or treatment for Ebola right now. Actually, there are public health control measures that can slow down the spread and then the outbreak burns itself out, which is generally what has happened with all the previous Ebola outbreaks. But in this case, with such a widespread outbreak among multiple population centers, it is exceedingly difficult to try and slow down the outbreak enough so that the outbreak falters and dissipates.

The WHO Ebola Response Team just published an article in the New England Journal of Medicine explaining the current situation. One of their conclusions is that without an effective response, Ebola could become endemic in West Africa and just keep circulating in the population. It could become one of those diseases that travelers to West Africa will have to be wary of.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 08:37 PM

Originally Posted By: MartinFocazio
I travel frequently. If Ebola goes airborne, the biggest thing you have to fear is not catching Ebola, it's global economic collapse and the attendant hardships that come with that.

Here's why. In Western societies, for the most part, we get the idea behind germs and airborne transmission of disease, so we can and will take radical steps to prevent transmission to the degree we can. We have better science, infrastructure, communications and (to a degree) a population with a better understanding of disease prevention (well maybe not the anti-vax crowd, but like the Shakers, that's a self-limiting population).
---------------------
I'm not worried about North America in all of this, I am worried about the 4th world - the parts of the world where young, uneducated, and underemployed people are accumulating in vast numbers without much in the way of economic prospects or political power. These are people who can (and are) easily swayed into violent means of attaining what feels like power and direction, and charismatic leaders emerge in crisis to leverage their cult of personality to attain their own vision of how the world should work - from IS to Boku Haram, the flavor of the 2000's is radical Islamists stepping in to provide what feels like social order, economic stability and, most of all, power to a powerless class.

Ebola may, along with wiping out thousands of people, wipe out the remains of the semblance of progress towards a pluralistic, secular democratic culture that had been attained in West Africa and the Middle East during the cold war and slightly beyond.
Martin, I'm glad you are back. I have always appreciated your level headed, common sense posts.

I agree with you that it is fairly unlikely that we will see epidemic scale ebola in North America, for all the reasons you have stated. While it is probable that some infected people will enter the country, and probably infect a few other people, those outbreaks are likely to be rapidly contained. By way of example, the plague (the "Black Death" which devastated Europe in the 14th to 17th centuries) is still present in N America. Periodically individuals are infected from bats and other animals, yet those outbreaks are rapdily contained and seldom spread to other individuals. I totally agree that the big risk to us in the 1st World will be from damage to the worldwide economic system, and social unrest leading to terroism in the rest of the world.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 09/23/14 08:57 PM

Some info on the US military response to ebola:

US military in Liberia begins fight against Ebola
Quote:
A C-17 U.S. military transport aircraft landed Wednesday carrying Army Maj. Gen. Darryl Williams, who will command Operation United Assistance, along with a team of 12 military personnel to conduct site surveys and planning for construction of Ebola treatment units in Liberia.
-----------snip---------
Speaking to reporters Friday, Army Chief of Staff Gen. Ray Odierno said thousands of promised American troops will be moving into Africa over the next 30 days to set up facilities and form training teams to help the Africans treat Ebola victims.

Before troops are sent in, Odierno says the Army needs to make sure they are prepared to operate in that environment, which includes health care safety. The military units expected to deploy have not been identified.

Kirby said U.S. troops -– operating in support of Liberian government and the U.S. Agency for International Development -– would not be in direct contact with Ebola sufferers. Instead they’ll be providing logistics, engineering and other non-medical support.


I also wanted to post a link to an interesting article in the Wall Street Journal. However, the ETS auto-censor won't let me do it. Those who are interested can probably find it with google, if they substitute the name of a certain rather well known individual into the link.

http://online.wsj.com/articles/PHRASECEN...-low-1410898428 "Ebola Poses a New Challenge for U.S. Military"
Quote:
"It's a potential threat to global security if these countries break down, if their economies break down, if people panic," Mr. PHRASECENSOREDPOSTERSHOULDKNOWBETTER. said after a briefing at the Centers for Disease Control and Prevention, which has deployed more than 100 staff to the affected countries, one of the largest deployments in its history.
--------------snip--------
The operation will require the military to fuse its experience in responding to natural disasters with its training in biowarfare to minimize the risks of Americans contracting the disease. Personnel will bring medical assistance and training, logistical expertise and engineering experience to set up 17 field hospitals with 100 beds each, more than tripling current capacity.

"This is unprecedented as a public-health operation led by the U.S. military," Mr. Morrison said.

A defense official said the Pentagon anticipates having the Ebola treatment units running "in the next several weeks.'' The official said the centers would be turned over to Liberia and staffed by local and international health-care providers, not U.S. military personnel.
Posted by: Teslinhiker

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 04:27 AM

Originally Posted By: Arney
Originally Posted By: Meadowlark
I am...re-reading my 20 year old copy of The Hot Zone by Richard Preston.

It's been a long time since I read The Hot Zone but the thought just occurred to me that Preston described another Ebola outbreak that really was airborne. The Reston strain spread through an animal facility in Reston, Virginia through the airborne route. Fortunately, that strain did not make people sick, just the primates.

Anyway, so we have already seen a truly airborne (as opposed to droplet/aerosol spread) strain of Ebola already. Let's hope the current outbreak doesn't lead to a similar mutation.


Timely mention of an airborne strain of Ebola. I am currently about a 3rd of the way through reading a fiction book in that the plot line is of Ebola being spread via airborne methods. This book - Ebola K: A Terrorism Thriller is available on Amazon.com as of (today) a free Kindle Book and has garnered good reviews.

In one chapter, there is mention of real world statistics of how many people die of Malaria each year as compared to all the Ebola deaths. Although Ebola is contagious and can spread easily, it serves to demonstrate that the average person in Africa has a far greater chance of dying of Malaria then Ebola.
Posted by: Jolt

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 01:04 PM

Originally Posted By: Arney
Interesting but chilling read from Newsweek. I was just in NYC, too.

Smuggled Bushmeat Is Ebola's Back Door to America


Yikes!
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 03:00 PM

Originally Posted By: Teslinhiker
...it serves to demonstrate that the average person in Africa has a far greater chance of dying of Malaria then Ebola.

Malaria and Ebola are in different leagues in terms of perceived danger. Granted, hundreds of millions of people may contract malaria in a given year, but because we have treatments for it, the vast majority of people who can receive treatment will survive it. The majority of people who contract malaria are young children, not adults. Caring for someone with malaria does not put your life at risk. People who contract Ebola have, at best, a 50-50 chance of surviving, but in many cases, much worse odds, and anyone who tries to help you risks their own life.

The statistics in that book probably do not include this current, unfolding Ebola outbreak, which is the largest ever, by far.

The CDC just released the results of a computer model of the current Ebola outbreak. Applying a correction factor for the underreporting of cases, they estimate that as many as 1.4 million people may contract Ebola just in Sierra Leone and Liberia alone by the end of January 2015 if effective control measures are not implemented. If half of them die, that's a significant death toll--comparable to malaria's global death toll.
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 03:33 PM

Good point on the Malaria.
The most dangerous animal in the world in the Mosquito.
Posted by: Meadowlark

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 04:26 PM

Hi all --

Just thought I'd share some helpful websites for those seeking updated scientific information that, while grim, doesn't get too wild-eyed:


*Australian virologist's blog that breaks down the latest CDC reports -- http://virologydownunder.blogspot.com.au/2014/07/ebola-virus-disease-evd-2014-west.html

*Also from the same blog, a collaborative article which explains the terms, "airborne" versus "droplet sprays": http://virologydownunder.blogspot.com.au/2014/08/ebola-virus-may-be-spread-by-droplets.html

*Another blog from a scientist who works in a BSL4 lab: http://www.pathogenperspectives.com/

*Equations used for future prediction (for those who are into math):
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894

*Interesting comparison of US versus UK PPE precautions:
http://www.micro-blog.info/2014/09/ebola-ppe-and-paranoia/

*And the This Week in Virology Podcast: http://www.twiv.tv/ (Search "ebola" for relevant episodes)




--M



Posted by: Teslinhiker

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 10:26 PM

Originally Posted By: Teslinhiker
...it serves to demonstrate that the average person in Africa has a far greater chance of dying of Malaria then Ebola.


Originally Posted By: Arney

Malaria and Ebola are in different leagues in terms of perceived danger. Granted, hundreds of millions of people may contract malaria in a given year, but because we have treatments for it, the vast majority of people who can receive treatment will survive it. The majority of people who contract malaria are young children, not adults. Caring for someone with malaria does not put your life at risk. People who contract Ebola have, at best, a 50-50 chance of surviving, but in many cases, much worse odds, and anyone who tries to help you risks their own life.

A death is a death regardless of how a person dies or their age. Given that Malaria kills over 1/2 million people per year, it is far more deadly then all Ebola outbreaks combined.

Originally Posted By: Arney

The statistics in that book probably do not include this current, unfolding Ebola outbreak, which is the largest ever, by far.
The preface of the book specifically mentions that it occurs contemporaneously in 2014 along with the largest Ebola outbreak in African history.

Originally Posted By: Arney

The CDC just released the results of a computer model of the current Ebola outbreak. Applying a correction factor for the underreporting of cases, they estimate that as many as 1.4 million people may contract Ebola just in Sierra Leone and Liberia alone by the end of January 2015 if effective control measures are not implemented. If half of them die, that's a significant death toll--comparable to malaria's global death toll.


My technical background/work and hobby/interests is in big data analysis, statistics and computer modelling. Past and recent history in this field is replete with many, many results that can be wrong as computer modelling is not an exact science and not without its limitations as noted below. Have you actually read the full CDC report?

Abstract and Conclusion section:
The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.

Limitations section outlines on how modelling can be limited...and taken out of context by the media and general public who do not understand the report. The media as proven with this report, extracts the juicy 1.4 million number instead of reporting the above wording in the Abstract section. It goes without saying that the media will conveniently report the more sensationalistic numbers.

The findings in this report are subject to at least five limitations. First, extrapolating current trends in increase of cases to forecast all future cases might not be appropriate. Underlying factors such as a spontaneous change in contacts with ill persons or burial practices or substantial changes in movement within countries or across borders could alter future growth patterns. Therefore, limiting model-calculated projections to shorter durations such as 3 months might be more appropriate. Second, assuming that this epidemic has similar epidemiologic parameters to previous outbreaks (e.g., incubation and infectiousness periods) might not be accurate, although anecdotal evidence to date has not indicated otherwise. Third, reliance on expert opinion to estimate a correction factor regarding number of beds in use might not account sufficiently for factors such as patients being turned away from full ETUs. Fourth, the correction factor could change substantially over time. Notable regional differences in underreporting might mean that using one correction factor across an entire country is inappropriate. Finally, the illustrative scenario does not consider the logistics needed to increase the percentages of patients who are receiving care in an ETU or at home or in a community setting such that there is a reduced risk for disease transmission (including safe burial when needed).

In my own conclusion, is Ebola a dangerous disease? Yes it is but not nearly as deadly as the vast majority of people in the world die from a much higher percentage of diseases and medical conditions that are listed here.
Posted by: hikermor

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 11:00 PM

You are correct, but....

The thing is - Ebola is new, with many unknowns, and there is no handy vaccine. All the more reason to applaud and support those who are on the front lines right now ....
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 09/24/14 11:21 PM


You cannot really predict the future, but you can look at the historic record.

http://pmj.bmj.com/content/81/955/315.full.pdf

There are some spooky similar mathematic parametrics of the current mathematic modeling projections.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/26/14 12:45 AM

Yes, I read the full report in MMWR and I'm fully aware of the limitations of such extrapolation of current trends into the future.

I wrote a long reponse but decided it's not helpful to most readers to argue the points.

"Deadly" to most people is a subjective term, not a statistical one, and as I said, I think Ebola is perceived as the deadlier disease in the subjective sense. I then mention the CDC report to illustrate the gravity of the current outbreak because the trends indicate that without a robust response, Ebola could become deadly in the statistical sense, too, possibly killing in the neighborhood of the same number of people as malaria without a robust intervention. No prior Ebola outbreak has taken off like this before or infected so many people across such a wide area, so no one has any idea how or when this particular outbreak ends.

I'm not confident that there will be a widespread, sustained response to set up enough ETU's to put a dent in the natural course of the outbreak. Nor am I confident that the underreporting situation will noticeably improve, so in my opinion, corrected (and numerically higher) estimates are the better number to use. These are the two major components of the model that humans can directly influence in the weeks and months ahead. Of course, no one can predict how the virus itself will change over time.

Because I think the human intervention effort will fall short, I'm hoping that the virus makes some unexpected change that causes the outbreak to quickly subside on its own, leaving people wondering where the heck Ebola went. That would be the best case scenario.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/26/14 05:35 AM

Here's an area where the US healthcare system is totally unprepared to deal with even one Ebola patient--disposing of medical waste. Even the CDC's elite ward at Emory University hospital was not prepared.

US hospitals unprepared to handle Ebola waste
Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 04:24 AM

A "possible" Ebola case has been isolated in Dallas, Tx according to news via radio.

KVLI-AM in Beaumont, Tx is where I heard that report.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 02:28 PM

Reports say the patient is in strict isolation based on symptoms and travel history. I take this as good news that our medical system is alert to the risks and is taking fast and appropriate action.

Another report in WaPo indicates that Ebola may be less contagious than the "Spanish Flu" pandemic. This is thought to be the worst pandemic of modern times. It killed 50 to 100 million people in 1918 - 1920, which represented about 3-5% of the world population at that time.
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 04:02 PM

Ebola is bad for business.
The business of America is Business.
Ergo, America will do What it Takes to contain Ebola.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 05:22 PM

Originally Posted By: wildman800
A "possible" Ebola case has been isolated in Dallas, Tx according to news via radio.

They seem very hush-hush about this potential case. Can't find any specifics, like was this a businessperson who was in the region? Another aid worker who became infected with the Ebola response? A foreign visitor?

Unless this person became symptomatic while in the hospital, I would assume this person was already symptomatic and potentially infectious out in public, and the authorities would need to find and track down all the potentially exposed people.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 05:32 PM

More good news in this article. For the time being, it seems that Nigeria's outbreak has been contained.

The article says an already existing Gates Foundation funded emergency coordinating center for polio outbreaks was used for this Ebola outbreak in Nigeria. When I first read a while back that Ebola was in Lagos, its sprawling mega-city of a capital, I had a sinking feeling, but this is good news. People died, but the chain of transmission seems to have been broken.

Nigeria is a relatively wealthy African country, with a decent public health infrastructure from what I've read in the past, so Nigeria's experience is probably more indicative of what might happen in a First World outbreak, rather than being an example for other much poorer African countries.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 06:07 PM

Originally Posted By: Arney
Originally Posted By: wildman800
A "possible" Ebola case has been isolated in Dallas, Tx according to news via radio.

They seem very hush-hush about this potential case. Can't find any specifics, like was this a businessperson who was in the region? Another aid worker who became infected with the Ebola response? A foreign visitor?

I doubt the fact that they are hush hush means anything much. Because of the Health Information Privacy rules in HIPAA, hospitals and other medical providers are generally prohibited from releasing much of anything specific in any medical case. Unless the patient specifically signs a release, they can't give out much information.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 06:32 PM

Originally Posted By: AKSAR

I doubt the fact that they are hush hush means anything much. Because of the Health Information Privacy rules in HIPAA, hospitals and other medical providers are generally prohibited from releasing much of anything specific in any medical case. Unless the patient specifically signs a release, they can't give out much information.


Whatever else may be going on, the effect of HIPPA is exactly as AKSAR describes it, and even extends to prohibit the release of medical information about a spouse to their own spouse! We (DW and I) have run into this problem on several occasions. Please make sure you read, understand (if you don't, ask) all the forms you sign at the Doctor's office and hospital: you must specifically authorize info to be released to your significant other. The "default" is no information to anyone.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 09:32 PM

CDC confirms Ebola diagnosis for this person in Texas. He became symptomatic several days after returning from West Africa.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 09/30/14 09:38 PM

True, HIPAA comes into play. Although the public certainly knew a lot about most of the people flown back to the US, even before they even arrived, like Dr. Kent Brantly and Nancy Writebol. Did they consent to updating the public on their condition? I don't know.

Then again, there's also little known about the "other" US case--the person admitted to the NIH facility in Bethesda. So, the information flow can be inconsistent.

From what's been released recently, this new Dallas case appears to be a Texas resident.

Edit: On the drive home, the radio said the patient is from Liberia, not Texas, and came to the States to visit relatives. The report also said he was not in contact with many people after he arrived.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 04:41 PM

I heard a report that the 3 EMTs who transported him to the hospital are now required to stay at home for 21 days and "self Monitor" for any symptoms. Apparently this is the protocol if you "may" have been exposed.

I trust the EMTs to be responsible enough to actually comply and stay at home.

The thing that scares me is that if this protocol has to be implemented on a "large" number of people, I doubt that we can rely on individual compliance. It seems reasonable that some form of confinement may be necessary. That prospect opens up a whole set of other questions and problems that I don't think we are ready for.
Posted by: wildman800

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 06:01 PM

Forced Quarantine Detention was approved via Executive Order last August.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 06:08 PM

Another worrisome aspect of this Dallas case is that this gentleman actually went to the same hosptial two days earlier because he felt ill, but they didn't ask about his recent travel history and sent him home with a prescription for antibiotics. Only two days later did he deteroriate to the point to require an ambulance to take him back to the same hospital.

Fortunately, he stayed home during those two days when he was symptomatic and presumably infectious so his contact with the public was minimized. Still, whoever was caring for him is presumably at high risk.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 07:10 PM

Originally Posted By: wildman800
Forced Quarantine Detention was approved via Executive Order last August.

Forced Quarantine Detention has been on the books for many years. Federal law allows quarantine to prevent entry of infectious diseases into the US, and to prevent the spread across state lines. The last large scale Federal use of quarantine was for Spanish Flu in 1918. See the CDC page on Legal Authorities for Isolation and Quarantine .

Diseases must be added by executive order to the list for which quarantine is authorized. The executive order you are probably thinking of actually added pandemic influenza to the list. Viral hemorrhagic fevers (such as Ebola) had been on the list since 1983. See Q & A on the Executive Order.

States can use quarantine to prevent the spread of disease within their borders. Most states already have such laws on the books. See State Quarantine and Isolation Statutes. For example, see Texas.

Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 07:43 PM

[quote=wildman800]Forced Quarantine Detention was approved via Executive

The only source I can find for this is this:

http://www.whitehouse.gov/the-press-offi...icable-diseases

It was last July, is this the one you were referring to?

Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 07:54 PM

Turns out that the hospital was told at the first visit that this man had just arrived from Liberia when they asked for a SSN. Despite all the heightened awareness of Ebola, no one thought it might be Ebola in a guy who just got off a plane from Liberia?

And this isn't a dinky little community hospital. This hospital has a Level One trauma center and is in the heart of a major US city that receives many international flights from all over the world.

News is now reporting a second possible case, presumably one of his caregivers. And news is also reporting that he had contact with at least five school age children.

The Dallas case is noteworthy because it gives us an idea of what future domestic responses will look like in the days and weeks ahead.

There does not seem to be any plans to transfer this person to any of the special biocontaiment units that other Ebola patients have been admitted to, so perhaps future domestic cases will also be handled close to where they are diagnosed. I guess that probably puts more burden on hospitals in cities with populations from Ebola-stricken countries since those cities are the most likely to be where future cases are diagnosed.

I already posted an article that mentions that the disposal of Ebola-exposed medical waste is very difficult or even impossible for US hospitals under current regulations, even at the CDC's special unit that cared for Dr Kent Brantly. I have not seen any news since then that this problem has been remedied or clarified at the regulatory level. I'm curious how Texas Health Presbyterian Hospital deals with this issue.


From here and here.
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 08:08 PM

Thanks, excellent information.
Posted by: desolation

Re: EBOV versus Pandemic Flu Preparedness - 10/01/14 09:11 PM

Quote:
Several weeks ago, National Nurses United began surveying registered nurses across the U.S. about emergency preparedness. In preliminary results from more than 400 RNs in more than two dozen states released today:

More than 60 percent of RNs say their hospital is not prepared for the Ebola virus.
80 percent say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
85 percent say their hospital has not provided education on Ebola
30 percent say their hospital has insufficient supplies of eye protection (face shields or side shields with goggles) and fluid resistant gowns
65 percent say their hospital fails to reduce the number of patients they must care for to accommodate caring for an “isolation” patient


Source

Looks like we've got some work to do.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 03:04 AM

I've felt that I might have been a bit paranoid about my fears of the mixing bowl at immigration at JFK Terminal 1(see earlier posts). But the travel odyssey through major airports of our first US case (see: http://www.wtop.com/41/3713787/Man-with-Ebola-flew-through-DC-airport) makes me feel justified.

In this his case, the wisdom is that "no symptoms, no contagion." Assuming that to be true, it was by pure, dumb luck.

The number of potential exposures if he had been "contagious" and made the same trip through the same airports, with the wait times describe in the article, is astounding. The numbers of people exposed, and then exposed by them simply "blow up" as my mathematically inclined friends say.

IMO, the idea, as is being implemented now, of tracing all contacts and isolating them, would have been both mathematically and practically impossible to implement had this, quite possibly, been the case.

I think that the boarding of international airlines need to be our first line of defense: I don't think we can afford to wait until a passenger has passed through the system of several airports and catch them at the end of the journey and find they are (possibly) contagious. Passengers need to be screened at the start, and if there is any possibility of exposure, denied boarding until medically cleared: even if it takes the 21 days incubation period to be sure.
Posted by: JerryFountain

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 01:19 PM

Originally Posted By: bws48
Assuming that to be true, it was by pure, dumb luck.

The number of potential exposures if he had been "contagious" and made the same trip through the same airports, with the wait times describe in the article, is astounding. The numbers of people exposed, and then exposed by them simply "blow up" as my mathematically inclined friends say.

*******
I think that the boarding of international airlines need to be our first line of defense: I don't think we can afford to wait until a passenger has passed through the system of several airports and catch them at the end of the journey and find they are (possibly) contagious. Passengers need to be screened at the start, and if there is any possibility of exposure, denied boarding until medically cleared: even if it takes the 21 days incubation period to be sure.


Dumb luck is always important, but boarding precautions have already been instituted. Please see the Exit Screening Protocol at http://wwwnc.cdc.gov/travel/page/ebola-outbreak-communication-resources that has been sent to (and according to several sources implemented by) the governments and airlines involved.

Temperatures are being taken before boarding and passengers are refused boarding. Luck has nothing to do with it. There is no evidence reported that the virus is airborne, so even if there were contagion, the number of possible contacts is still manageable.

Respectfully,

Jerry
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 03:26 PM

Good information---thank you!

In theory, the procedures are there, or at least available to be put into operation.

So, as I understand it, the Texas patient should have been given a "conditional release card" which should then have been given to the Doctor in the ER that he saw when symptoms arose. I wonder if that is what happened?
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 04:11 PM

Originally Posted By: bws48
So, as I understand it, the Texas patient should have been given a "conditional release card" ...

It's hard to be sure without knowing his exact status when he was at the hospital the first time, but I don't think that is correct here.

The doctor examining him apparently was not told by the screening staff that Mr Duncan had just come from West Africa. If that info had been passed along, the doctor should have gotten a more detailed history. Mr Duncan had recently helped take the gravely ill daughter of his landlord in Monrovia to the hospital (a sad story in itself). The daughter died soon after.

With that history and the onset of his own symptoms, based on the CDC's protocol, I think immediate isolation would have been the prudent course of action. Severe disease comes on quickly once symptoms appear, and he was already starting to show symptoms and people become infectious when symptoms show, so I think a conditional release to send him home at that point would not be justifiable. Especially since he was staying with a family with children (not in the protocol, but we always try to protect children, right?)
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 04:21 PM

Originally Posted By: bws48
The number of potential exposures if he had been "contagious" and made the same trip through the same airports...is astounding.

It's true that it is "dumb luck" that Mr Duncan didn't become symptomatic during his long trip to Texas, but even if he did, I think we need to be more careful about how we define "exposures".

I would agree with your point if Ebola were a truly airborne disease like measles, where sitting on the same plane or walking through the same airport terminal could expose you to the disease, but Ebola requires contact with bodily fluids, which dramatically reduces the number of people directly at risk.

If Mr Duncan became feverish and had body aches on the plane and I was sitting in the row behind him, say, the risk appears very low. If he was vomiting or coughing on the plane and possibly creating infected aerosols, that changes the risk profile.

That said, out of prudence, I'm sure the authorities are reaching out to lower risk or contacts-of-contacts to alert them to self-monitor for a few weeks, just in case. That's what the Texas authorities seem to be doing. I'm not sure what the airlines are doing at this point.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 04:26 PM

It would also have helped if he had been direct and unambiguous on his first hospital visit. Something like, "I was recently in Liberia and came in direct contact with an Ebola victim who died." That may have gotten a different response from the hospital staff. Woulda, shoulda, dint...
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 04:33 PM

The thought just occurred to me--Mr Duncan was quite ill when the ambulance was called and he was vomiting. What happened to their garbage? I assume there was Ebola-infected items in their trash.

Edit: Just saw this article. Apparently nothing has happened because of the risk of the waste and no waste disposal company wants to deal with it. But an appropriate contractor is supposed to be out this afternoon.

So, just like with hospitals, dealing with infected or even just potentially infected materials will be a challenge whenever Ebola makes an appearance here. I wonder if potential contacts are also facing a similar problem with garbage removal, even if they are all symptom-free?
Posted by: JerryFountain

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 05:44 PM

Arney,
"It's true that it is "dumb luck" that Mr Duncan didn't become symptomatic during his long trip to Texas, but even if he did, I think we need to be more careful about how we define "exposures"."

On the same CDC page shown above are the instructions given to the worlds airlines for responding to the age of Ebola. All the airline pilots I know (and therefore probably their flight crews as well) have been given this information. The response would greatly reduce the risk to both crew and passengers.

Respectfully,

Jerry
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 07:20 PM

Yet another level to the story:

"Liberia to prosecute man who brought Ebola to US"

http://news.yahoo.com/dallas-er-sent-ebola-infected-patient-home-050718374.html

Apparently, the Liberian government is alleging that he lied on his exit questionnaire about his contacts with infected persons. The associated press claims they have a copy of the questionnaire he signed, which seems to confirm what the Liberian government is saying.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 11:23 PM

I found a glossary of some terms we have been hearing recently, and was the gist of what I was getting at regarding being careful about our choice of words, like "exposure," because they imply different levels of risk.

I'll paraphrase a bit:

A "contact" is someone who spoke to, touched, or was in promixity to a patient. Further follow up is necessary to determine what kind of interaction might have happened with the patient and what kind of risk the person is in.

An "exposure" is contact that puts a person at high risk of the disease, such as direct contact with bodily fluids without protection.

The list of contacts to Mr Duncan is around 100 as I write this, but the list of exposures is maybe a dozen or a bit more.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/02/14 11:58 PM

My opinion, but for people who have been exposed to Ebola and have seen first hand that there is no room in the hospital will do what they can to leave. With the funds to travel and family to stay with outside the hot zone, being prosecuted for lying on a questionnaire would be a small price to pay for escaping the HZ. The risk to friends and family is not part of the equation for a person who is scared and desperate to leave.
The current policy of using exposure/contact questionnaires depends on honesty and honor in those answering the questions; those two attributes will be pushed aside by desperation every time. Just my opinion.
Posted by: Famdoc

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 12:02 AM

It is the physician's duty to obtain a history, including, as appropriate, a travel history; this is a sad example of trusting someone else to do your work.

Allegedly, the patient was truthful to some degree when first seen in the ED; unlike when completing the form on departing Liberia.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 12:14 AM

Partially truthful. Saying you've recently been in Liberia should have been enough to get a response. When it didn't get a response, adding that he had had direct contact/exposure to an Ebola patient who died would have gotten a response. Speak loud enough and you'll probably clear the waiting room. He may not have been a medical professional, but he was probably the person in that ER with the most Ebola experience and he allowed them to send him home with an anti-b prescription.

The patient screwed up and put people at risk by not being fully open and honest. The medical staff screwed up by not being more suspicious of his history and asking the hard questions. Plenty of blame to pass around... but that's just my opinion too.

How many times did we hear House say, (paraphrasing) -- "People lie."
Posted by: Teslinhiker

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 01:15 AM

One thing that Martin alluded to in another thread was this:

Quote:

The Ebola situation is starting to spin out a huge amount of media that is surrounding actual information. Some of the information is good, some is irrelevant and some is just plain wrong.

Let us all rely on one another to find, assess, filter, and prioritize factual information in a logical and emotionless way.

For example, if you hear or see someone say, "The CDC says..." - you need to find and cite the link with the information from CDC.gov - not a news report that says "the CDC says" - the CDC itself. Same goes for ANY "official sources" - find and cite the originator, not the media's version of the information.


I am firmly in Martin's camp on this. Like all major news events, the reporting in the media ranges from slightly incorrect to damningly wrong and the current Ebola reporting is certainly no exception. It remains to be seen when after this current outbreak is over, what was real factual reporting and what was poorly researched reporting hastily presented in the all important (and self serving) readership race.

here are some much better sources of info:

WHO Sitrep Reports and the CDC updates.

That all said, Ebola is not even on my radar as threat to me, My DW or family. After all, statistically speaking, we have a much better chance of dying during the typical yearly Influenza season.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 02:18 AM

Quote:

That all said, Ebola is not even on my radar as threat to me, My DW or family. After all, statistically speaking, we have a much better chance of dying during the typical yearly Influenza season.


I am extremely concerned about Ebola.

The probabilities of death for a typically influenza pandemic.

Kill rate x infection rate

Ebola Kill rate 0.6
Infection rate (lets assume CDC projections of 1 million by the end of January) out of a West African Population of 10 million = 0.1

= 0.1x0.6 = 0.06 i.e 6% of the population will die in the currently affected West African Countries .

influenza Pandemic kill rate 0.02 (these probabilities were from a UK NHS document for a pandemic which the NHS would begin to fail)
Infection Rate 0.4

=0.4 x 0.02 = 0.008 i.e. 0.8% of the population will die (this is not a typical Winter Influenza Outbreak but one of a serious National public health emergency)

If in North America, you have >20-30 infected from Ebola in 1 months time, I would start planning to head for hills to self quarantine in 6 months time as a 6% death rate in the US would mean a highly probable collapse of Society as is now happening already in Liberia.

A report from just nearly 2 months ago.

http://www.youtube.com/watch?v=qaGnuZT08vQ







Posted by: Teslinhiker

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 02:43 AM

Originally Posted By: Am_Fear_Liath_Mor

Kill rate x infection rate

Ebola Kill rate 0.6
Infection rate (lets assume CDC projections of 1 million by the end of January) out of a West African Population of 10 million = 0.1


Read the actual CDC report, especially the Abstract and Conclusion section:
The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.

Originally Posted By: Am_Fear_Liath_Mor

A report from just nearly 2 months ago.

http://www.youtube.com/watch?v=qaGnuZT08vQ


I wish my wife would post her thoughts here about Samaritan’s Purse. They are a controversial organization and many NGO's will not associate with them. And it's too bad as they have deep pockets and leading logistics to respond to disasters globally. If you have enough incentive, go read the Wikipedia page on this organization. Also this 11 year old article goes into some great detail about SM.
Posted by: JerryFountain

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 02:48 PM

Originally Posted By: Am_Fear_Liath_Mor

Kill rate x infection rate

Ebola Kill rate 0.6
Infection rate (lets assume CDC projections of 1 million by the end of January) out of a West African Population of 10 million = 0.1


It is not a good use of statistics to assume that an infection rate (or a death rate for that matter) in West Africa would be of any use for determining rates in first world countries. The situation for both quarantine and medical care is SIGNIFICANTLY different.

Respectfully,

Jerry
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 03:12 PM

As I understand Ebola can survive on a surface for days. Read Workers Spray Ebola Patients’ Vomit Off of Sidewalk with Pressure Washer and No Protective Clothing and then ask yourself "Where will it turn up next?" How about that lady walking through the run-off in sandals -- where did she go next?

Peeps in general are not taking the Ebola threat seriously... just my opinion.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 03:34 PM


Quote:
It is not a good use of statistics to assume that an infection rate (or a death rate for that matter) in West Africa would be of any use for determining rates in first world countries. The situation for both quarantine and medical care is SIGNIFICANTLY different.


Yes this is very true, I have been very conservative with the probabilities when comparing infection rates from West Africa to North American and Europe, it could be potentially be higher due to the following;

i) Potentially much higher population densities in Major Western Cities.

ii) Greater mobility and a higher probability of virus transfer between individuals.

iii) Greater secondary effects of panic and less stored food in individual homes due to CANBAN business practice.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 04:55 PM

Very preliminary "breaking news" (which could be wrong) for the Washington DC area.

A man with "Ebola like" symptoms has been admitted to a local Washington DC hospital after returning from a trip to Nigeria.

http://www.wtop.com/109/3715125/Patient-with-Ebola-like-symptoms-in-DC
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 08:20 PM

Why we are not ready in two photo's. Pure opinion, but you decide.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 09:48 PM

Quote:
Why we are not ready in two photo's. Pure opinion, but you decide.


I think a lot of folks are not getting the seriousness or are suffering a lack of information passed down to the contractors of the CDC Level bio-security measures (level 4 requirements) required here if they want to be serious against halting the spread of this potentially DoD weaponised hemorrhagic fever.
Posted by: hikermor

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 10:21 PM

"this potentially DoD weaponised hemorrhagic fever."

Could you please be more specific? I am not sure I comprehend your meaning....
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 10:55 PM

Quote:
Could you please be more specific? I am not sure I comprehend your meaning....


The Clinical Study NCT02041715 was abandoned in West Africa shortly before the outbreak of the Ebola fever in the area.

http://beforeitsnews.com/health/2014/09/...eo-2550872.html

http://birdflu666.wordpress.com/2014/07/...se-flag-attack/

Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 10:59 PM

Since the topic here is about Ebola Preparedness, what level protection is adequate in a hot zone? I have nitrile gloves, a decent full-face respirator with both dust and organic vapor filters, but if Ebola isn't airborne, then gloves and other skin protection seems to be the way to go. But if it isn't airborne, why are all the responders in West Africa wearing respirators?

Is a less than $10 Tyvek hazmat suit adequate? Just wondering how you'd suit up given the situation in Dallas.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 10/03/14 11:43 PM

Originally Posted By: Am_Fear_Liath_Mor
Quote:
Could you please be more specific? I am not sure I comprehend your meaning....
The Clinical Study NCT02041715 was abandoned in West Africa shortly before the outbreak of the Ebola fever in the area.


This is the usual [colloquialism indicating falsehood redacted] conspiracy theory.

The clinical study was a safety trial of an experimental drug to treat ebola. The drug was developed by the small Canadian company Tekmira, and has since been fast tracked for use to treat ebola. In other words, the FDA has decided that the urgency of the current outbreak justified cutting short the usual lengthy (lengthy as in decades) procedure before approving a drug for general use.

The DOD did (in part) fund this research, as they fund much medical research. (Duh...ya think maybe a vaccine that protects from ebola might be useful for military personnel deployed to Africa?)

See Globe and Mail article:
Quote:
After Dr. MacLachlan’s call to Dr. Geisbert, now a professor at the University of Texas Medical Branch at Galveston, TKM-Ebola was tested on rhesus macaques at the U.S. Army Medical Research Institute of Infectious Diseases biosafety level 4 containment lab in Maryland.

All four macaques challenged with lethal doses of the Ebola virus, then treated for seven days with TKM-Ebola, survived. (In another arm of the study, one of three macaques given four doses, instead of seven, died.)

The results, published in The Lancet in 2010, were encouraging enough to persuade the U.S. Department of Defence’s biomedical research arm to sign a $140-million contract with Tekmira. A phase I clinical trial, designed to test the safety of the treatment in 28 healthy volunteers, began in January, and the U.S. Food and Drug Administration granted the drug fast-track approval in March.

But Tekmira announced in July that the trial had hit a road block: The FDA asked the company to halt the trial until it could provide more data to ensure the safety of the healthy volunteers, some of whom were being dosed with as much TKM-Ebola as would be given to a lethally infected patient. The hold was partly lifted in August, allowing Tekmira to offer the drug on an emergency basis to Ebola patients, but the trial itself is still on hiatus.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 12:10 AM


Quote:
The clinical study was a safety trial of an experimental drug to treat ebola


Yes it was! But did it all go terribly wrong in the Jungles of West Africa?
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 12:37 AM

Breaks in logic are common with many of the conspiracy theories. People see/hear of an activity and then they see a result (while not seeing a direct relationship) and they assume that the first activity caused the result when they may be unrelated and totally independent of each other. Unfortunately we don't know what we don't know and leaping to conclusions is often the result - BTDT. Then the internet takes the conclusion world wide at the speed of 1's and 0's and we can see the result of that too -- but it may be unrelated wink
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 12:58 AM

Originally Posted By: Am_Fear_Liath_Mor

Originally Posted By: AKSAR
The clinical study was a safety trial of an experimental drug to treat ebola
Yes it was! But did it all go terribly wrong in the Jungles of West Africa?

Did you even bother to read the article I linked?

Note that the drug apparently is not using the ebola virus itself. Rather, it uses small molecules which interfere with the ebola virus replicating itself. Think birth control for viruses. The trial was halted (note that this was before the current epidemic had blown up) because the FDA was concerned that the safety trials were initially using too high a dose. They were apparently concerned about possible toxic side effects of the drug, not that it would give people ebola. Drug trials usually start with a very small dose, then you wait awhile, then try a somewhat bigger dose, then you wait etc etc. That is why it can take decades to get new drug approved.

Since then, with the huge increase in ebola cases, the drug has been approved for emergency use.
Quote:
But Tekmira announced in July that the trial had hit a road block: The FDA asked the company to halt the trial until it could provide more data to ensure the safety of the healthy volunteers, some of whom were being dosed with as much TKM-Ebola as would be given to a lethally infected patient. The hold was partly lifted in August, allowing Tekmira to offer the drug on an emergency basis to Ebola patients, but the trial itself is still on hiatus.

Note that at least one ebola patient has been treated with the drug, and has recovered. Supplies of the drug are very limited, but apparently at least a few other patients are being treated with it.

If the test of the experimental drug did "..... all go terribly wrong in the Jungles of West Africa" as you suggest, then the FDA would hardly be approving it for use on other patients, now would they? Nor would they be fast tracking production of the drug for other patients.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 12:58 PM

I found something that gives detailed guidance on cleaning and disinfection of Ebola contaminated objects by using bleach solutions published by the WHO. It includes specific instructions on how to prepare and use the solutions so that they are of the proper strength and effectiveness, which is what I was looking for when I found this document. Hope that it is informative and helps planning and prep. Also, hope no one has to use it. . .

http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec5-6.pdf
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 01:58 PM

There's another good read at: Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
The FAQ section at the bottom is useful.
Posted by: Doug_Ritter

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 02:41 PM

Per Martin's point:

Boss, Coworkers of US Ebola Patient: He Knew He Had Ebola, US Trip Was 'Desperate Attempt to Survive'

http://www.breitbart.com/Big-Peace/2014/...empt-to-Survive
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 02:44 PM

In the WHO pdf above section 5.1 discusses preparation of bleach solutions. First they note that ordinary household bleach comes in 5%. Then the article notes that a 1:10 bleach solution is is strong and used to clean excreta and bodies. A 1:100 bleach solution is used to clean surfaces, equipment, bedding, reusable protective clothing...

Terminology question -- Household bleach is 5%, 1:10 is 10% (stronger) and 1:100 is 1% (way weaker). How do you get a 10% solution when starting with household bleach at 5%? ...or are they really saying 1:10 starting with household bleach and then cut that again to get the 1:100 solution? So 1:10 is really a .5% solution. Easy to get confued when terminology is mixed.

BTW, using the CDC guidelines, Dallas really messed up by using a pressure washer to clean up the hazardous waste site where their Ebola patient puked on the sidewalk. Sounds like a city bureaucrat told sanitation to clean "it" up and no one bothered to mention what "it" was. I wonder if those sanitation workers are on the list of peeps that need to be observed...
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 03:19 PM

Originally Posted By: Russ
Easy to get confused when terminology is mixed.


I'm a bit confused also; I think they are talking about diluting the normal "bleach" in the standard bottle (5%).

And as to the story quoted by Doug:

I take it with a grain of salt. As Martin said, the news outlets have a big incentive to hype anything, verified or not, as long as it sells:

If he was so afraid, I would think on his first visit to the ER he would have made it very clear that he thought he might have Ebola. Instead, if the other reports are true, he only said he had been in Liberia (or words to that effect). IMO, contradictory and inexplicable behavior for someone who fled when he "knew he had Ebola" and knew "he was going to surely die,. ."
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 03:52 PM

Been thinking about this and only Mr Duncan knows the truth and he seems to be keeping the truth to himself. However ... he fled Liberia knowing he had been exposed to Ebola and then went to stay with friends/relatives in Dallas. I'm quite sure he didn't tell them he had Ebola and probably didn't want to admit to anyone that he knew he had Ebola because that would mean that deliberately put friends/relatives to a high risk of exposure. He started lying about his exposure with that CDC form at the airport when he departed Liberia and he never changed his story. Just my opinion, but it seems to be corroborated with the reports out of Liberia and the fact that the folks in Dallas let him stay. Desperate people lie.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 04:15 PM

I think the reason for the terminology shift was to use 5% bleach concentrate to reference a starting point for their 1:10 and 1:100 (dilution) mixtures.

After reading the WHO info I checked the bargain store laundry bleach we have here and it does not specify a concentration, but it is lavender scented wink I'll be picking up a couple gallons of "name brand" bleach to use as a starting point. The lavender stuff is fine for laundry.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 05:25 PM

Our local Home Depot carries a "Germicidal" bleach that is listed as 8.3% sodium hypochlorite yielding "7.9% available chlorine". A little extra can't hurt.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 05:48 PM

If one reads an article like this one, it makes you realize the complexity of human psychology and the desire to believe what you want to believe in the face of a desperate situation. Also, how much trust do we put in what neighbors, friends, and people in authority tell us?

For one thing, the preganant landlord's daughter that Mr Duncan helped was reportedly diagnosed earlier at a clinic with malaria. I also read elsewhere a couple days ago (can't find that article again) that he was told by the family that the daughter was suffering from complications of her pregnancy when they sought his help to find medical help.

And if we believe stories that he was going to hop on a plane to marry his girlfriend in Texas in a matter of days, would he so willingly come into direct contact with someone he believed was gravely ill with Ebola? That doesn't add up.

I also agree with bws48's point that if he was so desperate to live and start his new life with his wife-to-be and he really thought he had Ebola, wouldn't he be more assertive at his first ER visit to Texas Presby? Would he let those people in the apartment tend to him like they did if he really thought he had Ebola? I would imagine that he realized the gravity of his situation at some point in this saga, whether back in Liberia or in Dallas, but perhaps he could not face that grim reality by that point.

On a related note, the news that the Dallas DA may prosecute Mr Duncan could be the wrong thing to do from a public health perspective. I think that will simply serve to stigmatize the sick (perhaps even Americans who get infected) and could drive infected people underground and that's the last thing you want. I don't think prosecution is a deterrant at all to keeping infected people out of the US but it may change people's behavior in undesirable ways once they are here.

The priority should be to find everyone who is infected or potentially infected, ideally, before they become infectious. Facing punishment just delays that discovery process, making it more likely an infected person becomes infectious out in public.

I said it before, but I think scrutinizing the Dallas case is important, and not just some morbid fascination, because it gives us an idea of how future cases will be handled across the country.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 06:07 PM

Originally Posted By: Russ
I think the reason for the terminology shift was to use 5% bleach concentrate to reference a starting point for their 1:10 and 1:100 (dilution) mixtures.

Correct, start with household bleach as the "1:" in these dilution ratios unless the directions specify otherwise.

Make sure to mix a fresh batch daily because the disinfecting potency begins to dissipate as soon as you dilute bleach into water.

The same thing applies to the bottle of bleach itself, just slower. If you're serious about having a properly potent disinfecting solution and your bleach is more than, say half a year old, I would recommend that you buy a fresh bottle because bleach is cheap. If you can't remember when you bought a bottle because it's been so long, then definitely get a fresh bottle. Just use up the old bleach for less critical uses like laundry or whatever else you normally use bleach for.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 06:11 PM

The article at: Ebola Patient 'Knew' He Had Virus, Flew to US to Survive

Only Mr Duncan knows, but he may be in denial. Cognitive Dissonance (when what you think you know clashes with reality) also plays a role; in the face of an Ebola epidemic where he lived, he refused to admit to himself that he could have Ebola and wouldn't admit having been exposed to anyone, possibly including himself. Possible, not a fact...

The CDC and WHO need to take that human flaw into account with their screening procedures.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 06:23 PM

Another good (?) article for medical professionals. Nurses: We Are Unprepared to Handle Ebola Patients
Quote:
...As of Aug. 25, more than 240 healthcare workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died, according to the World Health Organization.

Many of these infections occurred when healthcare workers were removing the personal protective gear - masks, gowns, gloves or full hazmat suits used to care for the patients, said biosafety experts. ...
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 06:30 PM

Speaking of dis-incentives to seeking medical care, last week, I was reading this article about the increasing frequency of ER billing surprises as more and more ER's utilize out-of-network or outside consultants even though the hospital/ER is in your coverage network.

Even with good insurance, I could see how an ER visit for a possible Ebola exposure could easily bankrupt a lot of families. Once the word "Ebola" is mentioned and everyone starts putting on their protective gear and infectious disease consultants are called in and they put you in a separate exam room, you could already be in the poorhouse at that point, even if they determine that you're not at risk and send you home without admitting you.
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 06:37 PM

Originally Posted By: Arney
On a related note, the news that the Dallas DA may prosecute Mr Duncan could be the wrong thing to do from a public health perspective. I think that will simply serve to stigmatize the sick (perhaps even Americans who get infected) and could drive infected people underground and that's the last thing you want. I don't think presecution is a deterrant at all to keeping infected people out of the US but it may change people's behavior in undesirable ways once they are here.

The priority should be to find everyone who is infected or potentially infected, ideally, before they become infectious. Facing punishment just delays that discovery process, making it more likely an infected person becomes infectious out in public.
I agree that it would be a very dumb move if the authorities in TX try to prosecute the gentleman. Driving people underground who think they have been exposed is exactly the last thing you want to do.

I find it difficult to believe that Mr. Duncan "knew" he had ebola. He was asymptomatic when he left Liberia. Even the blood tests apparently aren't definitive until about 3 days after you start showing symptoms. The NY Times "Well" has some good info:
Quote:
Q
Can a blood test show if a person has the Ebola virus before they are symptomatic?
A
With blood tests that we have now, no. In fact, in order to be fairly certain, you have to have the first symptom, which is a fever, for about three days before there’s enough virus coursing around in your blood for the blood test to be accurate.

What we should try to do is encourage people who have been potentially exposed (by recent travel in infected areas), AND have come down with a fever to report to an ER immediately and get checked out. This will be better for them, in that they can get appropriate care, and will also be better for the rest of us by minimizing the potential exposure of others.

EDIT: Note that the "Well" link has some other info about how long the virus can survive outside the body. (Short answer is it depends on how fast it dries out.)
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 06:44 PM

Originally Posted By: bws48
Very preliminary "breaking news" (which could be wrong) for the Washington DC area.
Apparently this case has tested negative for Ebola. And another possible case in the DC area turned out to be malaria. See the WaPo article Howard Hospital patient does not have Ebola, hospital official says
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 07:04 PM


Quote:
Breaks in logic are common with many of the conspiracy theories. People see/hear of an activity and then they see a result (while not seeing a direct relationship) and they assume that the first activity caused the result when they may be unrelated and totally independent of each other.


An analogy would be having a forest burning down, where the source of the fire breakout originated, where someone was testing a fire extinguisher. Questions would need answered.

There have been many in Liberia who believe this was the result of human experimention with various strains of Ebola where the CDC holds the patents. The only way to test antidotes/vaccines, is where you need an infected test population group to test with. Vaccine research trials are used as cover for exotic weapons of mass biological destruction weapons development.

Ebola, AIDS Manufactured by Western Pharmaceuticals, US DoD?
by Dr. Cyril Broderick, Professor of Plant Pathology

http://www.liberianobserver.com/security/ebola-aids-manufactured-western-pharmaceuticals-us-dod

In the end it doesn't matter as Pandora's box is now open and everyday it is now getting more and more difficult to close.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 07:11 PM


A new Ebola Vector. frown

http://www.wnd.com/2014/10/dogs-eating-ebola-victims-spreading-epidemic/
Posted by: AKSAR

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 09:46 PM

The NY Times has updated their What Are the Chances Ebola Will Spread in the United States? page. Lots of good info here.

I find it especially interesting that Nigeria appears to have contained ebola, at least at the moment.
Quote:
Although officials are pleased that success was achieved in a country of 177 million that is a major transport and business hub — and whose largest city, Lagos, has 21 million people — the lessons here are not easily applicable to the countries at the epicenter: Guinea, Liberia and Sierra Leone. Public health officials in those countries remain overwhelmed by the scale of the outbreak and are desperate for additional international assistance.
-----------------snip------------
After the first patient — a dying Liberian-American — flew into Lagos on July 20, Ebola spread to 20 other people there and in a smaller city, Port Harcourt.

They have all now died or recovered, and the cure rate — 60 percent — was unusually high for an African outbreak.

Meanwhile, local health workers paid 18,500 face-to-face visits to repeatedly take the temperatures of nearly 900 people who had contact with them. The last confirmed case was detected on Aug. 31, and virtually all contacts have passed the 21-day incubation period without falling ill.
If Nigeria can prevent the epidemic from spreading to that country, I am somewhat optimistic that the US and Canada can also manage to contain those ebola cases who enter the country.
Posted by: UTAlumnus

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 10:17 PM

Because it is only technically not airborne. Airborne transmission requires it to be transmitted by a droplet size that can stay in the air for long periods.

Ebola can be spread by droplets between .8 and 1.2 um. A sneeze creates droplets between .5 and 5 um.

I'm guessing that sneeze size droplets can't stay airborne for a long time.

I'll stick to the safer course and treat it like it's semi-airborne.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 10:32 PM

A new incident at Newark Airport (just outside NYC). Two people removed from flight, by responders in Hazmat suits:

http://www.dailymail.co.uk/news/article-...toms-Ebola.html

I applaud the first responders.

Hopefully, this is a false alarm.

But IMO, there is a point where the false alarms overwhelm the response system.

Isn't this the second incident coming from Brussels?
Posted by: chaosmagnet

Re: EBOV versus Pandemic Flu Preparedness - 10/04/14 11:02 PM

Originally Posted By: UTAlumnus
Because it is only technically not airborne. Airborne transmission requires it to be transmitted by a droplet size that can stay in the air for long periods.

Ebola can be spread by droplets between .8 and 1.2 um. A sneeze creates droplets between .5 and 5 um.

I'm guessing that sneeze size droplets can't stay airborne for a long time.

I'll stick to the safer course and treat it like it's semi-airborne.


Not disagreeing with you, but a citation for this would be helpful.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/05/14 12:26 AM

Texas Presbyterian Hospital backtracks on its explanation about how Mr Duncan could have been sent home after his first ER visit.

At first, the hospital issued a statement saying basically that nurses and doctors see different information from their electronic health records system and that the physician was not able to see the notation about recent travel from Liberia.

However, the hospital then issued a new statement yesterday explaining that actually, the physician could see the travel history notation. No further comment from the hospital.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/05/14 01:08 AM

Originally Posted By: Arney
I already posted an article that mentions that the disposal of Ebola-exposed medical waste is very difficult or even impossible for US hospitals under current regulations...I have not seen any news since then that this problem has been remedied or clarified at the regulatory level.

Just a follow up to this question I raised. The US Deptartment of Transportation has issued new regulatory guidelines on the transportation of Ebola-related materials. So Texas was issued a special permit and other states will follow, if necessary.

This is not the first epidemic the country has faced, though, and Ebola has been raging in Africa for months, so you would think this process would have already been ready to go as soon as the first confirmed case (Dr Kent Brantly, not Duncan) was flown back and hospitalized in the US.

On a side note: If you read the special packaging requirements for Ebola waste in the new regs and compare that to the scene of those guys simply power washing the sidewalk of Duncan's infected vomit, you can see a big disconnect there. Poor guys. They're probably low paid employees of a private contractor and may not even have health insurance of their own!
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/05/14 02:15 AM

Originally Posted By: IzzyJG99
I'm not too worried about them. The virus count in that vomit probably was bombarded for several days by UV light from the Sun.

Depends how thinly spread out the material is. If there were clumps or mounds of material, who knows how long the center part could remain infectious?

And what happened during the interim time before the sidewalk was finally cleaned? Was someone guarding it until then? Did someone's dog lick the vomit and then go home and lick their owner on the face shortly thereafter? Did a child innocently ride their bike through it and then somehow touched their tire later with an unprotected hand? These are hypotheticals, of course, but not unreasonable scenarios, I think.

Which just means that someone in charge should have thought about the infection risk pretty early on. It's no secret that he vomited outside when moving to the ambulance because it was widely reported.
Posted by: UTAlumnus

Re: EBOV versus Pandemic Flu Preparedness - 10/05/14 03:05 AM

Ask & receive:

Ebola Airborne Transmission

Airborne transmission (general)

Sneeze particle size
Posted by: chaosmagnet

Re: EBOV versus Pandemic Flu Preparedness - 10/05/14 01:37 PM

Excellent, thank you!
Posted by: hikermor

Re: EBOV versus Pandemic Flu Preparedness - 10/05/14 02:35 PM

Here is some more info on the likelihood of Ebola spreading: http://www.npr.org/blogs/health/2014/10/...tm_term=nprnews Things could be a lot worse
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/06/14 06:29 PM

According to this article, a nurse in Spain is the first to contract Ebola outside of Africa. This nurse in Madrid was diagnosed with Ebola after tending to a priest with Ebola who got it while in Sierra Leone.

If this nursing survey that has been posted a couple times already reflects reality--that many nurses feel that they and their institutions are ill prepared for Ebola--this Spanish incident could lead to a lot of soul searching, especially now that more and more community based hospitals in the US are dealing with cases or suspected cases in recent days rather than "elite" teams from the CDC and special high-risk biocontainment wards.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/06/14 11:44 PM


Quote:
According to this article, a nurse in Spain is the first to contract Ebola outside of Africa.


This is very disturbing news. This nurses PPE kit was obviously inadequate. This virus must be incredibly contagious, probably airborne despite the denial by the authorities that own the intellectual property rights to the virus.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 12:27 AM

Originally Posted By: Am_Fear_Liath_Mor
This virus must be incredibly contagious, probably airborne...

We would be seeing far more cases, even here in the US, if Ebola were a true airborne disease (since Dr Kent Brantly first set foot back in the US). However, it is true that Ebola is very contagious in the sense that it only takes 1-10 virus particles to infect someone (under "infectious dose" section).

As the WSJ reports, this Spanish nurse followed all the infection control protocols and only had contact with the patient twice--once while he was alive and once after he was deceased. Like I said earlier, a lot of people in healthcare are going to be grappling with the implications of this incident.

Speaking of airborne transmission, here is a good explanation in Scientific American about what is involved when people talk about Ebola mutating to become a true airborne disease and how there is little evolutionary pressure for it to do so. The risk of such a drastic mutation appears very low because the fundamental nature of Ebola and how it attacks the body would need to change to accommodate such a change.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 12:59 AM


Quote:
We would be seeing far more cases, even here in the US


Brother Miguel Pajares died on the 12th August, about 47 days ago. This time period is well outside the 2-21 day period quoted by the authorities.
The authorities also have indicated that the Ebola can also only be contagious when symptomatic. I do not believe this either. I also suspect that the contagious period may well even be infectious for days/weeks before before becoming symptomatic.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 02:12 AM

Originally Posted By: Am_Fear_Liath_Mor
Brother Miguel Pajares died on the 12th August, about 47 days ago.

The WSJ article I referenced above says Brother Manuel García Viejo--not Miguel Pajares--died on September 25th and the nurse developed a fever on September 30th. I don't think we're talking about the same person.

Edit: A different WSJ article mentions Pijares and that this nurse tended to him, too. So this nurse was exposed to two different Ebola patients.

Since Pijares' death is well outside the three-week maximum incubation period, it does not seem to make sense to link the nurse's infection to him versus the much more recent patient, which is squarely within the time window we would expect.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 03:26 PM

Quote:
Since Pijares' death is well outside the three-week maximum incubation period, it does not seem to make sense to link the nurse's infection to him versus the much more recent patient, which is squarely within the time window we would expect.


http://www.bbc.co.uk/news/world-europe-29519370

Three other individuals are also suspected of Ebola infection along with the nurses confirmed case. It does get worse. The nurse when feeling unwell i.e. symptomatic, asked for an Ebola test multiple times but was refused and was told to go on Holiday, only to be tested 6 days later after before becoming progressively more ill.

Considering the PPE kit and the protection barrier procedures undertaken then either the nurse was either infected 47 days ago with very few virus particles or received a heavy dose of virus 12-13 days ago.

Either way the policy of bringing Ebola infected individuals from west Africa needs to be halted even without getting into the criminal negligence issues being carried out by the Government authorities.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 05:19 PM

Originally Posted By: Am_Fear_Liath_Mor
The nurse when feeling unwell i.e. symptomatic, asked for an Ebola test multiple times but was refused and was told to go on Holiday, only to be tested 6 days later after before becoming progressively more ill.

This sounds so unbelievable that I'm inclined to think that this is uncomfirmed reporting by El Mundo, but if it is an accurate description of what happened, that is inexcusable. A health professional who had direct contact with not one, but two, Ebola patients suspects that they are infected, and is repeatedly refused testing?

This Guardian article quotes the El Mundo report, and then adds something else:
Quote:
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.

If this second description of how the nurse was "isolated" in the ER while she waited for her test results is true, then I suppose the bit about refusing to test her in the first place doesn't sound so far fetched. I really hope that this is not actually what happened so I'll keep an eye out for clarifications.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 05:57 PM

Having lived in Spain for a few years, I do not doubt the El Mundo report -- but that's just a biased opinion.
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/07/14 06:06 PM


The astonishment continues. eek

http://www.dailymail.co.uk/news/article-...g-assitant.html

Quote:
Dallas Ebola victim's stepdaughter - who took him to hospital as he was 'vomiting wildly' - is given all clear to return to work as a NURSING ASSISTANT


There should be a 40 day minimum quarantine.

http://pmj.bmj.com/content/81/955/315.full.pdf

Quote:
PUBLIC HEALTH MEASURES
Even in the 14th century the health authorities
in northern Italy had established the importance
of a 40 day quarantine period, which became the
gold standard for continental Europe for the next
300 years. The 40 day quarantine was not
adopted in England until the 16th century and
even then it was changed to 30 days only to find
that this was completely ineffective, whereupon
this regulation was speedily rescinded.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/08/14 03:53 PM

Ebola Patient Thomas Eric Duncan Dies

RIP
Posted by: Am_Fear_Liath_Mor

Re: EBOV versus Pandemic Flu Preparedness - 10/08/14 11:28 PM


Sheriff’s Deputy Who Was Forced to Enter Ebola Apartment Falls Ill

http://www.prisonplanet.com/breaking-she...-falls-ill.html

Frisco officials say risk is low that sheriff’s deputy who visited Duncan’s apartment has Ebola

http://thescoopblog.dallasnews.com/2014/...ic-duncan.html/
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/11/14 06:54 PM

This is an interesting Scientific American article: Ebola Spread Shows Flaws in Protective Gear and Procedures The nurse in Spain may have contaminated herself when removing her protective gear.
Meanwhile the guys who cleaned the Dallas apartment wore full-face respirators and Level B Saranac suits, reportedly one level above CDC recommendations.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/12/14 07:05 AM

Sierra Leone had already embarked a while ago on an unprecedented, almost medieval, quarantine of large swaths of the country, trapping a third of its citizens in their home districts. Travel between districts is restricted, and there are curfews within districts in an attempt to limit contact between people, but it is wreaking havoc with the economy and daily living.

According to this NYT's article, the government has now made it national policy that it acknowledges it can't help everyone and that people should take care of people with Ebola at home. Basically, it means that most people with Ebola there are on their own.

Quote:
Acknowledging a major “defeat” in the fight against Ebola, international health officials battling the epidemic in Sierra Leone approved plans on Friday to help families tend to patients at home, recognizing that they are overwhelmed and have little chance of getting enough treatment beds in place quickly to meet the surging need.

The case of the Spanish nurse illustrates how one simple accident can lead to infection. Well, the reality is, so many people with Ebola have been tended to at home anyway which unfortunately has led to many more infections.

As long as Ebola rages in West Africa, it will continue to be a recurring threat over here. As we enter cold and flu season in the Northern Hemisphere and fevers and other symptoms become more common, I just hope the fear factor doesn't go off the chart.
Posted by: bws48

Re: EBOV versus Pandemic Flu Preparedness - 10/12/14 10:43 AM

Originally Posted By: Arney

The case of the Spanish nurse illustrates how one simple accident can lead to infection.


True. Woke up this am to news that a health care worker at the Dallas Hospital has tested positive for Ebola:

http://www.foxnews.com/health/2014/10/12...tive-for-ebola/

I expect we will be hearing a lot about this in the next few days.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/12/14 02:24 PM

Okay, now it really is here -- time to get serious. Medical personnel need to review their equipment and procedures, and we may need to adjust the definition of airborne to include the droplets from sneezing. Full face respirators and triple redundancy may become standard practice, just like the Cleaning Guys. Complacency may be a killer ...

Another term to be concerned with is "Hubris": overbearing pride or presumption. Many in conservative media have used it to describe a certain politician, but it may also apply to the US medical establishment. We have great pride in our medical system and due to that pride we may be presuming that we can control this third world disease.

It might be time to rethink that presumption. It's here and it's not contained, time for the "full-face respirators and Level B Saranac suits" like those contractors in Dallas; maybe they weren't over-cautious, maybe they had it right. Then again, their incubation period isn't up yet...

The article An Ebola Outbreak Would Be Advantageous For Globalists is concerning. I'll leave it there with no further comment.
Posted by: M_a_x

Re: EBOV versus Pandemic Flu Preparedness - 10/12/14 08:33 PM

The coming season for influenza and colds plus the reluctance to go on sick leave for fairly minor symptoms may add to the risk.
Ebola is not really on the radar in our society.
I still think that it´s not time to panic about it yet.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/13/14 12:04 AM

The dogma that fever is a reliable indicator of the onset of Ebola symptoms, and therefore, the onset of infectiousness, in all infected people is finally being challenged in a mainstream article. It has been questioned from the beginning in the alternative press, but seems to be reaching the mainstream press now.

A Dutch physician treating Ebola in Sierra Leone said:
Quote:
... hospital staff members took the temperature of one of the doomed patients four times a day for three consecutive days, and the patient never showed a fever. The readings were taken by a digital thermometer placed in the armpit, he said.

Based on what his staff observed, Zwinkels wrote, "it seems that only measuring the temperature as a form of triage is insufficient."

Five of his nursing assistants became infected. Four of them died.

If it's true that a subset of Ebola patients do not present with fever, then that throws a lot of policies into question, whether it is determining which secondary contact of an Ebola case is considered at high risk and require quarantine, to the effectiveness of temperature screening at airports and border crossings.
Posted by: Arney

Re: EBOV versus Pandemic Flu Preparedness - 10/15/14 05:37 AM

There is a new press release put out by the WHO today that has some food for thought in it that I have not seen elsewhere.

First, just a general statement about the situation in West Africa:
Quote:
In Guinea, Liberia, and Sierra Leone, new cases continue to explode in areas that looked like they were coming under control...WHO epidemiologists see no signs that the outbreaks in any of these 3 countries are coming under control.

In the section called "Incubation period" is the following paragraph:
Quote:
Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval...

So...in this new West African outbreak, there were/are some Ebola cases that appeared more than 21 days after infection? That's news to me! So is quarantine for 21 days sufficient? When the CDC's Dr. Tom Frieden says on TV that "...even a single infection is unacceptable" then this news makes you wonder about the 21-day guideline.

And finally, there's the statement:
Quote:
WHO is alarmed by media reports of suspected Ebola cases imported into new countries that are said, by government officials or ministries of health, to be discarded as “negative” within hours after the suspected case enters the country.

Such rapid determination of infection status is impossible, casting grave doubts on some of the official information that is being communicated to the public and the media.

Except for Mr Duncan and Ms Pham, all the other "possible" Ebola cases in various locations in the US have been declared to be "negative," many within a short period of time. Have we been given a false sense of security by these rapid declarations? Presumably, the travel histories have ruled out most potential cases quickly, but if any of them had questionable histories, has rapid negative announcements been premature? Again, food for thought.
Posted by: Meadowlark

Re: EBOV versus Pandemic Flu Preparedness - 10/15/14 07:04 PM


Thanks for making sub-threads on this topic, Martin. I'll try to post accordingly. smile

Amid the hubbub, I must take a moment to say this: I'm grateful that the folks here at ETS are more measured in their approach to this developing situation compared to those on other forums; hopefully the new threads will help those who are seeking up-to-date, reliable information.

In this day and age of instant communication via social media, it's vital that people remember that they need to discern what is known, and what is speculation. While a disease like Ebola is very frightening and indeed a true threat, spreading unsubstantiated rumors or links from conspiracy websites will only worsen the situation.


--M
Posted by: MartinFocazio

Re: EBOV versus Pandemic Flu Preparedness - 10/15/14 08:16 PM

And I ask of all of us, please, keep up the efforts to Keep Calm and Carry On by example. Question sources. Ask for evidence. Always, ask for the evidence.
Posted by: Russ

Re: EBOV versus Pandemic Flu Preparedness - 10/17/14 05:20 AM

Interesting ... Dallas Hospital had Ebola Screening Machine military using in Africa
Quote:
... The military is using an Ebola screening machine that could have diagnosed the Ebola cases in Texas far faster, but government guidelines prevent hospitals from using it to actually screen for Ebola. ...
Posted by: gonewiththewind

Re: EBOV versus Pandemic Flu Preparedness - 10/17/14 02:16 PM

Another possible source of information:
MNT Ebola News