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    Ebola

    Ebola is an endemic disease of a region of Africa. Usually the virus lives in animals and it passes to humans when humans enter jungle and they get in touch with these animals carrying the virus to the human environment. This usually causes little outbreaks, limited in some tiny areas and recording some victims.

    Some factors have made the context worse in the last decades: the contacts with the jungles are more and more invasive [human world is literally eating the jungle], periods of starvation have forced poor people to eat wild animals of any species, also the most odd ones [from a Western perspective], like bats and rats. Unfortunately some of these animals are sane carriers of Ebola.

    Crowded areas with unsuitable sanitary structures do the rest: the virus is in full diffusion in those regions.

    Rationality:

    how many persons are dieing by Ebola in those countries?

    According to WHO on October 10th on 8,399 cases 4,033 persons have died = mortality rate a bit above 48%.

    The mortality rate has to be suitably underlined: it's well inferior to what expected. This means that the outbreak is not involving the most lethal variants of Ebola [at least so far] and that the sanitary structures are reacting, despite the objective difficulties connected with the area of the first mass contagion.

    An other data to be underlined, is the mean of casualties per day. It's increasing. But not in a so dramatic way [this indicates that policies to contain the outbreak are affecting its diffusion in a positive way].

    In the middle of August it was around 52 deaths per day, today is getting close to the double, 100 deaths per day. The total of deaths on August 20th was 1,350. So 2,683 patients have died in about 50 days = 53.66.

    http://en.wikipedia.org/wiki/Ebola_v...in_West_Africa
    http://www.telegraph.co.uk/news/worl...s-Johnson.html
    http://www.telegraph.co.uk/news/worl...act-Ebola.html
    http://www.mobs-lab.org/ebola.html

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    Heathrow Airport is to start screening from tomorrow,KB. It`s a good step but to be honest I don`t think it will make a dramatic difference. This is the worse outbreak of Ebola yet.

    http://www.bbc.co.uk/news/health-29604184

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    Quote Originally Posted by hope View Post
    Heathrow Airport is to start screening from tomorrow,KB. It`s a good step but to be honest I don`t think it will make a dramatic difference. This is the worse outbreak of Ebola yet.

    http://www.bbc.co.uk/news/health-29604184
    Neither do I. What about the people who don't start showing symptoms until they've been in the host country for three or four days?

    What I'd also really like to know is how the nurse in Dallas contracted Ebola. The CDC says it's very hard to contract it since it's not airborne. (Of course, there's already a documented case where the virus causing a hemorrhagic disease mutated and became airborne. Luckily, it took place in a lab, and was contained.) So, how did a nurse, hopefully in hazmat gear, get it?

    Even physicians are conflicted. I've talked to some who are pro blocking flights from West Africa and some who are against it.

    I'll confess it's a little concerning.. Maybe, though, I just shouldn't have watched The Walking Dead last night?!


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    I read an article the "bubonic plague" that wiped out 1/4 of Europe's population in 1300-s was actually some kind of African Ebola. http://abcnews.go.com/Health/story?id=117310

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    Quote Originally Posted by Angela View Post
    Neither do I. What about the people who don't start showing symptoms until they've been in the host country for three or four days?
    Exactly. How many people could they be in contact with before being formally diagnosed? However I think the condition is not contagious before symptoms arise...it seems.
    Quote Originally Posted by Angela View Post
    What I'd also really like to know is how the nurse in Dallas contracted Ebola. The CDC says it's very hard to contract it since it's not airborne. (Of course, there's already a documented case where the virus causing a hemorrhagic disease mutated and became airborne. Luckily, it took place in a lab, and was contained.) So, how did a nurse, hopefully in hazmat gear, get it?
    Well this is a good question. Both the Spanish nurse and the nurse who treated T.E.Duncan wore protective clothing. It is being said there was a breach of some sort in the protocol. Perhaps the time of getting out off the protective clothing? Regarding the airborne aspect, the powers that be are saying the virus is only passed on by direct contact and not airborne. However I hope the incident you are speaking of is the one I am aware of ..and that being the non-human primate affected by aerosol at lab, otherwise if you are speaking of a different case, that makes at least two incidents?
    Quote Originally Posted by Angela View Post
    Even physicians are conflicted. I've talked to some who are pro blocking flights from West Africa and some who are against it.
    I have to admit ATOW I haven`t considered the cons for this, but I think the areas where the virus is, should be treated as quarantine areas, with no movement out and only medical teams into. It would IMO seem to make more sense to put all effort into controlling and treating the epidemic there and keeping it contained via quarantine. And these countries need all the help they can get at the moment.
    It is all very well placing checks at points of travel, however if only a small number were to get past these airport checks, think of the consequences. Also we know the virus can live on surfaces. Imagine a passenger coming through the airport, they will touch surfaces such as door handles, counters and trollies etc. Now think of a passenger coming through to take a flight out of the country. They may handle the same trolly etc..thus you could have a potential for the virus to fly out to another destination. I think quarantine is the best way, even if this seems severe.

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    Quote Originally Posted by kamani View Post
    I read an article the "bubonic plague" that wiped out 1/4 of Europe's population in 1300-s was actually some kind of African Ebola. http://abcnews.go.com/Health/story?id=117310
    You might be interested in this, kamani.

    http://www.theguardian.com/science/2...-london-plague

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    Quote Originally Posted by Euna View Post
    Do you think we should take more seriously Ebola?
    Hi Euna and welcome to Eupedia...
    Yes, I think it could be argued that the international community may have been slow to react to this latest outbreak. Thankfully, it is now being taken much more seriously.
    On an individual level however, I don`t think we should be carried away with hysteria.

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    Quote Originally Posted by hope View Post

    I have to admit ATOW I haven`t considered the cons for this, but I think the areas where the virus is, should be treated as quarantine areas, with no movement out and only medical teams into.
    Agree, there is people still going in affected countries for pleasure (safaris and what not), due to imbecility. At least them should be stopped.

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    Quote Originally Posted by hope View Post
    Hi Euna and welcome to Eupedia...
    Yes, I think it could be argued that the international community may have been slow to react to this latest outbreak. Thankfully, it is now being taken much more seriously.
    On an individual level however, I don`t think we should be carried away with hysteria.
    Neither do I. However, I think I would be cautious and as hygienic as possible around someone who is bleeding profusely, or doing some projectile vomiting and evacuation.

    Seriously, how could the protocol have not included spraying the suits, the boots etc. with bleach before the health care workers removed them? You should see what I go through just to take care of my cat's litter box...disposable tray, disposable gloves, disinfectant...

    You know,my house smells of bleach occasionally already; the fumes may become positively noxious in the future. :)

    Other than that, all the old hygiene rules apply as they always should...wash your hands during the day, and as the first thing you do when you come home...and for goodness sakes don't touch your eyes or your mouth or food after you've been handling subway railings or straps or something. (or money, for that matter) Leaving your outdoor shoes in the mudroom isn't a bad idea either. This is all stuff my grandparents taught. It's preaching to the oblivious however. Have you ever seen the studies about how many people don't wash their hands after using the lavatory?

    Double Yuck.

    Ed. @Kamani,
    Imbecility seems to be the majority mental state among humans, and growing by the day, imho.

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    Quote Originally Posted by Angela View Post

    What I'd also really like to know is how the nurse in Dallas contracted Ebola. The CDC says it's very hard to contract it since it's not airborne. (Of course, there's already a documented case where the virus causing a hemorrhagic disease mutated and became airborne. Luckily, it took place in a lab, and was contained.) So, how did a nurse, hopefully in hazmat gear, get it?
    There was a research in 2012 which showed that Ebola virus can be transmited with no bodily fluid contacts from pigs to monkeys. http://healthmap.org/site/diseasedai...irborne-112112
    So though technically ebola is not air-born (virus cannot live in air without liquid substance), but it is likely that the virus can travel by air in short distances on smallest droplets of liquid. At least that would explain how poor nurses in the US and Spain got infected in spite of all the precautions.

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    Quote Originally Posted by Angela View Post
    Seriously, how could the protocol have not included spraying the suits, the boots etc. with bleach before the health care workers removed them?
    Actually I have just seen a piece from CNN news where Dr.Tom Friedman, director of the CDC apparently says, perhaps they should consider spraying virus killing solution on workers as they leave isolation unit! Now if this is reported correctly, it is rather worrying as I would have thought this would already have been one of the steps in the protocol..

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    Quote Originally Posted by Dagne View Post
    There was a research in 2012 which showed that Ebola virus can be transmited with no bodily fluid contacts from pigs to monkeys. http://healthmap.org/site/diseasedai...irborne-112112
    Yes this is the incident I was speaking of....thanks for the link Dagne.

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    Also, when watching Ebola Patient arrival in Germany, I noticed that medical personel were wearing serious respirators, not like the simple disposable ones. Perhaps that is needed after all?

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    1 members found this post helpful.
    This seems to be a very good article about Ebola virus and its spreading
    http://www.cidrap.umn.edu/news-persp...otection-ebola

    "Altogether, these epidemiologic and experimental data offer enough evidence to suggest that Ebola and other filoviruses may be opportunistic with respect to aerosol transmission.28 That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols".

    "Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces.23 Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively.23

    In still air, 3-mcm particles can take up to an hour to settle. With air currents, these and smaller particles can be transported considerable distances before they are deposited on a surface."

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    These last two cases of Ebola contraction by these poor nurses (may they recover) outside of Africa will teach us alot about how easily the virus can be spread. They had normal contact with other people (while they were infected). I believe the people that interacted with them are also quarantined, so we need to see what happens from now on. I think in the case of the Spanish nurse there were around 7 people. Got to wait and see. Travel is going to be a hard one to tackle albeit an important one.

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    The latest regarding the "protocols" at Texas hospital, which Dr. Tom Friedman, says there may have been a breach in, is rebutted by the head of the national nurses union, Roseann DeMoro, who tells reporters, "there were no protocols".

    http://www.bbc.co.uk/news/world-africa-29625481

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    Quote Originally Posted by Dagne View Post
    Also, when watching Ebola Patient arrival in Germany, I noticed that medical personel were wearing serious respirators, not like the simple disposable ones. Perhaps that is needed after all?
    For the medical teams working with Ebola patients, yes such is essential.

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    WASHINGTON— President Barack Obama spoke with world leaders and was briefed by his public health and national security teams Monday on international and domestic efforts to confront the Ebola epidemic.
    U.S. public health officials are “rethinking” the way they address effective Ebola infection control following the first U.S. case of the deadly virus in Texas.
    Speaking with U.N. Secretary-General Ban Ki-moon by phone, Obama agreed on the need for more “robust commitments and rapid delivery of assistance” to West Africa “to stop the epidemic at its source.”
    In a separate conversation with his French counterpart, Francois Hollande, Obama discussed coordinated actions to contain the epidemic, including treatment facilities in West Africa and passenger screening.
    Second US Ebola case
    The president was also briefed on the response to the diagnosis of a second U.S. Ebola case, a nurse, in Dallas, Texas, including the investigation into the apparent breach of infection control protocols.
    Media reports have identified the patient as 26-year-old Nina Pham, who cared for Liberian Thomas Eric Duncan, who died last week at Texas Health Presbyterian Hospital after arriving in the U.S. in September. She is now in isolation and in stable condition.
    Click to enlarge


    At a news conference Monday, the director of the Centers for Disease Control, Tom Frieden, said this case changes some things, but not others.
    "It doesn’t change the fact that we know how Ebola spreads. It doesn’t change the fact that it’s possible to take care of Ebola safely," Frieden said.
    "But, it does change substantially how we approach it. We have to rethink the way we address Ebola infection control because even a single infection is unacceptable," he said.
    Frieden said none of the 48 people who had contact, or may have had contact, with Duncan have developed symptoms.
    He said only one person may have had contact with the nurse, and that person is being monitored.
    The Associated Press reported about 70 staff members at Texas Health Presbyterian Hospital were involved in the care of Duncan, including the nurse. Frieden said they are being interviewed and monitored.
    "If this one individual was infected, and we don’t know how, within the isolation unit, then it is possible that other individuals could have been infected as well. So we consider them to be potentially at risk and we’re doing an in-depth review and investigation," said Frieden.
    Investigation

    The CDC director also said an investigation is underway into how the nurse could have become infected.
    Dr. Tom Frieden, director of the U.S. Centers for Disease and Control, holds a media briefing in Atlanta.


    "We look at what happens when people go into isolation, what happens in isolation and what happens when they come out of isolation. And, we’re particularly concerned about that third process, taking off the isolation personal protective equipment because, if it is contaminated, there is a possibility a worker will contaminate themselves and become infected in that process," Frieden said.
    Frieden said new guidelines have been implemented including new training of health care workers, the type of protective equipment they wear and the use of disinfectants as they leave an isolation unit.
    He added that every U.S. hospital must think about the possibility of Ebola when dealing with any patient with a fever, or other Ebola-like symptoms, who has traveled to Guinea, Liberia or Sierra Leone in the previous three weeks.
    Frieden cautioned more cases of Ebola in the United States are possible, especially among the health care workers who treated Duncan.
    Multiple levels of protection
    Frieden said U.S. health authorities are looking at multiple levels of protection, including the screening of people on departure flights in the three affected West African countries. All are given a questionnaire and have their temperature taken.
    He said nearly 80 were denied travel after displaying fever in the past two months, but none had Ebola.
    Sunday, U.S. authorities began a similar screening of people coming from the three countries at New York’s JFK International Airport. He said 91 people were identified. None had a fever.
    Of those, five were given additional evaluation, but none were determined to have been exposed to Ebola.
    Similar procedures are being put in place Thursday at four other so-called "gateway" airports, including Washington's Dulles, Newark’s Liberty, Chicago’s O’Hare and Atlanta’s Hartsfield-Jackson.

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    Quote Originally Posted by hope View Post
    The latest regarding the "protocols" at Texas hospital, which Dr. Tom Friedman, says there may have been a breach in, is rebutted by the head of the national nurses union, Roseann DeMoro, who tells reporters, "there were no protocols".

    http://www.bbc.co.uk/news/world-africa-29625481

    Panic is certainly not helpful in situations like this, so I absolutely understand why government officials try to be reassuring in these cases.

    However, when the statements are so easily proved to be false, it has the opposite effect, and actually increases the unease, an unease which can indeed turn into panic.

    I've watched the government news conferences quite carefully, and to say I'm unimpressed is a vast understatement.

    We were told that an Ebola outbreak in the U.S. was extremely unlikely.

    When a case was diagnosed (which apparently does not constitute an "outbreak", or so we are now being told) we were told that protocols exist for the safe treatment of Ebola and that American hospitals were prepared.

    Then, a poor young nurse came down with Ebola, and the implication was that she "broke" protocol.

    Yesterday, the CDC director, at the same time that he said all the prior statements were correct, and that everyone should remain calm, was suddenly talking about "mobile" Ebola units being formed, and plans for "re-education" of medical personnel about Ebola protocols, and that they might be looking at further measures.

    Now we have a second infected health care worker in Dallas. (Is it an "outbreak" yet?)

    As you report, the Nurses Union issued a statement that "there are no protocols".
    Maybe the nurses are engaging in a little hyperbole. (They are entitled, as far as I'm concerned; they are always on the front line in these situations, and they are the ones getting sick.) The protocols may exist in the literature; they may exist at the CDC; they may exist, and be in place, and have been repeatedly practiced at the four hospitals in the U.S. which have special Ebola treatment centers.

    The issue is that if those protocols werenot transmitted to the rest of the U.S. hospitals and health care workers, and they were not practiced, then the hospitals and health care workers are indeednot prepared. This is not to mention the fact that everyone who feels ill doesn't go to the Hospital Emergency Room. In fact, you try to avoid it. So, you go to your physician, or to the many clinics that have sprung up as health care has changed. To imply that these facilities are prepared is ridiculous.

    Anecdotally, from family and friends who are doctors, they maintain that they are scrambling to find the latest information about the "protocols" on the internet, and that they are very concerned, because in addition they don't have enough protective gear, theydon't have self contained isolation units that could be dedicated to Ebola patients, and they don't have the means to dispose of all this toxic waste.

    Now, after the diagnosis of this second infected health care worker in Dallas, the head of the hospital there is admitting the obvious, which should have been obvious to anyone with a working brain, that the hospital was indeed not prepared.

    http://www.bbc.com/news/world-africa-29625481

    Medical staff "may have done some things differently with the benefit of what we know today," he said, adding, "no one wants to get this right more than our hospital."


    "If we knew then what we know now about this hospital's ability to safely care for these patients, then we would have transferred him to Emory or Nebraska," the official told CNN senior medical correspondent Elizabeth Cohen.

    Oh, and under the rule that when dealing with bureaucrats and government officials, any government officials, from any country, that you shouldn't listen to what they say, but watch what they do, almost immediately after the CDC director left the podium after issuing all his reassuring platitudes, it was announced that plans are being drawn up to build an "Ebola hospital" in each state.

    I want to be clear that I'm not indicting the hospital or the medical personnel. I have absolutely no doubt that they did the very best they could under the circumstances. Their lives were and are on the line. It's absurd to think that they wouldn't have done everything in their power, according to the training they had received, to get it right.

    The point is that if you don't want to sow panic, you have to be honest about the situation. The main concern should not be covering your *** to avoid responsibility.

    I also, to give the CDC and its director some slack, have absolutely no idea why they are the only ones on the hot seat about this. They aren't in charge of the U.S. health system. The U.S. does have a Health and Human Services Department. Within that agency there is a unit dedicated to responses to major public health threats. Is the person in charge of that unit hiding under a desk or in a closet somewhere?

    The CDC is a small agency. If the situation should become more serious, more resources would have to be mustered, which would be beyond its mandate and capabilities. I sincerely hope Health and Human Services and even Homeland Security are exercising an abundance of caution and preparing for any and all contingencies. ( Oh, and I should think it would be obvious that you don't plan for the best case scenario, you plan for the worst case scenario.)I am starting to have my doubts, however. Sometimes, lately, it feels like being in a rudderless ship.

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    All good points, Angela, but I'm concerned about the statements made by the director of the CDC suggesting that medical staff treating Ebola patients were able to leave the treatment area without passing through a decontamination chamber. If that's correct, I imagine that city is now a vector for Ebola, and it really is time to panic.

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    Quote Originally Posted by Aberdeen View Post
    All good points, Angela, but I'm concerned about the statements made by the director of the CDC suggesting that medical staff treating Ebola patients were able to leave the treatment area without passing through a decontamination chamber. If that's correct, I imagine that city is now a vector for Ebola, and it really is time to panic.
    It's even worse than that. I'm just watching Sanjay Gupta on CNN. The second nurse to have come down with Ebola took a plane from Dallas to Cleveland (and back?) the day before she was diagnosed with Ebola and put in isolation. According to Dr. Gupta plane travel by someone who has been in contact with a known Ebola patient is against the protocols. (Here we go again.) Whether she knew of the protocol against travel or not, she did it, and I don't know of any law that could have prevented her.

    It only remains to be said that she was running a temp when she traveled. Granted, she only had a 99.5 fever and you get put in isolation with a 100.4 fever, but since the Index patient who died was only running a 100.3 fever, I am not consoled.

    Ed. I think we have to keep in mind that so far in the U.S. the only people to have come down with it are nurses who had to deal with a patient who was vomiting and evacuating. That wouldn't apply to this travel situation.

    However, everybody better start bringing their "A" game.

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    supposedly the virus does not survive well in cold temperatures, hence these outbreaks originate mostly from equatorial Africa. So Canada has the better location this time...

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    Quote Originally Posted by kamani View Post
    supposedly the virus does not survive well in cold temperatures, hence these outbreaks originate mostly from equatorial Africa. So Canada has the better location this time...
    Considering that the rate with which Ebola is spreading in Africa continues to increase, I'm sure it will still be around to invade Canada next year, during the heat of summer. But right now I suggest that we all pray to the weather gods that it stays fairly cool this fall.

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    There is problem when it comes to things like ebola or similar.

    Pharmaceutical companies interested in business and they don't want invest in R&D where they don't see profit.

    Capitalism has its imperfections and can never remove them.

    Therefore it is needed responsible government.

    Only government can funded projects which are not profitable but necessary for society, key of success for fight against ebola and similar is government with funds for science, research, development, prevention and curing, of course pharmaceutical companies are necessary as many another including stakeholders, but the role of government is essential.

  25. #25
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    All the EMT (Emergency Medical Personnel) people in my area had to undergo mandatory training this weekend to learn how to put on and take off protective gear for situations where they might have to stabilize and transport Ebola patients to the hospital. That included volunteer EMT as well. Some of them are freaking out a bit. I hope they don't get too many hysterical people who just have a stomach flu.

    Welcome to the new normal.

    Ed. Oh, I'm really proud of how DiBlasio, Cuomo and Christie, (the Mayor of New York City, the Governor of New York State, and the Governor of New Jersey) in the absence of any national guidance took the situation firmly in hand and not only got this doctor moved and treated without flubs of the Texas variety, but also imposed a 21 day isolation period on any one coming from West Africa who has been working with or in contact with Ebola patients.

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