Ebola virus

[fakingpatience]

I wasn't able to see if it was a nurse who cared for the patient the first time (when they didn't suspect Ebola) or the second, when they did.

 

I would also be curious to know how the ems crew who transported him the second time is doing; I know they're quarantined, and having been in a small ambulance without good ventilation or extensive PPE it seems they would be at high risk if it is transmitted easier than believed

[Whitcc1]

Wow! Very unfortunate! I just was reading up on the Vaccine! Looks like they had positive results in the live testing they did with primates.

 

Apparently they have already injected it into people now with the hopes it will help protect first responders!

 

 

 

 

Sent from my iPhone using Tapatalk

[True Anomaly]

Dammit, we were almost out from the 3-week window here....

 

I'd be curious to see what kind of treatment the nurse gets

[Acebecker]

This being the only real case since Duncan was diagnosed is interesting.  There has been a question in my mind about the contagiousness period - does it really only begin once the patient has symptoms?  No other virus I can think of behaves that way (notably, I am not a virologist - just a little peon working on the front lines of health care).  But given that we have not had any scares in other parts of Texas or in other parts of the country from the travelers who were on the plane with him, I think I may actually believe the CDC on this one.  I'm really hoping my suspicion is completely unfounded. 

[EMEDPA]

info from ID weekly on experiences with Eboia pts in the US:

 

Clinical Care
Ebola patients in Africa have only limited clinical evaluations and essentially no laboratory testing due to the lack of any infrastructure to support this. The Emory team was able to make careful clinical evaluations over time in their 2 patients and Dr. Ribner summarized the main points as follows:

1. Despite weight gains of 15-20 kg, the patients were profoundly hypovolemic due to their low serum albumin and vascular leak with third spacing. Fluid losses in their patients were 5-10 L/day.
2. Electrolyte losses were significant and included profound hyponatremia, hypokalemia and hypocalcemia. At initial assessment at Emory the patients were one week into illness yet these were their first laboratory determinations. Arrhythmias were noted, and both intravenous and oral electrolyte repletion was necessary.
3. Nutritional depletion was evident as well.
4. Ebola virus RNA was detected in blood, urine, vomitus, stool, endotracheal suctioning and semen and on skin. It was not detected in dialysate. Environmental testing in the patient rooms had no detection of viral RNA and included many high touch surfaces such as bed rails and surfaces in the bathroom.
5. Intensive 1:1 nursing care was necessary around the clock. Patients were monitored continuously and this level of nursing care allowed for rapid response to clinical changes. Nursing and other team members provided emotional support, and as the patients improved, help with self-care and physical therapy.

[ToppDog]

The sole purpose of any government is to protect its borders & its citizens from threats, period.  Everything else is gravy.

 

Yesterday, I almost posted about the "imperialist and elitist" comment, but I knew you both would sort it out just fine, & you did.  But, it still bugs me in a way that I feel needs discussed.  The one thing that jumped out at me was that the first criticism of Torshi's comments was that it wasn't very PC.  Trying to maintain political correctness in these types of situations is very dangerous, & may very well end up in many people dying unnecessarily.

 

The problem with our government, which it has always suffered from, is that it is reactionary, instead of preparing for the potential.  And, as a result, any government response is typically too little, too late.  For example, if our government had done what Torshi spoke of, we would not be reading today of how a nurse at the hospital in Dallas now has Ebola.  And, they're not talking about it, but it's also highly likely that some or all of those children in quarantine are already dead.  Again, too little, too late.

 

While I agree that simply halting travel between here & the effected countries in Africa would not solve the problem, using that as an excuse to do nothing is not a move in the right direction.  Again, it's too little too late, but the proper thing to do would have been to halt ALL unnecessary travel to the USA & to protect ALL our borders.

 

Think of it on a smaller scale.  If your job was to provide security for a ward in a hospital that housed immunosuppressed patients, & popping up within the community was a new variation of a very contagious disease that did not seem to be following all the conventional methods of transmission for that disease, do you think it would be better to restrict access to the ward to necessary personnel only, or do you continue to keep all the entrances unlocked & unguarded, & simply wave people in that wanted to wander in?  The latter is exactly what our government has been doing for a long time now, & continues to do in the face of a situation so obvious that the average six year old could figure out what to do.

 

Yes, we should be doing everything we can to help these people wherever they are, but that should not mean that we should ignore standard containment protocols out of political correctness, or worse yet, corporate monetary concerns.  And, doing everything we can should also include questioning a government response that is woefully inadequate & puts everyone at greater risk.  We currently have stricter regulations & enforcement of said regulations for moving our pets to Hawaii than we do for handling the largest Ebola outbreak on record, & this is completely unacceptable.

[rpackelly]

It's interesting, the nurse's aide in Spain cared for an Ebola patient that died, so did the nurse in Texas. The Liberian patient in Texas also helped a patient who, shortly thereafter, died.   HCWs in the US and Spain that cared for patients not near death have not developed disease.    I have not heard of any non-African MSF HCWs getting the disease.  I did read that at one of their units, they had abandoned the practice of IV starts because of the contagion risk.   

 

The virus is said to be most contagious when the patient is near death or dead, I imagine that hundreds of thousands or more viral particles are then present in all fluids.  Apparently early on in illness this is not the case, many fewer viral particles.  The initial case in West Africa started when a traditional healer died and was prepared for burial, that exposure lead to twelve or more cases in the initial ring of contagion.   Perhaps infection control procedures should be ramped up with very sick patients and patients after death  (I don't know how you could be more protected, but the Texas patient was intubated and put on dialysis, both very invasive and messy procedures usually).    It's interesting that EMEDPA read that the virus was not detected in dialysate, which means that at least one of the Emory patients was on dialysis, something that has not been discussed in the press.  

 

This will be a most valuable epidemiological teaching case in several years, although at a very high cost.  

 

EMEDPA, will you be taking Winter semester off if you go?

[EMEDPA]

EMEDPA, will you be taking Winter semester off if you go?

Yes, I was going to contact you and Dr O'Hara when plans are finalized. I am almost done with the program at this point. I only need the Practicum, Global Health Issues, and the D.A. after I finish Professional Ethics this term.

[EMEDPA]

The CDC is now saying there was a "lapse in containment protocol" which resulted in the nurse becoming exposed. I wonder if she did not remove her PPE appropriately with a second assistant looking for fluids on the outfit beforehand or something similar. the CDC has developed a course :

http://www.cdc.gov/vhf/ebola/hcp/safety-training-course/index.html?s_cid=cs_1344

which all providers traveling to W. Africa to assist with the crisis will be taking. it is 3 days in length and goes over the disease, PPE use, and has clinical scenarios with standardized "patients" to mimic conditions expected there. Looks like a great course. I have already spoken with the NYC medics folks and they will be sending all their volunteers through this course and an additional on-site course in Africa.

[Acebecker]

Interesting that it was on the skin of the patients but not live on the high touch surfaces.

[rpackelly]

After doing a bit more reading this afternoon, I discovered that last week a Norwegian MSF volunteer was also diagnosed and sent back to Europe for treatment.  But except for that, their record is especially clean in terms of exposures.  More training must be the key.  

[dmdpac]

Interesting that it was on the skin of the patients but not live on the high touch surfaces.

 

Some of my reading has touched on this.  While it's true that in the lab the virus can live on surfaces for days real life survival outside the host is a few hours at most.  It does not seem to be very hardy outside of the body and is pretty susceptible to UV, oxygen, heat et cetera.  The quickest link to address this that I found was a link followed through something EMEDPA posted. 

 

I thought this was interesting, too.  Seems that once you get it there is some, at least short term, immunity to the disease.

[primadonna22274]

E...sounds like you've got your Global Health practicum ???? God bless you.

[EMEDPA]

E...sounds like you've got your Global Health practicum God bless you.

Thanks- My practicum proposal is actually almost already done on another topic. The proposal for the project is already 18 pages long and will probably be 25 by the time it is accepted.

[True Anomaly]

Based on the protocol for "donning and doffing" PPE in the form of a video that we were sent last week, it seems rather easy to inadvertently breach containment protocol while removing the PPE since it all has to be done in a particular order with multiple hand cleanings during the process....particularly if you've had a long shift. Not making excuses...just saying it's possible

[UpRegulated]

Gotta stop the flights. Not enough political guts to do it, though. Political correctness at its finest.

 

CDC says it would impede the effort to contain. Nonsense. Fly aid workers in on military planes and bring them back on the same with a 21 day isolation. That's the only way to contain.

[EMEDPA]

interesting research: melatonin as an adjunct to treatment:

http://www.ncbi.nlm.nih.gov/pubmed/25262626

[Boatswain2PA]

Gotta stop the flights. Not enough political guts to do it, though. Political correctness at its finest.

 

CDC says it would impede the effort to contain. Nonsense. Fly aid workers in on military planes and bring them back on the same with a 21 day isolation. That's the only way to contain.

 

But that would be a movement toward actually securing our borders....we can't let THAT happen!

[rpackelly]

From the NYT 10/14 about viral load, stage of disease and contagion:

 

 

A concern for health workers is that as patients grow sicker, the levels of virus in their blood rise and they become more and more contagious. The researchers at Emory tested patients and found high levels of the virus in their body fluids and even on their skin.

At the peak of illness, an Ebola patient can have 10 billion viral particles in one-fifth of a teaspoon of blood. That compares with 50,000 to 100,000 particles in an untreated H.I.V. patient, and five million to 20 million in someone with untreated hepatitis C.

 

 

 

“That helped us to understand why, if this is only spread by body fluids, why it is more contagious than hepatitis A, B and C, and H.I.V.,” Dr. Ribner said. “It’s just that there’s so much more virus in the fluids they put out.”

[EMEDPA]

10,000 new cases/week by December possible:

http://news.yahoo.com/10-000-ebola-cases-per-week-could-seen-124410379.html

[rev ronin]

If you've followed my comments here, I don't think you'll find I'm much of an advocate for political correctness.  When I say "culturally imperialist", it's not because that's my default critique of anything at all, but because... well, I thought it fit.

 

But what I'm really not an advocate for is treating some life as more valuable than other life.  Whatever the underlying issue, I am not a fan of writing anyone off--whether because they have darker skin, more corrupt governments, or just live in the tropics where  things like Ebola originate.  That's my fundamental ethical problem with trying to dig a moat around the problem and let a few million people bleed out their pores until dead.

[ToppDog]

I agree, which is why I was hesitant to post initially.  I've always enjoyed your posts & your point of view.  I also agree that everyone should be treated fairly regardless of where they are from, & that we should be trying to help as much as possible.

 

I guess the point I really want to make is that I do not see restricting travel as equating to ignoring what is happening "over there".  To me they are two completely different issues that can both be addressed appropriately.  As the old first responder saying goes, don't make a bad situation worse.  Again, to compare it to something similar on a smaller scale, we are currently placing people with the potential of developing the disease due to their exposure risks in voluntary or mandatory quarantine in order to protect the rest of the population.  I think everyone would agree that these actions are prudent.  Restricting travel is just a larger example of the same concept.

 

Yes, we need to be sending all available resources & personnel to attack this problem head on & help the people of Africa, but if we don't also try to protect the people right here at home we may soon find ourselves so overwhelmed that we won't be able to send anyone over there even if we wanted to.  Regardless of what the CDC is saying in their press conferences, the hospitals around this country will only be able to handle these patients in relatively small numbers.  Once the tipping point has been surpassed, the system will break down & things are going to get very bad, very fast.  Any steps we can take to minimize this risk at home while still helping those overseas who are in desparate need of our help should be considered.

 

There is no reason why we can't be setting up hospitals around the world specifically for this purpose away from major population centers, & flying anyone who needs assistance to the nearest one for treatment.  This would also make it easier to facilitate the production of antiserums to the various strains & mass produce it for future patients.  Restricting travel would not hinder such efforts, & would in fact make it easier to accomplish.

[jtmathew]

@jtmathew Majority of African nations currently are led by corrupt officials, have poor infrastructure, and are extremely undemocratic even after years of help leading towards that direction. It's akin to the type of leadership in the Middle East, the only exception is they're not abundant in resources. It hasn't been until recently, such as Nigeria, (the fastest growing country in Africa), that we've been seeing development in that part of the world. Slowly, but surely, if accepted, Western and Eastern nations are moving their businesses down there. Many telecom and Indian migrants are moving there currently. It's becoming a hub. But, again, their corrupt leadership, who've stolen and funneled countless billions of dollars is the problem, their own leaders ruining their own people.

 

 @nandosport

I'm aware of history, I don't like the fact one is trying to belittle me simply because of disagreement. As for the past. That's the past. We're not going to move forward if we keep blaming Westerners as perpetrators of abuse of things that are happening over there today, it makes absolutely no sense, and all it does is push guilt amongst Westerners when in fact, so much more was involved. As for many nations in the past, it was pretty much a clash between new emerging societies, a developing one and primitive (non-advancing one), a prime example is the advancement of American settlers in the U.S versus  Native Americans. History for any nation is never perfect, and until we stop focusing on the negatives and pointing fingers, we should acknowledge and praise the advancements, despite history, and continue trying to help current nations that still haven't caught up yet in the 21st century. Life isn't a perfect Utopia and destruction is ever-lasting. Sorry to burst any ones bubble. It's like blaming what's happening in the Middle East, the rise of fundamentalism as a result of past-American imperialism and pressure, when in fact, it's an ideology bent on going after any nation regardless because one does not abide to their interpreted scripture.

 

I caution you to be careful in absolving Western governments from blame. As citizens of this planet it is our duty to recognize the past and learn from it. I dont perpetuate casting blame where it isnt due but, all too often, those that ignore history are bound to repeat it. You are naive to suggest that corruption is self imposed. The majority of corrupt leaders have extensive international economic connections and are sponsored to power by the global leadership community. It is also naive to suggest that these countries are resource poor. A little research would reveal the contrary. The skeletons of colonialism persist in these countries and understanding the history therein will only help the global community to prevent history from repeating itself.  

[db_pavnp]

I simply believe in a self-interested foreign policy.

 

I don't think you need to worry about the US departing from a self-interested foreign policy.  If they were actually afraid of ebola and felt that self-interest was at risk, the borders would have been closed a long time ago.  They aren't.  Because it's not that scary and the costs associated with it are unimaginably insignificant compared to the alternatives.

[Torshi]

My main point to one poster in general was to stop perpetrating white guilt, colonialism/imperialism and the like, things that happened in the past, not connected to any average person today, that was all.. Moreover, the majority of Africa has been a big welfare state experiment, based on per capita in relation to welfare aid, and the result is massive corruption that is absolutely staggering. This insane white guilt over historical treatment of Africa has created a cesspool of disease ridden countries. The less-developed countries in the last several years have received roughly $4.6 trillion in direct aid, this does not account for indirect aid and subsidies. Over the last 60 years, a trillion dollars has been sent to Africa alone. The per capita in Africa is lower than it was in the 1970's. More than 50% of people live off $1 a day in that region after trillions have been transferred. After all this, their countries are poorer, disease is higher, corruption is higher. The world's developing countries, every year lose about $1 trillion alone to corruption, Sub-Saharan Africa is losing most of their GDP due to corruption in the entire world. Simply because there is so much money from other governments and many are fighting for this pot of gold called foreign aid.
"I caution you to be careful in absolving Western governments from blame." - They are in part to blame, in my view, in providing so much for so less in return. It's a sacrifice, meaning one does not gain or if one does, but of lesser value.
Moreover, bad ideas and irrationalities are incredibly destructive to human life. Africa is a hot bed for crazy ideas in general as a whole, I'M NOT STATING ALL THINK THIS WAY. For example, there are beliefs if you have sex with a virgin it can cure aids. There is no better idea to spread such a disease. That is some bad mojo, bad thinking. There are practices in West Africa, if a relative dies, you wash their body, throw yourself on the body, hug it, and kiss the disease-ridden corpse. Some believe Ebola is the result of some sorcerer, so they go see some witch doctor.

 

 

Relevant off-topic:

The Bulgarians and Greeks have been controlled by the Ottomans for 400-500 years and are the Turks wrapped with guilt or does the international community pressure the Turks to send massive amounts of aid to them to seek reparations? I absolutely deny some form of compensatory payment that should be made to the descendants of those involved in horrible crimes of the past.

 

Moreover:

"The skeletons of colonialism persist in these countries" ----> Haiti, obviously far from Africa, gained its independence from their "colonial masters," not too long after the U.S. How is Haiti doing today with no white, colonial overlords to screw them up? Many countries have gained independence and see how well they are doing due to their own idea of freedom and corrupt governing.

Majority of these countries are in control of their own fate - perfect example would be Vietnam - rather than embracing collectivism, the mixture of capitalism has led them to become one of the biggest electronic and textile hubs for export business. Each nation can control their fate if they choose the right ideas, we can't keep looking at the West.

 

 

I caution you to be careful in absolving Western governments from blame. As citizens of this planet it is our duty to recognize the past and learn from it. I dont perpetuate casting blame where it isnt due but, all too often, those that ignore history are bound to repeat it. You are naive to suggest that corruption is self imposed. The majority of corrupt leaders have extensive international economic connections and are sponsored to power by the global leadership community. It is also naive to suggest that these countries are resource poor. A little research would reveal the contrary. The skeletons of colonialism persist in these countries and understanding the history therein will only help the global community to prevent history from repeating itself.