First, Greg's statements are pretty much spot-on. Don't get caught up in media hype; spend some time reading about this, and learning.
I
always do and it's amazing how often and by how much information from
reputable sources can differ from the "party line." But you need to dig, often into technical subjects, to find that even many of the so-called experts speak with more certainty than is justified. You need to find true experts
in the fields directly related to the expertise required to find truly authoritative statements.
First of all, this is nothing to panic about
in the US (Africa is another story) as portrayed in some sensationalist media garbage, but on the other hand it is being taken more lightly than it should be in too many reports. For instance, the
cancer clinic MD guest interviewed about Ebola last night on "The Colbert Report" who basically gave a "don't worry, be happy, you nearly need to drink their blood to catch it" message
didn't know what the hell he was talking about!
These
disease transmission experts do. Emphasis mine:
COMMENTARY: Health workers need optimal respiratory protection for Ebola
Lisa M Brosseau, ScD, and Rachael Jones, PhD
Sep 17, 2014
https://www.cidrap.umn.edu/news-per...ers-need-optimal-respiratory-protection-ebola
Editor's Note: Today's commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago.
Excerpt:
The precautionary principle - that any action designed to reduce risk should not await scientific certainty - compels the use of respiratory protection for a pathogen like Ebola virus that has:
1. No proven pre- or post-exposure treatment modalities
2. A high case-fatality rate
3.
Unclear modes of transmission
We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.
The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.
We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa and beyond.
There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids2,3 and that the only modes of transmission we should be concerned with are those termed "droplet" and "contact."
These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) "direct" contact with the body fluids of an infected person.
This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.
[Followed by much technical justification for their position]
--------------
This uncertainty exists because there was "no money in it" for big pharma to study Ebola (they have SAID as much) because Ebola
used to be such a rare disease and the danger and, therefore, the expense of privately researching Ebola resulted in a dearth of studies about it and its modes of transmission. Thus, most transmission info is
anecdotal.
And, as usual, one doesn't get much confidence about "our government agencies 'at work'" on the Texas case from these facts:
1. The hospital sent him home even though he said where he'd come from
2. The hospital took him out of the regular ER and isolated him only after a "close associate" who doesn't want to be identified called the CDC
3. They didn't quarantine the ambulance used to take him to the hospital but instead continued to use it for another 48hrs
4. They didn't quarantine the family immediately
5. They didn't clean up the vomit outside the apartment building for how long?
Delay in Dallas Ebola Cleanup as Workers Balk at Task
By KEVIN SACK and MANNY FERNANDEZOCT. 2, 2014
https://www.nytimes.com/2014/10/03/us/dal....
"In the latest indication, state and local authorities confirmed Thursday that a week after a Liberian man fell ill with Ebola in Dallas, and four days after he was placed in isolation at a hospital here, the apartment where he was staying with four other people had not been sanitized and the sheets and dirty towels he used while sick remained in the home. County officials visited the apartment without protection Wednesday night.
The officials said it had been difficult to find a contractor willing to enter the apartment to clean it and remove bedding and clothes, which they said had been bagged in plastic. They said they now had hired a firm that would do the work soon. The Texas health commissioner, Dr. David Lakey, told reporters during an afternoon news conference that officials had encountered a little bit of hesitancy in seeking a firm to clean the apartment."
--------------
And here's what should be considered in the Liberian man's case. A Liberian man with a US Visa finds out he was heavily exposed to Ebola when he carried to a clinic in Liberia a pregnant woman who shorty thereafter died from it. His choices are: lie on some exit paperwork in Liberia about not being in contact with Ebola while there, hop on a flight to the US and get top health care including the best doctors, nurses and treatment
OR stay in Liberia and die like a dog in a crowded makeshift clinic with inadequate everything.
How many more times do you think this might happen in an epidemic that is still growing? How many times might this have already happened, but not been caught (yet)?
--------------
More from my Ebola investigatory file, all you need to know.
The latest CDC model projections are that, worst case, as many as
1.4 million will be infected in Africa by Jan 2015. Since experience with this epidemic in Africa has shown that the vast majority of cases go unreported, suddenly appearing and swamping treatment facilities immediately after they are built, most of those 1.4 million cases will be unreported and, thus, the infected individuals will
not be quarantined:
The CDC Was Wrong About How to Stop Ebola
News that a man has been diagnosed with the virus in Dallas days after arriving from Liberia is alarmingand to prevent more U.S. cases, certain rules must never be broken.
by Dr. Kent Sepkowitz s an infectious-disease specialist in New York City
1 Oct 2014
https://www.thedailybeast.com/artic...ebola-from-spreading-to-other-u-s-cities.html
"
Although we lack carefully performed studies, Kent Brantly, the physician who developed the disease and was airlifted to Atlanta, seemed to have no gross exposure to the disease, though he worked on an Ebola ward. Ditto for Nancy Writebol the other American flown back in that dramatic first wave. According to reports, they were mighty careful at every step, but just not careful enough."
--------------
Make haste on experimental Ebola treatments, urges World Health Organization group
By Jon Cohen 5 September 2014
Science Magazine
https://news.sciencemag.org/africa/2014/09/make-haste-experimental-ebola-treatments-urges-who-group
Excerpt:
Researchers and health professionals should fast-track extraordinary efforts to give people unproven treatments and vaccines in locales hard hit by Ebola, more than 200 experts attending a World Health Organization (WHO) forum recommended today.
We have to change the sense that there is no hope in this situation to a realistic hope, said WHO Assistant Director-General Marie-Paule Kieny, who spoke at a press conference with two other attendees of the consultation. More people have become sick and died from Ebola in the last few months than in the 4 decades since the virus was discovered, she noted.
--------------
Ebola Is Rapidly Mutating As It Spreads Across West Africa
by MICHAELEEN DOUCLEFF
August 28, 2014
NPR.org
https://www.npr.org/blogs/goatsands...dly-mutating-as-it-spreads-across-west-africa
Excerpt:
For starters, the data show that the virus is rapidly accumulating new mutations as it spreads through people. Weve found over 250 mutations that are changing in real time as were watching, Sabeti says. While moving through the human population in West Africa, she says, the virus has been collecting mutations about twice as quickly as it did while circulating among animals in the past decade or so.
The more time you give a virus to mutate and the more human-to-human transmission you see, she says, the more opportunities you give it to fall upon some [mutation] that could make it more easily transmissible or more pathogenic.
Comment - OR it could mutate into a LESS transmissible and/or LESS deadly form which is to be sincerely hoped for
since it looks like the only way this epidemic will be stopped is for it to burn itself out.
--------------
Disease modelers project a rapidly rising toll from Ebola
By Kai Kupferschmidt 31 August 2014
Science Magazine
https://news.sciencemag.org/health/2014/08/disease-modelers-project-rapidly-rising-toll-ebola
Excerpts:
Extrapolating existing trends, the number of the sick and dying mounts rapidly from the current tollmore than 3000 cases and 1500 deathsto about 10,000 cases by 24 September, and hundreds of thousands in the months after that.
If the disease keeps spreading as it has, most of the modelers Science talked to say WHOs estimate will turn out to be conservative. If the epidemic in Liberia were to continue in this way until the 1st of December, the cumulative number of cases would exceed 100,000, Althaus predicts.
Such long-term forecasts are error-prone, he acknowledges. But other modelers arent much more encouraging. Caitlin Rivers of the Virginia Polytechnic Institute and State University in Blacksburg expects roughly 1000 new cases in Liberia in the next 2 weeks and a similar number in Sierra Leone.
The models are only as good as the data fed to them;
up to three-quarters of Ebola cases may go unreported. The modelers are also assuming that key parameters, such as the viruss incubation time, are the same as in earlier outbreaks.
--------------
Liberia's Ebola problem far worse than imagined, says WHO
Science News Staff 8 September 2014
https://news.sciencemag.org/africa/2014/09/liberias-ebola-problem-far-worse-imagined-says-who
Excerpts:
All agreed that the demands of the Ebola outbreak have completely outstripped the governments and partners capacity to respond. Fourteen of Liberias 15 counties have now reported confirmed cases. Some 152 health care workers have been infected and 79 have died. When the outbreak began, Liberia had only one doctor to treat nearly 100,000 people in a total population of 4.4 million people. Every infection or death of a doctor or nurse depletes response capacity significantly.
Liberia, together with the other hard-hit countries, namely Guinea and Sierra Leone, is experiencing a phenomenon never before seen in any previous Ebola outbreak. As soon as a new Ebola treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload.
--------------
Can Ebola Go Airborne?
Forbes, 9/03/2014
Dr. Scoot Gottlieb
https://www.forbes.com/sites/scottgottlieb/2014/09/03/can-ebola-go-airborne/
Excerpt:
But our relative comfort in the U.S. is based on our belief that our public health tools could easily contain a virus spread only through direct contact. That would change radically if Ebola were to alter its mode of spread. We know the virus is mutating. Could it adapt in a way that makes it airborne?
Its highly unlikely. It would be improbable for a virus to transform in a way that changes its mode of infection. Of the 23 known viruses that cause serious disease in man, none are known to have mutated in ways that changed how they infect humans. Of course, we only know about a small portion of the existing viruses.
Its already possible that Ebola can spread, in rare cases
(comment - "rare" only because they haven't been heavily documented in the scientific literature, that being due to the rare attention paid to the formerly "rare" virus in the medical science community because of the danger in studying it coupled with its rarity causing a "no money in it" attitude from big pharma), through direct contact with respiratory secretions. This might occur, for example, when an infected person coughs or sneezes directly on another, uninfected individual.
The Centers for Disease Control specifically recommends droplet protection be taken in the hospital setting when healthcare workers are treating patients infected with Ebola. This kind of direct spread is sometimes referred to as droplet contact, but its distinct from airborne spread.
Comment - it's called "droplet transmission." Here's a bit on that from Wikipedia:
Viral droplet nuclei transmission
Droplet nuclei are an important mode of transmission among many infectious viruses such as Influenza A. When viruses are shed by an infected person through coughing or sneezing into the air, the mucus coating on the virus starts to evaporate. Once this mucus shell evaporates the remaining viron is called a droplet nucleus or quanta. The mucus evaporation rate is determined by the temperature and humidity inside the room. The lower the humidity, the quicker the mucus shell evaporates thus allowing the droplet nuclei to stay airborne and not drop to the ground. The low indoor humidity levels in wintertime buildings ensure that higher levels of droplet nuclei will survive: droplet nuclei are so microscopic that they are able to stay airborne indefinitely on the air currents present within indoor spaces. The Wells-Riley equation predicts the infection rates of persons who shed quanta within a building and is used to calculate indoor infection outbreaks within buildings.
An infected person can release viruses by talking, sneezing, coughing and breathing, though less are released by just breathing. Some of viruses will become droplet nuclei. If these droplet nuclei are breathed into nose or mouth of an uninfected person (known as a susceptible) then the droplet nuclei may penetrate into the deep recesses of their lungs. Viral diseases that are commonly spread by coughing or sneezing droplet nuclei include (at least):
Common cold
Influenza A & B
Mumps
Measles
Rubella
SARS
--------------
An early warning of a pending epidemic? ZEBOV is the same strain now infecting humans in the current epidemic.
Science 8 December 2006:
Vol. 314 no. 5805 p. 1564
DOI: 10.1126/science.1133105
Ebola Outbreak Killed 5000 Gorillas
https://www.sciencemag.org/content/314/5805/1564
Over the past decade, the Zaire strain of Ebola virus (ZEBOV) (poster comment - this is the same strain causing the human epidemic right now) has repeatedly emerged in Gabon and Congo. Each human outbreak has been accompanied by reports of gorilla and chimpanzee carcasses in neighboring forests, but both the extent of ape mortality and the causal role of ZEBOV have been hotly debated. Here, we present data suggesting that in 2002 and 2003 ZEBOV killed about 5000 gorillas in our study area. The lag between neighboring gorilla groups in mortality onset was close to the ZEBOV disease cycle length, evidence that group-to-group transmission has amplified gorilla die-offs.