Is Ebola's Exponential Spread Uncontainable?

[Astronuc]

Europe is expecting more cases
http://news.yahoo.com/spains-ebola-case-wont-last-europe-152409340.html and - Ebola patient's death renews questions about care
http://news.yahoo.com/1st-ebola-patient-diagnosed-us-dead-152433429.html

Early diagnosis and treatment is critical to survival of those is and to prevent further spread of the disease.

 

[Astronuc]

Spain blames Ebola infection on human error as nurse worsens
http://news.yahoo.com/spanish-nurse-worsens-madrid-blames-infection-human-error-131914936.html

A British man showing symptoms of the Ebola virus died on Thursday in Macedonia, where authorities sealed off his hotel, keeping another Briton and hotel staff inside.

Showing symptoms, but apparently not confirmed.Update: Dead Briton in Macedonia did not have Ebola: official
http://news.yahoo.com/dead-briton-macedonia-did-not-ebola-official-173056206.html

 

[russ_watters]

Spain blames Ebola infection on human error as nurse worsens
http://news.yahoo.com/spanish-nurse-worsens-madrid-blames-infection-human-error-131914936.html

And "a stunning series of lapses" in protocol when diagnosing and treating her: http://www.cnn.com/video/data/2.0/video/world/2014/10/09/pkg-soares-spain-ebola-mistakes.cnn.html

And it was exactly the same story for our Ebola patient in Texas. This worries me. A person dying of Ebola at home in a remote villiage in Africa comes into contact with a limited number of people: he/she isn't taken to a large facility packed with new potential victims to infect. Western medical care is supposed to be able to handle Ebola, but we're failing miserably in our firsts tests. What if our better medical care is just better enough to be dangerous? I guess we'll find out in a few weeks.

Obama says Ebola is a national security issue. I have seen no evidence that those words mean anything. The CDC should be putting-out training materials and protocols and all hospitals should be training their staff on the proper protocols. And if the CDC doesn't have the manpower or fudning, it should be given to them. The military should be enlisted if needed -- it has the ability to mobilize quickly and many groups have specialized biohazard (bio warfare) training.

 

[Astronuc]

And it was exactly the same story for our Ebola patient in Texas. This worries me. A person dying of Ebola at home in a remote villiage in Africa comes into contact with a limited number of people: he/she isn't taken to a large facility packed with new potential victims to infect. Western medical care is supposed to be able to handle Ebola, but we're failing miserably in our firsts tests. What if our better medical care is just better enough to be dangerous? I guess we'll find out in a few weeks.

Obama says Ebola is a national security issue. I have seen no evidence that those words mean anything. The CDC should be putting-out training materials and protocols and all hospitals should be training their staff on the proper protocols. And if the CDC doesn't have the manpower or funding, it should be given to them. The military should be enlisted if needed -- it has the ability to mobilize quickly and many groups have specialized biohazard (bio warfare) training.

Indeed, it is worrisome that we're finding the 'system' unprepared.

Apparently, we're waiting for the appointment or approval of a new Surgeon General.

I'm not sure what power the CDC has with respect to ensuring the nation is prepared for such a disease.

Nevertheless, here is the CDC page - http://www.cdc.gov/vhf/ebola/

Supposedly, the US is prepared -
http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html
http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html

I guess medical staff now have to ask any patient with fever, nausea, vomiting, diarrhea, if they have been to west Africa, or had contact with someone from west Africa, or particularly the various nations involved: Liberia, Sierra Leone, Guinea, and possibly now Côte d'Ivoire.

 

[nsaspook]

http://www.washingtonpost.com/natio...ad9e76-4fb2-11e4-8c24-487e92bc997b_story.html

“The speed at which things are moving on the ground, it’s hard for people to get their minds around. People don’t understand the concept of exponential growth,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. “Exponential growth in the context of three weeks means: ‘If I know that X needs to be done, and I work my butt off and get it done in three weeks, it’s now half as good as it needs to be.’ ”
...
As the number of infections increases, so does the possibility that a person with Ebola will carry it to another country. This is known as an export.

“So we had two exports in the first 2,000 patients,” Frieden said in a recent interview. “Now we’re going to have 20,000 cases, how many exports are we going to have?”

The numbers are terrifying.

 

[Astronuc]

There may be an export in Brazil. A man from Guinea traveled to Brazil and is now in isolation.

Meanwhile - "Thomas Eric Duncan's temperature spiked to 103 degrees during the hours of his initial visit to an emergency room — a fever that was flagged with an exclamation point in the hospital's record-keeping system, his medical records show." And he was sent home?!

http://news.yahoo.com/ebola-patient-arrived-er-103-degree-fever-160922028.html

Along the lines of Russ's comment - Ebola crisis reveals massive disparities in U.S. hospital preparedness
http://news.yahoo.com/ebola-outbrea...-in-u-s--hospital-preparedness-214729813.htmlAnd - don't joke about Ebola at an airport or on a plane -
https://gma.yahoo.com/looks-ebola-scare-plane-004600681--abc-news-topstories.html

 

[Astronuc]

Nations step up measures to stem worsening Ebola outbreak
http://news.yahoo.com/spanish-ebola-nurse-better-state-talking-111534883.html

Spanish Ebola victim conscious and sitting unaided
http://news.yahoo.com/ebola-monitoring-rises-spain-tries-contain-health-crisis-113329659.html
Apparently the nurse is holding on.Congressmen went to Liberia a month before the first Ebola death in West Africa
http://news.yahoo.com/two-congressm...rst-ebola-death-in-west-africa-202855268.html
An example of the bipartisanship we need.But - Ebola toll passes 4,000 as fears grow worldwide
http://news.yahoo.com/ebola-death-toll-hits-4-033-172745850.html

 

[edward]

WOW
Duncan complained of abdominal pain.

Doctors gave him CT scans to rule out appendicitis, stroke and numerous other serious ailments.

http://www.cbsnews.com/news/ebola-outbreak-victim-thomas-eric-duncan-had-high-fever-in-er-visit/

Duncan also had a strong West African accent and had no social security card.

http://www.breitbart.com/Big-Journalism/2014/10/07/cnn-uggests-racism-behind-death-of-ebola-patient

 

[Astronuc]

Health worker 2nd in US to test positive for Ebola
http://news.yahoo.com/state-health-officials-2nd-ebola-case-texas-102955708.html

DALLAS (AP) — A Texas health care worker who was in full protective gear while providing hospital care for an Ebola patient who later died has tested positive for the virus and is in stable condition, health officials said Sunday. If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S.

CDC: Protocol breach in treating Ebola patient
http://news.yahoo.com/cdc-protocol-breach-treating-ebola-patient-133253723--politics.html

So hospitals and the US healthcare system aren't necessarily prepared for an infectious disease like Ebola.

 

[zoki85]

Health worker 2nd in US to test positive for Ebola
http://news.yahoo.com/state-health-officials-2nd-ebola-case-texas-102955708.html

"A Texas health care worker who was in full protective gear while providing hospital care for an Ebola patient who later died has tested positive for the virus and is in stable condition, health officials said Sunday."

??

 

[russ_watters]

"A Texas health care worker who was in full protective gear while providing hospital care for an Ebola patient who later died has tested positive for the virus and is in stable condition, health officials said Sunday."

??

The hospital lied.

 

[edward]

Their full protective gear is a joke. Full protective gear allows for complete decontamination of the gear before removing the gear.

http://www.channelnewsasia.com/news/world/texas-health-worker-with/1411424.html

It looks like an apron over a scrub suit. The military has a lot of surplus CBR suits.

This is full protection gear a person can take a shower in a concentrated chlorine solution or any decontamination fluid in one of these suits.

https://www.flickr.com/photos/kjtiii_cos/2507091873/in/set-72157605150146296

Modern biosafety level 4 suits. Click on biosafety level 4 on left.

http://www.wolfhazmat.de/indexus.htm

 

[dimensionless]

I'm uncomfortable with the amount of confidence that the CDC and TV ebola experts have on the world's ability to contain this. My guess, is that this is a new strain and its characteristics are poorly understood. Also, the virus has been spreading among people for 11 months now, so it has had some time to evolve within human populations.

We don't know how efficiently it spreads, and we don't know how many carriers out there are asymptomatic. I have read that asymptomatic ebola hosts don't spread the disease. However, I suspect this was characteristic of previous ebola outbreaks and it has not yet been observed with this strain. Hopefully other countries will be able to repeat Nigeria's successful containment. SARS was airborne, and the world was able to contain it. On the other hand, ebola's incubation period is twice that of SARS, and the comparison is not entirely a valid one.

 

[russ_watters]

Nigeria succeeded in containing it, so it can be done. Their response was pretty aggressive though.

http://www.usatoday.com/story/news/world/2014/10/08/ebola-nigeria-lagos-africa/16865421/

 

[edward]

Here is an interesting read. This doctor has 30 years of experience as an infectious disease specialist. Her blog is in The Scientific American and she makes some really good points.

http://blogs.scientificamerican.com...-the-u-s-politics-and-public-health-dont-mix/

 

[mheslep]

My guess, is that this is a new strain

New strain? On what basis?

 

[Astronuc]

Here is an interesting read. This doctor has 30 years of experience as an infectious disease specialist. Her blog is in The Scientific American and she makes some really good points.

http://blogs.scientificamerican.com...-the-u-s-politics-and-public-health-dont-mix/

That blog cites another blog - http://daviddobbs.net/smoothpebbles/our-ebola-response-shows-our-true-colors-aint-pretty/

Mostly a catalog of failures in the system, which had been proclaimed as prepared.

 

[edward]

That blog cites another blog - http://daviddobbs.net/smoothpebbles/our-ebola-response-shows-our-true-colors-aint-pretty/

Mostly a catalog of failures in the system, which had been proclaimed as prepared.

The first blog also states;

Some of us suspect the Dallas patient was not admitted in part because he was uninsured. He was inexplicably and irrationally sent home with antibiotics for a presumed viral infection, even though he should have been considered an obvious risk.

 

[Evo]

I'm uncomfortable with the amount of confidence that the CDC and TV ebola experts have on the world's ability to contain this. My guess, is that this is a new strain and its characteristics are poorly understood. Also, the virus has been spreading among people for 11 months now, so it has had some time to evolve within human populations.

We don't know how efficiently it spreads, and we don't know how many carriers out there are asymptomatic. I have read that asymptomatic ebola hosts don't spread the disease. However, I suspect this was characteristic of previous ebola outbreaks and it has not yet been observed with this strain. Hopefully other countries will be able to repeat Nigeria's successful containment. SARS was airborne, and the world was able to contain it. On the other hand, ebola's incubation period is twice that of SARS, and the comparison is not entirely a valid one.

It has been proven that ebola is not an airborn virus. They are still trying to determine contagion, especially in light of the Dallas nurse's diagnosis. There is no need to speculate about a new strain, they are still figuring out the current and only one.

 

[Astronuc]

About 70 hospital staffers cared for Ebola patient
http://news.yahoo.com/70-hospital-staffers-cared-ebola-patient-224521642.html

U.S. needs to rethink Ebola infection controls, says CDC chief
http://news.yahoo.com/u-needs-rethink-ebola-infection-controls-says-cdc-005533255.htmlThe fact that Duncan was sent home with a 103 F fever is mind boggling. He was given antibiotics for an apparent viral infection, for which antibiotics would be ineffective. If the fever was related to a bacterial infection, then he should have been hospitalized on the spot.

 

[Evo]

Well, if it was viral, no antibiotics should have been prescribed. If it was bacterial, then tests should have been performed, but he had no insurance and a temp of 103F is not that uncommon or life threatening that would require them to treat him in an ER. A normal doctor's office or accute care clinic would have been correct. That it turned out to be ebola is what makes it newsworthy. The only time I was admitted to a hospital *with a temperature* was 105F and I became unconscious for 3 days, and I had insurance.

In this case, the screw up was his "history", that should have raised an immediate red flag.

 

[zoki85]

Do animals get sick from ebola? How does first patient get infected?

 

[Astronuc]

Do animals get sick from ebola? How does first patient get infected?

The virus apparently resides in some animals (e.g., bats, . . . . ?) in the African wild. People capture those animals for food. People who eat contaminated 'bush meat' will contract the virus, and they can spread it to others.

The number of deaths due to Ebola now stands at 4447
http://news.yahoo.com/10-000-ebola-cases-per-week-could-seen-124410379.html

In Berlin, a U.N. medical worker infected with Ebola in Liberia died despite "intensive medical procedures." The St. Georg hospital in Leipzig said Tuesday that the 56-year-old man, whose name has not been released, died overnight of the infection.

The man tested positive for Ebola on Oct. 6, prompting Liberia's U.N. peacekeeping mission to place 41 other staff members under "close medical observation."

He arrived in Leipzig for treatment on Oct. 9. The hospital's chief executive, Dr. Iris Minde, said at the time there was no risk of infection for other people, since he was kept in a secure isolation ward specially equipped with negative pressure rooms that are hermetically sealed.

He was the third Ebola patient to be flown to Germany for treatment. The first man recovered and returned home to Senegal. A Uganda aid worker is still being treated in Frankfurt.

 

[OmCheeto]

... There is no need to speculate about a new strain, they are still figuring out the current and only one.

There are 5 species though:

Ebola virus disease (WHO)
Fact sheet N°103
Updated September 2014
The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa. The virus causing the 2014 west African outbreak belongs to the Zaire species. ​

I just tallied up the mortality rate for 4 of the 5 species since the 1978 thru 2012. The Reston species is not listed.

Species ___ Mortality rate _ Total Cases
Bundibugyo _ 32.0% __________ 206
Sudan ______ 53.8% __________ 792
Taï Forest _100.0% ____________ 1
Zaire ______ 79.1% _________ 1388​

Unfortunately, this is the Zaire species we are dealing with now.

 

[OmCheeto]

And, we have apparently gone from under-precaution, to over-precaution:

Ebola fears: La. waste facility won't take Dallas man's incinerated belongings
October 13, 2014
NEW ORLEANS - A Louisiana waste disposal facility said Monday it would not accept the ash from the incineration of a Texas Ebola victim's belongings, at least not until state officials agree that doing so would pose no threat to the public.
...
Veolia officials did not return calls for comment Monday. CWM said it was informed by Veolia that the materials had been decontaminated before Veolia accepted them and burned them at 2,100 degrees Fahrenheit.
​

2,100°F is the melting point of Iron. (ref)
That would make it quite the hyperthermophile, if it could withstand that temperature.

Current record: 251°F for for Methanopyrus kandleri.

 

[edward]

So how many time have we head "breach of protocol?" What is the CDC protocol and why hasn't anyone demonstrated it.?

If it is like this video it is pathetic.

http://khon2.com/2014/10/13/what-doctors-wear-to-treat-ebola-patients/

 

[Astronuc]

Feds could have done more in Dallas Ebola case, CDC director says
http://news.yahoo.com/feds-should-h...-ebola-case--cdc-director-says-214128692.html

From now on, Frieden said, the CDC will rush a team of infectious disease specialists to assist U.S. hospitals that confirm having a case of the deadly Ebola virus.

“We will put a team on the ground within hours with some of the world's leading experts in how to take care of and protect health care workers from Ebola infection,” Frieden said. “I wish we had put a team like this on the ground the day the first patient was diagnosed.”

Nurse with Ebola, in Dallas, doing well.
http://news.yahoo.com/texas-nurse-contracted-ebola-understood-risks-153314500.html

German hospital: UN worker dies of Ebola
http://news.yahoo.com/german-hospital-un-worker-dies-ebola-082155030.html Obama And CDC Sued Over Ebola Epidemic
http://news.yahoo.com/obama-cdc-sued-over-ebola-epidemic-120000465.html

 

[Astronuc]

Second Dallas health care worker infected with deadly Ebola virus
More than 70 hospital staffers are being monitored for symptoms
http://news.yahoo.com/ebola-diagnosed-in-second-dallas-nurse-105542930.html

 

[Doug Huffman]

In re Protocol. Radiation workers are regularly retrained and re-qualified on removal of Anti-C PPE. A violation of those protocols after working in highly contaminated areas is quite apparent on exit surveys or internal monitoring. A dress-out for a highly contaminated wet work area easily takes an hour (Anti-C's, double liquid impervious, air-fed/respirator) and a proper undress takes as long, longer with the surveys.

I have read medical attendants' ("nurses") comments complaining of the fifteen minutes for dress-out.

I did close-out inspection and certification of radioactive liquid holding tanks three times in my career. I also dried reactor vessel shield water (saturated K2CrO4) tanks for my experience in wet work.

This late: http://www.breitbart.com/Breitbart-...e-Told-to-Call-Authorities-for-Ebola-Protocol

 

[gravenewworld]

Have people never played quarantine before? It's absolutely ridiculous staff that were working on Duncan were allowed to travel without a short period of quarantine in their own home. It's a matter of national security, now the CDC is looking for over 100+ more people who make have had contact with the 2nd nurse now infected with Ebola. One person can easily lie, get into this country, and spread Ebola. How many other people are we letting in every single day from Ebola hotspots? We also sent hundreds of troops to those areas that will be coming home soon, how many of them will return infected?

Apparently Ebola isn't as easily contained as we all thought it would be, even though we 'are a 1st world country with a reliable health care system'. Do we really need to unnecessarily push our entire health care system to a breaking point just to test it out?

 

[edward]

Have people never played quarantine before? It's absolutely ridiculous staff that were working on Duncan were allowed to travel without a short period of quarantine in their own home. It's a matter of national security, now the CDC is looking for over 100+ more people who make have had contact with the 2nd nurse now infected with Ebola. One person can easily lie, get into this country, and spread Ebola. How many other people are we letting in every single day from Ebola hotspots? We also sent hundreds of troops to those areas that will be coming home soon, how many of them will return infected?

Apparently Ebola isn't as easily contained as we all thought it would be, even though we 'are a 1st world country with a reliable health care system'. Do we really need to unnecessarily push our entire health care system to a breaking point just to test it out?

To expand on your post.

The CDC said the nurse flew on Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth on Oct. 13. She first reported to the hospital with a low-grade fever on the morning of Oct. 14 and was immediately placed into an isolation unit.

Public Health workers will begin interviewing the 132 passengers on Flight 1143 immediately.

http://www.usatoday.com/story/news/...ealth-care-worker-ebola-second-case/17290575/

 

[SixNein]

Have people never played quarantine before? It's absolutely ridiculous staff that were working on Duncan were allowed to travel without a short period of quarantine in their own home. It's a matter of national security, now the CDC is looking for over 100+ more people who make have had contact with the 2nd nurse now infected with Ebola. One person can easily lie, get into this country, and spread Ebola. How many other people are we letting in every single day from Ebola hotspots? We also sent hundreds of troops to those areas that will be coming home soon, how many of them will return infected?

Apparently Ebola isn't as easily contained as we all thought it would be, even though we 'are a 1st world country with a reliable health care system'. Do we really need to unnecessarily push our entire health care system to a breaking point just to test it out?

I think you might want to step back and take a deep breath. We should be more afraid of the common flu than Ebola. In addition, anytime we send our troops to foreign places, we have a risk of importing disease from the region. Finally, ebola is more of a risk to health care workers than airplane passengers. They have to deal directly in bodily fluids, and they must be rigorous about decontamination afterwards. These nurses need to work in pairs, and they need to follow checklists a lot. Some of these mistakes has been caused by the lack of checklists. For example, asking someone if they have traveled recently to Africa should probably be on the checklist.

Personally, I'm more afraid of the fear of Ebola than I am Ebola itself.

 

[mheslep]

Flight 1143 was obviously a *return* flight for the nurse. What about the *outbound* flight to Cleveland? I assume CDC assumes no symptoms were apparent at that point, so Ebola was not contagious at that point?

 

[edward]

They experts keep saying that Ebola is hard to catch but I have heard no expert even mentioned the following two things.

The virus can survive several hours in a dried state on doorknobs or countertops.

If the fluid remains wet and at room temperature it can survive for days outside the body.

http://kfor.com/2014/10/15/video-the-messy-truth-about-getting-ebola/

We seem to have a very erratic learning curve with this disease.

 

[SixNein]

They experts keep saying that Ebola is hard to catch but I have heard no expert even mentioned the following two things.

http://kfor.com/2014/10/15/video-the-messy-truth-about-getting-ebola/

We seem to have a very erratic learning curve with this disease.

Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C)http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php#footnote52 http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php#footnote61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php#footnote61. In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20 and 250C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php#footnote53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php#footnote61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting.

A study on transmission of ebolavirus from fomites in an isolation ward concludes that the risk of transmission is low when recommended infection control guidelines for viral hemorrhagic fevers are followed http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php#footnote64. Infection control protocols included decontamination of floors with 0.5% bleach daily and decontamination of visibly contaminated surfaces with 0.05% bleach as necessary.

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php