Ebola outbreak in US...unneccssary scare?

[CharonY]

If you are in constant contact with a patient that is oozing virus your chances are much higher to get infected than by passing someone. That is not how infectivity is determined. Typically health personnel require protection to avoid infection, and for unknown reasons it failed in one controlled case. Currently, the outbreak is on a far more limited scale than the 2009 swine flu pandemic, for example. Does it have to watched? Obviously. Containment is the major factor here (and in contrast to flu it is more manageable), though the lack of infrastructure in several West African countries make it that much harder.

It is strange that some people living in mortal fear of ebola do not vaccinate against flu, despite the obvious difference in risk of contracting it. But that is obviously down to the difference between media fueled perceived and actual risk.

 

It would start to become worrisome if people outside of known areas start showing up with infections. But there are no indications of that happening yet.

 

I would like to emphasize that the persons at the highest risk are actually health workers (and also scientist working with live viruses). Just a momentarily slip can put you at risk. That happened e.g. to a Spanish nursing assistant when she touched her unprotected face with a glove (that is why I shout at my students if they do so) and there are also cases where researchers contracted HIV by handling needles incorrectly. It does take some courage in handling patients that are actively emitting the virus and it can be exhausting, which again increases the risk of momentarily lapses. On top of it, sometimes the training in these protective protocols are insufficient or the users simply do not have sufficient experience since it is only required on a rare basis. But again, this provides no evidence on how contagious a disease is per se.

 

Additionally it should be noted that during the various outbreaks household members often did not get infected, unless they were involved in taking care of the patient. Even nurses that treated patients before they were put into isolation generally did not contract ebola, probably just by means of protective gloves. Obviously, that is insufficient protection, but highlights that it is one the less contagious diseases. The risk increases during the later stages of the diseases (at which point they would not be moving around much) or when handling the bodies.

 

Refs:

Francesconi et al. 2003 Emerg Infect Dis

Dowell et al. Infect Dis. (1999) 179 (Supplement 1): S87-S91.

Edited October 15, 2014 by CharonY

[Endy0816]

It makes more sense when you realize that the temperature checks are pretty much worthless as far as a counter-measure to Ebola (since an infected person is far more likely to be presymptomatic when leaving a plane than they are to be running a fever) and that it is most likely just an attempt to calm people's fears.

 

This is my take on the situation as well.

 

It is also possible for males(sperm) to remain infectious for ~7 weeks even after they have beaten it. Best bet is combat via common sense methods to reduce transmission. It will burn itself out if given time to do so.

Edited October 15, 2014 by Endy0816

[CharonY]

I found one thing worrisome, though. It appears that the Dallas hospital is ill-equipped to handle ebola patients. If what the infected nurse says is true they had no established protocol, had no proper protective gear for several days, left the patient in the ER for hours before moving to isolation. If ebola was one of the highly contagious diseases the amount of contact would probably have yielded dozens of more infections during the two visits of the ebola patient.

 

Moreover, their total training in handling was an optional seminar and the nurses caring for the patient also had regular shifts handling other patients. The last two things are really sloppy, to put it mildly. And now it has been announced that another nurse in the same hospital is infected. I really wonder why the patient was not moved into specialized care. Or used dedicated personnel for that (well, the latter was probably a financial decision).

 

In Germany ebola patients are flown in and treated in facilities where people actually know how to handle it (though a few years back someone pricked herself with an infected needle but was treated successfully). Just recently three people have been treated recently in Germany of which one recovered and one died. One could argue that they were flown in specifically and were already at the right facility and the US is so much larger etc. But it is still weird to see the difference in responses.

Edited October 15, 2014 by CharonY

[Dekan]

Is it really weird? Obviously we all know (secretly) why Ebola gets treated more effectively in Germany, than in Texas

 

But we can't say so. That would be extremely "politically incorrect". It could lead to banning from the forum. Or even arrest by the police.

 

So, don't we all pretend to be dumb, and carefully skirt around the truth?

[CharonY]

I smell paranoia mixed with fragrant ignorance.

 

But to me, it appears that the US response tends to mired in "cover your arse" responses. This is of course only anecdotal and may be totally wrong. However, in the US I found that in many policies and guidelines are more often used because just following procedure never got anyone fired. This is coupled with a somewhat anti-authoritarian streak which basically says that if you follow protocol and visited the seminar, you can call yourself an expert.

 

In Germany there is (or was at least) a more authoritarian culture in which people knew their place and consult actual experts before committing to action. For example, in case of a reported Ebola case there is a minimum procedure to follow and the next step is to coordinate everything with so-called competence centrers. These are actually medical specialists who are allowed to make judgement calls to a certain degree. This approach also has its problems, obviously and they have screwed up a E. coli outbreak a few years back rather royally (and I still assume the fatalities will be higher than those expected by ebola in the US). In addition, training in Germany used to be more rigorous and specialized.

 

A problem is that there are no correct responses, each carries certain trade-offs. But purely protocol-driven responses have the problem of being inflexible. One complaint of the infected nurse was that policies kept changing. This makes it clear that the people involved (including staff) did not have the ability to make judgement calls.

 

I am not sure if that is politically incorrect, but then that term has become synonymous with "why are people criticizing my fact-free opinions"?

Edited October 16, 2014 by CharonY

[Willie71]

I found one thing worrisome, though. It appears that the Dallas hospital is ill-equipped to handle ebola patients. If what the infected nurse says is true they had no established protocol, had no proper protective gear for several days, left the patient in the ER for hours before moving to isolation. If ebola was one of the highly contagious diseases the amount of contact would probably have yielded dozens of more infections during the two visits of the ebola patient.

 

Moreover, their total training in handling was an optional seminar and the nurses caring for the patient also had regular shifts handling other patients. The last two things are really sloppy, to put it mildly. And now it has been announced that another nurse in the same hospital is infected. I really wonder why the patient was not moved into specialized care. Or used dedicated personnel for that (well, the latter was probably a financial decision).

 

In Germany ebola patients are flown in and treated in facilities where people actually know how to handle it (though a few years back someone pricked herself with an infected needle but was treated successfully). Just recently three people have been treated recently in Germany of which one recovered and one died. One could argue that they were flown in specifically and were already at the right facility and the US is so much larger etc. But it is still weird to see the difference in responses.

I'm late to the discussion, but it seems that the issue was that the hospital did not want to pay extra for the proper handling of the infected waste and linens. They ended up piled in the adjacent rooms to the patient and were stacked to the ceiling.

 

Both infected nurses have survived and are now Ebola free. I found this forum after wasting my breath (fingertips) on another forum where the hysteria is bought into, and quarantines are recommended. Trying to post information sourced from medical journals resulted in threats of banning me for not respecting the other members opinions. I figured its time to move on if the mods are so polarized against evidence. I like what I see so far.

[MigL]

Instead of always blaming Americans for their attitudes and responses to world events, why don't we put the blame where it actually belongs.

 

As CaptainPanic previously stated we have UN institutions full of people who are supposed to co-ordinate the efforts to control/minimize the spread of these types of infections.

Instead the WHO is conferencing around the globe attempting to stop smoking in Russia, controlling obesity and diet related disease in North America ( diabetis, etc. ), and other forms of social engineering, since these are all diseases 'of choice'.

Maybe they should stick to their mandate. They should have had systems in place for such epidemics since the first outbreak in the late 80s ( I think ), as there is no vaccine for it yet. An emergency response plan, if you will.

 

We are a global community. An infectious outbreak has to be controlled at the source, and the WHO should be the ones calling for a quarantine of the affected areas. Not British Airways and not some hospital in Texas.

 

Should this belong in the political, or some other, forum, please feel free to move my post and any/all responses to it.

Edited November 1, 2014 by MigL

[CharonY]

The problem is that the UN and by extension the WHO is not funded to actually do something. Their main purpose is to track global information, develop strategies and make recommendations. The various nations are very careful in limiting the actually influence the UN actually has. No one wants the UN or WHO to be able to actually enforce quarantines or taking any sorts of action that may interfere with sovereignty .

They do actually provide guidelines and emergency response strategies for emergency procedures but they are unable to just swoop in and to things. They further track the spread of ebola and AFAIK have the most up-to-date info on the events and they coordinate between local authorities and provide technical advice and supplies.

And again, most health professionals do not see that quarantines outside of the affected regions are necessary or helpful. So why should they call for it?

 

Edit: and I think it has been established that OP's blame on the US is misplaced.

Edited November 1, 2014 by CharonY

[Bill Angel]

 

Ebola can be transmitted in sneezes and coughs

By MYFOX NEW YORK STAFF

NEW YORK (MYFOXNY) - The Centers for Disease Control and Prevention released a new flyer clarifying the conditions that could lead someone to contracting Ebola.

According to the CDC, Ebola can be spread in droplets from sneezes and coughs.

"This isn't necessarily new information; it's a clarification,” said Dr. Roshini Raj, a gastro-enterologist at NYU Langone Medical Center.

"The confusion is that they've always said it does not spread through the air. But the truth is, when we talk about airborne diseases we mean without droplets. If germs are circulating through the air, can you get it? No, you can't get it. But if droplets with Ebola get into your eyes, nose or mouth, you can get the virus," said Dr. Raj.

The virus can also live on hard surfaces for up to three hours.

It's important to remember that a sneeze or cough from someone who does not have symptoms of Ebola is not going to transmit the virus.

The question being raised now becomes what is considered 'sick' and 'contagious.'

"Sluggish is a symptom, so is fever," said Dr. Raj. "It's important to monitor very closely for all symptoms. It's one piece of evidence we need to be very careful with.

See http://www.myfoxny.com/story/27154414/ebola-can-be-transmitted-in-sneezes-and-coughs

[John Cuthber]

Ebola can be transmitted in sneezes and coughs

By MYFOX NEW YORK STAFF

NEW YORK (MYFOXNY) - The Centers for Disease Control and Prevention released a new flyer clarifying the conditions that could lead someone to contracting Ebola.

According to the CDC, Ebola can be spread in droplets from sneezes and coughs.

"This isn't necessarily new information; it's a clarification,” said Dr. Roshini Raj, a gastro-enterologist at NYU Langone Medical Center.

"The confusion is that they've always said it does not spread through the air. But the truth is, when we talk about airborne diseases we mean without droplets. If germs are circulating through the air, can you get it? No, you can't get it. But if droplets with Ebola get into your eyes, nose or mouth, you can get the virus," said Dr. Raj.

The virus can also live on hard surfaces for up to three hours.

It's important to remember that a sneeze or cough from someone who does not have symptoms of Ebola is not going to transmit the virus.

The question being raised now becomes what is considered 'sick' and 'contagious.'

"Sluggish is a symptom, so is fever," said Dr. Raj. "It's important to monitor very closely for all symptoms. It's one piece of evidence we need to be very careful with.

See http://www.myfoxny.com/story/27154414/ebola-can-be-transmitted-in-sneezes-and-coughs

You seem to be citing the Fox network.

Are you aware of this issue?

http://www.forbes.com/sites/kenrapoza/2011/11/21/fox-news-viewers-uninformed-npr-listeners-not-poll-suggests/

Not to mention the disparity between the headline

"Ebola can be transmitted in sneezes and coughs"

and the expert opinion

"It's important to remember that a sneeze or cough from someone who does not have symptoms of Ebola is not going to transmit the virus."

Edited November 2, 2014 by John Cuthber

[Strange]

Me being ignorant in the subject, I wonder if the infected body fluids from ebola patients anywhere including US hospitals that get into the sewage can survive there, taking in account the great difficulty to kill the ebola virus.

Patients have to defecate and urinate too. Does it end in public sewer ?

 

You are far more likely to catch something else from those sources - which could also be very unpleasant and possibly fatal.

[John Cuthber]

 

5. Is it safe for Ebola patients to use the bathroom?

Yes. Sanitary sewers may be used for the safe disposal of patient waste.8 Additionally, sewage handling processes in the United States are designed to inactivate infectious agents.

From

http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html

[Willie71]

 

You seem to be citing the Fox network.

Are you aware of this issue?

http://www.forbes.com/sites/kenrapoza/2011/11/21/fox-news-viewers-uninformed-npr-listeners-not-poll-suggests/

Not to mention the disparity between the headline

"Ebola can be transmitted in sneezes and coughs"

and the expert opinion

"It's important to remember that a sneeze or cough from someone who does not have symptoms of Ebola is not going to transmit the virus."

 

 

 

To ad to your post, I went to some medical journals a few weeks back to clarify some of these issues, and antibodies are detected in saliva, AFTER major symptoms appear, but only one of multiple samples had the actual live virus present. These were copywrite protected journals, so I can't copy and paste prom them. What is the process for this type of info? reference it? paste the abstract? The digestive fluids in saliva are suspected kill the virus. Since the patient becomes increasingly more infectious towards death (in the wild, the virus is transmitted often via carrion) at the end stages of life, I would take precautions with saliva, but if someone is still well enough to be in public, a cough or sneeze is incredibly unlikely to transmit the virus, although theoretically "possible". The same was found with HIV years ago.

[John Cuthber]

Posting an abstract will almost always count as "fair use"
http://en.wikipedia.org/wiki/Fair_use

be sure to include a reference so that any of us who wish to can follow it up- by buying access in necessary.

[Willie71]

Posting an abstract will almost always count as "fair use"

http://en.wikipedia.org/wiki/Fair_use

be sure to include a reference so that any of us who wish to can follow it up- by buying access in necessary.

I'm in the middle of an ethics paper right now, but will likely have more time at the end of the week. I'll post some information on this topic then (specific body fluids and antigen/virus detction.) I'm visiting/posting as a break from my course during the day.

[CharonY]

Hmm are you referring to Rowe et al (1999) J Infect Dis, which focused on convalescent patients (but there are likely more that I do not know/remember, so a reference would be very welcome)? But in either case that is actually quite relevant. The majority of rapid virus detection are based on Ebola RNA detection (using RT-PCR). Further analysis are often based on antigens, which yields a bit more information (as at least parts of virus particles have also to be present)

However, the presence of RNA or even some antigens does not necessarily also mean the presence of infectious viruses (though it is often associated).

I presume it is this confusion that leads many people to believe that it is easy to catch Ebola.

Edited November 3, 2014 by CharonY

[Willie71]

Hmm are you referring to Rowe et al (1999) J Infect Dis, which focused on convalescent patients (but there are likely more that I do not know/remember, so a reference would be very welcome)? But in either case that is actually quite relevant. The majority of rapid virus detection are based on Ebola RNA detection (using RT-PCR). Further analysis are often based on antigens, which yields a bit more information (as at least parts of virus particles have also to be present)

However, the presence of RNA or even some antigens does not necessarily also mean the presence of infectious viruses (though it is often associated).

I presume it is this confusion that leads many people to believe that it is easy to catch Ebola.

 

That sounds right, possibly. It compared acute and convalescent patients in an African hospital, and the samples were tested for the antigen and the virus, and how long the virus was detected in the samples after collection. I thought it was the early 2000's, but I went through about 10 articles that week informing myself for the debate. I access the University library online, and its REALLY buggy, often taking 30+ minutes just to log in. When I am less irritated with the computer, I will clarify my source, and post the reference/abstract here.

 

I think this discrepancy is part of the confusion, but I think the biggest confusion comes from the media, who emphasize the 1/1,000,000,000 chance that something could happen theoretically- ie. infection via contaminated saliva, but the conditions that would result in that specific set of circumstances would be such a perfect storm its unlikely to ever happen.

 

I am no expert, but as a nurse, I try to keep informed of infection, types of tyransmission, and risk. I really enjoyed microbiology when I took it years ago. I remember the hype regarding HIV and the fear it would go airborn, the worlds population would be wiped out etc. I remember looking at the science and thinking: "yeah, but.....?????" People love a scandal, don't they.

Edited November 3, 2014 by Willie71

[Adriana Reis]

just media scare

want to worry about a disease? worry bout HIV, TB, cancer, Influenza, malaria, and so many others that kill more than the ones Ebola outbreaks together have

[Willie71]

OK, I was in the library today for my paper, and I looked up the article I was referring to.

 

Bausch, D. G., Towner, J. S., Dowell, S. F., Kaducu, F., Lukwiya, M., Sanchez, A., & ... Rollin, P. E. (2007). Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. Journal Of Infectious Diseases, 196(2), S142-S147. doi:10.1086/520545

[Kelnad]

The CDC states last week that Aids is similar to Ebola. The European spread of plagues didn't just nearly wipe them out, it nearly wiped out the natives of Mexico, a unknown mutation. Immigration should be considered a high risk because of a lack of immunization and the spread of known viruses, and restriction done for hot areas imp. Like for example there is lack of media on China's STARS outbreaks, the government lies and the media is fearful of other outbreaks being covered up because of the panic and tourism. There is evidence some claim of Ebola going air born, but not enough evidence for me. Aid's is the opposite of Ebola really its an attack on the immune system, where as the Ebola causes the immune system to attack its host. Why they bother treating it like the common cold is a wonder even why they treat the common cold as something you should build up your immune system to fight, when most viruses are over come by incorporating the virus in the system without letting the immune system kill the host, immunization is such a procedure right, little amounts of the virus?

[Endy0816]

Your immune system needs a sample to know what to go after. It is kind of like the viral definitions list your antivirus program uses.

 

Often a virus is rendered inactive(killed) before being used in a vaccine. Other times weakened or milder relatives of the virus are used instead.

 

Many of these places actually have decent vaccination rates. Should also note that we see about 95 times as many tourists. You figure with how Ebola can hide out for an additional month or so, the only realistic solution is to monitor and isolate.

[CharonY]

 

Like for example there is lack of media on China's STARS outbreaks, the government lies and the media is fearful of other outbreaks being covered up because of the panic and tourism.

 

Considering how media dealt with ebola the opposite seems to be the case (also it is SARS and AFAIK after the outbreak no further ones have been detected).

 

 

There is evidence some claim of Ebola going air born,

No evidence whatsover. I read somewhere that some TV people speculated that it might, which again supports that the media likes to overplay these scenarios.

 

 

Aid's is the opposite of Ebola really its an attack on the immune system, where as the Ebola causes the immune system to attack its host.

 

I am not sure what the relevance of the comparison of HIV (AIDS is the syndrome) and the ebola virus. But that is also not how ebola acts. There is a similarity between these viruses as both destroy macrophages. Ebola is much more aggressive and infects other cell lines quite efficiently.

 

 

Why they bother treating it like the common cold is a wonder even why they treat the common cold as something you should build up your immune system to fight, when most viruses are over come by incorporating the virus in the system without letting the immune system kill the host, immunization is such a procedure right, little amounts of the virus?

 

I do not understand the sentence, but if your question is why they do not provide vaccination, the answer is that those are still under (rushed) development. The main target being the infected areas (Sierra Leone, Guinea and Liberia).

[CharonY]

Hopefully final follow-up:

For a week no new cases of Ebola have been reported in the three affected countries.

 

BBC

[Strange]

A Scottish nurse who contracted Ebola in Sierra Leone has been readmitted to an isolation unit in London following an "unusual late complication".

 

http://www.bbc.co.uk/news/uk-scotland-34483584

[sunshaker]

Hopefully final follow-up:

For a week no new cases of Ebola have been reported in the three affected countries.

 

BBC

 

 

http://www.bbc.co.uk/news/uk-scotland-34483584

 

So a british nurse who treated ebola in sierra leone is once again in a critical condition, who has been allowed to mix all this time with the general population.

 

So we are to believe out of the 10's of thousands african's who "recovered", none are showing signs of illness but a british nurse is?

 

 

 

It also said several "high-risk" people linked to recent patients in Guinea and Sierra Leone had been lost track of.

we can guess where these are(in Europe)

 

 

Previous outbreaks have shown the virus can survive in semen and it was found in the eye of a US doctor two months after recovering.

This can pose health problems for the patient, but is there a risk of spreading the virus?

Men are advised to use condoms indefinitely until more is known

not being funny but condoms and Africans rarely mix.

 

Borders are down in Europe, many thousands of Africans that may still have this virus hiding within them have already spread across Europe, When the next outbreak occurs and it will, it will spread through europe/world like wild fire, billions are going to die. there will be no way to quarantine everyone, government services will break down, it is not if this will happen it is just a case of when it will happen.

 

It only took one African girl in a remote village to course the last outbreak, we now have thousands of potential carriers working their way across Europe/world.

Edited October 9, 2015 by sunshaker