Posts Tagged ‘Airborne’

This is none other than Maestro doing a follow up on the Ebola epidemic which has found it’s way into boarders of the United States. Here are some MYTHS ABOUT EBOLA YOU SHOULD KNOW ABOUT. Allow me to invade your space for a few moments to help you better understand what this Ebola Virus is all about.  I feel compelled to weigh in on this discussion to add a bit of color to help combat the whitewash. First of all, I want to be measured in this conversation. I am not an expert on infectious disease and know even less about the protocol to contain such a formidable virus. I recommend that if you feel any symptoms related to the outbreak, go to your nearest emergency room.

RECENT DEVELOPMENTS

Africa appears to be losing the fight against the Ebola Virus

Africa appears to be losing the fight against the Ebola Virus

Fears that a widespread outbreak of Ebola in the United States were heightened today as health officials revealed that a second Dallas nurse infected with Ebola flew on an airplane just a day before being placed in isolation. And as troubling as this second case may be, especially in terms of possible lapses in protocol, it also could serve as a much-needed wake-up call to public health officials nationwide about how vigilant they must be, experts said.

“The issue is with the healthcare workers at hospital in Dallas who were exposed while caring for a sick individual. The average person does not have to be concerned,” said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

The Ebola outbreak in West Africa has reportedly claimed more than 4,000 lives, and World Health Organization officials believe the true death toll could be far higher. An international response — including U.S. Military personal, as well as assistance from several other countries and nongovernmental organizations — has begun, yet global concern about the virus is spreading. So with all of the confusion and media spin with the latest development how worried should we be? I mean, what are the risks involved? Let’s separate fact from fiction in this crisis and get a better idea what we are facing. I don’t know about you, but I ascribe to the idiom, “Believe nothing of what you hear and only half of what you see”.

1. Ebola won’t spread in rich countries.

Until nurse Teresa Romero Ramos contracted Ebola in Madrid, the wealthy countries of Europe, North America and Asia seemed confident that the virus could be contained in advanced medical facilities. As Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, put it after the first U.S. Ebola case was confirmed in Dallas: “We’re stopping it in its tracks in this country.” Such assurances help calm people’s nerves but may be overstated. No system of protection is 100 percent. The Spanish government has concluded that Ramos got infected as she was removing her protective suit, touching her face before disinfecting her hands.

Like Ebola, the SARS virus spreads in hospitals, primarily through physical contact with contaminated fluids. As SARS spread across Asia in 2003, some hospitals, including in Hong Kong, had large numbers of health workers infected, while nearby facilities with similar populations of SARS patients had no employee infections.

Hubris is the greatest danger in wealthy countries — a sort of smug assumption that advanced technologies and emergency-preparedness plans guarantee that Ebola and other germs will not spread. It was hubris that left Toronto’s top hospitals battling SARS in 2003, long after the virus was conquered in poorer Vietnam. It was hubris that led the World Health Assembly in 2013 to cut the WHO’s outbreak-response budget in favor of more programs to treat cancer and heart disease. And it is hubris that causes politicians to routinely slash public health budgets every time the microbes seem under control, only to cry out in desperation when a new epidemic appears.

2. Post-9/11 emergency preparedness has the United States ready to fight Ebola.

Who can forget 9/11

Who can forget 9/11

In the years after the attacks of Sept. 11, 2001, and the anthrax mailings to political and military targets, the George W. Bush administration ordered a massive overhaul of bio-terrorism preparedness. From the CDC and Defense Department down to rural community clinics, doctors, nurses, hospitals and rapid-response teams went through drills imagining the arrival of pandemics or terrorist bio-attacks. Routines were put in place that supposedly prepared every health department in America for the arrival of a highly contagious disease. Military and health agencies were given billions of dollars to create rapid diagnostics, vaccines and cures for highly pathogenic organisms. On every list of biological organisms of concern was Ebola. So it is reasonable to assume that billions of dollars and countless exercises later, the United States is prepared.

But most of the training — both military and civilian — imagined the biological equivalent of an attack, in which something evil is found; responders from police, fire and health departments swoop in wearing hazard suits; and boom: The infected people are found, isolated and treated, and the danger to the community is gone. Even in 2005, when the White House feared that a highly virulent pandemic strain of bird flu would sweep across America,preparedness plans  focused on isolating a germ and its carriers the way a bomb or chemical weapon might be isolated and defused. Missing was preparation for a long haul of contagious patient treatment, with health workers repeatedly exposed to possible contamination.

Today, in the face of requests for help in West Africa, the answer from the U.S. Agency for International Development is:”There isn’t an existing cadre of people who have experience in treating this epidemic.”

3. It could go airborne.

Don't Take This Ebola Outbreak Lightly

Don’t Take This Ebola Outbreak Lightly

Yes, the virus is mutating — a recent paper in Science shows that more than 300 mutations have occurred. But what is now a virus that latches onto receptors outside endothelial cells lining the circulatory system won’t change into one that can attach to the alveolar cells of the lungs. That’s a genetic leap in the realm of science fiction.

Viruses mutate for two reasons: random error and natural selection. Random transformation from a virus solely adapted to infect cells that line blood vessels into one that can attach to entirely different classes of proteins found in the lungs borders on the impossible. Natural selection can overcome the impossible if great pressure is put on a viral population, forcing it to alter or die out. But in Liberia, Sierra Leone and Guinea, there is no such pressure on Ebola: The virus is spreading readily and infecting thousands of people without any need to change into a radically new form.

Far more realistic and perhaps equally worrisome is that the outer coat of the virus — the parts that are recognized by the human immune system and trigger production of antibodies and killer cells that devour viruses — might respond to immune system attack by mutating their outer proteins. If Ebola made such an adaptation, it might mean that people who have survived the disease could be reinfected, and vaccines now in the pipeline could prove ineffective.

4. Travel bans would keep Ebola from spreading in the United States.

The only evidence that any travel ban in the 21st century slowed down viral spread occurred right after the 9/11 attacks, when airports in the eastern United States were shut down for days, and few Americans traveled far from home for several weeks. Possibly as a result, the influenza season was delayed about two weeks in 2001. But the flu eventually came.

Many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 “swine flu.” None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures governments took to keep them out.

The days of Ellis and Angel islands screening out diseases effectively disappeared with the jet age.

5. A vaccine is around the corner.

There are several vaccine candidates in development right now, two of which recently got green lights from a special WHO scientific panel. That go-ahead means the potential vaccines

Vaccine expected in late 2015

Vaccine expected in late 2015

are now being tested on human volunteers. If after a few weeks of such testing the vaccines are shown to cause no undue side effects, the next phase of trials will be carried out, probably in the epidemic countries, to see if the vaccines can protect people from the virus. If it’s obvious in that phase that the vaccine is protecting people from Ebola, the products move to the final, and most difficult, phase — a clinical trial comparing vaccine vs. placebo in hundreds of people, also in the epidemic area.

The No. 1 question I hear privately from vaccine manufacturers regarding Ebola is: How will people dressed like space aliens in their protective gear get terrified, healthy people in Liberia or Sierra Leone to stand still for a poke in the arm?

At best, a vaccine might be ready for final testing by spring 2015 — and that question of trust will still remain.

The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

The current outbreak in west Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.

The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.

A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the Democratic Republic of Congo.

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.

  • Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.

    EBOLA VIRUS

    THE EBOLA VIRUS

  • The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
  • The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
  • The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
  • Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
  • Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
  • There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.

Symptoms of Ebola virus disease

The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

U.S. DEVELOPMENTS

Nurse who treated Duncan is infected:

On Monday, a Texas Health Presbyterian Hospital nurse by the name of Nina Pham has been diagonosed having Ebola.  She got a blood transfusion from American Ebola survivor Kent Brantly, according to Jeremy Blume, a spokesman for Samaritan’s Purse. Brantly was working for Samaritan’s Purse in Liberia when he contracted the virus.

The nurse had numerous contacts with Ebola patient Thomas Eric Duncan, and the Centers for Disease Control and Prevention said there may have been a “breach in protocol.” It didn’t say what the possible breach was.Duncan died last week.

The nurse is “clinically stable,” CDC Director Dr. Tom Frieden said Monday. The CDC said others who cared for Duncan could have been infected, but so far no other health workers are showing symptoms.

“They always helped other people and they take pride in helping other people. That’s what this family’s all about.”

U.S. nurses union calls for better preparation:

The National Nurses United union says 76% of nurses it questioned in 46 states said their hospitals have not communicated a policy on the potential of admitting patients infected by Ebola.

The union is asking for immediate upgrades to Ebola emergency preparations that include hands-on training and enough protective gear. The CDC said Monday it is “doubling down” on training and outreach to make every hospital “think Ebola.”

Diagnosis

It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:

  • antibody-capture enzyme-linked immunosorbent assay (ELISA)

    THE CDC

    THE CDC

  • antigen-capture detection tests
  • serum neutralization test
  • reverse transcriptase polymerase chain reaction (RT-PCR) assay
  • electron microscopy
  • virus isolation by cell culture.

The Atlanta-based Centers for Disease Control and Prevention has emerged as the standard-bearer — and sometimes the scapegoat — on Ebola.

Public health is the purview of the states, and as the nation anticipates more Ebola cases, some experts say the way the United States handles public health is not up to the challenge.

“One of the things we have to understand is the federal, state and local public health relationships,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Public health is inherently a state issue. The state really is in charge of public health at the state and local level. It’s a constitutional issue. The CDC can’t just walk in on these cases. They have to be invited in.”