Posted on 08/10/2014 12:46:23 AM PDT by Smokin' Joe
Ping to 2160
ping to 2160
I have not had time to review these, but they are presented here for all to see:
28 August 2014 EBOLA RESPONSE ROADMAP (from 28 Aug, 2014)
"This Sent Chills Up My Spine" - Dave Hodges On Hagmann And Hagmann
Hagmann & Hagmann Report - September 17, 2014 Ebola: What It Means For Us (Video)
Precisely. Given the nature of this pathogen the only logical conclusion is to assume the worst until we know the exact details of this new strain. Plenty of people are making tremendous assumptions, many based on the strains involved in earlier outbreaks, but little is actually known about this specific strain.
The misinformation/obfuscation/lies coming out of the "authorities" is very troubling.
Oh...Fudge.
That CIDRAP article does cut to the chase about the nature of Faluci’s lying before Congress —
“Adequate protection is essential
To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:
•Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
•All sizes of aerosol particles are easily inhaled both near to and far from the patient.
•Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
•Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
•Experimental data support aerosols as a mode of disease transmission in non-human primates.
Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.
Acknowledgements
We thank Kathleen Harriman, PhD, MPH, RN, Chief, Vaccine Preventable Diseases Epidemiology Section, Immunization Branch, California Department of Public Health, and Nicole Vars McCullough, PhD, CIH, Manager, Global Technical Services, Personal Safety Division, 3M Company, for their input and review.”
One person vomits in a subway station and aside from the fomites, there are droplets...
Is it bad sushi? A sick wino/junkie? or is a level 4 cleanup required?
placemark
Here’s the money shot, and it’s a big one:
“Adequate protection is essential
To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:
•Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
•All sizes of aerosol particles are easily inhaled both near to and far from the patient.
•Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
•Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
•Experimental data support aerosols as a mode of disease transmission in non-human primates.
Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.”
Ebola is airborne, and viable for up to 90 minutes. That’s a declared value for the variable (d).
Detection of Ebola Virus in Oral Fluid Specimens during Outbreaks of Ebola Virus Hemorrhagic Fever in the Republic of Congo (2003 outbreak) From DiscussionRT-PCR assays for the detection of Ebola virus yielded consistent results with both oral fluid specimens and serum specimens. RT-PCR of oral fluid samples confirmed all of the results found with blood specimens. The assessment of sensitivity (100%) and specificity (100%) of standard RT-PCR diagnostic tools that use oral fluid samples for the detection of Ebola virus indicates that these samples can be used for confirmation when blood/serum collection is not possible.
Given the current diagnostic algorithm for laboratory-confirmed cases of Ebola that involve confirmation by antigen detection, RT-PCR, or detection of IgM antibodies in the blood, detection of Ebola virus by RT-PCR in oral fluid specimens seems to be sufficiently reliable as a diagnostic tool in outbreak investigations.
If oral fluids are useful for diagnosing Ebola, there is no reason whatsoever to believe that oral fluids cannot be a transmission vector.
Oops, meant to ping you to the cidrap paper as well.
I really should make a ping list that’s an actual list, and not just in my sleep deprived brain.
Ebola Hemorrhagic Fever, Kikwit, Democratic Republic of the Congo, 1995: Risk Factors for Patients without a Reported ExposureAbstract
In 1995, 316 people became ill with Ebola hemorrhagic fever (EHF) in Kikwit, Democratic Republic of the Congo. The exposure source was not reported for 55 patients (17%) at the start of this investigation, and it remained unknown for 12 patients after extensive epidemiologic evaluation. Both admission to a hospital and visiting a person with fever and bleeding were risk factors associated with infection. Nineteen patients appeared to have been exposed while visiting someone with suspected EHF, although they did not provide care. Fourteen of the 19 reported touching the patient with suspected EHF; 5 reported that they had no physical contact. Although close contact while caring for an infected person was probably the major route of transmission in this and previous EHF outbreaks, the virus may have been transmitted by touch, droplet, airborne particle, or fomite; thus, expansion of the use of barrier techniques to include casual contacts might prevent or mitigate future epidemics.
LOL It’s okay. I check this thread daily and keep up with posts. If you’d like to put me on a ping list, though, I won’t mind a bit.
News24.com
2014-09-18 18:17
Dakar - The World Health Organisation says more than 700 more Ebola cases emerged in West Africa in one week, a statistic that shows the outbreak is accelerating.
Just three weeks ago the number of new cases was around 500 for a one-week period. The number of people believed to have killed is now more than 2,600, an increase of roughly 200 from the last estimate, WHO said on Thursday. Most deaths have been in Liberia.
The new figures from the UN health agency show that the disease is thought to have sickened more than 5 300 people. Just under half of those cases were recorded in the last three weeks.
Some 318 health care workers have been sickened, and about half have died.
MSF asked specifically for US Army Chemical Corps decontamination equipment.
See:
MSF’s role in containing the epidemic is vital because
the capacity and readiness of other aid agencies to
tackle emergencies of this sort have fallen away over
the past few years, as they concentrated instead on
working with and empowering local organisations,
rather than being the shock troops of response.
That’s why MSF has found itself in the unprecedented
position of appealing to the US and other countries
to send in military teams trained to deal with
nuclear, chemical and biological emergencies.
with link and complete article context below —
So far the plague has been fought almost single-handedly by one French aid agency
PETER POPHAM
Thursday 18 September 2014
http://www.independent.co.uk/voices/comment/to-stop-ebola-killing-thousands-more-we-need-doctors-who-are-willing-to-put-their-lives-on-the-line-9741995.html
Médecins Sans Frontières (MSF), the French-founded aid agency, is back in West Africa, where it started its work 43 years ago when its pioneering doctors and nurses flew out to bring medical assistance to victims of the Biafran war.
Today, the emergency is the Ebola plague, and according to Joanne Liu, the organisation’s president, the international response so far has been “lethally inadequate”.
With more than 2,600 fatalities, 5,300-plus infected, a mortality rate for those untreated of 90 per cent and the numbers doubling every 24 days, the epidemic is “exploding like a bomb in the community”, as a spokesman described it to me. MSF finds itself almost single-handedly tackling the largest epidemic of its kind in history.
I say “almost single-handedly” because the Red Cross is also involved, and President Obama is sending 3,000 US soldiers, with their logistical and engineering capabilities, to the worst-affected areas. But with the entire health system of Liberia, the worst-affected country, in a state of collapse, this tightly focused, single-minded agency remains at the sharp end of the response to the crisis, and it is dramatically over-stretched. As things stand, it simply cannot cope.
That’s why it is urgently seeking to recruit medical professionals to bolster its teams in the field. The work is obviously not for everyone. The pay is poor compared with working for the NHS. And after a one-month tour, fieldworkers are obliged to take an unpaid 21-day layoff because the work, as the organisation does nothing to disguise, is testing in the extreme. Doctors and nurses are bottled up in their protective suits and obliged to work in conditions of strict military-style discipline inside the treatment centres. That discipline continues outside working hours, with an absolute ban on physical contact of every sort and fanatical attention to cleanliness.
“It’s really exhausting to live in conditions like that,” the spokesman said, “which is why we have short rosters, so people don’t lose their vigilance. We want staff to be sharp and fresh, and we don’t even allow them to volunteer for a second tour until they have been off for at least three weeks.”
MSF’s role in containing the epidemic is vital because the capacity and readiness of other aid agencies to tackle emergencies of this sort have fallen away over the past few years, as they concentrated instead on working with and empowering local organisations, rather than being the shock troops of response. That’s why MSF has found itself in the unprecedented position of appealing to the US and other countries to send in military teams trained to deal with nuclear, chemical and biological emergencies.
The other reason MSF finds itself so exposed is because the authorities in these states barely functioned, even before the outbreak. “It is difficult for people in the West to imagine the extent of disorganisation in these countries,” Adam Nossiter wrote in The New York Times this week. “There is a near-total absence of effectively functioning institutions of any sort, let alone those devoted to healthcare.”
When Ebola broke out in Uganda in 2000, the government immediately imposed tough measures to stop it exploding. In Liberia there is no one to play that role. MSF, the only game in town, is fighting to get ahead of the epidemic curve instead of behind it, where it has been until now.
For any nurse or doctor tempted to put their life on the line in the best possible cause, opportunity knocks.
NEJM: Face to Face with Ebola — An Emergency Care Center in Sierra LeoneOne day, a surveillance officer from the Ministry of Health is admitted to the center. He was one of the few people who had come from Freetown, the capital city, to help in Kailahun, joining the surveillance team to assess new patients and deaths. He told me he'd come because the people here are his community, his friends, his colleagues. We laughed together, commiserated with one another, and then he was admitted to our center and, sadly, later died.
(snip)
Last week, 250 contacts of infected persons were identified for contact tracing, but given the number of confirmed cases, there should have been more than 1500. The alert system — whereby an investigation team (and, if needed, an ambulance) is sent to a village when a suspected case or death is reported — is not functioning properly, and the Ministry of Health has only four ambulances in a district with about 470,000 people. Our health promotion teams are still visiting villages where no other health care provider has been. Every day sees deaths in the community that are surely caused by Ebola, but they are not counted by the Ministry of Health because the cause has not been confirmed by laboratory testing. The epidemiologic surveillance system is nonfunctional. We need to define the chains of Ebola transmission to interrupt them, but we lack key data.
http://m.allafrica.com/stories/201409180480.html/?secid=10052
About 300 Survive Ebola - Official
18 September 2014 , By Winston W. Parley, Source: New Dawn
(Photo: FrontPageAfrica)
Approximately 300 infected patients have survived Ebola treatment in Liberia since the outbreak here from March to September, Assistant Health Minister for Preventive Services, Tolbert Nyenswah, has announced.
Appearing on “Truth Breakfast Show”, a live broadcast talk show on Tuesday in Monrovia alongside foreign partners from the World Health Organization and the US’ Center for Disease Control, Mr. Nyenswah said if all of the survivors were combined since the outbreak in March, “We have close to 300 survivals.”
He named treatment centers at the JFK, ELWA unit one, two and three, among others, as areas where the cases were treated. Nyenswah, who chairs the government’s Incidence Management System, said things were “gradually improving with what they do in ending the outbreak”, expressing confidence that the WHO’s prediction could be disproved if such positive response continues.
He noted that in Lofa County’s Ebola Treatment Unit where weeks ago, 100 positive cases were being admitted, emerging report is now indicating that cases have reduced between five and ten as a result of the community engagement.
According to him, the prospect was that in two or three weeks, if the current scale of intervention continues at the community level, “We can reduce the cases in two or three weeks to zero cases in Lofa.”
Working closely with partners here, Nyenswah said community mobilization and awareness is critical, in terms of providing them active case surveillance, checking for sick and dead people or visitors, among others.
As a result, he boasted that today, West Point Community, has become a success story, and further named Ashmum Street, Rock Valley, New Georgia Community, Caldwell, St. Paul Bridge, Diggsville, ELWA, Seventy Second, Police Academy, and others as organizing themselves in the process.
Notwithstanding, the coordinator of the Ebola fight stated that infection prevention and control still remain very critical, stressing that training health workers, providing them PPEs, and what they need, are very important to winning the fight.
“If you look at the laboratory services since the outbreak and where we are today, you will note that we have only one lab, which was at the Liberia Institute of Bio Medical Research.”
At this lab, he said they conducted 30 to 40 tests per day. However, with the increase of the lab for three across Liberia, he said they can now perform around 300 to 400 tests a day on Ebola cases. Additionally, he said the labs are expected to be expanded to additional three - one in Bong, one of [Clay Ashland], and one in the Southeast Liberia which will total six labs in the country.
As regards community dwellers’ demand to have test results before releasing dead bodies to health team, the Assistant Minister pleaded that “it won’t be possible because Ebola lab is not a rapid diagnostic test that runs in fifteen minutes like malaria. He said instead, that Ebola lab takes between four to eight hours.
While acknowledging increased support that Liberia has been receiving from partners in the past three weeks, Mr. Nyenswah said challenges still remain, explaining that to build and run an ETU with 100 beds for a month costs around two million dollars.
UMN CIDRAP:COMMENTARY: Health workers need optimal respiratory protection for Ebola
Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data. In the 1940s and 50s, William F. Wells and other "aerobiologists" employed now significantly out-of-date sampling methods (eg, settling plates) and very blunt analytic approaches (eg, cell culturing) to understand the movement of bacterial aerosols in healthcare and other settings. Their work, though groundbreaking at the time, provides a very incomplete picture.
Early aerobiologists were not able to measure small particles near an infectious person and thus assumed such particles existed only far from the source. They concluded that organisms capable of aerosol transmission (termed "airborne") can only do so at around 3 feet or more from the source. Because they thought that only larger particles would be present near the source, they believed people would be exposed only via large "droplets" on their face, eyes, or nose.
Modern research, using more sensitive instruments and analytic methods, has shown that aerosols emitted from the respiratory tract contain a wide distribution of particle sizes—including many that are small enough to be inhaled.5,6 Thus, both small and large particles will be present near an infectious person.
(snip)
Being at first skeptical that Ebola virus could be an aerosol-transmissible disease, we are now persuaded by a review of experimental and epidemiologic data that this might be an important feature of disease transmission, particularly in healthcare settings.
What do we know about Ebola transmission?
(snip)
On the basis of epidemiologic evidence, it has been presumed that Ebola viruses are transmitted by contaminated hands in contact with the mouth or eyes or broken skin or by splashes or sprays of body fluids into these areas. Ebola viruses appear to be capable of initiating infection in a variety of human cell types, but the primary portal or portals of entry into susceptible hosts have not been identified.
(snip)
Ebola virus, on the other hand, is a broader-acting and more non-specific pathogen that can impede the proper functioning of macrophages and dendritic cells—immune response cells located throughout the epithelium.15,16 Epithelial tissues are found throughout the body, including in the respiratory tract. Ebola prevents these cells from carrying out their antiviral functions but does not interfere with the initial inflammatory response, which attracts additional cells to the infection site. The latter contribute to further dissemination of the virus and similar adverse consequences far beyond the initial infection site.
The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out by the observed risk factors or our knowledge of the infection process. Many body fluids, such as vomit, diarrhea, blood, and saliva, are capable of creating inhalable aerosol particles in the immediate vicinity of an infected person. Cough was identified among some cases in a 1995 outbreak in Kikwit, Democratic Republic of the Congo,11 and coughs are known to emit viruses in respirable particles.17 The act of vomiting produces an aerosol and has been implicated in airborne transmission of gastrointestinal viruses.18,19 Regarding diarrhea, even when contained by toilets, toilet flushing emits a pathogen-laden aerosol that disperses in the air.20-22
Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces.23 Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively.23
In still air, 3-mcm particles can take up to an hour to settle. With air currents, these and smaller particles can be transported considerable distances before they are deposited on a surface.
(snip)
Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity.27 However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols.25-27
Altogether, these epidemiologic and experimental data offer enough evidence to suggest that Ebola and other filoviruses may be opportunistic with respect to aerosol transmission.28 That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.
If this is true, why are we sending the US military to Liberia?
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