The Ebola Thread

[Beet]

A reminder of why ebola is treated as a biohazard level 4:

The head doctor fighting an outbreak of the deadly Ebola virus in Sierra Leone has himself caught the disease

"It was not immediately clear how Khan had caught the virus. His colleagues told Reuters that he was always meticulous with protection, wearing overalls, mask, gloves and special footwear. Three days ago, three nurses working in the same Ebola treatment center alongside Khan died from the disease."

The high risk to health workers is one of the most insidious aspects of this disease.

Also...

"In a sign of the growing frustrations with the failure of region's governments to tackle the outbreak, a Liberian whose brother died from the disease set fire to the Health Ministry in protest on Wednesday."

Also...

* Dozens of nurses at a government hospital in eastern Sierra Leone town of Kenema went on an indefinite strike on Monday following the death of three of their colleagues on Sunday. They demand " "immediate relocation to an isolated area of the Ebola ward and its takeover by the French medical agency, MSF".

As we know, MSF is already stretched beyond its limits. This is the only hospital in the country with an ebola testing center.

* Dozens of laboratory technicians at Sierra Leone's only Ebola-testing facility went on strike last week over a $20 monthly risk premium which they were promised but never paid.

Link: http://www.reuters.com/article/2014/07/21/us-health-ebola-africa-idUSKBN0FQ0XO20140721

The problem is, you have to pay these health workers huge premiums to work under these conditions. And then the worse the outbreak gets, the more tourism and investment falls, the less able the society is to deal with the disease. So it's a vicious cycle of economic collapse, which makes dealing with the outbreak harder, which leads to further economic collapse.

* According to reports in local media, the doctor mentioned mentioned above, Dr. Khan, is one of two "prominent" doctors showing ebola-like symptoms.

* "a national broadcaster last evening reported that following the deaths of eight ( 8 ) nurses within one month, ostensibly from Ebola infection, the Kenema city Ebola Unit is now abandoned by nurses who accuse the Health Ministry of being “incapable” of protecting health workers."

http://news.sl/drwebsite/publish/article_200525829.shtml

[Beet]

A doctor at the Phebe Hospital in Bong County has been tested positive of the deadly Ebola Virus Disease, barely a month after a head doctor at the Redemption Hospital in the Borough of New Kru Town died of the disease at the John F. Kennedy Memorial Hospital in Monrovia.

In Monrovia, several hospitals have shut their doors to the public, including Redemption Hospital and the James Davies Memorial Hospital in Nee-Zoe community, Paynesville after nurses and doctors refused to report for work.

http://allafrica.com/stories/201407241076.html

[Beet]

It's now spread to Nigeria.

[Beet]

Authorities are now considering shutting down the John F. Kennedy Memorial Hospital in Monrovia for 21 days, after senior medical practitioner, Dr, Samuel Brisbane died of ebola yesterday. JFK is one of the biggest state run referral hospitals (referenced in my posts above). Nurses are not working or getting paid anymore and could be seen standing around the hallways in fear. The OPD Wall, the Operation Room, the pharmacy and other important segments of the hospital were all closed to the public.

The meagre health system in Liberia is being absolutely eviscerated. Pretty soon it will completely cease to function.

[Beet]

Jeez.

You must be logged in to read this quote.

http://crofsblogs.typepad.com/h5n1/2014/07/sierra-leone-police-use-tear-gas-to-curb-ebola-related-riot.html

I think one thing we've learned from the West Africa situation is that, when there's an ebola outbreak, sending people to the hospital is not the best place to go. Hospitals are needed for normal patients of normal ailments; a critical mass of ebola patients at a hospital, and pretty soon other patients will not be willing to go anymore. Ebola isolation units are special facilities that ideally should be set up away from population centers, and well defended.

[Miles]

Holy sh*t, a woman in Charlotte, NC has contracted it. 'Hoping she ends up ok.

[True Federalist (진정한 연방 주의자)]

Holy sh*t, a woman in Charlotte, NC has contracted it. 'Hoping she ends up ok.

She is from Charlottle, not in Charlotte.  She is in Liberia where she has been helping out with a medical aid mission.  By all appearances, she is a woman who should end up at the right hand of Christ, though hopefully not soon.

[Beet]

Holy sh*t, a woman in Charlotte, NC has contracted it. 'Hoping she ends up ok.

She is from Charlottle, not in Charlotte.  She is in Liberia where she has been helping out with a medical aid mission.  By all appearances, she is a woman who should end up at the right hand of Christ, though hopefully not soon.

My heart skipped a beat. But yeah, Charlotte is the headquarters of Samaritan's Purse, the organization the Ft. Worth doctor who contracted it is from. Dr. Kent Brantly is only 33 years old; with a wife and kids in Texas. Last I checked his blogspots from 2009 were still up. God bless him. You can donate directly to the organization's West African ebola response here. I donated $50.

Nancy Writebol worked in the decontamination unit, basically she was one of those who you see helping the doctors suit up and take off their suits afterwards. The fact that she was infected, and doctors are infected, shows that there are multiple failures in the current operational procedures which must be corrected. For a supposedly "hard to catch" disease it certainly is hard to defend against. Which is going to be an issue going forward because, BSL-4 is not replicable on the ground.

[Beet]

Fascinating comment on reddit from someone who works on micro-finance:



It is said that an element as simple as Clorox bleach can kill ebola, so maybe I was wrong to disagree with Simfan early in this thread. The problem is it must be applied consistently. I wonder if it could help health workers to have their suits completely soaked in bleach?

Also, again what we have learned here is that ebola isolation cannot be confused with "normal" medical institutions; if at all possible these isolation centers should be built from scratch and it should not be assumed that a normal hospital is equipped to deal with it.

[Tender Branson]

https://www.youtube.com/watch?v=aCbfMkh940Q

[MaxQue]

Cleaning with bleach can't hurt, but it won't solve the crisis. It won't protect you while you're wearing them, it will only clean already infected clothes. Bleach is obviously removed beofre them wearing them (if not, they'll get terrible chemical burns and long-term respiratory issues, perhps even chemical poisoning).

[Beet]

Sorry if this seems like a lot of posts, but a major speech today by Liberian president Ellen Johnson Sirleaf is pertinent

http://allafrica.com/stories/201407270112.html?aa_source=acrdn-f0

It looks like full mobilization of gov't resources, including the armed forces to enforce local quarantines. should have been done a month ago

[Beet]

So apparently the guy's family only traveled back to the U.S. a few days ago. And now it's already reported he's under quarantine? I hope the guy's family is being tested/monitored, if not under quarantine for the requisite 21 day period.

[Sol]

Holy sh*t, a woman in Charlotte, NC has contracted it. 'Hoping she ends up ok.

She is from Charlottle, not in Charlotte.  She is in Liberia where she has been helping out with a medical aid mission.  By all appearances, she is a woman who should end up at the right hand of Christ, though hopefully not soon.

My heart skipped a beat. But yeah, Charlotte is the headquarters of Samaritan's Purse, the organization the Ft. Worth doctor who contracted it is from. Dr. Kent Brantly is only 33 years old; with a wife and kids in Texas. Last I checked his blogspots from 2009 were still up. God bless him. You can donate directly to the organization's West African ebola response here. I donated $50.

Nancy Writebol worked in the decontamination unit, basically she was one of those who you see helping the doctors suit up and take off their suits afterwards. The fact that she was infected, and doctors are infected, shows that there are multiple failures in the current operational procedures which must be corrected. For a supposedly "hard to catch" disease it certainly is hard to defend against. Which is going to be an issue going forward because, BSL-4 is not replicable on the ground.

Headquarters are actually in Boone. (pedant)

[Beet]

Well, according to Samaritan's Purse, Nancy Writebol had never even had contact with patients, and they are "investigating how [infection] might have occurred." That puts a damper on all the pollyanas saying "oh don't worry, it only transmits through blood or feces, durrr hurr hurr" I'm pretty sure this woman would have known if she had touched the blood or feces of a patient.

Meanwhile, Patrick Sawyer, the Liberian Finance Ministry consultant who died in Nigeria, had been on three flights... one to Togo, one to Ghana, and one to Lagos. And apparently they don't have all the flight lists yet still.

[Beet]

http://www.cdc.gov/media/releases/2014/t0728-ebola.html

CDC on risk to U.S. population:

'I want to underscore that Ebola poses little risk to the U.S. general population.  Transmission is through direct contact of bodily fluids of an infected person or exposure objects like needles that have been contaminated with infected secretions.  Individuals who are not symptomatic are not contagious. The mortality rate in some outbreaks can be as high as 90 percent, but in this outbreak, it is currently around 60 percent, indicating that some of our early treatment efforts may be having an impact.'

The 60 percent figure being thrown around seems too low. In Guinea, the disease has a fatality rate of about 75 percent. In Sierra Leone and Liberia it is much lower, but that is because new suspected cases are piling up very fast in those countries. Many of those cases will die.

CDC on response strategy:

'Fundamentally we need to work together to do three things.  These things are 100 percent in line with the global health security agenda.  First we need to build systems to find cases quickly.  And when health care can make a difference between life and death.  This means traditional healers, supporting primary care and accurate laboratory testing.  Secondly we need to respond by isolating cases, and managing the response through emergency operation centers which every country should have.  Third, we need to prevent future cases through infection control, safe burial practices, prompt diagnosis and isolation of new cases.'

'I think what I can say is that what we're trying to do is to approach this as a two-faze response here.  Perhaps three because we already had phase one.  In this phase, we want to, as quickly as possible, surge as many resources as we can into the area to try to get things going in all of these different areas where there is ongoing transmission.  There is five or six districts that have cases.  Once we do that surge, we have to maintain the effort.  So we're developing rosters of people with appropriate skilling, a new class of epidemic emergency service offices and we're looking to engage them in the outbreak response as well.'

They are still going for the isolate and contain route. Getting cooperation from the local population is going to be the number one issue.

[Beet]

Meanwhile, Patrick Sawyer, the Liberian Finance Ministry consultant who died in Nigeria, had been on three flights... one to Togo, one to Ghana, and one to Lagos. And apparently they don't have all the flight lists yet still.

So apparently this guy was a U.S. citizen. He lived in Minnesota for a decade and his wife and kids are still there. (A little awkward that his Americanness was erased, when the two Samaritan's purse workers were reported as the 1st and 2nd cases). Apparently he was also some big shot with the Liberian government, who had spoken for the Finance Minister before, and the Nigerians were under a lot of pressure to release him. Even now the Liberians are supposedly displeased with his treatment, although the Nigerians certainly made the right choice.

Sheik Umar Khan, the top Sierra Leone doctor, has died in Kailahun. Yesterday it was reported that the president of Sierra Leone, Ernest Bai Koroma, flew up to Kenema, a large market town near Kailahun, to visit the epicenter of the outbreak in that country and an ebola treatment center for the first time. He was tipped to visit Dr. Khan in Kailahun, but his helicopter was reported to not be able to make up due to lack of fuel, and he was to return the following day. I wonder now if they said "Don't bother coming, he's about to die." Or "He's already dead, but we're not ready to announce it."

[True Federalist (진정한 연방 주의자)]

The 60 percent figure being thrown around seems too low. In Guinea, the disease has a fatality rate of about 75 percent. In Sierra Leone and Liberia it is much lower, but that is because new suspected cases are piling up very fast in those countries. Many of those cases will die.

[...]

They are still going for the isolate and contain route. Getting cooperation from the local population is going to be the number one issue.

Guinea has had the most resistance from the local population to measures intended to control the spread of Ebola, which likely has contributed to the higher mortality rate there as well.

[Beet]

http://www.nbcnews.com/storyline/ebola-virus-outbreak/no-market-scientists-struggle-make-ebola-vaccines-treatments-n167871

With a disease like ebola I don't think it's unethical to give people the opportunity, with informed consent, to take medications that have not yet passed all the regulatory hurdles. If it was you, wouldn't you want the chance? In March 2009, when a researcher in Germany pricked herself accidentally with a needle that contained ebola, the top experts in the field were consulted within a day and she was given an experimental treatment. Although it was never confirmed that she did indeed contract ebola, she survived fine. The chance of someone dying from the vaccine is very small compared to dying from ebola.

[Beet]

Samaritan's Purse and Serving In Mission are evacuating non-essential employees.

http://www.cbc.ca/news/canada/british-columbia/azaria-marthyman-ebola-doctor-returns-home-to-victoria-1.2721631

This guy, Dr. Azaria Marthyman, returned from Liberia to Canada after treating ebola patients in the last 5 days. From all indications in the above article, he has not been tested, is not under quarantine, and is "taking time off with his family." Ugh.

[Beet]

A classic sign of infection by Ebola … is a certain expression that invariably creeps over the patient’s face as the infection progresses. The face becomes fixed and “expressionless,” “masklike,” “ghostlike” (in the words of doctors who have seen it), with wide, deadened, “sunken” eyes. The patient looks and sometimes behaves like a zombie. This happens because Ebola damages the brain in some way that isn’t known. The classic masklike facial expression appears in all primates infected with Ebola, both monkeys and human beings. They act as if they were already embalmed, even though they are not yet dead. The personality may change: the human patient becomes sullen, hostile, agitated, or develops acute psychosis. Some have been known to escape from the hospital.

Disseminating clotting cuts off the blood supply in tissues, causing focal necrosis—dead spots in the liver, spleen, brain, kidneys, and lungs. In severe cases, Ebola kills so much tissue that after death the cadaver rapidly deteriorates. In monkeys, and perhaps in people, a sort of melting occurs, and the corpse’s connective tissue, skin, and organs, already peppered with dead areas and heated with fever, begin to liquefy, and the slimes and uncoagulated blood that run from the cadaver are saturated with Ebola-virus particles. That may be one of Ebola’s strategies for success.

- Crisis in the Hot Zone, by Richard Preston

http://www.newyorker.com/news/news-desk/takes-richard-preston-ebola

[Beet]

Death and Denial in the Hot Zone

[Henry Jallah, a 23-year-old farmer] says he has accepted the advice of Liberia's Health Ministry to stay away from dead and sick people in the town, yet he is hesitant to believe it is really Ebola that claimed his family. He offers other explanations: poisoned drinking water as vengeance for a conflict over land, or some kind of curse. His family never took his aunt to a case management center, he says, because "some people say when you go over there, they can inject you -- when you having the sickness, they inject you and kill you."
...
In bustling Duala Market [in Monrovia, the capital], 92 percent of people said they did not believe Ebola existed, according to a recent survey of 1,000 people conducted by Samaritan's Purse. In fact, many in the capital initially viewed the virus as a hoax created by the government to generate and "eat money" from aid donors.
...
Compounding these problems, even when people believe Ebola exists, many are wary of hospitals because they believe the institutions provide poor care -- a concern that existed well before the current crisis. To be sure, Liberia's health-care system has improved since civil war ripped the nation apart; there has been a reduction, for example, in the under-5 child mortality rate. Yet Monrovia's largest hospital, John Fitzgerald Kennedy Memorial Medical Center, or JFK, is nicknamed "Just For Killing" among locals because people go there with treatable diseases such as malaria and still die.

[Beet]

More details still emerging about Patrick Sawyer...

FrontPageAfrica has now learned that upon being told he had Ebola, Mr. Sawyer went into a rage, denying and objecting to the opinion of the medical experts. “He was so adamant and difficult that he took the tubes from his body and took off his pants and urinated on the health workers, forcing them to flee."

Umm... so two health workers in Nigeria were urinated on by a patient showing advanced symptoms? Have they been tested?

[Beet]

This from a Nigerian pastor:



The part below the black line (original post here https://www.facebook.com/permalink.php?story_fbid=10154412557025106&id=373216405105) I cut off just to show how many people are buying into this sh**t, presumably upper class, educated Nigerians with access to Facebook.

We all knew the Sierra Leonians and Liberians were nuts on ebola, here's evidence Nigeria, a far larger country, is filled with fools as well.

And I kid you not, I didn't want to mention this before, but back in April when this thing had its first wave of news coverage, I was sitting in this Panera Bread in Arlington where a lot of news companies are located. This place is right outside of the Politico headquarters. It's not a place you would associate with conservative Christianity, let alone superstition. Well, these two black women were sitting at a table next to me talking in serious tones about beet juice. "Why beet juice?" I remember one of the asking in earnest tones. Then I realized they were talking about ebola. One of them was telling the other that beet juice cures ebola, which was a rumor going on at the time. They were very serious. This attitude exists in the United States, as well.

[Beet]

Ok, going to post my individual policy recommendations here. Governments are always one step behind events and being reactive. We see this again and again. But here we have to get in front of this to contain it, and that means doing done things that may seem to make little sense.

First of all, all regular international flights out of Guinea, Sierra Leone, and Liberia need to be suspended immediately. The proper controls are not in place. Only specially designated flights for foreign nationals and those coming in to assist the ebola response can be allowed. These specially designated outgoing flights cannot be normally fitted commercial jets. They must be aircraft specially fitted to allow individual isolation if every passenger, so if one develops symptoms mid flights that person does not infect others. On offloading each passenger must go to a designated compound that is also fitted to allow indivual isolation, and stay there for 25 days. After which if they show no symptoms they are free to go. For example, one if those large Amazon.com warehouses with tents set up inside would be the type of building that might be suitable.

Second of all, massive response is needed in West Africa to bring the situation under control. Certain areas (those being most amenable to quarantine) must be closed off and abandoned for the time being, while contact tracing occurs strategically, prioritizing those more at risk of traveling. The armed forces of West African states, particularly Ivory Coast, Mali, and Senegal must be mobilized to completely shut the border ( Conakry may be saved if eastern Guinea can be cut off ). Additionally, NATO forces should be deployed to the area to assist with surveillance.

Finally, large amounts of people and supplies are going to have to go in, to train contact tracers, nurses, burial workers, and construction if new, well defended treatment centers away from population areas. Spend $1 billion. Register every citizen and address, go door to door to every single household and examine the situation, and educate them about the facts of ebola, and provide chlorine solution for sanitary purposes. Health workers are to be protected by armed escort whenever possible. Focus on urban areas first. Go neighborhood by neighborhood with response teams divided by geographical area, identifying everyone who needs to be traced. House by house, block by block, town by town, until quarantine is reestablished. This should be an international effort. It would be nice if the Russians and the Chinese could also contribute.

This is what needs to happen ASAP and if I can I will call my congress critter about it tomorrow.