Ebola

[Sensei]

I'm a little surprised that this has not been discussed, so I thought that a thread might be in order. There has been a lot of fear mongering by the media and other gun forums about this outbreak. I'll let you know my take on it as someone who has a pretty good handle on the science and reasonable lines of communication to the CDC.

First the facts:
1) Ebola is a viral illness capable of caused hemorrhagic fever in its most extreme presentation which means that victims may have bleeding from various organs and the mucous membranes. Most victims do not develop bleeding beyond bloody diarrhea or vomiting.

2) It is indeed a deadly bug with some strains of Ebola boasting a 90% fatality rate. The current strain, Ebola Zaire, is one of the bad ones. However, the current outbrake is reporting 40-60% deaths depending on location. This suggests that access to modern medical care, mainly hydration and electrolyte replacement, it vital to surviving.

3) There is no proven treatment other than supportive care. Zmapp is an experimental treatment using a monoclonal antibody, but the N's are far too small to determine if it is any more effective than standard care. There is a vaccine being developed but I've not been given a time table for when it will be released to the public. Even if it is fast tracked as an orphan drug I doubt that we would see it in widespread use by the end of the year.

4) Transmission is by direct contact with blood or secretions. That means diarrhea, vomit, semen, and vaginal secretions are very high risk. The virus is also present in sweat and saliva, but we are unsure about how effective these fluids are at transmission. There is no evidence that Ebola is transmitted by droplet or airborne means. This seems to be a significant point of speculation due to the historical experience with a sister virus known as the Reston virus. Several stories have been told about this virus in books and reports, but we are still unsure if the Reston virus was truly an airborne strain.

5) While viruses do mutate, there is very little chance that mutation is going to lead to a more virulent or airborne strain.

6) The incubation for Ebola can be as long as 21 days but averages about 7-10. People are not contagious during this incubation as the virus is not being shed. Once symptomatic, people are quickly incapacitate which tends to limit travel. That is why this disease is going to be very bad for West Africa. I suspect that fatalities this year will be in the tens of thousands, and that the outbreak could last for many months due to overcrowding and an abundance of animal reservoirs in Africa.

What are the odds that we will see a wide spread outbrake in the US - very, very small. There is a very small chance that we will see a few cases show up on our shores. The odds of these causing widespread death and destruction is minuscule; problems due to panic and public fear is another story. What can or should you do about Ebola now - not a damn thing. If it is going to happen in the US, the outbreak would be very slow due to our containment measures. To put things in perspective, the current African outbrake probably began last December.

[Joe in PNG]

One thing that most Americans do not seem to understand is the type of care most people get in a third world environment. As many folks here know, third world medical care is appalling:
-There is a serious lack of trained doctors and nurses
-There is an even more serious lack of medical equipment, meds, and what the clinics have tends to be pretty broken down.
-Many clinics don't have access to constant power, clean running water, and sewage disposal. This makes washing up and sterilizing pretty difficult at the best of times.
-Sometimes, even in hospitals, much of the care is done by family members- feeding, washing, cleaning the beds, et al.

Thus, during an epidemic, the rudimentary medical facalities get overwhelmed, which means many Ebola patients need to be treated at home... which means more people have close contact with the oooie-goooies of ebola symptoms... no rinse, repeat.

[RoyGBiv]

http://www.medicaldaily.com/17-ebola...rambles-298660

The looters, described by AFP as club-wielding youths, had been sparked to attack the quarantine center by the widespread mistrust of medical workers shared by many West Africans. Unfortunately, this mistrust and misunderstanding has only propeled the spread of Ebola. According to Information Minister Brown, “All those hooligans who looted the centre are now probable carriers of the disease” due to the fact that much of the bedding and mattresses they stole were visibly soaked with bodily fluids from the quarantined patients.

makes containment ...... a challenge.

[PPGMD]

3) There is no proven treatment other than supportive care. Zmapp is an experimental treatment using a monoclonal antibody, but the N's are far too small to determine if it is any more effective than standard care. There is a vaccine being developed but I've not been given a time table for when it will be released to the public. Even if it is fast tracked as an orphan drug I doubt that we would see it in widespread use by the end of the year.

Even if Zmapp is effective, the makers said that after they provided the drugs to the patients that received them that they are completely out and that it will be some time before they will have enough for additional treatments for others.

Also common forgotten is that the American nurse and doctor that survived also received a blood transfusion from a survivor.

So it might have been that transfusion, it might have been the Zmapp, it might have been luck that their immune systems could tolerate the disease, or it might have been any combination of factors.

[Default.mp3]

4) Transmission is by direct contact with blood or secretions. That means diarrhea, vomit, semen, and vaginal secretions are very high risk. The virus is also present in sweat and saliva, but we are unsure about how effective these fluids are at transmission. There is no evidence that Ebola is transmitted by droplet or airborne means. This seems to be a significant point of speculation due to the historical experience with a sister virus known as the Reston virus. Several stories have been told about this virus in books and reports, but we are still unsure if the Reston virus was truly an airborne strain.

Just FYI for those who didn't know, there is a book that does a decent job at detailing the RESTV incident (Reston references Reston, VA... so yeah, it could have been a Helluva incident): The Hot Zone, by Richard Preston.

[5pins]

Just FYI for those who didn't know, there is a book that does a decent job at detailing the RESTV incident (Reston references Reston, VA... so yeah, it could have been a Helluva incident): The Hot Zone, by Richard Preston.

I remember reading that book when it came out. IIRC the Reston strain only affected monkeys and the one person that was infected showed no symptoms and did not spread the virus.

[Totem Polar]

That book made me pee my pants. Of course, it was written with that effect in mind. I like sensei's analysis more.

I have a friend and former student who is one of the top infectious disease specialists in the west. For years, we'd have these short conversations about xyz disease or abc disease in the news, and his response was always "that's just the media; it's totally blown out of proportion." One day, the same mini conversation happened around one of the flus (maybe swine, IIRC?) and without missing a beat he responds "Oh that could kill millions. Or not, we won't know until {blah blah science herd stuff..}"

The flu worries me more than viral hemorrhagic fevers. I'd be curious to hear from our resident Flu SMEs, because, I'm always curious about influenza.

[Sensei]

Just FYI for those who didn't know, there is a book that does a decent job at detailing the RESTV incident (Reston references Reston, VA... so yeah, it could have been a Helluva incident): The Hot Zone, by Richard Preston.

Sir, be very careful using this book. It contains enough sensationalism and exaggeration so as not to be taken seriously - a common theme with depictions of military service these days. I tried to read it but had to stop at the beginning when the author described a victim collapsing in a pool of blood. Those of us who have actually seen hemorrhagic fever know that this is not how it happens. Most people to succumb to Ebola die a death of dehydration. Those that do have a hemorrhagic fever component do not melt.

The truth about RESV outbreaks is that nobody knows exactly how it is transmitted. It is a disease of monkeys and exposure to humans illecits an immune response without symptomatic disease. Most of the outbreaks can be traced to contamination during containment. There are a couple of outbreaks in simians that are head scratchers, but this is not proof of airborne transmission. Here are a couple of RESTV resources that are no nonsense:

http://www.cdc.gov/ncidod/dvrd/spb/o...hilippines.htm
https://web.stanford.edu/group/virus/filo/ebor.html

[Default.mp3]

Sir, be very careful using this book. It contains enough sensationalism and exaggeration so as not to be taken seriously - a common theme with depictions of military service these days. I tried to read it but had to stop at the beginning when the author described a victim collapsing in a pool of blood. Those of us who have actually seen hemorrhagic fever know that this is not how it happens. Most people to succumb to Ebola die a death of dehydration. Those that do have a hemorrhagic fever component do not melt.

I was afraid of that; I'm glad I tempered my statement as "decent" rather than "great". Seems like a lot of the non-fiction works written by journalists rather than experts in the field tend to fall toward sensationalism (though was a pretty awesome read for my middle school self, and I guess better than most of the YA tripe). I guess they gotta move units somehow. Thanks for the heads up.

[45dotACP]

Truthfully, I'd be more concerned about H5N1.

Ebola in the U.S. doesn't particularly spook me unless the I.V. fluid shortage gets really bad.

I also read the Hot Zone in high school, and after taking a microbiology class in college, found that it was...like many of the books I read in high school...ridiculous drivel written by someone with an incomplete grasp of the facts.