While not our usual fare, I provide this guest essay for discussion without comment, as it is concerned with an issue of great interest and impact to millions of people – Anthony
Guest essay by Alec Rawls
Negative atmospheric pressure sounds climate related, but it is just an analogy to the inward draw of air that contagious disease laboratories and isolation rooms use to keep pathogens from escaping. The only way to make it safer for Ebola hot-zone residents to stay put and keep the current epidemic from spreading is to use immune survivors to separate and treat the sick, a strategy developed by the Greeks 2400 years ago, but our national policies are working ever more powerfully in the opposite direction, creating strong incentives for infected and possibly infected people to flee to the United States from Liberia, Guinea and Sierra Leone. Given this rapidly changing climate of contagion, and the importance of bringing the Greek solution to the national consciousness, I asked Anthony to please let me publish this post in his broader “puzzling things” category.
An example of something that creates an undesirable “positive atmospheric pressure” in the Ebola hot-zone is the promise that CDC Director Tom Frieden issued last week, telling the world that if anyone arrives at a major American airport with history or symptoms that indicate possible Ebola infection they will be whisked straight to the hospital, providing the strongest possible incentive for people who think they might be infected to come here for treatment. (This incentive can also be described as the creation of negative atmospheric pressure in the United States because the flux direction depends on position.)
At the same time, Frieden insists that travel from Liberia, Guinea and Sierra Leone to the United States should remain unrestricted, providing opportunity as well as incentive for hot-zone residents to flee here. From Frieden’s October 9th interview on Fox News:
Staff from CDC and the Department of Homeland Security’s Customers & Border Protection will begin new layers of entry screening, first at John F. Kennedy International Airport in New York this Saturday, and in the following week at four additional airports … [which] … receive almost 95 percent of the American-bound travelers from the Ebola-affected countries.
Travelers from those countries will be escorted to an area of the airport set aside for screening. There they will be observed for signs of illness, asked a series of health and exposure questions, and given information on Ebola and information on monitoring themselves for symptoms for 21 days. Their temperature will be checked, and if there’s any concern about their health, they’ll be referred to the local public health authority for further evaluation or monitoring.
This funneling of hot-zone travelers through screening here in the U.S. was just made mandatory, guaranteeing care to the possibly infected. The resulting outward pressure—motivating infected people to move to a previously uninfected continent—will spread the infection, not contain it. Set aside that the CDC is supposed to give priority to American lives and should first and foremost work to keep Ebola from coming here, intercontinental spread of Ebola is a disaster for the whole world. Each breach of containment endangers everyone everywhere.
Not making obvious mistakes like this is the easy part (or should be), but creating “negative atmospheric pressure” in the hot-zone is not so easy. It has to be safer for residents of the hot-zone to stay put than to leave. That means that transmission within the hot-zone has to be stopped or greatly reduced.
So long as the contagion keeps expanding within the hot-zone itself the pressure on residents to flee will keep increasing. But fighting transmission inside the hot zone is a labor intensive enterprise. Health care workers have to first diagnose who is infected and who is not, then isolate and treat the sick, all of which presents a high risk of transmission to the people doing this work. So how can transmission be stopped?
The only people who can fight Ebola on the ground without becoming vectors of transmission themselves are the immune survivors
Ebola is perhaps the most infectious pathogen ever encountered, transmissible by a single particle. The repeated assurances that Ebola is not highly contagious apply only while patients remain asymptomatic. Once they start explosively erupting at both ends, protection for anyone in attendance must be perfect, which is very difficult to achieve. Sixteen members of Doctors Without Borders have become Infected and these are the best trained and equipped people in Africa. The numbers are vastly higher for the less well trained and equipped native African health care workers.
Three weeks ago NPR ran a happy talk segment on how easy it is to stop the spread of Ebola that completely ignored the problem of transmission through health care workers:
So to stop the chain of transmission, all health workers in Texas have to do is get the people possibly infected by the sick man into isolation before these people show signs of Ebola.
Then R0 drops to zero. And Texas is free of Ebola.
Then we all found out how difficult it is to keep health workers from getting the disease. The transmission rate, R-zero, does not drop to zero. With enough training and equipment transmission might be lowered dramatically, but only at impossible cost. Here a hospital director reacts to the CDC’s prep call (via Brian Preston):
Ebola Preparation “will bankrupt my hospital!” “Treating one Ebola patient requires, full time, 20 medical staff. Mostly ICU (intensive care unit) people. So that would wipe out an ICU in an average-sized hospital.”
At extreme expense we might be able to protect medical workers from contamination in a very limited number of Ebola cases. In Africa, forget it. But immune survivors do not need to be protected from contamination and this is a resource that Africa has in rapidly growing numbers.
Immune survivors can make it both safer and more remunerative for hot-zone residents to stay put
Survivors have full immunity only to the Ebola strain they were infected with, but if they provide care in their local area they should be okay. Dr. Bruce Ribner on PBS:
Ebola virus is a new infection on this continent, but our colleagues across the ocean have been dealing with it for 40 years now, and so there is strong epidemiologic evidence that, once an individual has resolved Ebola virus infection, they are immune to that strain, recognizing that there are five different strains of Ebola virus.
Designate local isolation compounds for triage and treatment, drop off people and supplies, and no one comes out without a clean bill of health, bleached clothes, and a nice chlorinated shower. The immunity (in most cases) of the survivors means they could provide care without transmitting the disease, allowing the contagion to be rolled back, and the income they receive (this is where aid money comes in) would prop up the local economy, all of which would work to keep hot-zone residents in place.
If coming to America is off the table then flight from the Ebola hot-zones is a very daunting proposition. Africa is not a thriving land of opportunity and travel is more of a way to catch disease than avoid it. Thus if transmission within the hot-zone can be drastically reduced, negative atmospheric pressure is readily attainable, and this is what the use of immune survivors allows. Not being vectors, they can intercede to stop transmission in the cases under their care.
Some of these survivor health-workers will get infected with different strains and some will surely die from it, but the fact that they are largely immune will allow the work of isolation and treatment to continue, which is simply not possible otherwise on any major scale.
Six weeks ago I started writing on my own blog the about the need to focus on an immune survivor strategy. Since I only post intermittently nobody sees my stuff unless I post elsewhere (thanks Anthony), but I did send my post to Stanford health economist Jay Bhattacharya and he said hey, that’s Thucidydes!
The immune-survivor treatment strategy was implemented by the Greeks 2400 years ago
Jay sent me this passage from Thucydides:
But whatever instances there may have been of such devotion, more often the sick and the dying were tended by the pitying care of those who had recovered, because they knew the course of the disease and were themselves free from apprehension. For no one was ever attacked a second time, or not with a fatal result. All men congratulated them, and they themselves, in the excess of their joy at the moment, had an innocent fancy that they could not die of any other sickness.
Neither am I the only one to advocate the use of immune survivors today. The day after I published my post Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, wrote the following in The New York Times:
The United Nations … should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection.
We have one immune survivor here in the United States, Dr. Kent Brantly, and with luck and prayers he may soon be joined by Nina Pham and Amber Vinson, but West Africa has a few thousand, and with the infection rate expected to soon reach 10,000 per week, that will become another 3000 survivors a week. The resource is there, we just have to use it, but the rationalizations provided by CDC Director Frieden show that he is looking in the opposite direction.
Frieden wants non-immune aid workers to go to Africa
That’s what he keeps saying whenever he tries to explain why he is against travel restrictions, that restrictions will make it harder for aid workers to travel to Africa:
One strategy that won’t stop this epidemic is isolating affected countries or sealing borders. When countries are isolated, it is harder to get medical supplies and personnel deployed to stop the spread of Ebola.
As the likely author of whatever restrictions would be imposed, Frieden would be free to attach whatever exceptions he deems necessary for getting aid workers in and out, but set that aside. His premise to begin with is that outsiders should be going in and providing treatment. Like the happy talkers at NPR (who were trying to explain why Frieden is so confident that Ebola will not spread in the United States), Frieden ignores the problem of health care workers as a disease vector. About people who are being tracked and monitored he says:
The moment if they have any symptoms, if they have fever, they will be isolated. That is how you break the chain of transmission.
Yeah, not really. For a very small number of Ebola patients, at huge expense, maybe, if levels of protection and training are vastly improved. For Africa? Send in supplies and a small number of organizers at most, but no one from the outside should be sent in to deal with possibly infected subjects, not our military, not the National Guard, and unexposed natives should not be recruited either. Turn it over to the immune survivors. That is the only way to stop the contagion, and this critical resource is not here in America. It only exists in Africa, so stop bringing Ebola patients here!
Frieden keeps insisting that efforts to contain Ebola geographically will cause it to spread geographically
It is a bizarre contention. All non-government commentators regard isolation and treatment as complimentary strategies but Frieden insists they are either/or:
Restricting travel or trade to and from a community makes it harder to control in the isolated area, eventually putting the rest of the country at even greater risk. Isolating communities also increases people’s distrust of government, making them less likely to co-operate to help stop the spread of Ebola.
He is equating isolation with abandonment, which is a non sequitur. Does a patient placed in an isolation room become harder to control? Does being cared for in isolation make him more distrustful, and make observers distrustful, or does it make every one thankful? Frieden’s strained efforts to support this weak narrative are illogical to the point of dishonesty:
When a wildfire breaks out we don’t fence it off. We go in to extinguish it before one of the random sparks sets off another outbreak somewhere else.
Really, the guy’s never heard of a firebreak? We actually set fires, sacrificing part of the tree population to save the rest. Not that we should do that in Africa, but c’mon dude. Don’t just lie about stuff!
Travel restrictions may indeed have some downsides, but they also have a most important upside: they stop sick people from traveling around the world spreading disease. The question, which Frieden never even attempts to address, is whether the downsides he puts forward outweigh the upside in terms of disease transmission. Indeed, it is perfectly clear that Frieden is not accounting the upside at all, since he implicitly assumes it would be outweighed by the flimsiest of hypothesized downsides.
In reality, it is hard to think of any downside to travel restrictions that could begin to compare to the importance of keeping the Ebola-infected from freely carrying the disease wherever they want. The first imperative is to stop Ebola from making its way around the world and as director of the CDC it is Frieden’s first responsibility to make sure it doesn’t travel here. If other countries are also self-protective that is good. It will limit the spread of Ebola which makes everyone safer.
Is Frieden (and/or Obama) trying to reduce outward pressure by holing the containment vessel?
As meteorologists know, atmospheric pressure can be a tricky concept. Because it pushes in different places, distinguishing cause and effect can take some care, and this applies to the disease transmission analogy as well.
To achieve negative pressure in the Ebola hot-zone containment is obviously not enough. Transmission within the hot zone must be greatly reduced or else pressure to flee will build and build until it inevitably explodes. Could Frieden be looking at this looming build-up of pressure and getting the causality backwards? Is he proceeding on the idea that, if we never have containment in the first place, then the pressure cannot build enough to have an explosion?
Actions suggest that he and others may actually be trying to reduce outward pressure by getting rid of containment up front and even encouraging people to flee. Witness the “Ebola Outbreak-related Immigration Relief Measures” issued by the U.S. immigration service in mid-August, which the CDC would surely have had input on. Some of the measures are reasonable, allowing “Nationals of Guinea, Liberia and Sierra Leone Currently in the United States” to stay here for now instead of forcing them to go back to the hot zone when their visas expire, but the measures gratuitously go much further, providing extreme incentive for residents of these countries to get themselves into the United States ASAP.
The really damaging relief measure (pressure relief measure?) is the first, which offers an opportunity for, “[c]hange or extension of nonimmigrant status for an individual currently in the United States, even if the request is filed after the authorized period of admission has expired.”
A change of status means a change from non-immigrant to immigrant status, thus any West African who is here on a tourist visa is eligible to be immediately switched to permanent resident status, leading to citizenship, and here’s the kicker: as Doug Ross noticed, there is no cut-off date for who is eligible for this change of status.
Instead of applying only to West Africans who were already here in mid-August, any Ebola-zone citizens who can get themselves over here on a tourist visa are immediately eligible to switch to permanent resident status, providing huge incentive for immediate mass outflow from West Africa to the United States. Obama/Frieden are offering them a once-in-a-lifetime jump-to-the-head-of-the-line opportunity to become American citizens.
We know Obama’s motivation, but why is the CDC going along?
President Obama, being a politician, can of course have political motivations for incentivizing West Africans to come here for citizenship. His intentional collapse of our southern border suggests that one of the ways that he wants to “fundamentally transform America” is by importing a new electorate, more to his liking. (DHS let a huge contract for the internal transport of unaccompanied illegal alien minors months before the vast wave of “unaccompanied minors” arrived, proving that the entire crisis was engineered by Obama.)
But CDC Director Frieden is supposed to be non-partisan, guided only by the objective requirements for keeping his countrymen safe from disease. How can a medical doctor be supportive of a ramped-up influx of immigrants from West Africa that is highly incentivized to carry Ebola?
Friedan’s big career-making achievement was dramatic reductions of tuberculosis in New York City and India, accomplished by systematic tracking, isolation and treatment of the infected. His oft-repeated mantra on Ebola is the same. “We know how to stop Ebola,” he says, by tracking, isolating, and treating infected individuals. Could he be fixated on tracking as a means?
Frieden wants people who could be infected with Ebola to fly so that they won’t travel “over land”
Note the particular language Frieden uses to explain why he thinks travel restrictions will be counter-productive. He keeps saying he wants the possibly infected to travel by means that enable tracking. That points directly to a preference for airline travel:
FRIEDEN: Right now, we know who’s coming in. If we try to eliminate travel, the possibility that some will travel over land, will come from other places, and we don’t know that they’re coming in, will mean that we won’t be able to do multiple things. … Borders can be porous — may I finish? – especially in this part of the world. We won’t be able to check them for fever when they leave, we won’t be able to check them for fever when they arrive. We won’t be able, as we do currently, to take a detailed history to see if they were exposed when they arrive.
When they arrive, we wouldn’t be able to impose (ph) quarantine as we now can if they have high-risk contact. We wouldn’t be able to obtain detailed locating information, which we do now, including not only name and date of birth, but e-mail addresses, cell phone numbers, address, addresses of friends, so that we could identify and locate them.
We wouldn’t be able to provide all of that information, as we do now, to state and local health departments, so that they can monitor them under supervision. We wouldn’t be able to impose controlled release, conditional release on them, or active monitoring, if they’re exposed, or to, in other ways…
The whole point of tracking is to stop further transmission so that we don’t have to do more tracking. The fact that a mode of travel enables tracking isn’t a plus if it also multiplies the need to track, as around the world commercial jet travel obviously does. In Frieden’s accounting the smallest amount of un-tracked contagion is more dangerous than a wide open and highly incentivized avenue of tracked contagion, because this is what we are talking about here.
The “overland” spread of Ebola that is Frieden’s sole concern would be extremely difficult under a travel ban. Even if frightened people could make their way out of Liberia and Guinea and Sierra Leone by ground travel (very difficult, snce many neighboring countries have closed their borders) they would still need to fly to reach the United States, which requires a visa, which requires a passport, which would still identify them as coming from a hot-zone country. The other possibility is that they fly to Mexico or Canada and travel overland at this end, but a) these crossings are within in our power to control, and b) if we impose a travel ban then Mexico and Canada will surely follow suit.
Frieden focuses entirely on the relatively tiny number of cases where a few West Africans might still get in by these untracked routes (a number that might well be decreased, not increased, by travel restrictions), and he completely ignores ignores the vast majority of cases where travel restrictions would keep the possibly Ebola-infected out. This selective accounting is not legitimate. It is basic economics and basic epidemiology that all impacts have to be fully accounted. Only looking at untracked flow is like buying merchandise for $100 a pop, selling it for $1 a pop, and thinking you are making money because you are only counting the flow of $1 receipts.
NIAID head directly mis-states travel requirements
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, does not seem to be aware of how travel documentation works. On Sunday he claimed that:
“If you say, ‘Nobody comes in from Sierra Leone, Liberia or Guinea,’ there are so many other ways to get into the country. You can go to one of the other countries and then get back in [to the United States]. So when they come in from a place where you know you can track them, you know [where they are].”
Wrong. Escapees from the hot-zone would only be able to get here via “other countries” if those other countries start issuing them passports that hide their true origin. Frieden and Fauci are doctors, not travel agents, but the entire USCIS knows that their claim about border hoppers being able to fly to the United States is wrong.
Regardless of Fauci’s confusion, the underlying error is still the same. Even if travel restrictions did somehow lead to an increase in un-tracked travel across the Atlantic (highly dubious), this increased avenue for Ebola transmission would still be tiny compared to the vast wide-open “above ground” highway for Ebola transmission that a travel ban would close off.
These supposed experts are acting as if there is no danger so long as we can track transmission, ignoring what a desperate game it is try to smother every outracing tendril from each outbreak. It’s like trying to stamp out an intrusion of cockroaches before any can escape through a crack.
Learning the wrong lesson from Nigeria’s close call
With heroic effort Nigeria just pulled off the squash-all-the-cockroaches feat, dedicating thousands of man hours of urgent detective work to successfully run down and isolate each multiplying pathway of Ebola exposure before they could multiply out of reach and consume a city of 21 million.
It was a very near thing and Frieden and Fauci are clearly learning the wrong lesson from it. They view it as confirmation that tracking works and can “stop Ebola in its tracks,” but the real lesson of Nigeria is the tremendous danger that just one infected airline passenger can pose. Realizing how lucky they were, Nigeria learned its lesson and stopped its hot-zone flights.
Much better not to let possibly infected people enter in the first place. Once an Ebola-infected person arrives a country might be quick enough to stop the contagion by tracking, monitoring and isolating individuals, but if the contagion gets away from them they will have to stop it the old fashioned way, the Greek way, by making use of the immune survivors as they emerge one by one from the spreading catastrophe.
Every nation has to be prepared for those same three stages of Ebola prevention and response. First we try to keep it from entering. If that fails then we try to contain the outbreak with tracking, monitoring and isolation of exposed individuals, and if that fails and there is an epidemic, only immune survivors can roll it back. Frieden and Fauci are fixated only on the middle third of this puzzle, the tracking. They aren’t concerned with keeping Ebola from getting here and they aren’t looking at how to fight it if it breaks out. Neither are they merely absent from these other battlefields but their fixation on tracking has them aggressively bringing Ebola here (losing the first battle), when the only people who can safely treat the disease are in Africa (losing the final battle).
A perfect storm of illogic
Put Frieden’s apparent belief that tracking is a panacea together with his apparent confusion about cause and effect and they support each other. This seems to be his actual thinking: that if we let the infected out of the hot zone (while carefully tracking) then there won’t be an explosion because the pressure won’t have a chance to build up.
Could it be that simple, that he just doesn’t understand atmospheric pressure, where the whole point of creating negative pressure is to stop the outflow of the pathogen, so if pressure is reduced by the outflow of the pathogen that means we failed? Is the guy just that stupid? Or does he have some horrific political agenda like President Obama? (Definitely possible, since untracked TB and other infectious diseases pouring over our unenforced southern border elicit no protest from him.)
Either way, Congress better provide some countervailing force and quickly because the CDC is working hard to bring the negative pressure to our side of the Atlantic, sucking Ebola in. It is clear what we should be doing: imposing travel restrictions and using hot-zone Ebola survivors to separate and treat the newly infected. Then the problem won’t just stay in West Africa, it will be solved there.
The alternative, if Obama and Frieden can’t be stopped, is that we suffer our own Ebola epidemic, where the only way to avoid decimation or worse will be to deploy our own rapidly growing army of immune survivors. It’s either Thucydides in Africa or Thucydides in America, our choice.
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This article starts from the premise that Ebola is highly infectious and then goes on to debate a number of other issues. However – just like the assumption that atmospheric CO2 is the cause of global warming, this initial premise is actually quite wrong.
Ebola is NOT a highly infectious agent. It is a virus which can only be transmitted through broken skin via bodily fluids. It is not airborne and infectivity outside a moist environment is on the timescale of 1-2 hours before it dries out. If you read the CDC/WHO information you will find all of this information, together with the case counts and deaths attributed to this Ebola outbreak. In three West African countries with virtually no organized health system there are to date less than 5,000 deaths from around 10,000 cases over a three month period. If Ebola were highly infectious (influenza or smallpox) infection rates would be many thousand fold higher than this (definition of infection rates is number of cases divided by exposed population and do the maths). The fact that Nigeria and Senegal – hardly highly developed countries themselves – have cleared outbreaks based on travel-related infections shows that the systems of follow-up and monitoring work. That three health care workers in developed countries (two in the US and one in Spain) does not alter this finding.
By using a false premise, the author has built a case for a series of extremely severe actions that will harm a large number of people – does this sound like another current scare story we are concerned about here at WUWT?
It’s possible that Ebola can get in the blood stream via nose & mouth, without broken skin:
http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola
All that has to happen is that someone with the disease coughs. You get the water droplets in the cough on you and touch your eye, nose or mouth. Or after the person coughs, you touch a surface where the water droplets landed a couple of hours later and again touch your eye, mouth or nose. The people arguing It is not airborne are trying to hide behind a technical definition that is not helpful and hides or minimizes the potential problem.
>>What is transmission by droplet contact?
Some diseases can be transferred by infected droplets contacting surfaces of the eye, nose, or mouth. This is referred to as droplet contact transmission. Droplets containing microorganisms can be generated when an infected person coughs, sneezes, or talks. Droplets can also be generated during certain medical procedures, such as bronchoscopy. Droplets are too large to be airborne for long periods of time, and quickly settle out of air.
Droplet transmission can be reduced with the use of personal protective barriers, such as face masks and goggles. Measles and SARS are examples of diseases capable of droplet contact transmission.
>> What is airborne transmission?
Airborne transmission refers to situations where droplet nuclei (residue from evaporated droplets) or dust particles containing microorganisms can remain suspended in air for long periods of time. These organisms must be capable of surviving for long periods of time outside the body and must be resistant to drying. Airborne transmission allows organisms to enter the upper and lower respiratory tracts. Fortunately, only a limited number of diseases are capable of airborne transmission.
Diseases capable of airborne transmission include:
Tuberculosis
Chickenpox
Measles
Ebola is highly infectious (takes very little of it to infect someone) and only moderately contagious (on average each infected person infects about 2 people). But the measure of contagiousness is a function of human behavior. Ebola is not highly contagious so long as the sick are isolated, but it is highly contagious to anyone who tries to care for the Ebola patients. That’s why the Greek strategy of using immune survivors to give care is so important. It is the only way to give care without continuing to transmit the disease. Modern protective equipment may be able to block transmission in a few cases at great expense, but if an outbreak spreads in any significant degree, the expertise and the equipment and the are going to be quickly exhausted.
If it gets that bad, commercial airlines will probably find that they can’t get staff willing to fly the planes to infected areas.
They’ll just use different uniforms.
Its kind disappointing on a supposed free thinking site like this to see the same alarmism against Ebola that we criticise so much about the climate science movement. The fact is Ebola is one of the worlds lightweight diseases with flu, aids and measles responsible for over 350m deaths. So why is no one demanding quarantine from africa for AIDs, why arent travel restrictions put in place for countries with flu and measles outbreaks? We should be channeling our resources into creating a serum and vaccine for the disease, trying to quareteen a continent especially one with such limited border control as africa is just folly, and dare I say if it wasn’t a african state it wouldn’t even be contemplated.
Except that closed borders, travel restrictions & quarantine are precisely what African countries have done successfully to stop spread of the epidemic from the three affected states to their nations.
Tim
October 22, 2014 at 3:04 pm
“Its kind disappointing on a supposed free thinking site like this to see the same alarmism against Ebola that we criticise so much about the climate science movement. The fact is Ebola is one of the worlds lightweight diseases with flu, aids and measles responsible for over 350m deaths.”
One doubling in one month so far. 5000 deaths so far.
In 12 months, global mortality through Ebola will exceed total current mortality if the trend proceeds like that.
Exponentials. They always surprise people when it’s too late.
For a good logarithmic chart…
http://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa
(you find that page easily by searching for Ebola 2014 in the wikipedia)
CAGW hasn’t killed anyone. Ebola has.
“…CDC Director Frieden is supposed to be non-partisan…”
So was the IRS.
Vaccination could begin in West Africa in January 2015, says Der Spiegel
German
http://www.spiegel.de/gesundheit/diagnose/ebola-impfung-koennte-anfang-2015-in-westafrika-starten-a-998425.html
Google translated
https://translate.google.com/translate?sl=de&tl=en&js=y&prev=_t&hl=de&ie=UTF-8&u=http%3A%2F%2Fwww.spiegel.de%2Fgesundheit%2Fdiagnose%2Febola-impfung-koennte-anfang-2015-in-westafrika-starten-a-998425.html&edit-text=
This post is overly long. I gave up when it descended into nonsense about Obama wanting to recruit Ebola patients from Africa as future voters.
Some points about the medical aspects of this piece.
1. Ebola is not the most infectious agent ever discovered, not by a long shot. Good, old pneumonic plague would have already felled millions during the time of the current Ebola outbreak. So did influenza in 1918.
2. In 1967, there was an outbreak of Marburg virus in Europe. A handful of people died, but the outbreak was then contained. The same will happen to Ebola – it will be contained in any country with a somewhat reasonable health surveillance system. This includes the U.S.
3. The author’s suggestion to use immune survivors to care for the patients is good in principle. However, it is essential that these be properly trained, lest they spread the infection through careless handling of infected materials.
4. The author criticizes the announcement that symptomatic flight passengers arriving from Africa be examined for Ebola infection. What is the alternative? Letting them loose into the general population? The mandate of the CDC is to ensure health surveillance. Travel restrictions should be imposed and enforced by other agencies.
Addition – the current outbreak likely is due to a single strain, so the problem of survivors having incomplete immunity will likely not arise in the current situation. Moreover, in most such cases, there is partial cross-immunity; having survived one strain will probably produce a more favourable outcome in case of a second infection. M. Palmer, MD/medical microbiology specialist
Odd, it has been reported that there are 3 to 5 strains currently active and that the virus mutates rapidly and could get mixed with other viruses though that I believe that is thought to be true of a number of viruses. But as a chemist, you must know all that. But it seems there are a lot of unknowns. Maybe Holdren’s dreams are coming true …
http://phys.org/news/2014-08-potential-therapy-sudan-strain-ebola.html
http://www.huffingtonpost.com/2014/04/16/ebola-africa-new-strain_n_5162354.html
http://www.cbc.ca/news/health/ebola-outbreak-in-guinea-5-things-you-should-know-1.2584439
http://www.the-scientist.com/?articles.view/articleNo/40896/title/Ebola-Outbreak-Strains-Sequenced/
Obama wanting to recruit more immigrants is not nonsense, but objective reality. Not only has he opened our border even wider & released illegal immigrant felons from custody, but as an election year ploy invited tens of thousands of “child” immigrants into the US, many of whom do in fact carry various diseases, yet have been released into the care of previous illegal immigrants.
After the election, he is planning on using unconstitutional executive orders to enact immigration “reform” in order to let in millions more of future Democrat voters. His plan for non-legislative “comprehensive immigration reform” was shelved until after the election at the begging of Democrat candidates across the country. Maybe he’ll be dissuaded from taking this drastic step by surviving Democrats in Congress, but I’d be surprised. His administration is actively preparing for the influx of a new wave of illegals already, with plans rapidly to make them legal with Green Cards & eventually of course voting citizens.
Whatever. Surely even Obama is aware that dead African immigrants aren’t going to vote for him. All you left-and right-wing Americans with your mutual dark suspicions and absurd accusations really need to have your collective heads examined. It is getting annoying to have every factual discourse polluted with such nonsense.
Face palm. Thank you Michael Palmer for you little injection of sanity.
The electorally popular thing to do would be to BAN ALL West Africans from infected countries from entering the United States of America. What part of this sentence does NOT make sense. People really should think about what they type before launching into conspiracy style theories.
Michael Palmer
October 22, 2014 at 8:44 pm
“Whatever. Surely even Obama is aware that dead African immigrants aren’t going to vote for him.”
Michael, you are not paying attention. ESPECIALLY dead people vote democrat. USA does not check the identity of voters. Supreme court of the USA tends to strike down laws that demand voter identification with a photo ID; arguing that such laws are racist.
It is one of these empire end stage things that are plain insane but currently happening.
“The author criticizes the announcement that symptomatic flight passengers arriving from Africa be examined for Ebola infection. What is the alternative?”
Travel restrictions. Don’t let passengers from Liberia, Guinea and Sierra Leone arrive here. The combination of unrestricted travel and the promise of care is a huge incentive for people who think they may have been exposed to hop a plane here. Does Mr. Palmer really not see the problem?
As I clarified earlier, Ebola IS perhaps the most infectious pathogen ever encountered. Infectiousness is how much is required for infection. With Ebola, one germ. It is not the most contagious, meaning the average infected person does not transmit to a lot of other people, but it is highly contagious to anyone who tries to care for a symptomatic Ebola patient–these people ARE likely to get it–hence the need to use immune survivors to administer care if transmission is to be stopped.
Also need to take into account how quickly a contagion cycles from one generation of infection to the next. Ebola is only a little more contagious than HIV, but its generation cycle is fast, a couple of weeks, so it can run through a whole population very quickly. Lagos could have lost half its population in six months. Of course by then everyone is running and the whole country gets it.
Ebola already is spreading uncontrolled in the hot-zone countries. The danger is very real.
Thanks to Michael for the addition about the liklihood of substantial cross-immunity. I left that out on account of, as Michael notes, the post is already quite long.
Only one germ, huh? And how was that “germ” operationally defined? As a single virus particle, carrying a single genome copy? Highly unlikely, and also not very relevant for the current discussion.
I don’t object to travel restrictions, but – not being a US citizen and not a lawyer either – I would assume that authorities other than the CDC would have to impose them. As long as they are not imposed, the CDC is doing the right thing by screening.
Michael Palmer,
One germ = one organism.
It is possible for one ebola virus to infect a single blood cell [that’s how they reproduce]. Then the blood cell’s DNA is turned to making copies of the virus. It bursts, and voila! Instant carrier.
It’s not negative pressure. Lord I hate the laymen that call it that. IT IS VACUUM. FFS you scientists know so little of real world applications that I as a simple engineer that makes things work knows.
Can we call it antipressure, please? BTW Germans don’t have the problem, we have the word Unterdruck for it. Under-pressure.
The US military calls the reverse overpressure.
I lost a friend from Sierra Leone I used to go to school with in Belgium in the 80’s to ebola in the last few weeks. There is a lot of fear and panic in the media but it truely is a serious problem and I hope it is brought under control soon.
It is being reported that this is the second outbreak of Ebola in Guinea. So I took look. Apparently the current outbreak is not the first incidence of the disease in West Africa.
Abstract – 1999
Human Infection Due to Ebola Virus, Subtype Côte d’Ivoire: Clinical and Biologic Presentation
In November 1994 after 15 years of epidemiologic silence, Ebola virus reemerged in Africa and, for the first time, in West Africa. In Côte d’Ivoire, a 34-year-old female ethologist was infected while conducting a necropsy on a wild chimpanzee…….
http://jid.oxfordjournals.org/content/179/Supplement_1/S48.short
Let’s look at a genuine quarantine: an example from the Australian Department of Agriculture regarding Rabies and the export of dogs and cats into Australia:
The cat/dog is currently living in Country A
Country A is not an approved country
Country B is an approved Category 3 country
The Country B government allows cats/dogs to be imported from Country A to Country B
The animal receives the rabies vaccination and testing in Country B and certification is provided by the Country B competent veterinary authority
The animal returns to Country A
About 5 months later the animal returns to Country B until the time of export to have final preparations undertaken by an approved veterinarian
The animal spends about, or a minimum of, 45 days in Country B for the preparations to be completed
Final vet check is performed in Country B 5 days before export to Australia
Certification of the permit conditions is provided by the Country B Official Government Veterinarian
Animal is exported from Country B to Australia.
http://www.agriculture.gov.au/biosecurity/cat-dogs/step-by-step-guides/non-approved-countries
Veterinarians engage in quarantine operations all the time.
When my brother & his DVM wife imported alpacas from Bolivia, they had to live for weeks at the now closed Harry S Truman Animal Import (quarantine) Center on Key West.
A big part of her business was filling out quarantine paperwork for other species. It’s not as if we don’t know how to do this.
Frieden is a buffoon, merrily dancing in the court of his emperor.
This isn’t new. A year and a half ago when I was in ER because they thought I had meningitis, they put me in a negative pressure room, at the rinky dink local hospital. They weren’t genius about keeping the sliding doors closed at all times though – which is the whole point of the system. Keeping the door open constantly overwhelms the air intake. A bit more training and our local tiny hospital already has what it takes.
Ebola doc comes back from hot-zone, plays with girlfriend, takes Uber rides, goes bowling, starts showing Ebola symptoms:
http://www.nydailynews.com/new-york/doctor-treated-ebola-patients-rushed-bellevue-fever-article-1.1984941
This cuts against Frieden’s first reason for leaving travel open: so that aid workers can freely travel in and out. Wrong. They should only be taking chartered flights out. Then we can force these possibly-exposed people to undergo the necessary period of quarantine BEFORE they come back. Set up a quarantine compound and don’t let anyone get on a charter plane out until they have stayed there for three weeks.
dbstealey October 22, 2014 at 11:25 am
Juan,
That may be the theory. But when Valerie Jarrett gets to take Air Force 2, then we know the score: whatever the President says, goes.
If V.P. Joe Biden doesn’t like it, what’s he gonna do about it?
Air Force 2 is whatever plane the VP is in, just like Air Force 1 is any plane the President is in, if they’re not in them the designation doesn’t apply.
As long as President Obola agrees…
Technically true, however the two Boeing VC-25As (747 variant) configured as presidential transports are typically referred to as Air Force One even when the C-in-C isn’t aboard them, unless he’s on some other aircraft, which is then Air Force One, Marine One or even Navy One (once, when Bush landed on a carrier, in the copilot seat).
The usual Air Force Two is a Boeing VC-32 (757 variant), of which I believe 1st Airlift Squadron (Andrews AFB, MD) has six. This VIP transport unit also has various other aircraft, such as Boeing C-40B Clippers (737 variant). Recent presidents have flown on Gulfstream IIIs, too, for shorter hops or security reasons. But the same call sign rule applies to Veep as to POTUS.
milodonharlani October 23, 2014 at 7:48 pm
As you must know, there are 55 Democrat Senators, & Reid has changed the rules to disallow filibusters for nominations. Hence, there is nothing stopping the majority party from confirming the administration’s nominee if it wanted him.
Except as I pointed out Rand Paul has put a hold on the nomination so no vote on the confirmation can be held! Since you don’t seem to understand what a ‘hold’ is here’s a definition:
In the United States Senate, a hold is a parliamentary procedure permitted by the Standing Rules of the United States Senate which allows one or more Senators to prevent a motion from reaching a vote on the Senate floor.
I’m sure that I know more about holds than you do, unless you’ve worked or studied parliamentary procedure in the Senate. In that case, you’d know that holds, like filibusters, can be defeated via a cloture motion. I suspect that you’re getting your information from leftwing blogs rather than the real world.
The reason that Paul’s hold wasn’t long ago overridden is that Reid & vulnerable Democrats didn’t want the nomination to be voted on before the election. There was nothing stopping them from defeating the hold last year or this year, except their own survival instincts.
Instead of reading those blogs, how about consulting a real, award-winning, working journalists, with impeccable Left Wing credentials, Amy Goodman, Juan González & Denis Moynihan, who actually know what’s what in DC, instead of just looking for lame excuses. This, ripped from today’s headlines:
http://www.democracynow.org/blog/2014/10/23/ebola_czar_we_need_a_surgeon
Although I’m a libertarian conservative & registered Independent, I couldn’t have said it better myself:
“Fear of the NRA’s perceived power, however, prompted several Democrats — those with tight re-election races in 2014 — to indicate they would not vote to support Murthy. Among those expected to vote against him were Mary Landrieu of Louisiana, Mark Pryor of Arkansas, and Mark Begich of Alaska. These incumbent Democrats and others didn’t want to provoke the NRA before the midterm elections. So the U.S. has no surgeon general.”
At the very least the so called highly trained workers, before being allowed home should be in isolation for 21 days tended by and training the survivors in some place where they can enjoy a rest. The idea of paying those survivors to bring aid and hope to their communities makes more sense than any other idea
milodonharlani October 22, 2014 at 3:56 pm
While the apparent resistance to HIV found among some in Northern European populations suggests a possible viral agent behind the Black Death, recent DNA studies IMO pretty conclusively show that the plague pathogen was indeed the bacterium Y. pestis:
The resistance to HIV-1 in some N Europeans is due to the double knockout of the gene producing the protein CCR5 which HIV-1 uses as its mode of entry to the immune system cells. A single copy of the knockout gene is found in about 20% of N Europeans in dictating that it must have conferred a survival advantage in the past. Evidence from the survivors from Eyam in Derbyshire, for example, indicate that it also appeared to give resistance to plague, it doesn’t mean that the plague was passed via a virus just that Y Pestis also utilizes CCR5.
dbstealey October 23, 2014 at 7:39 pm
Michael Palmer,
One germ = one organism.
It is possible for one ebola virus to infect a single blood cell [that’s how they reproduce]. Then the blood cell’s DNA is turned to making copies of the virus. It bursts, and voila! Instant carrier.
Specifically, immune system cells, such as monocytes and macrophages, not red blood cells.
After that first cell is infected the host will have about 1,000 virus particles in the body, not enough to be detected or infectious.
milodonharlani October 23, 2014 at 7:38 pm
The Ebola virus has been detected in sweat, so it could indeed be transmitted therefrom:
http://www.cdc.gov/vhf/ebola/transmission/qas.html
It has not, and that report does not say that it does.
” The whole live virus has never been isolated from sweat.”
http://www.who.int/mediacentre/news/ebola/06-october-2014/en/
WHO as well as the CDC disagree with your baseless assertion:
http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/epr-highlights/3648-frequently-asked-questions-on-ebola-hemorrhagic-fever.html
That the whole live virus hasn’t been isolated from sweat doesn’t mean that infective viri don’t exist there. That they have been detected indicates that they do. Isolation from sweat, where the sample is small, is naturally more difficult.
Have you ever worked in a lab? I;m guessing not. But please, by all means, feel free to wipe the sweat from an Ebola patient’s brow, then rub your eyes.
But before you do that, please bear in mind again what the CDC says:
“When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with
blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
objects (like needles and syringes) that have been contaminated with the virus
infected fuit bats or primates (apes and monkeys)”
As with most of your guesses you’re wrong. The viruses have not been detected in sweat (WHO). The fact is that live virus does not exist in sweat, compared with blood plasma which contains more than one million live virus particles/ml. Neither of your cites show anything to the contrary. Sweat is hypo-osmotic compared with plasma and is acidic so survival of the virus would be unlikely. Merely possessing the RNA for Ebola does not mean that it’s infectious because the RNA has to enter the cell to replicate and needs its protein coating to do so via endocytosis.
What “guesses” of mine have been wrong? That was the only “guess” I made. OTOH your WAG guess about how the Senate works was laughable.
Ebola virus has not been detected only by reverse-transcription polymerase chain reaction (RT-PCR) in sweat, but tissue in & around sweat glands have tested positive for EBOV antigens in primates.
But if you’re so sure that contact with sweat doesn’t put you are risk, please, by all means, go for it. And forget about the respirator, if you’re also sure about no possible airborne transmission. Be my guest.
@milodonharlani
…
The presence of antigens in and around sweat gland tissue does not prove the presence of virus.
Secondly, the presence of this in primates does not prove it carries over into humans.
Humans are primates. Monkeys & apes, like us, have both apocrine & eccrine sweat glands. Our skin is similar, with the same number of follicles per square inch (in chimps at least). It’s just that much of our body hair grows short instead of long. Since researchers can’t infect humans to test for antigens, they use other primate species.
Ebola RNA has been detected in human sweat. That intact viri haven’t been observed in sweat doesn’t mean they cannot exist there. Indeed, the most reasonable supposition would be that they are there, as per WHO & CDC conclusions. Categorically ruling out the possibility of infection via sweat is unwarranted & risky, to say the least.
The Reston version of Ebola (RESTV) shows that a virus that infects “primates” does not also infect humans.
But most Ebola strains do infest both monkeys & apes, like humans. The point is that there is no reason to suppose that a virus for which antigens have been found around monkey sweat glands doesn’t also exist around human sweat glands. Why would any health care professional want to bet the other way?
Unless you can say “all” the word “most” is never conclusive.
..
When actual Ebola viral particles are detected in human sweat, I will concede. Until then, it’s “guessing” In fact, it wouldn’t be that hard to collect some sweat from a person confirmed to be infected to determine if viral particles are in fact in the person’s sweat.
juan,
Thanx for you assertion. But since you are an anonymous commenter like Phil., I will go with this national report:
http://www.newyorker.com/magazine/2014/10/27/ebola-wars
At least the author signs his name to it.
After that first cell is infected the host will have about 1,000 virus particles in the body, not enough to be detected or infectious.
So, don’t worry?
That sounds like NY Mayor DiBlasio. The mayor says not to worry:
http://www.nytimes.com/2014/10/24/nyregion/craig-spencer-is-tested-for-ebola-virus-at-bellevue-hospital-in-new-york-city.html?_r=0
No just that your assertion that “It is possible for one ebola virus to infect a single blood cell [that’s how they reproduce]. Then the blood cell’s DNA is turned to making copies of the virus. It bursts, and voila! Instant carrier”, is false.
Phil., wake up and learn something:
The virus is extremely infectious. Experiments suggest that if one particle of Ebola enters a person’s bloodstream it can cause a fatal infection…. Once an Ebola particle enters the bloodstream… where it takes control of the cell’s machinery and causes the cell to start making copies of it. [source]
Phil you are correct.
..
The statement, “Then the blood cell’s DNA is turned to making copies of the virus” is false.
…
The virus carries it’s own DNA/RNA , it does not use the DNA of the cell it invades.
The virus injects its RNA genome into the cell and reverse transcriptase makes a DNA copy which is then processed by the cell to produce RNA copies which become the viruses.
I was wrong about the mechanism? Well, excuse me!
But your stated claim was that 1,000 virus particles are “not enough” to infect someone.
Typical misdirection there, Phil.
You can listen to Mayor DiBlasio. Me, I prefer to avoid taking the chance that having 1,000 ebola viruses in me is nothing to worry about.
Re quarantie, problem is culture.
An outbreak in East Africa a few years ago was stomped quick, as some people knew what to do and the rest listened. President of country urged people not to even shake hands.
In the stricken countries in West Africa a large proportion of people are ignorant and won’t listen. There are reports of relatives of dead people taking their bodies out of Red Cross bags and doing the Islamic funeral preparation ritual of washing the body – with many people participating, using a common wash bowl!
I hear that Liberia is succeeding at stopping the outbreak, it is only 20% Muslim and may have many differences from the other two that were stricken early.
http://classicalvalues.com/2014/10/ebola-and-cannabis/
It has anti-viral properties. See the bit by Dr. David Allen at the bottom.
Some say a vaccine is ready. I involves Russian ‘secret’ research into Ebola and a lab accident with Ebola in 1996 and another in 2004.
Was that in response to:
From: http://classicalvalues.com/2014/10/ebola-and-cannabis/
dbstealey October 25, 2014 at 10:40 am
I was wrong about the mechanism? Well, excuse me!
But your stated claim was that 1,000 virus particles are “not enough” to infect someone.
Typical misdirection there, Phil.
No typical misdirection and evasion by you!
You said: “It is possible for one ebola virus to infect a single blood cell [that’s how they reproduce]. Then the blood cell’s DNA is turned to making copies of the virus. It bursts, and voila! Instant carrier”
As I pointed out it is not an ‘instant carrier’ as you put it because that early in the replication process a total body viral load of ~1,000 particles is not enough to cause infection. Later when the patient is symptomatic, vomiting, diahorrea, bleeding and producing fluids containing millions of particles/ml is when infection takes place.
You can listen to Mayor DiBlasio. Me, I prefer to avoid taking the chance that having 1,000 ebola viruses in me is nothing to worry about.
What I said was having 1,000 Ebola particles in ‘someone else’ was nothing to worry about, but as usual you don’t quote what someone posts instead you misquote it.
Phil me boi,
Still smarting over the b!tch-slapping the planet is giving you? Global warming has stopped, and not just recently. That means you and your kind were flat wrong all along.
You’re wrong here, too, but I have other folks I am busy straightening out, so you will just have to wait your turn.
Straighten yourself out first, as usual you don’t have a clue what you’re talking about.