News Is Ebola's Exponential Spread Uncontainable?

[StevieTNZ]

http://www.nbcnews.com/storyline/eb...r=155869377766434&cid=sm_fb_20141024_34324287

A doctor just back from West Africa has preliminarily tested positive for the Ebola virus at New York's Bellevue Hospital, city officials told NBC News on Thursday.

 

[nsaspook]

There is something seriously wrong with the PPE requirements and procedures if medical personnel are getting sick and this doctor thought it was safe to be in public so soon after arriving from a hot zone after being in direct contact with infected victims.

 

[Astronuc]

http://www.nbcnews.com/storyline/eb...r=155869377766434&cid=sm_fb_20141024_34324287

Officials: New York doctor has Ebola, 1st in city
http://news.yahoo.com/doctor-visited-africa-tested-ebola-nyc-003404036.html

Press conference now.

Officials are searching for or trying to locate his contacts and will isolate those they suspect of being exposed in contact.

 

[lisab]

There is something seriously wrong with the PPE requirements and procedures if medical personnel are getting sick and this doctor thought it was safe to be in public so soon after arriving from a hot zone after being in direct contact with infected victims.

This! This has been bugging me all along. I think there's some kind of subliminal thinking among Westerners who, when confronted with the fact that African medical workers are being infected at high rates, might think: oh, it's because they don't have Western training or equipment, it's because they're poor. Total BS, IMO! These doctors and nurses are professionals. Every day, they do the same procedures Western docs do: set bones, stitch wounds, assist births, perform surgeries. They know how to protect themselves from diseases Western medicos only see once or twice (or never) in their careers.

The PPE protocol should be getting a close review, IMO.

As far as the doctor who just tested positive, I wish him all the best.

 

[russ_watters]

There is something seriously wrong with the PPE requirements and procedures if medical personnel are getting sick...

Did you read some of the things the nurses union was saying about the Texas PPE protocols? The protocols they did receive didn't work. After complaining that their necks weren't covered, they were instructed to wrap themselves in surgical tape! Unbelievable.
http://www.cnn.com/2014/10/15/health/texas-ebola-nurses-union-claims/

 

[nsaspook]

As far as the doctor who just tested positive, I wish him all the best.

I wish the doctor well too but I don't think he should have been bowling or having close contact with others until the possible incubation period had passed.

 

[OmCheeto]

I wish the doctor well too but I don't think he should have been bowling or having close contact with others until the possible incubation period had passed.

This just tells me that the doctor considered that there was zero risk that he had been infected, based on available information.

I contracted whooping cough about 10 years ago. It is also not considered an "airborne" transmissible disease. Yet, its infection rate is staggering.
I was working in a hospital at the time, and although there was a "this is not a problem" official attitude, a friend working in the pharmacy confided that Pertussis inoculations had been ordered for all doctors and nurses.

If a patient sneezes, or coughs, and a doctor, moments later, walks into their room, what's to keep him from catching it?

It's still my guess, that this is not a PPE problem.

And I'm not implying that Pertussis is anything nearly as bad as Ebola, I'm only inferring a potential transmission mode.

Pertussis in Other Countries
Worldwide, it is estimated that there are 16 million pertussis cases and about 195,000 pertussis deaths in children per year. Despite generally high coverage with childhood pertussis vaccines, pertussis is one of the leading causes of vaccine-preventable deaths worldwide. Most deaths occur in young infants who are either unvaccinated or incompletely vaccinated.

Hopefully, the clinics the Army Corp of Engineers are building in the affected nations, have no windows.
Sometimes, western technology, makes things worse.

 

[nsaspook]

This just tells me that the doctor considered that there was zero risk that he had been infected, based on available information.

Logically it seems that assumption of near zero risk is flawed in some way.
http://news.yahoo.com/1st-ebola-case-nyc-3-others-quarantined-060226282.html

A three-week quarantine makes sense for anyone "with a clear exposure" to Ebola, said Dr. Richard Wenzel, a Virginia Commonwealth University scientist who formerly led the International Society for Infectious Diseases.

Some health workers could "have a kind of denial there are any exposures," and an automatic quarantine would address that, Wenzel said.

At the same time, he conceded health workers might be leery of volunteering if they knew they would be confined to their homes for three weeks after they got back.
...
Graham said the federal government should rent out a hotel — perhaps one in the Caribbean, to ease public fears — and then staff it with doctors and quarantine all returning health care workers there for three weeks.

I might volunteer for a three week Caribbean vacation.

http://www.reuters.com/article/2014/10/24/us-health-ebola-newyork-idUSKCN0IC2CU20141024

Reuters) - The Obama administration is considering quarantines for healthcare workers returning from Ebola-ravaged West African countries, an official said on Friday, as authorities in New York retraced the steps of a doctor with the disease.
...
Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, said he could not pinpoint anyone factor that contributed to Pham’s speedy recovery. He said it could be any of a number of factors, including the fact that “she's young and very healthy” and was able to get intensive care very quickly.

Pham received donated blood plasma from Dr. Kent Brantly, who contracted Ebola working in Liberia for a Christian relief group and survived after being treated with an experimental drug. Brantly was released from a hospital in August.

It's good to see that early treatment works so fast.

 

[Astronuc]

Many New Yorkers were dismayed to learn that in the days after he came home, Dr. Craig Spencer rode the subway, took a cab, went bowling, visited a coffee shop and ate at a restaurant in the city of 8 million.

Spencer, a 33-year-old emergency room doctor, returned to the U.S. on Oct. 17 and sought treatment Thursday after suffering diarrhea and a 100.3-degree fever. He was listed in stable condition at a special isolation unit at Bellevue Hospital Center, and a decontamination company was sent to his Harlem home. His fiancee, who was not showing symptoms, was being watched in a quarantine ward at Bellevue.

So he returned home Oct 17, and by Thursday, Oct 23, he was seeking treatment for symptoms that were indicative of Ebola, after he returned to New York City from treating Ebola patients in Guinea. He should have quarantined himself!

So now - after the fact - NY, NJ order Ebola quarantine for doctors, others arriving from West Africa and who may or did have had contact with victims of the disease.
http://news.yahoo.com/1st-ebola-case-nyc-3-others-quarantined-060226282.html Why don't Ebola doctors returning from West Africa quarantine themselves?
'As long as a returned staff member does not experience any symptoms, normal life can proceed,' Doctors Without Borders says
http://news.yahoo.com/why-dont-ebola-doctors-self-quarantine-140038847.html
According to Dr. Mary Travis Bassett, New York City's health commissioner, "Spencer had been taking his temperature twice a day."

He began feeling sluggish on Tuesday but did not develop a fever until Thursday at 11 a.m., when he discovered he was running a 100.3-degree temperature. Spencer alerted Doctors Without Borders, which in turn alerted New York health officials.

Meanwhile, back in W. Africa - Mali reports first case.
http://news.yahoo.com/doctors-without-borders-ebola-risk-cant-zero-120707049.html

BAMAKO, Mali (AP) — Many people in Mali are at high risk of catching Ebola because the toddler who brought the disease to the country was bleeding from her nose as she traveled on a bus from Guinea, the World Health Organization warned Friday.

The U.N. agency is treating the situation as an emergency since many people may have had "high-risk exposures" to the 2-year-old girl during her journey through several towns in Mali, including two hours in the capital, Bamako. The girl was traveling with her grandmother.
. . . .

 

[jim hardy]

And I'm not implying that Pertussis is anything nearly as bad asEbola, I'm only inferring a potential transmission mode.

It's suspected in some circles that Ebola transmits via aerosols.
http://www.cidrap.umn.edu/news-pers...ers-need-optimal-respiratory-protection-ebola

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.1

Here's their reference 1:
http://www.ajicjournal.org/article/S0196-6553(07)00774-2/abstract

Conclusion
None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices.

A few TV news reports have shown personnel wearing face protection with an external air hose, suggesting they're full face respirators like I'm used to from the Nuke plant.

This is how we learn, by experience.

 

[Astronuc]

http://news.yahoo.com/number-ebola-cases-passes-10-000-101744209.html

DAKAR, Senegal (AP) — More than 10,000 people have been infected with Ebola and nearly half of them have died, according to figures released Saturday by the World Health Organization, as the outbreak continues to spread.

The number of confirmed, probable and suspected cases has risen to 10,141. Of those cases, 4,922 people have died, according to the UN/WHO.

It is the largest outbreak yet. Hopefully, it will be the last.

 

[Vanadium 50]

Astro, why do you think it will be the last? I think our experience is that diseases don't just disappear. They have to be eradicated.

 

[Astronuc]

US journalist

Astro, why do you think it will be the last? I think our experience is that diseases don't just disappear. They have to be eradicated.

I not thinking it will be the last, but hoping it will be the last major outbreak. There are apparently vaccines being developed, or at least treatments, but unless folks change their ways, there will likely be more such occurrences.

US journalist Ashoka Mukpo discusses his experience with Ebola
http://news.yahoo.com/us-journalist-says-body-war-ebola-192305250.html

Receiving a blood transfusion from Ebola survivor Dr. Kent Brantly, who was treated in Atlanta, was a turning point. The next day, Mukpo's eyesight was clearer, his headache and fever had lessened, and his body felt more under his control.

 

[Astronuc]

Poor health systems in Asia cause for concern/alarm regarding Ebola.
http://news.yahoo.com/poor-health-systems-asia-cause-ebola-alarm-051240578.html [/PLAIN]

SINGAPORE (AP) — The longer the Ebola outbreak rages in West Africa, the greater chance a traveler infected with the virus touches down in an Asian city.

How quickly any case is detected — and the measures taken once it is — will determine whether the virus takes hold in a region where billions live in poverty and public health systems are often very weak. Governments are ramping up response plans, stepping up surveillance at airports and considering quarantine measures. Still, health experts in the region's less developed countries fear any outbreak would be deadly and hard to contain.
. . . .

 

[OmCheeto]

Have any of you been tracking the rate of new Ebola infections? It seems that there is pretty clear exponential growth, and the virus is anything but contained. Is anyone else bothered by this? By looking at this just mathematically, some huge swath of people will become infected. At a certain point the shear number of infections could threaten to collapse the efforts to contain it. Maybe the outbreak is just too big to contain. Maybe the outbreak is too slow moving to cause a health care collapse. I'm no epidemiologist, but I'm guessing that this outbreak will continue for years into the future.

About a week a ago, I saw a bar graph on wiki of the number of reported cases per week:

It looked as though the cases per week had leveled off. Unfortunately, the author did not reference the source. So I snooped around and found the "situation reports" at the WHO, where I found periodic total count numbers for the 3 primary affected nations.

After entering in the data, and doing a little bit of smoothing, as the data out of Liberia is really jumpy, it looks as though the above graph is moderately accurate.

Here's my graph:

​

So it does appear that the new case rate per day has been dropping.

Interpolating the data some more, I took the numbers from the 4 highest count consecutive reports, and the numbers from the four latest reports, and determined that the reduction in reported cases is about 2.17 per day over a 26 day period. Which, if the trend continues, the epidemic will be over a couple of weeks before Christmas.

Let's cross our fingers. :)

Here's my csv file with the raw data, in case anyone else has a better way of interpreting the data.

 

[OmCheeto]

...
US journalist Ashoka Mukpo discusses his experience with Ebola
http://news.yahoo.com/us-journalist-says-body-war-ebola-192305250.html

Excellent video. I was going to post about his case yesterday, as I thought his case was peculiar.
He claims that he thinks he caught Ebola, while washing a car?

October 6, 2014
The American journalist with Ebola who arrived at a Nebraska hospital today believes that he may have gotten infected when he got splashed while spray-washing a vehicle where someone had died from the disease.

 

[Astronuc]

Who's over-reacting?

US doctor who survived Ebola: Christie's mandatory quarantine creates 'police state' - as opposed to a personal quarantine?
http://news.yahoo.com/ebola-doctors-mandatory-quarantine-police-state-125216108.html

Apparently a person exposed to Ebola can be asymptomatic (until they're not) up through 21 days.

 

[nsaspook]

Mandatory quarantine, confinement, vacation, "controlled monitoring" or whatever else we will call it should be an expected condition of reentry in the the US after high risk of exposure to Ebola. I don't think you need to be in total isolation for 21 days but legally restricted freedom of movement of possible carriers to stop potentially exposing others to Ebola is not a 'police state'.

The US military has a 'half-way' house in Italy for returning personnel.

http://www.cnn.com/2014/10/27/politics/soldiers-monitored-ebola/index.html

Jessica L. Wright, the undersecretary of Defense for personnel and readiness, issued an Oct. 10 memo that said troops who have faced an elevated risk of exposure to Ebola will be quarantined for 21 days -- and that those who haven't faced any known exposure will be monitored for three weeks.

 

[OmCheeto]

I cannot comprehend how horrible it must be in those countries:

Liberia already had only a few dozen of its own doctors. Then came Ebola.
October 11, 2014
...
Now, doctors put on their protective gear in the kitchen. There is no incinerator, so a 10-foot pile of Ebola-laced garbage and excrement sits in the back yard. There is no morgue, so bodies sometimes decay outside, next to where patients sit in white lawn chairs. There are no protective hoods for the full-body medical suits, so the health workers cut theirs out of extra Tyvek material. Moses, the top doctor here, received only one day of Ebola training.
...
According to the Liberia Medical and Dental Council, the country has 173 homegrown doctors. But the number is actually much lower. Most of A.M. Dogliotti’s graduates have gone abroad. Liberia’s ambassador to the United States said the country has closer to 50 doctors — or one for every 90,000 citizens, not counting foreign physicians.

Eight dead in attack on Ebola team in Guinea. ‘Killed in cold blood.
September 18, 2014
The bodies of eight people, including several health workers and three journalists, have been found days after they were attacked while distributing information about Ebola in a Guinean village near the city of Nzerekore, according to Reuters.

"The eight bodies were found in the village latrine," Albert Damantang Camara, a spokesman for Guinea's government, told Reuters on Thursday. "Three of them had their throats slit."

I need some good news...

Liberia: New Ebola mobile lab speeds up diagnosis and improves care
October 20, 2014
One of the challenges to bring the Ebola outbreak under control in Liberia has been lack of access locally to laboratories able to provide a quick and firm diagnosis of the disease. This month the United States Navy opened a new high-tech mobile laboratory near the Island Clinic, one of the Ebola treatment units in Monrovia, Liberia, that is supported by the WHO.

 

[Astronuc]

New York state backtracks on Ebola rules after nurse quarantine row
http://news.yahoo.com/concerns-mount-over-us-ebola-quarantine-163358012.html

Kaci Hickox, who became the first American health worker isolated under the new quarantine orders on Friday, claims she was made to feel like a criminal and that her compulsory quarantining was "inhumane."
. . . .
"This hero was treated with disrespect, was treated with a sense that she had done something wrong, when she hadn't; was not given a clear direction," de Blasio told a press conference.

"We owe her better than that and all the people better than that."

Ms. Hickox was only "allowed to wear paper scrubs, and" and was kept in a tent that was "equipped with just a hospital bed, a non-flush chemical toilet and no shower." Sounds rather unpleasant.Meanwhile - there is a potential case in a hospital in Baltimore, MD.Australia issues blanket visa ban on Ebola-hit countries
http://news.yahoo.com/australia-issues-blanket-visa-ban-ebola-hit-countries-022047232.html

 

[OmCheeto]

That is interesting... People who had been infected with cowpox were immune to smallpox. I will have to ask a milk maiden if I can find one.
...
http://en.wikipedia.org/wiki/Reston_virus

And now we get an expert opinion on this idea:

Could Reston virus be a vaccine for Ebola virus?
October 23, 2014
I have received many questions about whether immunizing with Reston virus could protect against infection with Ebola virus. Usually the question comes together with the statement ‘because Reston virus does not cause disease in humans’. I can think of two reasons why a Reston virus vaccine is not a good idea.

There have been very few confirmed human infections with Reston virus (4 according to Fields Virology 6th Edition), and although these individuals did not show signs of disease, the number is too small to make any conclusions. For example, if the case fatality ratio of Reston virus in humans were 1%, we might not have yet seen any deaths due to the small number of confirmed infections. However if we were to immunize a million people with a Reston virus vaccine, and the case fatality ratio were 1%, there would be 10,000 deaths, obviously an unacceptable rate for a vaccine. As the virus causes disease in nonhuman primates, and there are so few human infections, it is not possible to know the case fatality ratio.

I'll take that as; "It's a good idea, but it needs more testing".

 

[Astronuc]

Top UN Ebola official: new cases poorly tracked
http://news.yahoo.com/5-000-ebola-health-workers-needed-west-africa-092859165.html

KAMPALA, Uganda (AP) — Authorities are having trouble figuring out how many more people are getting Ebola in Liberia and Sierra Leone and where the hot spots are in those countries, harming efforts to get control of the raging, deadly outbreak, the U.N.'s top Ebola official in West Africa said Tuesday.

"The challenge is good information, because information helps tell us where the disease is, how it's spreading and where we need to target our resources," Anthony Banbury told The Associated Press by phone from the Ghanaian capital of Accra, where the U.N. Mission for Ebola Emergency Response, or UNMEER, is based.

Health experts say the key to stopping Ebola is breaking the chain of transmission by tracing and isolating those who have had contact with Ebola patients or victims. Health care workers can't do that if they don't know where new cases are emerging.
. . . .

A lot of work ahead.Meanwhile - Connecticut has the most mandatory Ebola quarantines in America
http://news.yahoo.com/connecticut-ebola-scare-quarantine-150928265.html

 

[OmCheeto]

Top UN Ebola official: new cases poorly tracked
https://www.physicsforums.com/threads/the-exponential-spread-of-ebola.768849/page-6
A lot of work ahead.

Are you sure that was the link you intended? I think this one is the one you wanted: http://hosted2.ap.org/OHCOL/8ef5320...st Africa/id-29160ff184384c01a3777c78ce146fae

Anyways, there appears to be a little bit of good news coming from the region:

Obama assails Ebola quarantines, saying they are based on fear, not facts
October 28, 2014

Of the seven Americans treated for Ebola, all have survived

many Liberians, who at first denied the epidemic was real, have come to their senses and changed their behavior by avoiding direct physical contact with sick or dead people.

Just left Sierra Leone: good news in fight vs leading cause of Ebola infection: safe burials in Freetown have gone from 30% to nearly 100%.

Still, as you said, a lot of work ahead.

In the article it also states that the head of the World Bank says they need 5000 more medical personnel in the areas. The U.S. Military has 700 personnel in the region, and expects to send thousands more.

 

[nsaspook]

http://news.yahoo.com/ebola-nurse-defensive-gets-call-obama-223238909.html

The Pentagon announced Tuesday that the Joint Chiefs of Staff recommended to Defense Secretary Chuck Hagel that he require all U.S. troops returning from Ebola-fighting missions in West Africa to be kept in supervised isolation for 21 days. Balancing that and similar quarantines announced by several state governors, President Barack Obama said the Ebola response needs to be "based on science."
...
Vinson, 29, was infected while caring for Thomas Eric Duncan, who died at Texas Health Presbyterian Hospital Dallas on Oct. 8. She inserted catheters, drew blood, and dealt with Duncan's body fluids, all while wearing protective gear.

I'm all for handling Ebola with the best known science but they really don't understand the method of transmission to medical professionals treating gravely ill people. It seems the latest US examples are of people who believed they had zero change of being an Ebola carrier and acted accordingly.

 

[Astronuc]

Simple new test finds Ebola in 15 minutes, could be ‘game changer’
Test would cut down on days-long wait for diagnosis
http://news.yahoo.com/simple-new-te...inutes--could-be--gamechanger--200026694.html

Tulane University scientists have created an Ebola diagnostic device that they say is as easy to use and nearly as fast as a home pregnancy test.

The potentially game-changing device, which takes only a drop of blood and 15 minutes to identify the disease, is awaiting federal approval before it can be used in West Africa. Doctors there say it is sorely needed to prevent people from spreading the deadly virus while they wait days for lab results.

Robert Garry, a professor of microbiology at Tulane, has teamed up with Corgenix, a Colorado-based company, to create the device with nearly $3 million in federal funds. They are awaiting a green light from the Food and Drug Administration to fast-track approval for its use in West Africa. Another company, Genalyte of San Diego, says it has developed a test that takes just 10 minutes and also needs only one drop of blood to diagnose.

Ebola fatality rates have been reported to be 70 to 90%, but it depends on age and probably health.

Why do some survive Ebola? Sierra Leone study offers clues
http://news.yahoo.com/why-survive-ebola-sierra-leone-study-offers-clues-070129976.htmlMeanwhile - "The nation's preparedness effort to fight outbreaks of Ebola and other infectious diseases has been under-funded and lacking in political will and commitment."

http://news.yahoo.com/funding-tame-ebola-outbreak-fallen-short-162948502.html

 

[Astronuc]

Nurse free to move about as restrictions eased
http://news.yahoo.com/nurse-free-move-restrictions-eased-051512351.html

FORT KENT, Maine (AP) — A nurse who treated Ebola patients in Sierra Leone can move about as she pleases after a Maine judge eased state-imposed restrictions on her, handing officials in Maine a defeat in the nation's biggest court case yet over how to balance personal liberty, public safety and fear of Ebola.
. . . .

 

[Astronuc]

Ebola 'Patient Zero': How Outbreak Started from Single Child
http://news.yahoo.com/ebola-patient-zero-outbreak-started-single-child-143918755.html

Apparently it is not known how the child contracted the disease, but it spread rapidly among family, friends and associates, then beyond the local community.Post-Ebola survivors have poor health afterwards.
'Post-Ebola Syndrome' Persists After Virus Is Cured, Doctor Says
https://gma.yahoo.com/post-ebola-syndrome-persists-virus-cured-doctor-says-181100681--abc-news-topstories.html

 

[klimatos]

There are three considerations about the current Ebola situation that, when taken separately are matters of interest, but when taken together are matters of concern.1. While the lethality of airborne Ebola infection is low under the warm and humid conditions of sub-Saharan Africa, the U. S. Army Medical Research Institute of Infectious Diseases (USAMRIID) suggests that the virus can be carried through ordinary ventilation systems under cooler and dryer conditions—conditions that are common in the rest of the world’s more populous areas. The 1989 infectious outbreak of Ebola in rhesus monkeys in a quarantine facility in Reston, Virginia, is thought to have spread in this manner. http://www.infowars.com/u-s-army-ebola-goes-airborne-once-temperature-drops/2. Many viral infections (hepatitis B, HIV, EBV, herpes simplex, etc.) are characterized by “asymptomatic carriers”. These are individuals who can infect others with the disease, but show no symptoms themselves. No such carriers have been identified as yet in connection with Ebola, but it would be foolhardy to assume that such carriers do not exist or will not exist. http://en.wikipedia.org/wiki/Asymptomatic_carrier3. The U. S. is posting troops to infected areas to help fight the current outbreak. When their tour of duty in these areas is completed, they will be returned to the U. S. where they will presumably be quarantined for a period of time. Quarantines are completely ineffective against asymptomatic carriers, and many of these posts have the cool and dry conditions that favor the airborne spread of the disease.Something to think about.

 

[Astronuc]

Guinea Is Seeing More Ebola Cases: Can The Trend Be Stopped?
http://www.npr.org/blogs/goatsandso...ing-more-ebola-cases-can-the-trend-be-stopped

In the current Ebola crisis, much of the focus has been on Liberia and Sierra Leone. But the virus also continues to spread in Guinea, where the first case in the current outbreak was identified in March.

According to the latest figures from the World Health Organization, Guinea has had fewer cases than either Sierra Leone (4,759) or Liberia (6,525). WHO has recorded 1,731 Ebola cases and 1,041 deaths in Guinea. This, however, is just a few dozen fatalities fewer than in Sierra Leone. And despite the lower numbers in Guinea, some data suggest the outbreak is spreading faster there than in the neighboring countries.
. . . .

So what's going on?

. . . As of June, when the epidemic began to hit the fan, there've been a lot of people leaving those countries [Liberia and Sierra Leone] to come back to their family [in Guinea]. Some of those people were sick without knowing it. When they were back, they started to show symptoms and contaminate their own family and the people around them. We've seen that many, many times. This explains why the epidemic re-launched and why it was very difficult to control it again.

 

[Astronuc]

As world leaders vow to 'extinguish' Ebola, new cases emerge in Mali.

http://news.yahoo.com/g20-leaders-commit-extinguish-ebola-outbreak-083640465.html

And there is a separate outbreak of a different strain of Ebola, which claimed at least 49 lives in the Democratic Republic of Congo since August. DRC now claims to be free of the disease.