outbreak of new Ebola strain

[Luther Blissett]

One of the supposed beheadees was named Cantlie. "Can't lie"

I think Cantlie is the one who has his own anti-western series on the caliphate network now. I heard he was just picked up for syndication.

[Col. Quisp]

This Patient Zero flew from Liberia to Brussels to Virginia, before arriving in Dallas. Might he have gotten the virus in the Liberian airport, or on the plane from Liberia to Brussels? I saw another comment that said he had been in Liberia for a funeral of his daughter, who died of ebola. Not sure if that's true.

Where did you get that info from? Last I read:

U.S. authorities haven’t disclosed the flights or airlines the patient took. None of the major U.S. airlines with overseas networks -- American Airlines Group Inc., United Continental Holdings Inc. and Delta Air Lines Inc. -- flies to Liberia.

I think i got the info from FluTrackers or Pandemic Flu Information board. But by now it's been divulged openly.

Here's info from NBC News:

Timeline: How Ebola Made Its Way to the United States

The state of Texas said Thursday that as many as 100 people might have come into contact with Thomas Eric Duncan, the first patient diagnosed with Ebola in the United States, or had contact with those he came across. Health officials are finding them and monitoring symptoms — and seeking to calm public fear of a wider outbreak.


Here’s a timeline of the case, compiled from information provided by federal and state health authorities, Dallas school, fire and hospital officials and NBC News reporting.

Sept. 15: Duncan takes his friend and neighbor Nathaline Williams, 19 and seven months pregnant, in a cab to a hospital in Monrovia, Liberia, believing that she is having a miscarriage, according to an interview with the cab driver. The cab driver later tells Dr. Nancy Snyderman of NBC News that Duncan carried Williams back to her apartment after four hospitals would not take her. Williams later dies from Ebola. The driver later says that Duncan appeared to be well.

Dallas Ebola Patient's Taxi Driver Describes the Scene
NBC News

Sept. 19: Duncan leaves Monrovia on Brussels Airlines Flight 1247 to Brussels, Belgium, the first step of a trip to the United States to visit family. He takes United Airlines Flight 951 from Brussels to Washington Dulles.

Sept. 20: Duncan takes United Flight 822 from Washington Dulles to Dallas. Health officials later say that Duncan was not showing symptoms while he was traveling. Ebola is only spread through direct contact with the body fluids of an infected patient who is symptomatic.

Sept. 24: Duncan begins to show symptoms.

Sept. 26: Duncan goes to Texas Health Presbyterian Hospital. He is examined and sent home with antibiotics. He tells hospital staff that he recently traveled from Liberia, but that information is not passed along.

Sept. 28: Dallas fire rescue is called to the apartment complex in Dallas where Duncan is staying. He is taken to the same hospital and admitted.

Sept. 29: A relative, Josephus Weeks, calls the 800 number of the Centers for Disease Control and Prevention and is told to call the state health department, according to Weeks’ account. He is called back several times, he says. He later accuses health officials of not moving fast enough. A state health official later tells NBC News that a call took place and that Weeks and other relatives told health authorities that Duncan had no contact with anyone who had Ebola.

Duncan's Relative: Just Pray For Us
NBC News

Sept. 30: Medical tests confirm that Duncan has Ebola. The CDC and state health officials call a press conference and alert the public.

Oct. 1: Dallas fire reports that all its ambulance workers have tested negative for Ebola. They are sent home, to be monitored for 21 days. Dallas schools report that five children in four schools may have had contact with Duncan but are not showing symptoms. Schools stress to parents that there is “no imminent danger to your child.” Dallas County health officials say they are watching 10 to 18 people who had close contact with Duncan, mainly family and close friends, and would “not be shocked” if a second case surfaces.

Oct. 2: Duncan is listed in serious condition by the hospital. State health officials say they are looking at about 100 people who may have had contact with Duncan or his relatives. Dallas County says that 80 people had contact either directly with Duncan or with people who had contact with Duncan. Duncan’s family is ordered by state health officials to stay home, with no visitors unless health officials give their approval, until Oct. 19.

Uh oh. Just heard NBC camera person covering Liberia tested positive to ebola.

NBC News Freelancer in Africa Diagnosed with Ebola

An American freelance cameraman working for NBC News in Liberia has tested positive for Ebola and will be flown back to the United States for treatment.

The infected freelancer was hired Tuesday to be a second cameraman for NBC News Chief Medical Editor and Correspondent Dr. Nancy Snyderman. Snyderman is with three other NBC News employees on assignment in Monrovia, reporting on the Ebola outbreak.

The freelancer came down with symptoms on Wednesday, feeling tired and achy. As part of a routine temperature check, he discovered he was running a slight fever. He immediately quarantined himself and sought medical advice. On Thursday morning, the 33 year-old American went to a Medicins Sans Frontieres (MSF) treatment center to be tested for the virus. The positive result came back just under 12 hours later.

The cameraman, who also is a writer, is the fourth American to have contracted Ebola in Liberia. He has been working in Liberia on various projects for the past three years. NBC News is withholding the cameraman’s name at the request of his family.

“We are doing everything we can to get him the best care possible. He will be flown back to the United States for treatment at a medical center that is equipped to handle Ebola patients,” NBC News President Deborah Turness said in a note to staff.

“We are also taking all possible measures to protect our employees and the general public,” Turness added in the note. “The rest of the crew, including Dr. Nancy, are being closely monitored and show no symptoms or warning signs. However, in an abundance of caution, we will fly them back on a private charter flight and then they will place themselves under quarantine in the United States for 21 days – which is at the most conservative end of the spectrum of medical guidance.”

American aid workers Dr. Kent Brantly and Nancy Writebol were infected in July while working for Samaritan’s Purse in Monrovia. Last month, Dr. Rick Sacra was diagnosed with the virus after working at a local hospital in Liberia. Liberian national Thomas Eric Duncan is currently being treated for Ebola at a hospital in Dallas, TX.

Here is the full text of Turness’ note to NBC News staff:

All:

As you know, Dr. Nancy Snyderman and our news team are in Liberia covering the Ebola outbreak. One of the members of their crew is an American freelance cameraman who has worked in Liberia for the past three years and has recently been covering the epidemic for US media outlets. On Tuesday he began working with our team. Today, he tested positive for Ebola.

We are doing everything we can to get him the best care possible. He will be flown back to the United States for treatment at a medical center that is equipped to handle Ebola patients. We are consulting with the CDC, Medicins Sans Frontieres and others. And we are working with Dr. Nancy on the ground in Liberia.

We are also taking all possible measures to protect our employees and the general public. The rest of the crew, including Dr. Nancy, are being closely monitored and show no symptoms or warning signs. However, in an abundance of caution, we will fly them back on a private charter flight and then they will place themselves under quarantine in the United States for 21 days – which is at the most conservative end of the spectrum of medical guidance.

We know you share our concern for our colleagues and we will continue to keep you up to date and informed. Please don't hesitate to reach out to me or David Verdi with any questions.

Deborah

Been nice knowing you guys!

[Ben D]

Is it correct that the Ebola virus is not atmospherically transmitted, and can only infect another person when there is physical contact and where there is a cut or open sore of some sort through which the virus enters?

On Edit...I have done a search and seems it is correct....

http://www.cdc.gov/vhf/ebola/transmission/

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) with blood or body fluids (including but not limited to urine, saliva, feces, vomit, and semen) of a person who is sick with Ebola objects (like needles and syringes) that have been contaminated with the virus infected animals.

Ebola is not spread through the air or by water, or in general, food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats.

[8bitagent]

Geez, I didn't know that even according to the CDC and the UN the kill rate was so high. They're now saying 70-80% mortality rate. Christ.
Could you imagine if this thing went airborne? We'd be looking beyond Spanish Flu and into the dark ages of Europe. So how come the white "saints" who get infected with Ebola in Africa
get the special secret serum, yet these relief organizations can't administer this special serum to the thousands dying in West Africa?

[km artlu]

I posted upthread about a little slither of doubt I entertain re the "not airborne" aspect. That's been augmented since then by pondering the Westerners contracting Ebola while in Africa.

Especially the recent report of an NBC cameraman. I try to imagine how that person in particular would have been exposed, his not having been connected to providing medical care.

If I had that NBC gig my level of caution would be obsessive and hyper-vigilant. Seems appropriate. And yet the narrative insists that he would have somehow been so incautious as to have put himself in the way of bodily fluids secreted or excreted by a symptomatic individual.

It's difficult for me to conjure forth credible scenarios allowing for that. Okay -- he engaged the services of a prostitute. Similarly to his having passed the time playing Russian roulette. With a symptomatic prostitute no less. I don't think so.

Perhaps he was a victim of random projectile vomiting? Possible, not compellingly plausible. And, although medical personnel are clearly more exposed through their actions, one would also assume they'd be much more skilled in protective protocol.

An itch in the mind, as the man said. Viruses trade DNA, right? Through this they exchange capabilities, I am told. That can't happen simultaneously across an entire viral population, can it?

There would be outliers among them to be the first to express airborne capability, I assume. And stemming from that there would be an initial cohort of cases which would defy the "not airborne" insistence. Few enough of them, at first, to maintain the official narrative.

Mosquito-borne would apply equally to these speculations.

Someone please shoot down these lines of reasoning. I know that it's all speculative, from a layman's perspective, and I would be very pleased for its flaws to be exposed.

[semper occultus]

In a recent commentary, Drs. Lisa M. Brosseau, Sc.D., and Rachael Jones, Ph.D., make the case for respirators, not just face masks, as necessary equipment in the fight against Ebola.

Recommending the precautionary approach in such a serious matter, the duo says that, just because it hasn’t been confirmed that Ebola can transfer through the air doesn’t mean that it shouldn’t be treated as such, especially when people’s lives are on the line.

The fact of the matter is that Ebola has never been proven not to transmit through the air, which is reason enough to assume that it does for the safety of workers on the ground.

The two doctors explain that, scientifically speaking, Ebola currently has “unclear modes of transmission,” meaning nobody truly knows all the ways that infections can emerge.

“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,” they wrote, citing an earlier paper Dr.Brosseau published in the American Journal of Infection Control.

http://www.genesisradiobirmingham.com/scientists-warn-ebola-transmission-may-be-airborne-urgefull-respirators-for-frontline-health-workers-naturalnews-com/

Ebola 'could become airborne': United Nations warns of 'nightmare scenario' as virus spreads to the US

Exclusive: Anthony Banbury, chief of the UN's Ebola mission, says there is a chance the deadly virus could mutate to become infectious through the air

By Katherine Rushton4:36PM BST 02 Oct 2014

http://www.telegraph.co.uk/news/worldnews/ebola/11135883/Ebola-could-become-airborne-United-Nations-warns-of-nightmare-scenario-as-virus-spreads-to-the-US.html

There is a ‘nightmare’ chance that the Ebola virus could become airborne if the epidemic is not brought under control fast enough, the chief of the UN’s Ebola mission has warned.
Anthony Banbury, the Secretary General’s Special Representative, said that aid workers are racing against time to bring the epidemic under control, in case the Ebola virus mutates and becomes even harder to deal with.

“The longer it moves around in human hosts in the virulent melting pot that is West Africa, the more chances increase that it could mutate,” he told the Telegraph. “It is a nightmare scenario [that it could become airborne], and unlikely, but it can’t be ruled out.”

He admitted that the international community had been “a bit late” to respond to the epidemic, but that it was “not too late” and that aid workers needed to “hit [Ebola] hard” to rein in the deadly disease.
Mr Banbury was speaking shortly before the first Ebola diagnosis was made in the US on Tuesday evening. The man, who contracted Ebola in Liberia before flying to Dallas, Texas, is the first case to be diagnosed outside Africa, where the disease has already killed more than 3,000 people.

The number of people infected with Ebola is doubling every 20 to 30 days, and the US Center for Disease Control and Prevention has forecast that there could be as many as 1.4m cases of Ebola by January, in the worst case scenario. More than 3,300 people have been killed by the disease this year.
Mr Banbury, who has served in the UN since 1988, said that the epidemic was the worst disaster he had ever witnessed.
“We have never seen anything like it. In a career working in these kinds of situations, wars, natural disasters – I have never seen anything as serious or dangerous or high risk as this one. I’ve heard other people saying this as well, senior figures who are not being alarmist. Behind closed doors, they are saying they have never seen anything as bad,” he said.

[Pele'sDaughter]

This outbreak is different from what we've seen in Africa in the past. Usually the virus burns through the host population quickly and it's done. I'm also concerned that the method of transmission has changed. I could even get paranoid and speculate that this was tweaked in a lab somewhere. "They" do want a reduction in population and what better way than a pandemic. It was quite disturbing that Prison Planet posted video of someone purportedly cleaning up ebola vomit off a sidewalk while wearing no protective gear whatsoever. I highly doubt that it what the video portrays, but at the same time I know people are likely to be that ignorant as we are always so poorly informed by NIH and CDC and most of us don't bother to find out for ourselves. The damned hospital that should've known better said this patient had the flu and sent him away! WTF!

[stefano]

I posted upthread about a little slither of doubt I entertain re the "not airborne" aspect. That's been augmented since then by pondering the Westerners contracting Ebola while in Africa.
[...]
Someone please shoot down these lines of reasoning. I know that it's all speculative, from a layman's perspective, and I would be very pleased for its flaws to be exposed.

"Airborne" means something specific in medicine, that the virus can stay alive in micro-droplets in the air, as with flu. Ebola isn't airborne in that sense but it can spread through the air in some freakish circumstances ("via infectious aerosol particle", as in the bit semper posted), say if a patient coughs right into your eye, or if you're in a room being spray-cleaned and a drop of water containing fresh blood splashes into your mouth. Given the number of cases so far, some of them will have been transmitted in ways like that. Real airborne transmission would require a series of mutations, but those mutations become more likely as the number of human hosts grows. Most plagues mutate in that way - becoming more infectious and less deadly over time.

This outbreak is different from what we've seen in Africa in the past. Usually the virus burns through the host population quickly and it's done.

It never reached a city before - this time it broke out in three major cities. The outbreak in DRC this time will probably be contained in the same way as previous outbreaks.

They're now saying 70-80% mortality rate.

It's 46.5% overall, says the WHO - probably less, as I expect the undercount of cases is bigger than the undercount of fatalities. Wide difference from place to place, from 27.0% in Sierra Leone to 61.4% in Guinea.

[stefano]

I was just doing these for work from the WHO's figures - obviously no good news. These are the cumulative figures, the WHO says new cases are coming off, but I think that's just because there are fewer people counting (especially in Monrovia).

[Col. Quisp]

Post from Sharon Sanders, of FluTrackers - I recommend visiting their site regularly - also this post has some images that might help explain how Ebola can be transmitted through droplets. Note, it is alleged Duncan knew he had probably gotten Ebola, and fled to the US where he assumed he would get ZMapp. Saw that on Drudge.

A Note to HHS/CDC - Please stop saying ebola is "not airborne" in your messaging - close proximity and droplet size matter
Dear HHS/CDC:

Please stop saying that ebola is only transmitted through direct contact with body fluids of an infected person - and that ebola is not airborne. This is not entirely accurate.

Ebola can be spread via the air depending on proximity and droplet size.

At FluTrackers we have been talking about this for months.

Thanks, and a couple of blogs by two members, below, that convey our opinions on this matter (my bolding in red):



It's what falls out of the aerosol that matters....


v2 031014
"Aerosol" is a messy word. It means different things to different people. So does "airborne".

What's in an aerosol?

Here we're talking about a mixture of different sized stuff. Think of the size range in a handful the sand from a shelly beach.

A cough/sneeze includes big, wet, heavy propelled droplets that quickly fall to the ground or hit your windscreen (hate it when that happens) or your friend's face (they hate it when that happens) down to dried or gel-like "droplet nuclei" that can float in the air for hours, travelling where the wind blows them; and every size in between.

I've also talked about this before, here.

The public rightly get confused about aerosols. And science and physics and medicine have their own defined meanings - sometimes at odds with each other - that may well be out of step with what the public think.

I do wish the the big public health entities would settle on some definitions for these and other words. It would make everyone's life a lot easier.

Direct contact.

When we talk about "direct contact" and Ebola virus transmission, we do include the bigger wetter heavier droplets that might be propelled from of a sick person during vomiting, or coughing as a risk for transmitting virus.

Even though that is not physical direct contact, and even though the droplets travel across a gap between people - through the air - it is still a direct line from person A (red in the graphic below) to B (blue). If B is too far away, then those droplets fall to the ground before they hit B. The droplets may remain infectious on the ground. That depends on temperature, humidity, surface type and the type and amount of virus.

The airborne route.

Even though it involves a short period of travel through the air, coughing wet droplets directly onto someone's mucous membranes is not an airborne thing. The term "airborne" is reserved for floaty clouds of droplet nuclei. In humans droplet nuclei have not, to the very best of our knowledge and observations and tests, been found to contain doses of Ebola virus that cause disease in humans. Too little virus coughed into the cloud perhaps or too little that survives..it's not known why, but it is pretty clear that in households where a case of Ebola virus disease was residing, only those household members who had direct contact developed disease, and those that breathed the same air but did not have direct contact, did not develop disease.

While Ebola viruses may be present in floaty clouds of droplet nuclei, or forced to be in a floaty clouds of droplet nuclei under lab conditions with lab viruses at lab virus concentrations, a floaty cloud of droplet nuclei has not been shown to act as a source of acquisition for Ebola virus and resulting disease among humans. Sorry, did I just repeat myself?

Rest in peace.

Please don't say Reston ebolavirus or the Hot Zone. That (by all accounts riveting) book was not a scientific work, it is a dramatized work and the language is colourful and emotive and scary. The Reston ebolavirus event in non-human primates was never proven to be airborne.

Lastly and most recently, an airborne route was not found to play any role in causing disease or infection when Ebola virus infected and uninfected non-human primates were caged near each other. I've written about this and other non-human primate studies here.

To summarize.

Healthcare workers wear face protection(masks and goggles) to prevent their eyes and mouth being hit by wet droplets of virus-laden body fluids while they are in close contact with ill Ebola virus diseases patients. The also wear all-over gowns so that they don't have to sterilize their clothes between each room they move between. Use of protective equipment doesn't need to convey confusing messages about the type of route Ebola virus uses to spread but it's just lacking in enough public discussion via forums the public attend/view. Knowledge is a bit like vaccination - when coverage reaches a certain level, the community is safe (or it's understanding is complete anyway).

And why wouldn't healthcare workers protect themselves from ill patient fluids-however they come into contact with them? For a healthcare worker, body fluids from ill people they are in close and often prolonged contact with, should generally be considered infectious. This is the case whether we're talking about Ebola virus disease, HIV, measles, influenza or something else. Some of those are caused by airborne viruses, some, like Ebola virus and HIV, not.

Below is my latest attempt at trying to make all those words into a picture.

If you have ways that can help me make this even simpler - please pass them along (thanks @chrisfharvey).







Posted by Ian M Mackay


---------------------------------------------



Monday, August 11, 2014

Ebola: Parsing The CDC’s Low Risk vs High Risk Exposures





# 8940

Five days ago (Aug 7th) the CDC released a revisedCase Definition for Ebola Virus Disease (EVD) which I covered here. As has been pointed out before, case definitions and other guidance documents are based on the CDC’s current understanding of a particular pathogen – but they not static – and they can be expected to evolve as more is learned about any given threat.

In this latest guidance, the CDC set forth three categories of potential exposure; High Risk, Low Risk, and No Known Exposures.

The High Risk exposures are the ones we have all heard about time and again:

High risk exposures
A high risk exposure includes any of the following:

Percutaneous, e.g. the needle stick, or mucous membrane exposure to body fluids of EVD patient
Direct care or exposure to body fluids of an EVD patient without appropriate personal protective equipment (PPE)
Laboratory worker processing body fluids of confirmed EVD patients without appropriate PPE or standard biosafety precautions
Participation in funeral rites which include direct exposure to human remains in the geographic area where outbreak is occurring without appropriate PPE

The CDC also listed Low Risk exposures, and over the past day or so have caused quite a stir on the Internet, with charges that this is some kind of `admission’ that Ebola is an airborne virus.

It isn’t, but that hardly matters if your primary goal is to drive web traffic.

First, let’s look what the CDC considers to be Low Risk exposure:

A low risk exposure includes any of the following

Household member or other casual contact1 with an EVD patient
Providing patient care or casual contact1 without high-risk exposure with EVD patients in health care facilities in EVD outbreak affected countries*

The term `casual contact’ is defined as:

a) being within approximately 3 feet (1 meter) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations); or
b) having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations).
At this time, brief interactions, such as walking by a person or moving through a hospital, do not constitute casual contact.

For the record, airborne viruses transmit well beyond a 1 meter radius of a patient. This 1 meter zone is basically within `spittle range’, where large droplets of mucus, blood, sweat, or other bodily fluids could potentially be coughed, sneezed, or otherwise propelled or flung onto another person.

While these risks may be considered low, they are not zero, and so it is important that people understand them. Still, to be infectious, a person has to be both infected, and symptomatic. And the odds of being exposed to someone outside of the `hot zones’ in West Africa right now are very slim.

There is actually another type of transmission, not really addressed here, and that is through fomites - surfaces or objects that an infected person might contaminate with body fluids - that could later infect someone else.

The trouble with including fomite exposure as an exposure risk is - unless you knew you’d been in a room with an Ebola patient (already covered above under Low risk) - you’d have no reason to suspect you’d touched a contaminated surface.

While I took exception to what I considered to be an overly simplistic infographic last week on Ebola transmission risks (see The Ebola Sound Bite & The Fury), I consider these guidelines – based on what we currently know about the Ebola virus – to be quite reasonable.

As far as what should be done about people who fall into either High Risk or Low Risk Exposure groups, the CDC has released the following tables in a document called Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure.



* Outbreak-affected countries include Guinea, Liberia, Nigeria and Sierra Leone as of August 4, 2014
1 Fever: measured temperature ≥ 38.6°C/ 101.5°F or subjective history of fever
2 Other symptoms: includes headache, joint and muscle aches, abdominal pain, weakness, diarrhea, vomiting, stomach pain, lack of appetite, rash, red eyes, hiccups, cough, chest pain, difficulty breathing, difficulty swallowing, bleeding inside and outside of the body. Laboratory abnormalities include thrombocytopenia (≤150,000 /µL) and elevated transaminases.
3 Conditional release: Monitoring by public health authority; twice-daily self-monitoring for fever; notify public health authority if fever or other symptoms develop
4 Controlled movement: Notification of public health authority; no travel by commercial conveyances (airplane, ship, and train), local travel for asymptomatic individuals (e.g. taxi, bus) should be assessed in consultation with local public health authorities; timely access to appropriate medical care if symptoms develop
5 Self-monitor: Check temperature and monitor for other symptoms
6 Consultation: Evaluation of patient's travel history, symptoms, and clinical signs in conjunction with public health authority

[divideandconquer]

According to the US Army's Center for Aerobiological Sciences and the US Army Medical Research Institute of Infectious Diseases at Fort Detrick, Ebola has an aerosol stability that is comparable to Influenza-A and winter temperatures may provide the climate needed to facilitate aerosol transmission. http://www.mdpi.com/1999-4915/4/10/2115/pdf

"Filoviruses, which are classified as Category A Bioterrorism Agents by the Centers for Disease Control and Prevention (Atlanta, GA), have stability in aerosol form comparable to other lipid containing viruses such as influenza A virus, a low infectious dose by the aerosol route (less than 10 PFU) in NHPs, and case fatality rates as high as ~90% ."

"The mode of acquisition of viral infection in index cases is usually unknown. Secondary transmission of filovirus infection is typically thought to occur by direct contact with infected persons or infected blood or tissues. There is no strong evidence of secondary transmission by the aerosol route in African filovirus outbreaks. However, aerosol transmission is thought to be possible and may occur in conditions of lower temperature and humidity which may not have been factors in outbreaks in warmer climates [13]. At the very least, the potential exists for aerosol transmission, given that virus is detected in bodily secretions, the pulmonary alveolar interstitial cells, and within lung spaces"

In 1998 the WHO and CDC infection-control guidance for healthcare workers providing care to Ebola patients recommended the use of respirators but now they recommend simple face masks when the potential for transmission via inhalation cannot be ruled out. http://www.cidrap.umn.edu/news-perspect ... tion-ebola

Being at first skeptical that Ebola virus could be an aerosol-transmissible disease, we are now persuaded by a review of experimental and epidemiologic data that this might be an important feature of disease transmission, particularly in healthcare settings.

What do we know about Ebola transmission?

No one knows for certain how Ebola virus is transmitted from one person to the next. The virus has been found in the saliva, stool, breast milk, semen, and blood of infected persons.8,9 Studies of transmission in Ebola virus outbreaks have identified activities like caring for an infected person, sharing a bed, funeral activities, and contact with blood or other body fluids to be key risk factors for transmission.10-12

On the basis of epidemiologic evidence, it has been presumed that Ebola viruses are transmitted by contaminated hands in contact with the mouth or eyes or broken skin or by splashes or sprays of body fluids into these areas. Ebola viruses appear to be capable of initiating infection in a variety of human cell types,13,14 but the primary portal or portals of entry into susceptible hosts have not been identified.

Some pathogens are limited in the cell type and location they infect. Influenza, for example, is generally restricted to respiratory epithelial cells, which explains why flu is primarily a respiratory infection and is most likely aerosol transmissible. HIV infects T-helper cells in the lymphoid tissues and is primarily a bloodborne pathogen with low probability for transmission via aerosols.

Ebola virus, on the other hand, is a broader-acting and more non-specific pathogen that can impede the proper functioning of macrophages and dendritic cells—immune response cells located throughout the epithelium.15,16 Epithelial tissues are found throughout the body, including in the respiratory tract. Ebola prevents these cells from carrying out their antiviral functions but does not interfere with the initial inflammatory response, which attracts additional cells to the infection site. The latter contribute to further dissemination of the virus and similar adverse consequences far beyond the initial infection site.

The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out by the observed risk factors or our knowledge of the infection process. Many body fluids, such as vomit, diarrhea, blood, and saliva, are capable of creating inhalable aerosol particles in the immediate vicinity of an infected person. Cough was identified among some cases in a 1995 outbreak in Kikwit, Democratic Republic of the Congo,11 and coughs are known to emit viruses in respirable particles.17 The act of vomiting produces an aerosol and has been implicated in airborne transmission of gastrointestinal viruses.18,19 Regarding diarrhea, even when contained by toilets, toilet flushing emits a pathogen-laden aerosol that disperses in the air.20-22

Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces.23 Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively.23

In still air, 3-mcm particles can take up to an hour to settle. With air currents, these and smaller particles can be transported considerable distances before they are deposited on a surface.

There is also some experimental evidence that Ebola and other filoviruses can be transmitted by the aerosol route. Jaax et al24 reported the unexpected death of two rhesus monkeys housed approximately 3 meters from monkeys infected with Ebola virus, concluding that respiratory or eye exposure to aerosols was the only possible explanation.

Zaire Ebola viruses have also been transmitted in the absence of direct contact among pigs25 and from pigs to non-human primates,26 which experienced lung involvement in infection. Persons with no known direct contact with Ebola virus disease patients or their bodily fluids have become infected.12

Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity.27 However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols.25-27

Altogether, these epidemiologic and experimental data offer enough evidence to suggest that Ebola and other filoviruses may be opportunistic with respect to aerosol transmission.28 That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.

Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)

Facemasks, however, do not offer protection against inhalation of small infectious aerosols, because they lack adequate filters and do not fit tightly against the face.1 Therefore, a higher level of protection is necessary.

From NCBI August 1995: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997182/

Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus.
The potential of aerogenic infection by Ebola virus was established by using a head-only exposure aerosol system. Virus-containing droplets of 0.8-1.2 microns were generated and administered into the respiratory tract of rhesus monkeys via inhalation. Inhalation of viral doses as low as 400 plaque-forming units of virus caused a rapidly fatal disease in 4-5 days. The illness was clinically identical to that reported for parenteral virus inoculation, except for the occurrence of subcutaneous and venipuncture site bleeding and serosanguineous nasal discharge. Immunocytochemistry revealed cell-associated Ebola virus antigens present in airway epithelium, alveolar pneumocytes, and macrophages in the lung and pulmonary lymph nodes; extracellular antigen was present on mucosal surfaces of the nose, oropharynx and airways. Aggregates of characteristic filamentous virus were present within type I pneumocytes, macrophages, and air spaces of the lung by electron microscopy. Demonstration of fatal aerosol transmission of this virus in monkeys reinforces the importance of taking appropriate precautions to prevent its potential aerosol transmission to humans

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[Twyla LaSarc]

This outbreak is different from what we've seen in Africa in the past. Usually the virus burns through the host population quickly and it's done. I'm also concerned that the method of transmission has changed. I could even get paranoid and speculate that this was tweaked in a lab somewhere. "They" do want a reduction in population and what better way than a pandemic. It was quite disturbing that Prison Planet posted video of someone purportedly cleaning up ebola vomit off a sidewalk while wearing no protective gear whatsoever. I highly doubt that it what the video portrays, but at the same time I know people are likely to be that ignorant as we are always so poorly informed by NIH and CDC and most of us don't bother to find out for ourselves. The damned hospital that should've known better said this patient had the flu and sent him away! WTF!

I'm having some problems finding the link, but the hosing down of vomit was done three or four days after the fact. There is no confirmation of anything having been done to actually sterilize the area. "Surely someone put bleach on it!" seems to be the extent of commentary of the care taken in this situation.

The relatives had to call CDC.

The airlines were the ones to release the flight data to notify their customers after the CDC didn't.

This lot makes the characters in Idiocracy seem like inellectually mature, well-balanced people I could have a beer with.

[Col. Quisp]

https://twitter.com/wfaachannel8/status/517739906211528704

A neighbor woman walked through that vomit wearing sandals. Cleaning crew not wearing hazmat suits....Gr-e-e-e-a-a-at..

[Wombaticus Rex]

Apologies if this has been posted before, but I found it to be the best, most thoughtful and wide-reading thinkpiece I've read thus far on the subject:

http://prosperouswaydown.com/uncharted- ... overshoot/

Highly recommend sitting down and engaging with the whole thing.

[Perelandra]

^Wow, that's well done, thank you.