Monday, November 3, 2014

More Common Sense Talking - 21 Days



Not breaking news, but worthwhile reading -

From The Atlantic, (10/21/14) , in the article entitled "21 Days", some more straight-up info on Ebola, our responses, and things to think about.

RTWT.

Highlight quotes:
For 4.1 percent of patients, based on mathematical modeling, the period between exposure and onset of the first symptoms is longer than 21 days. Around 13 percent of infected people in the current outbreak did not have a documented fever, according to a New England Journal of Medicine report last month. 
Hatfill: At the moment, it's the fruit bats. And their range extends way past Africa, the ones that are transmitting this. We found Ebola Zaire antibodies in bats in Bangladesh, and as far over as Borneo. And we're going to put 4,000 troops in the middle of this habitat. Are you going to tell the bats not to poop on the soldiers?
Hamblin: I could tell them, but I don't think they'd listen.
Hatfill: No, I don't either. So it's a problem.
But again, funding is intermittent. And with the sequestration, we're not even training Navy SEALS in combat-casualty care anymore. You had this whole unit that was ready for some type of emerging disease, whether it was Ebola or whatever. And they practiced. So, I mean, you couldn’t do better than that. And then it's gone.Hamblin: Totally gone?
Hatfill: Yeah. You could bring it back, but you still wouldn’t immediately have the experienced people who have rehearsed protocol for years. Intubation [placing a breathing tube down a dying patient’s throat] is difficult enough. You ever tried to do it in a space suit?
Hamblin: No.
Hatfill: So you practice these things. And develop a sense of calm. You don't take a nurse that's just come out of ICU training and then say, "Yeah, you go in there." You'd be crapping yourself. You need very experienced people that are used to it, and you need appropriate guidelines. We've taken a BSL-4 disease, and we're treating it in BSL-3 conditions. Because they did it in Africa.
So when I heard Anthony Fauci [director of the National Institute of Allergy and Infectious Diseases] say, yeah, one glove is sufficient, I just lost my mind.
Hamblin: There were claims, I'm not sure the origin of them, after the first Dallas nurse contracted Ebola, that it was maybe because she wore too much protective gear. I didn’t understand what that meant.
Hatfill: That's just complete nonsense. Look how they dress in Africa, and look at the first CDC guidelines. There's no comparison. You wear hoods. You wear masks and hoods over them. You wear goggles. You're getting sprayed when you come out and you're walking through a little kiddie pool filled with bleach. So the outside of your suit is being decontaminated before you try to take it off.
Hamblin: So what led to us treating it with such relative casualness? The CDC not having experience with Ebola in the U.S.?
Hatfill: [Thomas Frieden, CDC director] has become a political animal, in my opinion. And when you're dealing with this type of agent with no cure, no real vaccine, you must always err on the side of caution. They ignored a lot of published data. We've known for years now that the skin is a site of viral replication. The Langerhans cells, the antigen-presenting cells in the skin, are major targets for Ebola. The strains we know of. What that means is, you're shedding virus from the skin to the point where some people actually found you could come up, take a swab, just a cotton swab off the skin, and diagnose [Ebola] with a non-PCR method, and get a positive result from a live virus. 
Hamblin: So you’re saying there is at least some evidence that a person could brush up against someone and contract Ebola virus?
Hatfill: People have touched the bed of a patient and caught this, after the patient died and was removed. They brushed up against the bed and caught it.
 Hatfill: Here's the problem. You don't want to panic everyone. And [the CDC leaders] were at a loss that their [preventive] procedures didn't work and this happened and the leadership were shocked. You don't want to panic people, but people aren't stupid. You see people wearing semi-space suits taking these patients into hospitals, and everyone's telling you there's no aerosol transmission.
In the classical outbreaks of Ebola, there has been no evidence of aerosol transmission. That nurse and lab technician who handled the blood from the first guy, Duncan, I'm sure his blood went to the lab and he had a full blood count at his first admission. Well, Coulter counters [machines used to perform blood tests] are notorious for making little aerosols. And the fact that nobody in the laboratory came down with it is, yay. So we haven't seen aerosol transmission, classically, in all these smaller outbreaks for the last 30 years. And it's assumed that it wasn't transmitted aerosol. But that doesn't mean that it can't be. And we really don't know the amount of viral shedding.  [O]ther people have found live virus in saliva, tears, and nasal secretions.
So to say it's not aerosol transmitted is irresponsible. People aren't stupid.

 Hatfill: When the SARS epidemic happened, Singapore came very close to being wiped out. People don't realize this. And over there, if you chew gum or spit on the street, they cane you. Singapore had this under control overnight, and all their contact tracings were confined to their house, to the point where they would phone you every hour and you'd better answer the phone or the cops came by to arrest you. And they stopped it. You saw in the U.S. the journalist went out for pizza, this nurse went on a plane. Are you out of your mind? Though in a way this is good, because it shows aerosol and skin shedding in early infection is not occurring.
The cops went in to check Duncan's apartment without any personal protective equipment. His family members didn't come down with it. Again, this is like, whew. Kinda dodged a bullet there.
Sanjay Gupta, who is a neurosurgeon, did probably the best demonstration I've seen on why the CDC protocol failed. He dressed up in the recommended protective equipment and they put chocolate syrup on his hands. As an experienced neurosurgeon, how many times he's donned and doffed this gear? He took off his gear, and, yep, there were chocolate splashes all over his skin. There's a reason we use front-zipping Tyvek suits and not gowns. If an experienced neurosurgeon can't do it, what do you think a poor gal just out of ICU training is going to do?
The nurse that got infected knows she's in there with an Ebola patient, and God bless her for volunteering to do this. It's a very, very brave thing to do. But it's not just issuing a guideline. You have to practice implementing it. And the whole hospital has to practice. You can't come up with it at the last minute.
 Hamblin: How do we get the government to invest in emerging infectious disease preparedness?
Hatfill: We spent 120 billion on this, on emerging disease and bioterrorism, what have we got to show for it? Machines that the FDA hasn't licensed for rapid diagnosis.
Hamblin: I don't understand where the money you mention is going.
Hatfill: It disappeared. It just disappeared.

18 comments:

Percy said...

Not new. Read it then. Mad me angry and sad. Have been muttering about it to others, but the attitude seems to be "What else it new?"

I guess I have to add to that the fact that no one has any idea what they should or can do when a local case or two show up. Dallas, you'll notice, is still there with people in it. What were they supposed to do as a practical matter? What is anyone to do who doesn't have a remote farm, a big bank account, and a place to put all the needed stuff (much less the right weapon and ammo to defend things and people should it come to that)?

Glad you're putting it out there for those who missed it first time around. But some practical best practices guide for normal people along in here would be useful.

Anonymous said...

Thanks for the link.

I read thru the "rebuttal" also. One that was written by the grad student--the professional student, who started with the politically suspect BA in International Affairs (Conflict and Security). The one who is younger than 30. Boy he sure manages to take down Dr. Hatfill.

Not.

I'll sum up the rebuttal.

Strawman, strawman, ad hominem (mild), legalistic arm waving, strawman.

All from the guy with ONE scientific degree, who has been SHAVING for less time than Hatfill has been working the problem. In person, on the ground, in the field and lab.

Not the guy I'd have picked if I was serious about rebutting Hatfill's points. But in the liberal progressive world, one expert is just as good as any other.

And once again, the rebuttal is full of confident pronouncements that are all missing a critical word--"YET."


WRT Hatfill's interview, I found particularly disturbing the number of OTHER nasty things waiting to break out and kill us.

All in all, a full fisking of the rebuttal would be better done by someone like our host, but isn't really necessary.

I'm gonna put my faith in Hatfill over the grad student.

nick

FrozenPatriot said...

That $120 billion just disappeared, and we're no better prepared now than had we not spent it, means certain bureaucrats need to take that slow march to the gallows. Whether that happens will be determined by the actions of "We the People". The fedgov ruling caste will always protect their own -- their own people, policies, largesse, and legitimacy.

On an unrelated (and happier) note, I recently bought some rope and have a new favorite youtube clip: http://m.youtube.com/watch?v=CvbBNiQ6lFE

Aesop said...

@Percy

No, it wasn't intended to be breaking news, but a good read from someone qualified to speak, and telling the truth.

As for best practices, I'll work on it today. It's otherwise quiet, fortunately.

Anonymous said...

I was wondering about what happens when someone is co-infected with the flu and Ebola, which could happen in the coming months.

http://www.mdpi.com/1999-4915/4/10/2115/pdf

I got some chills down my spine at that introduction. Is there a doctor in the house who can be reassuring and say 'Nah. not an issue here.", or else say "Oh yeah, that's bad."?

Rob Crawford said...

Well, we can be sure a good portion of that money got funneled into Democrat campaign funds.

tweell said...

Here's some incredible misinformation for you.

https://www.youtube.com/watch?v=k0UDx1UsmOM

Yep, that's an official Maricopa County of Arizona video.

Anonymous said...

I'm Anonymous at 1:06 and if nobody wants to go around opening various .pdf files (understandable), this is what I read and is in that document put out by USAMRIID:

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 (<10 pfu) by the aerosol route in NHPs, and case fatality rates as high as ~90% ( [6–8]). There are
allegations that the former Soviet Union weaponized filoviruses [9].

Filoviruses in aerosol form are therefore considered a possible serious threat to the health and safety of the public. A number of promising vaccines and post-exposure treatments have been developed but are not yet available [10]. However, the efficacy of most of these vaccines and therapies has not been determined for an aerosol route of viral challenge (exceptions include [11,12]).

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.

(HERE IT COMES) 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 [14]."

Grouch, MD said...

No one has tried that yet, that is, coinfecting test subjects with flu and Ebola. My supposition is that it Would Be Bad.
Cross the streams: http://youtu.be/jyaLZHiJJnE

Anonymous said...

Ah, thank you Dr. Grouch. So essentially if that happens we get the Gozer of virii. Got it. Thank you!

Grouch, MD said...

Choose and perish!
No, I hadn't considered a confection in nature. Viruses (and bacteria, for that matter) tend to swap DNA when mixed together. Not sure thinking about it will make me sleep better at night.

Grouch, MD said...

Aerosol transmission is possible. There are at least 2 papers describing it; neither of them apply in nature but would apply with intentional weaponization

Tucanae Services said...

Truth or happy face? -- http://www.washingtonpost.com/world/africa/as-ebola-declines-in-liberia-health-officials-reassess-response-plans/2014/11/03/88126a4c-6365-11e4-bb14-4cfea1e742d5_story.html

FrozenPatriot said...

...so WHO issued new numbers Friday and I just now got a chance to add them to the running total and graph. (I'm traveling last weekend and this week with limited interwebz access on the ol' laptop)

http://bit.ly/1x2P70d

The total cases went down by 136 between Wednesday and Friday of last week. According to the 31OCT WHO SITREP, "the cases reported are fewer than those reported in the Situation Report of 29 October, due mainly to suspected cases in Guinea being discarded." Keep in mind this same crowd of assclowns readily admits a deficiency factor of between 2.5x and 3x.

Why would they revise already-low numbers further down??

Also, the total deaths went up by only 31. Don't get me wrong -- 31 dead people still sucks and I'm by no means cheering for more -- however the 10 reports (roughly a month) preceding the last three averaged 225 deaths per reporting period. The last three reports have declared 46, -2, and 31 deaths respectively, for a total of 75. Compare this to more than 700 deaths which should have occurred, statistically speaking...

This alleged drop in deaths also knocked the CFR (Case Fatality Rate) from between 50% (the 20OCT SITREP) and 58.5% (the average of all SITREPS) down to 36.5%!! This is largely due to Liberia's numbers in the 25OCT and 27OCT reports. Liberian cases jumped from 4665 up to 6535, however deaths decreased from 2705 down to 2413, causing Liberia's CFR to drop from 58% down to 37%...

The cynic in me wants to believe the WHO is padding the numbers lower still in order extinguish rekindled ridiculous, antiquated notions like individual preparedness, national borders, sovereignty, and common sense.

Stupid slaves...thinking those things still apply...

Aesop said...

I expect anomalous results, because they've been finagling the number right along. Liberia's death numbers are totally cooked. When you get a 1600 case spike in one report, but deaths are going backwards(?), they're FOS. We're supposed to believe "Oops, those 300 people and 1000 more didn't die!"
Sh'yeah, right.
Anything that suddenly points sideways is suspect.

And given the shortage of treatment beds compared to numbers of confirmed patients, no way in hell is the death rate going down.

People are simply dying at home without bothering to get a blood test, and infecting their families, friends, and neighborhoods on the way out.

I'm thinking Phase I with this outbreak was from 1 case to recently, say 10K cases.

Phase II is when they can't even accurately count the outbreak any longer.

Phase III will be when the infection rate is so high things start to fall apart. (Rioting, starvation, and the government(s) unable to do much about it.) That's when this'll start becoming a problem in the neighboring countries, and at this point, there's no international agency or NGO help left to send. Mali's going to get more cases, and Ivory Coast, particularly the rebel-controlled northern half of the country, may already have them.

My SWAG on that is 60-90 days.
60K-180K cases by New Year's, and 120K-360K by Jan. 31st. Mid February is 175K-500K cases, which is 1-3% of the entire region. Long before then, mid-December is the current fond wish, our troops finish their mission, and hopefully are pulled out. Which will probably be the signal to most people there who can, to try and get out any way possible.

One example of how things are going is that in Guinea, the reported cases are all in the capitol. I don't think the cases in the countryside are decreasing, I think they're simply not even bothering to report them anymore.

Nobody anywhere is saying "It's getting better", they're universally saying "It's much worse than what we think it is."

Which is consistent with 300 new cases every day, and no place to put any of them.

Frank Ch. Eigler said...

By the way, see http://blog.wolfram.com/2014/11/04/modeling-a-pandemic-like-ebola-with-the-wolfram-language/ for an interactivish model for simulating the pandemic.

gamegetter II said...

Aesop-


"Phase III will be when the infection rate is so high things start to fall apart. (Rioting, starvation, and the government(s) unable to do much about it.) That's when this'll start becoming a problem in the neighboring countries,"

Have you read this...

Thousands break Ebola quarantine to find food

DAKAR, Senegal (AP) — Thousands of people in Sierra Leone are being forced to violate Ebola quarantines to find food because deliveries are not reaching them, aid agencies said.

"The quarantine of Kenema, the third largest town in Sierra Leone, is having a devastating impact on trade — travel is restricted so trucks carrying food cannot freely drive around," the committee said in a statement. "Food is becoming scarce, which has led to prices increasing beyond the reach of ordinary people."

http://news.yahoo.com/thousands-break-ebola-quarantine-food-124818527.html

Aesop said...

That's Sierra Leone, and why the outbreak there keeps on going.
And the government losing its grip.