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.