"I like a good story, well told. That is the reason I am sometimes forced to tell them myself." - Mark Twain
Saturday, December 13, 2014
And As A Reminder
Here's the YouTubed home vid of a doc coming out of PPE isolation in W. Africa (in this case, for his last time). Note the process, and the fact that despite doing this one or more times a day while working there, the second safety monitor catches him a couple of times; also note the numerous times where he washes and re-washes and re-washes his gloved hands before touching the next item(s). The apron, goggles, and boots are re-used; everything else is toast after a single use, including both pairs of gloves, suit, and hood.
This is TIME's Person Of The Year, #30014. Now you have a taste for why.
The process of treating ebola patients should be reassessed. Considering that the treatment has killed 600 medical workers maybe there shouldn't be treatment at all. Mostly the treatment is an attempt to keep the patient hydrated. The most important part is preventing the virus from finding new hosts as the victims begin spewing from every hole. Couldn't ebola survivors be hired to do the hands on work since they are likely immune at least for a while. Stopping the virus is more of a logistical problem than a medical treatment issue. The infected have to be quickly quarantined but first you have to find them.
1) In Africa, there is no "treatment" as such. That's a large reason for the 70-90% mortality of the disease there. 2) In the West, actual hydration treatment has turned 70-90% mortality to 80% survival, provided it's begun early enough in the course of the disease. (In W. Africa, most people don't seek treatment until they're already on the verge of dropping dead on the spot - and many do.) 3) Ebola survivors are used as much as possible at the ETUs to care for others in the "hot" zones, because they're already there, they're immune, and the don't need all the literally hot protective crap. 4) Prior to this outbreak, the number of Ebola survivors worldwide wouldn't fill a neighborhood bar, so it isn't like they had a bunch of folks to draw upon. 5) Within the outbreak, 7-8 out of 10 people die anyways, so they haven't had a lot to pick from afterwards either. 6) The debilitation afterwards precludes much serious work for weeks to months. This is before we consider we're talking about people for whom malnutrition and malaria are endemic and daily realities. 7) It's documented, even amidst this crisis, that bribing your way out of "quarantine" routinely occurs, which is why they fail to work there again and again. 8) It's an isolation problem more than a logistical problem per se. So you combine a grabby-huggy culture, with religious customs that dictate playing in Ebola-encrusted post-death baptismal fonts, and poor people who have to hustle every single day to scrounge up their $1.25 avg. daily earnings to by their daily crust, and you're fighting cultural, religious, and economic factors that make enforcing isolation a near impossibility. As if that wasn't enough, add in superstition and scientific ignorance last observed in a Monty Python witch-burning scene, and a literacy rate that makes Appalachia look like MIT, Stanford, and Oxford combined, and you have very probably one of the worst and most unsolvable problems in living memory.
Which is why we either need to find an effective vaccine, or eventually, Ebola is going to win.
"Ebola survivors are used as much as possible at the ETUs to care for others in the "hot" zones, because they're already there, they're immune, and the don't need all the literally hot protective crap."
I'm curious about the extent to which a survivor of one brand of Ebola is thought to have become immune to other brands of it. I realize that in the current chaotic situation the answer may simply be that no one knows. But are there informed guesses out there? How much of a worry is this for healthcare worker Ebola survivors who choose to return to further exposure to the disease?
Any immunity from one strain of Ebola to any other strain, AFAIK, is a total unknown.
It's unethical to test in humans, (and as noted, the dearth of a prior-Ebola Survivor pool of candidates pretty well precluded anyone finding out before now), so unless some survivor(s) from the tiny but growing pool from this bout chooses to work the next outbreak totally unprotected, and lives, the only possible info source will come from animal testing at NIH/NIAID here, and similar organizations in the UK, France, et al.
Whether that will become common medical knowledge, or classified bio-war proprietary information is anyone's guess, mostly based on their prior assumptions about the whole thing.
At any rate, the priority is finding something that would enable most people to survive one outbreak, before we progress to worrying about cross-strain immunity.
We make baby steps, while the disease leaps chasms.
Aesop: Got it. There are, as I understand it, five strains of Ebola (so far). Four can and have been contracted by humans. Three, or perhaps all four, have been noted in the current epidemic in West Africa. Now there's a new one, referred to as Guinea, according to the NEJM. The reports are not clear about this. The one in the Democratic Republic of Congo is a variant of the worst of them, the Zaire strain (heavier viral load, whatever that means), genetically different from what is killing off people in West Africa.
The thing is mutating. The "disease leaps chasms," indeed. So it is disturbing to learn, if I understand what is being said, that healthcare workers who have survived one of these are thought to be immune to other strains of the disease as well and therefore are permitted to work with Ebola cases generally without full PPE. Is that really happening?
Percy, that's all wrong. The current west-African outbreak strain is EBOV, which is the worst (lethality over 80% in all previous outbreaks exceeding 300 cases). It is, however, genetically distinct from the recent Congo outbreak (which was also EBOV).
Well, wrong about what's behind the West Africa situation, true. (I misread something and reported what I mistakenly understood it to say.) But "all wrong"? Using the same abbreviation for two genetically different strains, one in West Africa and the other in the DRC, doesn't help much. Nor does it tell us whether a survivor of one of those is immune to the other. This, I assume, remains unknown.
Incredible. God Bless them.
ReplyDeleteThe process of treating ebola patients should be reassessed. Considering that the treatment has killed 600 medical workers maybe there shouldn't be treatment at all. Mostly the treatment is an attempt to keep the patient hydrated. The most important part is preventing the virus from finding new hosts as the victims begin spewing from every hole. Couldn't ebola survivors be hired to do the hands on work since they are likely immune at least for a while. Stopping the virus is more of a logistical problem than a medical treatment issue. The infected have to be quickly quarantined but first you have to find them.
ReplyDelete1) In Africa, there is no "treatment" as such. That's a large reason for the 70-90% mortality of the disease there.
ReplyDelete2) In the West, actual hydration treatment has turned 70-90% mortality to 80% survival, provided it's begun early enough in the course of the disease.
(In W. Africa, most people don't seek treatment until they're already on the verge of dropping dead on the spot - and many do.)
3) Ebola survivors are used as much as possible at the ETUs to care for others in the "hot" zones, because they're already there, they're immune, and the don't need all the literally hot protective crap.
4) Prior to this outbreak, the number of Ebola survivors worldwide wouldn't fill a neighborhood bar, so it isn't like they had a bunch of folks to draw upon.
5) Within the outbreak, 7-8 out of 10 people die anyways, so they haven't had a lot to pick from afterwards either.
6) The debilitation afterwards precludes much serious work for weeks to months. This is before we consider we're talking about people for whom malnutrition and malaria are endemic and daily realities.
7) It's documented, even amidst this crisis, that bribing your way out of "quarantine" routinely occurs, which is why they fail to work there again and again.
8) It's an isolation problem more than a logistical problem per se.
So you combine a grabby-huggy culture, with religious customs that dictate playing in Ebola-encrusted post-death baptismal fonts, and poor people who have to hustle every single day to scrounge up their $1.25 avg. daily earnings to by their daily crust, and you're fighting cultural, religious, and economic factors that make enforcing isolation a near impossibility.
As if that wasn't enough, add in superstition and scientific ignorance last observed in a Monty Python witch-burning scene, and a literacy rate that makes Appalachia look like MIT, Stanford, and Oxford combined,
and you have very probably one of the worst and most unsolvable problems in living memory.
Which is why we either need to find an effective vaccine, or eventually, Ebola is going to win.
Have a cheery day.
"Ebola survivors are used as much as possible at the ETUs to care for others in the "hot" zones, because they're already there, they're immune, and the don't need all the literally hot protective crap."
ReplyDeleteI'm curious about the extent to which a survivor of one brand of Ebola is thought to have become immune to other brands of it. I realize that in the current chaotic situation the answer may simply be that no one knows. But are there informed guesses out there? How much of a worry is this for healthcare worker Ebola survivors who choose to return to further exposure to the disease?
because... napalm.
ReplyDeleteWhat, and create another gasoline shortage?
ReplyDelete@Percy
ReplyDeleteAny immunity from one strain of Ebola to any other strain, AFAIK, is a total unknown.
It's unethical to test in humans, (and as noted, the dearth of a prior-Ebola Survivor pool of candidates pretty well precluded anyone finding out before now), so unless some survivor(s) from the tiny but growing pool from this bout chooses to work the next outbreak totally unprotected, and lives, the only possible info source will come from animal testing at NIH/NIAID here, and similar organizations in the UK, France, et al.
Whether that will become common medical knowledge, or classified bio-war proprietary information is anyone's guess, mostly based on their prior assumptions about the whole thing.
At any rate, the priority is finding something that would enable most people to survive one outbreak, before we progress to worrying about cross-strain immunity.
We make baby steps, while the disease leaps chasms.
Aesop: Got it. There are, as I understand it, five strains of Ebola (so far). Four can and have been contracted by humans. Three, or perhaps all four, have been noted in the current epidemic in West Africa. Now there's a new one, referred to as Guinea, according to the NEJM. The reports are not clear about this. The one in the Democratic Republic of Congo is a variant of the worst of them, the Zaire strain (heavier viral load, whatever that means), genetically different from what is killing off people in West Africa.
ReplyDeleteThe thing is mutating. The "disease leaps chasms," indeed. So it is disturbing to learn, if I understand what is being said, that healthcare workers who have survived one of these are thought to be immune to other strains of the disease as well and therefore are permitted to work with Ebola cases generally without full PPE. Is that really happening?
Percy, that's all wrong. The current west-African outbreak strain is EBOV, which is the worst (lethality over 80% in all previous outbreaks exceeding 300 cases). It is, however, genetically distinct from the recent Congo outbreak (which was also EBOV).
ReplyDeletemike18xx:
ReplyDeleteWell, wrong about what's behind the West Africa situation, true. (I misread something and reported what I mistakenly understood it to say.) But "all wrong"? Using the same abbreviation for two genetically different strains, one in West Africa and the other in the DRC, doesn't help much. Nor does it tell us whether a survivor of one of those is immune to the other. This, I assume, remains unknown.
..........Nice..^_^v............
ReplyDelete