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The Ebola outbreak

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Thu, Jul 31, 2014 - 9:09pm
cris
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@ssj - I have an honest disagreement about the "airborne" bit

I think this is a grey area.

It is clear that the virus can be transmitted in droplets, and that virus from droplets is resilient on surfaces. To say it is not airborne is not strictly correct.

The cynical part of me believes the media is stressing this "fact" in order to minimize panic.

i keep worrying about the airplane incident. Those planes (and their crews for that matter) are basically just huge fomites.

Thu, Jul 31, 2014 - 9:11pm
cris
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An easier to read graph of cases

Thu, Jul 31, 2014 - 9:24pm
Lamenting Laverne
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Possible new strain (or maybe rather a unknown old strain)

I think it is positive that the video ag1969 posted was accompanied with a transcript including links to the background material, which can be found here: https://scgnews.com/ebola-what-youre-not-being-told 

I was curious about the "New Strain" article that was mentioned, and went back and found the source on the New England Medical Journal website: https://www.nejm.org/doi/full/10.1056/NEJMoa1404505#t=article . They conclude that the strain in Guinea is different than Ebola Zaire.

Part of Abstract: [..." Epidemiologic investigation linked the laboratory-confirmed cases with the presumed first fatality of the outbreak in December 2013. This study demonstrates the emergence of a new EBOV strain in Guinea.] 

However, another report, using "Phylogenetic Analysis" also linked from the transcript, stated as part of the conclusion:

[... "This approach indicates that the outbreak in Guinea is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus"...]

The report can be found here: https://currents.plos.org/outbreaks/article/phylogenetic-analysis-of-guinea-2014-ebov-ebolavirus-outbreak-2/

I hope the details contained in these two reports makes more sense to you - it is certainly well above my head - but what I do get from them is that there is a strain either of Zaire or a new strain, that has had longer time to evolve and "specialize", which could maybe explain why the current outbreak seems to be more mobile and resilient.

Fri, Aug 1, 2014 - 1:23am
SteveW
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Repatriation

“Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend.” ― Albert Camus
Fri, Aug 1, 2014 - 1:55am
SteveW
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@LL: Ebola strain

"suggest a single introduction of the virus into the human population. This introduction seems to have happened in early December 2013 or even before."

This to me is the key conclusion of the NEJM article.

The more extensive and recent article in PLOS shows the key findings in Figure 6. The Congo outbreak of 2007 and the Gabon outbreak of 2002 share a common ancestor with the current outbreak shown as "D". The current outbreak has a hypothetical single introduction shown as "A", which due to mutation evolves into a related set of new strains that continuously mutate. All these strains trace their ancestry to the Zaire Ebola virus.

This is a best fit analysis since the rapid mutation rate of the RNA virus gives somewhat different results depending upon the type of analysis and regions of the genome used. It is however definitely a member of the Zaire Ebola virus first reported in 1976.

“Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend.” ― Albert Camus
Fri, Aug 1, 2014 - 11:12am
moderator
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Cris and everyone else

Great stuff. Very helpful. Please keep going.

Saw this on twitter yesterday and now picked up by ZH: https://www.zerohedge.com/news/2014-08-01/american-ebola-patients-way-at...

Fri, Aug 1, 2014 - 2:25pm
cris
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Many thanks to you, Turd

Many thanks to you Turd for developing a community where this sort of communication to like indeed folks is possible.

Turning to today's developments, ZH has a great article:

https://www.zerohedge.com/news/2014-08-01/who-warns-ebola-outbreak-out-c...

And if I can adjust my tinfoil hat for a moment, this article posted yesterday is thought provoking:

https://theeconomiccollapseblog.com/archives/this-is-what-is-going-to-ha...

Fri, Aug 1, 2014 - 2:44pm
cris
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Spreading

Fri, Aug 1, 2014 - 4:23pm
Lamenting Laverne
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I'll see your tinfoil and raise it one

Ok - I am fully aware that I should put a robust leash on my natural tendency to go all conspiratorial and crackpotty when posting in this forum.

But you gotta admit that having a big exercise like this right now on this very current subject "as almost complete surprise drill to make it more realistic" with no plans to release the result "for security reasons" is noteworthy.

https://www.myfoxny.com/story/26170612/drill-in-new-york-city

Fri, Aug 1, 2014 - 6:30pm
Strongsidejedi
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@cris - woeful under prep by US fed CDC

Cris,

I just discovered this webpage from CDC.

https://www.cdc.gov/quarantine/quarantine-stations-us.html

Zerohedge published a story on Ebola prep citing the existence of these quarantine stations.
But, look closer at what is really in place. I looked specifically at the Los Angeles station.

https://www.cdc.gov/quarantine/stations/los-angeles.html

This station is for:

Nevada, Utah, Colorado, and all the following counties in Southern California (excluding the U.S.-Mexico border counties): Los Angeles, Orange, San Bernardino, Riverside, Ventura, Santa Barbara, San Luis Obispo, Inyo, and Kern.

How large is this station?

The answer comes in the location:

https://www.cdc.gov/quarantine/quarantinestationcontactlistfull.html

CDC Los Angeles Quarantine Station
Tom Bradley International Terminal
380 World Way
5th Floor Room 5118 (North Side)

If I am interpreting this CDC fact sheet correctly, any passenger arrivals via ship (LA Harbor) and aircraft (LAX) must go to this quarantine facility. The thing is that if a passenger ship arrives at San Pedro with Ebola, how the hell is the passenger supposed to get from Port of LA to LAX without exposing other people first?

Also, if a long-distance flight arrives with several sick passengers, I seriously doubt that CDC will have someone there to review the case immediately. Do they really have PREP supplies stacked there?

I've concluded tonight that if a passenger arrived in the US in the last months having been exposed in the endemic areas, we likely do not know it.

Fri, Aug 1, 2014 - 6:40pm (Reply to #31)
cris
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@ssj - just to speculate for a moment

If by any chance this virus gets to the CONUS, it may very well spread incredibly quickly. The "First World" may have more healthcare technology, but that very same technology in other sectors of our society will allow for rapid viral spread.

Think about how much more mobility and interaction with the world the average American has vs the average African, particularly rural Africans. Combine that with the long incubation period, and the potential is frightening.

I suspect the best defense is a good offense. I really hope the military is starting to mobilize behind the scenes.

I hope I am just being paranoid. The next week will be very telling.

Fri, Aug 1, 2014 - 6:41pm (Reply to #30)
Strongsidejedi
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@lLamenting L (on NYC drill)

@LamentingLaver

You made another interesting observation with your post about the NYC drill.

However, that drill is for delivery of prophyllaxis or medication to a mass distribution event.

The best example would be a theoretical "public health emergency" where tens of thousands of doses of a vaccine or medication need to be delivered to a community in just a few days time.

Ebola would not fit this type of event because there is no vaccine against ebola and there is no medication that can treat Ebola or prevent it.

Mainly, my prior posting regarding withdrawal from areas of mass people and isolation for a few months would be the plan of action. We're not at that stage in the West. But, if people are reading this board from Western Africa, they should certainly be considering these steps.

Fri, Aug 1, 2014 - 7:04pm (Reply to #32)
Strongsidejedi
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@cris - contagion and CONUS

@cris,

I share your observations and concern. Ebola is here with the arrival of the patient from Africa to Atlanta area this afternoon.

One difference in Africa is that HIV may be under diagnosed and under treated. Therefore, if say 5% of the population in the capital cities of those three African nations have HIV-AIDS related leukopenia, the relative immunosuppression confers a decreased ability to survive.

My opinion is substantiated by this paper:

https://jvi.asm.org/content/77/18/9733

A comparison of immune parameters in survivors and nonsurvivors of infection has provided clues into the constituents of an effective immune response. Baize et al. (2) characterized the immune responses of patients in two large Ebola virus outbreaks in Gabon in 1996. There was no significant difference in viral antigen load between survivors and nonsurvivors, but immune responses varied, suggesting that survival is dependent on the initial or innate immune response to infection. Survivors exhibited more significant IgM responses, clearance of viral antigen, and sustained T-cell cytokine responses, as indicated by high levels of T-cell-related mRNA in the peripheral blood. In contrast, antibodies specific for the virus were nearly undetectable in fatal cases, and while gamma interferon (IFN-γ) was detected early after infection, T-cell cytokine RNA levels were more indicative of a failure to develop adaptive immunity in the days preceding death.

An outbreak of Ebola in the CONUS Southern states would be a worse case scenario. Because the Black population has a higher incidence of HIV diagnoses, I conclude that the Southern Black population centers would be at particular risk.

see the maps of HIV incidence and prevalence reported by CDC in 2011 here: https://www.cdc.gov/hiv/pdf/statistics_surveillance_raceEthnicity.pdf

Since Ebola has a 7-21 day incubation period and since CDC will be taking precautions extremely seriously, I conclude that around the end of August we will know if any contagion outside the 3 African nations appears.

The most readily apparent example would be contagion in other African nations over the next weeks.

Fri, Aug 1, 2014 - 7:12pm (Reply to #27)
Strongsidejedi
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@TF on Ebola

@Craig,

The reason they are sending that patient to Atlanta is due to the fact that CDC is in Atlanta.

Bloomberg was reporting that the patient was being transported via military aircraft from Africa to Atlanta and landing at a military base.

Hopefully, they are taking extreme levels of precaution during transport. However, video tape of the plane arriving, the patient being transported (police escort?), and hospital briefings should be following.

The physician (Dr Brantly) was sending the lay person ahead of himself. Dr. Brantly was reported to be taking a blood transfusion from a young man who survived. I think they are hoping that clotting factors may assist Brantly.

However, hemorrhagic diseases like this are difficult to treat! My guess is that Dr. Brantly will be brought in the second trip (probably 48 hours).

Late entry/edit: Story at Atlanta paper regarding the patients being transported to Emory University

https://www.ajc.com/news/news/breaking-news/emory-to-treat-2-ebola-patie...

Sat, Aug 2, 2014 - 12:53am
SteveW
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Director General for WHO

reports that the outbreak is not under control.

https://online.wsj.com/articles/who-warns-of-catastrophic-consequences-o...

“Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend.” ― Albert Camus
Sat, Aug 2, 2014 - 2:42am (Reply to #36)
Strongsidejedi
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@SteveW WHO director

World Health Organization statement of Dr. Margaret Chan (Director, WHO, United Nations) published on 1 Aug 2014 at
https://www.who.int/dg/speeches/2014/ebola/en/

I have also located a WHO document on the West Africa Ebola response plan for July through December 2014 at
https://www.who.int/csr/disease/ebola/evd-outbreak-response-plan-west-af...

It is apparent to me that one month into this report's timeframe, the response is not going very well. Dr. Chan is making her comments four weeks into the process and must be feeling rather frustrated with the poor progress.

UN-WHO appears to be attempting to break transmission chains. Guidance document is here:
https://www.who.int/csr/disease/ebola/evd-outbreak-response-plan-west-af...

Sadly, I would point out that the interventions do little to aid the people infected currently and who may or may not be suffering of the disease.

In the public proclamations of both Dr. Chan of WHO and Dr. Thomas Frieden of US CDC, ebola is noted to NOT be communicable via airborne routes and is also thought to be similar to prior outbreaks of Ebola.

It is not a good idea for Dr. Frieden to be so confident of the behavior of this particular strain. Until the strain is isolated and the RNA sequenced by CDC/NIH, one should take great care in describing transmission behavior.

While I respect the opinions of both Dr. Chan and Dr. Frieden, the duration of this particular epidemic is different from the prior epidemics of Ebola over the past decades. In a prior message here, I have pointed to the possibility that the prevalence and incidence of the virus in the Western African population centers may be reflecting vulnerability in those populations due to undiagnosed immunodeficiency such as ARC/AIDS/HIV.

Similar pockets of vulnerability will exist in SE Asia, European, Latin/Central American nations, and CONUS.

Therefore, it is unwise for the CDC to be taking the position that the virus will not reach CONUS.

It is theoretically possible that an infected patient could already be in the population centers of western African nations. Moreover, it is also possible that a case could appear in a distant nation in the next weeks or months.

Note that the seasonal appearance of respiratory diseases will occur in 4-6 weeks when kids return to school in September. Those classrooms become breeding grounds for GI and respiratory viral illness which will manifest nationally by October.

The worst case scenario would be for the wild Ebola virus to appear in a major population center in CONUS in late August or early September. The children would be returning to school with the physicians and medical community under prepared to differentiate an early Ebola viral illness from an severe case of influenza, rhinovirus, or norwalk/rotaviral infections.

CDC would have to push Ebola diagnostics into the population centers of CONUS in the next 4 weeks.

Can CDC do this?

Only the federal government knows.

You heard it here first folks.

Sat, Aug 2, 2014 - 4:32am (Reply to #29)
cris
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Spread to Uganda "officially denied"

Spread to Uganda has been "officially denied":

https://reliefweb.int/report/uganda/ebola-outbreak-west-africa-uganda-ta...

Take that for what it is worth. Hate to be cynical, but reminds me of Pilger's law:

https://www.independent.co.uk/news/media/tv-radio/pilgers-law-if-its-bee...

Sat, Aug 2, 2014 - 6:39am
Lamenting Laverne
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@ SSJ - diagnostics equipment

"CDC would have to push Ebola diagnostics into the population centers of CONUS in the next 4 weeks"

It would appear that they already started that process back in early April. I wrote this comment on the 14th April: https://www.tfmetalsreport.com/comment/253683#comment-253683​

Snippet from key link in comment:

"On April 8th Congress was informed by the the Department of Defense [DoD] that because of emerging threats JBAIDS hemorrhagic fever assays have been deployed to National Guard units of all 50 States.

By partnering with the U.S. Army Medical Research and Materiel Command and the Food and Drug Administration, we have made accessible additional diagnostic assays for high consequence, low probability biological threat agents for use during declared public health emergencies. This collaboration has facilitated the availability of viral hemorrhagic fever diagnostic assays for use during a declared emergency and adds previously unavailable preparedness capabilities to this fielded system"

Edit: Also, I would like to ask, if it is of any significance that this message came from the Department of Defense and not the Department of Health? 

Sat, Aug 2, 2014 - 1:48pm
SteveW
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@SSJ: Ebola sequence and diagnostics

The 3 sequences reported in the paper LL cited have been deposited in Genbank. "The EBOV in samples obtained from three patients was completely sequenced with the use of conventional Sanger techniques (GenBank accession numbers, KJ660346, KJ660347, and KJ660348)."

https://www.nejm.org/doi/full/10.1056/NEJMoa1404505#t=article

The sequence in and of itself says nothing about the possibility of aerosol transmission, AFAIK.

Diagnosing the presence of Ebola RNA in a sample by RT-PCR is a relatively trivial exercise for any competent molecular biology lab, of which there will be several at any major University as well as corporate labs. This is the most sensitive test. The prime concern would be that the sample had been properly treated so that it was not infectious. It should be possible to heat inactivate samples and still detect virus but all the reports I've seen have use specialized P4 type labs for diagnosis.

“Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend.” ― Albert Camus
Sat, Aug 2, 2014 - 2:33pm
SteveW
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Tin foil hat for the weekend

https://philosophyofmetrics.com/2014/08/02/global-pandemic-and-quarantine/

While JC Collins makes a seemingly reasonable comment that moving patients around the world contravenes quarantine 101 measures he then states "Perhaps this Ebola outbreak is random but it is highly unlikely considering the large amount of evidence supporting the theory that Ebola was manufactured."

Simply downright unwarranted paranoia. Firstly the state of the art in 1976, when Ebola virus was first reported, was incapable of manufacturing such virus. Secondly there is evidence that the ancestor of Ebola is around 40 million years old since related DNA sequences have been found in the DNA of the primitive primate, the tarsier, wallabies and one of two species of bat whose complete genome has been sequenced.

https://www.ncbi.nlm.nih.gov/pubmed/20686665

This also supports the speculation that bats may be a natural reservoir since they might well be virus resistant due to a virus like protein coded within their own genome.

“Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend.” ― Albert Camus

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