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Tracking the next pandemic: Avian Flu Talk

WHO Worker - Where did exposure come from

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debg View Drop Down
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    Posted: August 27 2014 at 10:25am
Associated Press
By CLARENCE ROY-MACAULAY3 hours ago
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A man, left, walk past a Ebola awareness campaign poster, in the city of Abidjan, Ivory Coast, Monday, Aug. 25, 2014. (AP Photo/Sevi Herve Gbekide )
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A man, left, walk past a Ebola awareness campaign poster, in the city of Abidjan, Ivory Coast, Monday, Aug. 25, 2014. (AP Photo/Sevi Herve Gbekide )

FREETOWN, Sierra Leone (AP) — A third top doctor has died from Ebola in Sierra Leone, a government official said Wednesday, as health workers tried to determine how a fourth scientist also contracted the disease before being evacuated to Europe.

The announcements raised worries about Sierra Leone's fight against Ebola, which already has killed more than 1,400 people across West Africa. The World Health Organization said it was sending a team to investigate how the epidemiologist now undergoing treatment in Germany may have contracted the disease that kills more than half its victims.

"The international surge of health workers is extremely important and if something happens, if health workers get infected and it scares off other international health workers from coming, we will be in dire straits," said Christy Feig, director of WHO communications.

Dr. Sahr Rogers had been working at a hospital in the eastern town of Kenema when he contracted Ebola, said Sierra Leonean presidential adviser Ibrahim Ben Kargbo on Wednesday. Two other top doctors already have succumbed to Ebola since the outbreak emerged there earlier this year, including Dr. Sheik Humarr Khan, who also treated patients in Kenema.

Rogers' death marks yet another setback for Sierra Leone, a country still recovering from years of civil war, where there are only two doctors per 100,000 people, according to WHO. By comparison, there are 245 doctors per 100,000 in the United States.

The Senegalese epidemiologist who was evacuated to Germany had been doing surveillance work for the U.N. health agency, said Feig, the WHO spokeswoman. The position involves coordinating the outbreak response by working with lab experts, health workers and hospitals, but does not usually involve direct treatment of patients.

"He wasn't in treatment centers normally," she said by telephone from Sierra Leone. "It's possible he went in there and wasn't properly covered, but that's why we've taken this unusual measure — to try to figure out what happened."

WHO said late Tuesday that it was pulling out its team from the eastern Sierra Leonean city of Kailahun, where the epidemiologist working with the organization was recently infected. The team was exhausted and the added stress of a colleague getting sick could increase the risk of mistakes, said Daniel Kertesz, the organization's representative in the country.

Canada also announced late Tuesday it was evacuating a three-member mobile laboratory team from Sierra Leone after people in their hotel were diagnosed with Ebola. The Public Agency of Canada said none of the team members was showing any signs of illness but that they would remain in voluntary isolation during the 21-day incubation period.

Health workers have been especially vulnerable because of their close proximity to patients, who can spread the virus through bodily fluids. WHO says more than 120 health workers have died in the four affected countries — Sierra Leone, Liberia, Guinea and Nigeria.

While some local health workers have lacked proper protective gear, the teams from the World Health Organization and Doctors Without Borders are usually well-equipped and trained in how to use the protective suiting.

A team of two experts was sent Tuesday to investigate whether the case occurred through straightforward exposure to Ebola patients, or something else, said Feig, the WHO spokeswoman. She said the team is checking to see if there is an infection risk in the living and working environments that had not been discovered.

There is no proven treatment for Ebola, so health workers primarily focus on isolating the sick. But a small number of patients in this outbreak have received an experimental drug called ZMapp. The London hospital treating a British nurse infected in Sierra Leone, William Pooley, said he is now receiving the drug.

It was unclear where the doses for Pooley came from. The California-based maker of ZMapp had said that its supplies were exhausted and that it would take months before more doses would be available.

Two Americans, a Spaniard and three health workers in Liberia have received ZMapp, though it is unclear if the drug is effective. The Americans have recovered and have been released from an Atlanta hospital, but the Spaniard died, as did a Liberian doctor.

Health officials in Liberia said the other two recipients of ZMapp in Liberia — a Congolese doctor and a Liberian physician's assistant, have recovered. Both are expected to be discharged from an Ebola treatment center on Friday, said Dr. Moses Massaquoi, a Liberian doctor with the treatment team.

___

Associated Press Medical Writer Maria Cheng in London; Jonathan Paye-Layleh in Monrovia, Liberia; David Rising in Berlin; Krista Larson in Dakar, Senegal; and Rob Gillies in Toronto contributed to this report.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 10:47am
Originally posted by debg debg wrote:

Canada also announced late Tuesday it was evacuating a three-member mobile laboratory team from Sierra Leone after people in their hotel were diagnosed with Ebola.



Great find Deb.   This thing is way out of control.  If cases are popping up in their hotel like that, I would get the hell out of there too. It's everywhere at this point, and that's why the WHO is clearing out.  This thing is definitely limited airborne in my opinion, and the ol' bodily fluids and touching a person as the "only" way to contract it is clearly B.S., excuse the acronym there. 

The WHO needs to give some answers here, along with travel restrictions.  The WHO is almost encouraging traveling to Africa and is clearly downplaying it, yet they're heading out?   Stern Smile



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Post Options Post Options   Thanks (0) Thanks(0)   Quote pheasant Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 11:34am
I know it has been mentioned before, but there is the documented case of the monkeys getting infected in the Virginia lab via airborne transmission through the air ducts.

I realize it was a different strain that should not infect humans,but it was Ebola.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote AZHeather Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 11:36am
I was on the WHO website and was reading on how to remove PPE after exposure and I just want to see if anyone else thinks that leaving your hands exposed while removing your hair cover, face mask and goggles seems like a good idea. Me...I would be putting on another set of gloves before toughing those things barehanded.

http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf?ua=1
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 2:10pm
Phesant, That was droplet transmission.  Yes, this is via the air but not the same as airborne.  It makes SIP the best practice in an outbreak.  With proper airborne transmission, only evaccuation or a bunker with porcelain air filters will do.

That said, I am absolutely certain that there is more going on here vis a vis transmission than the WHO have told us.  Bearing in mind the infectivity of the ebola virus, 1 - 10 particles to establish infection, I am also certain that it is infectious whilst the viral load is still small and so before symptoms appear.

AZHeather - me too!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 2:28pm
great read got me hooked 20 years ago


The Hot Zone

The bestselling landmark account of the first emergence of the Ebola virus. A highly infectious, deadly virus from the central African rain forest suddenly appears in the suburbs of Washington, D.C. There is no cure. In a few days 90 percent of its victims are dead. A secret military SWAT team of soldiers and scientists is mobilized to stop the outbreak of this exotic "hot...more
Paperback422 pages
Published June 15th 1999 by Anchor (first published 1993)
Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth.🖖

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Post Options Post Options   Thanks (0) Thanks(0)   Quote pheasant Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 3:58pm
Techno,

there was a discussion on a different thread about the Nova documentary years ago, here on youtube www.youtube.com/watch?v=qTcfnTISMDk

I watched it.

In the video, again from nova, they talk about the reston strain of ebola, which we know is not contagious to humans. But it did spread through the ventilation system in the monkey house.

Unless i am mistaken, we saw airborne in that situation, where the military came in and killed all the monkeys.

Many of the posters here are more scientifically inclined than i am
please advise..as to how i am mistaken

I should add, "through the ventilation system" they referred to different holding areas in different parts of the facility.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 5:01pm
Yes it did travel by air.  It is not correct to call that airborne though.  The airborne viruses have adapted through evolution to specifically travel by air.  They aerosolise and have strong outer coatings to protect them in the air.  They also target the mucous membranes to produce coughs and sneezes.  That is the site where infection occurs too.  An airborne pathogen can travel miles by air.  Wind will carry it over vast areas. 

Droplet infection takes place over small areas, usually only a few feet at most.  Droplet infection occurs when non airborne pathogens are splashed and produce droplets.  You could, in theory, turn any pathogen into a droplet infective agent by say pushing an infeted person's hand into a fan, or shooting them with a dumdum or fleschette.  Ebola does this for itself in the last days of infection when the host is in their death throes.  Then everywhere bleeds and a cough or sudden movement spreads droplets into the air LOCALLY.  This is what happened in the reston outbreak,.  The ventilation system carried it just as the fan did in my imaginary senario.

The distinction between droplet and airborne infections is widely misunderstood.  I have even heard medical personnel get it wrong.  Also, there is a tendancy to call this hair-splitting.  The press is worse, a half-understood system can be more misleading than a completely incomprehensible one.  So, many press folk call droplet infections airborne because they do not understand the fine distinction, or think it irrelevant.

True, if you were to walk past an ebola patient in a narrow corridor the distinction would be arbitary, but that is an unlikely senario (thankGod).  However if you are working out your survival plans, or you are a medical director trying to control an outbreak, it is vital.  It even affects the type of mask one needs to protect your respiratory system, as droplets can be fielded in by a much larger mesh than would be required to trap aerosolised viral particles. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pheasant Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 5:41pm
Fascinating, thank you.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 5:56pm
Aerosolized Ebola is or isn't proven to exist of this current strain? In the six months since it appeared no one in the world has done a lab-monkey test similar to the infamously flawed Canadian one? This is the first thing I would have done in March no matter what I knew about the shape, size, fragility of viruses, etc. I would of still done the test. Ebola is caughed out in late stage. It does exist in the upper respiratory. It makes it to every part of the body. I'm not saying I think it is aerosolized but given its lethality, a hard test would be performed regardless of what I knew about how various virus behave.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 6:54pm
Not to nitpick, but I'd say that Ma Nature's been running a real world test on this strain for a few months now, and a truly efficient airborne virus would have gone at least partially global by now. But to be honest, at 60% fatal I'd say it was plenty scary enough already
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arirish Quote  Post ReplyReply Direct Link To This Post Posted: August 27 2014 at 9:37pm
JD- I could not agree more! This has been going on for months and it's not up to 2000 deaths yet and it hasn't spread much farther than it's original outbreak area. If this were a pandemic influenza virus it would already be on many Continents and we'd be talking hundreds of thousands of casualties. This thing is scary but it's not influenza!   
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: August 28 2014 at 6:32am
No. You two are right. I totally agree. It is not the flu and almost certainly doesn't propegate just like the flu. It is spreading in much slower, more limited ways than the flu. But it is spreading and increasing its base nevertheless. "40% increase in just the last 3 weeks". And that is not counting the ~10,000 uncounted cases. What makes this disease more fearful than just about anything in human history is (1), there is no known cure or vaccine, (2), it is in fact methodically spreading, and (3), it is almost 100% fatal.

While H5N1 and other avians, along with MERS, ect. are still lurking threats to be studied and watched, this disease IS on the move with no end in sight. The WHOs prediction of having it under control in 9 months is lunacy. A month ago they said 3 months. 9 months from now, this slow moving virus will have infected and killed tens of millions. Good luck getting a grip on it manually by then. Less they're ready to take WillobyBrats advise...
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Post Options Post Options   Thanks (1) Thanks(1)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: August 28 2014 at 6:44am
Good Post onefluover! I couldn't have said that any better! Thanks
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Post Options Post Options   Thanks (1) Thanks(1)   Quote quietprepr Quote  Post ReplyReply Direct Link To This Post Posted: August 28 2014 at 8:46am
The thing that scares me the most is whether or not the ebola strain currently on the loose is mutating. We have already heard it is not the same strain as the major outbreaks of the past and that perhaps the tests are getting false negatives for that reason in some cases. I am certainly no medical expert and defer often to the repsected posters here but it scares me to think we may be a short mutation chain away from true airborne transmission. I agree that if it was truly airborne it would be global by now, the 1918 flu did it in a matter of months without air travel. The terrifying part is the devastation that pandemic caused with a low single digit CFR. This thing is moving very slowly but we are seeing the potential for an exponential increase in cases because there has been absolutely no progress in stopping this thing or even slowing it down. We cant even get governements to stop or even limit travel into the hot zones in any meaningful way. By the time they really get on board, how far will it have spread?
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