Ebola: It's In The US Now

[Nanci]

Patient left Liberia on the 19th, arrived in the States on the 20th. On the 24th, he showed symptoms and sought treatment on the 26th. He wasn't admitted at that time. Patient was admitted 28th. Today his testing came back positive. There were two separate tests run that both came back positive for Ebola.
Patient doesn't appear to be a health worker and came to the States to visit family. Patient was asymptomatic at the time of his flight and the CDC is not currently contacting or testing those that shared a flight with them.

He's in Dallas.

 

[MegF.]

I think we'll be okay....it's not easily spread unless you come into contact with bodily fluids...I'm not going to start screaming and running for the hills yet...they really should be holding all flights into Africa though...

 

[Nanci]

The thing that I don't like is- what were they relying on before, to keep it out of the US? Asking people if they felt okay? Obviously that didn't work. It failed once; it will fail again.

 

[Nanci]

It will be interesting to see if this patient, with the supportive care of a US hospital, will survive.

 

[LittleFrog]

What i don't get is WHY isn't the CDC contacting and testing the people on his flight and the people he came in contact with?

 

[vetusvates]

Patient left Liberia on the 19th, arrived in the States on the 20th. On the 24th, he showed symptoms and sought treatment on the 26th. He wasn't admitted at that time. Patient was admitted 28th. Today his testing came back positive. There were two separate tests run that both came back positive for Ebola.
Patient doesn't appear to be a health worker and came to the States to visit family. Patient was asymptomatic at the time of his flight and the CDC is not currently contacting or testing those that shared a flight with them.

He's in Dallas.

I think we'll be okay....it's not easily spread unless you come into contact with bodily fluids...I'm not going to start screaming and running for the hills yet...they really should be holding all flights into Africa though...

What i don't get is WHY isn't the CDC contacting and testing the people on his flight and the people he came in contact with?

Precisely little frog. And Meg, at least take a look at passengers leaving areas of raging infection.
Every time this person sneezes...body fluids are aerosolized.
On the flight would mean the prior sentence reads in past tense (sneezed, were). As well as meandering around Dallas not getting treated until yesterday. Kissing and hugging relatives.........
Brushing teeth...
They say "he"...so every time he shaves/shaved...

 

[Shiari]

Actually, there are no reported cases of Ebola being transmitted through the air. It's been done in the lab, but not in real life so far. It requires direct contact with infect bodily fluids (blood, vomitus, sputum, semen, etc) or through fomites such as contaminated needles.

 

[Myca]

I know one of the people who worked on the special systems in Atlanta. I am concerned. I am also not surprised it showed up in the US although honestly I expected to see it in Florida first. I also believe we will see more of it.

 

[Rich Z]

This article is expressing some concerning facts and details -> http://www.cnn.com/2014/09/30/health/ebola-us/

How many medical facilities can handle a large number of people having to be placed in isolation for three weeks? That guy was out on the streets for four days after showing symptoms. That's a REAL scary thought to process..

 

[Rich Z]

I think we'll be okay....it's not easily spread unless you come into contact with bodily fluids...I'm not going to start screaming and running for the hills yet...they really should be holding all flights into Africa though...

I'm not worried about flights going INTO Africa. It's the ones COMING OUT that have me more concerned.

 

[HerpsOfNM]

Again, going off the fact that I worked as a necropsy technician within an ABSL-3 lab in Albuquerque...google it if you'd like.

Ebola, and a few other nasties (other hemorrhagic fevers, AIDS, smallpox, etc) are ABSL/BSL-4 diseases/select agents. The lab I worked for had the ability to aerosolize just about anything, and for research/vaccine testing purposes. I'd like to assume the ABSL/BSL-4 labs have the same ability, which is how they've confirmed aerosolized transmission WITHIN A LAB SETTING. This was most likely achieved by making certain the infection would even take hold, i.e., by overdose. Additionally, Texas has 2 ABSL/BSL-4 labs, one in Galveston and another in San Antonio; with additional labs around the nation. I'd like to assume protocols are in place for these situations, just like they were for where I previously worked. And no, I'm not at liberty to discuss any further.

To quote, but one of a number of articles:

The CDC is working to identify and monitor all the people who may have come into contact with the patient while he was infectious. Those people, like the DFR fire crew, will be monitored for 21 days for Ebola symptoms.

Should symptoms develop, those patients too will be isolated, and investigators will then determine who they came into contact with and monitor those people for symptoms.

So no, the CDC is attempting to contact those within contact of this patient. The order of magnitude of people this individual has been in contact with is very mildly concerning given the mode of transmission for Ebola. But like Meg, I'm not overly concerned at this point. Just like my wife, who's a microbiologist that plays with tuberculosis for a living isn't concerned about this.

 

[Nanci]

Center for Infections Disease Research and Policy:
We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.100774-2/abstract)
The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.
We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.
There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids2,3 and that the only modes of transmission we should be concerned with are those termed "droplet" and "contact."
These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) "direct" contact with the body fluids of an infected person.
This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.,
Persons with no known direct contact with Ebola virus disease patients or their bodily fluids have become infected.
Source - Oxford Journals: Medicine & Health The Journal of Infectious Diseases

 

[Jace91]

I'm not worried about flights going INTO Africa. It's the ones COMING OUT that have me more concerned.

^This^ They should have closed the boarders the moment they confirmed the outbreak.

 

[Nanci]

Actually, there are no reported cases of Ebola being transmitted through the air. It's been done in the lab, but not in real life so far. It requires direct contact with infect bodily fluids (blood, vomitus, sputum, semen, etc) or through fomites such as contaminated needles.

Right- it's not airborne, but could be spread by droplets, like influenza or MRSA or rhinovirus. If someone with ebola, in the infectious state, coughs or sneezes and you breathe in the droplets, you could be infected.

 

[tsst]

It is absolutely ludicrous that these flights are allowed in from the infected areas. This is the way pandemics start. The hubristic belief that we can control it without medical borders would be laughable if not so deadly. Instead inaction to contain it to the African continent will be costly. ALL flights from Africa should be 100% stopped. And ALL flights in should contain the precursor that you may not be permitted to leave. This is one of the very few things the UN should be doing. A worldwide travel ban from Africa should be in place.

 

[Rich Z]

It really doesn't need to be airborne to cause problems. From what I understand, if someone actively shedding Ebola coughs into their hand and then puts that hand on a railing, those virus particles will be there alive and able to be transmitted to a new victim for close to a week.

 

[vetusvates]

Again, going off the fact that I worked as a necropsy technician within an ABSL-3 lab in Albuquerque...google it if you'd like.

Ebola, and a few other nasties (other hemorrhagic fevers, AIDS, smallpox, etc) are ABSL/BSL-4 diseases/select agents. The lab I worked for had the ability to aerosolize just about anything, and for research/vaccine testing purposes. I'd like to assume the ABSL/BSL-4 labs have the same ability, which is how they've confirmed aerosolized transmission WITHIN A LAB SETTING. This was most likely achieved by making certain the infection would even take hold, i.e., by overdose. Additionally, Texas has 2 ABSL/BSL-4 labs, one in Galveston and another in San Antonio; with additional labs around the nation. I'd like to assume protocols are in place for these situations, just like they were for where I previously worked. And no, I'm not at liberty to discuss any further.

To quote, but one of a number of articles:


So no, the CDC is attempting to contact those within contact of this patient. The order of magnitude of people this individual has been in contact with is very mildly concerning given the mode of transmission for Ebola. But like Meg, I'm not overly concerned at this point. Just like my wife, who's a microbiologist that plays with tuberculosis for a living isn't concerned about this.

Center for Infections Disease Research and Policy:
We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.100774-2/abstract)
The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.
We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.
There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids2,3 and that the only modes of transmission we should be concerned with are those termed "droplet" and "contact."
These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) "direct" contact with the body fluids of an infected person.
This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.,
Persons with no known direct contact with Ebola virus disease patients or their bodily fluids have become infected.
Source - Oxford Journals: Medicine & Health The Journal of Infectious Diseases

Right- it's not airborne, but could be spread by droplets, like influenza or MRSA or rhinovirus. If someone with ebola, in the infectious state, coughs or sneezes and you breathe in the droplets, you could be infected.

Thanks, Nanci, for attending to the scientific/clinical...clarification/distinction.
Airborne (viruses talking flight, floating, flying, helicoptering, landing) ≠ aerosolized projectile snot droplets.
That is how I have been accustomed to formally using the two different terms.

 

[MegF.]

I wasn't aware that MRSA was an airborne disease...We never wore masks for MRSA positive patients only gowns and gloves.They were treated as contact patients, not airborne disease patients.....Only in the case of lung type MRSA would you need to wear a mask. I actually meant to say flights coming OUT of Africa not the other way around....

 

[Nanci]

I wasn't aware that MRSA was an airborne disease...We never wore masks for MRSA positive patients only gowns and gloves.They were treated as contact patients, not airborne disease patients.....Only in the case of lung type MRSA would you need to wear a mask. I actually meant to say flights coming OUT of Africa not the other way around....

It's not airborne. It can be spread by droplets. If a patient with pneumonia with MRSA in their sputum coughs, the MRSA is aerosolized and can be breathed in by a person within 3 to 6 feet of the patient.

 

[MegF.]

Okay...as I said lung type MRSA...which is pretty rare. I can't remember more than one or two patients in nearly 10 years with MRSA in the lungs....hundreds with skin though...plenty of contact patients. MRSA would be the last thing I'd worry about as an airborne disease....