Why Ebola is not like "Contagion" by SIGNYM

REAL WORLD EVENT DISCUSSIONS

Why Ebola is not like "Contagion"

POSTED BY: SIGNYM
UPDATED: Monday, October 20, 2014 17:56
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Saturday, October 18, 2014 2:22 PM

I believe in solving problems, not sharing them.

In the movie, "contagion" the outbreak of a virus was attempted to be controlled by heroes in the CDC, Dr Ellis Cheever (Laurence Fishburne) and Dr Erin Mears (Kate Winslet) ... public servants who dedicated (and in one case, lost) their lives to fighting disease.

However, unlike the CDC of fiction, the real CDC is headed by a political appointee, Dr Thomas Frieden, who famously said “Essentially any hospital in the country can safely take care of Ebola. You don't need a special hospital to do it,”

http://www.latimes.com/nation/nationnow/la-na-four-ebola-quotes-haunt-
frieden-20141016-story.html

His statement was prompted by political concerns, not scientific ones. It pandered to the idea that the populace needs reassurance, not facts. And it put the onus squarely on hospitals that are neither prepared nor equipped to cope.

Obama is continuing in that fine governmental tradition by appointing yet another politician to be Ebola czar. Ron Klain, "a veteran Democratic political aide", was just chosen to head up the anti-Ebola activity. One hopes that he's LESS of a political animal than Frieden, and has the authority and the fortitude to tell inconvenient truths.

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Another difference... in the movie, the virus had a R(naught) - a basic reproduction number - of 3 because it spread by contaminated objects (fomites), while Ebola seems to have an r naught of more like 2.

Disease Transmission R0
Measles Airborne 12–18
Pertussis Airborne droplet 12–17
Diphtheria Saliva 6–7
Smallpox Airborne droplet 5–7
Polio Fecal-oral route 5–7
Rubella Airborne droplet 5–7
Mumps Airborne droplet 4–7
HIV/AIDS Sexual contact 2–5
SARS Airborne droplet 2–5
Influenza Airborne droplet 2–3
Ebola Bodily fluids 1-2

http://en.wikipedia.org/wiki/Basic_reproduction_number

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Saturday, October 18, 2014 6:01 PM

MAGONSDAUGHTER

Yep, given the amount of international travel, diseases will spread. Luckily, ebola is not airborne. The carrier has to be at an acute stage to be most contagious - most likely vomiting, shitting stage - small possibility sweat. You have to come into contact with these bodily secretions. The most vulnerable are health care workers and family members because they care for an acutely unwell person. That's why hospitals need to be on top of their hygiene practices, particularly in dealing with acute stages and particularly how they remove and dispose of their protective clothing.
Air borne diseases like SARS require more government intervention because everyone is at risk. Highly government controlled and regulated Singapore was able to stem SARS because it used draconian and strict measures to control the outbreak, measures that would be unpalatable no doubt to Americans who instinctively resist government interference.
Whaddaya do?
Basically, we’re (the world) is pretty unprepared for an airborne contagion.

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Saturday, October 18, 2014 8:37 PM

SIGNYM

I believe in solving problems, not sharing them.

Well, Ebola IS airborne to some extent, and CAN be spread by contaminated surfaces to some extent.

A truly airborne virus is one where the completely dried virus particle can float in the air and still remain viable. Virus particles are so small, they can stay suspended for long distances... days, and miles. (Of course, the concentration becomes so small at that point that the probability of becoming infected is quite low.)

But when people sneeze, cough, fart, vomit, talk, thrash around, or urinate, they create tiny droplets called aerosols which can protect the virus in it, and the aerosols are small enough that they can remain suspended for three feet (the CDC says) or (IMHO) more. When the aerosol settles on a surface, the virus is STILL viable, and if in a humid environment at room temperature can remain viable for a few days (fomite).

So it's not as if you actually need to TOUCH a person - or their excretions, or sopping material - in order to catch Ebola, you can be several feet or several days away and still be exposed.

So, not as contagious as measles, but not as harmless as it sounds.

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You can't build a nation with bombs. You can't create a society with guns.

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Saturday, October 18, 2014 9:37 PM

MAGONSDAUGHTER

It's clearly not something to be sneezed at - sorry for the bad pun. It's a serious disease with lots of risk factors.

According to WHO

Quote:
Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.

People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

The difference between SARS and Ebola is the symptoms. Diseases where people cough and sneeze and the disease is air borne through moisture particles are most likely to cause massive outbreaks. People are still active when unwell, going to work, travelling and spreading the disease willy nilly. It's why the common cold is so successful, it's just that these days people dont die when they infection - infection to death is extremely low.

Ebola - people are extremely unwell and their most infectious. Too unwell to be travelling and going to work, so you are most likely to be infected when caring for an unwell person.

The trouble with health care conditions in parts of Africa is that they encourage the spread of disease through poor hygiene procedures and facilities. Acutely unwell people go to hospitals and medical centres, and pass it on to carers. It's a different kind of spread. It should be taken seriously, but not hysterically.

And if people could stop blaming and take some action, it would probably be useful.

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Saturday, October 18, 2014 11:47 PM

SIGNYM

I believe in solving problems, not sharing them.

Quote:
Ebola - people are extremely unwell and their most infectious. Too unwell to be travelling and going to work, so you are most likely to be infected when caring for an unwell person.

The trouble with health care conditions in parts of Africa is that they encourage the spread of disease through poor hygiene procedures and facilities. Acutely unwell people go to hospitals and medical centres, and pass it on to carers. It's a different kind of spread. It should be taken seriously, but not hysterically.

As you say, those most at risk are health care workers. It all seems too distant. The funny thing is, I have niece who is an ER doctor in Akron, where Amber Vinson (the second nurse) traveled.

Personally, if I were sick in Africa I wouldn't go to a hospital. Because of the lack of resources, everybody who LOOKS like they MIGHT have Ebola are all put in isolation together. So even if all you have is malaria, you'll wind up in the same areas as people with Ebola. Even if you didn't have it to start out with, you'd probably wind up with it anyway.

And for what? Successful treatment depends on sophisticated medicines. Infusions, vasopressors, blood transfusions from the recovered infected, anti-virals. None of those are available there. You wind up dying in a nightmare of a place. If it were me, I'd just lock myself in a room at home and resolve to either die or survive alone.

Quote:
And if people could stop blaming and take some action, it would probably be useful.

As far as the USA is concerned, the only people I blame are the head of the CDC, hospital administrators, and other flim-flam men whose view from 30,000 feet led them to complacency and hubris. I really empathize with the nurses, EMTs, and doctors who have to figure out who to DEAL with the possibility (and sometimes actuality) of Ebola. A month ago, I listened to a show about how difficult it is to put on, work in, and (most importantly) remove protective gear. It's NOT normal hospital isolation technique, and it left a profound impression on me. Just recently, I saw an article on the same topic, which had even more detail. If the m-effers whose job it is to set policy, acquire equipment, and organize training had even bothered to educate themselves just a smidgen about the topic, they wouldn't have set their staff adrift to deal with an impossible situation.

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You can't build a nation with bombs. You can't create a society with guns.

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Saturday, October 18, 2014 11:57 PM

MAGONSDAUGHTER

Yeah agree with all that. Especially if you are in an environment that puts unreasonable demands upon you or is cutting corners for cost reasons. We get outbreaks of golden staf in our hospitals for similar reasons, plus its resistent to anti biotics. STOP USING ANTI BACTERIAL CLEANING MATERIALS EVERYONE. Unless you live in a hospital, you really just need to clean and keep your cleaning materials clean.

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Sunday, October 19, 2014 7:56 AM

MAGONSDAUGHTER

Jude Law did a terrible australian accent in that film

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Sunday, October 19, 2014 11:25 PM

SIGNYM

I believe in solving problems, not sharing them.

Oh, was that Australian? I had no idea!

--------------
You can't build a nation with bombs. You can't create a society with guns.

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Monday, October 20, 2014 1:46 AM

MAGONSDAUGHTER

Yeah, Aussies are the new bad guys in Hollywood films.

Worst would have to be the two idiots in Pacific Rim.

Supposedly Australian accents are hard to do, but as most the audience is American it's only us that cringe, so I suppose it doesn't matter.

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Monday, October 20, 2014 4:16 AM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

I've always wondered about that. There's a show here - Elementary - where a American does a British accent. There's another show - The Mentalist - where an Aussie does an American accent. I can hear the times when the US accent slips. I wonder how good the British one is.

SAGAN: We are releasing vast quantities of carbon dioxide, increasing the greenhouse effect. It may not take much to destabilize the Earth's climate, to convert this heaven, our only home in the cosmos, into a kind of hell.

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Monday, October 20, 2014 4:46 AM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

But back to the topic at hand ... what I wonder about are emergency rooms.

So, you have people come in and heaven knows what they've got.

For maximum safety you should find and isolate the potential Ebola cases first - not just from the general ER population and the general staff, but also from each other. So the first thing you do is take the temperature of everyone who comes in and ask about their recent travel history and the history of people they're in contact with. That will probably work 90% of the time, but it does assume they're going to tell the truth, and, more unrealistically, that they'll know all they need to know about others. So there's an unavoidable shortcoming with basic procedures.

But there's also a problem of ER facilities. Most scenarios assume the person will come in with a genteel mild fever and maybe a few body aches, minimally infective, and be capable of sitting quietly waiting to be taken to a specialized facility. But what if the person comes in violently floridly ill, where the very air around them is contaminated? You're going to need a very specialized ER isolation room with a separate entry for suiting up and decontamination. Can you see hospitals altering their ER facilities to accommodate this scenario just in case it comes to pass? I can't.

Anyway - yeah, Obama - once again hiring people on their ability to politically triangulate - and seemingly utterly oblivious to that real world out there that runs by its own unalterable, apolitical rules.

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Monday, October 20, 2014 7:09 AM

OONJERAH

Nigeria Is Ebola-Free: Here’s What They Did Right
http://time.com/3522984/ebola-nigeria-who/

"It's been 42 days since the last new case

"The World Health Organization declared Nigeria free of Ebola on Monday,
a containment victory in an outbreak that has stymied other countries’
response efforts."

... oooOO}{OOooo ...

Part of being smart is knowing what you're dumb at.

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Monday, October 20, 2014 5:56 PM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

Thanks for that.

One particular point of note: "Keeping borders open. Nigeria has not closed its borders to travelers from Guinea, Sierra Leone and Liberia, saying the move would be counterproductive. “Closing borders tends to reinforce panic and the notion of helplessness,” Shuaib said. “When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.” Shuaib said that if public health strategies are implemented, outbreaks can be controlled, and that closing borders would only stifle commercial activities in the countries whose economies are already struggling due to Ebola."

Countries that have had Ebola in the past tend to do better in controlling the spread and eventually extinguishing the outbreak, due to better knowledge in the population and in government. But Nigeria is not in that category. What I got out of this is very similar to the credo of wildland firefighting policy - all fires start out small. Nigeria jumped on this aggressively with public health measures and education, and training, equipment, supplies and facilities for its medical and support staff. They did this to contain it early, keeping it from getting ahead of them and raging beyond control.

Senegal was also declared Ebola free two days ago after halting the spread from the case of one man who entered the country with the disease.

But as noted in the article, Ebola can come back. Guinea - and Doctors Without Borders - thought they had addressed all Ebola cases earlier this year. Doctors without borders shuttered their facility in May and kept only a skeleton crew there. But people coming back to Guinea from Liberia and Sierra Leone brought it back. http://www.emsworld.com/news/11681519/ebola-reemerges-in-places-it-had
-been-beaten-back Today Guinea is a raging hotspot.

While it's good to see Ebola can be controlled, I don't see the Nigerian approach helping in areas where the problem is now beyond public health resources. But Liberia, which erected a cordon sanitaire around the slum of West Point in August (which did no good), and shut down the country for 3 days in late September, seems to have slowed the spread -

I wonder what's going right.

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