Experimental Drug Given to American Ebola Patients

robjvargas said:

Not necessarily. Ebola is a virus, many variants of which induce a hemorrhagic fever.

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Yes, I was only talking about the strain(s) that induce scary disease, and yes, it's a virus, hence...

I've recently seen articles that say while it's not technically "airborne," you can potentially get it from breathing the same air as an infected person.

The articles are referencing this 2012 study. Can someone who is better at science tell me that this study was not well done?

heza said:

I've recently seen articles that say while it's not technically "airborne," you can potentially get it from breathing the same air as an infected person.

The articles are referencing this 2012 study. Can someone who is better at science tell me that this study was not well done?

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I have to run and only looked at the abstract and beginning but it's talking about what I kind of suspect it would be - Ebola Reston, which, I believe, was thought to be airborne. That's not this strain. Ebola Reston is the strain in the book, The Hot Zone.

Note they discuss aerosolized transmission - that's a different thing than airborne, but it's where people tend to get confused. Aerosolized transmission is, as far as I know, possible. That's like sneezing, coughing, and the droplets spreading disease when touched and transferred, etc. People touch their faces a LOT. Someone sneezes into their hand, puts that hand on a subway pole, then walks off, then you put your hand on the pole and then rub your eye, that's a possible way for a disease transfer to happen, but it's by bodily fluid, even though people tend not to think of it that way.

The good thing is that Ebola is hot as hell - it's not transmissable unless someone is symptomatic and mostly symptomatic people get very sick, very fast and very obviously. They're not, generally, wandering about for long. That's what's kept outbreaks contained thus far - this is in much more heavily populated areas though.

Diana Hignutt said:

Actually, yes, a lot of Ebola patients do shit out the linings of their intestines and die bleeding...I thought the term diarrhea was a dash less, well, horrifying...I did not intend to insult anyone. Ebola is a nightmare.

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I know what happens to a lot of Ebola patients. Gastrointestinal bleeding and, sometimes, the rotting/dissolution of their internal organs, do not equal "shit[ting] out the linings of their intestines." And "shitting out the linings of their intestines" absolutely does not equal "diarrhea."

I'm not sure why, in your quest to find something "less horrifying" than "shitting out the linings of their intestines,"--which was admittedly a good instinct--you couldn't have simply focused on something other than what comes out of the victims' anuses and gone with something not only accurate but less dismissive, like "internal hemorrhage," or, you know, just "Ebola," as in "they were going to die of Ebola." Only you can know why it was so important to make sure we all know that Ebola involves stuff coming out of butts and that these people were looking at not only a painful death but an undignified death which would involve their butts and that must have factored in their decision.

Either way, I'm sure you didn't mean to insult anyone. You didn't insult me. I found your use of "diarrhea" to describe Ebola to be inaccurate and flippant. Not insulting.

(ETA: I mean it, btw; I'm sure you didn't intend to be insulting and you didn't insult me.)

The best survival rate I've seen is 40%, so I'll need a link for your claim of over half.

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As Cornflake already pointed out, I did not "claim" "over half." I said "up to half," which is consistent with every estimate I've seen. That's anywhere from 50% down.

Here is a list from the WHO of the death rates of various regional Ebola outbreaks prior to this:

http://www.who.int/mediacentre/factsheets/fs103/en/

With one anomaly of 25%--which is amazingly low--most of them fall between 53% and 90%, but there are a few under 50%. A 53% death rate is a 47% survival rate, which is just slightly less than half, and of course there are a few (as I mentioned) in which over half actually did survive, so IMO saying "up to half survive" may not be an exact average but it's not outrageous. I can hunt for other references, too, if you like.

Finally, I shall reserve my opinion on their motives, I do not have definitive information on same.

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That's fine. It also doesn't change the risks or possible results of their action.

That said, I shall reiterate my statement of admiration for their humanitarian efforts under the worst possible conditions.

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Well, on that we agree.

cornflake said:

I have to run and only looked at the abstract and beginning but it's talking about what I kind of suspect it would be - Ebola Reston, which, I believe, was thought to be airborne. That's not this strain. Ebola Reston is the strain in the book, The Hot Zone.

Note they discuss aerosolized transmission - that's a different thing than airborne, but it's where people tend to get confused. Aerosolized transmission is, as far as I know, possible. That's like sneezing, coughing, and the droplets spreading disease when touched and transferred, etc. People touch their faces a LOT. Someone sneezes into their hand, puts that hand on a subway pole, then walks off, then you put your hand on the pole and then rub your eye, that's a possible way for a disease transfer to happen, but it's by bodily fluid, even though people tend not to think of it that way.

The good thing is that Ebola is hot as hell - it's not transmissable unless someone is symptomatic and mostly symptomatic people get very sick, very fast and very obviously. They're not, generally, wandering about for long. That's what's kept outbreaks contained thus far - this is in much more heavily populated areas though.

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They are talking about aerosolized transmission with this strain.

I read today that Ebola is contagious during the incubation stage--that 2 to 21 day time frame before symptoms appear. I hope you are right and what I read today was wrong, Cornflake. I will try to look up the article I read and post a link, if my mind cooperates. But honestly I take most of what I read on the net in stride until I can get it verified by several other sources. So I believe you. And am glad to know it.

Ambrosia said:

They are talking about aerosolized transmission with this strain.

I read today that Ebola is contagious during the incubation stage--that 2 to 21 day time frame before symptoms appear. I hope you are right and what I read today was wrong, Cornflake. I will try to look up the article I read and post a link, if my mind cooperates. But honestly I take most of what I read on the net in stride until I can get it verified by several other sources. So I believe you. And am glad to know it.

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Yes, aerosolized transmission is basically transmission via bodily fluids - people just don't think of it that way. They tend to think of that as 'airborne,' or think of bodily fluid transmission as the way one might get HIV, from direct transmission of some fluids into open wounds. There are differences between viruses though - HIV is a physically big sucker, and hard to get. Ebola is less so.

I looked to see if I could find what you'd read and don't see any reference to that. The WHO says -

The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patients become contagious once they begin to show symptoms. They are not contagious during the incubation period.

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A lit review from the NIH says -

When no symptoms are visible, EBOV-infected persons do not seem to be contagious.

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Same thing also says aerosol transmission seems to be not a particularly big threat, but that's hard to tell.

There may be some new information coming out of this outbreak, so you may want to look for what you read, but I didn't find anything.

FDA lifts hold on experimental Ebola drug

This is a different company than the one who gave the experimental drug to the U.S. dr and nurse. That company is Mapp Biopharmaceutical Inc., out of San Diego. Apparently the two drugs act differently, with Tekmira's drug targeting the virus and Mapp Biopharmaceutical's ZMapp strengthening the body's immune response to the virus. (That's the best my layman brain can make out of it.)

FDA Lifts Hold

Canadian drugmaker Tekmira Pharmaceuticals Corp. said the U.S. Food and Drug Administration modified a hold recently placed on the company's drug after safety issues emerged in human testing.

The company has a $140 million contract with the U.S. government to develop its drug, TKM-Ebola, which targets the genetic material of Ebola. But last month the FDA halted a small study of the injection in adults to request additional safety information.

Tekmira said Thursday the agency "verbally confirmed" changes to the hold that may allow the company to make the drug available, although it has yet to be proven as safe and effective.

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CDC chief says Ebola's spread to U.S. "inevitable"

Ebola's spread to U.S. "inevitable"

But he doesn't think it will be a "large" problem.

Ebola's spread to the United States is "inevitable" due to the nature of global airline travel, but any outbreak is not likely to be large, US health authorities said Thursday.

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Correct me if I am wrong, but he is talking "outbreak" and not an isolated traveler flying in from another country being treated here, right? Cause that is already happening--at least the isolation of travelers who are suspected of having Ebola.

However, Ken Isaacs, vice president of program and government relations at the Christian aid group Samaritan's Purse warned that the world is woefully ill-equipped to handle the spread of Ebola.

"It is clear that the disease is uncontained and it is out of control in West Africa," he told the hearing.

"The international response to the disease has been a failure."

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And there is only one plane in the whole world with a level four isolation chamber? And it only holds one person? That seems odd to me.

"One of the things that I recognized during the evacuation of our staff is that there is only one airplane in the world with one chamber to carry a level-four pathogenic disease victim," Isaacs said.

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Our local TV news ran a story stating that Ebola is not *that* contagious as to require Level Four isolation. Casual contact isn't a viable means of transmission (barring mutation, of course).

The doctor and nurse were treated as such out of caution, not need.

Can't find a link to the story, so take from that what you will.

By outbreak I suggest he means person to person transmission on US soil, but probably only a handful of cases. I think it would be equally plausible to predict only imported cases will happen here. There are some fundamental differences including a tendency for acutely sick people to end up in hospital.

Given the fatality rate I think higher level precautions are a rational choice. But I don't think there will ever be a time when it kills for US citizen that influenza in a given year.

cornflake said:

I have to run and only looked at the abstract and beginning but it's talking about what I kind of suspect it would be - Ebola Reston, which, I believe, was thought to be airborne. That's not this strain. Ebola Reston is the strain in the book, The Hot Zone.

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The abstract mentions Ebola Reston, but the species they experimented with was Ebola Zaire. They also conclude that their experiment provides evidence to support airborne transmission.

Ambrosia said:

Ebola's spread to U.S. "inevitable"

But he doesn't think it will be a "large" problem.

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Circa 2006, I lived in Liberia for a few months. At that time, in the entire nation of Liberia, there were 7 doctors and 2 dentists. The population was around 3 million people.

I'm just sharing this to demonstrate the utter lack of infrastructure and health care in that part of the world. Yes, it is has improved somewhat since 2006, but it's nowhere near adequate.

In many ways, comparing an Ebola outbreak in Africa to a potential Ebola outbreak in the US is comparing apples and oranges. For better or worse, the US has infrastructure that Africa does not.

Ambrosia said:

Ebola's spread to U.S. "inevitable"

But he doesn't think it will be a "large" problem.

Correct me if I am wrong, but he is talking "outbreak" and not an isolated traveler flying in from another country being treated here, right? Cause that is already happening--at least the isolation of travelers who are suspected of having Ebola.

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See, this bothers me. I mean, I understand that it's unrealistic to think it will never hit the US or any other country outside of Africa. But the attitude seems to be it's not that big of a deal. Some people might get it and die, but it wouldn't be a huge problem.

Well, I don't want to fall under one of those people that might get it. We should be taking as extreme measures as possible to avoid it happening. As it is, look how many people have died so far for lack of help.

Kweei said:

As it is, look how many people have died so far for lack of help.

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Did you read melindamusil's post? That's the biggest reason so many have died. The healthcare infrastructure just doesn't exist there. As one example, I've read that when patients are diagnosed with EBOV, their families have kidnapped them from the hospital because they don't trust modern medicine. In those cases, the "cure" attempts usually lead to infecting dozens more.

Funeral rituals over there often involve bodily fluids leaving the body, which is the primary way EBOV spreads, so there's that, too.

Two very good posts about this situation:
From the head nurse at Emory: http://www.washingtonpost.com/poste...anted-to-bring-the-ebola-patients-to-the-u-s/

And from the Director of the Division of Medical Ethics at an NYU hospital:
http://www.washingtonpost.com/poste...e-ebola-serum-while-hundreds-of-africans-die/

Kweei said:

See, this bothers me. I mean, I understand that it's unrealistic to think it will never hit the US or any other country outside of Africa. But the attitude seems to be it's not that big of a deal. Some people might get it and die, but it wouldn't be a huge problem.

Well, I don't want to fall under one of those people that might get it. We should be taking as extreme measures as possible to avoid it happening. As it is, look how many people have died so far for lack of help.

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I don't think there are any more extreme measures that could be taken - there are people watching at airports, every hospital everywhere is on crazy alert, etc.

I think it's unrealistic to think it won't end up in the U.S., but it does seem unlikely, given Ebola itself, that it'd turn into an epidemic here.

Ambrosia said:

And there is only one plane in the whole world with a level four isolation chamber? And it only holds one person? That seems odd to me.

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I don't know if that's true or not, but I do believe they mean a built-in, integrated biohazard unit in the plane. Any plane can move a patient like that - they go in portable airlock dealies. The Spanish government brought one of their citizens from one of the affected African countries back home for treatment and used a regular jet, afaik.

Concern over a potential incident in Canada. Man arrives in Canada after visiting Nigeria experiencing flu-like symptoms. He has been rushed to a Brampton hospital for isolation, testing, and treatment.

http://www.cbc.ca/news/canada/toron...ton-hospital-with-flu-like-symptoms-1.2731761

(Incident does not mean outbreak.)

http://www.cnn.com/2014/08/08/health/ebola-american-victims/index.html?hpt=hp_t2
Brantly, the doctor, held the hands of Ebola patients as they died.
Just... wow.
The courage he demonstrates just blows my mind.

cornflake said:

I don't think there are any more extreme measures that could be taken - there are people watching at airports, every hospital everywhere is on crazy alert, etc.

I think it's unrealistic to think it won't end up in the U.S., but it does seem unlikely, given Ebola itself, that it'd turn into an epidemic here.

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+1. Speaking as a layman, it seems that the mortality rate of Ebola would be significantly decreased if the patients are given adequate support (like IV fluids and treating the symptoms). And it's already been established that Ebola is really not as contagious as we may fear.

Ebola isn't too much of a threat to the USA, because of a few major factors.

1. Modern sanitation. Ebola is spread through fluid contact. Ebola, once it's symptomatic, causes the victim to have really bad diarrhea. In the 3rd world a lot of that stuff ends up in open sewers and can contaminate the water supply or nearby homes.
2. Population Density. We're really spread out and Ebola kills quick enough that unless people are packed together, it'll eventually burn out because of a lack of fresh hosts.
3. We live differently. In the 3rd world people live in close quarters. A small home might have a dozen people living in it, and the people in the family might be sharing beds and be in close physical proximity. Here in the USA, again, this would help Ebola burn out.
4. Medical Infrastructure. We have large numbers of trained health care professionals, and we've got ready access to a limitless supply of basic protective equipment.

In my opinion, the worst case scenario for Ebola, would be for it to reach one of the Indian megalopolises. Those are places that are extremely packed with people, and that have horrible levels of sanitation and cleanliness.

As far as the first world goes, I think the more densely populated areas are the places more at risk. European/Asian cities in particular being more vulnerable than US ones simply due to the fact that people live in closer proximity.

Dommo said:

Ebola isn't too much of a threat to the USA, because of a few major factors.

I agree in general, but....

1. Modern sanitation. Ebola is spread through fluid contact. Ebola, once it's symptomatic, causes the victim to have really bad diarrhea. In the 3rd world a lot of that stuff ends up in open sewers and can contaminate the water supply or nearby homes.

It also may be aerosolized, and it's spread through all bodily fluids, including urine, sweat, etc.

However, all one has to do is watch any of a dozen episodes of any local news from sweeps week to see how much fecal matter is on doorknobs, keyboards, gas pumps, fast food restaurant surfaces, public transit, etc. Which brings me to ...

2. Population Density. We're really spread out and Ebola kills quick enough that unless people are packed together, it'll eventually burn out because of a lack of fresh hosts.

Most of the population of the U.S. lives in urban areas, some of which includes suburbs, but regardless. We are not really spread out. Some certainly are. The population of, say, Wyoming is really spread out. The population of the U.S. is not.

3. We live differently. In the 3rd world people live in close quarters. A small home might have a dozen people living in it, and the people in the family might be sharing beds and be in close physical proximity. Here in the USA, again, this would help Ebola burn out.

See above. The places this would be likely to hit based on air travel are the places people live in close proximity.

4. Medical Infrastructure. We have large numbers of trained health care professionals, and we've got ready access to a limitless supply of basic protective equipment.

Oh, no, we don't. Compared to Liberia, certainly. On hand, if there were Ebola patients cropping up in the wild in a couple of populated spots in the U.S.? I daresay it'd get very ugly, very fast, as people panic rushed to emergency rooms, went looking for gear for themselves, and hospitals ran out quickly. Remember SARS and tent ERs? Multiply that by a large number, add panic, more gear, push packs and then recall the days following 9-11, when there were doctors and rescue personnel on television asking the general public to bring supplies down to drop-off sites.

In my opinion, the worst case scenario for Ebola, would be for it to reach one of the Indian megalopolises. Those are places that are extremely packed with people, and that have horrible levels of sanitation and cleanliness.

That would indeed be bad, though I don't know that the superstition exists to the same level there.

As far as the first world goes, I think the more densely populated areas are the places more at risk. European/Asian cities in particular being more vulnerable than US ones simply due to the fact that people live in closer proximity.

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Outside of a couple of places like Tokyo, I don't think European or Asian cities have people in closer proximity than American ones do, or have more people in them,

The benefit we have is that Ebola is hot, and there's more basic education that's been available, so the superstition/fear thing driving people back into the communities is likely to be less of a problem.

People with Ebola in general, get very sick, very fast, once they get symptomatic, and here, would likely seek help and treatment, which would limit the exposure to the general population. That, plus education of the public about transmission if it did hit here, and a significant number of health personnel and draftable others to ring areas, enforce quarantine, etc., should maybe be able to keep it from getting out of hand.

Cornflake,

I guess the gist of what I'm getting at is that ebola is a close quarters disease. It spreads by people being clustered tightly together. Americans just aren't a "close" people. We tend to emphasize personal space (e.g. people tend to avoid touching each other even in crowded places), minimize interpersonal contact (e.g. we don't kiss and touch frequently), and that we typically don't have extremely large individual households (e.g. instead of a dozen people getting infected when ebola hits home, only 3 or 4). These to me, seem to address many of the infection risks presented by ebola.

I grant you, that in the North East or in Chicago what you're saying is true as far as density. However, it's not normal for Americans to have the kind of close contact that really facilitates Ebola transmission.

In other words, I'm skeptical that any ebola outbreak in the USA could actually sustain itself before basically burning out.

Dommo said:

Cornflake,

I guess the gist of what I'm getting at is that ebola is a close quarters disease. It spreads by people being clustered tightly together. Americans just aren't a "close" people. We tend to emphasize personal space (e.g. people tend to avoid touching each other even in crowded places), minimize interpersonal contact (e.g. we don't kiss and touch frequently), and that we typically don't have extremely large individual households (e.g. instead of a dozen people getting infected when ebola hits home, only 3 or 4). These to me, seem to address many of the infection risks presented by ebola.

I grant you, that in the North East or in Chicago what you're saying is true as far as density. However, it's not normal for Americans to have the kind of close contact that really facilitates Ebola transmission.

In other words, I'm skeptical that any ebola outbreak in the USA could actually sustain itself before basically burning out.

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It's not about touching each other, though I suspect you've not been on mass transit at rush hour, anyplace, heh.

If someone on the Tube had Ebola, wiped his face with his hand, put his hand on the pole, coughed into his hand, put his hand on the opposite pole, got off the train.... how many people could theoretically be infected?

Someone feels ill but goes to, say, a football game. That person goes to the bathroom. That person doesn't wash his hands, like a good percentage of people. That person touches - the toilet handle, stall door, doorframe, railing, money that he uses to pay for a beer or the card swipe, the straw and napkin dispenser, railings, seats....

Imagine a person was visiting family in Nigeria and has to come back to work at a deli or coffee shop in a city. Even though he doesn't feel that well, he has to go back to work when scheduled; can't afford to lose pay.

Infected, symptomatic people in the wild in a city can generate insane disease vectors without touching or kissing a single other person.

Something close to two million people live on the island 10 miles long by three miles wide (and 1/4 of that space is parkland). Tell me we're not a close quarters kind of people.

It's not even just that people who don't feel well might continue to be out in public. Often someone infected with a virus is shedding that virus (and thus contagious) before they notice symptoms.

Honestly, though, I don't think this is as contagious as some fear. Much has been made of the fact that the two American health workers "maintained sterile technique" and still caught Ebola.

However, the physician of the pair wasn't an infectious disease specialist; from what I read at the link below, it seems that he was a young doc just out of internal medicine residency doing a 2-year missionary fellowship. He was caught up in this unexpectedly, by report he was holding the hands of people as they were dying (granted, he could have been wearing gloves), and I am not sure that "maintained sterile technique" would mean the same in an impoverished country with an inexperienced physician doing missionary service as it does at, say, Emory in the full light of big eye oversight.

He and his colleague have my best wishes.

CNN on the male physician's mission: http://www.cnn.com/2014/08/08/health/ebola-american-victims/index.html?hpt=hp_t2
WHO on the Ebola virus, including latency period and asymptomatic shedding: http://www.who.int/mediacentre/factsheets/fs103/en/