Tag Archives: ebola

Nothing to worry about here

“CHICAGO (CBS) – An 8-year-old refugee from Congo died Tuesday after landing at Chicago’s O’Hare International Airport.

David Dieme, an 8-year-old boy landed Tuesday at approximately 4:30 p.m. with a refugee family at O’Hare International Airport.

Dieme was traveling with his father and several other children, who arrived to Chicago on a flight from Dubai. After clearing paperwork, the family was being escorted to their next flight, when a U.S. Customs and Border Protection officer noticed Dieme unresponsive.

Emergency Medical Services was immediately notified and arrived at the terminal. Standard procedures are in place to address sick passengers, according to a spokesman for the Centers of Disease Control and Prevention. Dieme was sick prior to the flight, but did not report any symptoms on the flight. He was examined at the airport by CDC officials, in an isolated room. Dieme’s temperature was taken, but he had no fever. He experienced diarrhea and vomiting. It was determined he should be taken to the hospital.”

8-Year-Old Refugee Dies After Flight To O’Hare

What could possibly go wrong?

“No need for alarm” Ebola deaths return to Libera

“Authorities in the West African country are perplexed as to what could have caused the resurgence of the disease that is confirmed to have killed a 17-year-old on June 28.

The boy, who hails from Margibi country outside the country’s capital, Monrovia, died under unexplainable circumstances three days after falling ill. A post-mortem diagnosis revealed that he succumbed to the Ebola disease.

His death is the first since World Health Organisation (WHO) declared the country Ebola- free on May 9. On whether this outbreak could be ringing a knell for yet another full-scale outbreak of the disease, Dr Joa Ja’KkenoOkech-Ojony, a Ugandan epidemiologist and public health specialist leading the Ugandan team of specialists in Liberia says,“There is no need for alarm.”

“Meanwhile, health officials in the Democratic Republic of Congo (DRC) are investigating the possible outbreak of Ebola in Masambio village, according to Reuters.

It is reported that six hunters fell ill last week with symptoms of Ebola including diarrhoea, bloody urine and vomiting, after killing an antelope. Four of the hunters have since died.”

http://www.observer.ug/lifestyle/health/38632-liberia-on-ebola-alert-after-case-resurgence

One of the worlds rarest diseases

“No cause for alarm” after the first outbreak that jumps from the bush into major cities apparently makes a come back

“No cause for alarm” as they continue to quarantine possible cases across our country

Foolishness that in the end will be paid for

Just when you thought it was safe to go in the water; Mass evacuations in Sierra Leone as Ebola suddenly worsens

Wow!  Strange stuff here. The vice president of S.L. goes into quarantine and they expel him from the party while he is absent.  In the meantime 11 exposed workers are being flown to the U.S. and scattered around the country for treatment.

I would be guessing that Sierra Leone will soon be falling into civil war again and Ebola treatment will stop. If that happens , it will be raging all across the country unchecked. Do the math on that one.

“The news of the mass evacuation follows media reports from Sierra Leone claiming the virus’s spread has begun to worsen since an initial improvement in January. “It is now very clear to most observers that the Ebola situation in the North and West of Sierra Leone has been worsening in recent weeks. On Thursday March 12th 2015 has come news that an American citizen is now being urgently flown out of the country having caught Ebola as part of rising cases here,” reported the Awareness Times, headquartered in the capital of Freetown. The newspaper notes that several British citizens are also under Ebola warnings.”

Rest here from Breitbart: http://www.breitbart.com/national-security/2015/03/16/ebola-quarantined-sierra-leone-vp-requests-us-asylum-as-11-americans-flown-home/

Ford hood soldier found dead in pool of vomit just returned from W. Africa

From KVUE.com:

“KILLEEN, Texas (KCEN) — Killeen Police and Fort Hood Military Police currently have a home blocked off on the 3300 block of Cantebrian Drive where a man was found dead in a yard Tuesday morning.

Fort Hood officials confirm the man is a soldier who recently returned from a deployment to West Africa. Officials say there are no indications the soldier had Ebola, however medical personnel at Carl R. Darnall Medical Center are running tests as a precaution to make sure there is no threat to the community.

The soldier was found in or near a pool of vomit, prompting concern about Ebola, according to a Defense Department official speaking on condition of anonymity because they were not authorized to speak about the investigation.

“At this point, there is no indication of the Ebola virus disease, but medical tests are underway to ensure there is no threat to the community,” the Fort Hood statement said”

The rest here: http://www.kvue.com/story/news/local/2015/01/13/fort-hood-soldier-found-dead-in-yard/21698101/

“Shocking poll” Democrats lose millenials

“Harvard University on Wednesday provided new proof that the Democrats are going to be broadsided in Tuesday’s national elections as millennial voters, in a shocking shift, now prefer a Republican-controlled Congress and give President Obama his second lowest grade ever.

A new and massive poll of 2,029 18- to 29-year-olds from Harvard’s Institute of Politics just released found that of those who say they will “definitely be voting,” 51 percent want the GOP in charge, 47 percent favoring Democratic control”

“a huge shift from the last IOP midterm poll. In 2010, younger voters kept to their historic trend with 55 percent favoring Democrats, 43 percent Republicans. That is an eight-point change, very good news for the Republicans who had feared that the Obama generation would show up at the polls and in knee-jerk fashion simply pull the Democratic levers.”

“Shellacking” that’s the term isn’t it? Yes, I believe that one of epic proportions is about to happen. No matter how much the Dear Leader flies around the country telling everyone how great things are, there is no covering up the shape that our country is in.

Things are bad enough that it is starting to saturate the psyche’s of even the youngsters. I have nephew who is 9 and is after his mother to watch the news because he is worried about Ebola. She is one of those non-news, insulate yourself from reality types  and he is now infusing her with what is going on.

“Shellacking” Yep, I think that term is a little mild for what is about to happen to the big gay party.

From Washington examiner, original here: http://www.washingtonexaminer.com/shock-harvard-poll-millennial-voters-want-gop-in-charge-abandon-obama/article/2555411

Just in time for winter!

Ebola can survive for up to 50 days at 4 degrees C

http://www.dailymail.co.uk/sciencetech/article-2809803/Ebola-surfaces-TWO-months-Tests-reveal-certain-strains-survive-weeks-stored-low-temperatures.html

Just when you thought it was safe to go in the water. Remember kids, keep your fingers out of your eyes and mouth and DON’T touch the bottom of your shoes.

Ebola NYC?

http://www.nydailynews.com/new-york/doctor-treated-ebola-patients-rushed-bellevue-fever-article-1.1984941

Doctor who treated Ebola patients in Guinea rushed to Bellevue Hospital with fever

The 33-year-old doctor identified as Craig Spencer returned recently while working in West Africa with Doctors Without Borders. He quarantined himself after developing nausea and a high fever, sources said, but was rushed to the hospital Thursday. Preliminary test results are expected in the next 12 hours.”

Where are all of the adults? Who lets someone back in who has been treating Ebola patients and doesn’t monitor them? It’s not like we are talking about Chickenpox here.

Epic stupidity or arrogance, it is hard to tell which one. On the upside, if it does take off in New York I have 200 N95 respirators  that will suddenly be for sale…..

UPDATE:”

“The chances of the average New Yorker contracting Ebola are extremely slim,” officials said. “Ebola is spread by directly touching the bodily fluids of an infected person. You cannot be infected simply be being near someone who has Ebola.”

As a precaution, officials removed the door to Spencer’s building when they arrived on the scene, a witness told CBS 2.

Sources said Spencer went bowling last night in Williamsburg and took an Uber car to get there and back, 1010 WINS’ Carol D’Auria reported.”

Take no chances, take the whole damn door!

Liberia loses another Dr. to Ebola

“The medical profession in Liberia and the nation as a whole have again been terribly hit by Ebola.  It was announced last weekend that Dr. Thomas Scotland on Saturday succumbed to Ebola in the JFK’s Ebola Treatment Unit (ETU).  This brings to six the number of medical doctors we have lost to Ebola, in a nation already woefully doctor-starved.

First we lost Dr. Sam Mutooro Muhumuza, the Ugandan physician, in July, and on the 26th of that month, our Independence Day, Dr. Sam Brisbane, a physician with over 40 years of experience. Next came Dr. Abraham Borbor, another long-serving internist; then a very promising fourth year medical student, Malikee Siryon, who died last week.

The next casualty was Dr. John Dada, a Ugandan-born intern at the Obs and Gyns section of the JFK, who died at the weekend. He studied at the University of Liberia’s A.M. Doggliotti College of Medicine, remained here and became a naturalized Liberian.”

http://www.liberianobserver.com/editorials/another-doctor-another-widow-and-5-more-orphans

Nothing to see here, just move along. We have everything under control.

Liberia transport minister in quarantine after driver dies of Ebola

http://www.modernghana.com/news/574823/67/liberia-minister-in-quarantine-after-driver-dies-o.html

And that after this:

“Liberia said its chief medical officer Bernice Dahn, who has been leading the fight against Ebola, does not have the deadly virus.

But, Minister of Information Lewis Brown said, Dahn placed herself in quarantine after her special assistant died Thursday. ”

And this:

“MONROVIA, Liberia — One of Liberia’s most high-profile doctors has died of Ebola, a government official said Sunday, highlighting the risks that health workers face in trying to combat the deadly disease.”

But don’t worry, Dear leader has said that everything is safe.

Just remember that these aren’t hut dwelling bushmeat eaters going down here. These are educated Govt. officials who know all about protocol and are the elite of their society.

As the head of Samaritins purse stated and as evidenced by the unusual spread in Africa “Something is different about this one”

Just don’t forget that “Never let a crisis go to waste” is a double edged sword.

Yep, decided to go to the airport

EbolaPassengerAtDulles

Liberia needs 79,940 more body bags

http://www.washingtonpost.com/news/morning-mix/wp/2014/10/15/liberia-needs-79940-more-body-bags/

Don’t worry folks, CDC has it all under control. There is no way that it can possibly spread here.

And if it does the CDC, DHS, TSA and the rest will keep us safe by quarantines and wellness check points……That would make easy targets. Oops..Did I say that out loud?

2cnd healthcare worker gets Ebola

http://www.breitbart.com/system/wire/ap_ab3cd5a9b32c450aa5a13e1a4a14c60e

So, what is odd about this? The paramedics who transported Duncan and rode around in the ambulance for two days are fine. The step daughter who rode to the hospital with him is fine.

There is no word about the girlfriend or the daughter who drove to the hospital hugging his blanket and sat in the ER for 4 hours. There is no word about the guys who pressure washed the vomit off of the sidewalk in front of the apartment.

Hmmm…. Fuzzy math. Something is not adding up.

So which one is it? Super transmissible , nasty little bug or not so much? If it is passed that easily, that means that the CDC is quietly sitting on a bunch of unreported cases.

Just remember that if this goes nasty, where it came from. You kill me, I kill you right back.

The case for Ebola being airborne

The Center for Infectious 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.

Health workers need optimal respiratory protection for Ebola

Today’s commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago.

Healthcare workers play a very important role in the successful containment of outbreaks of infectious diseases like Ebola. The correct type and level of personal protective equipment (PPE) ensures that healthcare workers remain healthy throughout an outbreak—and with the current rapidly expanding Ebola outbreak in West Africa, it’s imperative to favor more conservative measures.
The precautionary principle—that any action designed to reduce risk should not await scientific certainty—compels the use of respiratory protection for a pathogen like Ebola virus that has:
  • No proven pre- or post-exposure treatment modalities
  • A high case-fatality rate
  • Unclear modes of transmission

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.1

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.

The second line of reasoning is that respirators or other control measures for infectious aerosols cannot be recommended in developing countries because the resources, time, and/or understanding for such measures are lacking.4

Although there are some important barriers to the use of respirators, especially PAPRs, in developing countries, healthcare workers everywhere deserve and should be afforded the same best-practice types of protection, regardless of costs and resources. Every healthcare worker is a precious commodity whose well-being ensures everyone is protected.

If we are willing to offer infected US healthcare workers expensive treatments and experimental drugs free of charge when most of the world has no access to them, we wonder why we are unwilling to find the resources to provide appropriate levels of comparatively less expensive respiratory protection to every healthcare worker around the world.

How are infectious diseases transmitted via aerosols?

Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data. In the 1940s and 50s, William F. Wells and other “aerobiologists” employed now significantly out-of-date sampling methods (eg, settling plates) and very blunt analytic approaches (eg, cell culturing) to understand the movement of bacterial aerosols in healthcare and other settings. Their work, though groundbreaking at the time, provides a very incomplete picture.

Early aerobiologists were not able to measure small particles near an infectious person and thus assumed such particles existed only far from the source. They concluded that organisms capable of aerosol transmission (termed “airborne”) can only do so at around 3 feet or more from the source. Because they thought that only larger particles would be present near the source, they believed people would be exposed only via large “droplets” on their face, eyes, or nose.

Modern research, using more sensitive instruments and analytic methods, has shown that aerosols emitted from the respiratory tract contain a wide distribution of particle sizes—including many that are small enough to be inhaled.5,6 Thus, both small and large particles will be present near an infectious person.

The chance of large droplets reaching the facial mucous membranes is quite small, as the nasal openings are small and shielded by their external and internal structure. Although close contact may permit large-droplet exposure, it also maximizes the possibility of aerosol inhalation.

As noted by early aerobiologists, liquid in a spray aerosol, such as that generated during coughing or sneezing, will quickly evaporate,7 which increases the concentration of small particles in the aerosol. Because evaporation occurs in milliseconds, many of these particles are likely to be found near the infectious person.

The current paradigm also assumes that only “small” particles (less than 5 micrometers [mcm]) can be inhaled and deposited in the respiratory tract. This is not true. Particles as large as 100 mcm (and perhaps even larger) can be inhaled into the mouth and nose. Larger particles are deposited in the nasal passages, pharynx, and upper regions of the lungs, while smaller particles are more likely to deposit in the lower, alveolar regions. And for many pathogens, infection is possible regardless of the particle size or deposition site.

It’s time to abandon the old paradigm of three mutually exclusive transmission routes for a new one that considers the full range of particle sizes both near and far from a source. In addition, we need to factor in other important features of infectivity, such as the ability of a pathogen to remain viable in air at room temperature and humidity and the likelihood that systemic disease can result from deposition of infectious particles in the respiratory system or their transfer to the gastrointestinal tract.

We recommend using “aerosol transmissible” rather than the outmoded terms “droplet” or “airborne” to describe pathogens that can transmit disease via infectious particles suspended in air.

Is Ebola an aerosol-transmissible disease?

We recently published a commentary on the CIDRAP site discussing whether Middle East respiratory syndrome (MERS) could be an aerosol-transmissible disease, especially in healthcare settings. We drew comparisons with a similar and more well-studied disease, severe acute respiratory syndrome (SARS).

For Ebola and other filoviruses, however, there is much less information and research on disease transmission and survival, especially in healthcare settings.

Being at first skeptical that Ebola virus could be an aerosol-transmissible disease, we are now persuaded by a review of experimental and epidemiologic data that this might be an important feature of disease transmission, particularly in healthcare settings.

What do we know about Ebola transmission?

No one knows for certain how Ebola virus is transmitted from one person to the next. The virus has been found in the saliva, stool, breast milk, semen, and blood of infected persons.8,9 Studies of transmission in Ebola virus outbreaks have identified activities like caring for an infected person, sharing a bed, funeral activities, and contact with blood or other body fluids to be key risk factors for transmission.10-12

On the basis of epidemiologic evidence, it has been presumed that Ebola viruses are transmitted by contaminated hands in contact with the mouth or eyes or broken skin or by splashes or sprays of body fluids into these areas. Ebola viruses appear to be capable of initiating infection in a variety of human cell types,13,14 but the primary portal or portals of entry into susceptible hosts have not been identified.

Some pathogens are limited in the cell type and location they infect. Influenza, for example, is generally restricted to respiratory epithelial cells, which explains why flu is primarily a respiratory infection and is most likely aerosol transmissible. HIV infects T-helper cells in the lymphoid tissues and is primarily a bloodborne pathogen with low probability for transmission via aerosols.

Ebola virus, on the other hand, is a broader-acting and more non-specific pathogen that can impede the proper functioning of macrophages and dendritic cells—immune response cells located throughout the epithelium.15,16 Epithelial tissues are found throughout the body, including in the respiratory tract. Ebola prevents these cells from carrying out their antiviral functions but does not interfere with the initial inflammatory response, which attracts additional cells to the infection site. The latter contribute to further dissemination of the virus and similar adverse consequences far beyond the initial infection site.

The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out by the observed risk factors or our knowledge of the infection process. Many body fluids, such as vomit, diarrhea, blood, and saliva, are capable of creating inhalable aerosol particles in the immediate vicinity of an infected person. Cough was identified among some cases in a 1995 outbreak in Kikwit, Democratic Republic of the Congo,11 and coughs are known to emit viruses in respirable particles.17 The act of vomiting produces an aerosol and has been implicated in airborne transmission of gastrointestinal viruses.18,19 Regarding diarrhea, even when contained by toilets, toilet flushing emits a pathogen-laden aerosol that disperses in the air.20-22

Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces.23 Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively.23

In still air, 3-mcm particles can take up to an hour to settle. With air currents, these and smaller particles can be transported considerable distances before they are deposited on a surface.

There is also some experimental evidence that Ebola and other filoviruses can be transmitted by the aerosol route. Jaax et al24 reported the unexpected death of two rhesus monkeys housed approximately 3 meters from monkeys infected with Ebola virus, concluding that respiratory or eye exposure to aerosols was the only possible explanation.

Zaire Ebola viruses have also been transmitted in the absence of direct contact among pigs25 and from pigs to non-human primates,26 which experienced lung involvement in infection. Persons with no known direct contact with Ebola virus disease patients or their bodily fluids have become infected.12

Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity.27 However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols.25-27

Altogether, these epidemiologic and experimental data offer enough evidence to suggest that Ebola and other filoviruses may be opportunistic with respect to aerosol transmission.28 That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.

Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)

Facemasks, however, do not offer protection against inhalation of small infectious aerosols, because they lack adequate filters and do not fit tightly against the face.1 Therefore, a higher level of protection is necessary.

Which respirator to wear?

As described in our earlier CIDRAP commentary, we can use a Canadian control-banding approach to select the most appropriate respirator for exposures to Ebola in healthcare settings.29 (See this document for a detailed description of the Canadian control banding approach and the data used to select respirators in our examples below.)

The control banding method involves the following steps:

  1. Identify the organism’s risk group (1 to 4). Risk group reflects the toxicity of an organism, including the degree and type of disease and whether treatments are available. Ebola is in risk group 4, the most toxic organisms, because it can cause serious human or animal disease, is easily transmitted, directly or indirectly, and currently has no effective treatments or preventive measures.
  2. Identify the generation rate. The rate of aerosol generation reflects the number of particles created per time (eg, particles per second). Some processes, such as coughing, create more aerosols than others, like normal breathing. Some processes, like intubation and toilet flushing, can rapidly generate very large quantities of aerosols. The control banding approach assigns a qualitative rank ranging from low (1) to high (4) (eg, normal breathing without coughing has a rank of 1).
  3. Identify the level of control. Removing contaminated air and replacing it with clean air, as accomplished with a ventilation system, is effective for lowering the overall concentration of infectious aerosol particles in a space, although it may not be effective at lowering concentration in the immediate vicinity of a source. The number of air changes per hour (ACH) reflects the rate of air removal and replacement. This is a useful variable, because it is relatively easy to measure and, for hospitals, reflects building code requirements for different types of rooms. Again, a qualitative ranking is used to reflect low (1) versus high (4) ACH. Even if the true ventilation rate is not known, the examples can be used to select an appropriate air exchange rate.
  4. Identify the respirator assigned protection factor. Respirators are designated by their “class,” each of which has an assigned protection factor (APF) that reflects the degree of protection. The APF represents the outside, environmental concentration divided by the inside, facepiece concentration. An APF of 10 means that the outside concentration of a particular contaminant will be 10 times greater than that inside the respirator. If the concentration outside the respirator is very high, an assigned protection factor of 10 may not prevent the wearer from inhaling an infective dose of a highly toxic organism.

Practical examples

Two examples follow. These assume that infectious aerosols are generated only during vomiting, diarrhea, coughing, sneezing, or similar high-energy emissions such as some medical procedures. It is possible that Ebola virus may be shed as an aerosol in other manners not considered.

Caring for a patient in the early stages of disease (no bleeding, vomiting, diarrhea, coughing, sneezing, etc). In this case, the generation rate is 1. For any level of control (less than 3 to more than 12 ACH), the control banding wheel indicates a respirator protection level of 1 (APF of 10), which corresponds to an air purifying (negative pressure) half-facepiece respirator such as an N95 filtering facepiece respirator. This type of respirator requires fit testing.

Caring for a patient in the later stages of disease (bleeding, vomiting, diarrhea, etc). If we assume the highest generation rate (4) and a standard patient room (control level = 2, 3-6 ACH), a respirator with an APF of at least 50 is needed. In the United States, this would be equivalent to either a full-facepiece air-purifying (negative-pressure) respirator or a half-facepiece PAPR (positive pressure), but standards differ in other countries. Fit testing is required for these types of respirators.

The control level (room ventilation) can have a big effect on respirator selection. For the same patient housed in a negative-pressure airborne infection isolation room (6-12 ACH), a respirator with an assigned protection factor of 25 is required. This would correspond in the United States to a PAPR with a loose-fitting facepiece or with a helmet or hood. This type of respirator does not need fit testing.

Implications for protecting health workers in Africa

Healthcare workers have experienced very high rates of morbidity and mortality in the past and current Ebola virus outbreaks. A facemask, or surgical mask, offers no or very minimal protection from infectious aerosol particles. As our examples illustrate, for a risk group 4 organism like Ebola, the minimum level of protection should be an N95 filtering facepiece respirator.

This type of respirator, however, would only be appropriate only when the likelihood of aerosol exposure is very low. For healthcare workers caring for many patients in an epidemic situation, this type of respirator may not provide an adequate level of protection.

For a risk group 4 organism, any activity that has the potential for aerosolizing liquid body fluids, such as medical or disinfection procedures, should be avoided, if possible. Our risk assessment indicates that a PAPR with a full facepiece (APF = 50) or a hood or helmet (APF = 25) would be a better choice for patient care during epidemic conditions.

We recognize that PAPRs present some logistical and infection-control problems. Batteries require frequent charging (which requires a reliable source of electricity), and the entire ensemble requires careful handling and disinfection between uses. A PAPR is also more expensive to buy and maintain than other types of respirators.

On the other hand, a PAPR with a loose-fitting facepiece (hood or helmet) does not require fit testing. Wearing this type of respirator minimizes the need for other types of PPE, such as head coverings and goggles. And, most important, it is much more comfortable to wear than a negative-pressure respirator like an N95, especially in hot environments.

A recent report from a Medecins Sans Frontieres healthcare worker in Sierra Leone30 notes that healthcare workers cannot tolerate the required PPE for more than 40 minutes. Exiting the workplace every 40 minutes requires removal and disinfection or disposal (burning) of all PPE. A PAPR would allow much longer work periods, use less PPE, require fewer doffing episodes, generate less infectious waste, and be more protective. In the long run, we suspect this type of protection could also be less expensive.

Adequate protection is essential

To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:

  • Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
  • All sizes of aerosol particles are easily inhaled both near to and far from the patient.
  • Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
  • Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
  • Experimental data support aerosols as a mode of disease transmission in non-human primates.

Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.

Acknowledgements

We thank Kathleen Harriman, PhD, MPH, RN, Chief, Vaccine Preventable Diseases Epidemiology Section, Immunization Branch, California Department of Public Health, and Nicole Vars McCullough, PhD, CIH, Manager, Global Technical Services, Personal Safety Division, 3M Company, for their input and review.

WHO “There is no evidence that the EVD (Ebola) epidemic in West Africa is being brought under control”

PDF outlining the numbers:http://apps.who.int/iris/bitstream/10665/136020/1/roadmapsitrep_8Oct2014_eng.pdf?ua=1

It seems that the media is suddenly silent on Ebola. The last wave of panic actually forced the administration to do something, even if it was only a half measure. Well we can’t have that going on, now can we?

This is last weeks report from WHO and it does not look good if you look at the graphs. Bear in mind that there are an admittedly  large number of unreported cases.

Happy Friday!

https://38.media.tumblr.com/fde4230478f91ecae20441f2beb1b365/tumblr_nd74zsXAbz1qj26eao1_500.jpg

I have finally come up with a plan. Yes there will be a gun underneath the plastic and also a potted plant.  I know I can hold out, I know I can. Whatever you do …Don’t panic.

Ebola-hit Liberia cancels nationwide elections

Ebola-hit Liberia cancels nationwide elections

By Zoom Dosso

Medical staff members of the Croix Rouge NGO remove the corpse of a victim of Ebola, from a house in Monrovia, on September 29, 2014.  By Pascal Guyot (AFP)

Medical staff members of the Croix Rouge NGO remove the corpse of a victim of Ebola, from a house in Monrovia, on September 29, 2014. By Pascal Guyot (AFP)

Monrovia (AFP) – Ebola-hit Liberia has suspended nationwide elections in the latest measure to combat an epidemic which has shut down society in three west African nations, restricting travel and forcing the cancellation of public events.

Almost three million voters had been due to take part in Senate polls on Tuesday but organisers said there was no way a “mass movement, deployment and gathering of people” could go ahead without endangering lives.

President Ellen Johnson Sirleaf was exercising powers under a state of emergency announced in August “to suspend… any and all rights ordinarily exercised, enjoyed and guaranteed to citizens,” the foreign office said in a statement issued late Wednesday, quoting a presidential proclamation.

Liberia, which has seen more than half of the almost 4,000 deaths so far in the outbreak ravaging west Africa, had been due to elect half of its legislative upper chamber.

The election commission said in a statement it had recommended the postponement because it could not conduct “a free, fair, transparent and credible election” because of the epidemic.

The elections are the latest casualty of an epidemic which has forced Liberia and neighbouring Sierra Leone and Guinea to announce a nationwide state of emergency.

Schools have been shut while the three governments have banned all public gatherings except those deemed essential and cancelled a variety of public events.

Athletes from the three nations were barred from competing in combat sports and swimming in the Youth Olympics in China in August while Guinea and Sierra Leone were forced to play Africa Cup of Nations qualifiers outside of their countries.

Almost half of Sierra Leone’s population of 6.3 million population is under travel restrictions imposed between and within its five worst-hit districts.

The Muslim-majority nation defied warnings to avoid large gatherings during its recent Eid festival, but worshippers were at pains to keep their distance and celebrations were muted in the quarantined areas.

– ‘Undermining democracy’ –

Liberia’s election commission said it would consult political parties and candidates with a view to fixing a new date, before the end of the year if possible.

Chairman Jerome George Korkoya was quoted as saying the outbreak prevented training and deployment of 25,000 staff needed for 4,700 polling stations across the country.

The election would also require 365 “educators” to raise awareness of the polls in 73 electoral districts across the country as well as 400 election supervisors.

Computer engineers would not be able to go around the country setting up Internet connections for the transmission of results, and the turnout would be extremely low in any case, Korkoya added.

“The commission is required to internationally procure ballot paper printing services for the printing of 2,640,000 ballot papers, 78,750 mock ballots and 5,000 polling kits, all of which have to be flown into the country,” he said.

“The timely delivery of these materials, most of which are sensitive, cannot be guaranteed in the wake of the current wave of the suspension of flights to Liberia.”

Modelled on the American system, Liberia’s upper house is composed of 30 senators, two representing each of the country’s 15 counties for staggered nine-year terms.

Fifteen senators were elected in 2011 and another 15 seats in the chamber were supposed to go up for election this year.

Liberia’s lower chamber, the House of Representatives, was due Thursday to discuss a request by Sirleaf for sweeping new powers, which civil society activists said posed a threat to civil liberties.

The president has asked for a temporary extension of the state of emergency removing a constitutional right to make public speeches which could “undermine” the response to the epidemic.

A group of organisations including Liberia’s Press Union has written to parliament saying the move “undermines the core of our democratic system of government, which effectively threatens the future of our country”.

Moses Acarous Gray, a lawmaker from the main opposition Congress for Democratic Change, said Sirleaf was seeking to prevent individuals or groups from “making any public speech” or gathering for any reason.

Seal our own airports: Plane cleaners srike at LaGuardia

http://www.myfoxny.com/story/26744552/plane-cleaners-strike

“NEW YORK (AP) – Airplane cabin cleaners have set up pickets outside a LaGuardia Airport terminal over health and safety issues.

About 200 Air Serv workers who support domestic flights at Terminal D began a 24-hour strike on Wednesday night.

They say their concerns include possible exposure to Ebola.”

Just wait until the first one gets sick. Those birds won’t be flying anywhere.

Polio-like illness claims fifth life in U.S.

a study published in Virology Journal, found EV-D68 among some of the 3,375 young, ill people tested in eight Latin American countries, including the Central American nations of El Salvador and Nicaragua, in 2013.  (See Fig. 3)

Though the U.S. government is keeping secret the locations of the illegal immigrant children, there are significant numbers of them in both cities in which the current outbreak was first identified, Kansas City, Missouri and Chicago, Illinois, according to local advocates and press reports.”

http://sharylattkisson.com/polio-like-outbreak-claims-fifth-life-in-u-s

Don’t panic anyone, the government has everything under control. In the meantime watch out for people with blood shooting out of their eyes, coughing, sniffling children and dogs with fevers.

Additionally do not approach any individual who is vomiting buckets of blood or any child who is crying and did not just fall down.

If you see men in spacesuits do NOT fire upon them, they are not aliens, they are from the government and they are there to help you.

If you see razor wire around your neighborhood do not attempt to climb it. Not only will it cut you badly, increasing your chance of infection, but it was put there by the government for your own protection.

Remember to stay calm and everything will be all right. Just do not lick anyone who appears ill, breathe in or out, touch the bottom of your shoes or drive with your windows rolled down.

This has been a public service announcement.

Second person with possible Ebola is Deputy who entered Duncan Apt.

FRISCO (CSBDFW.COM) – An afternoon news conference has been called in Frisco, a suburb of Dallas, to discuss a possible second case of Ebola.

According to a statement from the City of Frisco, the patient claims to have had contact with Thomas Eric Duncan, referred to as Dallas ‘patient zero.’

The Frisco patient has been identified as a Dallas County deputy Michael Monnig, who was not one of the 48 people being monitored by federal, state and local health officials because he never had direct contact with the patient.  Monnig did enter the apartment where Duncan stayed after Duncan had been admitted to the hospital.

Complete Coverage Of Ebola In Dallas

The call came in shortly after noon from Care Now, 301 W. Main Street, where the patient was “exhibiting signs and symptoms of Ebola.”

CBS 11 has confirmed with Care Now that the facility is in contact with the Centers for Disease Control and is holding everyone in the facility until receiving clearance from the CDC.  The patient has been transported to Texas Health Presbyterian Hospital by Frisco firefighter-paramedics, the same hospital where Duncan, the first patient to be diagnosed with the virus on American soil, was admitted.  Duncan died earlier today, after spending more than 10 days in isolation at that hospital.

Texas Health Presbyterian Dallas confirmed the patient’s arrival to the Emergency Room in statement, which reads in part, “Right now, there are more questions than answers about this case. Our professional staff of nurses and doctors is prepared to examine the patient, discuss any findings with appropriate agencies and officials.  We are on alert with precautions and systems in place.”  The hospital is still admitting and caring for other patients at this time.

http://dfw.cbslocal.com/?lead=frisco-patient-exhibiting-ebola-symptoms

General: If Ebola Reaches Central America, ‘There Will Be Mass Migration into the U.S.’

General: If Ebola Reaches Central America, ‘There Will Be Mass Migration into the U.S.’

 Weekly standard:

9:23 AM, Oct 8, 2014 • By JERYL BIER

Those looking for good news on the fight against Ebola will not find much encouragement from Marine Corps Gen. John F. Kelly, the commander of the U.S. Southern Command. As Jim Garamone of Department of Defense News reports, Kelly told an audience at the National Defense University in Washington, D.C. on Tuesday that, if the disease reaches Central America, “it’s literally, ‘Katie bar the door,’ and there will be mass migration into the United States.” He also said with certainty that “there is no way we can keep Ebola [contained] in West Africa.”

“By the end of the year, there’s supposed to be 1.4 million people infected with Ebola and 62 percent of them dying, according to the [Centers for Disease Control and Prevention]…”

“So, much like West Africa, it will rage for a period of time,” Kelly said.

This is particularly possible scenario if the disease gets to Haiti or Central America, he said. If the disease gets to countries like Guatemala, Honduras or El Salvador, it will cause a panic and people will flee the region, the general said.

“If it breaks out, it’s literally, ‘Katie bar the door,’ and there will be mass migration into the United States,” Kelly said. “They will run away from Ebola, or if they suspect they are infected, they will try to get to the United States for treatment.”

Kelly said that human trafficking could be an additional wrinkle in the battle to contain the disease. He related a disturbing anecdote from a recent visit to Central America where some men from Liberia were headed to the United States: