Wednesday, August 06, 2014

Should You Be Concerned About Ebola in the USA?

Donald Trump recently put himself into the news again when he expressed concern about Ebola making its way to the USA.  He, like many, favors quarantine of Ebola victims.  He is against letting victims, including medical personnel and Americans, into the USA.

The question:  Is he right?

The Washington Post thinks Trump is wrong, but their story is mixed:

  • Ebola is contagious - which means that you have to be in direct contact with bodily fluids of the infected person

  • "Amesh Adalja, a member of the public health committee of the Infectious Disease Society of America and an infectious disease doctor at the University of Pittsburgh" says that there is NO chance of infection for the general public.  This is in part due to the superior contagion-blocking capabilities of US medical establishment - hoods, masks, full-body suits, etc.

  • However, the CDC reports that American hospitals do a poor job of controlling infection - "One in 25 patients in U.S. hospitals has an infection acquired as part of his or her care".

  • Hygiene is critical - keep in mind, that health workers can sometimes neglect hand-washing.  In Britain, the NHS has permitted exceptions to sterile procedure (long sleeves, no use of alcohol-based sterilants) for Muslims.  It has led to higher infection rates.


An explanation of how the Original Plague (also known as the Black Death) spread:
...the 14th-century strain, the cause of the most lethal catastrophe in recorded history, was no more virulent than today's disease. The DNA codes were an almost perfect match.

According to scientists working at Public Health England in Porton Down, for any plague to spread at such a pace it must have got into the lungs of victims who were malnourished and then been spread by coughs and sneezes. It was therefore a pneumonic plague rather than a bubonic plague. Infection was spread human to human, rather than by rat fleas that bit a sick person and then bit another victim. "As an explanation [rat fleas] for the Black Death in its own right, it simply isn't good enough. It cannot spread fast enough from one household to the next to cause the huge number of cases that we saw during the Black Death epidemics," said Dr Tim Brooks, a scientist from Porton Down, who was not part of the Crossrail team, will put forward his theory in a Channel 4 documentary, Secret History: The Return of the Black Death,on Sunday.

To support his argument, Brooks, who has yet to examine the Crossrail evidence, has looked at what happened in Suffolk in 1906 when plague killed a family and then spread to a neighbour who had come to help. The culprit there was pneumonic plague, which had settled in the lungs of the victims and was spread through infected breath.

The skeletons at Charterhouse Square reveal that the population of London was also in generally poor health when the disease struck. Crossrail's archaeology contractor, Don Walker, and Jelena Bekvalacs of the Museum of London found evidence of rickets, anaemia, bad teeth and childhood malnutrition.

So, the factors that were important were:

  • General poor health (in these cases, complicated by lack of food, but it must be remembered that TOO MUCH food also leads to immune system impairment)

  • Other diseases - we have AIDS, asthma - which would be particularly susceptible to airborne Ebola, cancer, heart disease, diabetes, and a multitude of non-lethal, chronic illnesses.  In Western societies, you can live a long life, even though not healthy - until another factor, such as Ebola, enters the picture.

  • Closeness to neighbors - the original plague spread rapidly in the cities.  The countryside was largely immune, both for reasons of better nutrition, and because of the distance between potential victims.

  • The major plague outbreak years had AIRBORNE transmission.

  • Compulsive attention to hygiene - in a crisis situation, this is a component that may be ignored or given less attention.  And, a widespread plague IS a crisis.


Health workers are at greatest risk - about 100 have died in this outbreak.  One of them "Sierra Leone’s leading doctor in the fight against Ebola, Sheik Umar Khan, a national hero" is, by his name, a Muslim.  Now, why is that important?

Islamic beliefs have led nurses and other health workers to wear long sleeves, and refuse to use alcohol-based sterilants.  In Britain, the problem is so great because the NHS has allowed them to ignore procedures for reasons of religion.

The real concern is the possibility that Ebola might become airborne - infectious through coughs and sneezes.  From Wikipedia (I know of Wikipedia's unreliability on politically-related subjects, but for basic information, it's not bad).
It is not entirely clear how Ebola is spread.[15] EVD is believed to occur after an ebola virus is transmitted to an initial human by contact with an infected animal's body fluids. Human-to-human transmission can occur via direct contact with blood or bodily fluids from an infected person (includingembalming of an infected dead person) or by contact with contaminated medical equipment, particularly needles and syringes.[16] Semen is infectious in survivors for up to 50 days. Transmission through oral exposure and through conjunctiva exposure is likely[17] and has been confirmed in non-human primates.[18] The potential for widespread EVD infections is considered low as the disease is only spread by direct contact with the secretions from someone who is showing signs of infection.[16] The quick onset of symptoms makes it easier to identify sick individuals and limits a person's ability to spread the disease by traveling. Because dead bodies are still infectious, some doctors disposed of them in a safe manner, despite local traditional burial rituals.[19]

The CDC claims that Ebola absolutely CANNOT be spread through the air.

However, the organization then issues an advisory that seems to contradict their claims:
Crew members on a flight with a passenger or other crew member who is ill with a fever, jaundice, or bleeding and who is traveling from or has recently been in a risk area should follow these precautions:

  • Keep the sick person separated from others as much as possible.

  • Provide the sick person with a surgical mask (if the sick person can tolerate wearing one) to reduce the number of droplets expelled into the air by talking, sneezing, or coughing.

  • Give tissues to a sick person who cannot tolerate a mask. Provide a plastic bag for disposing of used tissues.

  • Wear impermeable disposable gloves for direct contact with blood or other body fluids.



The study that looked at transmission between species showed that non-contact transmission was possible.
There are three likely candidates for the route of transmission: airborne, droplet, or fomites.

Airborne and droplet transmission both technically travel through the air to infect others; the difference lies in the size of the infective particles. Smaller droplets persist in the air longer and are able to travel farther- these droplets are truly “airborne.” Larger droplets can neither travel as far nor persist for very long. Fomites are inanimate objects that can transmit disease if they are contaminated with infectious agents. In this study, a monkey’s cage could have been contaminated when workers were cleaning a nearby pig cage. If the monkey touched the contaminated cage surface and then its mouth or eyes, it could have been infected.

Author Dr. Gary Kobinger suspects that the virus is transmitted through droplets, not fomites, because evidence of infection in the lungs of the monkeys indicated that the virus was inhaled.

- See more at: http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112#sthash.ByoHbzTT.dpuf

The other side?  The Canadian Health authorities have grave concerns about airborne Ebola:
In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated (1613). The importance of this route of transmission is not clear.

Couple the above with concerns that Ebola might be used as a Bioweapon, and you have some interesting - and disturbing - issues.

So, could Trump be justified in his concerns?  Answer in the comments.

 

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