Wednesday, October 29, 2014

Quarantine

Yeah, I am writing about Ebola, again.

Excellent article HERE  interview with Steven Hatfill in the Atlantic.  Title of the article is 21 Days.

I will excerpt the passages I think are most interesting, maybe 15% of the article.  It is a good read.  I suggest you pop the link open and read the entire thing.

...aerosol droplet transmission of Ebola virus has been shown in animal studies. “It is therefore irresponsible for government health officials to emphatically state that aerosol transmission does not occur,”  
There was one other Ebola outbreak in the United States, for which the country was well prepared. It happened in 1990...The macaques were evacuated to Fort Detrick by its highly trained Aeromedical Isolation Team....The Fort Detrick team was very experienced, and very practiced. The rapid response unit had worldwide airlift capability designed to safely evacuate and manage contagious patients under high-level containment. They knew exactly how to handle the infected macaques.
When doctors left the isolation unit, they went through an air lock into an anteroom, where they spread their arms and were sprayed down with a glutaraldehyde-based disinfectant. The colorless liquid killed every known life form. ...When they came out, the suits were cut away from them and incinerated on site.
That facility at Fort Detrick was the quintessential Biosafety Level 4 (BSL-4) containment lab. But it was shuttered in 2010, a casualty of budgetary cuts.
An average of 12.7 days after exposure to Ebola virus, sudden-onset flu-like symptoms take the person.

BUT

For 4.1 percent of patients... the period between exposure and onset of the first symptoms is longer than 21 days. Around 13 percent of infected people in the current outbreak did not have a documented fever (ERJ note:  one-in-eight)
You could change the airflow around Fort Detrick and bring it back, but you still wouldn’t immediately have the experienced people who have rehearsed protocol for years. Intubation [placing a breathing tube down a dying patient’s throat] is difficult enough. You ever tried to do it in a space suit?
We've known for years now that the skin is a site of viral replication. The Langerhans cells, the antigen-presenting cells in the skin, are major targets for Ebola. What that means is, you're shedding virus from the skin ...you could come up, take a swab, just a cotton swab off the skin, and diagnose [Ebola] with...a positive result from a live virus.
When the SARS epidemic happened, Singapore came very close to being wiped out. People don't realize this. And over there, if you chew gum or spit on the street, they cane you. Singapore had this under control overnight, and all their contact tracings were confined to their house, to the point where they would phone you every hour and you'd better answer the phone or the cops came by to arrest you. And they stopped it. You saw in the U.S. the journalist went out for pizza, this nurse went on a plane. Are you out of your mind? Though in a way this is good, because it shows aerosol and skin shedding in early infection is not occurring.
Sanjay Gupta, who is a neurosurgeon, did probably the best demonstration I've seen on why the CDC protocol failed. He dressed up in the recommended protective equipment and they put chocolate syrup on his hands. As an experienced neurosurgeon, how many times he's donned and doffed this gear? He took off his gear, and, yep, there were chocolate splashes all over his skin. There's a reason we use front-zipping Tyvek suits and not gowns. If an experienced neurosurgeon can't do it, what do you think a poor gal just out of ICU training is going to do?

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