Tuesday, October 28, 2014

Some Descent Academic Work on Ebola

A recent entry at WRSA referenced several important articles that should be used to direct our clinical policies. One is a study that focused on rapid diagnosis of Ebola and it is available for review through NIH portal.

Rapid Diagnosis of Ebola Hemorrhagic Fever by Reverse Transcription-PCR in an Outbreak Setting and Assessment of Patient Viral Load as a Predictor of Outcome (2004)

This study was conducted on the previous largest Ebola outbreak and that virus was slightly different from the one now wreaking havoc on the world. Still, this study reveals some very useful information regarding the testing methods we currently use to determine if one is affected by Ebola or not. According to this study, PCR testing had a significant number of false negatives early in the course of the infection. In fact the tests may remain falsely negative, even several days after the onset of symptoms.   Another test to see if someone is positive is called the ELISA assay and it tests for antibodies to a particular virus, rather than the actual viral particles. It is a very sensitive test, but it takes time for your body to develop antibodies and therefore it will remain negative well into the symptomatic period of the illness.

All this means is that the nurse initially placed in isolation near the Newark airport has no business exiting isolation at this time. In fact, she should remain in isolation for at least 21 days and failure to do so should result in immediate suspension of her nursing privileges, her professional license, as well as continued enforced isolation.  Furthermore, when you read that the 5 year old boy is being kept for several additional days in isolation, despite initial testing showing a negative result, that means that whoever made this decision is likely aware of what literature states. It is not being overly cautious as the government talking head stated, rather it is being appropriately cautious. 

This patient developed severe diarrhea, similar in amount to cholera,  where up to 10 liters of fluid needed to be replaced per day. Following the onset of severe diarrhea, the patient developed multiple organ failures, needed ventilator support, his brain became encephalopathic, and he became septic with bacterial super-infections needing multiple courses of antibiotics.  Fortunate for him, he was in a biosafety level 4 (BL4) isolation area where the people who took care of him could perform all these risky procedures because they were sufficiently trained to do so. He survived, but discharge was delayed because various body fluids remained positive for over 1 month. This is a very important finding mentioned in this study and it it worth repeating:  different body fluids became negative as the person recovered from Ebola, at different times. After the viral particles were cleared from the patient's blood, sweat continued to show viral particles on day 40.

Elsewhere I've read that semen may remain positive for virions, for months. Therefore, when is it safe to release someone from Ebola quarantine? That depends on how irresponsible the individual is. If it is someone who plans on going clubbing, then keep that joker in isolation until his semen becomes clear of the virus, even if it takes 6 months.  That photo of Obama hugging one of the nurses -  this is the same nut largely responsible for the fact that this disease is starting to appear on this continent. Also keep in mind that the treatment given to one of the 1st evacuees from West Africa, is not available for us but is held in reserve for Obama and his staff.

At election time, just think: all this could have been avoided if our elected ones just kept appropriate travel restrictions and instituted appropriate quarantine measures.  In fact, there is a 2003 directive that provides for such quarantines, and Obama has not revoked this. If you read his amendment, it only concerns itself with the handling of SARS cases, and Ebola is still covered as a quarantine worthy disease under that 2003 directive.  For whatever reasons, they chose to ignore being reasonable.  You shouldn't.


GW said...

Great coverage on ebola. I've been linking your site to several places. Saw something a bit scary the other day about ebola becoming airborne in colder, dryer climates. Was wondering if you would care to comment. . http://wdtprs.com/blog/2014/10/usarmy-ebola-virus-can-go-airborne-in-low-temperatures/

Ex-Dissident said...

Hey GW, it is really great to hear from you.

The link you provided leads to something by a certified nut - Alex Jones. Still, the link in his post to an NIH article is real enough and despite my reservations about Alex Jones, Ebola is a serious enough threat. I don't see any reason why one cannot have air-born transmission of Ebola. Such transmission has been documented in animal studies, and one needs to be exposed to only a small number of viral particles to catch it - I recall a number as small as a dozen. When you keep in mind that blood will contain millions of viral particles per milliliter and saliva also has significant numbers of virions, a sneeze should create an adequate number of contagious fomites to be dangerous to those nearby. For that reason, everyone who works with Ebola patients should be wearing a respirator rather than just a surgical mask. It makes sense that cold weather could increase their infectivity as this virus survives longer in the cold, and I can easily see a situation where one person might be co-infected with Ebola and the common cold. If that occurs on a public transit facility in a large city, it would be catastrophic. The medical system will become overwhelmed within a week and shortly after you will have thousands of cases that will then grow to millions. This would be biblical.