Tuesday, September 23, 2014

Let's Talk About Ebola

If you reached this from Facebook, I'll apologize up front.  This isn't an attempt to get blog hits (I don't care about 'em).  The things I'm going to say in this post may sound alarmist, and currently go against the conventional guidance offered by the CDC.  I'm going to have my say, and post my evidence.  I hope you will examine it critically and reach your own conclusions.

If you've reached this post from Facebook, then you probably know a bit about me.  I've been involved with emergency medicine for my entire adult life.  Very early in that career I became involved with WMD/CBRNE response, and with that I've done a fairly involved study of select agents (Including several graduate courses at GMU, in which I maintained very high grades).  I've spent a very large amount of time in "Level A" (self-contained biohazard/HAZMAT suits), and I've even treated patients while wearing these suits.

I'll cut to the chase.

I'm hearing that some agencies are still presenting that Ebola virus cannot be indirectly transmitted (Through aerosols).  Research conducted on non-human primates has pretty solidly proven that Ebola can be effectively transmitted through aerosols.  I'm going to present two quick cases here.

First, a couple of cases of inadvertent transmission of Ebola from test monkeys to separated control monkeys.  The monkeys mentioned in this case were not expected to get Ebola, and were held separate from the test monkeys.  Two of the three control monkeys came down with Ebola and subsequently died.

Second, an actual experiment designed to see if monkeys could be infected with Ebola through an aerosol route.  In this experiment, doses as low as 400 plaque forming units were aerosolized and delivered to monkeys through a head-only aerosol mask.  Two things are important to note from this study.  First, it was uniformly lethal.  Second, the dosage level is low, really low.  This is not a bug to be trivialized.

I'd like to call your attention to the skill medical providers that have gotten Ebola while working with these patients (I think we're up to six, as I write this).  None of them can recall an infectious event, with an Ebola patient or not (One of the doctors that was infected with Ebola could not recall working with an Ebola patient.  He was on a Labor and Delivery Ward).  These docs all came down with Ebola, but cannot recall being directly exposed to Ebola.  Please consider that, in light of the two studies above.

We're seeing an explosion of cases in Western Africa, and a rise in lethality (from ~30% to ~50%). This is probably not due to any mutation or increase in base lethality, but instead due to a break down of services. Still, this is an ominous sign, as we're now playing catch-up with this bug in a major city (Monrovia has a population of over 1 million people, as of 2008).  Further, we know that the virus has hit the slums of the city, where no social services were present before the outbreak.

It is reported the Ebola is not infectious until the patient is symptomatic.  Early symptoms include a flu-like syndrome (Fever, body aches, possibly a cough).  The point being that these patients will look just like the majority of your "Feeling Sick" patients.  You are not going to be able to look at an early Ebola patient and magically recognize them as being this sick (They don't all weep blood, is what I'm saying).  Listen for your other clues, travel, degree of fever, fever with any unusual bleeding.  Pay attention to these.

All of that being said, this is a virus, not a magic boojum bug spawned by Satan and coming to kill you.  Conventional US healthcare can care for these patients, if proper isolation protocols are followed.  One of the reasons that Liberia is being hit so hard is because they are under-resourced (even now, they're not getting anywhere near the support that they need).  All of our hospitals should have a literal ton of masks, goggles, and gloves.  Use 'em.  Take it seriously.

Folks on the true front lines (Firefighters, Medics, Police Officers), keep your eye armor with you, and keep some masks in your pocket.  If someone says they're sick, believe them, get them checked out.

Be safe, and take care of each other.  Make sure you're still around tomorrow and the next day.  We're going to need you to continue doing the great deeds that you do.