Ebolee

This has been really hard with the fast pace of things, and the technical challenge presented by the iPhone.  You'll have to copy and paste links, and there are far fewer than I'd like.  No idea about the font changes, sorry.  Right now there are two nurses being treated after providing care to Patient Zero in Dallas.  Hopefully there will be no more;  hundreds of contacts are being monitored.

(For y'all taxonomy hardliners, we shall adhere to the recent Redneck Approved change in nomenclature).

1). How do I catch Ebolee?

Like most of the viral hemorrhagic fevers to date, you have to start out by messing with weird African animals.  What is a duiker or a rousette anyhow?  The present outbreak is thought to have started when a 2 year old toddler was bitten by a fruit bat, back in December 2013.  So those hot roasted friut bats on a stick at the county fair?  Just say no this year.  Once we get past the Mutual of Omaha scenario, you have to contact a sick person to become exposed; then its all to do with ... hotness.

Viral dynamics give us a long period to avoid the making of mistakes.  In the first days of infection a patients viral load is low; it often takes three or four days after fever onset to get a positive test, even in presence of fever.  Large bore needle sticks or such are probably the only likely transmission mode.

Then the patient develops symptoms; fever, fatigue, pain, and messy barfing and diarrhea.  Still a relatively low viral load, but transmission is possible with contact of body fluids.  Maybe not across unbroken skin.  Maybe.  One of the infected MDs reports a drop of blood, immediately cleaned with bleach....

In the end phase, that part where everything is bleeding and oozing, (not really liquifying, that's pure fiction) viral loads are extremely, actually extraordinarily, high. Transmission becomes... inevitable.  Sweat, urine, snot, tears, all of it becomes highly infectious.  At this time transmission by aerosols is debated, but seems quite likely.

So, stay away from hot, barfing, bleeding people, hot roasted fruit bats, and you'll be fine.

But.  The reservoir for Teh Ebolee is not settled science, this is the study responsible for Excalibur being euthanized .  I'm not sure myself:

http://www.thefreelibrary.com/Ebola+virus+antibody+prevalence+in+dogs+and+human+risk.-a0131127452

And survivors often have no idea how they were exposed; Nancy's story in particular is troubling:

http://news.sciencemag.org/africa/2014/10/ebola-survivor-i-senga-omeonga-every-day-i-m-still-thinking-when-was-i-contaminated

http://news.sciencemag.org/africa/2014/10/ebola-survivor-i-senga-omeonga-every-day-i-m-still-thinking-when-was-i-contaminatednews.sciencemag.org/africa/2014/10/ebola-survivor-ii-nancy-writebol-we-just-dont-even-have-clue-what-happened

But, by way of reassurance;

http://www.npr.org/blogs/goatsandsoda/2014/10/06/354054915/firestone-did-what-governments-have-not-stopped-ebola-in-its-tracks

2). What's the treatment?

There's really not any today.  It's mostly supportive care, but in a first world country that can include ventilators, plasmapheresis, and dialysis, along with fluids, transfusions, and antibiotics, immunodulators, and antivirals.  There are several specific agents recently FDA approved for use only in the present emergency.  Supplies are extremely limited, and some of these agents haven't been fully investigated in animals, let alone people.  For the most part, it looks like they aren't making Ebolee disease worse, and do appear to be helping.

Convalescent plasma from survivors is demonstrating benefit.  There seems to be only one survivor donating, and it's unclear how long antibody production continues. It is also unknown if survivors are truly immune or how long that immunity persists. There are plenty of examples however of antibody positive people walking around in Africa; they never got sick but often report nursing family members through illness, so lasting immunity is definitely possible.

Most hopefully, there is at least one vaccine in Phase III clinical trials.  It's a viral protein which uses a monkey adenovirus (cold virus) to stimulate immune response in humans.  It's been protective in animals.  It could be available within a few months if the trial goes well; it's actually deployed in Africa right now.  Efficacy is of course uncertain, but in theory, immunizing half the population would stop the virus in its tracks.

An antiretroviral agent, lamivudine, may have shown anectdotal efficacy in treatment of infected patients, when started early. It's relatively cheap and available, and quite safe.  It'll probably see some use if it proves useful-cross resistance will be a consideration.

There are several other 'numbers only' drugs in development.  The patients here in the US are receiving brincidofovir for example.  These drugs have been under study for quite awhile fortunately, so like the vaccine, may be rushed to market faster than expected.

Right now we are just waiting to see if the genie can be put back in the lamp; that will buy us some time but this is by no means over.  Vaccine is key, and quarantine, backed by force of law, will be required.  As will travel restrictions, distasteful as it may be.  These are long standing tools in the management of infectious disease, for good reason.

This Week in Virology

 

I'm not a virologist, but I do play one on TV - yes, I really do - and this has been a really exciting week.  Just this morning the news broke of a Marburg outbreak in Uganda, just ...awesome.  There is a lot of information, and misinformation, out there right now.  Don't panic.  But do keep in mind #21Days - that's how long you may find yourself locked into yer house.

In short, there are a handful of emerging threats making news.  In order of importance to you:

1). Electronic medical records, in our fragmented, overworked, under-staffed medical system;

2).  EVd-68;

3).  Chikingunya

4)  Ebolavirus

We'll jump to the last one since it's of course making all the headlines.  We all read The Hot Zone back in the '90's; what's not to love about liquified internal organs, bleeding orifices, unclear modes of transmission and 90% mortality rates?  Bottom line here is, it's in Africa, and will pretty much stay there for the foreseeable.  Over there, yer witch doctor granny can't cure Ebola or AIDS, no matter what sort of smoke she blows up yer arse, and she is pretty much state of the art.  You'd likely have a better outcome here, at least we had running water and lanterns:

This brings us to  #1.  The reason you'd do better here, beyond hygiene and some clean water?  No electronic records.  The providers at our vacation MASH unit were able to communicate. EMRs are ridiculously difficult to work with and we'll leave it at that for now.  You'd get really scared if too much information were divulged, but it probably represents one of the biggest threats to your health today.

EVD 68 has been around a few years now, just not really making the news until recently.  It was first linked to paralysis in some kids in California, at least a year ago, actually I'm pretty sure it was two years ago..  It was linked to the deaths of one child and four adults this week.  The scary part? Its related to polio virus, just like in the iron lung days; we don't have a vaccine in development.  

Chikingunyan might be sort of fun.   Nobody has died, but you'll get lots of time off work.  The scary part?  It's vector - mosquitoes.  There isn't enough DEET in the world.  

Not going Alex Jones here, but the USG is actually responsible for this interesting week we find ourselves in. Not in a secret bioweapon sort of way though, awesome as that would be.  These viruses weren't cooked up in a plot to depopulate the planet, but they are now here in the US, to stay, due to poorly formulated policies mostly related to immigration.