Ebola

[sfs]

Thanks for pointing that out. I should have phrased that last bit better. I read the article as meaning those who worked with the infected collecting the samples, not those working in the lab ex post facto.

Correct. (But it's worth making clear that the samples were collected for diagnosis, not for research, and the research was done with the leftover material. I think the study was important, but not so important as to be worth losing people over. We already feel bad enough without having that on our consciences.)

 

[USincognito]

I cannot believe some of the local reporting I'm seeing here on D-FW media. Apparently the patient went to the hospital a week earlier than the visit which prompted admission and activation of the city's Emergency Command Center. His apartment has, at least at late as this afternoon, not been cleaned out.

It's not like any of this was a surprise. I'd think health care workers during the initial visit would have pressed more when encountering a west African presenting HF symptoms.

Not that I'm worried, but that lack of screening wasted a week of treatment for the victim and monitoring/quarantine for those with whom he came in contact.

 

[sfs]

I cannot believe some of the local reporting I'm seeing here on D-FW media. Apparently the patient went to the hospital a week earlier than the visit which prompted admission and activation of the city's Emergency Command Center. His apartment has, at least at late as this afternoon, not been cleaned out.

It's not like any of this was a surprise. I'd think health care workers during the initial visit would have pressed more when encountering a west African presenting HF symptoms.

Not that I'm worried, but that lack of screening wasted a week of treatment for the victim and monitoring/quarantine for those with whom he came in contact.

According to the timeline I've seen, it was two days between his first visit and his second, which isn't as bad. On the other hand, according to an NBC report, he only ended up in the hospital the second time because his nephew called the CDC directly. Not really good.

This photo of workers cleaning up dried vomit outside the patient's apartment with a power washer and no protection does not suggest a high level of preparedness either. It's pretty unlikely that there's any real danger of infection there, but it's really not what you want to see.

 

[USincognito]

This photo of workers cleaning up dried vomit outside the patient's apartment with a power washer and no protection does not suggest a high level of preparedness either. It's pretty unlikely that there's any real danger of infection there, but it's really not what you want to see.

That gets to my concerns which aren't over the virus or it's spread, but that this incident is making Dallas - one of the premier cities for health care provision and research - look unprepared and frankly bush-league.

eta - They finally got a HazMat team in to clean up the apartment and, surprise, they didn't have the proper permits to transmit disposed materials across Texas highways so last I saw they were just standing around in the parking lot.

 

[Michael]

That gets to my concerns which aren't over the virus or it's spread, but that this incident is making Dallas - one of the premier cities for health care provision and research - look unprepared and frankly bush-league.

eta - They finally got a HazMat team in to clean up the apartment and, surprise, they didn't have the proper permits to transmit disposed materials across Texas highways so last I saw they were just standing around in the parking lot.

This is the kind of thing that worries me. The west sure has had an 'ego' about their ability to 'contain' the virus, but none of those countries have experienced "drive by infections", like that one in Dallas. The more it spreads overseas, the more likely we will see a repeat of this incident in various locations. Are we *really* that prepared? I currently doubt it based on what I've seen thus far, but maybe we'll get our act together over time.

 

[Gracchus]

We will probably have to have some local Caucasian deaths, perhaps even a major epidemic, before we are unable to deny reality any more.

Because humans are dishonest, like the fellow who boarded the plane, unwilling to recognize the obvious danger, and unprepared to face the inevitable, like the health system, there will be an epidemic, sooner or later.

 

[USincognito]

I saw a doctor on one of the news channels today discussing mutations in Ebola vs. influenza. The precise wording slips mind now, but my impression of the gist was that while flu fragments and recombines with large base number indels, Ebola mutations tend to be smaller and more stable. Anyone like Steve or our genetics wonks care to offer corrections or clarifications?

 

[sfs]

I saw a doctor on one of the news channels today discussing mutations in Ebola vs. influenza. The precise wording slips mind now, but my impression of the gist was that while flu fragments and recombines with large base number indels, Ebola mutations tend to be smaller and more stable. Anyone like Steve or our genetics wonks care to offer corrections or clarifications?

Influenza mutates very rapidly, and more rapidly than Ebola. Probably more important is that influenza is a segmented virus, i.e. its genome comes in physically distinct segments. That means segments from different viruses can recombine if there is a mixed infection, dramatically changing the virus. Ebola is nonsegmented, and has not been seen to recombine.

 

[USincognito]

Influenza mutates very rapidly, and more rapidly than Ebola. Probably more important is that influenza is a segmented virus, i.e. its genome comes in physically distinct segments. That means segments from different viruses can recombine if there is a mixed infection, dramatically changing the virus. Ebola is nonsegmented, and has not been seen to recombine.

Thanks!

 

[sfs]

My boss and I had an op-ed piece in yesterday's Boston Globe about Ebola diagnostics, here. Just doing our bit to ruffle feathers.

 

[Michael]

My boss and I had an op-ed piece in yesterday's Boston Globe about Ebola diagnostics, here. Just doing our bit to ruffle feathers.

I agree about the need for quicker diagnosis, and I appreciated your insights in the segmentation/mutation aspects as well.

My "concern" is the egotistical nonsense that has been going on in the news here in the US. We've been acting like we're already "prepared" to deal with this issue, but we aren't. Here the government goes blaming individuals for 'procedural' issues, while the nurses unions have been vocal about the fact that they have received *no* training at all. The ego aspect worries me. We aren't immune from the effects of this virus, either medically or economically. It's ridiculous IMO how little we've actually done to combat this virus overseas before it even gets here in force. I think that the government of Cuba has sent more trained medical staff to Africa than we have.

 

[Michael]

FYI, I *still* like my idea of using the USN Mercy both to quarantine patients, and to ensure that they're getting the best possible care, from the most competent and well trained and well prepared staff. I can't for the life of me understand why it took the medical team in Dallas nearly a week to even *start* giving Mr Duncan medications to treat it, nor why we risk exposing untrained staff to deal with it. It would make a lot more sense IMO to give the first vaccines to the medical staff that are assigned to deal with Ebola patients and to quarantine all patients that are known to have Ebola.

 

[Gracchus]

My "concern" is the egotistical nonsense that has been going on in the news here in the US.

We are so prepared, that a nurse who helped treat the man who died in Dallas has come down with Ebola.

It is a truism in war that all the carefully thought out battle plans have a tendency to disintegrate when the first shot is fired. There is miscommunication, careless mistakes, the common belief that rules are for other people; then things get out of hand. We are just lucky that Ebola is not communicable until it becomes symptomatic.

 

[USincognito]

My boss and I had an op-ed piece in yesterday's Boston Globe about Ebola diagnostics, here. Just doing our bit to ruffle feathers.

I sent the link to the editorial page editor of the Dallas Morning News.

eta - She e-mailed me back and has forwarded it to the board for review.

 

[sfs]

I sent the link to the editorial page editor of the Dallas Morning News.

eta - She e-mailed me back and has forwarded it to the board for review.

Cool.

 

[Split Rock]

My boss and I had an op-ed piece in yesterday's Boston Globe about Ebola diagnostics, here. Just doing our bit to ruffle feathers.

Very good piece.

 

[juvenissun]

Did we have ebola, say, 500 years ago?
I guess not. But it would be interested to know why not.
Was ebola evolved out yet at that time?

 

[Michael]

My boss and I had an op-ed piece in yesterday's Boston Globe about Ebola diagnostics, here. Just doing our bit to ruffle feathers.

About the only "good news" I've seen about Ebola today was this article about a new procedure that may allows us to speed up the diagnosis process:

Colorado Test For Ebola Could Speed Up Diagnosis To 10 Minutes « CBS Denver

Then again, it's pretty clear from the second case of a Nurse being infected that it's going to be an uphill fight, and we're not doing anywhere near enough in terms of education and quarantine.

Nurses: We Were Told to Call Authorities for Ebola Protocol

There apparently are no real "protocols" being taught or put in place yet, despite our government's claims.

All that arrogance we heard from our leaders, and yet the first "drive by" case in the West has led to *at least* two more infections inside of a hospital scenario. That simply doesn't jive with all that blustery talk we've been fed about how we're better "prepared" to deal with this problem than other countries. For crying out loud, the second nurse was flying on a commercial airline the night before she starting showing symptoms. How in the world is this country actually better prepared if they can't contain even one case?

 

[Loudmouth]

My boss and I had an op-ed piece in yesterday's Boston Globe about Ebola diagnostics, here. Just doing our bit to ruffle feathers.

Are people using RT-PCR for screening? If so, something like Trizol would seem to be an obvious choice for sample collection if you are worried about sending samples to a lab. I would assume that common RNA extraction techniques will neutralize most, if not all, viruses.

 

[sfs]

Are people using RT-PCR for screening? If so, something like Trizol would seem to be an obvious choice for sample collection if you are worried about sending samples to a lab. I would assume that common RNA extraction techniques will neutralize most, if not all, viruses.

Yes. The CDC protocol uses Trizol. Our lab gets better results with AVL (with a little ethanol thrown in now, to make sure the little nasties are really, truly dead), both for PCR and (especially) for sequencing.