The New Yorker has the best article I have read yet on the Ebola outbreak. Finally we get human story and details of how this outbreak started and spread, along with the outstanding heroic efforts of those on the front line. The article has details on everything, the genetics, the virology, the story of escalating fear as health workers started to get infected, and the hard decisions.
Who would get doses of ZMAPP, and which other experimental therapies would be tried? ZMAPP is the genetically engineered copy of antibodies against Ebola, and it does appear to be useful, even though it has not been properly tested. Kent Brantly, the US doctor who contracted Ebola, improved within hours of receiving ZMAPP. His recovery was so fast his medical staff wondered if it were possible, but his colleague Nancy Writebol did not show the same progress.
Know thy enemy: only six proteins and one line of code, yet so incredibly deadly. The virus is not one virus, but a swarm of particles — an evolving population.
Since Ebola makes errors as it replicates, each genome was like a hand-copied text, and detectable differences would emerge among the genomes; there isn’t [...]
I am glad that Nigeria is officially free of Ebola now. The story is reassuring. New outbreaks of Ebola are stoppable. But the numbers are sobering. They show how far gone the situation is in West Africa.
The index patient (as the source of the outbreak is known) arrived in Lagos, a megacity of 21 million people, on July 20th — a recipe for disaster. Over the next six weeks 19 further people were diagnosed with Ebola. The death toll was eight people, many of them health workers. Those infected generated 989 contacts, and it took 18,500 in-person, follow up visits to make sure that the virus did not spread further.
Translate those ratios to West Africa, where the latest WHO situation report shows there were 2,638 new cases between September 26 and October 17. In Nigeria, each infected person on average generated 50 contacts, and each contact generated 18 follow-up visits. This is only the roughest of ballpark estimates, but if the ratios were similar, it means that solving the spread in Liberia, Sierra Leone, and Guinea would generate 130,000 contacts and require 2.4 million follow-ups in the next three weeks. By mid November that will double. Obviously things [...]
Compare the response of The Firestone Rubber Plantation in Liberia to the Hospital in Dallas, Texas.
The rubber plantation has 8,000 workers with 71,000 dependents. It is an hour north-east of Monrovia, surrounded by Ebola outbreaks. The virus arrived on the plantation in March. Knowing that the UN and the Liberian government were not going to save them, the managers sat around a rubber tree and googled “Ebola” and learned on the run instead. They turned shipping containers into isolation units, trucks into ambulances, and chemical cleaning suits into “haz-mat” gear. They trained cleaners, and teachers, they blocked visitors, and over the next five months dealt with 71 infections, but by early October were clear of the virus. There were only 17 survivors (the same 70% mortality rate as elsewhere). But without good management, there could have been so many more deaths.
In contrast, the nanny-state takes a good brain and stops it thinking. In Texas, trained health professionals were caught unprepared, following inadequate protocols they assumed were good enough, and even risking their own lives. A nurse who cared for a dying Ebola patient — and knew how bad Ebola could be — still needed to phone someone to [...]
The bad news -Medecins Sans Frontieres (MSF) said the disease was still out of control. Thanks to the mistake with a plane, a few US schools have closed, and whole neighborhoods are being roped off. How fast does a 19Kb string of information spread? Outside Africa, Norway has one case, Germany has had one death, one survivor, and one case. Spain has lost two, and is treating one. France and the UK have a survivor each. Today, at least, Senegal has been declared free of Ebola.
The WHO organization has admitted it botched the Ebola outbreak in West Africa.
“In a draft internal document obtained by The Associated Press, the agency says “nearly everyone” involved in the response failed to notice the potential for Ebola’s explosive spread.
The agency acknowledged that its own bureaucracy was a problem, pointing out that the heads of WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa.”
The good news – CSL have said they will develop a plasma product from survivor’s blood. At the moment this is the most pragmatic possible treatment. There are 3000+ survivors who have antibodies, which [...]
I’ve been watching Ebola with concern. I hoped we’d have more time. We can still gain control but every week matters. What we do now will be so much easier than what we have to do if we leave it to run.
The summary: The WHO warns that there may be 10,000 new cases a week in West Africa by early December. Can you imagine trying to set up new beds to cope with that each week? Meanwhile the Centre for Infectious Disease Research has advised the CDC that the evidence suggests some airborne spread of Ebola is occurring, which may explain the toll on health workers. Sadly a second health-worker has also been infected with Ebola in Texas (and she was on flight 1143 from Cleveland to Dallas the day before – the CDC wants passengers to call.). Sixteen members of Doctors without Borders have been afflicted, and nine have died. That team deserves medals more help.
There are different versions of airborne infections, hopefully this is in the “only just airborne” category. Just being barely airborne is not the same as, say, being spread like measles. Nonetheless, the game has changed. Healthworkers need even more serious, much [...]
I trained in microbiology so I’ve watched the Ebola situation unfold with quiet dread. When my favourite lecturer was asked what was worst of the worst infectious epidemics he could imagine, he responded that the sum of all fears would be a cross between Ebola and Newcastle’s disease. It would be a highly fatal hemorrhagic disease, combined with a highly contagious virus spread by birds. It’s time to talk of the dark dark possibility that one mutation could bring — the aerosolization of Ebola.
As long as this Filovirus stays in its current form, spread only through direct contact with an infected and obviously ill person, we have a chance to limit the spread. Quarantine is effective. If it goes airborne, the task becomes like preventing the flu, but without clinically tested vaccines, in a totally unprotected population, and with a 60% fatality rate. This is the nuclear option.
The Ebola virus has several different forms, and at least in animal studies, it has “gone airborne” before. Theoretically, it’s an odds game. The more times the virus is copied — the better the odds are that the right mutation will occur. To be brutally blunt, every infected person is another [...]
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