Sunday, October 12, 2014

Ebola 8.

Not having any fun today.  I'll keep this short, because there's plenty of "in depth!" coverage on the new Ebola patient in Dallas (not the dead one); and they're updating rapidly now.  First a nurse in Spain, following the rules, gets it; now a nurse in Dallas, following all the rules, gets it.

I would not bet the current head of the CDC will still have that job a month from now.  The noises I hear from his office do not make me think he's smart and in charge; more like he is not very bright, and is reading the Instruction Manual For Pandemics: 1. Be sure your ass is covered.  2. Prevent panic, lie all you want to achieve this.

"Clearly it must have been a protocol breach." - before any investigation, is not smart.  It would actually be better for Item 2 if you said, for the public; "Of course, we're looking into all possibilities, including that the virus may have changed.  That's unlikely; but we're watching."  But it would, of course, violate #1.

There were 2 things today that actually shocked me.  I'll pass them on:

1) In the NYT, well buried in the article, was this tidbit:

"Health officials have been monitoring 48 people in the Dallas area who may have come into direct or indirect contact with Mr. Duncan, including health care workers and Mr. Duncan’s relatives. But they said the person who tested positive was not among those under observation and had been “self-monitoring” to check for symptoms of Ebola."

Emphasis mine.  Current wording in the article is a little different now; but the statement is there.  So; the nurse infected is not even one of those thought to be at "higher risk".  I will be totally astonished if Duncan's girlfriend, and some of the others in that apartment, do not become symptomatic in the next 2 weeks (it may be that long).

And 2).  The Ebola mutation rate?  We hear it's "high"; but- I got to wondering about sample sizes, etc.

It's much, much MUCH worse than they're reporting.  The science gives the details; but the reporting does not.  I was guessing, before I dug out the science; that out of 4,000 dead, they might have sampled the DNA from, oh, maybe 4-500 people?  Since they report finding "more than 300" mutations that show this present virus is different from previous outbreaks?


They had blood samples from 78 people; all from Sierra Leone, in the first 24 days of the outbreak.

From 78 people; they sequenced DNA from 99 viruses.

In 99 viruses, they found- "more than 300" separate mutations.  How many?  Well; 395, actually, but only 340 that are really, really different.

395 mutations found in 78 people- at one location, months ago.  Yes, that's really bad; and our journalists are either blindingly incompetent- or... worse.

I wouldn't leave Dallas today- but I might start packing the vehicle, and being sure it's full of gas.  Think that's over reacting?  Just read all the above again.


greatblue said...

Why aren't the barrels they are using to collect the biohazardous waste red in color like medical waste bags? I've seen blue, which is usually used for water, and yellow. I hope these barrels are being incinerated along with the waste, though I can just imagine the air pollution that results. I shudder to think the barrels might just be landfilled or recycled.

The whole response has seemed more or less impromptu. I can understand why nurses and other health care workers are up in arms!

ChrisBear said...

Just got back to a point where I can read blogs. Glad to see you are still plugging away :)

MPR this morning is discussing this case. The meme 'she must have made a mistake' is being reinforced, though they did ask the question 'What if she did follow all the procedures?'. The response was that the procedures must be missing something. No mention of the possibility of changes in the virus.

I think this will settle down- too much in the spotlight. It is the disease we do not see coming that will sweep over cities and states- pnuemonic (sp?) Plague, a flu mutation, one of the many tick-borne diseases (did you hear about the new one identified in WI last summer?). Call me a most optimistic pessimist.

Luddene said...

I've been watching all of this and trying not to be obsessive about it. I’m really not concerned for myself, as I live a fairly secluded life, and can if need be, be totally isolated. I, too, have seen several mentions that the nurse was self-monitoring. Having some back ground in microbiology, I keep seeing things that I would do different. Why are the health workers in Dallas (or Spain) allowed to go home at night? Why isn't the staff that is caring for an ebola patient living in the hospital? Is it an imposition for these people? Of course, but then, so is dying. The LA Times reported that on Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper. What? The patient has more sense than the health care staff? See here:
Just as you, I can’t imagine that his girl/fiancé isn’t also infected. Moreover, I have a hard time not envisioning some dog (rat, coon, possum, etc. – they’re all in our cities) visiting Ducan’s vomit at some point in the 5 days they left it on the sidewalk before power washing it into the gutter. All of this goes to show that we have become so complacent about infectious diseases that we have forgotten how to deal with them.

Judy said...

I, too, have wondered why Duncan's close family members haven't shown signs of the virus yet, so I asked an MD friend of mine about it. He speculated that the virus might be most infectious during the last couple of days when the body is throwing off tons of virus-laden bodily fluids - vomit, diarrhea, etc. - in its attempt to find a new host. It could be that the victim is not as contagious until the final stages, which might explain why his family members have shown no signs of infection to date. The incubation period of the virus can be up to 21 days, with most infected people becoming symptomatic between 2 and 10 days, according to everything I've read.

If we assume that it's true that the virus cannot be transmitted by an asymptomatic person and that Duncan wasn't symptomatic before Sept. 25 when he first presented to hospital, that might be day 1 of the 21-day countdown for his family. They are really close to being out of the woods if that's the case. Since they are being closely monitored until 10/19, it looks as if the CDC is using his actual diagnosis date as the starting point of quarantine.

None of this explains the transmission to the nurse who wasn't even considered at high risk for catching it. Thank goodness for her (and others) she was cautious enough to self monitor.

As for the vomit on the sidewalk, I was flabbergasted when I saw the videos of how that was handled. I've since read that both bleach and UV light will kill the virus. It sat out in the TX sun for days before being power washed into the gutter. It might not have been viable at that point, but I think the people in charge of sending that crew out to clean up should have used the precautionary principle, which has been what they've done to sanitize the public areas where the Dallas nurse with Ebola lives.

Luddene said...

I can't believe that everyone is so stupid. Have collectively lost our brains?

"Second Nurse Infected with Ebola Was on Jetliner Before Diagnosis"

Hank Roberts said...

So, how confident are we about detecting people (or animals) carrying the virus? Or should we be calling it a family of viruses?

From "the science" link above:
The variations they identified were frequently in regions of the genome encoding proteins. Some of the genetic variation detected in these studies may affect the primers (starting points for DNA synthesis) used in PCR-based diagnostic tests, emphasizing the importance of genomic surveillance and the need for vigilance. To accelerate response efforts, the research team released the full-length sequences on National Center for Biotechnology Information's (NCBI's) DNA sequence database in advance of publication, making these data available to the global scientific community.

PS, kids, please don't punch this published recipe into your Home DNA Assembly Kit -- it would be a capital error to assemble any possible variation on this virus at home.