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Old 07-28-2014, 06:25 PM   #1
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Exclamation EBOLA: 2014 West African Outbreak

Okay, we lost the info we had collected here but sadly, this outbreak has a long way to go & we'll have lots of... opportunity to keep up to date. A lot has been happening since TBM went down yesterday.

Frist, I'll give a very quick & essentially unsupported summary - unsupported as in - no URLs. If you go to ProMed:

http://www.promedmail.org/

and click on any of their Ebola postings, the bottom of that posting has a list of all Ebola posts in this current outbreak in reverse temporal order... 2 pages of them. Those are all well supported by links.

Summary:

As best we know, a small outbreak of Ebola kicked off in Guinea as far back as January. As is typical with these outbreaks, word didn't filter out for months. By late March, word was out that something nasty was going down & shortly after that - within days, came word of a similar outbreak in Sierra Leone. The locations were both close to a shared border. It wasn't long before the disease was identified as Ebola - zaire strain or very close to the original zaire strain & that's the one with the highest mortality.

One of the original Guinean cases sought the help of a renowned healer in Sierra Leone - that didn't work & that's how it got its start in SL. I read in the last few days - wish I remembered where that this healer & family are pretty much all dead & that the healer insisted the illness was the work of an evil serpent.

It wasn't long before this really went nuts. A case from the first cluster had the wherewithal to go to Conachry, capital of Guinea in order to seek skilled help. This is a trip of hundreds of miles - days in that part of the world & stops led to new areas being 'seeded' with Ebola & new outbreaks starting. It continued to 'cook' in Sierra Leone & soon, Liberia was seeing cases.

And the ball started rolling fast.

Previously, even the nastiest outbreaks were controlled in time. They started in small communities in isolated areas. You're not infectious, (able to pass on the disease), until you yourself start FEELING sick & when you do, you go down hard. Never mind travel anywhere, staying on your feet isn't an option within a few hours. This limited spread to those who TOUCHED the sick or what they were using - bedding, dishes, food etc.

THIS IS A CONTACT DISEASE. It is NOT airborne. Blood, semen, tears, sweat, salive, urine, feces... touch those with bare hands or any part of your body with a break in skin... THAT is how you contract Ebola.

Unfortunately, these areas where Ebola is endemic are too poor for people to have reliable access to clean water, never mind soap, rubber gloves or any protective gear. Women care for the sick - so mom or wife, sister, daughter were usually the next to get ill. Small children & when patients die, women prepare the bodies for burial. Without going into detail let's just say lots of potential for transmission exists there!

Grieving has its own customs there - much hugging & kissing of the body & touching before they're buried & the virus remains hot in the body. Contact tracing has shown in some cases ALL people who attended such gatherings subsequently died of Ebola.

Okay - this all occurs within a small geographical area. Blanket an afflicted area with trained people, PPE & all the basic medical stuff needed, carry on a lot of patient, public education & the outbreaks stop. Carefully & quickly contact trace to break chains of transmission, handle burials until it passes & support the local population as best you can. Again, the outbreak stops.

This one hasn't & I'll yap about that in a further post.

For now, I simply want to do a real fast forward & say that as we hit the end of July we have seen almost 1200 known cases with closing in on 700 deaths. That's roughly 58% - in line with what we know about Ebola. Case fatality rates, if you exclude small outbreaks of 1-2 cases, range from a low of 25% to close to 100%. I spoke of known cases. We never know how many people may have been stricken & died, unknown & not noticed in the jungles of Guinea, Sierra Leone & Liberia.

The WHO has made it clear this outbreak will be very difficult to fully control & stamp out - if we're very lucky, it will take 'several months'. I'm of the personal opinion we're looking at a lot longer than that.

Okay, that's a start - I've got to grab a bite.
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Old 07-28-2014, 06:37 PM   #2
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Sue, What do mean we lost the info?
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Old 07-28-2014, 06:46 PM   #3
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Quote:
Originally Posted by Sonny View Post
Sue, What do mean we lost the info?
I'm not CS but the stuff from last month or so, was lost, possibly forever, when the whatever thingy went wonky last night.

There's an intelligent, technical explanation for it in ADMIN by Jason.

Hope that helps
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Old 07-28-2014, 06:50 PM   #4
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my god there's a whole months worth of posts missing?

missing time? like alien abduction?
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Old 07-28-2014, 06:51 PM   #5
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What she said - working on the second part of this now... bear with me.

The info is out there but we had it nicely collated here.

---------- Post added at 06:51 PM ---------- Previous post was at 06:51 PM ----------

Yes Sonny - all gone.
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Old 07-28-2014, 06:58 PM   #6
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Quote:
Originally Posted by Sonny View Post
my god there's a whole months worth of posts missing?

missing time? like alien abduction?


Ya know........... I thought I felt the presence of the mother ship last night......


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Old 07-28-2014, 07:16 PM   #7
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To hell with it, I'm not hungry. I'll eat later.

It's kind of hard to do a strict time line of events, discuss implications, etc. separately. So I'm not even going to try. Let's just say, this catching up is going to be scattered - as is the outbreak!

I said this outbreak is going to be hard to control, as has been told us by the WHO, Doctors Without Borders, ProMed & any expert I've heard interviewed. This outbreak has been getting steady media coverage - just not a ton of it until the past week or two & it's really ramping up. The world is becoming increasingly concerned so the media is all over it.

I mentioned earlier that previous outbreaks were always eventually stamped out & a big reason for that is they were limited to small geographic areas. Furthermore, most occurred in areas that sadly, became increasingly familiar with Ebola.

Now we have a widespread outbreak confirmed in 3 countries, with 2 other nations with every reason to believe they'll see cases of their own & nations at the other end of flights from affected countries on alert. Each of the three countries has come through periods of horror in recent memory - ghastly wars, tyranny, corruption on an almost incomprehensible scale.. small wonder residents have a deep distrust of government & even less reason to trust the west. You might be hard pressed to find a family there who's not had members shot dead, others raped and/or tortured & getting your daily bread is a grim struggle. Conditions are not conducive to co-operating with anyone trying to help them through this outbreak.

We have the biggest outbreak we've ever seen & no single 'ground zero'. Organizations trying to help are dealing with 3 national governments, many levels of regional & local governance & that's before they have boots on the ground. Infrastructure - where it exists, flat out sucks. Health care is a joke & their private hospitals are places I wouldn't take my worst enemy for a hang nail. No organization can set up a centralized approach with these 3 nations - there's no 'centralized' to approach!

Local tradition & culture naturally take precedence in peoples' minds... as they would HERE. The first place people will turn to is local healers - why not? Most matters can be handled that way & have been forever. If your local tribal healer has 'healed' your family for years & for the most part been successful, why would you not go there first? Knowledge of Ebola in West Africa is... nil. They've not dealt with it before.

The measures for prevention & control being proposed & carried out by western health care workers contravenes cultural practices that go back... forever. Hand OVER the sick & not see them? Forget about it! NOT mourn properly over the dead? Not gonna happen. There, if you can bring a patient to any kind of health care setting, they don't go alone. The family comes to & does much of the care & feeding of the patient. If the patient dies...I've already explained a bit about mourning practices.

That has unfortunately segued into people not reporting the sick, taking off with the sick & disappearing & rumours that western interests are experimenting on locals, cannibalizing the dead & doing very nasty things to the living & dead. If I believed that - think I'd hand over my sick child? Nope - watch me disappear into the boonies. Those behaviours, based on fear & understandable considering the complex & nasty history of the area are leading to further spread. I disappear to my auntie's village 2 days walk away with my sick child. 2 weeks later, half the village is sick & no one from outside knows. It spreads from there & so on & so on...

Laurie Garrett has written an outstanding opinion piece/article on the politics of this outbreak - a must read to understand why this will take so long to control:

http://www.cnn.com/2014/07/24/opinio...ola/index.html

Please believe me when I say it's a must read.


Our next big issue... this has hit the cities. Conachry in Guinea. So far it doesn't appear as though this is leading to explosive growth of the illness there & I'm keeping my fingers tightly crossed. Now, a high potential for illness in Loma, Togo as well as Lagos, Nigeria - got something on those places for the next post. These cities suffer from poor infrastructure as well, iffy health care unless you're well off & in the case of Lagos - it's not one city with one city government - we're looking at 20+ loosely linked municipalities, all with their own governments. Not going to be easy. We're going to have to wait & see what happens in the cities... unfortunately.

Anther important factor - lack of medical resources. As usual, the medical NGOs & charities are doing their best with what little they have. And they don't have enough - not nearly. They need more trained people; of all types. Doctors, nurses. I have no idea of the quality of medical/health care education in the afflicted nations but even if it's superb in theory, how do you practice sterile technique, infection control procedures & all that good stuff - when you don't have the equipment for patient CARE? You sure don't have it to waste in practicing - even one set used over & over is a set less for patients & even with that - you can't get in enough practice time. Covering those skills, making sure local health care workers do it properly - need staff from the west to get that ball rolling. People to train safe burial teams, epidemiologists, camp support workers - it's all needed. Part of the reason, (I think), we're seeing more health care workers coming down with his is they're beyond exhausted. PPE is tough to put on right & even tougher to remove safely when you're fresh. Very easy to slip up - without noticing - when you're dehydrated & stumbling with lack of sleep. Money & supplies are needed. At this point, bleating about how we shouldn't have to isn't going to cut it. Don't know about anyone else but I really don't want to learn a case has shown up in my town, province, country, continent. Don't get me wrong - it's going to happen in limited fashion at some point. I just don't think anyone is prepared for the shock of that & potential implications.

This may be limited to Africa right now but like SARS, the world has to get their collective stuff together on this one. The WHO is on its highest level of alert over this & rightly so. It's coming to a point where some governments may have to be told by the greater outside world what's going to happen & not. That's always going to be something done only when all other measures have been exhausted but it can't be excluded. Embargos, flight restrictions - anything we need to bring to bear politically & economically may need to be examined.

There are tales out of Sierra Leone of some crops rotting in the fields - no one to harvest them but I've yet to find anything really solid on that. I also don't know what the economic implications would be for world markets in those specific commodities but certainly the fragile economy in Sierra Leone doesn't need this.

Next: Nigeria & Togo.
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Old 07-28-2014, 07:48 PM   #8
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So a man gets on a plane bound for Lagos, Nigeria last week, flight originates in Guinea. He feels fine. By the time the plane reaches its final destination in Lagos - he is one sick pup. He has been throwing up. He has diarrhea. Exactly what happened from there remains unclear to me as I've read a number of differing reports. The Nigerian government hastily assured their people & the world this was all under control; contacts in Lagos from the flight as well as plane & airport staff had been notified, were being carefully checkout. He'd been whisked to hospital straight from airport where he'd immediately been quarantined. Sounds good, eh?

Then I found this on ProMed yesterday:

***
Date: Sun 27 Jul 2014
Source: Nursing World Nigeria, Sunday Newswatch report [edited]
http://www.nursingworldnigeria.com/2...-co-passengers


Following the death of an Ebola virus disease victim from Liberia, PS, in Lagos [Nigeria], on Thursday [24 Jul 2014], the federal government and the Lagos state government have jointly launched a hunt for some of the passengers of the airplane that brought the late Liberian into the country, Sunday Newswatch has learnt.

The late PS, who was reported to have arrived in Nigeria last Sunday [20 Jul 2014] aboard a Liberian carrier, Asky Airline, was said to be in company of over 100 co-passengers of different nationalities, among whom were about 35 Nigerians. The 40 year old visiting Liberian died of the deadly virus after testing positive for the disease at the Lagos University Teaching Hospital (LUTH).

According to sources in the federal Ministry of Health, the Nigerian co-passengers of the late Ebola victim were supposed to be quarantined for thorough investigations, based on an order placed by the federal government, but no sooner had the news broken out, than the suspected victims of the deadly virus took to their heels, after having been contacted by officials of the ministry. This prompted the federal government, in conjunction with the authorities in Lagos, to take the latest action and launch the hunt, categorising the alleged escapees as fugitives. Further investigations by Sunday Newswatch revealed that among them are 2 notable Nigerians, who live on a street in a vicinity categorised among the upper-end areas in Lagos.

A security personnel, who was among those detailed for the hunt, confided in Sunday Newswatch that a serious search had began, in order to fish out suspected Ebola virus patients, who might be on the run, and that there were specific instructions to move them to designated quarantined areas, as soon as they are seen. "We learnt that some of them are no longer staying in their houses, and that is why we are looking for them. They are not supposed to run; they should understand that government is only trying to help them. If they are tested and [found] positive, they will quickly attend to them. The government knows how to help them, but they are running like criminals, as if they would be jailed. But we must get them; we cannot allow them to mix with the people, and continue to spread the virus. It is very dangerous for the country," the source said.

When probed further on the modus operandi of the search operation, he revealed that the exercise is not only being conducted by the federal government, but that they have the support of the Lagos state government, which he claimed, has its personnel among the team looking for the escapees. "We are not doing it alone, even Lagos people are with us. Just this morning, they held a meeting with us, and they helped us in the areas to visit. We just came back from a big man's house. We went there with officials of Lagos, but the family said the man left for London yesterday. Though we don't believe them, we have told the airport people to check the manifest of all airlines that left for London yesterday (Friday [25 Jul 2014]). We need to confirm his whereabouts," he said.

The Lagos state government had earlier announced that it was trying to establish contact with those that travelled with the late PS on his way to Nigeria last Sunday [20 Jul 2014], so as to ascertain their status, and ensure that they are properly treated, while preventing spread of the disease. The state commissioner for health, Dr Jide Idris, who disclosed this after confirming the death of the Liberian on Friday [25 Jul 2014], said the hospital where the deceased died would also be cordoned off and sanitised, while explaining the need to properly dispose of the remains of the deceased. "We are dealing with those he had contact with. We have the manifest for questioning to ensure we screen them. We are doing that already. There is a protocol; we are talking with the hospital involved, the staff over there, after dealing with the body, we have to deal with the hospital, to sanitise the hospital, more importantly too, there is the need for us to do contact tracing. We are doing that with the World Health (Organization) people. We are going to trace all the contacts that the man came in with on the airplane, and where they went to. Since we have got the manifest now, we are going to trace all of them. Each one of them is going to be questioned, and there is a protocol to follow for questioning. They are going to be followed in the next 21 days to see if any of them develops any symptoms. This is what we are in the process of doing. We have been trying our best to contain the spread of the disease. We need to sanitise. We need to treat and dispose of the body properly. Those are the things we are working on right now. There are other processes and procedures we need to follow, which we are doing right now, and we are doing so in conjunction with the federal Ministry of Health," he said.

He also revealed that the Lagos state government, in conjunction with the federal government, had established contact with the Liberian government to resolve all diplomatic issues concerning the burial. "First and foremost, his body needs to be properly disposed. There are issues involving diplomatic relationship. We need to get consent from the Liberian government, which the federal Ministry for Health is doing right now. But we have to deal with the body and how to sanitise and ensure that the viruses are killed and prevented from spreading. These are the issues we are handling right now. That is the latest we can give you now," Idris had said on Friday [25 Jul 2014]. He further explained that governments at both levels were not leaving anything to chance. "The Nigeria Centre for Disease Control (NCDC) has stepped in to volunteer. The United Nations Children Fund (UNICEF) has also stepped in. We have set up contact screening centres. We have the Federal Ministry of Health assisting us with laboratory work. All stakeholders are involved. We are confident that the step[s] will stop further propagation of the disease. We plead that you do not spread scary messages, so as not to spread panic. If you know anybody who has travelled to Liberia where the viral disease is established, report to us on time. We have set up treatment centres for probable symptoms," he stated.

The minister of health, Prof Onyebuchi Chukwu, also assured Nigerians that there was no cause for alarm, assuring that necessary steps had been taken to control the spread of the virus, noting that all the passengers that the patient came in contact with aboard Asky Airline had been traced and are being investigated. "I want to reassure the general public that the federal Ministry of Health is presently working with other ministries, agencies and international organisations, as well as with the Lagos state government to prevent the possible spread of the virus."

US assistance
-------------
Meanwhile, the United States has said its officials are closely monitoring the outbreak of the deadly virus in Nigeria, and that it was working with the federal government and the Lagos state government, as well as aid groups, to try to stop the spread. "Our thoughts and prayers are with those fighting the virus," Will Stevens, spokesman for the State Department's Africa Bureau, said in an interview monitored on AFP, adding, "The USA will continue to provide a comprehensive, multi-agency response to assist countries affected."

Wait... WHAT?

If this is accurate... OMG! OMG in theory, anyway. The notion of 30+ POTENTIALLY infected folks disappearing into the neighbourhoods of Lagos is frightening. Logically, the odds that many are potentially infected may be low. The highest risk would be to those who sat right near him when he was... ill. Aerosol spread & all. Cabin crew who touched him - maybe he needed help walking to/from airplane bathroom. Whoever the cabin crew may have touched NEXT or to whom food/drinks were handed. What about the poor schmucks who used that bathroom on the plane?

As to airline or airport crew - the |customs agent who handled his passport & whoever the next person in line was - who handed over & were handed back their papers. The bagged I just grabbed was touched by the worker who grabbed the sick passenger's bags. Did Mr. Sawyer, (the unfortunate dead PAX), use a bathroom in the airport? Did he sit anywhere? Who sat in the same seat after him? Or who sat near him when he was sick. Note this all played out last Sunday & with average incubation for Ebola being about 10 days, if this is about to plunge Lagos into a world of hurt; look to Wednesday or Thursday - give or take a day or two for news to come forth.

Okay, if that's not bad enough - remember I said the plane stopped in Loma, Togo? HE GOT OFF THE PLANE! Now I'm entering the realm of SPECULATION because all \I know is that he did get off the plane:

***Not only did the passenger come into contact with people at the megacity’s main airport and in the aircraft itself, he’d spent time in an airport at the uninfected African country of Togo where his flight had a scheduled stopover.***


http://www.news.com.au/world/the-arr...-1227004137380


I would very much appreciate our Aussie friends looking at that phrasing - 'he spent time inn an airport' - does that indeed mean he was in the airport as opposed to parked on the tarmac? If he got off the plane, (this is me speculating), how was he feeling? He may have been starting to feel slightly craptastic as the flight time from Togo to Nigeria isn't long. You know what it's like when you feel a bit off - you may go to the bathroom few times & wipe your face & hands, perhaps use a water fountain or buy water. He might have sat down if he felt weak. We don't know what happened but from what I read out of Togo - they're taking this extremely seriously...

Okay, I need a quick supper break.
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Old 07-28-2014, 08:20 PM   #9
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So, lots happened yesterday & I'm sure most are aware oddf the details but in case they're not...

First, Liberia announced yesterday it was closing its borders. Most of them. Exit & entry will be limited to 3 check points, including 2 airports:

***Ebola: President Ellen Johnson Sirleaf restricts movements in Liberia***

Details at link:

http://www.cbc.ca/news/world/ebola-p...eria-1.2719952


For those not inclined to read through the article - borders are closed. It's my opinion this may be partly driven by the fact that the sick person landing & subsequently dying in Lagos came from Liberia. It's further my opinion that this is a gesture more than anything else. Sufficient bribe money may get you through & is there border control in the jungle? Didn't think so.

Another article I read on the border closings, (can't recall where I found it), further stated most types of crowd gatherings would be banned - I wonder if that includes markets? Locations still holding many people, (restaurants), would have to screen a 5 minute film on Ebola symptoms, prevention, etc. Wonder where the equipment to show this film will come from? Oh yeah, security forces can commandeer personal vehicles 'in the fight against Ebola' - yeah, that's going to go down well.

Nigeria has shut down the private hospital where the sick airline passenger ended up, (same link) & plans a thorough disinfection. Staff will be monitored. Again, we should know if anyone there took ill by mid to late week. The line about 'the primary source having been eliminated' - I read in a Nigerian newspaper the man had been cremated.

Now, to catch up on today's stuff.
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Old 07-28-2014, 09:32 PM   #10
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Thanks for doing the catch-up CSue.

For now, I'll just add this and will try to do more tomorrow.


American doctor who contracted Ebola virus in Liberia in grave condition, officials say - @AP
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Old 07-28-2014, 09:49 PM   #11
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Damn - grave is poor indeed. I say in an TV interview here in Canada that Mrs. Writebol is not doing well at all either.

Just finishing reading something here, then posting it.
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Old 07-28-2014, 10:04 PM   #12
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Some info from Nigeria via ProMed:

***
Ebola Virus: Lagos, FG Urge Citizens Not to Panic as No Nigerian Is Infected
----------------------------------------------------------------------------
The Lagos State Government on Monday [28 Jul 2014] called on all Nigerians to be calm and not panic, assuring them that both the State and Federal Governments [FG] are well prepared to ensure that the Ebola virus disease [EVD] did not spread and that no Nigerian is infected with the virus.

Addressing a joint Ministerial Press briefing of the Lagos State Ministry of Health and Federal Ministry of Health on developments concerning the disease, the Commissioner for Health, Dr Jide Idris, affirmed that there has been only one case of imported Ebola, resulting in the death of a Liberian diplomat in Lagos. He added that health authorities were being very pro-active about the detection of the ebolavirus in the Liberian, who was on his way to Calabar for a conference, by ensuring that all contacts are being actively followed.

Dr Idris said part of the measures taken after the death of the Liberian was the demobilization of the private hospital where he was admitted and elimination of the primary source of infection, adding that the decontamination process in all affected areas has commenced. He added that the corpse of the victim has since been cremated, and the ash is awaiting further directives from the Liberian Embassy, and commended the role of the Management of the hospital and their ability to detect a high-risk patient within 24 hours. Adhering strictly to WHO guidelines, the body of the deceased patient was decontaminated using 10 percent sodium hypochlorite and cremated, with the permission of the government of Liberia. A cremation urn has been prepared for dispatch to the family. The vehicle that conveyed the remains was also fully decontaminated," he added.

In terms of contact tracing, Dr Idris informed that so far a total of 59 contacts was registered consisting of 44 hospital contacts (38 healthcare workers and 6 laboratory staff) and 15 airport contacts comprising 3 ECOWAS [Economic Community of West African States] staff (driver, Liaison, and Protocol officers), the Nigerian Ambassador to Monrovia, 2 nursing staff and 5 airport passenger handlers. He explained that out of the number, 20 contacts had been physically screened of which 50 percent are of the type 1 contact and another 50 percent were type 2 contacts. The airline manifest has not been provided by the airline at the time of this report and therefore, the precise number of passenger contacts is yet to be ascertained, especially as 2 flights were involved (Monrovia-Lome (Togo) and Lome-Lagos). There was no report of a medical incident filed. Dr Idris added that an isolation ward was designated by the Lagos State Ministry of Health at the Infectious Disease Hospital, Yaba, for case management, while the designation of 3 other health facilities is underway. A total of 100 PPE [personal protective equipment] was procured by the NCDC/FMOH and distributed to the private hospital and the State Ministry of Health. WHO also donated 250 PPE to the NCDC/FMOH [Nigeria Centre for Disease Control/Federal Ministry of Health].

The Commissioner also said a call-in team was established for the public to dial in and obtain information on the Ebola virus disease while toll-free lines were obtained from a telecommunication service provider to be used for answering questions, creating awareness, and receiving notifications of any suspected case, just as public awareness creation through social media such as Twitter and Facebook accounts was also activated. He stressed that in recognition of the importance of involving the community early in the response, traditional and religious leaders were alerted about the disease and requested to report [any cases?] promptly to health-care workers.

The Special Adviser on Health, Dr (Mrs.) Yewande Adeshina, also appealed to operators of traditional health care centres to be wary of patients with fever symptoms who show signs of extreme weakness and diarrhea and immediately alert health authorities about such patients. The President of the Nigerian Academy of Science, Professor Oyewale Tomori, who was also at the briefing, said all the contact persons are being screened on a continuous basis to look for any possible signs of the disease. He commended the timely action taken by the Lagos State Government and the private hospital, adding that there is absolutely no need for people to panic, as the golden rule is to observe the personal hygiene of always washing the hands regularly with soap.

The briefing was attended by the Special Adviser to the Governor on Information and Strategy, Mr. Lateef Raji and Permanent Secretary Ministry of Health, Dr Modele Osunkiyesi, Permanent Secretary, Health Services Commission, Dr Hamid Balogun and Permanent Secretary Primary Health Care Board, Dr Kayode Oguntimehin.

--
Communicated by:
ProMED-mail
<[email protected]>***


Several things jump out at me here...

First, it's too early by a few days at least, to give the 'all clear'. It will be a few days before the mostly likely time to break with symptoms passes & until the full 21 days pass... no guarantees.

Of 59 contacts from the airport & hospital, why were only 20 'physically screened'? It might be as simple as there's genuinely no need to examine them medically - yet. If so that would hold for the others. Or... they've buggered off & their current whereabouts are unknown.

The two big kickers - no passenger manifest? A WEEK later & no manifests? Unless fellow passengers self reported including information such as: "Yes, I was sitting right in front of him & man, did that dude hurl!", no one can be sure who was on that plane as passengers that COULD have been close contacts.

Two flights - TWO flights. Lovely. He MAY have started feeling unwell on the first flight - just not sick enough to think much of it or for anyone to notice. But maybe sick enough to be infectious. What of contacts on that flight? Two planes - were either of them properly disinfected? I doubt they had a chance to take the first one out of service before it was known this man was ill & with what.

I noted the donation of first 100, then an additional 250 sets of PPE to the Nigerian CDC. That is not a lot, not nearly enough if they start seeing cases.

Good they're not making sure information is getting out & trying to get healers & faith leaders on side. A fascinating aspect of cruising a few Nigerian news sources was seeing how important faith - all manners of faiths - seems to be in that nation. From traditional to Christian, Muslim & more - it's a 'faith heavy' country. It also relies heavily on traditional medicine. In the event of an outbreak - the government is desperately going to need these people on board.
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Old 07-29-2014, 12:18 AM   #13
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Default So What If It DID Go Airborne?

Might as well mull over the idea & the implications. From being almost a 'filler' news story in online news sources & subject of periodic updates on TV, the West African outbreak is now consistently one of the top 2 lead stories on just about all network news as well as every online news source I'm routinely accessing.

I honestly don't believe it has gone airborne. If it had, we'd be seeing a lot more cases among residents in affected areas who do not enjoy the benefit of PPE. But considering this outbreak is occurring in a part of Africa where it is - to the best of our knowledge - unknown, it could be facing mutation pressures or enjoying environmental advantages that might lead to it gaining the ability to infect via the respiratory system. Not that it needs that to thrive - it clearly is enjoying a comfy little ecological niche.

But... let's play this one out. We're going to have to assume some numbers here. I'm going to go with 2 in 10 exposed via the airborne route contracting it. For no reason other than I can, I'm going to drop the average case fatality rate of this strain, (Ebola zaire), to 20%. Couple of reasons I did that - I think the CFR in traditional areas of infection is so high because adequate basic care & support is sorely lacking. The current outbreak is seeing deaths in the 60% range & I don't even want to think about the consequences if that remained the fatality rate. I also dropped it because there seems to be an idea out there that once an infectious disease goes airborne, the fatality rate drops. I will ASSUME that is true & would hold up here. So overall that means of every 100 people exposed, 20 would get sick & 5 would die... leaving a total 'death rate' in humans from an airborne Ebola zaire at 5%.

That's our basic starting number based on pure math.

Let's examine what might & probably would really happen; why that number wouldn't hold up.


This puppy is going to suddenly 'learn' how to go airborne in some area in Africa where it's right now having a large impact, pick a village on the edge of a current hot zone. There's only one known case from the village right now & people are nervous. They're not touching each other & are making good use of water & donated soap to keep clean. An aid worker from Paris is leaving tomorrow after months of work in the area & the village is throwing a feast to say farewell. One of the guests is incubating the new airborne virus but he still feels fine. At one point late in the evening, he suddenly sneezes a few times. No big deal - he just inhaled a nose full of an especially spicy dish - a favourite of his & in any case he feels fine. He doesn't actually feel sick until the next day but writes it off to a hangover. There are a few sore heads in the village that morning.

Our aid worker flies home to Paris for a week or so of R & R before heading back. There's such a staff shortage, he feels compelled to return for another few months. The night before he leaves he goes out to a popular, crowded bar with some friends. He may sneeze or cough a few time - the air is thick with smoke but he thinks nothing of it. He too feels a bit poorly the next day but he's flown hung over before. He's not scared; too busy feeling like an idiot. His trip is not going to start well...

And there you go. He's infected friends & possibly some strangers in a crowded bar that saw a lot of traffic while he was there. We won't talk about the young lady he picked up that night. He may have infected people at the airport, certainly some on the plane - which was stopping in Cairo.

It doesn't take more than that & only after he's travelled do health boffins come to the sick making realization that it looks like this may have gone airborne. New cases are popping up that can't be explained by the usual modes of transmission & there are so much more of them. It takes a week for this to be confirmed & the world put on notice but by then, the second generation is seeding throughout Europe & 2 North American locations.

And off we go.

You can imagine the reactions. People LOVE outbreak movies - I watch them all & happily pick them apart for feasibility, etc. Suddenly the world is living an outbreak movie & the reality of that sucks. Facts about the disease are found everywhere & they don't make for pleasant reading. It can be contracted through close contact & not by air - what the heck do you do? Where is it safe? How long will this be an issue? When will it burn out & all go away?

The Ebola we know burns out fast - within a few months because it runs out of victims. People go down hard & aren't fit to travel by the time they're infectious. IF you add a narrow window of transmissibility via airborne secretions lasting only an hour or two before or as a person is beginning to feel wonky, the potential for spread grows dramatically.

And there may be a frustrating, seeming randomness to it all. A person in a non-ventilated room full of people may have a massive sneezing fit & no one gets sick. Another person in a larger, better ventilated room can have a small cough or two - the kind you have while inhaling a tiny bit of water & 12 of 14 people in that room get nailed.

A town in your county may see almost half its residents get sick. Your town - same size & almost identical comparables, only has a few cases. These are factors impossible to plan for.

How fast would such an airborne spread? Would be we see waves? Are specific populations more likely to have poor outcomes? Could we see super spreaders? I think it's a safe bet that poorer countries with lousy infrastructures & little health care to speak of would not do well at all. We'd be in no position to help them because for all we DO have - we don't have enough for a massive outbreak of Ebola.

All manner of health care settings in a community COULD be quickly swamped. If you kicked every current patient out of every available care bed in my city - acute care, psych, long term care, rehab... we might come up with 1000 beds. Add 1000 or so we could quickly put together from emergency equipment if it were still available & that would have to do for an intake area of roughly 100K people.

There's nothing you can specifically do for Ebola. You can only try to keep the person hydrated, nourished in some way - tough to do when this bug really loves to nail the digestive system, clean, dry & as comfy as you can manage.

Our health care system could be overwhelmed very quickly. Patients will NEED help - self care is impossible when you can't move. You're too weak to lift a glass for a sip of water. And this may be airborne but contact transmission is still very much in play - anybody volunteering to do THAT laundry?

One societal factor I'm not concerned about is crime. People will be too afraid, until/unless they're desperate for food, clean water & other basics & we may run out of many items very quickly.

We've 'what iffed' scenarios like this before but few with such a nasty disease or the numbers I've chosen. Recovery from Ebola can take a very long time. Your digestive system is trashed, as is your immune system - Ebola attacks the immune system. You may have lost much of your skin. Energy is gone... lots of systems to recover & that's difficult at the best of times. We have SARS victims that got the best help going in terms of rehab - some never really recovered. I've heard of past Ebola patients with troubled recoveries... I have some catch up reading to do there.

Medically & societally, I've written as though there's no other call on the health care system but Ebola & that's certainly not the case. I think it's a safe bet that most of the chronically ill, immune suppressed, babies, pregnant women & other vulnerable groups we may not know about will die. Secondary infections may take a higher toll than the disease itself. Inadequate support for recovery, the need for proper nutrition & other resources that may not be there will kill more.

Who does societies' work? Crops need to planted, tended, harvested & processed in some ways. They need to be transported to markets - will we have enough people to cobble together a basic network of services provision?

Lord only knows but I surely don't want to be finding out. Ebola as is, is bad enough.

I've mentioned we will see cases here. Someone will bring a case to North America or Europe & may end up infecting one or more family members or close friends. That alone - the reaction to it - will give us interesting indications as to how we might react to a far more challenging scenario.
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Old 07-29-2014, 12:29 AM   #14
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Not to mention the Nigerian Hospital that just "closed"due to ebola death
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Old 07-29-2014, 12:43 AM   #15
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It's where the traveller was treated Malcolm. I doubt they would have seen many patients in the coming days anyway. Might as well close & do a complete disinfection of the facility.
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Old 07-29-2014, 12:58 AM   #16
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Quote:
Originally Posted by Sonny View Post
my god there's a whole months worth of posts missing?

missing time? like alien abduction?
Eaten by the Net-Mice.., The ones with the bloody red eyes.

edit:

But more on topic. The Ebola thing is getting serious. This is that largest recorded outbreak of any of the Ebola types..,
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Old 07-29-2014, 01:52 AM   #17
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According to a CNN report I just watched, Patrick Sawyer not only changed planes in Togo, he changed flights in Ghana. So three planes potentially contaminated in part & more people at risk.

And no flight manifests yet provided for contact tracing......
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Old 07-29-2014, 02:42 AM   #18
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There does seem to be a middle-ground between "requires direct contact" in the sense much of the media is reporting and airborne in the manner of, say, flu. We know from the 2012 study that primates contracted Ebola zaire from pigs, without direct contact. They were in different, but adjacent, cages. The authors of that study believe that the disease was probably spread by droplets (e.g., coughing) that wound up in the primates lungs.

So, this is not true "airborne" transmission in the sense of flu which wafts through the air over several yards, but is also not true that spread requires direct contact with an infected person in the sense that MSM has latched onto. It is somewhere in between.

Just thought I'd throw that in.

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Old 07-29-2014, 06:51 AM   #19
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Just found this article today in the UK press, most of it is just a rehash of information we already knew, however there is one new “gem” the fact that Tom Sawyer (the casualty that died in Nigeria) sister had also Died of Ebola.

There is also mention that he was vomiting and suffering from diahhorea when he boarded the first flight in Liberia, however I am a little sceptical about this information until it can be confirmed in other sources on the grounds that would staff allow him to board the aircraft with those symptoms at the moment?

http://www.independent.co.uk/life-st...w-9634779.html
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Old 07-29-2014, 08:25 AM   #20
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Being lazy about it, but I'll ask here to see if any of you know...

Is there a modern precedent to what Liberia has done with regards to the borders?

Was something like this employed with SARs?
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Old 07-29-2014, 08:37 AM   #21
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http://www.theguardian.com/cities/20...ine-yumen-city

http://www.newstimeafrica.com/archives/34680

China of course is all over Africa these days. (Something to consider)

http://www.newstimeafrica.com/archives/34285
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Old 07-29-2014, 08:53 AM   #22
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A link to the original thread, started 3/22/14, with posts going up to 5/26/14.

http://thisbluemarble.com/showthread.php?t=57320

Also, Sue's post OP on this thread was cross posted to TB2K last night....
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Old 07-29-2014, 08:56 AM   #23
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Britain is now trying to establish whether any Briton or anyone who arrived in Britain recently sat near Sawyer or used the same toilet on one of the aircraft he took.

http://timesofindia.indiatimes.com/w...w/39241068.cms
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Old 07-29-2014, 08:59 AM   #24
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Quote:
Nigerian ambassador, 3 ECOWAS staff, 55 others had contact with Lagos Ebola victim

The Lagos State Government disclosed, yesterday, that the Nigerian Ambassador to Liberia, Chigozie Obi Nnadozie, three staff of the Economic Community of West African States, ECOWAS, and 55 others had contact with the victim of Ebola Virus Disease, EVD, Patrick Sawyer, who died in Lagos, last Thursday.

The Joint Federal and State Team in collaboration with other health organisations on prevention of Ebola outbreak in Lagos, has begun monitoring of the 59 persons that had contact with the victim, who died of Ebola Virus Disease, EVD, in a private hospital in Lagos, last week.
http://www.vanguardngr.com/2014/07/n...victim-idris/?
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Old 07-29-2014, 09:08 AM   #25
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Article is from yesterday, but I thought this section was interesting:

Quote:
The U.S. Centers for Disease Control and Prevention said the closure of borders on account of infectious diseases is "quite uncommon" and generally is only called for in "very serious epidemics."

Speaking on a conference call on Monday, CDC officials said sometimes, neighbouring countries might close their borders "out of fear" of the disease being introduced within their boundaries.

They also said that the sheer size of the outbreak means that the response will be "more of marathon than a sprint," officials said.

The incubation period for those who have been exposed to the disease is 21 days. CDC officials say it will take two full incubation periods without a new case in order to declare the outbreak over.

That means even if there were no more cases after today, officials would still have to wait another 42 days before giving the all-clear.
http://www.cbc.ca/news/world/ebola-o...ents-1.2719952
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