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lurker1981 posted:This is terrible My omelet is a bunch of dead people.
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Oct 4, 2014 09:18
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Regarde Aduck posted:My omelet is a bunch of dead people. Amen, bro. Seriously, though, I think people with ebola should be kept away from uninfected people. As politically incorrect as my opinion may be, I stand by it. Folks who can literally murder others by sharing bodily fluids are dangerous, especially when our main means of breeding involves doing exactly that. One could conceivably even say that to murder one person could be considered genocide, if you think about all the possible benefits that could have been derived from the unborn descendants of that person (not to mention that it is not entirely unreasonable to think that you could create billions of people from, say, an original group of 10 people). Then again, there is the possibility that one of your descendants could be the next Hitler or Stalin... edit: Has the CDC found a cure for AIDS yet? lurker1981 fucked around with this message at 09:47 on Oct 4, 2014 |
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Oct 4, 2014 09:29
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Everyone wants that. The question is how to do that without completely losing the trust of the susceptible population. And that involves making sure that they still get fed, are provided services, are provided medicine (alot of things can potentially kill you, not just ebola), and don't actively mislead the authorities, As Princess Leia once said, the more you tighten your grip, the more
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Oct 4, 2014 09:45
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Charlz Guybon posted:Liberia places restrictions on reporting on Ebola Didn't the president get quarantined due to one of the staff being infected? If it's starting to hit the military/police/elite's, they probably don't want that getting out.
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Oct 4, 2014 09:46
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Aw man, a star wars reference. You're better than that.
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Oct 4, 2014 09:46
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lurker1981 posted:edit: Has the CDC found a cure for AIDS yet? No, but there are treatments that are pretty effective.
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Oct 4, 2014 09:48
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Regarde Aduck posted:My omelet is a bunch of dead people. Can't make an omelet without murdering a bunch of people. My tenure at the IHOP was short lived.
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Oct 4, 2014 10:05
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Discendo Vox posted:Normally phase 1 trials involve giving the substance to healthy uninfected people. Where are you hearing that that's different for cancer compounds? More importantly, why would that be different for cancer compounds? From a while back, but I think it is still relevant to discuss and something you should know about as you are mixing up some important trial design characteristics in my humble opinion. Where I'm hearing this is different for some cancer compounds is in the trials I deal with, take as an example brentuximab vedotin. A form of chemotherapy. Phase I trials were done in patients that stood to possibly benefit from the trial. http://clincancerres.aacrjournals.org/content/18/1/248.short I can literally give you hundreds of examples of these types of trials and there not limited to oncology, but quite prevalent even in mild conditions such as back pain: https://clinicaltrials.gov/ct2/show/NCT00689780?term=phase+I&cond=%22Back+Pain%22&rank=2 From my experience, phase I trials involving non healthy volunteers is quite common and sometimes even the norm. quote:To the extent that such a rationale exists, it would normally be because the mechanism of action has serious negative effects on healthy patients. That shouldn't be the case wih an EVD treatment. Discendo Vox posted:There are two problems with what's currently being proposed, coming from very different directions. First, a massive intervention rollout of a phase zero drug is different from a clinical trial- you're not going to get meaningful information on the drug like this (in particular, I'm pretty drat confident they aren't going to have a placebo condition). Second, the intervention is in a population where there are strong reasons to think that the intervention is going to destroy the remaining trust in the healthcare apparatus and remaining effects of rule of law, even if the drug works properly. Again, were talking about a phase I trial so placebo is not even remotely necessary. The aim is to establish safety, with efficacy as a secondary endpoint. Moreover, placebo would be the current best practice, which is fluid replacement therapy. This a placebo all hospitals are capable of. A lot of useful information could be gained. I cant comment on the second argument as there is no data for or against it. Maybe intervention will drive people away, or maybe providing a effective treatment to sick people will make them trust you more.
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Oct 4, 2014 10:37
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ma i married a tuna posted:Seriously. I mean, what do, to name a few, AIDS, smallpox, cholera, and bubonic plague have in common? They've all caused epidemics killing millions. And another thing: they're also not airborne. The common cold on the other hand... While I appreciate the point you're making, there actually is a rare form of bubonic plague that has been known to go airborne. It's called Pneumonic plague, and it is caused by the same Y. Pestis that causes the bubonic plague, so it's not like that never happens. Sorry if I sound like I'm trying stir up some fear, I live in Dallas, but don't go around licking obviously sick people. So I think I'm probably healthy. I mean, if I have flu-like symptoms, I'm far more likely to die from the flu than ebola. thrakkorzog fucked around with this message at 10:51 on Oct 4, 2014 |
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Oct 4, 2014 10:43
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IAMNOTADOCTOR posted:Again, were talking about a phase I trial so placebo is not even remotely necessary. The aim is to establish safety, with efficacy as a secondary endpoint. Moreover, placebo would be the current best practice, which is fluid replacement therapy. This a placebo all hospitals are capable of. A lot of useful information could be gained. I cant comment on the second argument as there is no data for or against it. Maybe intervention will drive people away, or maybe providing a effective treatment to sick people will make them trust you more. When I get infected with Ebola, I hope the doctors give me a placebo.  It can't be any worse than, I don't know, our governments making some kind of attempt to make sure we don't get infected in the first place. VVVVV - Supposedly some lady wrapped all the contaminated items in plastic bags before they arrived. As to whether or not she is under quarantine, I have no idea. Didn't Tom Clancy write a book about this (and 9/11)? Maybe he was a prophet... lurker1981 fucked around with this message at 10:52 on Oct 4, 2014 |
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Oct 4, 2014 10:44
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I'm still worried about the 5 officers who entered the quarantined apartment without PPE and then later the sheriff and his aides who did the same thing to serve legal papers. They might end up being the ones who spread this on a substantial level. I guess in 30 days we'll see who has eyeballs popping out of their heads.
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Oct 4, 2014 10:47
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lurker1981 posted:When I get infected with Ebola, I hope the doctors give me a placebo. There's a reason we double blind. quote:The logo of the Cochrane Collaboration illustrates a meta analysis of data from seven randomized controlled trials (RCTs), comparing one health care treatment with a placebo in a forest plot. The diagram shows the results of a systematic review and meta analysis on inexpensive course of corticosteroid given to women about to give birth too early – the evidence on effectiveness that would have been revealed had the available RCTs been reviewed systematically a decade earlier. This treatment reduces the odds of the babies of such women dying from the complications of immaturity by 30–50%. Because no systematic review of these trials had been published until 1989, most obstetricians had not realized that the treatment was so effective and therefore many premature babies have probably suffered or died unnecessarily.[18] Without proper testing all kinds of effects can be masked or misrepresented, making any data we draw from it meaningless.
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Oct 4, 2014 10:51
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CoolCab posted:Without proper testing all kinds of effects can be masked or misrepresented, making any data we draw from it meaningless. That won't prevent your interpretation of the data from getting published in prominent medical journals. https://www.youtube.com/watch?v=k7OLCbjuidE lurker1981 fucked around with this message at 10:58 on Oct 4, 2014 |
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Oct 4, 2014 10:55
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lurker1981 posted:That won't prevent your interpretation of the data from getting published in prominent medical journals. Yes and this is a terrifying loving problem, read Bad Science by Ben Goldacre.
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Oct 4, 2014 10:57
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EugeneJ posted:I'm still worried about the 5 officers who entered the quarantined apartment without PPE and then later the sheriff and his aides who did the same thing to serve legal papers. They might end up being the ones who spread this on a substantial level. You're unnecessarily worried about people who had brief contact with the asymptomatic contacts of an ebola patient.
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Oct 4, 2014 11:05
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Meatwave posted:You're unnecessarily worried about people who had brief contact with the asymptomatic contacts of an ebola patient. Bigger concern would be them coming into contact with infectious materials since the apartment hadn't been cleaned yet.
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Oct 4, 2014 11:07
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Xandu posted:Bigger concern would be them coming into contact with infectious materials since the apartment hadn't been cleaned yet. I thought that was because vehicles with hazardous materials weren't allowed in that area. Surely following the rules is more important than keeping American citizens safe...
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Oct 4, 2014 11:12
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lurker1981 posted:I thought that was because vehicles with hazardous materials weren't allowed in that area. USDOT issued a special hazardous waste permit to a Chicago company last night. Its an election year. Whats most worrying is the fact the family were quarantined inside an apartment and had environmental exposure for 7 days before local authorities were forced to make alternate arrangements.
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Oct 4, 2014 11:18
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Here's a map of "African population interconnectivity": From here: http://currents.plos.org/outbreaks/article/containing-the-ebola-outbreak-the-potential-and-challenge-of-mobile-network-data/
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Oct 4, 2014 13:05
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OK, so tell me. This is now in the 'problem defined; trenches dug in; novelty wearing off; long, laborious, deadly snafu on the ground without immediate solution but requiring actual work still for months to come' phase as far as the media is concerned, isn't it? I'd like some positive news feed. As in: X people tested NOT shown to have Ebola. MIGF, do you have anything like that? I mean, for gently caress's sake, we know that (sane) optimism is like placebo. So far, there's the stuff that Ebola will probably NOT get airborne and that Nigeria seems to have dealt with that miniscare from August, right?
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Oct 4, 2014 13:29
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meristem posted:OK, so tell me. This is now in the 'problem defined; trenches dug in; novelty wearing off; long, laborious, deadly snafu on the ground without immediate solution but requiring actual work still for months to come' phase as far as the media is concerned, isn't it? The suspected Toronto case tested negative
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Oct 4, 2014 13:41
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Serious Optimism stuff, GSK's vaccine will probably be ready and in sufficient numbers to start slowing down the spread by Late Winter / Spring. That is ignoring the other possible vaccines that are in the pipeline (although GSK's is the only one in trials). So Ebola should start to be managed in the first half of next year. Its just a pity that for what ever reason GSK's vaccine only seems to work for a few months, so isn't a long term solution. Hopefully one of the other vaccines works better, but given they will probably be all operating via the same mechanisms its probable they will have the same issue. So a true vaccine might be many years off.
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Oct 4, 2014 13:47
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I don't even know anymore. If I lived in Dallas I would not be going outside, and if I did I would be wearing protection. Potential 1000's of exposures now, not to mention the judge and two ladies going into their apartment sure aren't going to be quarantined. This is not good, IMHO, but I live in Ohio and would be freaking the gently caress out if/when a case is reported here.
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Oct 4, 2014 13:55
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Michael Corleone posted:I don't even know anymore. If I lived in Dallas I would not be going outside, and if I did I would be wearing protection. Potential 1000's of exposures now, not to mention the judge and two ladies going into their apartment sure aren't going to be quarantined. This is not good, IMHO, but I live in Ohio and would be freaking the gently caress out if/when a case is reported here. There is a single case and 10 being watched that are considered high risk, you are unnecessarily paranoid. Even if the disease spread as rapidly as it has in Liberia it would be months before thousands of cases.
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Oct 4, 2014 13:58
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Michael Corleone posted:I don't even know anymore. If I lived in Dallas I would not be going outside, and if I did I would be wearing protection. Potential 1000's of exposures now, not to mention the judge and two ladies going into their apartment sure aren't going to be quarantined. This is not good, IMHO, but I live in Ohio and would be freaking the gently caress out if/when a case is reported here. Where are you getting thousands of potential exposures? The last I heard the CDC was tracing about a hundred contacts.
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Oct 4, 2014 14:01
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Michael Corleone posted:I don't even know anymore. If I lived in Dallas I would not be going outside, and if I did I would be wearing protection. Potential 1000's of exposures now, not to mention the judge and two ladies going into their apartment sure aren't going to be quarantined. This is not good, IMHO, but I live in Ohio and would be freaking the gently caress out if/when a case is reported here. Fear is one hell of a thing
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Oct 4, 2014 14:02
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MaximumBob posted:Where are you getting thousands of potential exposures? The last I heard the CDC was tracing about a hundred contacts. All the people in the hospital, all the people the kids exposed at there school, the idiot public service officials, plus everyone they've come in contact w/, etc, etc. But, that is potential, and probably not many, if any will become infected, just potential, and yes, fear is a hell of a drug. This guy was walking around the streets for days...
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Oct 4, 2014 14:09
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Michael Corleone posted:All the people in the hospital, all the people the kids exposed at there school, the idiot public service officials, plus everyone they've come in contact w/, etc, etc. But, that is potential, and probably not many, if any will become infected, just potential, and yes, fear is a hell of a drug. This guy was walking around the streets for days... There's no evidence that contact with an asymptomatic person is a risk. Look, it's a virus with a scary fatality rate and scary symptoms. And even in the best case scenario it's likely to cause a long-lasting crisis in a region that can ill afford it. That's scary and sad enough without people making up facts or whipping themselves up into a froth over things that aren't an issue.
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Oct 4, 2014 14:26
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Michael Corleone posted:All the people in the hospital, all the people the kids exposed at there school, the idiot public service officials, plus everyone they've come in contact w/, etc, etc. But, that is potential, and probably not many, if any will become infected, just potential, and yes, fear is a hell of a drug. This guy was walking around the streets for days... He likely wasn't out walking around much. As I understand it, he was quite ill and felt like total poo poo.
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Oct 4, 2014 14:31
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Sheng-ji Yang posted:Isn't the Common Cold pretty much spread in the same way as Ebola? Yes http://cmr.asm.org/content/26/1/135.full Children especially are prone to asymptomatic infection and virus shedding of Rhinovirus. It's also not contagious until symptoms appear. quote:HRVs are transmitted from person to person via contact (either direct or through a fomite) or aerosol (small or large particle) (13, 14). HRV infection is efficiently initiated by intranasal and conjunctival inoculation but not by the oral route. Also I'd say playing cards would be a form of contact and not aerosol.
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Oct 4, 2014 14:41
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thrakkorzog posted:While I appreciate the point you're making, there actually is a rare form of bubonic plague that has been known to go airborne. It's called Pneumonic plague, and it is caused by the same Y. Pestis that causes the bubonic plague, so it's not like that never happens. pneumonic plague isn't really ~that~ rare, though: it pretty reliably crops up whenever there is a surge in y. pestis infection, as it is dependent on anatomical circumstances that are not hard to bring about. The point of which is that it's something that y. pestis has always been capable of for as long as we've known about it. It's not some combination of freak mutation and radical behavioral change, like we're talking about with Airborne Ebola hypotheticals.
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Oct 4, 2014 15:09
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Discendo Vox posted:Not necessarily- they won't be able to collect very good information if this is really a large-scale interventionary approach. Of course, the sort of spray-and-pray administration it's going to get isn't going to be all that efficacious, either. The thing is that one of the many things that have hindered ongoing research was that nearly all outbreaks were small and tended to be concentrated in rural areas that are hard to get to. An unfortunate consequence of a truly endemic manifestation of ebola in urban centers will be that people will be continuously exposed for long periods of time, a s well as a lot of people who've survived at least one bout. And both of those things will create much larger pools for studying how to survive it as well as possibly how to create a vaccine or treatment. But it's still in the worst possible way.
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Oct 4, 2014 16:03
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Also, bubonic plague is caused by a bacterium. Bacteria are not as limited in the tissues they grow in as viruses are. Because bacteria don't actually enter cells, they can become much more invasive. Under the right circumstances this includes invasion of the respiratory tract, where bacteria can enter and grow. A virus is limited by its protein coat, as well as receptors of its host cells. These factors allow the virus to enter and grow only inside certain cells. This is also known as tissue tropism. http://www.ncbi.nlm.nih.gov/books/NBK8149/ quote:Viral affinity for specific body tissues (tropism) is determined by (1) cell receptors for virus, (2) cell transcription factors that recognize viral promoters and enhancer sequences, (3) ability of the cell to support virus replication, (4) physical barriers, (5) local temperature, pH, and oxygen tension enzymes and non-specific factors in body secretions, and (6) digestive enzymes and bile in the gastrointestinal tract that may inactivate some viruses. For Ebola to become airborne, it would have to be able to grow inside cells of the respiratory tract. It would most likely have to gain the ability to infect epithelial cells inside the lungs, or other lung cells. The mutations required to gain this ability would basically turn Ebola into an entirely different virus anyway. Also, airborne has a strict definition. Many people confuse aerosol or droplet transmission with airborne transmission. For a pathogen to be truly airborne, it would have to remain suspended in air after the droplet evaporated, and be able to cause infection. There are many pathogens that are technically airborne, but cannot cause infection. This is because the pathogen is too large to enter the respiratory tract and reach the lungs, and also due to tissue tropism. So, even if Ebola could become airborne, it still might not be able to cause infection this way.
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Oct 4, 2014 16:15
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IAMNOTADOCTOR posted:Where I'm hearing this is different for some cancer compounds is in the trials I deal with, take as an example brentuximab vedotin. A form of chemotherapy. Phase I trials were done in patients that stood to possibly benefit from the trial. To the extent that it's the norm, it's a bad thing. It conflates efficacy and safety testing unless there's a reason to think side effects are structurally different between healthy and sick populations, to such an extent that healthy population Phase I data would be meaningless (although even then it would be better to still include a healthy clade). Among other things, it can be harder to determine the source of causal processes in side effect groups. To the extent that it has become an acceptable practice, it's a sign of good experimental design being deteriorated by political pressure. IAMNOTADOCTOR posted:Yes and no, see the back pain example. Also, antibodies such as ZMAPP all carry a large inherent risk of serious side effects, and previous studies with anti ebola viral antibodies saw serious side effects. Yes, but the circumstances of those studies (which you'd think would elicit greater caution in subsequent studies) were a lot more ideal than what's being planned right now. I return to this at the end of my post. IAMNOTADOCTOR posted:Again, were talking about a phase I trial so placebo is not even remotely necessary. The aim is to establish safety, with efficacy as a secondary endpoint. Moreover, placebo would be the current best practice, which is fluid replacement therapy. This a placebo all hospitals are capable of. A lot of useful information could be gained. I cant comment on the second argument as there is no data for or against it. Maybe intervention will drive people away, or maybe providing a effective treatment to sick people will make them trust you more. Placebo is absolutely the best practice for phase one trials- you still have placebo effects in safety testing. I agree that current best practice would be a meaningful placebo here (it's suboptimal in terms of theory due to difficulty in maintaining the blind, but see next sentence). The placebo you describe would not be available or practiced in the intervention theater we are discussing, particularly on the scale being countenanced. Ultimately, a lot of my practice quibbles are less important than the simple fact that staging a large-scale intervention with an incredibly untested drug in limited quantities in an area that already has fragile rule of law, suspicion of outside intervenors, and a recent history of attacks on HCWs, will have serious social consequences. This is already an area where the population doesn't trust the government or the "West"- Liberia, which has some of the best relations with the US, is itself nearing collapse. What happens when ZMapp starts killing a percentage of the people that take it? More inevitably, what happens when members of the public say ZMapp will harm those who take it, regardless of its actual effects? Discendo Vox fucked around with this message at 17:07 on Oct 4, 2014 |
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Oct 4, 2014 17:04
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Well then we stop giving them it, more zmapp for us! (Depending on ability to pay.)
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Oct 4, 2014 17:15
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Nessus posted:Well then we stop giving them it, more zmapp for us! (Depending on ability to pay.) We wouldn't be having infected people in the US pay for ZMapp either. It's still effectively at Phase I.
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Oct 4, 2014 17:23
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Ebola Roulette posted:Also, bubonic plague is caused by a bacterium. Bacteria are not as limited in the tissues they grow in as viruses are. Because bacteria don't actually enter cells, they can become much more invasive. Under the right circumstances this includes invasion of the respiratory tract, where bacteria can enter and grow. Thank you for this post. It'd be really good to have stuff like this in the OP, maybe - now that there's one US case the same points keep coming up over and over again and there's an influx of panicked refugees from GBS.
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Oct 4, 2014 18:11
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http://www.nydailynews.com/news/national/sick-passenger-examined-ebola-newark-airport-article-1.1963383 " A vomiting passenger has prompted the quarantine of United Airlines Flight 998 from Brussels after landing at Newark Liberty International Airport early Saturday afternoon, according to reports. Two passengers — a father and daughter — believed to be from Libera were removed from the flight of 255 passengers from Belgium after exhibiting signs of the deadly Ebola virus during the seven hour flight, WNYW-TV reported. The remaining passengers were under quarantine on the Boeing 777 at Gate B54 after landing at about noon, according to FlightAware’s activity log, while waiting for a team of Center for Disease Control officials to examine the sick traveler. A statement from a United Airlines spokesperson stated the flight crew and passengers were told to stay on board "until they could assist an ill customer." "We are working with authorities and will accomodate our customers as quickly as we can." A phone call to the CDC by the Daily News was not immediately returned." Not great news if they were that far into the symptomatic stage and were let on the airplane, I think. Hopefully it turns out it wasn't Ebola.
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Oct 4, 2014 19:21
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Why hasn't Brussels Airlines followed the decision of pretty much every other airline and cancelled flights to the major hotspots? At some point, people are going to just say "gently caress flying through Belgium, that's where all the Ebola-carriers pass through" and it's going to majorly gently caress with their business. Are they making that much money off flights to Monrovia and such that they can afford to take that risk, not to mention the risk posed to their flight crews?
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Oct 4, 2014 19:39
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Governments have recommended against it so that aid workers and the like can get in.
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Oct 4, 2014 19:42
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