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Paul MaudDib posted:Sort of. You're right. I thought I read that somewhere. Thanks. So survival depends on multiple factors including adaptive immunity, cytokines produced, and amount of virus exposure. I think that same study also suggests that the GP produced by Ebola alone can cause significant host damage. I also found this study that indicates how someone got infected determines their incubation period, not the amount of virus they were exposed to. http://jid.oxfordjournals.org/content/179/Supplement_1/S1.long quote:In Yambuku, as expected, the incubation period for person-to-person transmission of EBO was longer than the incubation period for injections or needlestick accidents. Thus, the empirical recommendation of 3 weeks for quarantine surveillance of EHF contacts appears to be appropriate.
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Oct 13, 2014 16:25
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mastervj posted:I did just that with the family. I got my parents and sister to match my 500. And as wrong and self-righteous as that sounds, MSF are the only thing I will shamelessly plug. Those guys are awesome, have steel plated balls and ovaries, and deserve every single cent. That's awesome, good for you and your family!
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Oct 13, 2014 16:29
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Zedsdeadbaby posted:I'm wondering, what's stopping something like the TSA patting down everyone at the airport and inadvertently spreading the virus? Ebola can spread through touch. The fact that even the TSA's probably not dumb enough to pat down a symptomatic West African traveller, I hope.
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Oct 13, 2014 17:04
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An article I linked a while back is probably where we read that the infectious dose determines the outcome of infection. I didn't think of it before because it was talking about viruses in general, not Ebola specifically. http://www.ncbi.nlm.nih.gov/books/NBK8149/ quote:Even at the earliest stage of pathogenesis (implantation), certain variables may influence the final outcome of the infection. For example, the dose, infectivity, and virulence of virus implanted and the location of implantation may determine whether the infection will be inapparent (subclinical) or will cause mild, severe, or lethal disease.
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Oct 13, 2014 17:24
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Unlike in Spain, Dallas Ebola patient's dog will be saved Rick Jervis, USA TODAY 5:55 p.m. EDT October 12, 2014 DALLAS -- The health worker who tested positive for Ebola has a dog, but the mayor of Dallas says unlike in a recent Spanish case, the dog will be kept safe for eventual reunion with its owner. Mayor Mike Rawlings told USA TODAY that the dog remained in the health worker's apartment when she was hospitalized and will soon be sent to a new location to await its owner's recovery. There are no plans to euthanize the dog, he said. "This was a new twist," Rawlings said. "The dog's very important to the patient and we want it to be safe." 
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Oct 13, 2014 17:25
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The US is really doing well so far. One patient, one nurse infected.  nurses Union mad, too.
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Oct 13, 2014 17:40
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I was wondering whether or not non-clinical disease was happening/possible with Ebola.
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Oct 13, 2014 17:41
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Torpor posted:The US is really doing well so far. One patient, one nurse infected. Don't you mean 5 patients?
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Oct 13, 2014 17:41
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Torpor posted:The US is really doing well so far. One patient, one nurse infected. Sample size isn't significant. Calm yourself. Grim Up North posted:Unlike in Spain, Dallas Ebola patient's dog will be saved Kill the dog. KILL THE DOG
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Oct 13, 2014 17:42
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Fruity Rudy posted:I'm confused as to how they're planning on getting West Africa spread under control as is being claimed. I've seen zero evidence at the moment that that is an achievable outcome. All of those nations have a really poor public health infrastructure, a poorly informed public, governments without any real resources to deal with an outbreak of this size, and ideal poor hygiene conditions for transmission. Yes, we have dealt with Ebola in the past, but it burned out before reaching significant population clusters. What's the magic bullet that's going to change that math in West Africa? It isn't like the population that ignored local official warnings is suddenly going to follow the instructions of foreign health workers. You do have to understand that current notions of "getting west africa under control" include things like west african nations collapsing so spectacularly that it becomes extremely difficult for people in afflicted countries to get about within their own countries, let alone travel to others. And this happening while stronger West African states are able to patrol their borders to isolate or arrest (or possibly even straight up kill) people attempting to flee. Much like how ebola in the past tended to become under control because it would wipe all but 5 people in a cluster of rural towns and those 5 people just happened to not catch it in the meantime, so it's looking like "under control" will be in West Africa.
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Oct 13, 2014 17:44
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Tim Raines IRL posted:Don't you mean 5 patients? You are right of course.  I think about them differently, I guess. The Dallas patient just seems different since it was a situation where the hospital had to diagnose and treat without prior preparation.
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Oct 13, 2014 17:45
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Torpor posted:You are right of course. It is different because Presbyterian was effectively chosen at random. This is more like what would happen at any hospital large enough to claim on paper these capacities. Even as we figure out the exact cause of transmission, there are already good and easy to implement lessons learned: e.g. implement a PPE/infection control coordinator that has the sole job of making sure PPE is used and removed safely. That wasn't done at Presbyterian and is now part of the response plan at Presbyterian and other hospitals.
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Oct 13, 2014 18:03
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Discendo Vox posted:Kill the dog. KILL THE DOG We should finish what Sherman started imo Its the only way.
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Oct 13, 2014 18:05
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Nintendo Kid posted:You do have to understand that current notions of "getting west africa under control" include things like west african nations collapsing so spectacularly that it becomes extremely difficult for people in afflicted countries to get about within their own countries, let alone travel to others. And this happening while stronger West African states are able to patrol their borders to isolate or arrest (or possibly even straight up kill) people attempting to flee. Pretty much. There's almost no chance of the affected countries controlling it at this point, barring a massive international intervention which just isn't in the cards. For that matter, even if Ebola just vanished off the face of the earth tomorrow, those countries would still probably have major economic depressions and famines. At this point the international public-health strategy seems to be containment - try to prevent it from spreading to the less-poor African countries who at least have a chance of addressing it. Failing that, keep it from taking hold off the African continent. This is a really loving risky strategy, but it's really the only one we've got if an international intervention is off the table. Treatments and vaccines are all too far off to be worth banking on - a year or so, plus more time to ramp up production and get people vaccinated or treated. As bad as the crisis is in those countries, it can still get a lot worse. They have 8000 confirmed cases (believed to be an under-estimate because of collapse of reporting capability), doubling every 15 days, the population of SL/Guinea/Libera combined is 22 million. If it's allowed to fester, that's a lot of potential refugees to slip through the cracks in containment. And if it makes it to other dirt-poor countries (India, South/Central America, etc) then it looks even worse. How do you deal with a reservoir of 500-1000 million (like India) instead of 22 million? Paul MaudDib fucked around with this message at 18:25 on Oct 13, 2014 |
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Oct 13, 2014 18:10
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Trabisnikof posted:It is different because Presbyterian was effectively chosen at random. This is more like what would happen at any hospital large enough to claim on paper these capacities. Even as we figure out the exact cause of transmission, there are already good and easy to implement lessons learned: e.g. implement a PPE/infection control coordinator that has the sole job of making sure PPE is used and removed safely. That wasn't done at Presbyterian and is now part of the response plan at Presbyterian and other hospitals. It seems that Presbyterian is now the Ebola hospital in Dallas since the CDC already set up camp there and they overtook an entire ICU but I would think in different circumstances they would have expected Ebola patients to show up more in county/public hospitals than random general hospitals. I still think Presbyterian was an odd choice, it seems obviously driven by proximity but in Dallas if you weren't insured Parkland would be the logical choice and set up already for isolation because of the number of TB cases that show up there.
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Oct 13, 2014 18:13
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Paul MaudDib posted:How do you deal with a reservoir of 500-1000 million (like India) instead of 22 million? I think you know the answer to that.
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Oct 13, 2014 18:42
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I have some more questions for medical goons... Is there any chance some people are getting a non-clinical infection and recovering without ever getting sick enough to report? Also, there are three vaccines in trials. What are the dangers of not finishing the trial and just ramping up production, at least enough to give to medical professionals who are willing to take the risk? I imagine that volunteer numbers would go up if volunteers were offered a vaccine, experimental or otherwise.
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Oct 13, 2014 18:49
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ZombieLenin posted:I have some more questions for medical goons... Also what if the vaccine gives 1/1000 people Ebola? 
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Oct 13, 2014 18:51
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Nessus posted:With the latter I imagine they want to have at least a reasonable idea that it helps. I doubt these vaccines would replace PPE in any case, they're a backstop; the problem there being that if you have a vaccine people assume that that means 'immunity.' As opposed to 'higher resistance to accidental infection'. Right, but that's why I'm curious as to why offering it to medical professionals is off the table. You aren't inoculating everyone, just people in the line of fire who are willing to receive the vaccine. And, of course, I assume that it won't replace PPE. Honestly, it's not even about whether or not it's effective so much as it protects doctors and nurses from accidental infection (or makes them think it might) so you encourage more people who are needed to volunteer to go into the hotzone. And if it is turns out it is effective--even if it gives 1/1000 people active infection--at some point it seems that this might be infinitely more acceptable than loosing 70% of your population to the disease.
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Oct 13, 2014 19:05
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ZombieLenin posted:Let's all quit our jobs and prepare for the end times! Hallelujah! Few pages late, but I 60% matched you. 
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Oct 13, 2014 19:07
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Ebola Roulette posted:I thought I read something like that too but now I'm wondering if it had something to do with amount of virus exposure affecting incubation period. I'll search some more and post when I find it. Is there even any way of knowing what the initial load was? Seems like the sort of thing that would be impossible to determine.
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Oct 13, 2014 19:17
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Nuclear War posted:This loving thread man. I contacted MSF and I'll be going to an information meeting at the end of the month. I guess if they need nurses with my qualifications I might be going to africa at some point. Here's hoping
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Oct 13, 2014 19:30
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ReidRansom posted:Is there even any way of knowing what the initial load was? No, not really. Well, scientists can know the initial load while doing experiments. But not in infections that occur naturally.
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Oct 13, 2014 19:31
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Oct 13, 2014 19:41
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I checked on the off chance that I might have something that could be used to help people, and saw this message:quote:Please be advised that, at this time, Doctors Without Borders is no longer recruiting specifically for the Ebola emergency in West Africa. However, if you would like to be considered for the Ebola response in addition to other field assignments, please specify this on your field application. http://www.doctorswithoutborders.org/work-with-us What's up with that? I hope they've been totally inundated with thousands of med goons who want to help, but I thought they'd always be able to use more.
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Oct 13, 2014 19:41
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Ravenfood posted:Way late, but out of curiosity, what are your qualifications? Last time I checked MSF's site they didn't seem to want/need me so I'm curious what changed. Im a RN and used to be/am a military NCO so I have some experience running/working at field hospitals. Gotta say again, like I said before, though, I'm just going to a meeting for possible applicants with skills that might be needed and its not like Im packing my bags or anything. I just want to at least offer my services and we'll see what happens. I don't have money to donate, but I do have time and skills so I figure why not give it a go? Edit: the woman I talked to said they were still looking for people to go to Africa on a longer timescale, like after christmas or nearer next summer. It might be the American Branch is just getting too many requests to work through? Nuclear War fucked around with this message at 19:48 on Oct 13, 2014 |
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Oct 13, 2014 19:44
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At least one of the vaccines in development is another unrelated virus with an ebola protein tacked on the surface. It couldn't give you the bola. We'll see if it works.
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Oct 13, 2014 19:49
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ZombieLenin posted:Also, there are three vaccines in trials. What are the dangers of not finishing the trial and just ramping up production, at least enough to give to medical professionals who are willing to take the risk? I imagine that volunteer numbers would go up if volunteers were offered a vaccine, experimental or otherwise. The CDC and NIH are doing exactly that with a couple of products, very specifically in HCWs in limited settings. Unfortunately, a couple nonprofits with infinite money and zero sense are planning to stage a full intervention with a treatment called ZMapp. ZMapp is phase zero, meaning there's been no controlled clinical study yet. A large scale intervention with a clinically untested drug in the affected regions has the potential to be the greatest bioethics disaster in human history.
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Oct 13, 2014 19:51
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tuyop posted:I checked on the off chance that I might have something that could be used to help people, and saw this message: They may be short on resources for other areas needing their services due to ebola response.
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Oct 13, 2014 20:04
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Nintendo Kid posted:They may be short on resources for other areas needing their services due to ebola response. And likewise their training resources may be limited. They may only have so many instructors etc.
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Oct 13, 2014 20:13
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I've said it before, but "lets just shove some vaccines in there see if that helps" is the opposite of a clinical trial. Drawing statistically significant results without controls is impossible; if we gave it to a bunch of people and some got better, there could be any number of external factors that are influencing the trial. Shove ten kinds of pills at random to Ebola patients and you will get a pill that seems to work: this is the Texan sharpshooter effect (unload a gun at the broad side of a barn, draw a circle around the highest concentration of holes, you seem to be a sharpshooter). The shot could be ineffective, make the problem worse or even give some fraction of the patients Ebola and we would never know.
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Oct 13, 2014 20:15
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CoolCab posted:I've said it before, but "lets just shove some vaccines in there see if that helps" is the opposite of a clinical trial. Drawing statistically significant results without controls is impossible; if we gave it to a bunch of people and some got better, there could be any number of external factors that are influencing the trial. Shove ten kinds of pills at random to Ebola patients and you will get a pill that seems to work: this is the Texan sharpshooter effect (unload a gun at the broad side of a barn, draw a circle around the highest concentration of holes, you seem to be a sharpshooter). The shot could be ineffective, make the problem worse or even give some fraction of the patients Ebola and we would never know. The irresponsible stuff is being done with a treatment, not a vaccine.
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Oct 13, 2014 20:16
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Discendo Vox posted:The irresponsible stuff is being done with a treatment, not a vaccine. Right, addressing both that and people asking "why don't we jab all the volunteers with a vaccine, can't hurt". The vaccine preparers seem to know that it certainly can while the zmapp people don't.
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Oct 13, 2014 20:18
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Discendo Vox posted:The CDC and NIH are doing exactly that with a couple of products, very specifically in HCWs in limited settings. Unfortunately, a couple nonprofits with infinite money and zero sense are planning to stage a full intervention with a treatment called ZMapp. ZMapp is phase zero, meaning there's been no controlled clinical study yet. A large scale intervention with a clinically untested drug in the affected regions has the potential to be the greatest bioethics disaster in human history. I thought there was a serious logistical barrier to Zmapp. As in its difficult to produce and takes considerable time to manufacture. Let alone the issue of it being a drug with zero clinical trials. I'd be interested to know though how many people given Zmapp before it ran out actually recovered? CoolCab posted:Right, addressing both that and people asking "why don't we jab all the volunteers with a vaccine, can't hurt". The vaccine preparers seem to know that it certainly can while the zmapp people don't. I never wanted to suggest this as a policy. I am only (seriously) curious why it's not an option, because I am not a medical professional, an epidemiologist, a pharmacist, or a biological scientist. ZombieLenin fucked around with this message at 20:23 on Oct 13, 2014 |
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Oct 13, 2014 20:20
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ZombieLenin posted:I thought there was a serious logistical barrier to Zmapp. As in its difficult to produce and takes considerable time to manufacture. Let alone the issue of it being a drug with zero clinical trials. Gates is throwing their practically unlimited funding into growing more of the stuff- it will be ready in approximately a month. ZombieLenin posted:I'd be interested to know though how many people given Zmapp before it ran out actually recovered? All of them, I believe, but it's a forced sample of n<10 healthcare workers under best practices hospital care in the US-meaningless in terms of its evaluation of the drug's effectiveness. The proposed intervention is basically all people (including children and pregnant women, and people with other illnesses) in the affected areas. Gates also has a poor reputation in the epidemiology community for employing spray-and-pray tactics with vaccine distribution. They don't tend to do followup or monitoring work of the sort necessary to ensure proper use of the pharmaceutical, or to prevent the development of drug-resistant strains. You basically have to isolate and monitor people given a vaccine or treatment in this sort of setting because otherwise people who don't take the medication properly, or just people who are unlucky, may develop a version of the infection that is resistant to the treatment. Then the individual with the resistant version of the infection can spread it back into the general population. Discendo Vox fucked around with this message at 20:30 on Oct 13, 2014 |
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Oct 13, 2014 20:27
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Discendo Vox posted:All of them, I believe, but it's a forced sample of n<10 healthcare workers under best practices hospital care in the US-meaningless in terms of its evaluation of the drug's effectiveness. The proposed intervention is basically all people (including children and pregnant women, and people with other illnesses) in the affected areas. ZMapp is 5-2 atm, the Spanish priest and a Liberian doctor got it and died.
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Oct 13, 2014 20:33
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How does immunity to ebola work? There's a few groups of villagers that are entirely immune to the virus, from what I understand. Is this immunity genetic from previous ebola cases in the area?
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Oct 13, 2014 20:35
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Discendo Vox posted:All of them, I believe, but it's a forced sample of n<10 healthcare workers under best practices hospital care in the US-meaningless in terms of its evaluation of the drug's effectiveness. The proposed intervention is basically all people (including children and pregnant women, and people with other illnesses) in the affected areas. I'm a political "scientist" by trade (go ahead and mock, the use of the word scientist is ridiculous). I say this only to communicate that I understand how that sample size is not large enough, and you have serious issues with confounding variables. I was just curious to know why people like Bill Gates want to bank on this. quote:Gates also has a poor reputation in the epidemiology community for employing spray-and-pray tactics with vaccine distribution. They don't tend to do followup or monitoring work of the sort necessary to ensure proper use of the pharmaceutical, or to prevent the development of drug-resistant strains. You basically have to isolate and monitor people given a vaccine or treatment in this sort of setting because otherwise people who don't take the medication properly, or just people who are unlucky, may develop a version of the infection that is resistant to the treatment. Then the individual with the resistant version of the infection can spread it back into the general population. So in the case of the Ebola vaccines there is the potential risk of accidentally creating incurable/untreatable worse Ebola? Noctis Horrendae posted:How does immunity to ebola work? There's a few groups of villagers that are entirely immune to the virus, from what I understand. Is this immunity genetic from previous ebola cases in the area? Totally not equipped to answer this, but from what I've read previous infection give immunity to particular strains of Ebola for at least 10 years. It might give immunity to all the strains, but there isn't enough (any) evidence to support this conclusively. Medical goons, feel free to correct me. ZombieLenin fucked around with this message at 20:43 on Oct 13, 2014 |
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Oct 13, 2014 20:39
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Noctis Horrendae posted:How does immunity to ebola work? There's a few groups of villagers that are entirely immune to the virus, from what I understand. Is this immunity genetic from previous ebola cases in the area? Those villages probably had unnoticed Ebola outbreaks.
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Oct 13, 2014 20:40
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ZombieLenin posted:
The importance of performing accurate double blind tests as well as the benefits of metadata review (which is essentially examining ALL the data available, valuing it based on how pure the trials were and then performing a metadata analysis) are best described using the logo for the Cochrane Institute which is dedicated to this kind of analysis: 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] Each of the seven trials failed to identify that this procedure could have prevented the killing of infants as their samples were too small. Dead infants are literally the stakes, RCTs are absolutely essential for any treatment and why zmapp being dished out without it should scare the poo poo out of you.
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Oct 13, 2014 20:41
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