Ebolavirus 2014: the r0 from shitposting is 6.9

The Something Awful Forums > Discussion > Debate & Discussion > Ebolavirus 2014: the r0 from shitposting is 6.9

My Imaginary GF: Jul 17, 2005; by R. Guyovich

This is bad, how can I help?
: http://forums.somethingawful.com/showthread.php?threadid=3671590

*******Hotline Numbers*******

SENEGAL:

UNITED STATES:

SIERRA LEONE: 117

LIBERIA: 4455 or 1333

GUINEA: 115

NIGERIA (Lagos state): 0800326524357

********

Will Ebola become airborne?

Ebola Roulette posted:

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/

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.

Thread Goal: To provide a central location to discuss the Ebolavirus outbreak on the African content while informing and educating without needlessly speculating.

Thread do's: To discuss the ongoing Ebola epidemic in West Africa, its proximate causes and secondary causes, the currrent status of the outbreak, and any proposed interventions you think could assist in reducing the scale of the humanitarian disaster. Some of us in this thread work in certain areas of African policy, while others may be able to provide insight as biologists, epidemiologists, climatologists, or whatever your specialty. Pandemics don't emerge in a bubble, and intersectionality will be key to controlling this outbreak snd preventing future ones.

Thread don'ts: Low-effort, culturally incompetent posts aren't welcome here. For example: Lol them monkeyeaters just can't stop pissing on each other, versus "In an area where no public sanitation exists, it is a sad fact of life that an improper defecation is a strong contributing factor with highly risks for transmission of the Ebolavirus. During late stages of the viral infection, some individual's executive functioning skills may deteriorate and their behavior becomes erratic."

Basically, if you wouldn't say it on your nightly news, don't say it here.

Groundrules: If you're able to read this and don't plan to travel to Africa within the next 9 months, the likelyhood of you contracting Ebola is so low as to not merit everyday consideration unless you work in healthcare screening at an international airport. SA is a diverse place with a wide variety of professionals; share your insught, and please refraim from needless fearmongering, posting unverified Western rumors, or pseudo-scientific bullshit. First, do no harm; second, help!

While media accounts in Africa are often contradictory, it is fine to repost speculation and rumors so long as you discuss the context in which you've heard them. If you are in Africa and wish to discuss a local rumor, I recommend this joint Nigerian/WHO partnership:

http://ebolaalert.org

Now, for some music:
https://m.soundcloud.com/unicef-liberia/hott-fm-ebola-song-liberia

Audio Resources:
http://m.soundcloud.com/unicef-liberia - has several songs and jingles on Ebola

http://www.bbc.co.uk/podcasts/series/ebola - Bi-Weekly BBC public health broadcast on Ebola

http://rfikiswahili.com - Je, unasema kiswahili? Iko ni lazima usikiliza. (Good Swahili radio site which has frequent news bullitins and has been closely following the West African Ebolavirus outbreak)

I've been keeping track of the sites I most frequently check and compiled a mini-resource guide for the current West and Central African Ebolavirus Pandemic&Outbreak. If you have any suggestions to add to this list, please feel free to PM them to me at any time.

First up, some general sites worth keeping an eye on:

http://www-sul.stanford.edu/depts/ssrg/africa/guide3.html - Stanford's country-by-country complete resource guide for Africa.

http://reliefweb.int/organization/who - WHO releases daily sitreps from the hotspot here

http://crofsblogs.typepad.com/h5n1/ - infectious disease doctor, aggregates outbreak news and has a comprehensive resource list

http://www.flutrackers.com/forum/forumdisplay.php?f=3136 - forum frequented by healthcare workers, no-bullshit nor speculation. Often has articles translated to English that wouldn't be found elsewhere

http://virologydownunder.blogspot.com.au/?m=1 - joint blog of four Australian medical professionals, very informative and well-sourced. Great at discussing the technical aspects in for a layman's understanding without compromising quality

http://afludiary.blogspot.ca/?m=1 - blog in the styling of VirologyDownUnder.

https://www.redcross.org.nz/blog/from-the-field/nursing-in-ebola-country/ - Red Cross nurse in Kenema, Sierra Leone, a hot zone where WHO has recently withdrawn from. Fairly infrequently updated (I'd image she's quite occupied with other matters)

Media and Institutions

http://saharareporters.com - Some better quality West African reporting, based in Nigeria

http://tnrliberia.com/index.php - Liberian daily newspaper, internet portal is aimed for consumption by Liberia's expatriate population

https://gabonpress.wordpress.com - Gabon-based reporting, in French (Salut AEF!) and comprehensive when machine-translated to English by Google

http://www.newvision.co.ug - Daily print paper in Uganda; while this West African Ebolavirus Zaire-strain outbreak hasn't spread to Uganda yet, Uganda has experienced and successfully contained several Ebola outbreaks since Ebola's first modern documentation in DRC '76. Also, I'm occassionally published there

http://www.mohsw.gov.lr - Official website of the Liberian Ministry of Health & Social Welfare (MoH). Publishes daily sitreps of the outbreak in Liberia; latest release is Sitrep #101, covering up to 24 August 2014
:smith:

Scientific, Journal, and Technical Links

Ebola Roulette posted:

http://www.cdc.gov/vhf/ebola/outbre...inea/index.html - This is the one I use to get CDC updates.

http://www.who.int/mediacentre/factsheets/fs103/en/ - This one's pretty informative. It has info on transmission, diagnosis, and has a neat table summarizing past Ebola outbreaks.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC224575/ - This website is really scientific and technical but useful for explaining how Ebola works in the body. I find it interesting, but I'm a microbiology nerd

http://www.nejm.org/search?q=ebola&sort=date - New England Journal of Medicine has made access to all their Ebola articles free

http://ebola.thelancet.com - The Lancet has made free and available all articles they have relating to Ebola

Some interesting twitters to follow:

https://mobile.twitter.com/AhmedTejanSie - to quote from him on his role,

Dr. Ahmed Tejan Sie, UNC posted:

@Stopebola14 I'm a member of @SLaction1 working with #SierraLeone #Ebola Op Ctr to implement #convalescentserum. Please support us. Thx

https://mobile.twitter.com/frankietaggart - reporter on the ground in Sierra Leone

https://mobile.twitter.com/HaertlG - WHO's social media guy

https://mobile.twitter.com/MSF - Official twitter account of Medicine Sans Frontiere/Doctors Without Borders, who need no introduction

https://mobile.twitter.com/UmaruFofana - Average Leonese female national (well, as average a Leonese twitter user as any) detailing her experiences on the ground in Sierra Leone.

https://mobile.twitter.com/aetiology - Associate Professor of Zoonotic Infectious Disease at Kent State University, all-around level-headed and informed tweeter. Often gets requests from journalists for interviews/has conversations with journos on the ground. Frequently tweeted back and forth with WHO during early stages of outbreak; I generally check out the twitter accounts of those whom are @'d with her to identify potential new resoures

General Reading Recommendations

The Origin of AIDS by Jacques Pepin

And The Band Played On by Randy Shiltz

Dreylad recommended posted:

No Time to Lose by Peter Piot. ---Belgian doctor describes his research from the 70s onwards on the Ebola and AIDS viruses in Africa and trying to organize the various competing groups of countries, private interests and NGOs to tackle these problems.

My Imaginary GF fucked around with this message at 05:27 on Oct 13, 2014

# ? Aug 29, 2014 11:27

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# ? May 2, 2024 15:56

My Imaginary GF: Jul 17, 2005; by R. Guyovich

Country-Specific Background and Sitrep Links

DRC

The Congo: Where dreams go to die. Ruled by King Leopold of Belgium as his personal fiefdom, its subjects were certainly enserfed if not outright enslaved. I'll leave descriptions of that period to the informative book, King Leopold's Ghosts. Three days after achieving independence, DRC's first Prime Minister, Patrice Lumumba, was assassinated, with civil war breaking out immediately following.

Economics:

Richest of all nations in natural resources, poorest in human development. Congo is resource-rich, infrastructure-poor, and is the crossroads of Africa.

Politics:

Formerly known as Zaire, Congo was site to two world wars that white people usually don't know about. Its last 'stable' government was under the dictator Mobutu Sese Seko, who, while a strong-man of the worst order, held Zaire together as well as Assad holds Syria. It was during Mobutu's reign that Zaire experienced its first recorded Ebolavirus epidemic, which is described in more detail below.

Now, Congo is a shell of its development level under Mobutu, which is quite :smith:

all around. I'll let a goon in Kigale describe the situation, per a July post in D&D's Sub-Saharan African Thread:

surrender posted:

It hasn't spread to the Congo yet, so I'm safe for now! To be honest, the transportation infrastructure here is so poor that the disease wouldn't be able to spread over a large geographic area, and the population density (outside of Kinshasa) is significantly lower than in the currently-affected regions.

In Congo news, the US government is leaning on Kabila to abide by the term limits and step down in 2016. The local rumor mill says that Kabila doesn't want to run for a third term, but members of his party are pushing him to stay in power because they're reliant on his patronage. Of course, the country's problems go beyond its own borders, so electing a new president won't do much to change the current situation.

Major Ethnicities:

Luba, Mongo, Bakongo

Ebola in DRC:

The world's first recorded* Ebolavirus outbreak occured from nosocomial transmission in DRC in 1976. To quote from Jacques Pepin's excellent book, The Origins of AIDS

*recorded, as in, like HIV, Ebolavirus has existed on this planet before homo sapien sapiens left the African continent. Its almost impossible that Ebolavirus outbreaks have never occured in humans before 1976; the difference with history is merely in the scale and speed of possible transmission. Instead of an isolated village dying out without transmission, our mobility and lives in state-level, rather than tribal-level, societies have the potential to assist, as much as they have the potential to hinder, viral infection.

Back to quoting Pepin in The Origins of AIDS

Jacques Pepin, pp. 7-8 posted:

Archival Samples

Additional support for a central African origin of HIV-1 came from testing of archival samples of blood. In the mid- and late 1980s, to understand the dynamics of HIV in the recent past, researchers tried to locate collections of sera obtained earlier for other purposes and kept frozen. Scientists tend to clean out their freezers once in a while to make room for new samples, or their samples are destroyed when they retire or move on to other positions. However, sometimes samples are forgotten for a long time or deliberately conserved. In Kinshasa, among mothers attending a well-baby clinic in the Lemba district, HIV-1 prevalence was 0.25% in 1970 (n=805) and 3.0% in 1980 (n=498). In the remote Catholic mission of Yambuku and surrounding communities of the Equateur province of Zaire, 0.8% of 659 samples collected in 1976 during an investigation of an epidemic of Ebola fever were found to be HIV-1 seropositive when tested ten years later. This proved that the virus had existed in this part of the world for some time, but not necessarily that it originated there; testing of archival samples of serum from American gay men who participated in epidemiological studies of hepatitis B also retrospectively documented cases of HIV-1 in the late 1970s, and even earlier for drug addicts.

The Yambuku epidemic of Ebola fever which had prompted the collection of these samples had largely been 'iatrogenic' (healthcare related). In this small rural hospital, syringes and needles were scarce and constantly re-used, fuelling transmission of the blood-borne Ebola virus between patients attending the hospital for other reasons (malaria, gonorrhoea, etc.). The nuns issued only five syringes to the nurses each morning, which were then used and re-used on the 300 patients attending each day. Three-fourths of the first 100 cases of Ebola in Yambuku were infected through injections received at the hospital. The epidemic came to an end after the hospital was closed following the death of several nurses and nuns, infected by their patients. Clearly, noble intentions for providing health care to the underpriviledged could have disasterous consequences when the risk of transmission of blood-borne viruses was not appreciated. This unfortunate situation was not new or specific to Yambuku hospital, and had already had infinitely more drastic consequences, although this was not known at the time, than these few hundred deaths from Ebola fever. It was decided to call this new disease after a nearby river rather than after the Yambuku mission, to avoid further stigmatisation after all it had gone through. The contrast between the two diseases is an excellent illustration of the genius of HIV. People infected with the Ebola virus quickly fall ill and die. This causes a spectacular epidemic, which triggers a massive (and always successful) reaction to control it. People infected with HIV, on the other hand, can live and quietly pass on the virus for ten years or more, and it will take even longer before physicians can recognize the emergence of this new disease, because symptomatic cases are not clustered within a short period of time.

Yes, well, symptonatic cases which emerge from clustered areas in a short period of time appears to have caused the unsuccessful reaction (thus far) to control the West African Ebolavirus Zaire-type Pandemic. Seriously, give Pepin's book a read if you're interested in public health at all.

NIGERIA
Sitreps kept daily, expect a 2-14 day CYA delay between their publication. Can be found at: http://reliefweb.int/organization/govt-nigeria

Nigeria, if GDP were used as the absolute measure of development, Nigeria would be the most developed nation on the African continent. Its not.

Random factoid: Slavery was officially banned in all of Nigeria in 1936.

Population as of May 2014:
174,000,000

Economics:

CIA World Factbook posted:

Despite its strong fundamentals, oil-rich Nigeria has been hobbled by inadequate power supply, lack of infrastructure, delays in the passage of legislative reforms, an inefficient property registration system, restrictive trade policies, an inconsistent regulatory environment, a slow and ineffective judicial system, unreliable dispute resolution mechanisms, insecurity, and pervasive corruption. Economic diversification and strong growth have not translated into a significant decline in poverty levels - over 62% of Nigeria's 170 million people live in extreme poverty.

With a 2013 GDP estimated at a rebased value of US$ 500billion, Nigeria is the economic heavyweight of the African continent. Nigeria is the classic developing state stuck in the oil trap: while resource-rich, Nigeria is human-capital poor.

Politics:
Originally formed from the merger of North and South Nigeria on 1 January 1914 due to growing Anglo-German tension, southern Nigeria and northern Nigeria are completely different worlds divided along religious, cultural, and linguistical demarcations. Following independence from Britain in 1960, Nigeria operated a parliamentary administration with Queen Elizabeth II as head of state. Due to growing internal tensions, the monarchy was abolished in 1963 and Nigeria became truly independent and self-governed by local elites. Nigeria is a member of the Commonwealth and considered within US' sphere of influence due to oil trade.

In 2011, the first 'relatively' free election in Nigeria was held since 1959/1960, with the People's Democratic Party's candidate, Goodluck Jonathan, a southern christian, elected President of Nigeria. Nigeria shares power between southern christians and northern muslims as the elected heads of PDP on a 2-term rotating basis. Elections are scheduled for 2015.

Important to note, population is seen as a weapon in these battles for political control over Nigeria. There is little, if any, trust between southerners and northerners to be able to put the interests of the nation ahead of the interests of religion. What this means is that opposition leaders are keen to hamper Jonathan's orders, and Jonathan keen to demand the impracticle. To put it optimistically, it's a rocky situation.

Ethnicities:
Three major tribal groups divide Nigeria along linguistical lines: Hausa, Igbo, and Yoruba. These groups fight over oil revenues and have, at various times, have rebelled against the Federal Government when under control by the wrong tribal group.

SIERRA LEONE

My knowledge is limited. Anyone willing to help out here, please PM or post it in this thread and I'll quote you for this section.

GUINEA

Home of HIV-2, the less lethal strain of HIV.

Other than that, my knowledge isn't that great. I'll go back and write up more info here if things flare up or when I locate where I've left some books on the issue.

LIBERIA

Sitreps kept daily, found through: http://www.mohsw.gov.lr

You know racists in America who say that African-Americans should go back to Africa? Well, Quakers tried that as a way to forestall a civil war over slavery. Founded in 1822 by the American Colonial Society, Liberia obtained independence from America in 1847 and implemented a governing model structured on the original American constitution. Original, being the operative word.

Americo-Liberians retained the American institution of slavery and ruled from 1847 to 1980 as the dominant-minority. In 1980, civil war broke out, which has continued in various stages of intensity until a peace agreement was reached in 2003 and semi-democratic elections held in 2005. For all intents, Americo-Liberians overwhelmingly compose Liberia's middle and upper classes.

Estimated Population as of May 2014:
4,500,000, of which 85% live a sustinance lifestyle (most severe poverty).

Economics:

I'll C/P from CIA World Factbook for this. Simple summary is immensely poor and recovering from recent civil war. Dependent upon tarrifs and international donations for funding, Liberia is comparable to DRC in development human development without DRC's low population density. Overcrowded, overpoor, and underfed, Liberia is truly the south of America's south and the most difficult environment to contain Ebolavirus within.

CIA posted:

Liberia is a low income country that relies heavily on foreign assistance. Civil war and government mismanagement destroyed much of Liberia's economy, especially the infrastructure in and around the capital, Monrovia. Many businesses fled the country, taking capital and expertise with them, but with the conclusion of fighting and the installation of a democratically elected government in 2006, several have returned. Liberia is richly endowed with water, mineral resources, forests, and a climate favorable to agriculture, and iron ore and rubber have driven growth in recent years. Liberia is also reviving its raw timber sector and is encouraging oil exploration. President JOHNSON SIRLEAF, a Harvard-educated banker and administrator, has taken steps to reduce corruption, build support from international donors, and encourage private investment. Rebuilding infrastructure and raising incomes will depend on financial and technical assistance from donor countries and foreign investment in key sectors, such as infrastructure and power generation. The country achieved high growth during 2010-13 due to favorable world prices for its commodities. In the future, growth will depend on global commodity prices, on sustained foreign aid, trade, investment, and remittances, on the development of infrastructure and institutions, but mostly on maintaining political stability and security.

Ebolavirus in Liberia:

Liberia has not experienced a recorded Ebolavirus pandemic outbreak before.

Latest (dated the 24th of August) sitrep from the Liberian Ministry of Health:

http://reliefweb.int/sites/reliefweb.int/files/resources/Liberia%20Ebola%20SitRep%20101%20%20August%2024%202014.pdf

To note: 1,386 cases, 754 fatalities. Cumulative admission/isolation stands at 129. Case fatality rate among confirmed and probable: 57.6%, a number which likely underestimates the actual CFR.

Contacts listed: 3,509. Under follow-up: 1,897. Contacted on 24th: 1,515. Completed 21 days: 16. Noted in sitreps, there's a backlog in receiving and processing case investigation forms from the field.

SENEGAL

My Imaginary GF fucked around with this message at 22:17 on Aug 29, 2014

# ? Aug 29, 2014 11:29

My Imaginary GF: Jul 17, 2005; by R. Guyovich

General Information on Ebola

Taxonomy

A less technical explanation, per: http://virologydownunder.blogspot.com/2014/08/behind-naming-of-ebola-virusesnot-yet.html?m=1

Do Drs in Australia Say G'day? posted:

The disease.

The disease caused by EBOV, SUDV, TAFV and BDBV is called Ebola virus disease (EVD). Frankly, that is a tough one to explain after all of the above. It reads as though we are talking about just 1 virus causing disease (EBOV). But not so. Viruses from 4 species cause EVD - EBOV, SUDV, TAFV and BDBV. Diseases are named by World Health Organization's International Classification of Diseases (ICD) site, (4) and the name of this disease goes back many years and has not been updated yet. The disease has been called Ebola haemorrhagic fever, but is not now. And to continue from the taxonomy above, EVD is caused by a virus that can be ascribed to a species. In West Africa right now, EVD is due to infection by an Ebola virus variant classified in the species Zaire ebolavirus.

Really, check out the link. Its a must-read if you want to understand the precise terms used by official institutions and their exact meaning.

Discovery and Previous Outbreaks
Ebola first reached epidemic status due to iatrogenic factors discussed above. It is likely that Ebola has existed for longer than human civilization.

CDC's dedicated Ebolavirus page, pertinent snippits from which are quoted and summarized below:

Transmission

CDC posted:

Researchers have hypothesized that the first patient becomes infected through contact with an infected animal.

When an infection does occur in humans, the virus can be spread in several ways to others. The virus is spread through direct contact (through broken skin or mucous membranes) with:

●a sick person's blood or body fluids (urine, saliva, feces, vomit, and semen)

●objects (such as needles) that have been contaminated with infected body fluids

●infected animals.

Risk Flowchart (via @aetology)

Diagnostic Testing for Ebola Performed at CDC

CDC posted:

Several diagnostic tests are available for detection of EVD. Acute infections will be confirmed using a real-time RT-PCR assay (CDC test directory code CDC -10309 Ebola Identification) in a CLIA-accredited laboratory. Virus isolation may also be attempted. Serologic testing for IgM and IgG antibodies will be completed for certain specimens and to monitor the immune response in confirmed EVD patients (#CDC-10310 Ebola Serology).

Lassa fever is also endemic in certain areas of West Africa and may show symptoms similar to early EVD. Diagnostic tests available at CDC include but are not limited to RT-PCR, antigen detection, and IgM serology all of which may be utilized to rule out Lassa fever in EVD-negative patients.

Cause of Fatality:

IAMNOTADOCTOR posted:

The spontaneous bleeding that a lot of people associate with Ebola only occurs in 30-40% of patients and is usually mild.

Ebola virus disease has a biphasic character, starting with symptoms such as fever, extreme weakness, abdominal pain, anorexia, diarrhea, nausea, headache, generalized joint pain, mucosal redness of the oral cavity, trouble swallowing and conjunctivitis that last less then a week. Patients then often experience a small remission of symptoms for 1-2 days. After which in the second phase symptoms can resume and new symptoms such as spontaneous bleeding, neuropsychiatric abnormalities and kidney failure can also occur. Some authors believe that survivors are predominantly those that do not progress to the second phase and show improvement after the second week.

Dying to Ebola virus disease is presumed to be very similar to dying to septic shock: the extreme immunologic response of the patient to the Ebola virus infection leads to a sharp drop in blood pressure, leaky blood vessels and subsequent multi organ failure. It is the response of the body to Ebola and not the virus itself that does the most damage. In the final stages of the disease patients are usually comatose as a result of inadequate circulation of blood to the brain.

Treatment:

No known treatment for Ebolavirus infection in humans has been proven effective. There is no known and effective treatment for Ebola at this time, apart from safe and sanitary palliative care.

My Imaginary GF fucked around with this message at 16:24 on Aug 29, 2014

# ? Aug 29, 2014 11:29

My Imaginary GF: Jul 17, 2005; by R. Guyovich

ADDITIONAL DISCUSSIONS

What can I do to help?
Please consider making a donation to a front-line organization battling this outbreak, such as Medicine Sans Frontiers (Doctors Without Borders):

http://www.doctorswithoutborders.org/our-work/medical-issues/ebola

A quick donation link is set up at the top of the page.

Traditional Medicine

(Will update when several books on order arrive; suggestions welcome)

Cultural Practices in West Africa: Communalism vs. Individualism, or, what are the cultural factors which initially helped fuel this outbreak?

Gonna shamelessly quote myself,

My Imaginary GF posted:

I'm glad you ask! Several factors:

1. Lack of trust in institutions
The slum residents have heard many orders from the government in the past. The government's corruption is well known. They suspect that either Ebola is not real, or Ebola is real and can be treated if you are rich. To say the second out loud has proven a route to rapid disappearance, so it is safer to say the former. Therefore, it is a plot by the elite to scam the west out of more aid money because the elite have wasted so much of the people's wealth that they are perpetually on the verge of default.

2. Patriamonialism
In the traditional cultures of Africa, there are common common sayings: mtu ni watu, or, a person is plural persons. The role of state development is to surpress the natural instinct for patriamonialism; for, mtoto wa nyoka ni nyoka, or, the son of a snake is a snake. Now, these are Swahili proverbs that I'm familiar with, and are held in areas of West Africa as much as in East. How do these apply to the Ebola outbreak? To have Ebola is a stigma against your kin; if your son has Ebola, it is your fault. If your wife has Ebola, it is the husband's fault. Therefore, it is more rewarding to have a fatalistic view than it is to admit weakness; it is better to die with your family than live forever as a social outcast.

3. Why us, why here?
While the isolation centre grew as an organic community project, it was viewed by residents with distrust: the cities get all the good hospitals, the cities get new roads, the cities get running water. There is no love lost between the slums and the urban elites, and both groups view the other with entrenched animosity. The elites are elite because they are blessed by the gods (and immoral crooks) while the slums are lived in by those unfavored by divine providence (and are simple, honest folk). Let us recall that, before this riot, three scared patients escaped isolation at the center and returned to their family. How could a family not be fearful and question their return? Far better to tell a selective truth of what they saw at the center: people from all walks of life, entering on their own power and leaving in impromptu body bags. So the family has a choice, believe the common wisdom and tell their neighbors that it is the institution bringing the sick from the city out here to infect us and die, or banish their family member and make an admission that is often worse than death, for loss of community is everlasting while the relief of death can only occur to each individual once.

E:

To not steal is to admit to the community that your family is weak and cursed.

IF YOU ARE IN WEST AFRICA AND HAVE SYMPTOMS OF EBOLA, WOULD LIKE MORE INFORMATION, OR ARE IN A POSITION TO SHARE THIS INFORMATION BEFORE LEAVING
IF, and only IF, you are in West Africa, there are several Ebola emergency hotlines set up by country. Either give them a call now, or, if you are an expatriate, call your embassy immediately.

SIERRA LEONE: 117

LIBERIA: 4455 or 1333

GUINEA: 115

NIGERIA (Lagos state): 0800326524357

FAQ

Is Ebolavirus airborne? What does aerosolized mean?

Let me link to this excellent blog post: http://virologydownunder.blogspot.com.au/2014/08/ebola-virus-may-be-spread-by-droplets.html?m=1

I cannot recommend a better article on airborne transmission possibilities which includes citations and retains a comprehensible format, and quote from the article below:

Ebola virus may be spread by droplets, but not by an airborne route: what that means posted:

I admit to being very uneasy saying that there is no risk at all of an airborne route of ebolavirus infection. Clearly it can be forced to happen, but we have no evidence that it has ever happened in humans in an outbreak. But let's put that into context. An absence of evidence is not evidence of absence. Outbreaks of ebolaviruses are not particularly conducive to large careful research projects measuring infectious droplet nuclei around critically ill people, especially when the occur in exotic locations in someone else's back yard.

So have I deserted by position from yesterday's post stating no airborne role for ebolavirus transmission between humans? No, not at all. What we know is that the overwhelming majority of human EVD cases acquire their infection during the time they are in direct contact with the fluids of a very ill EVD case; be that through physical contact or wet droplet spray impact. Beyond that fact, it may just be a discussion based on academic musings and hand-waving. But it is a discussion we should be having a little more I feel. A back-and-forth rather than messages with guarantees and statements dealing in black and white absolutes. I'm not sure the public believe in or feel safer with such absolutes today. We're all a bit too cynical for that.

If infection can happen between primates via the air, it is a very, very inefficient process as a study of 78 people from 27 households with EVD cases during the 1995 Kikwit revealed.(10) Those 78 household members had no physical contact with the cases, and they did not get sick. Others who had physical contact, got EVD.

In a recent study by the authors of the 2012 pig/macaque study we started this post with, infected NHPs did not pass EBOV to uninfected NHPs only 30cm away. Not only was there no disease but no antibodies were detectable in the uninfected NHPs 4-weeks later. There had been no infection at all.

While at some point we'll need to be more sure of all this for humans than we are now, we can say that pigs aren't primates and airborne route has not been shown to be a risk for human acquisition of an EBOV.

If you recover from Ebola, can you catch it again?

Ebola Roulette posted:

You're immune after recovering from Ebola, but only to that particular strain.

http://www.nejm.org/doi/full/10.1056/NEJMc1300266

According to that article, a followup study with patients who recovered from Ebola showed they were still immune even after ten years. However, if you recover from the Zaire strain for example, you can still get any of the other four strains.

Lots of people now have antibodies to Ebola. Can these be used for a vaccine?

WoodrowSkillson posted:

In general a vaccine works by fooling your body into thinking you already have gotten the disease, and tricking it into producing antibodies with the ability to fight the disease. Having victims of the virus being monitored at one of the worlds best health care facilities may help speed up a vaccine or treatments, but you cannot just exchange antibodies to fight a disease.

My Imaginary GF fucked around with this message at 22:18 on Aug 29, 2014

# ? Aug 29, 2014 11:30

My Imaginary GF: Jul 17, 2005; by R. Guyovich

SO WHATS THE PLAN?

From: WorldHealthOrganizationNews@who.int
To: undisclosed-recipients@null, null@null
Subject: WHO statement: WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa
Date: Aug 28, 2014 6:01 AM

WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa

Statement WHO/07
28 August 2014

GENEVA ¦ 28 August 2014 - The World Health Organization is today issuing a "roadmap" to guide and coordinate the international response to the outbreak of Ebola virus disease in West Africa.

The aim is to stop ongoing Ebola transmission worldwide within 6–9 months, while rapidly managing the consequences of any further international spread. It also recognizes the need to address, in parallel, the outbreak’s broader socioeconomic impact.

It responds to the urgent need to dramatically scale up the international response. Nearly 40% of the total number of reported cases have occurred within the past three weeks.

The roadmap was informed by comments received from a large number of partners, including health officials in the affected countries, the African Union, development banks, other UN agencies, Médecins Sans Frontières (MSF), and countries providing direct financial support.

It will serve as a framework for updating detailed operational plans. Priority is being given to needs for treatment and management centres, social mobilization, and safe burials. These plans will be based on site-specific data that are being set out in regular situation reports, which will begin this week.

The situation reports map the hotspots and hot zones, present epidemiological data showing how the outbreak is evolving over time, and communicate what is known about the location of treatment facilities and laboratories, together with data needed to support other elements of the roadmap.

The roadmap covers the health dimensions of the international response. These dimensions include key potential bottlenecks requiring international coordination, such as the supply of personal protective equipment, disinfectants, and body bag.

The WHO roadmap will be complemented by the development of a separate UN-wide operational platform that brings in the skills and capacities of other agencies, including assets in the areas of logistics and transportation. The UN-wide platform aims to facilitate the delivery of essential services, such as food and other provisions, water supply and sanitation, and primary health care.

Resource flows to implement the roadmap will be tracked separately, with support from the World Bank.

For more information please contact:

Fadéla Chaib
Communications Officer, World Health Organization
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail: chaibf@who.int

Tarik Jasarevic
Communications Officer, World Health Organization
Telephone: +41 22 791 50 99
Mobile: +41 79 367 62 14
E-mail: jasarevict@who.int

----------------------------------------

GOAL

To stop Ebola transmission in affected countries within 6-9 months and prevent international spread.

CONTEXT

The 2014 Ebola Virus Disease (EVD, or “Ebola”) outbreak continues to evolve in alarming ways, with the severely affected countries, Guinea, Liberia, and Sierra Leone, struggling to control the escalating outbreak against a backdrop of severely compromised health systems, significant deficits in capacity, and rampant fear.

To accelerate actions on EVD in West Africa, a Ministerial meeting was convened in July in Accra, Ghana, and an operations coordination centre established in Conakry, Guinea. The escalating scale, duration and mortality of the outbreak led the Governments of Guinea, Liberia, and Sierra Leone and WHO to launch an initial Ebola Virus Disease Outbreak Response Plan on 31 July 2014, which outlined the main pillars for action based on the situation at that time and an initial estimate of resource requirements. Since then the outbreak has been further complicated by spread to Lagos, Nigeria.

In August 2014, an Emergency Committee was convened by the Director-General of WHO under the International Health Regulations (2005) [IHR 2005], which informed the Director-General’s decision on 8 August 2014 to declare the Ebola outbreak a Public Health Emergency of International Concern and issue several Temporary Recommendations to reduce the risk of international spread.

As of 27 August 2014, the cumulative number of Ebola cases in the affected countries stands at more than 3000, with over 1400 deaths, making this the largest Ebola outbreak ever recorded, despite significant gaps in reporting in some intense transmission areas. An unprecedented number of health care workers have also been infected and died due to this outbreak.

National authorities in the affected countries have been working with WHO and partners to scale-up control measures. However, the EVD outbreak remains grave and transmission is still increasing in a substantial number of localities, aggravating fragile social, political and economic conditions in the sub-region and posing increasingly serious global health security challenges and risks.

The Ebola response activities to date have generated significant knowledge on the effectiveness and limitations of current approaches, highlighting key areas for course corrections. Clearly, a massively scaled and coordinated international response is needed to support affected and at-risk countries in intensifying response activities and strengthening national capacities. Response activities must be adapted in areas of very intense transmission and particular attention must be given to stopping transmission in capital cities and major ports, thereby facilitating the larger response and relief effort.
This updated and more comprehensive roadmap builds on current, country-specific realities to guide response efforts and align implementation activities across different sectors of government and international partners.

PURPOSE OF DOCUMENT

To assist governments and partners in the revision and resourcing of country-specific operational plans for Ebola response, and the coordination of international support for their full implementation.

OBJECTIVES

1. To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission

2. To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission

3. To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with an intense transmission area and those with international transportation hubs

MAJOR ASSUMPTIONS

This Roadmap builds on nearly 40 years of experience gained in EVD control, and is rooted in the fundamental strategies that have been proven effective in the context of previous outbreaks. However, it incorporates new experience gained, particularly over the past 3 months, in urban and widespread transmission settings. This experience is unique in the history of EVD and clearly indicates that in such areas with very intense transmission, combined with fragile and very weak health systems, the standard Ebola strategies must be complemented by new approaches. These approaches must allow for the rapid scaling of control activities when the case load outstrips currently available resources, and include a fundamental role for communities and their leaders in strategy implementation.

This Roadmap assumes that in many areas of intense transmission the actual number of cases may be 2-4 fold higher than that currently reported. It acknowledges that the aggregate case load of EVD could exceed 20,000 over the course of this emergency. The Roadmap assumes that a rapid escalation of the complementary strategies in intense transmission, resource-constrained areas will allow the comprehensive application of more standard containment strategies within 3 months. This plan recognizes that a number of currently unaffected countries could be exposed to EVD, but assumes that the emergency application of the standard control strategies will stop any new transmission within 8 weeks of the index case.

Fundamental to the Roadmap is the strengthening of laboratory, human resource, and response capacities, all of which are on the critical pathway for short- and long-term EVD control, as well as strengthening of the public health infrastructure against future threats. Some areas require particularly urgent action, such as infection control training.

It is expected that solutions to the current limitations on air traffic to and from the worst affected countries will be addressed within 2 weeks, and that by the end of September, a comprehensive, UN-led plan will be launched to complement the Ebola Response Roadmap by providing a common operational platform for enhancing response activities and for addressing the broader consequences of the outbreak. The UN-led plan is expected to underpin support for the increasingly acute problems associated with food security, protection, water, sanitation and hygiene, primary and secondary health care, and education, as well as the longer-term recovery effort that will be needed. That plan will also need to address the complex social consequences of this emergency, such as the increasing number of children who have been orphaned.

Course corrections to this Roadmap will be driven by the availability of human and financial resources for its implementation, the evolving epidemiology, and the broad context in which this outbreak is evolving.

PRIORITY ACTIVITIES

OBJECTIVE 1: To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission
Key Milestones: Reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months.

PRIORITY ACTIVITIES
 Apply full Ebola intervention package to the extent of available resources
• Case management: Ebola treatment centres with full infection prevention and control (IPC) activities; Ebola referral/isolation centres; referral processes for primary health care facilities
• Case diagnosis: by a WHO-recognized laboratory
• Surveillance: contact tracing and monitoring
• Burials: supervised burials with dedicated expert burial teams
• Social mobilization: full community engagement in contact tracing and risk mitigation
 Develop and apply complementary approaches for intense transmission areas
• Case management: community-based care supported by intensified IPC and appropriate PPE
• Case diagnosis: by epidemiologic link to case confirmed by WHO-recognized laboratory
• Surveillance: monitoring for new transmission chains (i.e. in infected areas)
• Burials: trained and PPE-equipped community burial teams
• Social mobilization: community engagement to implement complementary approaches
 Assess short-term extraordinary measures to limit national spread
• Implement specific programmes to ensure continuity of essential and supportive services in containment areas (e.g. primary health care, psychosocial support, food)
• If non-essential movement in and out of a containment area is stopped, ensure that essential movement (e.g. for response providers, essential services) continues unhindered
• To facilitate EVD response, defer mass gatherings until intensity of transmission is reduced

 Implement WHO’s Temporary Recommendations under IHR to prevent international spread
• Prohibit travel of all Ebola cases and contacts (except for medical evacuation)
• Implement and monitor exit screening at international airports, seaports and major land crossings
• Align practices of all international airline carriers with national travel policy
 Ensure essential services and lay the foundation for health sector recovery and strengthening of national core capacities for outbreak response
• Establish short-term capacity to address critical gaps in essential services (including health, food, education, protection, WASH [water, sanitation and hygiene]) through national service providers, NGOs, UN agencies, humanitarian organizations and other partners, based on needs assessment and gap analysis
• Develop a medium-term investment plan to strengthen health services that includes syndromic surveillance and laboratory networks to diagnose relevant pathogens
• Introduce a fast-track training programme for priority health worker gaps (including surveillance)

OBJECTIVE 2: To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission
Key Milestone: Stop all transmission within 8 weeks of index case.

PRIORITY ACTIVITIES
 Initiate emergency health procedures
• Immediately communicate the case and relevant information through the IHR contact point in the relevant WHO Regional Office
• Establish an emergency operations centre and activate relevant national disaster/emergency management mechanisms
• Coordinate operations and information across all partners, and the information, security, finance and other relevant sectors
• Initiate public crisis/risk communications plan
 Immediately activate Ebola response protocols and facilities, in keeping with WHO IPC guidance and universal precautions
• Immediately isolate all suspect and confirmed cases in designated Ebola treatment centre with full IPC
• Secure access to diagnostic capacity in a WHO-recognized laboratory
• Fully implement contact tracing and monitoring
• Ensure safe burials
• Implement public communications strategy to facilitate case identification, contact tracing and risk education

 Implement IHR Temporary Recommendations to prevent international spread
• Prohibit travel of all Ebola cases and contacts (except for medical evacuation)

OBJECTIVE 3: To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with areas of active transmission and those with international transportation hubs

Key Milestone: Full Ebola surveillance preparedness and response plan established in areas sharing a land border with an Ebola-infected country and at all major international transportation hubs within one month.

PRIORITY ACTIVITIES
 In all unaffected countries
• Provide advice to travellers to Ebola-affected areas with relevant information on risks, measures to minimize those risks, and steps to take following a potential exposure
• Identify an isolation unit where any suspect Ebola case could be properly investigated and managed
• Verify access to diagnostic capacity in a WHO-recognized laboratory
• Establish a strategy for identifying and monitoring the contacts of any suspect Ebola case
• Where appropriate, ensure that preparedness activities include contingency planning for health centres, schools and other vital infrastructure and services

 In all unaffected countries sharing a land border with an Ebola-infected area
• Establish active surveillance for clusters of unexplained deaths or febrile illness in areas bordering Ebola-affected countries and in major cities
• Provide the general public with accurate and relevant information on the neighbouring Ebola outbreak and measures to reduce the risk of exposure
• Establish a protocol for managing travellers who arrive at major land crossing points with unexplained febrile illness
• Identify and prepare an isolation unit where any suspect Ebola case can be properly investigated and managed
• Arrange a process for rapidly shipping diagnostic specimens to a WHO-recognized laboratory
• Engage international support team(s) if/as required to accelerate the development, implementation and assessment of preparedness measures

 In all unaffected countries with an international transportation hub
• Reinforce the capacity to manage travellers who arrive at international airports with unexplained febrile illness and potential exposure to Ebola
• Ensure a protocol, and identify an isolation unit, for the investigation and management of any suspect Ebola case

MAJOR ISSUES IN OPERATIONALIZING THE EBOLA RESPONSE ROADMAP
 Human Resources for Strategy Implementation: mobilizing and sustaining sufficient human resources to implement Ebola response interventions requires a comprehensive approach to their remuneration, training, equipment, physical security, and access to health care. Implementation of Ebola response activities to date have highlighted a number of specific considerations that must be addressed to operationalize fully the Ebola Roadmap:

• National staff considerations:
o Remuneration: Governments must rapidly establish a comprehensive package that defines the salary, hazard pay and – where appropriate – insurance/death benefit available to each category of worker required to implement the national strategy (e.g. physicians, nurses, physicians assistants, laboratory workers, cleaners, burial teams, surveillance officers). If necessary, UN (e.g. WHO) or partner agencies should assist Governments as needed in implementing this package.

o Training & Equipment: a specific accelerated training programme must be developed for each category of worker that is adaptable to the district/treatment centre level and places particular emphasis on IPC and proper use of PPE. Consideration must be given to particularly vulnerable groups such as cleaners and to the needs of women, who constitute a significant proportion of care providers. All Ebola workers must have access to sufficient quantities of the appropriate PPE.

• International staff considerations:
o Mobilization of International Expertise: WHO and partners will continue intensive outreach to all international medical NGOs, humanitarian organizations (i.e. the Red Cross Movement), Global Health Cluster partners, foreign medical teams and Global Outbreak & Alert (GOARN) Partners to mobilize sufficient medical expertise to support the staffing of all Ebola Treatment Centres in countries with intense and widespread transmission. For newly infected countries, Rapid Response Teams should be deployed within 72 hours, if requested, to provide expert support to the establishment and staffing of new case management facilities.

o Accelerated Training of Supplementary International Expertise: WHO will establish a specific programme to identify, train and deploy an extended roster of international health care workers to provide clinical care in Ebola treatment centres and Ebola referral/isolation centres. Particular emphasis will be given to implementing protocols for health care worker protection, based on WHO IPC Guidance and the WHO Carew Management Handbook.

• Medical Care of Health Workers: WHO will continue its work with the international community on a two-pronged approach to ensuring the best possible care of exposed health care workers through a combination of specialized medical referral centres in affected countries (for national and international health care workers) and medical evacuation where necessary and appropriate.

My Imaginary GF fucked around with this message at 12:13 on Aug 29, 2014

# ? Aug 29, 2014 11:31

Pohl: Jan 28, 2005; In the future, please post shit with the sole purpose of antagonizing the person running this site. Thank you.

I'm looking at the taxonomy chart and I had no idea Ebola had been around since the 70's. I can't remember when I heard about it the first time, but I know it changed the world. People really freaked the gently caress out.

Thanks for the detailed and informative posts. I'm looking forward to this discussion.

Edit: when Ebola first showed up on the national news, AIDS was a major topic. You can imagine the overlap in coverage... suddenly gay people caused Ebola. It was really amazing.

Pohl fucked around with this message at 11:49 on Aug 29, 2014

# ? Aug 29, 2014 11:43

Torka: Jan 5, 2008

Senegal confirms first case.

http://www.bbc.com/news/world-africa-28983554

# ? Aug 29, 2014 14:25

AtomikKrab: Jul 17, 2010; Keep on GOP rolling rolling rolling rolling.

Yeah Ebola was a big scary thing when I was a kid back in the early 90s, I'm really sad that a lot of people in africa are not taking the disease seriously because they distrust the government.

# ? Aug 29, 2014 14:37

GROVER CURES HOUSE: Aug 26, 2007; Go on...

AtomikKrab posted:

Yeah Ebola was a big scary thing when I was a kid back in the early 90s, I'm really sad that a lot of people in africa are not taking the disease seriously because they distrust the government.

It's also not a poverty/lack of education thing: my Soviet great-grandparents blew off polio :psypop:

, not just the vaccine against it, as a government conspiracy until one of my great-uncles got it. They both taught in a university, language and naval engineering respectively, both very prestigious fields at the time.

# ? Aug 29, 2014 14:45

Dreylad: Jun 19, 2001

And now that polio and smallpox basically don't exist people don't believe in vaccines anymore. It's all hosed up.

# ? Aug 29, 2014 15:08

IAMNOTADOCTOR: Sep 26, 2013

I think that in the general public there are a lot of misconceptions on the symptoms of Ebola virus disease.

Something to consider about Ebola virus disease: fatality's are not a result of blood loss. The spontaneous bleeding that a lot of people associate with Ebola only occurs in 30-40% of patients and is usually mild.

Ebola virus disease has a biphasic character, starting with symptoms such as fever, extreme weakness, abdominal pain, anorexia, diarrhea, nausea, headache, generalized joint pain, mucosal redness of the oral cavity, trouble swallowing and conjunctivitis that last less then a week. Patients then often experience a small remission of symptoms for 1-2 days. After which in the second phase symptoms can resume and new symptoms such as spontaneous bleeding, neuropsychiatric abnormalities and kidney failure can also occur. Some authors believe that survivors are predominantly those that do not progress to the second phase and show improvement after the second week.

Dying to Ebola virus disease is presumed to be very similar to dying to septic shock: the extreme immunologic response of the patient to the Ebola virus infection leads to a sharp drop in blood pressure, leaky blood vessels and subsequent multi organ failure. It is the response of the body to Ebola and not the virus itself that does the most damage. In the final stages of the disease patients are usually comatose as a result of inadequate circulation of blood to the brain.

# ? Aug 29, 2014 16:00

CSPAN Caller: Oct 16, 2012

I've noticed that people are asking about the R0, the basic reproduction number, for Ebola. Is it possible to explain it in simple terms?

# ? Aug 29, 2014 16:20

My Imaginary GF: Jul 17, 2005; by R. Guyovich

CSPAN Caller posted:

I've noticed that people are asking about the R0, the basic reproduction number, for Ebola. Is it possible to explain it in simple terms?

Sure. R0's a simplified number for the most likely number of individuals a carrier will pass the virus along to during the infectious stage. Low-R0 means easier to control through best practices infection control methods. Any R0 at or above 1 means that, absent intervention, infection transmission will not be checked until the potential host population is exhausted; any R0 below 1 means that, absent intervention, it is statistically likely that an infection will burn itself out in a host population. Again, real simplified number used for basic modeling. R0's got little bearing in the current West African outbreaks, and will become increasingly less relevant the more the infection mutates. That's my understanding.

If anyone wants to help, I'm thinking of adding a Definition of Terms to the FAQ section. I'll go find some of my MPH texts and grab some of the terms I see frequently used in official releases.

# ? Aug 29, 2014 16:32

SkySteak: Sep 9, 2010

Everything seems to be pointing toward fast mutation and a large spread rate. Is this likely to doom the entire world or end up as another large demon haunting Africa? The latter itself is horrifying, let alone it getting worse in other places?

# ? Aug 29, 2014 18:34

Pohl: Jan 28, 2005; In the future, please post shit with the sole purpose of antagonizing the person running this site. Thank you.

SkySteak posted:

Everything seems to be pointing toward fast mutation and a large spread rate. Is this likely to doom the entire world or end up as another large demon haunting Africa? The latter itself is horrifying, let alone it getting worse in other places?

I think this outbreak seems unprecedented because we have been told for decades that it couldn't happen. The fact that it continues to grow, and Dr.'s are dying is not helping people to feel safe. There is no reason to freak out, but I am beginning to wonder what the hell is going on.

# ? Aug 29, 2014 19:04

Fangz: Jul 5, 2007; Oh I see! This must be the Bad Opinion Zone!

SkySteak posted:

Everything seems to be pointing toward fast mutation and a large spread rate. Is this likely to doom the entire world or end up as another large demon haunting Africa? The latter itself is horrifying, let alone it getting worse in other places?

No, Ebola mutates and spreads slowly. If this was a flu variant everyone would be dead by now.

The severity of this outbreak is mainly a matter of an incompetent and resource deficient response.

Edit: put it this way, China beat SARS by shutting down theaters, discos, and other entertainment venues, shops, restaurants, markets, bars, universities, schools, and many other businesses.

The countries affected by this outbreak are, in comparison, simply not taking things seriously.

Fangz fucked around with this message at 20:21 on Aug 29, 2014

# ? Aug 29, 2014 20:06

IAMNOTADOCTOR: Sep 26, 2013

SkySteak posted:

Everything seems to be pointing toward fast mutation and a large spread rate. Is this likely to doom the entire world or end up as another large demon haunting Africa? The latter itself is horrifying, let alone it getting worse in other places?

Ebola is not a fast mutating virus at all, compared to influenza or even HIV the mutation rate is reported to be 100x lower. http://www.ncbi.nlm.nih.gov/pubmed/...0&sType=toolbar

Even if the virus starts mutating very rapidly the effects are going to be less then minimal as there are currently no effective targeted treatments that could be nullified. One of the fears of the recently detected mutations in the viral DNA was that is had changed in such a way as that it would no longer be recognized by ZMapp ( the experimental treatment used on some doctors) but this has not been the case.

So far the consensus still is that it is going to take around 6 to 9 months for this outbreak to be dealt with and that new outbreaks in other countries can be contained within 8 weeks.

edit; im slow

# ? Aug 29, 2014 20:25

Pohl: Jan 28, 2005; In the future, please post shit with the sole purpose of antagonizing the person running this site. Thank you.

Fangz posted:

No, Ebola mutates and spreads slowly. If this was a flu variant everyone would be dead by now.

The severity of this outbreak is mainly a matter of an incompetent and resource deficient response.

Edit: put it this way, China beat SARS by shutting down theaters, discos, and other entertainment venues, shops, restaurants, markets, bars, universities, schools, and many other businesses.

The countries affected by this outbreak are, in comparison, simply not taking things seriously.

I don't know if you can say they aren't taking it seriously. There would be no point in shutting down anything, because it wouldn't make a difference. On the other hand, I think I've read at least 2 news stories over the past few weeks where armed civilians have attacked the camps that were erected to house Ebola patients. Something like 20 people fled an Ebola quarantine clinic in Libera.

# ? Aug 29, 2014 20:33

Fangz: Jul 5, 2007; Oh I see! This must be the Bad Opinion Zone!

Pohl posted:

I don't know if you can say they aren't taking it seriously. There would be no point in shutting down anything, because it wouldn't make a difference. On the other hand, I think I've read at least 2 news stories over the past few weeks where armed civilians have attacked the camps that were erected to house Ebola patients. Something like 20 people fled an Ebola quarantine clinic in Libera.

All of the places I named are really good places to spread disease. Shutting stuff would make a huge difference. The biggest thing I have heard relating to disease spread prevention is putting soap outside of restaurants so that people could wash their hands before eating. That is how bad the containment effort is.

# ? Aug 29, 2014 20:41

Xandu: Feb 19, 2006; It's hard to be humble when you're as great as I am.

http://www.washingtonpost.com/blogs/monkey-cage/wp/2014/08/29/fighting-ebola-liberias-invisible-rebel/ posted:

In late July, the government announced a new travel policy at Roberts International Airport: required fever testing for all passengers. There was just one issue, as a traveler points out in an e-mail, �The thermometer read 32 degrees Celsius (87 degrees Fahrenheit) for every person�When the issue was pointed out by a traveling public health worker, [the screener] responded by stating that the thermometer was supposed to read lower than normal.� When I boarded a flight three days later, it was no surprise that my temperature read the same: 87 degrees. The government may appear to outsiders to be implementing effective preventive measures to hold the virus in check, but their containment strategies are dubious and the impacts are potentially harmful.

Helpful airport screening...

# ? Aug 29, 2014 20:41

Pohl: Jan 28, 2005; In the future, please post shit with the sole purpose of antagonizing the person running this site. Thank you.

Xandu posted:

Helpful airport screening... 87 degrees.

Haha, why are they letting dead people board planes?
Seriously though, that is really bad.

Fangz posted:

All of the places I named are really good places to spread disease. Shutting stuff would make a huge difference. The biggest thing I have heard relating to disease spread prevention is putting soap outside of restaurants so that people could wash their hands before eating. That is how bad the containment effort is.

Actually, you are right. I know Ebola is difficult to spread, so it seems ridiculous to me to impose a quarantine. I guess we are well past the point where anything and everything needs to be done however. I guess I have to agree with you, even if I don't like the idea.

# ? Aug 29, 2014 20:50

Xandu: Feb 19, 2006; It's hard to be humble when you're as great as I am.

Fangz posted:

All of the places I named are really good places to spread disease. Shutting stuff would make a huge difference.

Do we know that's how ebola is spreading, as opposed to primarily caregivers/hospitals?

# ? Aug 29, 2014 20:54

My Imaginary GF: Jul 17, 2005; by R. Guyovich

Xandu posted:

Do we know that's how ebola is spreading, as opposed to primarily caregivers/hospitals?

Frankly, there aren't enough resources to be sure. In previous outbreaks, nosocomial transmission served to amplify the initial infections resulting from the zoonotic-to-human index case. Once Ebolavirus makes the jump to humans, you can expect an average of 1.5 to 1.8 infections per individuals before death or recovery. However, if one of these isolated cases, whether they be the index or 12th-generation slow-burning infection, comes into contact with an individual who comes into frequent contact with bodily fluids and mucus membranes without biohazard protection, you can then expect a heightened transmission chain to occur.

For instance, the traditional healer who claimed to be able to cure Ebolavirus, caught it from a cross-border migrant, and proceeded to infect an addition 297~ or so cases. Now, calculate the average daily caseload of a traditional healer or healthcare worker in West Africa, the likelyhood that one of those cases indexed to that healer reaches a traditional healer or healthcare worker, and the individual's viral load when they go for treatment. Add to that the cultural practices at funerals, where to not touch the body is to reject your community (if you're Catholic, does everyone drink communion wine from the same cup? Did that ever occur?), and you have the potential to generate between one and 1,200 new cases during a period of mild infectious symptoms, at the least.

This has happened before, will happen again, and will continue to occur so long as humans live within urban polities. Its one risk we all take in life. What works in the west to stop the disease are several factors:

1. Cultural history with, and universal public education on, infection transmission

2. Institutions and societies which have evolved to adapt to previous outbreaks; hence my earlier comments about individualism vs. communal identity

3. Step-by-step procedure adherance at all levels due to complex insurance motives

Often, 3. can be the most critical of all. Lets say you're an air traffic controller at a private airport in Lagos. You make an above-average wage compared to others you know, when your superiors haven't embezzeled too much fron that week's salary. A senior diplomat demands permission to take off; you refuse until he turns in the proper paperwork. He threatens you, and you are well aware he could follow through and have you disappeared; assume you've been paid that month and firmly fear Goodluck's rage against you more than this diplomat. So the diplomat resorts to his third tactic: 'Now I know you're just doing your job, I'm glad for it. I'll tell you the truth why I want out right now: my colleague the Minister of Health called to tell me an Ebolavirus case arrived at the airport. I haven't been in contact with him; I just want out before everyone else wants out. If you let me fly right now, I'll give you my (whatever accessory an individual is currently wearing that is worth tens of thousands USD, usually a watch) Rolex. I'll be staying at [Hotel Name] in [District] of [City]. If you take my watch, sell it, you can afford to get your family out too. Or I can call and have you disappeared and make the same offer to whoever comes. You know your boss has been stealing your wages; don't you deserve at least one moment of good fortune in your life? You take the watch; the diplomat is cleared for takeoff and disappears in his chartered aircraft.'

I'm not saying that's an actual exact case to be taken as how things go down every time. I am saying that situation isn't unusual in most of the world. And its that situation which presents a grave danger when the diplomat, or the controller, enters the 3-5 infectious period when one can reassure themselves that its only nalaria, you've had malaria before, you aren't going to die, its only malaria, you just got your pills, you're starting to feel better, you sleep on it and with an asprin the malaria symptoms almost disappear...and then your body begins septic shock while you're carrying a high--and infectious--viral load.

And that's how a case of a two-year-old eating a lime on the ground in Guinea necessitates a multi-billion immediate response that would've been too late yesterday.

Edit:

I fail geography :smith:

My Imaginary GF fucked around with this message at 22:19 on Aug 29, 2014

# ? Aug 29, 2014 21:32

SelfOM: Jun 15, 2010

A new paper just came out from Pradis Sabeti's group (a leader in evolutionary biology) on the Ebola virus in Science. In the paper they sequence roughly 90 Ebola samples.

http://www.sciencemag.org/content/early/2014/08/27/science.1259657

Still going through the paper, but here are some interesting points from it:

Diverged from other Middle African lineages (outbreaks) to around 2004, suggests hypothesis that all outbreaks stem from a genetically diverse source population in its animal reservoir.
Sustained human-to-human transmission and no intermediate transmission from human and animals
Mutations in ebola happen much more quickly during outbreaks than between outbreaks (confirms previous results on this), and this is probably due to relaxed purifying selection. The cumulative number is about 50 mutations since this current outbreak. Important to stop the outbreak quickly before it is able to accumulate more mutations that may allow it to adapt to treatments.

This paper presents a comprehensive catalog of mutations that may have conferred this variant of Ebola its virulence.

edit: The paper is dedicated to 5 of the co-authors who died while completing their work in public health and research: http://news.sciencemag.org/health/2014/08/ebolas-heavy-toll-study-authors

SelfOM fucked around with this message at 21:48 on Aug 29, 2014

# ? Aug 29, 2014 21:41

Convergence: Apr 9, 2005

SkySteak posted:

Everything seems to be pointing toward fast mutation and a large spread rate. Is this likely to doom the entire world or end up as another large demon haunting Africa? The latter itself is horrifying, let alone it getting worse in other places?

It hasn't spread significantly in Lagos, which is more a model of a functional city than the rural areas currently being devastated. If it doesn't spread in Lagos despite multiple cases appearing there, there is very little risk of anything major happening in other large cities.

If it does start blowing up in Lagos, I think you'll see some much more hardcore quarantines come down on these countries.

# ? Aug 29, 2014 22:06

ComradeCosmobot: Dec 4, 2004; USPOL July

Convergence posted:

It hasn't spread significantly in Lagos, which is more a model of a functional city than the rural areas currently being devastated. If it doesn't spread in Lagos despite multiple cases appearing there, there is very little risk of anything major happening in other large cities.

If it does start blowing up in Lagos, I think you'll see some much more hardcore quarantines come down on these countries.

While it managed to not blow up IN Lagos, the problem is that people are fleeing rather than accepting quarantine/treatment. This happened early on when a nurse under quarantine for being under close contact with Patrick Sawyer and who later developed EVD escaped to Enugu.

More worryingly, as of just a few days ago, we learned that this happened a second time when a diplomat who met Sawyer fled and was treated surreptitiously in Port Harcourt, leading to the death of his doctor and putting untold numbers of the doctor's patients and hotel guests and staff at risk (only known additional case so far: his wife, but well over 200 are now being monitored), and it just broke that his sister escaped quarantine to flee to Abia State

This is particularly concerning as Port Harcourt is deep in Nigeria's oil-producing regions. Any sustained outbreak there could basically shut down most of Nigeria's two million barrels per day oil industry.

tldr: Nigeria is basically out of control at this point thanks to people who refuse to be quarantined.

# ? Aug 29, 2014 22:46

Fangz: Jul 5, 2007; Oh I see! This must be the Bad Opinion Zone!

Why the hell would you flee when you get infected? Are these people freaking nuts?

# ? Aug 29, 2014 23:12

Pohl: Jan 28, 2005; In the future, please post shit with the sole purpose of antagonizing the person running this site. Thank you.

Fangz posted:

Why the hell would you flee when you get infected? Are these people freaking nuts?

Well, everyone that goes to the hospital or a camp dies. Obviously, those places can not be trusted.

# ? Aug 29, 2014 23:22

Baloogan: Dec 5, 2004; Fun Shoe

Biological Weapons in the Former Soviet Union mentions use of hemorrhagic fevers as biological weapons.

# ? Aug 29, 2014 23:22

ComradeCosmobot: Dec 4, 2004; USPOL July

Fangz posted:

Why the hell would you flee when you get infected? Are these people freaking nuts?

If I might extrapolate slightly from what MyImaginaryGF has posted above, shame and ignominy is brought on you and your family if you are even suspected of having Ebola. Better to avoid the quarantine and run the risk of infecting your family and hundreds of others (because surely it is just malaria, like you and many of your family have dealt with for years) than to be quarantined and turn out to have not contracted anything.

# ? Aug 29, 2014 23:23

Caconym: Feb 12, 2013

ComradeCosmobot posted:

If I might extrapolate slightly from what MyImaginaryGF has posted above, shame and ignominy is brought on you and your family if you are even suspected of having Ebola. Better to avoid the quarantine and run the risk of infecting your family and hundreds of others (because surely it is just malaria, like you and many of your family have dealt with for years) than to be quarantined and turn out to have not contracted anything.

Also quarantine in a 'camp' or 'treatment centre' doesn't mean a single bed in an isolation ward, it frequently means being locked in a communal compound with others. Both suspected and confirmed. A quarantine ward in Liberia is basically one of the most dangerous places on earth if you're not actually infected. So no wonder the merely suspected cases run the gently caress away.

# ? Aug 29, 2014 23:42

My Imaginary GF: Jul 17, 2005; by R. Guyovich

In East Africa, the first question you ask when shaking hands with someone is, Habari gani?, or, How are you/Whats the news of [of your health]? Any answer that is negative is considered the height of incivility. You should answer Nzuri (well/good) Jema (Very good) and ask them back, na wewe je? And only after they answer, is it polite to cease shaking hands/brohugging/close contact. I'd imagine its similar in West Africa.

Basically, a cultural remnant from living under a tribal moot thats remained since de-colonization. It's rude to be sick, as you are sick for a reason; someone must hate you or curse you, and anyone with a curse isn't someone to do business with.

Try to imagine how this plays out when meeting individuals from a different tribe for the first time, or when an individual leaves their tribal home area. It makes more sense in that context and is absolutely understandable to me; however, the process of nation building and forging collective identity and trust in shared institutions is a long, unexciting, and fairly unrewarding to walk upon.

# ? Aug 29, 2014 23:42

My Imaginary GF: Jul 17, 2005; by R. Guyovich

SitRep #28 for Nigeria out now, from 27 August 2014.

http://reliefweb.int/report/nigeria/ebola-virus-disease-nigeria-daily-situation-report-sitrep-no-28-27th-august-2014

Looks like things may be going downhill in Port Harcourt. Watch for news coming from there over the next 1-2 weeks.

# ? Aug 30, 2014 00:32

Justin Godscock: Oct 12, 2004; Listen here, funnyman!

I've read that one reason for the scale of this Ebola outbreak is because, for the longest time, it was a disease primarily based in Central Africa with DR Congo and Uganda having the most share of outbreaks. Now, West Africa has an outbreak in nations that were ill-equipped to deal with something like Ebola and panic took over before the WHO could establish a controlled area.

# ? Aug 30, 2014 01:14

Ebola Roulette: Sep 13, 2010; No matter what you ~~win~~ ~~lose~~ ragepiss.

This outbreak is worse because Ebola is infecting people in cities, rather than small villages. In previous outbreaks, Ebola would hit a relatively secluded village or town, kill a lot of people, and burn itself out before it could spread. This outbreak is bad because it's not going to burn itself out. This probably has nothing to do with Western Africa being ill equipped, but a difference in culture and population density. Also, it's easy to quarantine a village out in the middle of no where, but not so much a city.

# ? Aug 30, 2014 01:23

CSPAN Caller: Oct 16, 2012

I don't doubt that the village versus urban setting is playing a huge role in the spread of Ebola.
However, West African countries are literally ill equipped.
A MSF doctor on NPR two weeks ago was talking about shortages of basic supplies like bleach, gloves, and masks.

The CDC's Ebola response guide even provides a protocol for re-using gloves. :shepface:

# ? Aug 30, 2014 01:57

My Imaginary GF: Jul 17, 2005; by R. Guyovich

Quick reminder on the scale of African geography:

In American terms, an epidemic with cases confirmed from the Galvaston to Portland, and a separate epidemic out in the boondocks of the Appallaccians where Federal rule to collapse and infrastructure left to crumble for 50 years. Oh, and a potential case could travel pretty far downriver and re-emerged anywhere along a 2,000 kilometer stretch by the time they've either died or become highly infectious. Thankfully, DRC outbreaks are easier to let die out, as their remoteness and the urgency of the overwhelming international response has been enough to contain outbreaks in DRC.

# ? Aug 30, 2014 02:27