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Nintendo Kid posted:In general, by giving the people chosen for the study the vaccine and exposing them to the disease causing agent. With emergency response units on alert at all times to treat people who end up getting the disease. No. Just no. Vaccinations have enough PR problems without rumours about a modern Unit 731. There is no IRB(mandatory ethical committee) in the world who would consent to such a trial and I cant think of a disease where this would be necessary. Vaccine trials usually follow the standard route of: Phase 1 trial: healthy volunteers get the vaccine, check for major side effects and the production of antibodies. ( Not yet completed for Ebola vaccines) Phase 2 trial: first signs of effectiveness. A couple hundred at risk patients get a control or vaccine. Takes 2-5 years. Check for effectiveness and side effects. For ebola this could done in the family of patients or people living a town or region where Ebola is currently active. Note that in this occasion all other precautions to prevent Ebola should also be used for both control and the vaccine group. Phase 3 trial: Similar to phase 2 but bigger. Here an example for haemorrhagic dengue virus ( http://www.ncbi.nlm.nih.gov/pubmed/25018116), very large scale trial, preferably thousand of people on both groups enabling the discovery of minor side effects. May be difficult to achieve for Ebola. Phase 4 trial: After the vaccine has been accepted and approved, post market follow-up of possible rare side effects. Informed consent remains a difficult issue in this population. IAMNOTADOCTOR fucked around with this message at 08:38 on Sep 1, 2014 |
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Sep 1, 2014 08:35
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My Imaginary GF posted:Now, Congo is a shell of its development level under Mobutu, which is quite Thanks for the shout-out, but I'm in Kisangani, capital of Orientale province and ~1000 km east of the current outbreak site (Boende). As for RDC news, this is probably the best source: http://radiookapi.net It's an ostensibly non-partisan radio station run by the United Nations throughout the country, and easily the best source for hype-free news.
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Sep 1, 2014 11:24
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all around. I'll let a goon in Kigale describe the situation, per a July post in D&D's Sub-Saharan African Thread:
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Health workers go on strike at a large hospital in Sierra Leone. That's not going to help to put it mildly. http://www.theweek.co.uk/world-news/ebola/57952/ebola-healthcare-workers-go-on-strike-over-safety-fears
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Sep 1, 2014 14:33
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IAMNOTADOCTOR posted:No. Just no. Vaccinations have enough PR problems without rumours about a modern Unit 731.
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Sep 1, 2014 16:58
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Nintendo Kid posted:It's interesting that you claim clinical trials are just like war crimes. Go home fishmech you are drunk
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Sep 1, 2014 17:02
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Nintendo Kid posted:It's interesting that you claim clinical trials are just like war crimes. It's interesting that you claim human vaccine trials for lethal diseases involve people saying "I volunteer as tribute"
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Sep 1, 2014 18:05
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Quarantine entire nations until the ebola spreaders are gone.
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Sep 1, 2014 18:07
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SedanChair posted:It's interesting that you claim human vaccine trials for lethal diseases involve people saying "I volunteer as tribute" That's not what I'm claiming. We got vaccines for a ton of diseases with way lower mortality rates as well as being much more treatable. Not everything's ebola.
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Sep 1, 2014 19:09
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Nintendo Kid posted:That's not what I'm claiming. We got vaccines for a ton of diseases with way lower mortality rates as well as being much more treatable. Not everything's ebola. I believe what you actually claimed was that the way we run drug trials is by fogging people in the face in order with 2 spray cans labeled "ANTI-DEATH" and "DEATH"
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Sep 1, 2014 19:14
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I guess I'm a little confused here. I'm not a scientist here, but I feel like I'm getting mixed messages. On one hand, you guys are saying we shouldn't be worrying about this if we don't live in Africa, while the statisticians are saying that "hundreds of thousands" of people could be infected. Granted, there's the possibility that all of those stay in Africa and it doesn't infest the rest of the world, but why are the WHO and the CDC freaking out as much as they are if we shouldn't be worrying about it? Why is it that health care workers are dying from it this time, when that didn't happen before? What is the likelihood that this actually mutates to become an airborne contagion?
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Sep 1, 2014 22:23
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Nintendo Kid posted:That's not what I'm claiming. We got vaccines for a ton of diseases with way lower mortality rates as well as being much more treatable. Not everything's ebola. Nintendo Kid posted:In general, by giving the people chosen for the study the vaccine and exposing them to the disease causing agent. With emergency response units on alert at all times to treat people who end up getting the disease. I am sorry re: your early onset Alzheimer's. I eagerly await a four page semantic argument about how the risk of death differs from other complications as to make your statement any less absurd.
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Sep 1, 2014 22:25
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Pillowpants posted:I'm not a scientist here, but I feel like I'm getting mixed messages. On one hand, you guys are saying we shouldn't be worrying about this if we don't live in Africa, while the statisticians are saying that "hundreds of thousands" of people could be infected. Granted, there's the possibility that all of those stay in Africa and it doesn't infest the rest of the world, but why are the WHO and the CDC freaking out as much as they are if we shouldn't be worrying about it? The odds of this spreading to places like the US in any meaningful form are very low, but still extant- it's not that it couldn't come here, but that most wealthier countries, like the US, have money, resources, and systems in place that are able to deal with an Ebola infection. The WHO and CDC are freaking out because both organizations are, as a part of their missions, concerned with the horrific humanitarian crisis in Africa, and because of that low, but still extant risk of broader contagion. Pillowpants posted:Why is it that health care workers are dying from it this time, when that didn't happen before? More infections, and a political/financial situation that makes it harder to maintain safeguards. Pillowpants posted:What is the likelihood that this actually mutates to become an airborne contagion? To the best of my extremely limited knowledge of viral evolutionary mechanics, extremely low.
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Sep 1, 2014 22:31
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Pillowpants posted:I guess I'm a little confused here. It did happen before. If you take a look at the DRC profile in the OP, you'll see how nosocomial transmission can be a large factor in fueling an Ebolavirus outbreak. You shouldn't be too worried of coming across Ebolavirus infection if you live in the West in a nation where civil servants are paid regularly and their careerss are worth more than any single bribe you could give them. While an outbreak in a western nation is more likely to occur than not the more individuals become infected in Africa, such an outbreak is extremely likely to be contained fully within 8 weeks. That's not to say nobody in the West could die from Ebolavirus; that is to say, at this point in time, unless you work as an airport screener or customs agent at an international terminal with frequent flights from West Africa, the odds of you acquiring Ebolavirus during 2014 is less than 0.0001%. The odds if you are a doctor in West Africa without adequate PPE? Significantly higher. E: Discendo Vox posted:To the best of my extremely limited knowledge of viral evolutionary mechanics, extremely low. Mostly this. While not impossible, the amount of evolutionary leaps required make it extremely unlikely. Viruses like Ebola tend to evolve more rapidly in human hosts; we let them reproduce more often, and unless you are exposed to a dose of radiation so large that it will mutate the virus more frequently than the virus reproduces, the reproduction number for the virus can be assumed the best-practice proxy for evolution rate. Mostly, viruses are likely to evolve drug resistance and either additional lethality (which burns the virus out quicker) or greater infectability through current means of transmission. Additional means of transmission, in my best understanding of the issue, are most likely to evolve when the virus makes the initial cross-species transmission (SIV[cpz] to HIV-1) or from viral recombinantions. Due to Ebolavirus' lethality, viral recombination is exceedingly unlikely; to be infected by multiple strains of Ebolavirus at the same time is, to the best of my understanding, an extremely lethal predicament. My Imaginary GF fucked around with this message at 23:40 on Sep 1, 2014 |
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Sep 1, 2014 22:33
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My Imaginary GF posted:
Quick pedantic and semantic side note, the term vector in medicine is used to describe an organism that helps spread a virus or other pathogen between the reservoir of the disease and potential hosts. For instance, ticks are the vector for the bacteria that causes Lyme disease and do so by spreading the bacteria from the reservoir (mice) to deer and humans.
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Sep 1, 2014 23:14
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GROVER CURES HOUSE posted:I am sorry re: your early onset Alzheimer's. I eagerly await a four page semantic argument about how the risk of death differs from other complications as to make your statement any less absurd. Interesting how you just makes things up, meme name.
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Sep 1, 2014 23:18
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IAMNOTADOCTOR posted:Quick pedantic and semantic side note, the term vector in medicine is used to describe an organism that helps spread a virus or other pathogen between the reservoir of the disease and potential hosts. For instance, ticks are the vector for the bacteria that causes Lyme disease and do so by spreading the bacteria from the reservoir (mice) to deer and humans. Its good, semantics are important. I'll go back and edit it; any suggestions on the proper term to use, and would you know what the Ebolavirus in its reservoir is called? Is it still Ebolavirus, or is it one of those SIV/HIV cases?
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Sep 1, 2014 23:38
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My Imaginary GF posted:Its good, semantics are important. I'll go back and edit it; any suggestions on the proper term to use, and would you know what the Ebolavirus in its reservoir is called? Is it still Ebolavirus, or is it one of those SIV/HIV cases? Ebolavirus is ebolavirus. It's so different that it has its own genus. It used to be from the genus filovirus and that's how many older textbooks will list it, but they bumped that up to the family of viruses so it includes Marburg, etc.
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Sep 2, 2014 00:00
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My Imaginary GF posted:It did happen before. If you take a look at the DRC profile in the OP, you'll see how nosocomial transmission can be a large factor in fueling an Ebolavirus outbreak.
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Sep 2, 2014 01:06
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Nessus posted:So basically it's kind of like plague, in that even a lovely-by-Western-standards medical system could easily contain it assuming basic standards are met, and they are just unfortunately not being met in West Africa? The SARS virus outbreak in China and the subsequent response would be what a competent healthcare system could muster.
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Sep 2, 2014 01:15
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Nessus posted:So basically it's kind of like plague, in that even a lovely-by-Western-standards medical system could easily contain it assuming basic standards are met, and they are just unfortunately not being met in West Africa? We know the factors which prevent Ebolavirus outbreaks. They are: 1. Adequate regulatory environment (Ban and enforcement on bushmeat consumption) 2. Cultural conditions which hinder spread (disposal of bodies in a non-infectious manner, adherence to government health recommendations, understanding of germ theory) 3. Either adequate infrastructure to handle cases, or infrastructure so grossly inadequate that cases cannot be spread more rapidly than an infectious clustering emerges (DRC as the latter) 4. Contact tracing, quarantine, and surveillance of case contacts Unfortunately, all four of those are made most difficult in the most developed regions of Africa, let alone the urban environments of West Africa. For instance, Nigeria: while funds are available, and educational outreach more successful than Liberia and Sierra Leone, there is a bit of gross incompetence--for a wide variety of reasons--in the political system. We are seeing that play out in the current Nigerian outbreak, where 4. is a very difficult concern due to widely competing interests and civil instability. I find it sufficient to say, Nigeria is on the verge of public civil war right now; there is already an private one occuring with various international funding streams being used to support competing interests. Ultimately, Ebolavirus outbreaks can be prevented from non-clustered spread with ease so long as a general population has trust within its medical institutions, and political will allows those institutions to pursue all necessary measures without undue and hindering interference. Those presently case-free nations where medicine is a corrupt and political institution, an outbreak could be devastating. Which nations those are, I'll leave GBS to judge. Tl;dr: Yes, an Ebolavirus epidemic in America among the general population is as likely as a bubonic plague epidemic.
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Sep 2, 2014 01:44
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Let's say I am a person who travels through international airport terminals frequently. Aside from not taking X and gyrating on every West African I see, what prevention measures if any are necessary? Obsessive hand washing or just lackadaisical handwashing?
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Sep 2, 2014 03:05
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My Imaginary GF posted:understanding of germ theory I wonder whether it's really necessary to make someone believe in the existence of microscopic creatures in order to convince them that a disease can be spread through bodily fluids/contact with the dead. Like surely you could get them to believe it can spread that way even if they think it's witchcraft or something Obviously that's no use for the people who think it's an authoritarian ploy and just doesn't exist at all though
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Sep 2, 2014 04:17
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Torka posted:I wonder whether it's really necessary to make someone believe in the existence of microscopic creatures in order to convince them that a disease can be spread through bodily fluids/contact with the dead. Like surely you could get them to believe it can spread that way even if they think it's witchcraft or something That course of action is considered unethical in most bioethics circles, although if such a violation of the norms of information in a public health intervention were actually seen as producing a benefit in this dire situation, I wouldn't be surprised if some folks started advocating for it.
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Sep 2, 2014 04:24
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Torka posted:I wonder whether it's really necessary to make someone believe in the existence of microscopic creatures in order to convince them that a disease can be spread through bodily fluids/contact with the dead. Like surely you could get them to believe it can spread that way even if they think it's witchcraft or something I meant 'understanding of germ theory' as a proxy for the social support infrastructure required to even be able to read about what a germ is. And yeah, in Uganda they've done outreach along traditional cultural lines, like a person infected with Ebolavirus has a bad spirit living in them that can spread through (all of Ebolavirus' transmission possibilities), therefore if you touch a corpse that died from this bad spirit you are likely to become infected by the bad spirit. However, politics. Lots of politics. Who's bad spirit is infecting the individual? I'm Christian, there are no such things as bad spirits. I'm a militant, anyone preaching the djinn is violating shariah. I'm an Evangelical doing development work, you can't tell my children that its a bad spirit and if you try I'll close the rural clinics and schools I've opened. I'm an Ebolavirus survivor, my community now thinks my entire family is cursed with bad spirits because we deserve it, ergo I am ostracized and become likely to turn towards a radicalized group in order to find acceptance and feel like my life has a purpose. Honest is the best policy, even when its not the most expeditious.
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Sep 2, 2014 04:27
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Yeah, this. Health communication interventions in this setting already tend to backfire in horrible and unpredictable ways- adding a layer of deception to it only makes it worse.
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Sep 2, 2014 04:32
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Understood, thanks guys 
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Sep 2, 2014 04:38
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And I'm wondering. I've read reports about how the majority of victims, both new cases and dead, are women, given that it's they who clean the bodies, take care of the dead, etc. How important do you think this fact is in the context of prevention? Would an outreach towards women be possibly more effective than a generic one geared towards the entirety of the population?
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Sep 2, 2014 06:46
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Saw this FAO Alert pop up: http://www.fao.org/news/story/en/item/242177/icode/ Recommend giving it a read, along with the document it links to. Talks about the food situation and the potential for mass famine in West Africa.
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Sep 2, 2014 09:27
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Randandal posted:Let's say I am a person who travels through international airport terminals frequently. Aside from not taking X and gyrating on every West African I see, what prevention measures if any are necessary? Obsessive hand washing or just lackadaisical handwashing? People who have Ebola are generally sick enough that they stay home or go to the hospital. If someone with symptomatic Ebola was at the airport you'd notice. But if someone with Ebola did show up as long as you avoid rolling in the sick guys puke or poo poo you should be ok. Everyone on the plane with Patrick Sawyer was fine, just the health care workers who treated him ended up sick. If you need two easy rules: wash your hands as per current recommendations (obsessively for goons) and avoid excessive contact with people (no problem for goons) and you don't have much to worry about.
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Sep 2, 2014 12:54
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My Imaginary GF posted:Saw this FAO Alert pop up: http://www.fao.org/news/story/en/item/242177/icode/ "It is critical that rural communities understand which practices pose the highest risks of human-to-human transmission as well as the potential spill-over from wildlife." In the context of the upcoming famine this stuck out as they're sorta implying that in the absence of food people are gonna forage/hunt en masse in the forest and eat even more bola-infested food, making the outbreak even worse. 
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Sep 2, 2014 13:28
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Another American missionary got sick. http://www.nbcnews.com/storyline/ebola-virus-outbreak/another-american-doctor-infected-ebola-charity-says-n193911 quote:Another American missionary doctor working in Liberia has tested positive for Ebola, an aid group said Tuesday.
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Sep 2, 2014 19:56
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MSF has started to call for what I was saying they needed a month ago, specialist Bio-hazard Military Brigades. They are the only people who have a hope in hell of bringing it under control before the same thing happens to even more countries, at which point it will be impossible to stop as the area would be to vast. http://www.theguardian.com/society/2014/sep/02/ebola-outbreak-call-send-military-curb-epidemic The problem is it just wont happen, as the only people with those units are the big Western countries, the ex Soviet Block, and China. None of which will volunteer any of their troops, and hell many of the soldiers would probably refuse the order. ukle fucked around with this message at 20:22 on Sep 2, 2014 |
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Sep 2, 2014 20:15
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School Nickname posted:"It is critical that rural communities understand which practices pose the highest risks of human-to-human transmission as well as the potential spill-over from wildlife." Yes, that's exactly whats happening. When the choice is starve to death today or risk Ebolavirus death later, well, everyone has to eat. CDC head had an insightful discussion of his trip to West Africa, audio found here: http://www.cdc.gov/media/releases/2014/t0902-ebola-outbreak.mp3 It does sound as if all volunteer and excess medical capacity of WHO/MSF has been deployed. I recall seeing that other programs like polio vaccination have been temporarily suspended as part of WHO's surge strategy. Unfortunately, as Ukle points out, it seems likely that nations with bioterrorism capacity won't be able to deploy military resources to West Africa. I have mixed feelings about that. Overall, I think its for the best: the amount of troops you'd have to deploy and the RoE given to them (and the RoE they'd folloe) would not produce productive results, and may actively hinder other response capabilities. In Nigeria news, there is a second suspected import case, in addition to the slow disaster that Port Harcourt's outbreak is becoming. I only hope enough resources are available, and departments willing to share intelligence about, potential contacts so as to avoid a repeat of the Sierra Leone healer incident. E: In some better news, the outbreak in DRC is of Kikwit-lineage EBOV, Zaire-strain and not Sudan-strain as one of the original tests came back positive for. So, no Ebolavirus recombinants spreading around thus far.
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Sep 2, 2014 22:26
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Honestly, my suggestion at this point would be to start deploying international troops around all the ports of entry to the affected areas. Even though they're nominally in safe zones, it's an easier to sell to Western nations and there's a pretty decent chance that they'll be required. And doing that would free up national troops to work closer in. Not a good solution, but I think that's about all that can be done. This epidemic looks like it's going to have to burn itself out.
Kaal fucked around with this message at 22:41 on Sep 2, 2014 |
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Sep 2, 2014 22:38
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ukle posted:MSF has started to call for what I was saying they needed a month ago, specialist Bio-hazard Military Brigades. They are the only people who have a hope in hell of bringing it under control before the same thing happens to even more countries, at which point it will be impossible to stop as the area would be to vast. They're soldiers. If their countries volunteer them (they won't) they'll do what they're ordered to do.
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Sep 3, 2014 00:46
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Jesus!  http://www.bbc.com/news/world-africa-29039041
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Sep 3, 2014 01:00
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Wow, no wonder doctors and nurses are striking. I doubt those bio-suits are built to withstand a physical confrontation. Also saw an article talking about food prices surging in many of the affected countries. Hungry, angry and scared patients escaping from understaffed hospitals is going to become increasingly common. At what point does it all crumble and hospitals close down and stop admitting ebola patients?
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Sep 3, 2014 02:53
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IAMNOTADOCTOR posted:No. Just no. Vaccinations have enough PR problems without rumours about a modern Unit 731. There is no IRB(mandatory ethical committee) in the world who would consent to such a trial and I cant think of a disease where this would be necessary. Plenty of vaccine trials will take volunteers and infect them with the disease after vaccination, as long as the disease is known to be completely curable with little to no long-term side effects. A notable example are the majority of trials for malaria vaccines.
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Sep 3, 2014 03:15
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School Nickname posted:"It is critical that rural communities understand which practices pose the highest risks of human-to-human transmission as well as the potential spill-over from wildlife." The vector is most likely bats. I'll try and dig up some more info. Vox has a pretty in depth article on Ebola, too. Oh, the WHO says it is good news that: Virological analysis: no link between Ebola outbreaks in west Africa and Democratic Republic of Congo. So we have multiple Ebola outbreaks happening right now. Pohl fucked around with this message at 03:28 on Sep 3, 2014 |
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Sep 3, 2014 03:19
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Thanks, I put a lot of work into that.
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Sep 3, 2014 03:30
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