Uh oh. . .

September 30, 2014 • 2:16 pm

From my CNN News bulletin:

A patient at a Dallas, Texas, hospital is the first case of Ebola virus diagnosed in the United States, according to the CDC.

Other Americans were diagnosed in West Africa and then brought to the United States for treatment.

68 thoughts on “Uh oh. . .

  1. Hopefully it can be controlled better in United States than in Africa. Quarantine should work better here, if necessary.

    1. Over there, hospitals are amplifiers. Here, they tend not to be. My colleagues have been harping on this problem for more than a decade now, trying to draw attention to medical transmission of HIV in sub-Saharan Africa — to deafening silence from the epi community at large.

      Now that Ebola’s the story, epi folks are finally talking about medical transmission… but not in the context of HIV. Very few seem to be putting 2 and 2 together, at this point.

  2. The Brits flew one of their citizens back to the UK and treated him in the high level isolation units at the Royal Free, London. He made it ….

    1. What made me roll my eyes was Rick Santorum coming out to reassure people. “We’ve got to trust the science, ” he says. How come he and his friends don’t do the same with climate change and evolution?

      1. Because curing illness is the same as flying airplanes. It’s okay to leave everything else up to Jesus except stuff that can kill you.

    1. Are you volunteering to be a guinea pig? Including going out after “vaccination” to where exposure is likely.
      I’m just glad my company didn’t get the contract for the Benin job, leaving me twiddling paperwork until the vessel goes to Turkey.

  3. I wouldn’t worry. Unlike in parts of Africa, we have a functional health care system, we have a much better appreciation of hygiene, and we do not kiss our deceased relatives. There is virtually no chance of sustained transmission here.

  4. David Gorski did an extensive write-up on Ebola when the two infected health workers were brought home a couple of months ago.


    The message seems to be that it’s not particularly contagious (much less so than ‘flu). Healthcare & mortuary workers here know to avoid bodily fluids, so a widespread epidemic in the West is highly unlikely. But it’s scary because the mortality rate is so high. So, pretty awful if you get it, but you’re unlikely to be exposed.

    An highly contagious airborne strain is the horror movie trope. No idea how likely that is.

    1. More here


      “As for the disease, it is not as bloody and dramatic as in the movies or books. The patients mostly look sick and weak. If there is blood, it is not a lot, usually in the vomit or diarrhea, occasionally from the gums or nose. The transmission is rather ordinary, just contact with infected body fluids. It does not occur because of mere proximity or via an airborne route…”

      I guess the question is when the horrific loss of bodily fluids, bloody vomiting etc. really occurs? If people in the early stages of the disease who are undiagnosed and still well enough to be moving around in public are not likely to be spraying around bodily fluids, I don’t see much reason for concern.

      1. If there is blood, it is not a lot, usually in the vomit or diarrhea, occasionally from the gums or nose.

        Somehow this just didn’t make me feel better.

        1. Right, but think about how our attitude to HIV has changed. In the early stages of uncertainty and ignorance, most of us would have been horrified at the prospect of sitting next to somebody who is HIV positive. Now we know better. Even if Ebola is more deadly, if there’s no more chance of catching from somebody than catching HIV, I’m not going to panic. I mean, I already try not to exchange bodily fluids with strangers.

          1. It was the blood part that I found amusing. I know it was to show that bodily fluids weren’t being flung around but it came off as “don’t worry, there’s only blood from the bum, mouth and nose”. 🙂

          2. ” Even if Ebola is more deadly, if there’s no more chance of catching from somebody than catching HIV, I’m not going to panic”

            Somehow I don’t think that all the health care professionals who have come down with Ebola were having unprotected sex with their patients. Ebola has got to be a lot more communicable than HIV.

          3. True, but it’s still quite low. My impression is that it’s closer to Hepatitis A/B/C in transmission routes and rates. Unlike HIV, there are documented cases of people getting Hepatitis from, for example, uncooked contaminated food (fecal oral route… not obeying the wash hands sign). So it’s a little more transmittable than HIV, but still not something you’re going to get from someone at the bus stop.

            Basically, think how worried you’d be if Hepatitis were 50% fatal, and that’s probably about how worried you should be about Ebola.

          4. From my professional experience, HIV is virtually identical in transmission dynamics to Hep B. (extremely resistant to all but the most direct routes of blood-to-blood and semen-to-blood). Hep C is strangely resistant to anal sex as a transmission vector — close colleagues are guessing at this point, but maybe it needs more of an intra-muscular route, which is why it would be seen in predominantly IV drug users (besides transfusion in a medical setting, before screening was available).

            Hep A (and E) are both completely different animals — the predominant mode of transmission is fecal/oral. So you can get either of those at the drop of a hat… this is why we routinely see outbreaks of Hep A at old folks’ homes and daycare centers. It’s where the shit is. We had an outbreak of it here that resulted from a lot of amphetamine snorters getting it from the powders they were trafficking in. Those powders led to a horse stable that was being used as a depot. Some trucker dipshit was using the space below a horse stall to store a big bag of the amphetamine, and it got shat and pissed on during a hot summer. Eventually, it was saturated with Hep A as well… then we got a lot of infected truckers across the southwest, and a lot of hippies on the west side (Manitou Springs), around 1989, all got extremely jaundiced and thrashed to within an inch of their lives. (Hep A is no fun).

            Last I checked, the only fecal/oral viral heps are A & E, and everything else (B, C, D, F, G, H, J, K… with some letters collapsing on others as certain viruses were found to be in various same families) are strictly bloodborne.

            In disease control parlance, I would say Hep B is sexually TRANSMISSIBLE… but not what I would consider a “sexually-transmitted” disease. I currently hold a minority scientific view on the matter — so remember that this is a scientific pariah talking now. But I would also assert that HIV is also in this camp, and that the WHO/UNAIDS/CDC party line of HIV being overwhemingly “sexual” (meaning penile-vaginal) is just flat-out wrong. It’s politically-motivated garbage, which if true, would have led to sexual outbreaks all over the planet, which have never come to pass. (except for sub-Saharan Africa… gee… why, oh why should THAT be the case?)

            Ebola, on the other hand, would be a LOT easier to transmit than Hep B or C (or HIV). But still, we’re not talking influenza-like transmissibility. Like the MD above says, you practice good infection control, and your outbreaks shouldn’t go anywhere. Like the fecal/orals (Hep A/E).

          5. “It’s politically-motivated garbage, which if true, would have led to sexual outbreaks all over the planet, which have never come to pass.”

            That makes much sense; but for slow people like me, would you explain the political motivations? Are we talking RR morality demagogues?

      2. ” If people in the early stages of the disease who are undiagnosed and still well enough to be moving around in public are not likely to be spraying around bodily fluids…”

        What if they sneeze?

        1. “Are we talking RR morality demagogues?” — answering here, so as not to use up too many column inches – nested too deep.

          I would say that it’s more like demagogues on the left that have maintained “the big lie” — but the religious right set the stage in the 80s.

          The original pronouncement that HIV was 90% sexual was the message that Jon Mann returned from Uganda with during the waning years of Reagan. It was based on his observation that there was a 1:1 ratio of men to women infected there, as opposed to it being a disease of gay men (MSM) and IV drug users (IDU). Since Jon Mann was fighting tooth and nail for resources from a recalcitrant administration, it was natural for him to point at that one ratio and tell the budget naysayers: “AHA! THERE’s your sexual transmission!!”

          The subsequent education efforts, then became focused by very well-meaning people on the left that “HIV is not a gay disease” and “everybody’s at risk”. The Oprah show went into overdrive, with breathless admonitions that it wouldn’t be long before half the planet was infected, and we were swamped in the clinic with people desperately wanting testing, despite a complete lack of risk factors. Consequently, we now had an epidemic… an epidemic of testing… and bad epidemiology. People stopped investigating risk factors thoroughly, and anonymous testing skyrocketed, and many politically-active HIV-positive gay men (a la Act-Up) started padding the numbers by testing anonymously and claiming to have only hetero risk. Claiming to have had sex with a female prostitute became the weapon of choice.

          So the right, who were largely responsible for demonizing gays and drug users in the same breath, created the crap environment that egged Jon Mann into making premature pronouncements… then Mann (and his wife) were martyred by the plane crash (off Nova Scotia, I think – a flight to Paris). And the 90% figure (which incidentally, does not exist in any scientific publication — we asked the WHO where that number came from… after a year or so of repeated pestering, they finally admitted they didn’t know where 90% came from) became orthodoxy — the default assumption for how anybody acquires the disease in Africa. After all, everybody knows what horn-dogs Africans are, and that nobody has any time for anything other than sex, sex, sex. (readers: this is sarcasm)

          The left, subsequently kept supporting “the lie”, and continue to this day, to support the lie. Despite the fact that it’s racist as hell, it fits their ideology better to think of anal sex and vaginal sex as the same thing, carrying the same risks… thus avoiding the uncomfortable conclusion that HIV actually IS predominantly a disease of MSM and IDU. (at least in developed nations). Take home message: politics & disease control do not mix. Doesn’t matter what flavor of politics; one should check that garbage at the door, and restrict oneself to the evidence, and try to get better evidence (like contact tracing) — rather than rely on ecological evidence (like M:F ratios).

          1. But given the politics of the 1980’s (roughly: “Let the sinners die!”), there would have been a LOT less funding for research if not for this… um… distortion. So, is it a good end from a bad means? Or has this distortion cost more than it bought in public investment (both money and basic human decency to care)?

            My question is genuine, not rhetorical. I don’t know.

          2. I don’t either. Too many variables. It got the money going. It has also resulted in misallocations that have killed millions, IMO. That’s all I think I know.

          1. Thank you so much for the thorough and enlightening reply, Stephen! I wonder if anyone’s ever calculated just how much leftist political correctness (oops, that’s redundant) has cost us in lives (and money)?

            I’ve been meaning to read And the Band Played On pretty much ever since it came out. Thanks for the reminder. His brother David lived not far from me; he was frequently featured in the newspaper when an AIDS story came up…But I’d heard of the book before that. I was of the generation who were told that if we were sexually active in the 60’s (also redundant) we’d have to be ten years out before we could breathe a sigh of relief.

      3. I guess the question is when the horrific loss of bodily fluids, bloody vomiting etc. really occurs?

        In at least several cases, the symptoms (bloody vomit and uncontrolled diarrhoea) have started some time after the plane took off. Which is indeed the stuff of nightmares.

  5. Thanks for the update.. but

    Seeing your headline “Uh oh…” scares me a hell of a lot more than Huff Po’s EBOLA IN U.S.

  6. I recall a animal lab in the U.S. had an outbreak of an airborne strain of Ebola that killed all their monkeys about a decade ago. Fortunately it wasn’t transmissible to humans, but scary nonetheless.

    1. Ebola-like virus. (Reston). Reston only infected monkeys, but was airborne. It’s related cousin, Marburg, infects humans. And yes, the Hot Zone is a great book – tells the story.

        1. If memory serves, some of the workers did test positive to an Ebola Zaire variant using an immunofluorescent assay.

        2. I do not remember that detail. And given that Reston doesn’t infect humans, I’m not sure if that’s because we have a huge immunological response and kill it off, or if (as I suspect) it is because the lock/key mechanisms of infection are all wrong with Marburg. I don’t know if there even WAS a really specific human antibody test for Reston, at that time. (1989)

          What the wiki said (so take it for what it’s worth for now), was that there were 6 (off 11?) animal handlers that tripped an ELISA test for Reston, but I have no special knowledge of how specific such tests are, esp. back then. It took about 6 months for the ELISA for HIV to get good enough to trust after March 1982, when the test finally came out.

          1. One other detail – is that pig handlers in the Philippines have been demonstrably infected by Reston (http://www.who.int/csr/don/2009_02_03/en/) — so what I said earlier, that Reston doesn’t infect humans, is no longer true. Apparently, it’s not discovered that infection leads to disease in humans (yet). But having it now demonstrated that it infects pigs and humans cannot be a good thing.

            Just what we need… another pig/human virus to add to the troubles (of bird/human viruses). Expect more infectious funsies to crop up out of SE Asia. Good times ahead.

      1. They were going to make it a movie, but it was canned when that piece of shit Outbreak was made instead.

  7. I watched the press conference on this. The guy only had contact with family members since becoming contagious, and the hospital is experienced in containment. Nevertheless, CNN is over this. This is going to be bigger than the missing airplane.

  8. A quick google search of the ratio of doctors, nurses etc, per population in countries like Liberia compared to the US and you can see why it is such a problem there. Some of the voluteer doctors were interviewed on BBC and talked of having to turn people with suspected ebola away from the treatment/isolation centers- sending them back to their homes- because there just isn’t enough beds or staff to treat them.

  9. I recall Obama reassuring us that Ebola could not happen here. I was thinking that was probably b.s., given the large outbreak and how much people travel.
    As long as it keeps reemerging in Africa, it will jump to other crowded poorer countries and there can be regular outbreaks somewhere in the world all the time. I suspect it will appear in the western countries on a semi-regular basis.

    1. I saw a map on the tele that indicated Spain and Saudi Arabia have had cases. Though haven’t researched if this is true.

      1. The Spanish case is another one of those “doctor gets infected in West Africa, comes home for treatment/ death” cases. I don’t know about any Saudi cases.

    2. I would say he’s probably right in that an ebola outbreak won’t happen here. One case does not an outbreak mate (at least, to my way of thinking).

      1. “I would say he’s probably right in that an ebola outbreak won’t happen here. ”

        Fingers crossed. I must read that the patient helped move a critically-ill Ebola patient on September 15th. On September 20th, he had no symptoms and flew to the U.S. On September 24th, he started showing symptoms, went to the hospital on the 26th, but was sent home (!), and then rushed to the hospital on the 28th.

        He has been in contact with 12-18 people since becoming symptomatic, including five children who then went to four different schools.

        So, that’s a nine-day incubation period. Yikes.

        1. Nine day incubation period – the mean for this strain is eleven days, so that’s not unexpected.
          I’m surprised at the first-presentation hospital didn’t hear “fever” and “recently returned from west Africa” in the same case history and hit the Big Red Button. When I got the flu after returning from Africa in late march, my quack had me into hospital for tests within minutes of the appointment starting. (it was just flu).
          I do remember rolling around helpless with mirth when I discovered that one client company, who liked their 2-month rotations to Africa, had their offices almost literally across the road from the London School of Tropical Medicine, where they have experience of nasty diseases too.
          Hang on – a Dallas hospital? So they’ve got no excuse what-so-ever for not being familiar with people coming back from sweaty parts of the world with horrible diseases. Someone is going get their arse thoroughly reamed over letting this guy back out of the building.

    1. It’s likely to remain a disease of the poor. The best hope for getting significant resource expended on it is going to be if someone manages to weaponise it.

    1. That is why many airports have fever-detecting cameras scanning the arrivals hall and exit ramps from airplanes.
      I don’t know if America does this though – or admits to doing it.

  10. While transmissable diseases are a potential threat in the interconnected 21st century, particularly slow developing ones like Ebola, it seems to me a small threat compared with road traffic deaths, heart disease, cancers etc. Having said that, I love medical SciFi like Contagion, Outbreak (or the less plausible Helix)! They have perhaps alerted the public to the potential for a major bacterial or viral disease spread. Not nice to be on the receiving end & about time people took what Stephen Q says above more seriously.

    1. There are a lot of differences. Traffic deaths are pretty constant; we don’t expect them to spike up by a factor of 10, 100, or 1,000 suddenly. So they are a steady, known risk whereas diseases present a variance in possible effect that make them more scary.

      Individuals also have significant control over how much traffic risk they take, and lack of control over its spread is probably one of the reasons disease upsets us so.

      In the traffic case, the risk sources (cars) are visible and well-understood by laymen; it the disease case, the bugs are not.

      Lastly, it is not necessarily irrational to to accept a 0.1% (or whatever, just an example) risk of death from source X while rejecting it from source Y, if you value doing activities associated with X more than activities associated with Y. The numbers don’t tell the whole story: personal value of lifestyle choice comes into play too. It may be perfectly rational for someone to accept a comparably high traffic risk and reject a comparably low disease risk, if they place a high positive value on the convenience of transportation and a high negative value on being forced to avoid physical human contact. Which most of us probably do.

    2. Yep. The huge condom campaigns in South Africa / Botswana have driven sexually-transmitted infections (Trich, chlamy, gonorrhea, HSV, HPV) to the lowest levels ever. HIV was virtually unaffected, though – and I’ve heard the current crop of “experts” handwave this away as having something to do with epidemic “phase”, or perhaps some amazing perfect storm of sexual “concurrency” was happening there in only certain circles, amplifying HIV even while other STD were being eradicated. It’s all special-pleading to me.

      It’s also notable that there have been literal screaming matches between experts in the halls of the CDC that have come to my attention through back channels. It’s essentially a shameful mess, IMHO, that more than a quarter-century of research has not been asking the right questions, because a critical mass of experts have the “sexual” blinders on. The behaviorists have been running the show, with stochastic modelers more interested in “being right” than in uncovering what is most plausible. So the modelers continue to torture their models to prove their perfect storm scenarios — while Africa continues to suffer the crap that makes their health care infrastructure suck so much: power outages, crap sanitation, theft and reuse of used sharps, reliance of traditional healers, some of whom might poke you with something if asked nicely.

      But maybe outbreaks of Ebola in such places will get NGOs and other powers that be to finally take infection control in medical settings seriously. And to trace infections to their real sources, instead of making default (sexual) assumptions. That’s all we’ve been asking for for-fucking-ever.

      1. I’m a little confused by this. What are you saying IS the reason that HIV was virtually unaffected? Some other transmission route? Like?

        1. Scientifically, the proper response really should be: “I don’t know. But I DO know ONE thing… you don’t know, either.”

          The sad reality is that proper data have rarely been captured. (e.g. properly-controlling for anal and/or subcutaneous [skin-puncturing] exposures. Experimental results have merely been interpreted to be resulting from sex, by and large. You can read the annotations here from publication#90 onwards, for the papers having to do with Africa (e.g. 90-92, 96-97, 99-104, 109, 111-121, 124-131, 133-134, 138-140, 142-144, 145, etc.). It reads like a broken record.

          We have collectively been shelling out HUGE bucks forever, on first-world researchers doing second-rate science in third world countries. It’s shameful as hell.

          My *guess*: Instead of thinking in terms of “other transmission route”, think about the possibilities for multiple transmission routes. And start with the routes we know to be particularly efficacious: introduction into the bloodstream via IV, via the butt, and via other misc subcutaneous exposures (anything from genital cutting practices to backyard dentistry). One thing I know is that there are no shortages of ways for African societies, when they are functioning, to facilitate bloodborne infections. All one has to do is pull off the sex blinders and reassess each situation. Africa is a big place. I wouldn’t expect there to be magic bullet answer that works everywhere. Other STI facilitate transmission, so do vaginal dessication (drying, e.g. with bark) practices, unreported anal exposures, unhygienic circumcision and other genital cutting. Then there’s scarring, tattooing, the “big butt” craze where people jabbed themselves with Vitamin B thinking it enhanced their butts (or gives them energy). Unregulated traditional healers that proliferated after the fall of apartheid. (which, incidentally, coincides with the explosive takeoff in SA/Botswana). It’s not always the case where the most impoverished, most uneducated there have th highest infection. It’s a mixed bag, and it is the ANOMALIES that are especially troubling. Taken together, they point to problems with the overall epi picture, as painted by the mainstream.

          1. Thanks. I think I see what you are saying now. I appreciate this perspective. It is definitely the case that conventional wisdom and various ideological biases make it very difficult not to get stuck in an explanatory cul-de-sac. It’s very tough to overcome those.

          2. Yep. After a while, if I keep spinning explanations, I can add my armchair theorizing to the pile, too. Incredibly daft that these questions haven’t been triangulated to satisfaction 30 years ago.

            Now with Ebola, contact-tracing is in the news again, after being politically marginalized by HIV. (stuff about how gay politics helped destroy disease control efforts [it wasn’t the right pulling the plug in this case, but largely the machinations of the left-leaning, in this case] is in those papers, too. Now, people can’t shut up about how necessary contact-tracing is. Though the focus is miserably downstream, and the space suits scaring the piss out of everyone, and people scattering disease for fear of ending up in an Ebola prison… at least people are mentioning tracing again. Too bad the expertise base in the USA has been largely destroyed. It used to be a well-oiled machine. (searching that publications list on “contact tracing” reveals much of the sordid history of the marginalization of this tried and true investigative method)

  11. I don’t know if this is being reported in America yet, but the UK press is reporting that the authorities in Liberia intend to prosecute the “Dallas case” when he returns to Liberia, as he apparently lied on a questionnaire he filled out before boarding his flight out of the country.
    The Independent, citing reports from AP, says that

    [the form]asked whether [the Dallas patient] had cared for an Ebola patient or touched the body of anyone who had died in an area affected by Ebola. He answered no to all the questions.

    however it seems that [the Dallas patient] had helped a pregnant woman into a taxi to get her to hospital, and the woman later died of Ebola.
    It sounds as if there’s genuine doubt whether [the Dallas patient] knew if she’d got Ebola when he filled out the form and flew to America – so he should have grounds for a workable defence, both in legal terms and in his own mind.
    How helpful this prosecution will actually be in reducing international transmission, I don’t know. It’ll be some time – months – before [the Dallas patient] is well enough to be returned home (and the odds of him being allowed to remain in the USA are pretty minimal), and one would hope that by that time the main epidemic will be under control. And in any case, a questionnaire like that is likely to be as effective as the “do you intend to commit acts of sedition, terrorism etc.” questions that most countries have on their visa applications, landing passes and so on. No one is going to answer “yes” to a question that could be re-phrased as “do you want to be denied boarding, arrested at gun point and given the 3rd degree in a dark cellar for the next 3 hours?”
    I’ve been quite critical of the ECOWAS diplomat whose fled from Lagos to Port Harcourt to run away from his diagnosis with Ebola and caused the disease outbreak there. As a bloody diplomat, I’d expect him to have a relatively good education (did my fingers really type that?), so he can’t hide behind claims of ignorance. I don’t know what the background of [the Dallas patient] is, so we’ll just have to give him the benefit of the doubt there. But relying on questionnaires for control of infection strikes me as insanely ineffective. What would be more effective, I’m not so sure on – compulsory body temperature checks were used in some parts of Asia during the SARS concerns, and fever is one of the commonest symptoms of Ebola infection. And it has the benefit of being an objective measurement. Other than that – do any of the medics here have better ideas?

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