Ebola getting ‘out of control’

[Doc]

http://www.bostonglobe.com/news/world/2 ... story.html

Ebola getting ‘out of control’
Outbreak hitting Africa is worst yet
By Sarah DiLorenzo
| Associated Press June 21, 2014

DAKAR, Senegal — The Ebola outbreak ravaging West Africa is ‘‘totally out of control,’’ said a senior official for Doctors Without Borders, who says the medical group is stretched to the limit in its capacity to respond.

The current outbreak has caused more deaths than any other on record, another official with the medical charity said. Ebola has been linked to more than 330 deaths in Guinea, Sierra Leone, and Liberia, according to the latest numbers from the World Health Organization.

International organizations and the governments involved need to send in more health experts and increase public education messages about how to stop the spread of the disease, Bart Janssens, the director of operations for the group in Brussels, told the Associated Press on Friday.

‘‘The reality is clear that the epidemic is now in a second wave,’’ Janssens said. ‘‘And, for me, it is totally out of control.’’

The outbreak, which began in Guinea either late last year or early this year, had appeared to slow before picking up pace again in recent weeks, including spreading to the Liberian capital for the first time.

‘‘This is the highest outbreak on record and has the highest number of deaths, so this is unprecedented so far,’’ said Armand Sprecher, a public health specialist with Doctors Without Borders.

According to a World Health Organization list, the highest previous death toll was in the first recorded Ebola outbreak in Congo in 1976, when 280 deaths were reported. Because Ebola often touches remote areas and the first cases sometimes go unrecognized, it is likely that there are deaths that go uncounted, both in this outbreak and previous ones.

The multiple locations of the current outbreak and its movement across borders make it one of the ‘‘most challenging Ebola outbreaks ever,’’ Fadela Chaib, a spokeswoman for the World Health Organization, said earlier in the week.

The outbreak shows no sign of abating, and governments and international organizations were ‘‘far from winning this battle,’’ Unni Krishnan, head of disaster preparedness and response for Plan International, said Friday.

But Janssens’ description of the Ebola outbreak was even more alarming, and he warned that the governments affected had not recognized the gravity of the situation. He criticized the World Health Organization for not doing enough to prod leaders and said that it needs to bring in more experts to do the vital work of tracing all of the people who have been in contact with the sick.

‘‘There needs to be a real political commitment that this is a very big emergency,’’ he said. ‘‘Otherwise, it will continue to spread, and for sure it will spread to more countries.’’

[Nonc Hilaire]

Defense against filoviruses used as biological weapons.
Bray M.

Abstract
The filoviruses, Marburg and Ebola, are classified as Category A biowarfare agents by the Centers for Disease Control. Most known human infections with these viruses have been fatal, and no vaccines or effective therapies are currently available. Filoviruses are highly infectious by the airborne route in the laboratory, but investigations of African outbreaks have shown that person-to-person spread requires direct contact with virus-containing material. In consequence, filovirus epidemics can be halted by isolating patients and instituting standard infection control and barrier nursing procedures. The filovirus disease syndrome resembles that caused by other hemorrhagic fever viruses, necessitating studies in a biocontainment laboratory to confirm the diagnosis. Some progress has been made in developing vaccines and antiviral drugs, but efforts are hindered by the limited number of maximum containment laboratories. Terrorists might have great difficulty acquiring a filovirus for use as a weapon, but my attempt to do so because of the agents' ability to inspire fear. Accurate information is the best tool to prevent panic in the event of an attack. http://www.ncbi.nlm.nih.gov/pubmed/12615303

[Doc]

Defense against filoviruses used as biological weapons.
Bray M.

Abstract
The filoviruses, Marburg and Ebola, are classified as Category A biowarfare agents by the Centers for Disease Control. Most known human infections with these viruses have been fatal, and no vaccines or effective therapies are currently available. Filoviruses are highly infectious by the airborne route in the laboratory, but investigations of African outbreaks have shown that person-to-person spread requires direct contact with virus-containing material. In consequence, filovirus epidemics can be halted by isolating patients and instituting standard infection control and barrier nursing procedures. The filovirus disease syndrome resembles that caused by other hemorrhagic fever viruses, necessitating studies in a biocontainment laboratory to confirm the diagnosis. Some progress has been made in developing vaccines and antiviral drugs, but efforts are hindered by the limited number of maximum containment laboratories. Terrorists might have great difficulty acquiring a filovirus for use as a weapon, but my attempt to do so because of the agents' ability to inspire fear. Accurate information is the best tool to prevent panic in the event of an attack. http://www.ncbi.nlm.nih.gov/pubmed/12615303

OK so you can't have bio hazard labs in Africa because terrorists might get them. And you can't have them in the US because incompetent bureaucrats might get them
http://www.bustle.com/articles/31480-cd ... lse-escape

CDC Closes Labs After Anthrax, Bird Flu, Smallpox, and Who Knows What Else Escape

[manolo]

Folks,

President Obama is instituting a surge in the global war on Ebola virus.

http://news.yahoo.com/obama-stop-ebola- ... 48034.html

The Obama administration is moving large amounts of extra funding into the provision of military personnel, doctors and equipment for the beleagured African nations.

Many countries are following Obama's lead with pledges of help in this growing crisis, including China.
It is good to see us working together with common purpose.

Alex.

[monster_gardener]

Folks,

President Obama is instituting a surge in the global war on Ebola virus.

http://news.yahoo.com/obama-stop-ebola- ... 48034.html

The Obama administration is moving large amounts of extra funding into the provision of military personnel, doctors and equipment for the beleagured African nations.

Many countries are following Obama's lead with pledges of help in this growing crisis, including China.
It is good to see us working together with common purpose.

Alex.

Thank You VERY Much for your post, Alex Manolo eThinker,

Only if proper infection control is done....

And I am NOT pleased with obama's record of being willing to protect the US generally including from the recent surge of often disease carrying illegal aliens across the US border....


Ebola can be transmitted via sex by semen as long as 3 weeks to 2 months after a survivor appears to have
recovered....

One reason I was extremely dubious about obama not cancelling that recent African conference in Washington

Also hoping that those two American aid workers allegedly saved by that new drug are kept quarantined for a while yet longer....

Once human infection occurs, the disease may spread between people, as well. Male survivors may be able to transmit the disease via semen for nearly two months.

Plus dogs can asymptomatic when infected with ebola..... NO bringing back cute puppies from Africa...

IMHO anyone coming in from plague areas directly or indirectly, needs to be thoroughly vetted by Immigration, perhaps even quarantined....

I do not have confidence that obama will do this...

While pigs that have been infected with REBOV tend to show symptoms of the disease, it has been shown that dogs may become infected with EBOV and remain asymptomatic. Dogs in some parts of Africa scavenge for their food and it is known that they sometimes eat infected animals and the corpses of humans. Although they remain asymptomatic, a 2005 survey of dogs during an EBOV outbreak found that over 31.8% showed a seroprevalence for EBOV closest to an outbreak versus 9% a farther distance away.[1

http://en.wikipedia.org/wiki/Ebola_virus_disease

[Doc]

WHO estimates 14,000 dead by November


http://www.nbcnews.com/storyline/ebola- ... st-n209226

Ebola Death Rate 70 Percent, WHO Says in Dire New Forecast

World Health Organization researchers issued a dire new forecast for the Ebola epidemic Tuesday, one that sees 20,000 cases by November. And 70 percent of patients are dying.

That's a big increase over the previous estimates of a 50 percent fatality rate.

“These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from Ebola virus disease are expected to continue increasing from hundreds to thousands per week in the coming months,” the WHO Ebola Response Team, led by Dr. Christopher Dye, wrote in a report rushed into print by the New England Journal of Medicine.

This projection includes nearly 10,000 people in Liberia alone. WHO said earlier Monday that more than 5,800 people had been infected with Ebola and more than 2,800 had died of it since the virus first broke out in Guinea in December. “The true numbers of cases and deaths are certainly higher,” they wrote.

Obama Commits Troops to Combat Ebola
Nightly News

But forget about the tales of horrific bleeding from the eyes nose and mouth. Bleeding is one of the most unusual symptoms, the team of experts from around the world said.

Still, it’s looking so bad that Ebola could take permanent hold in West Africa, they said — something that’s never happened before. “For the medium term, at least, we must therefore face the possibility that Ebola virus disease will become endemic among the human population of West Africa,” they said.

“The true case load, including suspected cases and undetected cases, will be higher still."

What could change that? Quick action by the world, the experts said. That means sending more people to track down potential Ebola cases so they can be isolated and treated, providing better hospital treatment and safer burials, and getting better buy-in from the community. In some places, residents still don’t believe Ebola is a virus, and they have attacked and even killed health workers trying to spread the word about the danger.

Patients are also running away and spreading the disease that way.

To stop the epidemic, transmission must be cut in half, they said. “Considering the prospects for a novel Ebola vaccine, an immunization coverage exceeding 50 percent would have the same effect,” they wrote.

The United States is leading a new response, sending troops and supplies and offering to help coordinate help. WHO and the UN are urging other countries to help. Germany, France, Cuba and China are among countries also sending teams and equipment.

To make the forecast, the team looked at all the available data on the epidemic, which has spread more widely than any previous outbreak of Ebola, in part because it broke out in an area where people travel widely across borders.

It remains clear that close contact with an infected person or their bodily fluids are needed for infection to happen. There’s nothing mysterious about how Ebola spreads, and it's not as easily transmitted as influenza or measles.

Caregivers and health care workers have a high risk. More than 300 health care workers have been infected, and half of them have died.

The most common first symptoms are fever and fatigue. Hemorrhage — the most feared symptom — is seen in fewer than 5 percent of patients, although about 18 percent had unexplained bleeding, the WHO team said.

"There will be more epidemics and outbreaks of Ebola and other new or re-emerging infections."

Ebola has an incubation period of 11 days, and people cannot infect others before they begin to show symptoms — unlike flu, which people can pass along before they even feel ill.

One important number is how many other people each patient infects. It’s different for each country, Dye says — an average of 1.7 in Guinea and 1.8 in Liberia. In Sierra Leone, an infected person sickens two other people on average. Some patients infect many more people than that — than a dozen mourners were infected at the funeral of a single traditional healer who died in Sierra Leone, for instance. And some die or recover without infecting anybody else.

Another important number is what’s called doubling time — how long it takes the number of cases to double. This varies greatly from country to country; in Guinea it’s just under 16 days, in Liberia it’s nearly 23 days and in Sierra Leone it’s 30 days. That’s what leads to the projection of 20,000 cases by Nov. 2. “The true case load, including suspected cases and undetected cases, will be higher still,” the WHO team wrote.

Obama Sends 3,000 Troops to Ebola Hot Zone in Africa
Nightly News

Most of those infected are ages 15 to 44, although people those ages only account for 44 percent of the population in those countries. Older patients are more likely to die, and those who have diarrhea, hemorrhage, difficulty breathing or confusion also seem more likely to die.

Most of those who died succumbed on average four days after they were admitted to a hospital or clinic, and if someone survived, it was usually 11 days before they were better enough to go home, on average. It’s possible that patients who get hospital care live longer, the researchers said, but there’s not enough information to say that for sure.

Patients get vastly different care, depending on where they are treated. Three out of four patients treated in the U.S. have recovered or nearly recovered and the fourth has released little information about his condition. They all got the best possible care, including carefully measured and balanced rehydration, 24-hour nursing care, immaculate conditions and experimental treatments, including drugs and transfusions of blood from patients who have recovered.

In West Africa, some lucky patients get good hospital care that includes saline to replace fluids lost to vomiting and diarrhea, antibiotics to prevent other infections, and pain control. But many are given little more than a bed or a space on the floor, and many are also turned away to die at home or in the streets. So it’s hard to say what will save someone’s life.

“Classic ‘outbreak control’ efforts are no longer sufficient for an epidemic of this size."

The report strongly suggests what doctors is saying is true — there’s nothing unusual about the virus itself, say Dr. Peter Piot of the London School of Hygiene and Tropical Medicine, who helped discovered Ebola, and Dr. Jeremy Farrar of Britain’s Wellcome Trust.

It’s spreading because of dysfunctional health systems, a lack of action by local and international governments and a population that hasn’t caught on immediately to the dangers and what to do about Ebola, they wrote in a commentary in the journal.

“Classic ‘outbreak control’ efforts are no longer sufficient for an epidemic of this size,” they added.

“Rather, what’s required is a large-scale, coordinated humanitarian, social, public health and medical response, combining classic public health measures with safe and effective interventions including behavioral changes, therapies and, when possible, vaccination.”

It will take both a “massive” response and, probably, the use of new treatments and vaccines to control the epidemic, Farrar and Piot wrote.

“But we must also look to the future. There will be more epidemics and outbreaks of Ebola and other new or re-emerging infections,” they added. “Yet our response to such events remains slow, cumbersome, poorly funded, conservative and ill-prepared.”

[Doc]

2014 Ebola outbreak interactive map/timeline The outbreak is spreading out to other countries. It won't take much before it will be spread beyond any chance of containment.

http://healthmap.org/ebola/

[Doc]

CDC as many as one million dead in just two countries by Jan

http://bostonherald.com/news_opinion/in ... by_mid_jan

US: Ebola cases could hit 1.4 million by mid-Jan.
3de4817f7df146bc8aab592fc7206b26.jpg
Photo by:
The Associated Press
Empty streets are seen during a three-day lockdown to prevent the spread on the Ebola virus, in Freetown, Sierra Leone, Sunday, Sept. 21, 2014. Volunteers going door to door during a three-day lockdown intended to combat Ebola in Sierra Leone say some residents are growing increasingly frustrated and complaining about food shortages.(AP Photo/ Michael Duff)
1
Tuesday, September 23, 2014
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By:
Associated Press

LONDON — New estimates by the World Health Organization and the U.S. health agency are warning that the number of Ebola cases could soar dramatically — the U.S. says up to 1.4 million by mid-January in two nations alone — unless efforts to curb the outbreak are significantly ramped up.

Since the first cases were reported six months ago, the tally of cases in West Africa has reached an estimated 5,800 illnesses and over 2,800 deaths. But the U.N. health agency has warned that tallies of recorded cases and deaths are likely to be gross underestimates of the toll that the killer virus is wreaking on West Africa.

The U.N. health agency said Tuesday that the true death toll for Liberia, the hardest-hit nation in the outbreak, may never be known, since many bodies of Ebola victims in a crowded slum in the capital, Monrovia, have simply been thrown into nearby rivers.

In its new analysis, WHO said Ebola cases are rising exponentially and warned the disease could sicken people for years to come without better control measures. The WHO's calculations are based on reported cases only.

The U.S. Centers for Disease Control and Prevention, however, released its own predictions Tuesday for the epidemic's toll, based partly on the assumption that Ebola cases are being underreported. The report says there could be up to 21,000 reported and unreported cases in Liberia and Sierra Leone alone by the end of this month and that cases could balloon to as many as 1.4 million by mid-January.

Experts caution those predictions don't take into account response efforts.

The CDC's numbers seem "somewhat pessimistic" and do not account for infection control efforts already underway, said Dr. Richard Wenzel, a Virginia Commonwealth University scientist who formerly led the International Society for Infectious Diseases.

In recent weeks, health officials worldwide have stepped up efforts to provide aid, but the virus is still spreading. There aren't enough hospital beds, health workers or even soap and water in the hardest-hit West African countries: Guinea, Sierra Leone and Liberia.

Last week, the U.S. announced it would build more than a dozen medical centers in Liberia and send 3,000 troops to help. Britain and France have also pledged to build treatment centers in Sierra Leone and Guinea and the World Bank and UNICEF have sent more than $1 million worth of supplies to the region.

"We're beginning to see some signs in the response that gives us hope this increase in cases won't happen," said Christopher Dye, WHO's director of strategy and co-author of the study published by the New England Journal of Medicine, who acknowledged the predictions come with a lot of uncertainties.

"This is a bit like weather forecasting. We can do it a few days in advance, but looking a few weeks or months ahead is very difficult."

WHO also calculated the death rate to be about 70 percent among hospitalized patients but noted many Ebola cases were only identified after they died. Dye said there was no proof Ebola was more infectious or deadly than in previous outbreaks.

Outside experts questioned WHO's projections and said Ebola's spread would ultimately be slowed not only by containment measures but by changes in people's behavior.

"It's a big assumption that nothing will change in the current outbreak response," said Dr. Armand Sprecher, an infectious diseases specialist at Doctors Without Borders.

"Ebola outbreaks usually end when people stop touching the sick," he said. "The outbreak is not going to end tomorrow but there are things we can do to reduce the case count."

Local health officials have launched campaigns to educate people about the symptoms of Ebola and not to touch the sick or the dead.

Sprecher was also unconvinced that Ebola could continue causing cases for years. He said diseases that persist for years usually undergo significant changes to become less deadly or transmissible.

Dye and colleagues wrote they expected the numbers of cases and deaths from Ebola to continue rising from hundreds to thousands of cases per week in the coming months — and reach 21,000 by early November. He said it was worrisome that new cases were popping up in areas that hadn't previously reported Ebola, like in parts of Guinea.

Scientists said the response to Ebola in the next few months would be crucial.

"The window for controlling this outbreak is closing," said Adam Kucharski, a research fellow in infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.