New Ebola can spread by people without obvious signs of the disease

From CNN, July 29, 2014

Brantly’s family had been with him in Liberia, according to the Centers for Disease Control and Prevention, but left for the United States before he became symptomatic; as such it is highly unlikely that they caught the virus from him. Out of an abundance of caution they are on a 21-day fever watch, the CDC said.

Nancy Writebol from Charlotte, North Carolina, has also been infected. She is employed by Serving in Mission, or SIM, and had teamed up with the staff from Samaritan’s Purse to help fight the Ebola outbreak in Monrovia when she got sick. She, too, is undergoing treatment.

It is believed one of the local staff was infected with Ebola and came to work with the virus on Monday and Tuesday, Isaacs told CNN. “We think it was in the scrub-down area where the disease was passed to both Nancy and Kent,” he said. That staff member died on Thursday.

Dr. Brantly is a doctor with obvious experience in diagnosing Ebola cases. Yet, he was unable to detect infection in the co-worker who infected both him and Mrs. Writebol. Further, the co-worker was able to function for two days while still being able to infect at least two other people.

This suggests that we are indeed dealing with a “New Ebola” (as Pixie has put it at PFI Forum). This New Ebola apparently leaves people well enough, while they are infectious, to both travel and work without being detected. This makes this new Ebola pandemic-capable.

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Two ways Ebola could become a pandemic

Here are two possible ways Ebola could become a pandemic:

1. It could slow down.

In the past, Ebola patients were only infectious when they were very ill and obviously infected with this disease. If the virus were to change in such a way that patients were well enough to travel while they were infectious, they could spread the virus to others before they died, especially if it was not obvious that they had Ebola. There are anecdotal reports that this may be happening in the current outbreak in West Africa.

2. It could become airborne.

In the past, Ebola was spread strictly by bodily fluids. If it changed so that it was transmitted through respiratory droplets, Ebola might spread to others much easier. There is no evidence of this in the current outbreak. However, another strain of Ebola, the Reston virus, was shown to be capable of respiratory transmission. So conversion of any Ebola virus to a respiratory form is a theoretical possibility.

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Is MERS a biological weapon?

From The Conversation, July 2014

The features of MERS-CoV do not suggest an epidemic disease, but rather, a sporadic pattern. This could be an animal source or deliberate release. My paper shows there is slightly more weight to deliberate release than an animal source, although both are possible.

In the case of bioterrorism, if it is not considered at all, it can never be detected, unless it involves an eradicated pathogen such as smallpox. Public health does not have a good track record of correctly interpreting aberrant patterns.

The author is Dr. Raina MacIntyre, Professor, Head of the School of Public Health and Community Medicine at UNSW Australia. She is affiliated with the National Centre for Immunisation Research and the NHMRC Centre for Research Excellence in Immunisation in understudied populations.

The paper she alludes to in the quote above can be found here:

The discrepant epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV)
Environment Systems and Decisions (2014)

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Patient with SARS2 / MERS in the US

From the AP, May 2, 2014

Health officials say a deadly virus from the Middle East has turned up for the first time in the U.S.

No details about the case have been released. The Centers for Disease Control and Prevention planned a Friday afternoon briefing about the case.

The CDC says it is investigating along with health officials in Indiana.

According to an NBC report, the patient traveled by plane on April 24, 2014, from Saudi Arabia to London, then from London to Chicago. NBC cited the CDC as its source.

The CDC believes the patient took a bus from Chicago to Indiana, but did not specify the destination. The patient began to feel ill on April 27th and went to an emergency room on the 28th.

The obvious question now is: were others infected by this patient?


Update May 3, 2014

The patient is a healthcare worker.

Flight information:

British Airways flight 262 from Riyadh to London April 24, 2014
American Airlines flight 99 from London to Chicago April 24, 2014

The bus the patient took to Indiana has not been disclosed. One possibility is Tri State Coach / United Limo (CoachUSA) 8144 Indianapolis which travels directly from O’Hare to Highland, Indiana (adjacent to Munster where the patient is currently hospitalised). Given an arrival time in O’Hare of 10:22AM [h/t NawtyBits], the bus they most likely took would be the one that arrived in Highland at 12:20 or 1:20 PM on April 24, 2014. It would be helpful for public health authorities to disclose the bus information so that all passengers could be most quickly alerted to their exposure to this patient.


Update May 8, 2014

The bus suggested above has now been confirmed (h/t Pixie)

From WTHR, May 7, 2014

Individuals who took a shuttle bus from O’Hare International Airport in Chicago, Illinois to Highland, Indiana on April 24, between 11:30 a.m. and 12:30 p.m. CST, are asked to call the CDC hotline at 1-866-933-5295

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Possible efficient spread of SARS2/New SARS/MERS in the Middle East

There has been a rapid increase in the number of MERS cases in Saudi Arabia within the last few weeks. Although information from government officials has been lacking, there has been speculation by outside experts that the virus may have changed to become more efficiently transmitted. The attack rate among health care workers appears to have increased.

Dr. Ian Mackay has written an informative blog with a chart demonstrating what looks like a dramatic increase in the number of cases in Saudi Arabia.

You can find it here:

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Flu Vaccines – Special Guest Post By Pixie

It is the anti-vaccine pseudo-science websites and blogs which convince the moms that there is more danger in their child getting a vaccine than not.

The solution may not be to provide “correct information” on *safety* — often dismissed by the reader out of hand — but to provide “correct information” on the dangers of *not* getting vaccinated. That’s the missing piece. And that information can’t be presented once or twice. It can’t just be ponied out at the beginning of flu season. CDC has to go toe-to-toe with the 24/7/365 information cycle of the anti-vaccine websites and bloggers. They are relentless. The contrary message would have to be just as round-the-clock and relentless to have a hope of success.

The solution would, then, be to provide the public with outcome information, rather than statements about dry counter-studies filled with data, data which readers often suspect has been manipulated to serve someone else’s ends.

In the world of new media, whats lacking are the *stories* of adverse outcomes. Most moms, most pregnant women, have absolutely no idea *why* they should be vaccinated on a personal level. And I do mean not from a public health standpoint (which is often the stance that CDC takes) but from an individual perspective. The anti-vaccine websites and bloggers focus on the individual, not on some dry construct like “public health.” They talk about that mom’s kid, specifically. They seem to care.

When reading CDC statements, many moms find them to be self-serving of the interests of the CDC and other monolithic (and often, to them, suspect) entities. When CDC lists negative possible outcomes for their unvaccinated children, it’s often stated in dry, succinct, language. These statements are all too easy to disregard.

In contrast, the anti-vaccine propagandists use the new media very well indeed. They spell out, in technicolor language, all the horrors of vaccination as they see them. They provide a complex and convincing argument for vaccinations benefitting not some mom’s child, but “big pharma” and other powerful shadowy entities.

This “information” is repeated endlessly in various flavors. There is always something new to come back and “learn” on these websites.

In the mind of the mom, soon there’s no contest.

If CDC wants to promote the benefits of vaccination, they will need to promote the reality of some very negative outcomes that can happen to the unvaccinated. But they need to be serious about it, and do it in the style of the best new media practitioners. If they do that, then there’s a counter-artument, and the mom or the pregnant woman will have to take some time to actually weigh the vision of one negative outcome against another. At least, in that light, vaccination might stand a chance.

Will popping up in September with a photo and story of one unvaccinated kid on an ECMO machine work if CDC tries such a halfway measure? Of course not. They’ll be throwing rocks at a mountain, and their timing and motives will seem highly suspicious.

Now, CDC will say that privacy laws prevent the telling of these stories. Balderdash. Every day we see stories in local media in which the relatives of unvaccinated and critically ill or dead flu patients say that they’ll do anything it takes to let others know that they need to get vaccinated. And they often state that they’re sorry that they believed the anti-vaccine propaganda.

Each and every time a family is faced with their child barely surviving weeks on a heart/lung machine (and damaged for life) or worse, the death of their child from something “ordinary” like influenza, they say: “We just didn’t know what could happen. We never imagined it. We never knew. We had no idea.”

So if CDC wants to fight an information war, they have to fight it with the kind of information that their opponent has been using to win it. NONE of my co-op class students apart from my own was vaccinated against flu this year. ALL of their families “believe in” the dangers of vaccines. NONE of them know anything at all about the kinds of adverse and tragic outcomes that can come from remaining unvaccinated. NONE of the modern moms I know have any idea at all what it was like for families, for kids, before the era of childhood vaccines.

That’s an abject failure of communications on the part of the CDC. CDC doesn’t need a multi-million dollar communications center and budget. It needs a few good bloggers and a website or two that can tell a STORY.

As long as CDC acts like the bureaucracy it is, as long as it does not step up and provide a counter-story, the other, more dramatic, stories and claims (no matter how bogus) will win, vaccination rates will continue to remain low, and more kids and pregnant women will die. The tragedy is that they will die not ever knowing anything about the real danger they were entertaining by making the choice to remain unvaccinated.

If they had been able to compare the true dangers, they may have made another choice.

Moms don’t want to hear about “societal costs” or economics. They don’t want to hear about “pubic health.” They want to protect their kids from danger. Until you appeal to that hard-wired sentiment, forgetaboutit.

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pH1N1 and suppression of the immune system – another report

From NBCDFW, January 19, 2014 [hat-tip, Pixie]

“I have never seen a case of [Influenza] Type A followed by Type B right off,” said Dr. Honaker. “The immune system should kick in with Type A so you don’t get Type B, and this year we are seeing people in my office who have Type A and two or three weeks later they have type B.”

This is an anecdotal report from a physician in North Texas. An adequately powered study will need to be conducted before we can be sure that Dr. Honaker’s impression is true. However, given that there have been previous reports that pH1N1 is associated with immune system dysfunction, this issue deserves additional scrutiny.

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