Posting this for PersistentDST. I thought it was a really nice article about Amber Vinson. I'm sure you've probably read it, but in case not...

http://www.nbcnews.com/storyline/ebo...s-hero-n227251

From my understanding, this is not exactly true. You're not contagious unless you are exhibiting symptoms (vomiting, fever, etc...).

If you have been exposed to it, the incubation period is anywhere from 2-21 days (so weeks, not months) from the time you've been exposed until the time you start exhibiting symptoms (and are thus contagious).

The "people in the know" (The CDC et al) are still saying you have to have come in contact with bodily fluids, and I still believe that's probably true. Think about the only two people who have contacted it in the US...they were people cleaning up after a man who was vomiting and all sorts of other gross things. So, the opportunity to "break protocol" or have a breach in the system. All it would take is for them to scratch an itchy nose or something with the edge of a contaminated glove and boom...

However, I do think that micro particles (sneezes, a person inadvertently spitting while talking, etc...) come into play also, so keep that in mind. I think if it were airborne, the numbers would be far higher in West Africa than they already are, AND Duncan's family members would also be ill.

Disclaimer - I don't know much about all this except what I read. IUHoosierGirl is a much better source. I just find it very interesting and like reading about it.

Well, I wouldn't panic just yet. Let's see what happens with these nurses, the other healthcare providers, and their circles of friends/family. It very-well could be contained after the 21 day period for each of those dies out. Remember those are all people who wash their hands WAY more than you and I probably do. :D

The good news is, they've had really good luck with blood/plasma donations of people who have survived the virus being given to those who actively have it. Duncan wasn't a blood-type match for the one missionary guy who was in the states and willing to donate (and frankly, it may have been too late for him anyway because his diagnosis was so botched). Pham (Nurse #1) was a match and has received from him. I'm unsure if Vinson (Nurse #2) was able to receive or not.

Bottom line, until someone in your area has been directly exposed & is contagious, I wouldn't think too much about it. It's a needle-in-a-haystack situation at this point.

Also, the people Duncan lived with are almost at the 21 day period since he went into the hospital. They were in the apartment with his stuff until October 3rd though. I'd say if none of them get it by the 24th, a lot of people will calm down.

A) While it's more contagious than HIV, it's not more prevalent in the population. You have a much higher chance of being infected with HIV on a random one night stand than you do getting Ebola in any location of the world, except perhaps Liberia.

B) There's never going to be a true 'cure' as you think of it for a virus like Ebola. Viruses are very difficult to 'cure'--just look at how much money has been poured into HIV and we've gotten it to a very manageable infection. Viruses aren't like bacteria because they invade host cells. They can only replicate if they are inside a host cell. So therefore to truly 'cure' the infection, you have to kill the host cells...AKA you have to kill you. That's not very effective, is it? That's why the only two true options for viruses are vaccines (to prevent infection) or antivirals (to keep them from replicating)

C) In order to be infected by the average Ebola patient--not one that's essentially a human jello mold AKA late stage infection--you'd have to basically be directly sneezed/spat/vomited/pooped on OR ensure that their body fluids physically enter your mucous membranes or open wounds. How many times have you been directly sneezed on by a stranger? Probably not very many. How many times do you handle bodily fluids regularly? If you're a healthcare worker or daycare worker, then maybe. But otherwise...generally just if a loved one is ill. So if your loved ones or roommates haven't gotten it, you're probably not going to get it. One just doesn't go around licking the poles on the subway or the escalator rail, nor do we handle the dead like they do in West Africa.

IUHoosier, how long can the virus live on certain surfaces? Take, for example, a wet towel or a wet bar of soap? (Articles note disinfecting apartments).

On dry surfaces, not too long. The virus actually starts to degrade within minutes--so in whole, it's probably only on your average dry surface for a couple of hours. Doesn't mean it's necessarily contagious, however. It's also easily killed by standard disinfection procedures (aka household bleach). Rather wimpy when it comes to dry surfaces, actually. It's not like anthrax, which has a protective bubble around it so it can live for years in the soil.

Not sure about a 'wet' surface as you define it. Virus in bodily fluids (like a blood tube) can live for a couple days at room temp, but a bar of soap =/= blood. I personally wouldn't handle linens without protective gear just because of the type of contact with the patient. They're more likely to come in contact with the 3 big viral load carriers--blood, feces, and vomit.

High levels of Ebola have not been seen in saliva except in the sickest of patients (think near death or dead), and whole virus has never been seen in sweat. There was a study done in 2007 in an active Ugandan Ebola ward that swabbed ~40 different places (bed rails, stethoscopes, etc.) and NONE of them tested positive for the virus.

A little off topic, but another question for IUHoosiergirl88: how about MRSA? If someone is an active carrier, how serious should this be taken? Should this person be permitted to work in a kitchen, or kiss anyone?

And yes, I have someone in mind.

Thanks -- I am thinking of a typically wet bathtowel after a shower. One still rubs it all over one's body. I am also thinking of bar soap used to wash hands after using the toilet.

CNN has posted an interesting article on Gigi the robot.

Yes....in the early stages of infection there is not a lot of virus present in saliva or mucous. It also doesn't cause sneezing or coughing. So the likelihood that someone with very early disease would sneeze in your eye, or similar, is pretty darn low. The average person who is not a close family member or health care worker, would not be coming in contact with other fluids. Also....once people are at the point of having significant vomiting or diarrhea, they are probably not out and about. And certainly not at the stage where they'd be experiencing any bleeding issues related to the virus.

Feces/blood/vomit are all pretty equal, saliva is much much lower except when a patient is in advanced stages of the disease

You can not trust it all you want. However, the virology community actually knows a lot about Ebola, more than other hemorrhagic fevers that we don't see as often. The American public just doesn't have a high enough level of scientific literacy to understand if the data were presented to them. Fear is an easier response than educating one's self

Fruit bats are a reservoir for many nasty little diseases--Ebola being one of them. Bush creatures (monkeys, animals, whatever) come in contact with or eat infected bats, humans eat bushmeat and get infected. Rinse and repeat, that's caused every outbreak since the discovery of the Ebolavirus family (yes, there's different ones) in the summer of 1976. It probably was around before then, but that's the first time it was officially discovered and named.

In this outbreak, patient zero is assessed to be a 2 year old child in Guinea who died at the end of December 2013. (http://who.int/csr/disease/ebola/ebo...t-big.png?ua=1)

That's a logical thought, but they'll probably backfire and make the disease harder to control. If someone tells you you can't do something--what's the one thing you want to do? You want to do that thing. Plus, there aren't any direct flights from Liberia -> USA, so you'd have to stop ALL flights. And that is going to go over like a lead balloon.

The solution to this is twofold--make sure hospitals here are prepped (Texas Presbyterian wasn't, but tried to act like they were) and get folks on the ground in Liberia to get it contained. The UN acknowledged they blew this one, but it can be contained and burn out, just like it always has in the past. The bigger difference in this case is that it made its way into the big cities, whereas usually it hangs out in rural, isolated areas.

Nah. Although apes and monkeys are more closely related to humans, they have provided few diseases. Herded livestock and rodent pests are more frequent sources of human infections. The greater the population density of the animals a disease infects, the more opportunity that disease has to grow more virulent, to evolve new variants, and to spread.

And poultry.

As for flights, the two that have to date been most problematic are domestic, not international.

http://m.huffpost.com/us/entry/5998486

Most of these viruses and bacteria have been around long before humans have been here and will be around long after humans leave. If you want some reading material to illustrate this: "Level 4 Virus Hunters of the CDC" is a great book.

It came over here from Africa via Brussels, Belgium. If you ban travel from West African nations, those nations just aren't going to stamp passports--many nations do this now to obfuscate where their residents are actually coming from. If this happens, it looks like your patient zero came from Belgium, NOT West Africa. You've now made it harder to solve your problem of identifying people at risk. Now, everyone who came off an international flight displaying flu-like symptoms is an 'at risk' Ebola patient. You just took the risk pool from small to extremely large...and that's bad.


You keep throwing around a vaccine/cure like it's some easy thing to pull out of a hat. It's not--we have one possibly effective treatment (ZMAPP)--but that may prove in the long term to be no better than standard health practices. Ebola isn't a lucrative or high profile disease for pharmaceutical researchers, so developing a vaccine isn't high on their priority list. Ebola IS interesting for them because it is similar to a number of other related filoviruses, so if you knock out one you might be able to apply it to those other filoviruses...but maybe not.



The Ebola outbreak is a great opportunity for people to educate themselves on public health, science, and how things work in the pharmaceutical industry.

IUHoosier, thank you so much for the education! I particularly like how you illustrated that knee-jerk "solutions" actually compound and do not alleviate the risk. Exercising common sense -- which seemed to be in short supply in recent episodes -- can go a long way in managing risk.

Though I am not hanging out with wet towel at-risk folks, I am curious about the "shelf-life" of bugs and good health management practices. The Xenex robot probably is noisy like a CAT SCAn, but I like that it uses environmentally friendly xenon and see a lot of potential uses with proper use and without the knock-on effects of triclosan. Norovirus on cruise ships -- be gone! MRSA -- be gone!

Different contagious diseases spread in different ways. Some diseases are spread directly by rodents, but more often, insects act as intermediaries. Most diseases spread by rats and mice are actually carried by the fleas, lice, or ticks that live on the rodents. The way an infection spreads, greatly affects whether it becomes milder over the ages, stays much the same, or gets more virulent.

In my experience with some of my patients, a lot of times some of these viruses/diseases can be difficult to eradicate, because different diseases evolve at different rates. Generally, the fewer genes that are involved, the more rapidly the diseases evolve. Like with viruses, they evolve much faster than bacteria, because they have fewer genes. The fewer the number of genes, the more rapidly an organism can change yet remain functional.

For example, higher organisms have approximately 10,000-50,000 genes, bacteria have about 500-5,000 genes, and viruses have about 3-1,000 genes. So, the fewer genes, the more likely mutations will be tolerated and the faster evolution may occur. So, coming up with a solution is not as easy as you think it should be.

This has been going on since there has been written history and before. Measles and Chickenpox practically wiped out some Native American tribes brought by pioneers heading West and Syphilis was introduced to European explorers and taken to Europe. It's called Cultural Exchange and as the World has become easier to navigate so will the exchange, both the good and the bad. What I don't get is the ABSOLUTE PANIC Be smart but don't be a fear monger.As a resident of Dallas who lives just 3 miles West of Presby, I had to chuckle today as I visited CVS for some bandages and right there in the medicine aisle was a $2.98 special display for a gallon of bleach. I have a feeling Dallas is going to have some clean shiny homes after all this is said and done.

I kinda get what you're thinking, but the reality is people are going to get through borders and on flights no matter how much "locking down" we do of the borders. Plus, it's not cool to tell people "don't go helping the people who need it because you won't be welcome back". The rest of the world mostly thinks we're jerks (my opinion, of course) so why perpetuate that stereotype? If there aren't planes coming this way (due to locked down borders) then our humanitarian efforts can't get back that direction. Simple airline economics.

My understanding is that SARS (a few years ago) killed more people and was FAR more contagious than Ebola. Did we lock down our borders (or even discuss it?) to Asian countries then? Of course not. We shouldn't now either.

Go get a flu shot - that's probably your biggest viral threat right now & there IS a vaccine for that one! :)

IU Hoosier...thanks so much for all the good info! I find it very interesting reading. You too, CheerfulGreek.

This just posted on CNN, looks like Spain is having luck treating ebola.

http://www.cnn.com/2014/10/19/health...sis/index.html

Ditto what IUHoosierGirl and CheerfulGreek said - vaccines aren't just an easy thing to whip up.

It takes big bucks and resources to develop vaccines. Where was the real incentive to spend that kind of money for a disease that, while terrifying, had infected fewer than 2,500 people globally over the almost 40 years since it first popped up? (prior to the 2013-14 outbreaks, of course)(source)

Even if you do have the money and the will, it can take years to develop treatments. It depends on the nature of the virus and how wily it is.

I looked up the SARS outbreak the other day, because my memory was that SARS was much less scary than Ebola. The outbreak of 2002-03 killed fewer than 800 people, and had a fatality rate a little under 10% (source). The current Ebola outbreak has killed more than 4,500 people, and the fatality rate is likely between 50-70% (source).

I don't know about how contagious one is versus the other, but based on this thread, I suspect you're right that SARS is more contagious.

If we really want to talk about contagious, can we talk about how freaking contagious MEASLES is? There was a kid in the DC area who got measles last year, and public health officials were reporting all the locations this kid had been to while contagious but asymptomatic. Non-immune folks have up to a 90% chance of contracting it by getting near a contagious person.

Measles actually has a high R-naught value (aka the average number of people a sick person gets sick in an average uninfected population). The average measles patient infects 12-18 people, if it weren't for vaccines!

Just for comparison:
Measles: 12-18
Pertussis: 12-17
Diptheria: 6-7
Smallpox: 5-7
Polio: 5-7
Rubella: 5-7
Mumps: 4-7
HIV/AIDS: 2-5
SARS: 2-5
Influenza (1918 Spanish flu pandemic): 2-3
Ebola: 1-2

Ok, I know better than to go quoting crap I read without being able to find the source, so consider me wrong on the mortality/catchability of SARS! It was one of those things I read when people were discussing locking down borders, and the concept made sense to me (we didn't do it then, why now?) but of course I don't know how reputable my source was.

And ugh...yes...on measles. I remember when there was a big outbreak back in the late 80's. Was a big deal. Isn't the big thing about measles is that you're contagious when you don't know you have it? Once you have the symptoms, you're done being contagious? Like chicken pox? Ugh, ugh ugh.

1. It's not really a hygiene problem--do you know what spread the bubonic plague back in the day? Yup, fleas. People come in contact with fleas often due to pets. Bedbugs are still a problem in many major cities b/c they're so dang hard to get rid of. Lice actually are attracted to clean heads, vice dirty ones.

2. Do you know how many insect species live in this world? Around one million. And those are the only ones that have been discovered. Some estimate there may be as many as 30 million different species. Insects also play a crucial role in life as we know it, so getting rid of them isn't going to happen.

3. You "hate those other countries that don't like us"...have you ever been overseas (and Mexico/Canada doesn't count)? Most countries don't hate us. Even those that have unfriendly governments usually have American-friendly citizens. Putting that aside, Liberia and the USA are on good terms--we actually founded that country (their capital is named Monrovia after James Monroe). We went through a 5 year period from 1997-2003 where relations were a little rocky due to the election of Charles Taylor, but since he resigned in 2003, things have been pretty peachy. We actually deployed marines there to help stabilize the country during the Bush administration. Similar things can be said about Sierra Leone, and most of the other affected countries. They don't not like us.

Truth be told, even in the most hardcore, hardline anti-American governed countries, most of the citizens don't hate us.

I remember watching something on the history channel about the Bubonic Plague. I just remember it being spread by rats, and also, back then, people didn't practice the best hygiene measures. The thing that gets me, and maybe you or CG can answer this question, but what happened to the Bubonic Plague? Why aren't people affected by it today? A lot of the old diseases have seemed to "disappear", but the newer diseases are still doing damage. No, not like the Bubonic Plague, but still keeping numbers.

I actually agree with Iota guy in a sense. I find it to be aggravating giving other people in other countries "free healthcare", but people in this country don't receive it. Take care of your own lawn before you help someone else maintain theirs.

Nigeria is now Ebola-free:

http://www.nbcnews.com/storyline/ebo...-cases-n229536

Don Lemon on CNN right now: Nurse Amber Vinson's mother

Well, the diseases that are often carried by insects such as mosquitos/other external parasites, and flies or by animals such as rats and mice, in my experience, we've always referred to this as vectors. Sometimes multiple vectors are involved, such as (as mentioned above) in the spread of the Bubonic Plague by fleas carried by rats or typhus fever by ticks carried by rodents. I wouldn't say "eliminate", but controlling vectors usually limits the spread of a disease far more effectively than treating infected humans. In my experience as a vet, with my patients, insects and their relatives, the ticks and mites, are the most common vectors. Fleas also carry/transmit tapeworms.

However, other animals may act as vectors, as in the spread of rabies by bats and squirrels, or of West Nile virus by migrating birds. Plague and typhus normally rely on fleas and ticks to distribute them, although, under some circumstances, they can spread from person to person. Other diseases are obliged to spend part of their life cycles in a second host.

With the "hygiene" part of your post, you are partly correct. Hygiene/cleanliness does play a part, because infectious agents can also be taken in with food or drink. Poor hygiene may result in food or drinking water being contaminated with human and/or animal waste. Typically, such infections affect the gastrointestinal tract and include the many types of protozoa, bacteria and viruses that number diarrhea among their symptoms. I see it quite often with some of my patients that are outdoor pets. Parasites.

Well, over the long-term, novel diseases may adapt to humans or may go extinct. Adaption does not imply that the disease becomes mild -- merely that it gains the ability to survive and multiply in humans. The level of virulence acquired depends on the mode of transmission and how plentiful, crowded (and as said above), unhygienic the human hosts are.

I thought this was pretty interesting!

http://time.com/3522984/ebola-nigeria-who/

I always thought that natural selection and population resistance had something to do with it, in addition to basic hygiene and city planning. Several major rounds of plague destroyed pretty large portions of the population in some cases. In the middle ages, a major bout wiped out more than a third of the European population. Isn't that classic Darwinism?

Also, it's a bacterial infection, so several antibiotics are effective treatment against it, no?

Family says that Amber Vinson is free of ebola.

Wonderful news if this is the case. Hopefully she can be reunited with her family/friends in either Dallas or Ohio soon.

Its still around. It turns up from time to time in Colorado New Mexico or Arizona. I think usually in children that have been bitten by mice or rats, but it can be treated with antibiotics and so they may end up in the hospital but treated okay.

Its less contagious but turns up with about the same frequency as Hanta virus, but Hanta can be in dust a particulates left behind by rodents and can be prevented by wearing a dust mask or respirator when working in an attic or woodpile - some place you would expect rodents

Well, I don't know much about the history of diseases/viruses as far as how many civilizations were wiped out because of it. However, I do know that under some circumstances, diseases change little in their virulence or even get worse. Moreover, some, like bubonic plague, appear to oscillate in virulence.

Yep. It's caused by the bacterium Yersinia pestis, which infects many animals, especially rodents. From these it can be transmitted to humans (and their cats and dogs) by fleas.

What I don't understand is why would fleas leave the shelter of the fur/hairs on furry animals such as rats to venture onto the exposed surface of the relatively hairless, like people? I remember when I was a kid, our dog had fleas, and not only were they biting the dog, they were biting the hell out of us, too. That is until we eliminated them.