I recently finished a little consulting work and with some time on my hands I want to start like 4 or 5 threads but thought I'd start with this. I am considering firing up my old health blog, may at some point, but it is sort of catch 22 in that I want to discuss this but it is certainly going to be an emotional topic, my views are not necessarily conventional and if my old blog were on some outside chance to become wildly successful and the views widely picked up on, well I like consulting and hope to do more. So while seeing how things go I hope I can discuss it on this forum which is devoted primarily to so many eclectic energy related topics.
To start off then, this outbreak is the real deal, while I have about zero clinical experience I do say that as an MD with an MPH in epidemiology. I will begin with reasons to be very validly concerned but also talk about why I really doubt this will become some sort of replay of the black plague of centuries ago. So on the quite concerning front 1) the number of cases for about 2 1/2 - three months, since mid May, has been doubling in just over a month, faster than that recently. Ten doublings is a 1024 fold increase, there are currently about over 2,000 cases, so if the current trend were to continue unabated in a year there would be over 2 million cases, in three years everyone who would get it would have. What caught my attention and what is frightening is that the disease was doubling in a month with every patient placed in quarantine. I posted elsewhere weeks ago that if this disease breaks quarantine we would see a much quicker doubling time. That has happened and is starting to show up in recent disease outbreak posting numbers. In addition, this past week we have admissions that the true number of cases (as quarantine is broken) are no longer being captured and are much higher than official numbers. A Doctors without Borders (the primary boots on the ground group) doctor said in congressional testimony that the true number is probably 2-4x higher and there are "hundreds" of dead bodies in the streets of cities. Other health officials are also now saying the outbreak is much larger than the numbers indicate. So this leads to
2) How infectious is the disease? As an aside I've heard some people saying, why influenza kills 20,000 a year in this country and no one worries about that. Well, well, well then for comparisons sake the 1917 influenza outbreak killed 50-100 million (with a smaller world population) in two years, likely played a large role in ending WW I and had a case fatality rate of 5%. Ebola has a case fatality rate of 60% in the cohort of patients that received supportive care that are captured in the statistics. So how infectious is it, that really is the question. I don't like to say this especially with just a couple months data but it looks pretty darn infectious to me, the trend is quite disturbing, you also have so many of these doctors in moon suits taking every precaution to avoid infection still getting infected. We then can turn to Patrick Sawyer, the Ebola victim who flew into Lagos, Nigeria, barfed all over the plane and expired in a Nigerian hospital two days later (they closed down the whole hospital the next day). So another way of looking at infectivity is looking at how many new cases an infected person generates, with SARS and influenza it is in the 3-4 new cases per infectious person. Mr Sawyer infected 12 people in Nigeria in two days. Now we can say hey that was an extraordinary situation, he was in an airport and the hospital never suspected Ebola. So let's take a WAG that un-quarantined an Ebola patient infects 4 not 12 others. While incubation can last up to 21 days an average might be two weeks. So you see the problem? If one infection leads to 4 more in two weeks that is a doubling time of one week not over one month, if the current trend continues uninterrupted we may not have two years.
3) How is it transmitted? There seems to be this fixation on "oh not airborne, party on". Plague wasn't airborne, malaria isn't airborne. Ebola seems to transfer primarily from sweat and from fomite transmission (i.e. some one wipes their sweaty brow on a rag you grab the rag you get infected). As to the latter, there is a disturbing article (i'll dig it out if need be) from a previous 2012 Ebola outbreak where a thief stole a cell phone from an Ebola patient and subsequently got Ebola from the cell phone. Fomite transmission would also explain the many healthcare workers, about a hundred, getting the disease. It strikes me as even more socially disruptive than airborne transmission. A classic example of fomite transmission is the norovirus, diarrheal outbreaks on cruiseships. Once it gets hold you generally hear of them limping back to port to offer refunds.
4) Was this a weaponized attack? I doubt it, I am pretty sure Ebola has been looked at for weapon potential and may have been weaponized but a) the outbreak almost was extinguished (after two months) in Mid may with less than a new case per day. b) There was no media coverage complete with frothing demagoguery and glaring (gloating?) errors. c) It is a pretty indiscriminate thing to use as a weapon. Ebola has had many previous outbreaks they just never made it to population centers, I'll give a 1 or less percent chance of it being a weaponized attack. If you wanted to go entirely weird science, if there are EM weapons that could degrade immune response in a population that might explain the apparent increase in infectivity. Then you are left with qui bono? Who knows but I would give the very silly idea less than 1% of the previous less than 1%, to my knowledge there were no EM weapons in medieval Europe but plague did just fine wiping out a third of Europe.
5) Why this isn't the Zombie apocalypse. In a nutshell I'm pretty certain Ebola can be cured or at least greatly mitigated through both conventional and alternative approaches. When I first started paying attention about a month ago I thought very cynically I bet they will try and wait for a vaccine. That appears to be exactly what they are doing but they may be underestimating the rapidity of spread. The current line of contact tracing and patient quarantine has failed. The disease could be localized in Western Africa if you really go martial law, i.e point guns at people's heads and say go back. A charity organization doctor would need to dig out the url said she has been to the check points and the people just walk around them. There is a chance that the lack of infrastructure (i.e. electricity, running water) in the area is a significant reason behind the spread but I wouldn't count on it behaving differently in the U.S. if it took hold. Then again CDC's Freidman said about it coming to the U.S. "it's not in the cards" so who I am to dispute a tarot card reader. Alright, need to wrap this up, for perspective, again I'll need to did out the URL if asked, but when a USAMRID worker had an Ebola needle stick they called a group and asked for a treatment to be made over the week-end, five days later they gave the drug though the patient was negative for disease. The point being if they cut the redtape and BS, they could mass produce a number of promising drugs probably in a month or two at least that is my guess. The Zmapp drug likely works, it is a monoclonal variant of a 100 year old approach, namely take the toxin or disease, give it to an animal, let the animal mount an immune response then spin down the antibodies the animal mounted against the disease as a treatment. Works for tetanus, pertussis, diptheria ever hear of rabies anti-serum (and rabies is about 100% fatal, so it can be safely made). As I said the Zmapp is a modern variant to this tried and true approach, there are other conventional approaches, but they are not ramping things up with any alacrity or sense of danger. Lastly a couple others, massive IV vitamin C is a glorious anti-viral, Fred Klenner, MD cured 60 polio virus cases in a row with it in the midst of a U.S. polio epidemic, never adopted, which is why I am not optimistic about non-patentable approaches. Just reviewed the medical literature on colloidal silver as an anti-viral, there is a lot to be optimistic about there, it might help a lot. Even more optimistically I saw just today that Nigeria is going to use "nano-silver" (not sure why they call it nano, they do that in the medical literature [for no reason] as well, I think if they called it micron silver people would realize they can make it from two silver dollars and a nine volt battery). If it works and is adopted the outbreak should be over in a couple weeks. If things continue on their current trend, untreated, uninterrupted and this isn't a consequence of the area's great poverty it will be an interesting 2015.
To start off then, this outbreak is the real deal, while I have about zero clinical experience I do say that as an MD with an MPH in epidemiology. I will begin with reasons to be very validly concerned but also talk about why I really doubt this will become some sort of replay of the black plague of centuries ago. So on the quite concerning front 1) the number of cases for about 2 1/2 - three months, since mid May, has been doubling in just over a month, faster than that recently. Ten doublings is a 1024 fold increase, there are currently about over 2,000 cases, so if the current trend were to continue unabated in a year there would be over 2 million cases, in three years everyone who would get it would have. What caught my attention and what is frightening is that the disease was doubling in a month with every patient placed in quarantine. I posted elsewhere weeks ago that if this disease breaks quarantine we would see a much quicker doubling time. That has happened and is starting to show up in recent disease outbreak posting numbers. In addition, this past week we have admissions that the true number of cases (as quarantine is broken) are no longer being captured and are much higher than official numbers. A Doctors without Borders (the primary boots on the ground group) doctor said in congressional testimony that the true number is probably 2-4x higher and there are "hundreds" of dead bodies in the streets of cities. Other health officials are also now saying the outbreak is much larger than the numbers indicate. So this leads to
2) How infectious is the disease? As an aside I've heard some people saying, why influenza kills 20,000 a year in this country and no one worries about that. Well, well, well then for comparisons sake the 1917 influenza outbreak killed 50-100 million (with a smaller world population) in two years, likely played a large role in ending WW I and had a case fatality rate of 5%. Ebola has a case fatality rate of 60% in the cohort of patients that received supportive care that are captured in the statistics. So how infectious is it, that really is the question. I don't like to say this especially with just a couple months data but it looks pretty darn infectious to me, the trend is quite disturbing, you also have so many of these doctors in moon suits taking every precaution to avoid infection still getting infected. We then can turn to Patrick Sawyer, the Ebola victim who flew into Lagos, Nigeria, barfed all over the plane and expired in a Nigerian hospital two days later (they closed down the whole hospital the next day). So another way of looking at infectivity is looking at how many new cases an infected person generates, with SARS and influenza it is in the 3-4 new cases per infectious person. Mr Sawyer infected 12 people in Nigeria in two days. Now we can say hey that was an extraordinary situation, he was in an airport and the hospital never suspected Ebola. So let's take a WAG that un-quarantined an Ebola patient infects 4 not 12 others. While incubation can last up to 21 days an average might be two weeks. So you see the problem? If one infection leads to 4 more in two weeks that is a doubling time of one week not over one month, if the current trend continues uninterrupted we may not have two years.
3) How is it transmitted? There seems to be this fixation on "oh not airborne, party on". Plague wasn't airborne, malaria isn't airborne. Ebola seems to transfer primarily from sweat and from fomite transmission (i.e. some one wipes their sweaty brow on a rag you grab the rag you get infected). As to the latter, there is a disturbing article (i'll dig it out if need be) from a previous 2012 Ebola outbreak where a thief stole a cell phone from an Ebola patient and subsequently got Ebola from the cell phone. Fomite transmission would also explain the many healthcare workers, about a hundred, getting the disease. It strikes me as even more socially disruptive than airborne transmission. A classic example of fomite transmission is the norovirus, diarrheal outbreaks on cruiseships. Once it gets hold you generally hear of them limping back to port to offer refunds.
4) Was this a weaponized attack? I doubt it, I am pretty sure Ebola has been looked at for weapon potential and may have been weaponized but a) the outbreak almost was extinguished (after two months) in Mid may with less than a new case per day. b) There was no media coverage complete with frothing demagoguery and glaring (gloating?) errors. c) It is a pretty indiscriminate thing to use as a weapon. Ebola has had many previous outbreaks they just never made it to population centers, I'll give a 1 or less percent chance of it being a weaponized attack. If you wanted to go entirely weird science, if there are EM weapons that could degrade immune response in a population that might explain the apparent increase in infectivity. Then you are left with qui bono? Who knows but I would give the very silly idea less than 1% of the previous less than 1%, to my knowledge there were no EM weapons in medieval Europe but plague did just fine wiping out a third of Europe.
5) Why this isn't the Zombie apocalypse. In a nutshell I'm pretty certain Ebola can be cured or at least greatly mitigated through both conventional and alternative approaches. When I first started paying attention about a month ago I thought very cynically I bet they will try and wait for a vaccine. That appears to be exactly what they are doing but they may be underestimating the rapidity of spread. The current line of contact tracing and patient quarantine has failed. The disease could be localized in Western Africa if you really go martial law, i.e point guns at people's heads and say go back. A charity organization doctor would need to dig out the url said she has been to the check points and the people just walk around them. There is a chance that the lack of infrastructure (i.e. electricity, running water) in the area is a significant reason behind the spread but I wouldn't count on it behaving differently in the U.S. if it took hold. Then again CDC's Freidman said about it coming to the U.S. "it's not in the cards" so who I am to dispute a tarot card reader. Alright, need to wrap this up, for perspective, again I'll need to did out the URL if asked, but when a USAMRID worker had an Ebola needle stick they called a group and asked for a treatment to be made over the week-end, five days later they gave the drug though the patient was negative for disease. The point being if they cut the redtape and BS, they could mass produce a number of promising drugs probably in a month or two at least that is my guess. The Zmapp drug likely works, it is a monoclonal variant of a 100 year old approach, namely take the toxin or disease, give it to an animal, let the animal mount an immune response then spin down the antibodies the animal mounted against the disease as a treatment. Works for tetanus, pertussis, diptheria ever hear of rabies anti-serum (and rabies is about 100% fatal, so it can be safely made). As I said the Zmapp is a modern variant to this tried and true approach, there are other conventional approaches, but they are not ramping things up with any alacrity or sense of danger. Lastly a couple others, massive IV vitamin C is a glorious anti-viral, Fred Klenner, MD cured 60 polio virus cases in a row with it in the midst of a U.S. polio epidemic, never adopted, which is why I am not optimistic about non-patentable approaches. Just reviewed the medical literature on colloidal silver as an anti-viral, there is a lot to be optimistic about there, it might help a lot. Even more optimistically I saw just today that Nigeria is going to use "nano-silver" (not sure why they call it nano, they do that in the medical literature [for no reason] as well, I think if they called it micron silver people would realize they can make it from two silver dollars and a nine volt battery). If it works and is adopted the outbreak should be over in a couple weeks. If things continue on their current trend, untreated, uninterrupted and this isn't a consequence of the area's great poverty it will be an interesting 2015.
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