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morningfog

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Member since: Thu Jan 12, 2012, 03:24 PM
Number of posts: 9,468

Journal Archives

Dallas Ebola infection/incubation timeline 10.21.14

Duncan's family and pre-isolation contacts have been cleared and are no longer on the timeline.

Days since Duncan's death (Oct. 8)......13 days -- 76 people provided care to Duncan before his death. As of today, two nurses, Nina Pham and Amber Vinson, have shown symptoms and infection has been confirmed.

Days since Pham showed symptoms (Oct. 10).....11 days -- One person is being observed as having direct contact with Pham after she showed symptoms. She's being treated at NIH in Maryland.

Days since Vinson showed symptoms (Oct. 14)......7 days -- Vinson flew on a commercial flight (with some 100 other passengers) from Cleveland to Dallas with a temperature of 99.4 degrees. She was quarantined and transferred to Emory.

______________________________________________________

The incubation period of this strain is 7-10 days in most people who become infected.

Both Pham and Vinson were isolated when they had no symptoms other than a low-grade fever. Their viral load was low and it is unlikely they infected anyone prior to isolation.

The 74 other people in the same class/timeline as Pham and Vinson have passed through the most critical period, now at 13 days. If more post-isolation workers were infected, they would most likely have shown symptoms already. However, they do have another 8 days before the 21 day incubation watch period expires.

Pham's one pre-isolation contact is on their 11th day. They too are exiting the point were they would be most likely to show symptoms if infected. However, they do have 10 days before the 21 day incubation watch period expires.

Vinson's pre-isolation contacts are entering the critical period at 7 days now.

Pham and Vinson are being treated in centers who know what they are doing. It is unlikely any workers there will be infected, even if their current conditions deteriorate.

(NBC) Journalist being treated for Ebola still improving (could be released this week)

The Nebraska doctors treating an American video journalist for Ebola say he could be released by the end of the week if tests show he’s free of the deadly virus.

Ashoka Mukpo (ah-SHOH’-kuh MUK’-poh) has been treated at the Nebraska Medical Center in Omaha since Oct. 6.

He has been improving steadily since receiving an experimental Ebola drug and a blood transfusion from someone who survived the virus although he remains weak.

Dr. Mark Rupp said Monday that Mukpo could be released from the hospital’s isolation unit in the next few days if the U.S. Centers for Disease Control confirms he is Ebola-free.

http://www.washingtonpost.com/national/health-science/journalist-being-treated-for-ebola-still-improving/2014/10/20/d455e17c-588e-11e4-9d6c-756a229d8b18_story.html

Duncan's family being cleared shows how hard it is to catch Ebola in early stages.

I think this goes to the disconnect in the public perception and fuels the panic. It is hard to be infected by someone in the early stages, but it is incredibly infectious in the later stages. This is why nurses and doctors and other primary care providers have such high infection rates. This is why is spreads so much in the cultures with burial rituals that involve touching, cleaning and kissing the corpse.

This is why it is very unlikely that the people on Vinson's flight (and everyone else in Cleveland) have been infected. And why we can all take a breath and begin to look at the light of the end of the Ebola in the US tunnel. Until the next person brings it in.


* * *

The fact that Duncan's family remained healthy even as two of his nurses became infected illustrates the peculiar nature of Ebola, said Peter Hotez, dean of the National School of Tropical Medicine and professor at Baylor College of Medicine in Houston.

Although the West Africa outbreak of Ebola has a 70% mortality rate, the virus is actually not very contagious in the early stages of disease when people are most likely to circulate in the community, Hotez said. Ebola doesn't spread through coughs and sneezes, only through direct contact with bodily fluids.

Even then, people aren't contagious at all until they begin showing symptoms such as a fever. Before symptoms appear, levels of the virus in their blood are too low to be measured, Hotez said.

Yet Ebola is frighteningly infectious at advanced stages of the disease, when the virus begins multiplying out of control and patients begin producing large amounts of diarrhea, vomit and blood. At that point, even a tiny amount of blood is teeming with Ebola, which puts nurses and caregivers at high risk, Hotez said.

Few people in the general community are exposed to Ebola patients who are that contagious, because patients at that stage are usually too sick to move around. Most are hospitalized if a bed is available. In West Africa, patients who can't get to a hospital are bedridden and typically attended by relatives.

Those aspects of Ebola help explain why, on average, people in West Africa spread the disease to only one or two other people, said Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. In contrast, people with an airborne virus such as measles can spread the disease to 14 susceptible people.

Ebola has spread in West Africa because of burial rites that aren't practiced in the USA, in which relatives of the deceased touch the body and prepare it for the grave.

Only about 15% of Ebola cases in West Africa involve children, reflecting the fact that children are rarely home caregivers, Offit said.

http://www.usatoday.com/story/news/nation/2014/10/19/ebola-quarantine-ends/17443059/

Dozens Declared Free of Ebola Risk in Texas; No Longer Ebola in Spanish Nuring Assistant

At least one chapter of the Ebola saga neared a close Sunday, as most of the dozens of people who had direct or indirect contact here with Thomas Eric Duncan, the Liberian man who died of Ebola, had been told by officials that they were no longer at risk of contracting the disease.

Mr. Duncan’s fiancée, Louise Troh, who nursed him in their cramped apartment while he suffered from diarrhea and who was put under state-ordered quarantine, was set to be declared Ebola-free by officials at the end of Sunday. So, too, were the paramedics who drove an ailing Mr. Duncan to a hospital and health care workers who drew or processed his blood. And a mandatory quarantine was lifted for a homeless man who later rode in the same ambulance as Mr. Duncan before it was disinfected.

The 21-day monitoring period ended Sunday and Monday for nearly all the roughly 50 people. It concludes as federal health officials are tightening the guidelines for the protective gear worn by health care workers treating Ebola patients.

* * *

All of those whose monitoring was coming to an end had been potentially exposed to Mr. Duncan before he was admitted and put into isolation at the hospital on Sept. 28. They have been released from monitoring in stages. At least 14 of them had been released by Saturday. Others were released Sunday afternoon and some, like Ms. Troh, were released midnight Sunday. A few others may be released after Monday, officials said.

“It’s a significant hurdle for us to get over,” Mayor Mike Rawlings said. “It brings a little bounce in our step, because we know the science is working.”

The Ebola virus has an average eight-day to 10-day incubation period, but federal health officials recommend monitoring exposed people for symptoms for 21 days.

Dozens of others continue to be monitored. On Sunday, federal officials released updated numbers and said they were monitoring 149 people total, including the contacts of Mr. Duncan as well of Ms. Pham and Ms. Vinson. Most of those 149 are health care workers who treated Mr. Duncan. But some of them are passengers on a Frontier Airlines flight that Ms. Vinson took from Cleveland to Dallas the day before she showed symptoms. The federal Centers for Disease Control and Prevention has said passengers on that flight, and those on Ms. Vinson’s first flight from Dallas to Cleveland, were at low risk.

* * *

In Spain, officials said Sunday that tests showed that a nursing assistant who had been infected with Ebola has no traces of the virus left in her bloodstream. The medical worker, Teresa Romero, 44, contracted Ebola after caring for priests who got Ebola while doing missionary work in West Africa. Officials said Ms. Romero must undergo at least one more Ebola test to make sure she is virus free.

http://www.nytimes.com/2014/10/20/us/ceo-of-texas-hospital-group-at-center-of-ebola-scare-apologizes-for-mistakes.html?_r=0

Dallas Ebola infection/incubation timeline 10.19.14 (Duncan's family in 21st day!)

Days since Duncan showed symptoms (Sept. 24)......24 days.


Days since Duncan was isolated (Sept. 28).....20 days -- 48 people are being observed in this group, including his family and the first responders. No one from this group has shown any symptoms of infection. This is their 21st day!


Days since Duncan's death (Oct. 8)......10 days -- 76 people provided care to Duncan before his death. As of today, two nurses, Nina Pham and Amber Vinson, have shown symptoms and infection has been confirmed.


Days since Pham showed symptoms (Oct. 10).....8 days -- One person is being observed as having direct contact with Pham after she showed symptoms. She's being treated at NIH in Maryland.

Days since Vinson showed symptoms (Oct. 14)......4 days -- Vinson flew on a commercial flight (with some 100 other passengers) from Cleveland to Dallas with a temperature of 99.4 degrees. She was quarantined and transferred to Emory.

______________________________________________________


The class of people exposed to Duncan pre-isolation have not shown symptoms and likely will not. The incubation period of this strain is 7-10 days in most people who become infected. Today is the 21st day since exposure and tomorrow the incubation period will expire.

Both Pham and Vinson were isolated when they had no symptoms other than a low-grade fever. Their viral load was low and it is unlikely they infected anyone prior to isolation.

The 74 other people in the same class/timeline as Pham and Vinson are nearing the end of the most critical period.l period. If more were infected, they would most likely have shown symptoms by today, the 10th day. However, they have another 11 days before the 21 day incubation period expires.

Of course, the clock has just started (and will restart) for those treating Pham and Vinson. Pham has been upgraded to "good condition" following treatment and a blood transfusion from Dr. Brantly. VInson is to be transferred to Emory for treatment.


Duncan's pre-isolation contacts are out of the woods. No one outside of the hospital was infected by Duncan.

Pham and Vinson are being treated in centers who know what they are doing. It is unlikely any workers there will be infected, even i their current conditions deteriorate.

Pham and Vinson each had close contact with one individual after their temperature rose. Other than those two, there is little to no worry whatsoever of infection for those on the plane, in the general public, in schools,on cruise ships or anywhere in Ohio or Dallas.

In short, we are nearing a point, despite the fear and paranoia, where we can feel safe that Ebola in the US was contained to three individuals.

To put the risk to passengers on Vinson's flight in perspective, consider Patrick Sawyer

Patrick Sawyer, Nigeria's index patient, flew into Lagos while infected with Ebola. Sawyer was severely ill on his flights. He collapsed in the terminal. His symptoms were orders of magnitude worse than Vinson's 99.5 degree temperature. And no one, not one passenger, was infected by Sawyer during his travel. All subsequent infections in Nigeria were health care workers providing care to him.

Also consider Duncan's family. They lived with him for four days with a much higher fever and worsening symptoms. While not all the way out of the woods, they are pretty damn close, at day 18 since exposure.

The CDC has made a series of mistakes, blunders and really bad PR decisions. They have lost the public trust. They shouldn't have approved Vinson flying, it just looks really bad. They should have known better.

But, that is a different question than what is the actual risk to the passengers. While it can't be said to be "zero," the risk of infection to the passengers is very, very low. If anyone is infected by Vinson, it would likely be her fiance. But, even he should be fine.

As for the secondary fallout, schools and business where someone who was on Vinson's plane works, there is no scientific basis for it. It is pure hysteria.

I hope Vinson's case is our Ebola teaching moment.

Scientists Say Ebola’s Transmission Route Unlikely to Have Changed

News that two Dallas nurses were infected with Ebola despite wearing protective gear has sparked fears that the virus may be changing in a way that scientists don’t yet understand—by becoming airborne, for example.

While there’s no doubt that the Ebola virus is constantly altering its genetic makeup, those changes don’t seem to add up to anything significant so far. That makes scientists confident that Ebola hasn’t suddenly acquired the ability to be transmitted via air and that it is unlikely to do so.

“Ebola is more-or-less the same as it was in 1976,” when it was discovered, said Ian Jones, professor of virology at the University of Reading in the U.K. “Most viruses, once they’ve established a way of life, stick with it.”

No human virus is known to have changed its mode of transmission. Viruses like yellow fever that are transmitted by mosquitoes, or HIV that is transmitted by body fluids, continue to be passed on in the same way.

Ebola’s transmission route hasn’t changed either. It is usually the result of close and direct physical contact with a patient’s infected body fluids, especially blood, feces and vomit. While the virus can also be transmitted indirectly—via contaminated surfaces and objects—that risk is low and it can be lowered further by disinfection procedures. Ebola can survive on dry surfaces, such as doorknobs, for several hours but is easily killed.

Viruses that store their genetic information in DNA, such as small pox, typically don’t undergo a large number of mutations. By comparison, RNA-based viruses such as Ebola and HIV are less stable. HIV’s high mutation rate is one reason why it’s so hard to develop a vaccine for it.

So it wasn’t a big surprise when a study published in the journal Science in August found the 2014 Ebola virus had undergone more than 300 genetic changes compared with the virus that caused earlier outbreaks in the region.

What did those changes amount to? Is Ebola changing in a way that allows its host to live a few weeks longer, so that it could potentially infect even more people? Is it acquiring properties that could make it airborne?

The answer to those questions is no. “There’s no evidence that a particular mutation is being selected,” said Dr. Jones. “We don’t see anything happening that’s changing the direction of the virus in one direction or another.”


http://online.wsj.com/articles/scientists-say-ebolas-transmission-route-unlikely-to-have-changed-1413475957

The CDC's big mistake re: Vinson's flight was its reaction to the media

The CDC should have responded, but not reacted. The CDC should have said why Vinson was not a serious risk with a temperature of 99.5 degrees. The CDC should have repeated that infections are only through direct contact with bodily fluids and that infections are less likely in the early symptoms. It would have been more effective to educate the public on the risks, rather than adapt policy based on media and public reaction.

Instead, the CDC reacted and has now put contradictory messages out there that fuel confusion and panic.

Dallas Ebola infection/incubation timeline 10.16.14

Days since Duncan showed symptoms (Sept. 24)......22 days.


Days since Duncan was isolated (Sept. 28).....18 days -- 48 people are being observed in this group, including his family and the first responders. No one from this group has shown any symptoms of infection.


Days since Duncan's death (Oct. 8)......8 days -- 76 people provided care to Duncan before his death. As of today, two nurses, Nina Pham and Amber Vinson, have shown symptoms and infection has been confirmed. Pham was in his room often, from the day of his admission until the day before he died, which is when he would have been the most infectious and his bodily fluids contain the highest viral load. Vinson was in his room during the three days prior to the hospital wearing hazmat suits. It is unclear when her last contact with Duncan was.


Days since Pham showed symptoms (Oct. 10).....6 days -- One person is being observed as having direct contact with Pham after she showed symptoms.

Days since Vinson showed symptoms (Oct. 14)......2 days -- Vinson flew on a commercial flight (with some 100 other passengers) from Cleveland to Dallas with a temperature of 99.4 degrees. She was quarantined and will be transferred to Emory.

______________________________________________________


The class of people exposed to Duncan pre-isolation have not shown symptoms and likely will not. The incubation period of this strain is 7-10 days in most people who become infected. In three days the 21 day incubation period will expire.

Both Pham and Vinson were isolated when they had no symptoms other than a low-grade fever. Their viral load was low and it is unlikely they infected anyone prior to isolation.

The 74 other people in the same class/timeline as Pham and Vinson are now in the critical period. If more were infected, they will most likely show symptoms in the next 1-4 days, with just over two weeks to go until the 21 days.

Of course, the clock has just started (and will restart) for those treating Pham and Vinson. Pham has been upgraded to "good condition" following treatment and a blood transfusion from Dr. Brantly. VInson is to be transferred to Emory for treatment.


Both infected nurses treated Duncan between Sept. 28 and Sept 30.

This was the period before Ebola had been confirmed in Duncan, but during the period in which he had violent vomiting and diarrhea. The period before the hospital used hazmat suits to treat him.

The important question is how many others treated him during that period? How many of the other 74 who treated him did so during that period? They seem to be the ones most at risk.

The CDC's investigation suggests that health care workers were at highest risk from Sept. 28 to Sept. 30, the three days before Duncan was diagnosed. Both nurses who contracted Ebola worked on those days and had extensive contact with him when he had vomiting and diarrhea, Frieden said.

Medical records indicate that the workers wore protective equipment, including gowns, gloves and face shields during that time. The first mention in the records that they wore hazmat suits was on Sept. 30.

http://abcnews.go.com/Health/wireStory/texas-dept-2nd-person-tests-positive-ebola-26206324?page=2
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