Strains of Ebola; How Contagious is Nurse Nina Pham?

View 847 Friday, October 24, 2014

“I have observed over the years that the unintended consequences of social action are always more important, and usually less agreeable, than the intended consequences.”

Irving Kristol

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

For summaries of what is believed or known about strains of Ebola, see the messages from Stephanie and Brian below.

We do not yet know what strain of Ebola Dr. Craig Spencer has, nor are we really sure we know how Ebola is transmitted. In most cases the transmission mechanism is direct contact with bodily fluids – sweat, sputum semen, blood, mucus – of someone showing at least some symptoms of Ebola. In those cases infection rates appear to be very high

We have anecdotal stories of infection through other means, but those are stories fro the plague zone with no confirmation.

We can be fairly certain that there is no risk of catching Ebola from physical contact with a recently recovered Ebola patient; recovered Nurse Nina Pham was admitted to the presence of President Barrack Obama, and was given a Presidential hug in the Oval Office.

Apparently it is not so certain whether you can catch Ebola from a pet; Miss Pham’s Spaniel, Bentley, will be held in quarantine for another ten or so days before being allowed to come home, but Nurse Pham, a now recovered Ebola victim, will be allowed to play with him and give him a hug while remaining in quarantine from those not known to be immune to Ebola. We suppose that once Nurse Pham recovers sufficiently, she will be a source of plasma with anti-Ebola enzymes, which we will need if there are further outbreaks in the United States.

Given current policies such are nearly inevitable. Dr. Spencer, known to have been exposed to Ebola, came home and was not quarantined. He went to restaurants, rode subways, and went bowling. The cost of his failure simply to stay home and avoid contact people needlessly is estimated to be in the millions of dollars. Some officials have called for his prosecution for his behavior upon his recovery.

Nurse Vinson, who like Nurse Pham contracted Ebola while treating Thomas Duncan, is said to be recovering, and now has a positive prognosis. Duncan, who came from Liberia after conducting a dying Ebola patient in a vain search for a hospital that would admit her, died a few days after exhibiting Ebola symptoms. Prior to that he slept with his fiancé, and associated with many people, none of who appear to have contracted Ebola, even though two of his caretakers did come down with it within days of his death. http://www.myfoxdfw.com/story/26880079/family-friends-of-thomas-duncan-protest-outside-hospital

We may conclude that the Duncan strain of Ebola is not very contagious up to and even into the first stages of exhibiting symptoms. So far as I know we have no evidence to support similar hypotheses regarding the strain that Dr. Spencer exhibits. Doctors Without Borders does not require that its physicians remain in isolation for any period of time after they cease to treat patients and before leaving the plague zone. As a US citizen Dr. Spencer had every right to return to the United States. New York City had every right to require him to remain in self-quarantine so as to minimize the number of people with whom he would have had contact, thus saving millions of dollars in investigations of his contacts immediately before he developed symptoms; but nothing of the sort was imposed, and Dr. Spencer was left to his own devices. Apparently he was so certain that he had not been exposed and could not be contagious that he roamed the city, running in the parks, eating in public restaurants, probably shopping in local food markets, riding the subways, and going bowling. The assumption is that his (unknown) strain of Ebola is similar to that of Mr. Duncan, contagious only after symptoms have been fully developed. We may all hope that this assumption is true; evidence against it is anecdotal and comes from survivors in the plague zone.

Dr. Spencer’s timeline from Guinea to diagnosis of Ebola is given here: http://www.cnn.com/2014/10/24/health/new-york-ebola-timeline/index.html

I have asked for a summary of what is known about Ebola strains and their degree of contagion abilities, and we’ll report on that when I get it,

Nigeria, through a very strict enforcement of quarantine, has managed to emerge from being a plague zone. The United States has not implemented any such policy. So far there have been only two cases of Ebola in the US contracted from someone imported from the plague zone. At the moment we are winning the bet that Ebola won’t spread in the US.

From the October 17 View:

Nine Doctors Without Borders physicians, all equipped with the best of isolation and prophylactic gear, have died of Ebola. Of the physicians and nurses who have died of Ebola in this epidemic, most (more than 60%) had what was considered more than adequate protective gear and were instructed in its use. The US Military being sent into the plague zone have had four hours of instruction. https://www.jerrypournelle.com/chaosmanor/a-new-ebola-czar-military-deploys-to-plague-zone-competence-in-government/

I have errands. Back later this afternoon.

Far Cries

Dear Jerry,

You’ve talked about the new publishing and I wanted to let you know I’m plunging in with both pedal extremities. My backlist is handled by Open Road Media, the biggest e-publisher in New York, but I am trying to put out new stuff on my own, via Kindle Direct Publishing. The trouble is, you cannot, as in days of yore, sit back and leave everything to the publisher. You have to promote your stuff. There are various mechanisms for that sort of thing, but it’s all a new universe to me. So I am flogging my new collection of short stories.

Far Cries – Kindle edition by John DeChancie. Literature & Fiction Kindle eBooks @ Amazon.com. <http://www.amazon.com/Far-Cries-John-DeChancie-ebook/dp/B00O2PLT54/ref=sr_1_11?ie=UTF8&qid=1414181338&sr=8-11&keywords=Far+Cries>

I can pretty well guarantee that no one will have seen the likes of these stories before. Finally an answer to the question of why Presidents would keep the alien prisoner a secret…

Transmission of Ebola

You have stated that Ebola is non transmissible after recovery.

That appears to not be the case. I have read that patients that recover are still shedding virus for several days after ending symptoms. It may be a short time but anyone who plays with death is a fool, cutting the isolation time to zilch is a risk no sane individual should attempt, even if it is for political points.

Earl

Actually I have not said that, except in irony: the evidence being that Nurse Nina was permitted into The Presence just after she was pronounced ‘cured’ of Ebola. It is clear that this is the official view, else she would not have been permitted in The Presence, much less the recipient of a hug. Perhaps the Ebola Czar, formerly chief of staff to Vice President Biden, has not heard that the Oval Office may now be contaminated? Or there are more factors at work? It does seem clear that our ever competent government is certain that no harm can come from allowing a very recently recovered Ebola patient to touch the President.

I asked Stephanie to summarize what we now about strains of Ebola.

There are now 6 known strains, counting the one that has been dubbed Guinea:

Guinea ~70% fatal –> research papers in April of this year identify this with the current West African outbreak; general death rates seem to corroborate this Zaire ~90% fatal Sudan ~70% Bundibugyo ~35-40% Reston ~0% Tai Forest/Cote d’Ivoire ~~mostly animal; some researchers have developed it; human fatality rates not known; does not always present with hemorrhage

These have different fatality rates, with the most serious being Zaire, at 90% fatal. Reston appears not to infect humans, or at least not to be symptomatic in humans. Reston may also be airborne. Guinea is also in a different clade from any of the other strains. (clade: http://en.wikipedia.org/wiki/Clade) Classification is order Mononegavirales, family Filoviridae, genus Ebolavirus. Related to the Marburgvirus; may have diverged from a common ancestor. Mutation rate only about 25% of e.g. influenza virus.

If I read the papers correctly, Guinea developed separately from the other strains. This may or may not mean that it mutated from the original ancestor of the Ebolavirus and Marburgvirus independently of the other Ebola strains, which IIRC are all in the same clade.

Symptoms per CDC:

* Fever

* Severe headache

* Muscle pain

* Weakness

* Diarrhea

* Vomiting

* Abdominal (stomach) pain

* Unexplained hemorrhage (bleeding or bruising)

The UV as presented by the Sun would be insufficient to kill Ebola dried on a surface, and wholly insufficient to kill Ebola in liquid suspension, because next to no UVC reaches past the atmosphere. A UV light at a distance of 6-12" will kill the majority of Ebola, which is more sensitive to UVC than models indicated, but there will be 3-4% residue that is UV-resistant. Other solar wavebands may be as, or more, effective, but I’ve not been able to find research on it.

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. There is some evidence that indicates that some strains, in some people, have an incubation period up to some 42 days, or twice the maximum. This has, to my knowledge, not been proven.

Internally, victims’ tissues begin to break down, resulting in widespread hemorrhage. This hemorrhage escapes the body through available orifices (mouth, eyes, ears, nose, rectum, and any puncture wound such as provided for an IV). As the disease progresses, explosive diarrhea and projectile vomiting can be complicated by seizures. The waste material temporarily aerosolizes the virus present in the feces and vomitus, making anyone in the vicinity susceptible to contamination. The numbers I’m hearing most bruited about indicate that infection is possible if only 1-10 viruses are introduced into the body.

Insofar as is known, the Zaire strain, at least, is not a true aerosol virus. It is aerosolized during vomiting and defecating in the same fashion as one might aerosolize a liquid in a pump spray bottle; it will eventually settle out onto local surfaces. This does, however, naturally "weaponize" the virus (though not as effectively as, say, a fine powder of anthrax). One way to truly weaponize the virus would be to take a victim’s blood, dry it, and powder it to a sufficient level of fineness that the particles can become suspended in air, then disperse it in air in a population-dense area. [I’m not sure you want to publish that last bit though.]

This is all I can think of at the moment.

I want to emphasize that my degrees are not in biology, let alone epidemiology. However, by dint of the broad range of degrees I have, I was at one time my organization’s resident expert in what was then called NBC (Nuclear Biological Chemical) weapons tech and effects. (I think they call it CBRN now: Chemical Biological Radiological Nuclear.) So I know enough to be able to interpret the papers, by and large, and determine the implications and effects thereof.

Stephanie Osborn

Interstellar Woman of Mystery

http://www.Stephanie-Osborn.com <http://www.stephanie-osborn.com/>

And see the summary by Brian below.

We have often recalled Kipling’s Gods of the Copybook Headings on this site, starting actually in BIX days in the 1980’s.

Sarah Hoyt

Two excellent essays,

one the God of the Copybook Headings with modern footnotes and a study in voter fraud.

http://accordingtohoyt.com/

Direct links in case they cycle down the page http://accordingtohoyt.com/2014/10/24/theyre-baaaaaack/

http://accordingtohoyt.com/2014/10/23/will-you-also-tolerate-this/

My friend Sarah Hoyt has gone me one better, with links at nearly every line. Worth your attention.

And the sophisticated climate debate continues:

Child Armies of the Night

Dear Jerry

Let it not be said that either side in the Climate Wars has a monopoly on the bizarre.

While Climate Communicators have begun publishing peer-reviewed protocols for brainwashing Girl Scouts,

http://vvattsupwiththat.blogspot.com/2014/10/when-you-finish-washing-my-brain-train.html

their opposite numbers have dragged Cthulhu into the debate :

http://vvattsupwiththat.blogspot.com/2014/10/well-at-least-its-change-from.html

—

Russell Seitz

Fellow of the Department of Physics Harvard University

Thanks

Ebola Virus

Dear Dr. Pournelle,

You asked for a summary of Ebola. Regrettably, the real information is behind a paywall (http://jid.oxfordjournals.org/content/147/2/264.full.pdf)

but here is what I have been able to determine from freely available sources, such as Wikipedia and the very readable ‘Hot Zone’ (http://www.amazon.com/Hot-Zone-Terrifying-Story-Origins-ebook/dp/B007DCU4IQ/ref=sr_1_1?ie=UTF8&qid=1414247042&sr=8-1&keywords=hot+zone)

So far as I can tell, there are at least five known related viruses of this type:

1. Bundibugyo virus (http://en.wikipedia.org/wiki/Bundibugyo_virus). Mortality rate: 50%. Cause of spread: Eating monkey meat infected by the disease.

2. Ebola Sudan (http://en.wikipedia.org/wiki/Sudan_virus). Mortality rate: 50%.

3. Tai Forest virus (http://en.wikipedia.org/wiki/Ta%C3%AF_Forest_virus). Mortality rate: 0%. A killer among monkeys, but it had little impact on the human researchers investigating the deaths. One scientist was hospitalized, but recovered completely.

4. Ebola Zaire (http://en.wikipedia.org/wiki/Ebola_virus_disease#Classification) Mortality rate: 90%.

5. Ebola Reston (http://en.wikipedia.org/wiki/Reston_virus). Mortality rate: 0%. First observed in Reston, Virginia. While an absolute killer of Macaques, it had no effect whatsoever upon infected humans — which we discovered afterward, when blood tests showed that various members of the team sent to control it had become infected. This is, so far as I know, the only airborne version of the virus and can be spread just like the common cold. It killed pretty much every chimp that came down with it, but had no effect on humans. Thanks be to God.

I should also mention Marburg (http://en.wikipedia.org/wiki/Marburg_virus), which is not an Ebola variant but has similar qualities. Mortality rating: 25%.

All of these diseases share similar traits of being too successful: The virus multiplies too quickly, destroying so many cells that the internal organs fail. Dehydration, internal bleeding are also constants,resulting in high mortality. The victim becomes contagious with the onset of symptoms, 21 days after infection. Infection is primarily through contact with body fluids — the most dangerous of which is the ‘vomito negro’, the black vomit, which is practically all virus (http://www.life.illinois.edu/bio100/cindyk/ebola/symptoms.html).

I don’t believe there is any known treatment — the best that can be done is to make the patient comfortable. And, of course, inject them with antibodies from other survivors.

I believe it is unlikely that the doctor in NY will pass on the disease to any of the people he encountered — unless this is a mutant strain such as Reston which can spread through the air. I point out , however, that the patient in Dallas likewise was in contact with many people, and the only people who became ill were those who were actually working with his waste, post-infection.

I was forced to listen to a talk-radio host yesterday insisting on a travel ban to West Africa — why aren’t we doing this? So far as I can tell, the reasoning is as described in this link;

http://www.vox.com/2014/10/13/6964633/travel-ban-airport-screening-ebola-outbreak-virus

Essentially, the belief appears to be that a travel ban is futile, as a similar closing after 9/11 did nothing to prevent the propagation of influenza via air travel. It does, however, make it harder to treat the problem at its source — west Africa — and because people start lying on forms it becomes even harder to form a clear picture of what is going on.

I’m not sure I agree with the reasoning, but that is the theory.

At any rate, Nigeria is now Ebola-free (http://www.foxnews.com/health/2014/10/21/nigeria-declared-ebola-free-holds-lessons-for-others/). The solution there appears to be careful surveillance, rapid communication and tracking, and quick quarantine of cases. As opposed to Liberia, where tribal customs , lack of sanitation, superstition, and overcrowding have combined to turn the large cities into Ebola hothouses. (http://www.telegraph.co.uk/news/worldnews/africaandindianocean/sierraleone/11001610/Ebola-outbreak-fight-against-disease-hampered-by-belief-in-witchcraft-warns-British-doctor.html).

I believe the deployment of hospitals and educational personnel are just what is needed to stem the outbreak there. As to the US itself, so long as the disease does not mutate into an airborne variant, I do not believe we will see an epidemic here so long as patients can be quickly detected, diagnosed, and quarantined. This implies we will need to make sure there ARE medical facilities up to the task of imposing such quarantine, as Dallas Presbyterian apparently was not.

Respectfully,

Brian P.