Ebola- your questions answered

Phalaenopsis · October 2014

PinkDahLia44 said:

K, I've got one: How do you feel about the quarantine of those who traveled near Amber Vinson? Necessary or just appeasing the public? Or a third opinion?

They probably dont need quarentine, just need to be aware if they develop symptoms. And they shouldnt fly. With no fluids exchanged i doubt it will amount to anything, but it is better to pro-actively track potential contacts now then to go back in time if something does happen.

PinkDahLia44 · October 2014

Phalaenopsis said:

PinkDahLia44 said:

K, I've got one:

How do you feel about the quarantine of those who traveled near Amber Vinson? Necessary or just appeasing the public? Or a third opinion?

They probably dont need quarentine, just need to be aware if they develop symptoms. And they shouldnt fly. With no fluids exchanged i doubt it will amount to anything, but it is better to pro-actively track potential contacts now then to go back in time if something does happen.

I agree. Glad to know I'm not the only one.

Phalaenopsis · October 2014

Amjoy25 said:

I saw a Nightline about Ebola, and the way they are developing the treatment is crazy smart! So there is a treatment but it hasn't been through any clinical trials on humans, and it takes months (?) to make it. Just popping in to say that. Carry on.

They briefly mentioned a few experimental drugs Duncan received but didn't go into it further. I think the vaccine will come first.

Amjoy25 · October 2014

Would you liken it to HIV? Considering they are both viruses that need fluids to be swapped to be transmitted? If not, what known "controlled" virus do we (America) already have that you would liken it to?

Amjoy25 · October 2014

Phalaenopsis said:

Amjoy25 said:

I saw a Nightline about Ebola, and the way they are developing the treatment is crazy smart! So there is a treatment but it hasn't been through any clinical trials on humans, and it takes months (?) to make it. Just popping in to say that. Carry on.

They briefly mentioned a few experimental drugs Duncan received but didn't go into it further. I think the vaccine will come first.

They gave the treatment (z-map?) to one of the doctors and the decontamination specialist who contracted it, and who were sent back to the the U.S. to get the treatment. They both survived. https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-experimental-treatments.html

Phalaenopsis · October 2014

Amjoy25 said:

Would you liken it to HIV? Considering they are both viruses that need fluids to be swapped to be transmitted? If not, what known "controlled" virus do we (America) already have that you would liken it to?

It is similar to hepatitis c in terms of transmission through bodily fluids and how transmissible it is (the infectivity R0 is similar). In terms of symptoms, it's like a really really severe diarrheal viral illness. Norovirus comes to mind as something with few viral particles needed to transmit disease which is similar.

SweetCFly · October 2014

dknight413 said:
Ok last question before bed. There is someone at a local VA hospital who has just traveled to Dulles from an infected country, has a fever and is currently being monitored (very similar to the Duncan case). However, the hospital is not testing them for Ebola yet as it said it was "a rule out prior to testing". How do they arrive at this conclusion? And why wouldn't they just test to be safe?

Not @Phalaenopsis‌ but all hospitals should be doing this. Fevers can be a result of a lot of things- UTI, cancer complications, infection otherwise, etc. If there is reason to believe the fever is from another source the pt would (in our hosp at least) be considered low risk/rule out. Still same precautions/quarantining as a positive Ebola pt, but not enough reason or compelling evidence to send the bloodwork to CDC for testing.

Phalaenopsis · October 2014

dknight413 said:

Ok last question before bed. There is someone at a local VA hospital who has just traveled to Dulles from an infected country, has a fever and is currently being monitored (very similar to the Duncan case). However, the hospital is not testing them for Ebola yet as it said it was "a rule out prior to testing". How do they arrive at this conclusion? And why wouldn't they just test to be safe?

He needs to be tested. Period. I think the "rule out" is a BS line to stall while they wait for the Ebola test to arrive to the hospital. FYI, most of those cases end up being malaria. But still.

Phalaenopsis · October 2014

SweetCFly said:

Ok last question before bed. There is someone at a local VA hospital who has just traveled to Dulles from an infected country, has a fever and is currently being monitored (very similar to the Duncan case). However, the hospital is not testing them for Ebola yet as it said it was "a rule out prior to testing". How do they arrive at this conclusion? And why wouldn't they just test to be safe?
Not @Phalaenopsis‌ but all hospitals should be doing this. Fevers can be a result of a lot of things- UTI, cancer complications, infection otherwise, etc. If there is reason to believe the fever is from another source the pt would (in our hosp at least) be considered low risk/rule out. Still same precautions/quarantining as a positive Ebola pt, but not enough reason or compelling evidence to send the bloodwork to CDC for testing.

Actually, thats not entirely correct. the protocol is febrile illness + recent travel to endemic area = testing, and isolation.

Phalaenopsis · October 2014

Snowboarderbritt said:

Thanks for this! Do you think in a year or two that vaccine will become the norm for everyone? Like everyone will get it for the next 20 years?

I just don't think the vaccine will be necessary for everyone because ebola will be contained in the US. So, no.

Phalaenopsis · October 2014

dknight413 said:

SweetCFly said:

Ok last question before bed. There is someone at a local VA hospital who has just traveled to Dulles from an infected country, has a fever and is currently being monitored (very similar to the Duncan case). However, the hospital is not testing them for Ebola yet as it said it was "a rule out prior to testing". How do they arrive at this conclusion? And why wouldn't they just test to be safe?
Not @Phalaenopsis‌ but all hospitals should be doing this. Fevers can be a result of a lot of things- UTI, cancer complications, infection otherwise, etc. If there is reason to believe the fever is from another source the pt would (in our hosp at least) be considered low risk/rule out. Still same precautions/quarantining as a positive Ebola pt, but not enough reason or compelling evidence to send the bloodwork to CDC for testing.

Actually, thats not entirely correct. the protocol is febrile illness + recent travel to endemic area = testing, and isolation.
Ok so now im confused again. The pt meets both requirements but hasn't been tested and is not in isolation. What am I missing here? Also, just wanted to add that these nurses who are on the front line need to be getting HUGE bonuses. And pay raises. And more bonuses.

Yeah, the nurses are heros. I don't know... Do you have a link to the story?

Phalaenopsis · October 2014

dknight413 said:

https://www.washingtonpost.com/local/loudoun-inmate-who-traveled-from-ebola-affected-area-taken-to-hospital/2014/10/16/46c0bfde-5565-11e4-892e-602188e70e9c_story.html They *were* in isolation. Sorry. Just no test.

Ok, reading between the lines, sounds like she just had a low-grade temp, maybe 99.5 and didn't 'technically' qualify for a fever, but they were watching her just in case it went past the threshold for testing.

Phalaenopsis · October 2014

Im off to bed. Hope I could ease some fears a bit! I'll check-in in the am. Xoxo

SweetCFly · October 2014

Phalaenopsis said:

SweetCFly said:

dknight413 said:
Ok last question before bed. There is someone at a local VA hospital who has just traveled to Dulles from an infected country, has a fever and is currently being monitored (very similar to the Duncan case). However, the hospital is not testing them for Ebola yet as it said it was "a rule out prior to testing". How do they arrive at this conclusion? And why wouldn't they just test to be safe?
Not @Phalaenopsis‌ but all hospitals should be doing this. Fevers can be a result of a lot of things- UTI, cancer complications, infection otherwise, etc. If there is reason to believe the fever is from another source the pt would (in our hosp at least) be considered low risk/rule out. Still same precautions/quarantining as a positive Ebola pt, but not enough reason or compelling evidence to send the bloodwork to CDC for testing.

Actually, thats not entirely correct. the protocol is febrile illness + recent travel to endemic area = testing, and isolation.

----- in case there's no quote box -----

Yeah just saying what our nursing director told us in our meeting this AM about our hosp practice, that not all low risk patients would be tested if there was reason to believe the fever (despite recent travel to endemic area) was from another source. ETA for clarification: Low risk/rule out pts still in same iso, same 3 RN:1 pt ratio, and same PPE precaution as high risk, confirmed case pts. I thought it was strange though... I think if you have fever plus travel you should be tested no matter what. Even if you're negative for the virus it's money well spent and (some) stress and fear relieved IMO. I could have misunderstood her though! Sorry to have confused you @dknight413‌!

mancila60 · October 2014

Are they doing anything to prevent more people like Mr Duncan from bringing it in?

KerCo51 · October 2014

mancila60 said:

Are they doing anything to prevent more people like Mr Duncan from bringing it in?

I know they are taking the temperatures of people coming from Africa at some of the airports in the US. I'm not sure they can totally avoid that situation from happening again. Duncan likely came to the US to get better medical care, since he knew he was in direct contact with someone with Ebola.

Since I am sick, I have done nothing but watch Ebola coverage this week. It's tough to get away from.

huntjul · October 2014

Phalaenopsis said:

carriet2018 said:

Can dogs get it? Why do I keep hearing about that nurses dog in the news?

The dog supposedly was quarantined! But dogs can't get it so he's safe!

Veterinarian checking in here.

Strictly speaking the answer is, we do not know if dogs can get ebola, but we have LIMITED evidence to suggest they CAN but perhaps are asymptomatic. Note that means they could still transmit it, just not show signs.

https://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=bc580369-fea4-4f77-935d-b651390eb771%40sessionmgr4003&vid=0&hid=4206

Not sure if link will work for you guys (I'm logged in as an academic and don't have time now to turn that off), but here's the abstract:

Ebola virus antibody prevalence in dogs and human risk

in Emerging Infectious Diseases (journal):

During the 2001–2002 outbreak in Gabon, we

observed that several dogs were highly exposed to Ebola

virus by eating infected dead animals. To examine whether

these animals became infected with Ebola virus, we sam-

pled 439 dogs and screened them by Ebola virus–specific

immunoglobulin (Ig) G assay, antigen detection, and viral

polymerase chain reaction amplification. Seven (8.9%) of

79 samples from the 2 main towns, 15 (15.2%) of 99

samples from Mekambo, and 40 (25.2%) of 159 samples

from villages in the Ebola virus–epidemic area had

detectable Ebola virus–IgG, compared to only 2 (2%) of 102

samples from France. Among dogs from villages with both

infected animal carcasses and human cases, seropreva-

lence was 31.8%. A significant positive direct association

existed between seroprevalence and the distances to the

Ebola virus–epidemic area. This study suggests that dogs

can be infected by Ebola virus and that the putative infec-

tion is asymptomatic

jennlin · October 2014

dknight413 said:

Lol thanks. I got there. Just took a while . Well this has been fascinating. Thank you. Off to dream about vomit and explosive poop now

this is exactly what happened to me. i read a lot of this thread in bed..and with each MOTN wakeup, i swear i had ebola.

jennlin · October 2014

baconface said:

So even if the nurses in Dallas (or anywhere) weren't specifically trained for Ebola, I assume they would be trained in general on how to avoid transmission of something like hep C or HIV, no? But they still caught it.

Doesn't that mean that Ebola is more contagious?

my completely uneducated guess on this is that with hep c and hiv, you don't projectile vomit and diarrhea continuously while infected, which you do with ebola.

Phalaenopsis · October 2014

baconface said:

Phalaenopsis said:

Amjoy25 said:

Would you liken it to HIV? Considering they are both viruses that need fluids to be swapped to be transmitted? If not, what known "controlled" virus do we (America) already have that you would liken it to?

It is similar to hepatitis c in terms of transmission through bodily fluids and how transmissible it is (the infectivity R0 is similar). In terms of symptoms, it's like a really really severe diarrheal viral illness. Norovirus comes to mind as something with few viral particles needed to transmit disease which is similar.

Ok, so this is what I don't get. I keep reading the comparison to HIV or hepatitis, but those are 2 diseases that I would assume that most ER staff in this country are somewhat prepared to deal with, in the sense that they wear appropriate gear to protect themselves from it.

So even if the nurses in Dallas (or anywhere) weren't specifically trained for Ebola, I assume they would be trained in general on how to avoid transmission of something like hep C or HIV, no? But they still caught it.

Doesn't that mean that Ebola is more contagious?

Thx for the clarification, @huntjul! We should figure out why dogs are asymptomatic and extrapolate new therapies from their physiology.

@baconface In some ways, yes, Ebola is more contagious than hcv or HIV during its acute phase. During the acute illness patients spill body fluids everywhere, and it only takes a couple drops to get infected. Hcv and HIV are chronic diseases that live in your blood for years and years, so you really need more invasive contact, like sex or needles, to get them.

Phalaenopsis · October 2014

@sweetcfly I see what you meant. It's complicated to say the least.

Phalaenopsis · October 2014

mancila60 said:
Are they doing anything to prevent more people like Mr Duncan from bringing it in?

Yes. They are checking temps at airports. At this point in time, there are no plans for a travel ban. According to experts it wouldt work anyway.

Phalaenopsis · October 2014

dknight413 said:
I'm back! Did you see this?

https://www.washingtonpost.com/national/health-science/ebola-probe-expanding-to-nurses-flight-to-ohio/2014/10/16/9a1bd406-5575-11e4-b86d-184ac281388d_story.html

So now they are saying Amber Vinson may have started to have symptoms as far back as Friday:So she would have known she was sick before she boarded the plane back to Dallas. I know it's not a question, but I'm just shocked that a healthcare worker would show such blatant disregard for public safety. I'm interested to know how the nurses feel about this.

It is important to remember a couple thing. A) the virus is not airborne. Sitting on a plane next to passengers will not transmit the illness.

the family member taking care of Duncan when he was having diarrhea overnight at his home didn't get Ebola. Today is the lady day of their quarantine. There are nuances in transmission that we are still learning about since it's a new disease. C) health care workers are at a much higher risk than the general population due to prolonged contact with the fluids

All that said, I agree with you she shouldn't have flown. But the burden was on the CDC to probe her more into her symptoms. I doubt someone will get it from that flight, but it was too close for comfort. It's just too high risk to have allowed her to do it I think. That's how epidemics spread.

Oh and sorry for the poor typing on mobile

vargasgurl · October 2014

I heard in the news last night that CHOP has been designated for the selective treatment of the virus , should there be a child that's infected. https://6abc.com/health/chop-selected-to-possibly-provide-care-for-children-with-ebola/353779/ #goodtoknow Thanks for educating us!

Amjoy25 · October 2014

dknight413 said:

I'm back! Did you see this?

https://www.washingtonpost.com/national/health-science/ebola-probe-expanding-to-nurses-flight-to-ohio/2014/10/16/9a1bd406-5575-11e4-b86d-184ac281388d_story.html

So now they are saying Amber Vinson may have started to have symptoms as far back as Friday:So she would have known she was sick before she boarded the plane back to Dallas. I know it's not a question, but I'm just shocked that a healthcare worker would show such blatant disregard for public safety. I'm interested to know how the nurses feel about this.

Honestly, I didn't know much about this story, but I have friends on FB who are vilifying her for boarding a plane. It's pretty despicable IMO if she KNEW she could be contagious. Bad nurse.

Phalaenopsis · October 2014

@lynnyloo‌ nice! Are you a resident? From what I understand the us hcw they were treated with broncinofovir (sp?) an antiviral. But there's a lot of misinformation out there so I'm not sure. Hippaa should be dissolved on the sick patients (not including names) to facilitate easier access to information about the new disease. The experts studying it really need to have full disclosure.

PinkDahLia44 · October 2014

@SweetCFly‌ , 3 RNs to 1 pt?!? Where is your hospital getting the staff?

Amjoy25 · October 2014

PinkDahLia44 said:

@SweetCFly‌ , 3 RNs to 1 pt?!? Where is your hospital getting the staff?

I would hope this is commonplace in an ICU setting (which it should be a smaller ratio)....if not, your hospital needs to re-evaluate it's safety efforts.

ETA reading fail.

3 RN's to 1 patient?????11!!!! Wha????!!11

Phalaenopsis · October 2014

vargasgurl said:
I heard in the news last night that CHOP has been designated for the selective treatment of the virus , should there be a child that's infected.

https://6abc.com/health/chop-selected-to-possibly-provide-care-for-children-with-ebola/353779/

#goodtoknow

Thanks for educating us!

Dude. I freaking APPLAUD CHOP for forming a task force back in August. See, now that's what you call preparedness. It again speaks to the fact that a national protocol could have been instituted by the cdc earlier this year and it just didn't happen. Those kids would be in good hands at chop but it prob won't ever come to that.

Amjoy25 · October 2014

Phalaenopsis said:

I heard in the news last night that CHOP has been designated for the selective treatment of the virus , should there be a child that's infected. https://6abc.com/health/chop-selected-to-possibly-provide-care-for-children-with-ebola/353779/ #goodtoknow Thanks for educating us!
Dude. I freaking APPLAUD CHOP for forming a task force back in August. See, now that's what you call preparedness. It again speaks to the fact that a national protocol could have been instituted by the cdc earlier this year and it just didn't happen. Those kids would be in good hands at chop but it prob won't ever come to that.

#dude

vargasgurl · October 2014

Phalaenopsis said:

I heard in the news last night that CHOP has been designated for the selective treatment of the virus , should there be a child that's infected. https://6abc.com/health/chop-selected-to-possibly-provide-care-for-children-with-ebola/353779/ #goodtoknow Thanks for educating us!
Dude. I freaking APPLAUD CHOP for forming a task force back in August. See, now that's what you call preparedness. It again speaks to the fact that a national protocol could have been instituted by the cdc earlier this year and it just didn't happen. Those kids would be in good hands at chop but it prob won't ever come to that.

@Phalaenopsis‌ I agree .. They are taking this seriously and being proactive! I haven't seen a list but from the article, it seems they are not the only children's hospital.

Phalaenopsis · October 2014

Lia1303 said:
Is there really a potential for a mutation that would make it airborne or is this just more media fear mongering?

There has never been an epidemic virus that changed its mode of transmission. Can it happen in theory, I guess, which is why some ppl are mentioning it. But in reality and based on the evidence there is no reason to believe it will happen.

Phalaenopsis · October 2014

dknight413 said:
@Phalaenopsis‌ so she goes to the toilet on the plane to be sick or have a violent bout of diarrhea, and flushes...one of those super vortex airplane toilet flushes that shoots water everywhere. You're next in line to use the loo. Would you still use it or would you hold it 6 hours until you got to the airport?

I'd 'accidentally' spill water in my lap and pee on myself, blame Cece.

stephl3055 · October 2014

So back to the dog. Yes, they aren't asymptomatic, what does that mean for the owner? If the dog poops in the house and the owner cleans it up and doesn't clean his or her hands appropriate, could the owner catch it that way? Or from diarrhea? Are there tests that can determine if a dog is a carrier?

I love dogs and all pets, but I have a concern that the dog that belongs to the nurse will be released and that he could possibly spread this to other people, like the veterinary community. How are dogs being handled in Africa, because it seems like they roam more freely there than here.

muffyvonmuff · October 2014

Just popping in to say that DH is close friends with the NBC cameraman. He got the disease in Africa trying to bring light of the situation to the rest of the world since they are in such dire need for help. He is seriously one of the most caring and nicest guys He also is really smart and had countless offers to work on wall street and become rich in finance, but chose to dedicate years of his life traveling and helping villages in third world countries.

Anyway he had a blood transfusion with an Ebola survivor who had the antibodies. Our friend talked to his Dad over the weekend and he's doing great and is going to be ok.

tl;dr I know someone who got Ebola and they are going to be fine

layali · October 2014

I think this is the most levelheaded discussion about Ebola in the history of the interwebs ever.

But in all seriousness - thank you @Phalaenopsis for sharing your expertise with us.

huntjul · October 2014

stephl3055 said:

So back to the dog. Yes, they aren't asymptomatic, what does that mean for the owner? If the dog poops in the house and the owner cleans it up and doesn't clean his or her hands appropriate, could the owner catch it that way? Or from diarrhea? Are there tests that can determine if a dog is a carrier?

I love dogs and all pets, but I have a concern that the dog that belongs to the nurse will be released and that he could possibly spread this to other people, like the veterinary community. How are dogs being handled in Africa, because it seems like they roam more freely there than here.

We do not have enough info to know the answer to this yet. The only study we have suggests that as many as 30% of dogs in ebola-infected areas in Africa had antibodies. Antibodies indicate exposure. If humans get exposed, they pretty much just get sick. So why are these dogs alive and not sick? Perhaps they were asymptomatic--it didn't cause disease in them.

Generally asymptomatic species can still transmit the disease in the same way that the disease is otherwise transmitted--in this case bodily fluids. However, we don't know that this is the case yet.

As a precaution, dogs of the infected folks are either being euthanized or quarantined, and the veterinary community is aware of this possibility.

huntjul · October 2014

Here's my question:

Has this virus mutated?

I think it has. We have some evidence of that already (genomic surveillance) and also it's just not behaving like it used to (isolated outbreaks that burned themselves out). Also somewhere I saw a report that the levels of virus in the blood was sky-high in Liberia victims where previous outbreaks had lower levels of virus in the blood. This would explain why this outbreak seems to be SO contagious, esp to healthcare workers who should be using personal protective equipment.

acethebase · October 2014

Ok I'm not sure if this has been asked but could this potentially be like MRSA? As in a person with MRSA coughs in hand touches a grocery cart, then a young child comes along touches the cart and then proceeds to put his hands in his mouth. Is it like that or you have to CLEARLY see "wet" bodily fluids on the cart for you to even get it?

acethebase · October 2014

Also if it comes around our area or already is, what precautions would you advise us to take?

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