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-Signs, Portents, and the Weather-
CIDRAP Director: Two Ebola Possibilities That 'Should Keep Us up at Night'
2014-10-20
[Breitbart] Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, writes in the New York Times:

The Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.

There have been more than 4,300 cases and 2,300 deaths over the past six months. Last week, the World Health Organization warned that, by early October, there may be thousands of new cases per week in Liberia, Sierra Leone, Guinea and Nigeria. What is not getting said publicly, despite briefings and discussions in the inner circles of the world’s public health agencies, is that we are in totally uncharted waters and that Mother Nature is the only force in charge of the crisis at this time.

There are two possible future chapters to this story that should keep us up at night.

The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. This outbreak is very different from the 19 that have occurred in Africa over the past 40 years. It is much easier to control Ebola infections in isolated villages. But there has been a 300 percent increase in Africa’s population over the last four decades, much of it in large city slums. What happens when an infected person yet to become ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu — or even Karachi, Jakarta, Mexico City or Dhaka?

As if we needed yet another reason to avoid large urban areas.
Posted by:Besoeker

#18  What happens is that Ebola and Marburg, the evil twin of Ebola, are essentially endemic in these areas. A large proportion of the population has been exposed at levels below the threshold for infection for long periods of time and the body has developed immunity. I would venture the guess that most of the cases of Ebola are among individuals with suppressed immune systems or overworked immune systems fighting some other persistent infection that allows Ebola to sneak in the door.

The gentleman who died in Dallas is probably not native to the region he visited and did not develop an immune response. Almost certainly, Ebola is going to be much nastier in regions in which it is not endemic, such as the Western Hemisphere or Asia. If Ebola makes the jump into Sub Sahara Africa, it will decimate the local populations.

For me the best defense is to close the borders for a while and let the epidemic run its course in Africa. All epidemics peak and then decline as the populace develops immunity and the pathogen goes dormant to mutate and try again.
Posted by: Call Me Mystic   2014-10-20 23:25  

#17  If there are multiple strains, it would have been picked up by testing.
They don't seem to be testing very many asymptomatic people. That's the only way you can find those with Ebola who feel fine. That, or checking all contacts for seroconversion later. I don't know how much of that is being done, either.
Posted by: Anguper Hupomosing9418    2014-10-20 22:13  

#16  Multiple strains are picked up by testing --

1) if your test will do so. PCR (DNA based assay) is pretty good about that if a) some of your primers are pan-sensitive to all the strains of Ebola. If a strain has a mutation in the region of the primer itself the reaction won't work. b) some of your primers are specific to different strains. c) you have primers for all the strains. You can pick up new strains, but it gets complicated.

Other tests, such as ELISA (protein antibody based assay) won't pick up different strains unless your antibody particularly discriminates one strain from another; some do but field testing generally uses a less discriminatory, pan-sensitive antibody that would lump all strains together. In the field you generally want to know if your patient is positive.

2) if you're looking. In the field (be it in the Liberian bush or a Dallas ICU) you generally aren't.
Posted by: Steve White   2014-10-20 20:55  

#15  #7 I wonder if there is a racial component to the resistance spectrum.

Of course there is.

But I expect denial of this fact to kill more than a few people.

It is possible that there are 2 or more different strains of Ebola going on at the same time, one that produces immunity without illness and the other that produces 70% mortality followed by immunity in survivors

If there are multiple strains, it would have been picked up by testing.

-----

Saw a report the other day, where a scientist said we are seeing much higher levels of virus shedding . I assume relative to early outbreaks but this wasn't stated.
Posted by: phil_b   2014-10-20 20:22  

#14  Islamic Burial Rituals Blamed For Spread Of Ebola
Posted by: Guillibaldo Elmurong9506   2014-10-20 19:48  

#13  "Typhoid Mary" was white and before the system rigged itself to ignore certain 'protected groups' from reporting. The resistance to a travel ban is enough to tell you what would happen if such a scenario would play out today with members of such 'protected groups'.
Posted by: Procopius2k   2014-10-20 17:35  

#12  My concern is not in the United States, but Central America.
Posted by: Nimble Spemble   2014-10-20 15:59  

#11  If there were such a person as an "Ebola Mary", who had a long-term ability to transmit Ebola without getting sick herself, the path she would leave behind would be unmistakable. This hasn't been observed anywhere.
Posted by: Anguper Hupomosing9418    2014-10-20 14:48  

#10  "the potential for asymptomatics to be infectious"
Early in the course of Ebola outbreaks, contract tracing is much easier to do & much more reliable. The epidemiology research nearly always traces back to symptomatic sick Ebola patients triggering another round of infections. If the asymptomatically Ebola-infected had been contagious, there would have been outbreaks of infections with no apparent traceable source. It is possible that there are 2 or more different strains of Ebola going on at the same time, one that produces immunity without illness and the other that produces 70% mortality followed by immunity in survivors -- but we simply don't know. "Typhoid Mary" was detected wherever she went by outbreaks of typhoid fever among the families she worked for. She was detected by contact tracing & then specifically by being test for the infectious agent.
Posted by: Anguper Hupomosing9418    2014-10-20 14:45  

#9  Wise in so many ways Pan.
Posted by: Skidmark   2014-10-20 13:06  

#8  If we keep catching it, one at a time, we will learn to live with it. Like living with a wasps nest near by, killing one wasp at a time. My real concern is not with medical professionals and the middle class. If it hits the inner city of Detroit, NYC, LA and places like the Appalachians where they will not get medical attention soon enough it could be ugly.
Posted by: 49 Pan   2014-10-20 11:44  

#7  I wonder if there is a racial component to the resistance spectrum.

i.e. people in West Africa are already on the road to natural selection. Whereas whites in Europe and America are in the "snowball's chance" category.
Posted by: frozen al   2014-10-20 10:14  

#6  The unknown here is 'subclinical infection'. How much exposure starts the body to manufacture antibodies, versus what level of exposure overwhelms the system.
And it's entirely that the 'resistance spectrum' included people at one end of the curve that are naturally resistant, and at the other those that don't have a snowball's chance.
Posted by: ed in texas   2014-10-20 07:41  

#5  My feeling was natural immunity
Posted by: g(r)omgoru   2014-10-20 03:43  

#4  Appears more than a few countries in the region have become a bit concerned regarding Ebola, borders, and foreign travel:

>According to International SOS, these African nations "have implemented Ebola-related travel restrictions":

•Gambia has banned the entry of flights from Guinea, Liberia, Nigeria and Sierra Leone.
•Gabon has banned the entry of flights and ships from countries affected by Ebola.
•Senegal has banned flights from Guinea, Liberia and Sierra Leone.
•Cameroon has banned flights to and from Nigeria.Chad has suspended all flights from Nigeria.
•Nigeria has suspended flights to the country operated by Gambian national carrier Gambia Bird.
•Côte d'Ivoire has now lifted the ban on passenger flights from Guinea, Liberia and Sierra Leone.

These airlines "have restricted flights to Ebola-affected countries":

•Air France suspended flights to Sierra Leone from 28 August.
•The Togo-based carrier Asky Airlines has suspended flights to and from Guinea, Liberia and Sierra Leone.
•Arik Air (Nigeria), Gambia Bird and Kenya Airways have suspended services to Liberia and Sierra Leone.
•British Airways has extended their suspension of flights to Liberia and Sierra Leone until 31 December.
•Emirates Airlines has suspended flights to Guinea.
•Korean Air suspended flights to and from Kenya from 20 August.
•Senegal Airlines has suspended flights to and from Conakry (Guinea) until further notice.



Breitbart link.
Posted by: Besoeker   2014-10-20 03:43  

#3  One prospective study of 24 contacts followed over time found that 11 of the 24 developed Ebola antibodies although they never got sick.

Interesting. My feeling was natural immunity (not acquired incidentally. Almost certainly genetic) was up towards 50% in these populations.

What this means is transmission rates will be much higher outside of these populations. Onward transmission rates around 4 to 5, rather than the current 1.8 to 2.

Then there is the potential for asymptomatics to be infectious.

I Doubt we will see sustained spread in London or New York. Cairo, Karachi and Jo'burg are a different matter.
Posted by: phil_b   2014-10-20 03:25  

#2  Another aspect of Ebola hardly known to anyone. There have been cases of contacts of Ebola in Africa that never got sick -- however, their blood eventually showed the same antibodies to Ebola as the blood of those who have survived a clinical Ebola infection, i.e. in infectious disease-speak, they became seropositive for Ebola. One prospective study of 24 contacts followed over time found that 11 of the 24 developed Ebola antibodies although they never got sick. Blood tests done over the course of their observation showed characteristic changes of inflammation and modulators of inflammation like cortisol, similar but less severe than what would be seen in patients suffering from Ebola. These observed patients never tested + for Ebola virus itself, only for the changes of inflammation and immune modulators, followed by development of antibodies to Ebola, similar to that shown by those who survived clinical Ebola illness. It is not known if the 11/24 who turned seropositive are actually immune to Ebola, but it seems likely.
Recent Lancet article stated "forecasts that ignore naturally acquired immunity from asymptomatic infections overestimate incidence late in epidemics" by a substantial amount. If these asymptomatic survivors prove to be immune to the current Ebola strain, they might safely work with sick Ebola patients.
Posted by: Anguper Hupomosing9418    2014-10-20 01:35  

#1  No need to panic. What is going to happen is really clear. When infected people show up in new places what will happen is exactly what happened in Nigeria and Senegal and Dallas. A few cases snuffed out by modern epidemiological techniques.

And in the few countries already overwhelmed by the epidemic, the people will continue to suffer until the majority become immune to the virus, which seems likely to happen in six months to a year's time.
Posted by: rammer   2014-10-20 00:28  

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