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AIBU?

Ebola.

253 replies

TheLovelyBoots · 28/07/2014 11:36

I'm quite nervous. AIBU?

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OhYouBadBadKitten · 30/07/2014 23:04

This seems like a sensible thread to talk about this :)

I'm slightly wary that in reports I've read patients seem to be less ill in the early stages and more capable with trying to carry on with their day to day life for a bit. CFR seems to be 60% but of course it's going to be very hard to know the true CFR. I do wonder if this strain has mutated a little.

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HarveySchlumpfenburger · 30/07/2014 23:31

I haven't seen anything in the WHO reports/updates that suggests they think that is the case, OYBBK. And I think they would be looking out for that. As far as I know it's a fairly bog standard Zaire strain.

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OhYouBadBadKitten · 30/07/2014 23:39

You are probably right Rafa, it's certainly something they will be watching.

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Northernlurker · 31/07/2014 08:29

Another good (and frankly reassuring) Telegraph piece.

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Northernlurker · 31/07/2014 08:30

I think the point that is made in the piece I've just linked about lack of trust in the authorities is key and it's not something that you would see here. One sniff of Ebola and we would all be looking to the government and NHS to fix it for us, not backing away from them.

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OhYouBadBadKitten · 31/07/2014 08:54

We can see its low infectivity in that it's been going since march and although it's a very large outbreak as far as ebola is concerned, on the scale of disease outbreaks it is still very small.

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HarveySchlumpfenburger · 31/07/2014 09:35

I agree OYBBK and that's with some poor infection control procedures and some cultural beliefs and fears that are meaning it can't be contained properly. AFAIK the majority of cases are still in the few provinces around the Guinea/SL/Liberia border. There's a few isolated outbreaks within those few countries, from people who have travelled to those areas. But some of those were limited to 1-2 people and those areas haven't had a case since March/April. It's by no means geographically widespread within those 3 countries. Which is probably a good sign.

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TheLovelyBoots · 31/07/2014 09:37

That is a reassuring article, but what is not reassuring is that the most recently infected doctor stands firm that he followed all protocols.

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OhYouBadBadKitten · 31/07/2014 09:55

It's quite possible he had a needle stick injury Boots.

Rafa, I've sent you a pm about something :)

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TheLovelyBoots · 31/07/2014 09:59

Aren't the hazmat suits needle-proof?

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OhYouBadBadKitten · 31/07/2014 10:12

Not from what I've read, but I don't know if my knowledge is out of date now.
It is also possible that he picked it up from someone who hadn't been diagnosed as infected yet but who was concealing symptoms.

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HarveySchlumpfenburger · 31/07/2014 10:16

I've replied OYBBK

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OhYouBadBadKitten · 31/07/2014 10:28

:)

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OhYouBadBadKitten · 31/07/2014 10:36

The one thing I keep thinking about are those absolute heroes who are the health care workers looking after the patients with ebola, most of them local doctors and nurses with limited facilities.

The courage they show is absolutely outstanding - beyond anything I can imagine and I think that us in our comfy country with superb healthcare and no infections should remember those people if we get the wobbles about this outbreak.

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HarveySchlumpfenburger · 31/07/2014 10:46

Totally agree with that.

As much as we can all complain about the NHS sometimes, for the most part, it does provide a level of care and resources that many can only dream of.

I'm not sure I could volunteer to do it.

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Suzannewithaplan · 31/07/2014 11:16

I'm not all that concerned, without an established animal host to act as a reservoir ( afaik) Ebola isn't able to become endemic.

It kills too quickly to spread very far.

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HarveySchlumpfenburger · 31/07/2014 21:19

Samaritan's Purse told AFP when an experimental serum arrived in the capital, Monrovia, on Wednesday, there was only enough for one person and Brantly had asked for it to be given to Ms Writebol.
"Even as he battles to survive Ebola, this heroic doctor is still focused on the well-being of others," said the statement.
It also noted that Brantly, 33, had been given a unit of blood from a 14-year-old boy who survived Ebola because of his care.
"The young boy and his family wanted to be able to help the doctor who saved his life," it said.

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HarveySchlumpfenburger · 31/07/2014 21:20

Pressed post too soon. There is someone for whom the use of the word heroic is entirely justified I think.

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oohdaddypig · 31/07/2014 21:28

Sorry - haven't read wh

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oohdaddypig · 31/07/2014 21:30

Bloody phone. Haven't read whole thread... But the reporting in the DM is awful, awful, scaremongering stuff.

The actual numbers of people affected are very low, given its gone on for months. Given it can't be brought under control just shows the perilous state of healthcare in these countries - awful for those affected.

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scaevola · 31/07/2014 21:42

I've just read about Dr Brantly in the Washington Post. Amazing.

The focus of the article was that the CDC have increased the level 2 health warning to level 3 for Liberia, Guinea and Sierra Leone. That means they are now advising against non-essential travel (though they ignore that for themselves and continue to send experts).

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externalwallinsulation · 01/08/2014 09:18

Just wanted to come back and give my 2 cents on some of the questions!

"I read that a survivor is infectious for 40 days? men have been told no sex for 40 days after ebola?"

OK, think of it like this, you have the day of infection. This is followed by an incubation period during which the person is NOT infectious. Then you get rapid onset of symptoms, and the person becomes infectious. If they survive, they may remain infectious for as much as 40-50 days, which is why hospitals will be monitoring these people for a while!

"I've read that humans can be asymptomatic for Ebola! Doesn't that mean that they could be carriers?"

OK, so Ebola is zoonotic, which means it is transmitted from animals to humans. It's a really rare virus, and there aren't many cases, so there is still a lot of uncertainty about the details of how this transmission works, and where the reservoirs might be (though there is mounting evidence that bats are the natural reservoir, passing it to apes perhaps via fruit that they've nibbled that apes then eat, then to humans). As someone said upthread, the absence of these natural reservoirs of ebola-carrying animals in the UK makes it very very unlikely the virus could persist here.

Anyway, so a research team published some papers about 10 or so years ago, saying that he'd found signs of asymptomatic Ebola infection in humans who had never been sick. While this finding is interesting, it is not by any means conclusive. A lot more work is needed before we can say that.

To explain why there may be problems, you need to know just a tiny bit about immunity. Basically, your adaptive immune system is this incredibly complex defence mechanism against infection. In a nutshell: when you encounter a new pathogen in the environment, it mounts a defensive response, and then some of the cells that are defending you will store away a chemical marker of that specific infection. This means that your body can react even more quickly should it encounter that pathogen again in future. So in your body, you have an enormous number of biochemical memories of the huge number of pathogens you've encountered. Neat, huh?

OK, so the type of research that we're looking at here looks for those biochemical traces that of Ebola, the idea being that if you can show it is there and the person has not been sick, you can hypothesize that humans may be asymptomatic carriers.

Now here's the problem: Ebola is one of a group of pathogens called filoviruses, and there are a lot of different varieties of these in West Africa. As a couple of people have mentioned, there are even several strains of Ebola. Scientists know from an outbreak of a similar filovirus in the States that not all of them are lethal - some may make animals sick, but not people.

The research in question tested for traces of only one type of Ebola. This means that there is a possibility the scientists may have been picking up evidence of encounters with other very similar filoviruses, or even something that wasn't Ebola at all. This, combined with the fact that the virus doesn't spread in a way that suggests humans are a reservoir (i.e. it is fairly easy to control where you have isolation mechanisms and hygiene mechanisms in place), means there is a big question mark over humans as asymptomatic Ebola carriers.

Interesting paper here, with more detail of this argument. I'm just summarising: jid.oxfordjournals.org/content/190/11/1893.full.pdf

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OhYouBadBadKitten · 01/08/2014 09:26

Thank you external, that looks like a really interesting paper.

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OhYouBadBadKitten · 01/08/2014 09:38

That was very interesting to read. Is it over simplifying it to compare it to the way different flu strains circulate with some strains conferring immunity to infection with other strains?

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externalwallinsulation · 01/08/2014 09:51

My bad - should have been clearer- there is no evidence to suggest that the presence of the biochemical markers that the research team found would offer any protection (and you most definitely wouldn't get ethics approval for a study would actively test that out by injecting them with Ebola and seeing whether they got sick!). The numbers are really small, and the virus is rare, so hard to get decent data on this. If the markers are from a related virus, they may well not offer any protection at all. They are more just a sign that says: 'Something that looks like Ebola woz 'ere'.

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