Followup: yes, the fever criterion for ebola definitely needs revising downward
And that’s not the only thing that needs revising.
When I first heard the story about the Spanish nurse who has ebola, and compared it with that of Thomas Duncan, one thing leapt out at me: both of them reported to medical authorities initially with fevers of around 100 degrees, quite a bit less than the criterion of 101.5 for an ebola diagnosis. This was part of the reason their diagnoses were missed at first, and they were sent back into the community to put others at risk.
Obviously, everyone with a temperature of 100 can’t be screened for ebola, much less isolated. But if a person has a history of exposure to an ebola patient (as the Spanish nurse did), or has recently come from an area where the disease runs rampant and has other symptoms as well (Duncan fit that description), then a fever as low as 100 ought to qualify as another symptom of ebola.
More details of the Spanish nurse’s story only serve to solidify my impression and to underscore how the reliance on the criterion of a higher fever led the Spanish health care professionals astray.
Badly astray:
When Teresa Romero Ramos, the Spanish nurse now afflicted with the deadly Ebola virus first felt feverish on September 30, she reportedly called her family doctor and told him she had been working with Ebola patients just like Thomas Eric Duncan who died today in Dallas. Her fever was low-grade, just 38 degrees Celsius (100 degrees Fahrenheit), far enough below the 38.6-degree Ebola red alert temperature to not cause alarm. Her doctor told her to take two aspirin, keep an eye on her fever and keep in touch, according to Spanish press reports quoting Romero’s husband Javier Limé³n Romero…
…Romero discussed her slight fever and how she was feeling sick with friends and colleagues.
According to [the newspaper] El Paés, she talked incessantly about what the Ebola threshold was and, since she was far below it, they assured her not to worry””advice she apparently wanted to hear.
But even when she finally hit the ebola fever threshold days later, hospital workers didn’t seem alarmed. That is even more disturbing:
According to Spanish press reports quoting the Spanish nurses’ union, Romero called Carlos III hospital several times between September 30 and October 2 when her fever finally hit the 38.6 threshold. Still, it took until October 6 when she had become so deathly ill she was begging for an Ebola test before anyone at the hospital where she worked reportedly reacted. Then, rather than immediately isolating her and rushing her to the special ward used to treat the previous Ebola patients, they told her to go to the nearby emergency room at Alcorcé³n, where press reports say she sat in the public waiting room for several hours absent of any protective gear. “I think I have Ebola,” she reportedly told anyone who would listen. But no one took notice until her first test came back positive. By then, dripping with fevered sweat, she would have been inarguably contagious.
What was going on? Stupidity, denial, hubris, failure of public health authorities to communicate to hospital staff what ebola is about, all of the above?
At least they’ve learned—a little—from their errors:
Now a third nurse who also worked with the same Ebola patients who infected Romero is exhibiting the same low-grade fever. This time, authorities acted quickly to isolate her.
The blame game goes on:
Carlos III director Yolanda Fuentes told El Paés that the biohazard suits they provided did indeed conform with safety protocols established by the World Health Organization and the Spanish Ministry of Health. On Wednesday, German Ramfrez from the Chief Medical Internal Hospital in La Paz said it was Romero who erred when she touched her face with her infected glove as she undressed. Ramfrez told reporters at a news conference meant to quell panic that it was Romero’s “oversight”””not the Spanish medical community that has been blamed for its preparation for fighting the virus.
But the Spanish press report that the hospital was underequipped to handle cases and that rather than the Level IV suits they require, the Carlos III hospital only had Level II gear.
A horror story.
Hey,they killed the dog. How much more can they do?
I wonder if the deputy was running a low grade fever? That has not been mentioned – although one report said he was “flushed.”
No more flights from West Africa.
Related news is that the US will begin screening arriving passengers from the 3 African nations for fevers indicative of ebola. I heard an interview on the Beeb last night, in which the nervous-sounding American official stated that if the arriving passenger was suspected of having ebola, he/she could be taken to a local hospital. Certainly Africans are savvy enough to know that if they’ve been around an infected person, and start to feel symptoms, and if they can scrape up the money, they can pop some ibuprofen to get past the local authorities, fly into one of the US airports, and then get treated in a US hospital, where they might have at least a chance of survival. Katie bar the door.
The advice to take aspirin seems especially stupid, because how are you then suppose to monitor the actual fever. There are no words!
All of this goes back to the fatal conceit that viruses actually have an INCUBATION PERIOD.
Most doctors/ staffers STILL use this mental concept.
You can see it in EVERY action decried above.
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Even neo, implicitly, accepts the idea that with her higher fever she BECAME infectious.
The reverse is, in fact, the case. She’d been infectious all along. The only variable is HOW infectious she is.
In the final stages we can all SEE how distressed she is. That is all.
Her body has been spewing out ebola for many days before that.
Consequently, the number of candidates has simply EXPLODED.
Folks, this is how a pandemic gets rolling. At every critical early stage, the authorities shuttle carriers about — inside health care facilities — so that the maximum number of souls become infected.
Next, no-one wants to go to the emergency room. By such a time, it’s universally obvious that the hospital, itself, is wholly contaminated.
Thanks, fellas.
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Ebola candidates MUST NOT GO TO ERs. They need to stay put and have specialists come to them. Every step they take spreads ebola.
Ebola is totally unlike HIV.
It is NOT recognized by the human immune system.
All fevers are triggered by the immense (cellular) debris left over from ebola destruction. The T-cells go into hyper-production to sweep the body of these shattered segments.
The ebola virus just swims right on by, hidden in its lipid sheath.
Our T-cells don’t react to lipids — as a rule.
(Hence, hardening of the arteries/ lipid deposits.)
&&&
EVERYONE she was in contact with, objects too, has to be isolated until ‘cleared.’
I’d recommend that the habitation be burned out.
We’re so early in, we don’t even know which gases to use. Some effort is needed to discover how to tent and gas ebola contaminated structures.
Until this is found, we’re back to the Black Death solution: fire.
The ebola crisis in Spain has exploded a thousand times over, for this gal has been around.
A cascade of ebola lies directly ahead. It doesn’t know how smart we are and how elegant our First World medical care system is. It’ll just wade through like the Terminator.
Someone should’ve listened to Kyle Reese/ .Michael Biehn.
All of these half-assed measures are extreme folly… with the illusion that candidates have an incubation period.
Can’t anyone follow the bouncing DNA?
Cornhead,
It’s almost certainly too late but in any case Obama will continue to keep the borders open and continue to allow flights from the affected areas until we have an outbreak. Then he will take a few half-measures for political cover with the LIVs.
if a pandemic erupts, the responsibility for it will rest firmly upon Obama.
Our medical system is NOT set up to handle a pandemic. It will collapse and, irony of ironies, our major cities will be hit hard.
“The collapse of a complacent bureaucracy in the face of an emergent threat usually goes through 3 phases. Denial. Confident half-measures. When the half-measures don’t work there is finally panic; full-blown, shameless panic which either manifests itself in a bugout or in the demand by authority for absolute power to contain a crisis which only last week they declared did not exist. These psychological phases are remarkably constant throughout history.” Richard Fernandez
From the article linked at Drudge:
“Secretary of Health and Human Services Sylvia Burwell said that despite the best efforts of health officials, Americans have to prepare for the reality that there may be more cases of Ebola in the United States.”
Best efforts??? Major fail with the principle reason for even having a federal government, PROTECTING OUR BORDERS, being openly defied. How I have prayed that our fellow citizens will wake up and open their eyes. But alas, we are sliding down the slope to oblivion.
GB–Our major cities deserve to be the place that get hardest hit. You’ve seen the maps…those are the areas responsible for giving us this government.
>> “Carlos III director Yolanda Fuentes told El Paés that the biohazard suits they provided did indeed conform with safety protocols established by the World Health Organization and the Spanish Ministry of Health.”
Every statement in Spain has always trick. It´s always focused in avoiding responsabilities. First thing to do with spanish political (or semipolitical) statements is searching where´s the trick.
This is no exception.
WHO website says nothing about biohazard suits. If you download Ebola protocols (here http://www.who.int/csr/resources/publications/ebola/manual_EVD/en/ and here http://www.who.int/csr/resources/publications/ebola/filovirus_infection_control/en/), they say nothing about biohazard suits. WHO protocols are crisis management protocols, not entering into specific technical details.
With regard to Spanish Health Ministry protocols, they were changed at the beginning of the Ebola crisis to some ambiguous and non specific protocols that could fit everything.
So, the statement is true: biohazards suits fit WHO protocols (because WHO has none about biohazard suits) and fit Spanish Ministry Health protocols (because Spanish Government eliminated any specific indication in those protocols when the missionary arrived to the Carlos III).
Blert, objective accomplished.
You’ve educated me. You’ve warned me.
And you’ve scared me.
As a (stupid) doctor decried by blert, may I say this about the INCUBATION PERIOD, a concept blert apparently takes offense at.
Think of IC as the interval between initiation of infection and onset of first symptoms. Before symptoms one is clinically well (lab results aside). Without symptoms and without knowledge one has been infected, there is no reason to seek help. ‘Nuf said?
Don Carlos,
If a man becomes infected with ebola and three days later has sex with his wife, would it be possible for her to be infected by him?
Liberia is canceling national elections over this obola pandemic. Good thing that wouldn’t happen in 2016 in the United States.
” Sharon W Says:
October 9th, 2014 at 12:25 pm
GB—Our major cities deserve to be the place that get hardest hit. You’ve seen the maps…those are the areas responsible for giving us this government.”
Oh Oh. Cause and effect! Your name will show up on some “extremist watch” somewhere.
GB-
With respect, I think you can answer your question yourself.
Question to “web page”: Are you a spambot?
Thread Comment: My wife chides me, but if I ever get a fever of 100 (or even 99) I feel like crap. Maybe it’s just the man-cold syndrome.
DC…
The concept was originated in the 19th Century — even before it was understood that bacteria reproduce by fission.
The only biological model in anyone’s head was that of of the barnyard — the chicken coop.
The first presumption about bacteria was that while ultra tiny, they reproduced — more or less — like chickens and eggs. Hence the notion that an incubation period existed.
If the term LATENCY had been promptly adopted many errors would stop.
Latency is … a time delay between the cause and the effect of some physical change in the system being observed.
Both professional and common Joe think of incubation as meaning that the problem is contained until it ‘hatches.’
THAT’S the problem.
The Spanish — as posted above — are exemplars in making the ‘incubation error.’
And these WERE the professionals.
They DID conflate incubation with non-transmissablilty!
And, even now, they STILL DO.
Everyone has to STOP using the term and the concept of incubation.
It’s indefensible.
It’s errant.
It’s killing us.
The grand assumption that one can wander around, being a candidate for ebola transmission, …
Or wander around in the presence of an ebola candidate… is killing us all.
Ebola has to be IMMEDIATELY contained, isolated, quarantined.
Anyone treating ebola candidates has to stay entirely away from the general public — and hospitals in particular.
The ebola protocol must be to STOP moving candidates and victims around like HIV is the issue.
That means one does not even shake the hands of a survivor — until they are entirely clear — which may well mean months to wait.
It’s only now being accepted that a lethal dose is one (1) ebola virus. The human immune system can’t ‘see’ ebola. It reads ebola as if it’s a loose lipid.
By the time the immune system reaches ANY fever at all, ebola is running riot through the body. In which case, the number one vectors are those candidates who think the don’t have a problem. They’re out and about, doing their business — spreading ebola far and wide — without discomfort.
They only slow down for the end stages. During the early stages of their fever, candidates must be peaking in the damage they can do. They don’t stay isolated — and they are spewing ebola simply everywhere.
If ebola were a tad more robust in the environment, it would be sweeping through Europe like the Black Death — even now.
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I’m coming around to the belief that the ‘system’ can’t wake up until it’s too late.
I can’t see any mechanism that would get ebola under control in Spain. I think the nurse spread it all over town.
We’re following EXACTLY in the footsteps of the west Africans.
It is to be expected that ebola will travel far faster in Europe than it ever did in Africa. Crazy numbers could be only months away.
As for the Americas, the outlook is just as grim. T.E.D. is but the first. At either state of knowledge, they will come.
As President, Barry Soetoro has probably killed himself.
Why?
It’s in the very nature of pandemics to wipe out the most connected humans in a population. Who could possibly be more connected than an American president?
In the 14th Century, royals didn’t even hold court. They fled into the countryside and held all commoners at bay… with pikes and lances if necessary.
This is where the legacy of having estates in the country was burnished.
History is replete with royals living on the road for many months to ride out an epidemic back in the capital.
Venice’s claim to fame was their strict control of sicko’s trying to get in. Venice entirely skipped by the Black Death. (Very few cities did so.)
Barry is still treating this matter like it’s HIV and homosexuals. Hence his comity with the sufferers and candidates.
He identifies with the fringe, and always has.
The more any expert tells him this is folly, the more his back gets up. He’s still fighting grandma’s ghost.
“Anyone treating ebola candidates has to stay entirely away from the general public – and hospitals in particular.”
However, in the case of the late Mr. Duncan, he did not know that he’d been “treating” an ebola candidate until it was far too late.
I agree with Truth Unites…and Divides; I’m more educated about ebola now, and more alarmed.
blert,
It´s a tad more robust in the environment, in the right place.
I´m in a hot country, not really that worried about Ebola.
But the moment it spreads in some Scandinavian countries THAT can be a serious issue. Ebola survives two months at 4ºC. And this temperature is gonna be the maximum in January-February in some countries. I don´t know if somebody thinks about it, but the timetable is exactly the right one for the Ebola spreading in Scandinavia or Canada just on time for this period of the year.
The absolute first measure must be to have the general public wearing face masks. They would drastically reduce ebola aerosols.
All cuts must get prompt treatment — and bandages.
Ebola is weirdly lethal and vulnerable. Its lipid sheath is pretty ‘fatty’ in the chemical sense. That makes it vulnerable to a slew of household cleaning agents.
I wish the experts would provide a suitable list.
One can only hope that ebola can’t get in though the eyes. I suspect — no proof — that its lipid coating makes transmission by eyeball a low odds event.
This needs research — yesterday.
There is no question but that once a candidate has ebola, the eyes redden. (IIRC) But the human eye figures to react whenever T-cell counts are elevated, regardless.
It’s essential to prevent rapid-fire aerosol transmission of the ebola virus. Like all viruses, it’s tiny — and hence easily carried by exhaled (wet) air.
I would expect all smokers to be ultra-vulnerable to ebola via aerosol transmission.
blert:
I don’t have time to find the link now, but the information put out by authorities is that it can be transmitted through the eyes, as well as mucous membranes.
“If a man becomes infected with ebola and three days later has sex with his wife, would it be possible for her to be infected by him?” GB
“GB-
With respect, I think you can answer your question yourself.” Don Carlos
Actually, no I don’t feel particularly qualified to answer that question, which is partially why I asked you, a doctor with an interest in this issue.
I have my suspicions but your non-answer leads me to think that someone can be infectious well prior to any symptoms manifesting, which supports blert’s assertions as to the misleading nature of the term “incubation period”.
If I understand correctly, someone who has contacted ebola is infectious very quickly (minutes, hours, a day?) but the potential for infection is directly related to the degree and manner of contact, i.e. the earlier in the incubation period, the more intimate the contact required for infectious transmission. Correct?
GB…
That’s it.
Early in, the viral concentrations figure to be mighty low.
Ebola is a rapid fire virus, plainly.
It’s not ‘slow’ like HIV. Indeed, HIV is not known to be easily transmitted. If it were it would be everywhere by now.
Ring around the rosy pocket full of posies, ashes, ashes, we all fall down. Not just a quaint childhood rhyme any more. Glad we live in a small town. Worried for my daughter, son in law, and 2 grandsons in Chicago. At my insistence and a transfer to their bank account they now have water and food for 3 months of sheltering in place in case bug out is not an option. Fortunately, the other kids live in small midwest towns.
Imo, we are headed for a panademic at least as deadly as the Spanish flu. As noted above, the system will crash should that occur… medical system crash, financial system crash, and a swift societal crash.
The sheriff’s deputy Monning in Frisco, Texas does not have ebola.
FWIW, I was wondering how he could have ebola, but the other family members who lived with Duncan didn’t. They were living with him! And quarantined afterwards when it hadn’t been hazmatted.
So if Monning got ebola, and the others didn’t, that would seem a bit odd.
TU…D
Actually, one NEVER knows what any specific individual TOUCHED.
We don’t know if he had cut skin — an occupational hazard for a LEO.
We’re all so green in this.
Obviously, even the ‘experts’ were totally winging it… and they’ve been proven fulsomely wrong.
In the case of Spanish flu (it’s a sister of Avian flu, BTW) ran totally out of control for months and months on end.
None of the experts figured it out — ever.
It’s only now being re-studied — as DNA has been pulled up (literally) out of graves.
It’s from such samples that experts now know that’s highly related to Avian flu. — Which puts everyone’s hair on fire when Avian flu is in prospect. Spanish flu killed millions and affected the politics of the 20th Century — even right down to this day.
(Communism, Nazism, the Great Depression,… on and on it goes.)
Spanish flu wiped out the HEART of military aged European males. It was for this reason that the inter-war years were rotten economic times — even when things were not in chaos.
The German and Russian naval mutinies turned on Spanish flu and nothing else. It blew through (both) naval barracks like a fire storm. The censors suppressed this reality — and the result is that modern readers are led to believe that the boys just suddenly got upset.
Their primary riot was to get out of the barracks, period. The mutinies occurred on land.
The German mutiny triggered the Armistice.
The Russian mutiny threw the government over to the Reds.
This flu got the name Spanish flu because neutral Spain was the first European nation to openly discuss the disease. All of the combatant nations had been censoring their pains.
As I related before, my Granduncle had to bury his barracks in Kansas. Healthy soldiers were dropping like flies. Everyone set their energies on digging their own graves. Most of the old fort became a graveyard.
I sure hope I have some of his genetic blessings.
The UK is reversing its earlier policy and is now stepping up screening of arrivals from Ebola-affected areas:
People arriving in the UK from areas hit by Ebola face “enhanced screening” for the virus at Heathrow, Gatwick and Eurostar terminals.
Downing Street said passengers would be asked questions and potentially given a medical assessment.
GB: It depends!
I am not a virologist, just a stupid doc. But infectivity is clearly a function of initial viral load, rate of viral replication, viral concentration as a function of time ( 3 days in your query) and viral ‘penetration’ into the fluid(s) in question (saliva and semen in your query, presumably.). So your query has multifactorial features best responded to with a hedge: It depends! Which is reflected in the (ahem) ‘incubation’ period, said to be from 5 days to 21 days until the onset of symptoms and signs. Which I suspect was your own conclusion too.
blert seems to be in a state of high dudgeon about what he feels is the inappropriate use of the word “incubate”. It is the concept that matters, the asymptomatic period in which a bug multiplies, not the label, IMHO.
When Ebola actually first becomes infectious via bodily fluids of an infected person is still unclear. That question cannot be answered by non-laboratory means, in my opinion.
“People leaving areas affected by the outbreak have been subject to checks for some weeks, although people do not become infectious until they display symptoms.”
From Ann’s link.
Folks, this is what “incubation period” has led us to.
Even now, the general public is being fed absolute garbage.
Long before the T-cells go bananas, ebola is ripping through the victim’s body.
The ONLY logical reason for the progression of this virus is that it is NOT detected by the human immune system. If anything like that were happening, the fever would come on like gang busters much earlier, shortening the latency period.
It should be obvious to even a lay-man that the fever is being triggered by massive cellular debris. The ordinary function of T-cells is not to stomp on infections. It’s to clean up the chronic booboos in everyday, ordinary, cellular processes. The liver doesn’t catch everything.
The fever comes on late in the progression because in all of the earlier stages of the exponential the cellular debris is not wildly above the normal.
The comparatively slow growth of ebola makes one think that it does not rupture a given cell (after its ‘harvest’) all that quickly. It may be constrained by its need for lipids.
An extremely low lipid diet may stretch out ebola’s reproduction tempo — perhaps enough to save lives.
Alternately, one can imagine feeding ‘defective’ lipids into the blood stream that are close enough to be used as the viral ‘wrapper’ — but which have a nasty tail that alerts all T-cells that something’s wrong.
Bats may have organic catalysts that bust up the lipid sheath.
Ebola is so lethal because it’s so stealthy against our T-cell defenses.
In that sense, it mimics HIV, which also confounds our immune system.
We may be reduced to using a medical cocktail, no magic bullet being to hand.
“…people do not become infectious until they display symptoms.”
Blert, you might be correct that this has to do with a mistaken concept of incubation period, or it could be based on observations from previous Ebola epidemics. Because we have been fed so many lies, it is hard to know how reliable this heuristic might be although I suspect that it is probably reliable in all but the most serious cases of contamination.
So far here in Texas it appears we have been much more fortunate than the Spanish. We have had several bonafide exposures and yet so far none of Mr. Duncan’s contacts have confirmed Ebola. The Spanish priest was closer to death when the nurses had contact with him and he was probably experiencing a much more severe viremia by then and was probably shedding many more virions. By the time Mr. Duncan reached this stage of his illness he was already properly quarantined.
Another possibility is that the Spanish Ebola is a difference strain of Ebola which has already mutated to survive longer in the environment and is therefore more infectious. If so, the Spanish are in for a sizeable cluster of Ebola cases since they have already exposed many more people to the illness than we did in Dallas.
Incidentally, since Obama has the borders open, ISIS should have no difficulty importing Ebola into the USA and should be able to kill large numbers of people.
First World Healthcare and socialized medicine is So much better than that junk the Africans had… right?
Suicide viral bombers. Gotta love em. Hussein O does.
blert
most viruses lower white blood cell counts, but not many are as frequently and speedily fatal as ebola. Ebola attacks the endothelium, the inner lining of blood vessels, thus eye redness and bleeding at many sites…it destroys your plumbing, with so many leaks.
Don Carlos:
I’m neither a virologist nor a doc (stupid or otherwise), but wouldn’t the infectiousness start pretty soon after the virus enters the person, but be almost zero at that point? And wouldn’t it increase exponentially over time? Something more or less like this?
Neo-
a virion is one virus particle. It depends on many factors how many virions it takes to establish an infection. That is, how many troopers it takes to establish and occupy a beachhead, as opposed to being killed and repelled by defenders, while other soldiers are brought in (by viral multiplication, but I stretch the analogy).
Can only be quantified in a lab, but clearly one’s risk is less if one makes skin-skin contact and then soaps and Cloroxes, as opposed to ingesting or otherwise internally taking a viral dose, when one cannot follow with either.
Short answer to your question, though, is YES
It’s just hit me: fruit bats HAVE to have an extremely low lipid diet.
It’s an angle that needs to be played/ researched.
Such a constrained diet (throttle) may make it impossible for ebola to create enough injury to kill.
A low lipid diet should be easy to craft.
Unlike most wildlife, humans have a diet pretty rich in lipids… to say the least.
Various articles and podcasts on the ebola virus. Some here might find them useful:
http://www.virology.ws/ebolavirus/
For me this is the money quote in the articles mf recommended.
“Viral transmission can also occur when virus-containing respiratory droplets travel from the respiratory tract of an infected person to mucosal surfaces of another person. Because these droplets are larger, they cannot travel long distances as do aerosols, and are considered a form of contact transmission. Ebola virus can certainly be transmitted from person to person by droplets.”
In other words when Ebola is transmitted by droplets from the respiratory tract of an Ebola patient to a caregiver or bystander it is defined as contact. Problem solved. Ebola is only transmitted by contact.
I’m coming around to the view that our high lipid diets make humans subject to the MOST rapid growth of ebola.
%%%
If there is one unifying theme of west Africans, nurses and doctors… it’s that they are not heavy drinkers.
Since booze is totally out of favor with modern medicine (in contrast with the 19th Century) I can’t imagine any lab testing ebola’s resistance to alcohol in the blood stream.
It may prove out that ethanol is enough of a surfactant to screw up the lipid sheath that turns ebola into a stealth virus.
Indeed, ebola is apparently VERY sensitive to ‘soaping’ outside the body.
Some in vitro testing should be in order.
The more I think about lipids in the diet…
Ebola may require a lipid or two that cannot be crafted within our bodies — and have to be from our diet.
If so, restricting such an intake may put enough restraint on ebola’s exponential reproduction to give enough grace to survive it.
THIS may be the magic variable as to why even 30% of its victims survive at all.
This angle needs immediate laboratory research — as it’s something that can be effected without delay — and without further test protocols.
A change in ones diet has to be pretty harmless.
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1) Compared to all other primates, humanity is sky high in its lipid intake.
2) Humanity is sky high with morbidity from ebola.
Is THAT the connection?
Inquiring minds want to know.
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