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bunbury
Post  Post subject: Transmission of ebola virus  |  Posted: Sat Nov 01, 2014 12:17 pm
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The CDC states:
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Airborne transmission of EVD among humans has never been demonstrated in investigations that have described human-to-human transmission although hypothetical concerns about airborne transmission of EVD have been raised.3,10


In the same document it is reported that ebola was transmitted between non-human primates housed in cages 3 metres apart. The means of transmission is suggested to be spitting or throwing of feces. I don't know if it is possible to throw a monkey turd 10 feet while confined in a cage, but this would seem to qualify as airborne transmission if it happened. And while humans don't often throw turds at other people, it seems to me to be a bit harsh when pundits on TV ridicule people who worry about the possibility of transmission by sneezing and coughing.

In any scientific sense, "never been demonstrated" does not mean "cannot happen". Has every one of the cases in Africa been proven not to have been transmitted by sneezing or coughing? What minimum distance of separation is needed to distinguish between droplets from a sneeze drifting around a room and "airborne"? The question of airborne transmission is still open in my opinion.

http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html


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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Nov 01, 2014 12:34 pm
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Quote:
bunbury wrote:
[...]it seems to me to be a bit harsh when pundits on TV ridicule people who worry about the possibility of transmission by sneezing and coughing.

In any scientific sense, "never been demonstrated" does not mean "cannot happen". Has every one of the cases in Africa been proven not to have been transmitted by sneezing or coughing? What minimum distance of separation is needed to distinguish between droplets from a sneeze drifting around a room and "airborne"? The question of airborne transmission is still open in my opinion.


I thought that sneezing carried a possibility of transmission (no pun intended)? Surely, if saliva is one of the body fluids that is infectious, then there is a chance of transmission when some of that saliva is released by sneezing (since a lot of the time people release saliva from their mouths as well as mucus from their noses when sneezing)?

I find it quite worrying that health care workers in the West have managed to become infected despite wearing PPE and having the patient in an isolation unit - especially considering that the healthcare workers were not able to recall any lapses in protocol. It may be that there was a small lapse in protocol, but even that does not assuage public concerns, because that means that were a full-blown outbreak to occur in the West, then the chances are that the majority of us would not be sufficiently diligent to prevent transmission. There's also the possibility that the virus will mutate and become transmissible by air.

I would tend to agree with you in that the question of airborne transmission is still open to debate. It is impossible to prove a negative, but then, nobody has ever really done the experiment. It is always safer to err on the side of caution - irrespective of whether the infected find others' safety procedures 'offensive'. I always find that interesting, how relatives and loved ones especially (maybe it's just mine :lol: ) seem to take offence at your not wanting to be physically affectionate or even in close proximity to an infectious person. They take it as an insult, when in reality it is just precaution/common sense. This mentality is reflected in the attitudes of Ebola-negative healthcare workers who have returned from Africa and felt put out by the fact that they are expected to remain in quarantine for 21 days. They may not have the virus but, if it helps to calm the anxieties of the general public, then I think that it is in the public interest for the workers to comply with quarantine procedures. I guess it's a case of those associated with the disease not wanting their identity to be determined solely by the disease, as happened with leprosy.

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iNow
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Nov 01, 2014 3:32 pm
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I think the best way to view this is that transmission through sneeze or cough is exceedingly unlikely, but marginally possible. That's my "between the lines" reading of articles like this:

http://www.livescience.com/48547-ebola-sneeze.html

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Nov 01, 2014 3:50 pm
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Another thing: why don't hospitals install CCTV cameras in the isolation units so that, should a health worker happen to become infected, it would be possible to comb through the footage and observe any lapses in protocol? This would increase our knowledge regarding possible routes of transmission and ultimately may inform best practice and hence save lives.

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iNow
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Nov 01, 2014 6:05 pm
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I suspect it's a basic issue of cost/benefit analysis. It's unlikely that the costs of doing so are deemed worth the marginal potential benefit. It would probably have to be regulated as a industry wide requirement to make it happen.

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Nov 01, 2014 11:14 pm
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Surely it wouldn't cost that much? At the moment in the UK the expectation is that we are likely to see a handful of cases of healthcare worker infections over the next few months. That's, say, five CCTV cameras in total for the entire country. That is a drop in the ocean for the NHS budget. As for regulations, you would need to first obtain the consent of Ebola patients and all hospital staff who feature in the footage. That is not difficult, all it would require is a consent form to be signed on admission. I imagine that all involved would be keen to comply with the measure since it would help in the fight against this deadly disease.

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iNow
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sun Nov 02, 2014 3:51 am
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Rory wrote:
Surely it wouldn't cost that much?

surely, it would. The cost of the equipment. The cost of the installation. The cost of the wiring. The cost of the power. The cost of the maintenance. The cost of data storage. The cost to monitor the video footage. The cost of the staff to do so. The cost of litigation associated with the cameras, ad infinitum.

I'm not saying it's not a laudable goal, but when you multiply the above cited costs across each hospital wing of each hospital floor across each hospital across each region and roll it up where the funding gets approved, it sure looks like a sizable investment for marginal potential benefit.

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sun Nov 02, 2014 3:16 pm
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Quote:
iNow wrote:
surely, it would. The cost of the equipment. The cost of the installation. The cost of the wiring. The cost of the power. The cost of the maintenance. The cost of data storage. The cost to monitor the video footage. The cost of the staff to do so. The cost of litigation associated with the cameras, ad infinitum.

I'm not saying it's not a laudable goal, but when you multiply the above cited costs across each hospital wing of each hospital floor across each hospital across each region and roll it up where the funding gets approved, it sure looks like a sizable investment for marginal potential benefit.


Cost of 360 degree CCTV camera: £17.47

https://www.google.co.uk/?gfe_rd=cr&ei=lUVWVKKzAuLb7AbWjYHACg#q=360+degree+cctv+camera&tbs=vw:l,p_ord:p&tbm=shop&spd=10490164321139105015

Cost of installation: 1 hour's work (max) for a handy-person: £6.50

Cost of power: no idea, let's say £50/month

Cost of maintenance (negligible but, for the sake of argument, let's assume that it acquires a fault once every 6 months): £6.50 (1 hour of labour for a handy-person)

Cost to manage the video footage (would only occur upon infection of a healthcare worker which is in itself relatively unlikely, let's say 1/10 healthcare workers are infected per Ebola case): that would be approx. 21 days worth of footage (max), that's 504 hours of footage, that's £3,276 of wages to be paid to the employee.

Cost of litigation: N/A because you would obtain consent from all parties beforehand

That's approx. £3,356.47 total per hospital.

For £3,356.47 you could invest in deciphering what is the cause of transmission from Ebola patients to healthcare workers. x ONE

Or, for FREE you could allow healthcare workers to continue being infected, and so lose a very valuable member of society, whose tuition probably cost upwards of £20,000 - and pay to replace him/her, and pay for the counselling for his/her family members. x MANY

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iNow
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sun Nov 02, 2014 6:04 pm
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I see much more cost than benefit, but do stipulate that this is merely my own opinion and I respect that you hold an alternative opinion on this topic.

If we were dealing with thousands and thousands of Ebola cases being transmitted across the hospitals, I'd have a much easier time signing onto this idea and supporting it. However, since only a tiny handful of people are actually becoming infected in our hospitals, I find myself viewing the suggestion as a bit of an over reaction... Too strong a response given the actual scale of the issue. A focus on better protective gear and clothing and smarter procedures and policies seems to me to have a much higher ROI with a much lower cost.

Again though, that's just my personal opinion, hardly some fact.

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sun Nov 02, 2014 7:42 pm
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Well, at the moment there is no major Ebola crisis in the West but, if the response of the West to the outbreak in Africa has proven anything, surely it is that the initial complacency and inaction has led to the current state of crisis. It is easy to imagine how an outbreak here in the West has the potential to spiral out of control if multiple Ebola patients were to return simultaneously and to be treated by doctors/nurses some of whom contract the virus and so in turn become the patients who infect further hospital staff. A cyclical scenario such as this may result in the refusal of hospital staff to turn up for work through fear of the risks so making the situation worse. Preventative measures may help to stave off a crisis in the West.

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Jan 03, 2015 7:10 pm
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You have probably seen the news that the condition of Scottish nurse Pauline Cafferkey, recently diagnosed with ebola, has deteriorated - despite her having been treated with the plasma of ebola survivors and with antivirals. Would administration of generic virucides or disinfective agents, if given systemically at the maximum tolerated dose, be likely to kill the virus? Why or why not? Such agents are generally toxic and/or carcinogenic for humans - but, then, so are many of the traditional physical and chemical cancer treatments. As such, the risk-benefit considerations change when the patient is in a critical condition, and exposure to essentially poisonous substances sometimes saves a life.

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Tue Jan 06, 2015 11:09 am
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On screening passengers for Ebola at UK airports: could the natural variation in body temperature between individuals and under different conditions lead to the unnecessary holding of uninfected people and - worse - the unchecked passage of the infected? If a person has a normal body temperature of 36.5C then a low grade fever for that individual might be what the current screening protocol regards as 'normal' body temperature at 37C, and a moderate fever might be anywhere up to 37.5C, which still would not ring alarm bells in the current protocol. Although not feasible for everybody, one way to determine any change in body temperature on departure and re-arrival in the UK woukd be to requure all high risk health workers to take the same flights in batches. Sit them in an isolated room with 30 mins of inactivity before screening. One thing that Cafferkey has taught us (well, taught the Health Department) is not to ignore passengers when they tell you they feel unwell.

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Sat Jan 24, 2015 11:12 pm
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Pauline Cafferkey has made a full recovery and been released from hospital

Image

Awesome woman <3

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shlunka
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Wed Jan 28, 2015 6:23 pm

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I try to avoid ebola as I would avoid any other disease. With the avian flu, I avoided avians. Swine flu, I avoided swine. With Ebola, however, it's easier. All I have to do is avoid people and wild packs of ebolasaurs.

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marnixR
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Wed Jan 28, 2015 7:35 pm
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it's not ebolasaurs you have to avoid, it's their fleas - duh !

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Rory
Post  Post subject: Re: Transmission of ebola virus  |  Posted: Wed Jan 28, 2015 11:50 pm
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Don't go messing around with bats :geek:

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