NOTICE: Posting schedule is irregular. I hope to get back to a regular schedule as the day-job allows.

Sunday, August 3, 2014

All we have to fear is fear itself... [Full link to blog for email clients.]

OK, I am only going to say this once - but there are some TRULY HORRENDOUSLY IGNORANT comments being made about Ebola and the current scare. 

1. This is not Africa.  We actually have fully-competent medical professionals in every metroplex, city, small town, and rural community who are trained to recognize illness.  The reason Ebola is so deadly in Africa is that so many of the people who are sick get NO MEDICAL CARE!

2.  Medical care for a viral infection consists of rest, plenty of fluids and nutrients, treatment for fever, treatment for nausea-vomiting-diarrhea, treatment with anti-viral medications - i.e. medications specifically designed to interfere with viral replication.  Given appropriate supportive treatment - the mortality rate of even Ebola goes way down from what it is in Africa - in other words, even country doctors are able to treat it.

3.  Most airborne viruses are not lethal.  The dozen or so "lethal" viruses all require some form of direct transfer through bodily fluids in order to infect a new patient.  The reason for this is that what makes a virus deadly is how fast it multiplies - and what tissue it infects - in a human patient.  That *usually* means the lungs, mucus, blood - and that environment is hot (98.6 degrees F), moist (nearly 100% humidity) and full of soft cells.  Air is not.  Even Atlanta, Houston or Miami in the Summer does not reach those conditions.

4.  In order to grow and multiply quickly in those conditions, viruses are adapted to live best in those conditions.  That means the virus itself is actually quite fragile.  It will not survive on a cool dry surface.  Even in sputum (what you cough up) it will die in a few minutes exposure to air, and can be eliminated with alcohol wipes, dilute bleach, Lysol, or even just soap and water. 

5. Viruses are not bacteria.  The fact that Americans over-use antibiotics and there are resistant strains out there MEANS NOTHING to dealing with viruses. Presence or absence of TRICLOSAN in antibiotic soaps is MEANINGLESS.  PUREL(tm)  handsanitizer works just fine - it's the alcohol that does the trick.

U.S. Doctors do know how to deal with viral infections - see 1-5 above!

6.  Why are these patients going to Emory?  Because Emory has a HOSPITAL.  CDC and USAMRIID are RESEARCH institutions, not HOSPITALS.  Hospitals have very effective infection control mechanisms in place.  I run a research lab.  I deal with lab animals.  When I need to deal with human patients - I do so IN A HOSPITAL!

7. Yes, viruses have a high mutation rate.  That is why we need new influenze vaccines each year.  BUT!  What mutates is the PROTEIN COAT around the viral DNA/RNA.  Typically not the genes themselves.  Thus, the virus is HIGHLY UNLIKELY to sudden become more lethal just in the course of infecting a few humans!

See, what happens is, a virus "particle" attaches to a cell.  As stated above, a virus is genetic material wrapped in a protein capsule.  When the proteins attach to a cell, the proteins stay on the outside and the DNA/RNA enters the cell and starts to replicate.  The cell is "taken over" to make DNA/RNA copies and build more protein capsules.  The viruses are assembled, the cell dies, ruptures and releases more virus.  HOWEVER since the original protein coat does not enter the cell and has to be built from scratch by the infected cells, that coating is the most likely to mutate.  When that happens, the coat MIGHT be more likely to attach to different types of cells - but more likely, all that happens is that the bodies existing antibodies (and vaccines) won't quite recognize the new coat.  This slows down immunity, but doesn't stop it in its tracks.

8. Viruses tend to become LESS LETHAL as they mutate.  This is exactly the principle used in producing vaccines - take a virus, grow it in a cellular medium where it can reproduce and mutate to it's own content - then harvest the mutations that have gotten less "virulent" - it's called ATTENUATED VIRUS and is how most vaccines are created simply because THAT IS WHAT VIRUSES DO.  A more lethal virus is so unlikely that most research labs artificially create substances rather than let nature run its course.

9.  Yes, a change in transmission CAN occur throughout the course of an epidemic - however, what epidemiologists tend to find is that the alternate form was there all along, but not recognized. It's the sort of thing that requires Tens and hundreds of millions of infected to occur.  That's why we get things like bird flu and swine flu because the virus developed in a species untreated.  Then when they jump to humans - they don't really work that well unless the victims GET NO MEDICAL CARE (see #1&2).

10.  For every parent who has had a sick child AND DIDN"T GET SICK or who has had a close family member with any number of viral infections WHO DIDN'T CONTRACT THE DISEASE - keep in mind that it is in fact VERY HARD for viruses to jump from human to human.  The sole exceptions are common cold viruses - and only because they are slightly more stable in air - but even then, the transfer is *STILL* from bodily fluid exchange (sputum from sneezes and coughs). 

SIMPLE PRECAUTIONS protect any person coming in contact with a person infected with any viruses - wear a mask, avoid contact with bodily fluids, wear latex/nitrile/rubber gloves if you have to handle bodily fluids, disinfect hands and surfaces that may have come into contact with bodily fluids.  Extend the "glove" concept to sexual activity and these few precautions are used to effectively prevent viruses from influenze to herpes.

KNOW THE FACTS! and stop perpetuating the rumors and fear-mongering.

[Disclaimer:  I am a neuroscientist, not a virologist, immunologist or epidemiologist.  However, I was classically trained in physiology and pharmacology - so I had to learn how the physiology of the body reacts to viruses, how the immune system does its job, and how various drugs and pharmaceutical compounds affect those processes.  In addition, my training was specifically in conjunction with a Medical School curriculum - I have received a lot of medical and emergency training in the course of my career as well as all of the training required to work and do research in the hospital environment.  


  1. Thank you, I have been stating this all weekend and no one wants to listen.

  2. Have you read THE HOT ZONE? It's the most terrifying nonfiction book I have ever read, even the author Stephen King said so. Ebola virus is one of the deadliest and easiest to catch virus and should not be casually dismissed. The book discussed who and how it was contracted by a white male. He died in Nairobi with blood oozing from all the pores of his body practically turning him into mush.He was not someone from an African village in Kenya; he's British, if I recall, went exploring a cave where he got the virus. But the most disturbing revelation from the book was how the government handled the type of Ebola that was discovered here in the US in the early 90s.

    1. I am a Virologist. The Hot Zone is a good book and Preston is an excellent writer for science. Oggi- they never confirmed where the ex-pat contracted the virus. They THINK he got it from bats during a cave walk. It was never confirmed. Also he LIVED in Africa and he was treated for the disease in Africa. His country of origin is irrelevant.
      And the Reston incident was and excellent example of disease survey and control in this country. Ebola Reston is NOT contagious to humans. Ebola Marburg is more clinically relevant to humans than Reston strain. They did an excellent job containing the disease and not causing unnecessary public panic or danger.

  3. Yes, I have read it. Please keep in mind that while a True Story, THE HOT ZONE was written as a THRILLER - meaning that it was MEANT to SCARE readers. That is quite frequently done by exaggerating - but much more often by "cherry-picking" the cases. There is no excitement in the two USAMRIID workers who accidentally infected themselves with Reston Virus ... and survived with only cold symptoms. Nor is there awe and suspense in the cases of Ebola that have received medical care to counter fever, hemorrhage and blood volume loss ... and survived.

  4. Oggi, Ebola is deadly but it's not easy to catch. If it were easy to catch, there would have been more than a couple thousand deaths *total* since it was discovered.

  5. We should NOT be worried about the evacs to Emory. That is being done as much as anything to increase our knowledge of the disease. Much of the rest of the above, however, is wrong. My wife served in the Army with the authors of The Hot Zone and declined an invitation to work with them. Ebola is extremely dangerous, partly because it has quickly mutated into less lethal strains--which can spread further. It may seem paradoxical, but an illness with 95% 1 week mortality is not much threat because it kills off its hosts before it can spread. A disease with 60% mortality in two weeks could cripple civilization.

    The comment above that Ebola is hard to catch or else there would have been thousands of deaths is flat wrong. Ebola is highly contagious via close contact. The death count is as low as it is because every outbreak to date--including this one--has arisen in small jungle communities. One flight into Paris could change the arithmetic horrendously.

    We should not panic, but we should take Ebola in particular VERY seriously.

  6. I am a Virologist. The Hot Zone is a good book and Preston is an excellent writer for science. Oggi- they never confirmed where the ex-pat contracted the virus. They THINK he got it from bats during a cave walk. It was never confirmed. Also he LIVED in Africa and he was treated for the disease in Africa. His country of origin is irrelevant.
    And the Reston incident was and excellent example of disease survey and control in this country. Ebola Reston is NOT contagious to humans. Ebola Marburg is more clinically relevant to humans than Reston strain. The handlers acted quickly to contain the virus and to quarantine themselves. It was excellent as there was no danger to the public and no reason to cause unnecessary public panic.

  7. In response to point 8 the mutations in a virus are influenced by the environmental impacts. Viruses have varying mutation rates. Yes, typically in cell culture viruses become attenuated because there are no pressures from the host immune system. However in animals and in humans the virus will be pressured to maintain virulence.
    It is correct that Ebola does "burn hot" because of its lethality. However the variable incubation period is problematic because the virus is transmissible during that period.
    Also the cultures that dictate handling the body and kissing the deceased is what causes huge problems in Africa.
    Plus we know nothing about Ebola. We have no serosurvalence in Africa. Most people may come into contact with Ebola and be fine. However Ebola is not cross protective. Zaire strain will not protect against Cote De Ivory strain will not protect against other strains. So it may be that these strains are unique or it may be like other diseases (plague) where mode of transmission greatly impacts the pathology of the disease.
    No after what there are other diseases that I would consider as dangerous or more so than Ebola. There are many other hemorrhagic diseases that are in the Americas and can be transmitted by animals we have in this country. Any disease that has a reliable animal component (zoonotic disease) is dangerous. Plus if you go to Africa and don't consider getting Ebola, TB, Rift Valley, or any other major disease and realize that you will then be subjected to third world health care then you shouldn't be going.

  8. Ebola is a virus....while not primarily upper respiratory like influenza it can EASILY be transmitted to another person by aerosolization of infected fluids during coughing or sneezing. If an Ebola patient is bleed ing in the lungs, from mucosal tissue in the stomach, esophagus or nasopharynx there is a ready reservoir of virus available for aerosolization and dispersal by coughing or sneezing. To prevent infection from spreading patients must be isolated in special rooms that have controlled ventilation. Many hospitals have only one or two of these special rooms. Larger ones may have a dozen. Once a virus like this becomes spread at even a tenth of the magnitude of a typical influenza outbreak the hospital system will have nowhere near enough facilities to keep such patients isolated. The virus will spread, the only question being how fast and how far. It likely won't spread like the flu does but with a mortality rate greater than normal flu by an order of magnitude it won't be long before panic sets in and things get nasty. Ebola only has to have a mortality rate of 5 to 10% here as opposed to the 50+% rate in Africa for things to go south in a hurry. And the "infection control" expertise you attribute to American hospitals is a bit of a myth. That is why deaths from nosocomial infections run into the six figures every year. And I have spent 37 years in healthcare taking care of the sick and injured.....universal precautions are used nowhere near often enough to prevent spread of disease in hospitals. Ebola has more than enough potential to match or even exceed the 1917 flu pandemic.

  9. I appreciate the fact that people with greater expertise than I have weighed in on this subject. Please understand that what I am trying to do is defuse the attitudes of people who are scared shitless that transporting two patients to the U.S. for treatment.

    A few of the points mentioned above are worth a follow-up. (1) are person who is so far along in the progress of the disease to be coughing up blood is unlikely to be traveling by air to the U.S. Yes, there *is* a person who got off a plane and collapsed soon after, but what the *public* does not understand is that ONE VIRUS PARTICLE is not going to infect a person with a new disease. Duration of incubation is important because it takes time for enough viral particles to build up in blood and the internal bleeding is a very late stage symptom. When an Ebola victim is most contagious, they are not moving around!

    Regarding mutations: The poster above mentioning that that the virus quickly mutates to a less lethal but longer incubation form *still* makes my case - that viruses are more likely to mutate to *less* severe forms in humans. It is the long incubation in an animal reservoir which results in the previously unknown "deadly mutations." My statement was made *specifically* to counter rumors to the effect of "viruses quickly mutate to more deadly forms in the course of an epidemic." In fact, the 85% vs. 60% mortality cited in that previous comment has actually been show to be two different virus strains from the very start (1976 Zaire/Sudan outbreaks). Since the emergence of Ebola Zaire in 1976, the actual mortality rate of the subsequent outbreaks has been ~50-60% - still with incubation periods of around 7-10 days (*only* *very* *rarely* is incubation as long as two weeks - and in fact, a patient lasting 12 days is most likely to survive). Since discovery of Marburg virus in 1969, the total mortality from these viruses is about 3000 people - in 45 years!

  10. With respect to Universal Precautions - I quote from Harrison's Principles of Internal Medicine regarding the Zaire/Sudan outbreak in 1976: "Both epidemics were associated with interhuman spread (particularly in the hospital setting) and the use of unsterilized needles and syringes—a common practice in developing-country hospitals. The epidemics dwindled as the clinics were closed and as persons in the endemic area increasingly shunned affected persons and avoided traditional burial practices." and regarding Ebola Zaire epidemic in 1994: "The epidemic smoldered until April, when intense nosocomial transmission forced closure of the hospitals; samples were finally sent to the laboratory for Ebola testing, which yielded positive results within a few hours. International assistance, with barrier nursing instruction and materials, was provided; nosocomial transmission ceased, hospitals reopened, and patients were segregated to prevent intrafamilial spread. The last case was reported in June 1995."

    Thus, it doesn't require full Biosafety Level IV just to stop the spread - simple hygiene is sufficient - and that is something which hospitals *do.* To wit: "In a 1996 episode, a physician exposed to Ebola-infected patients traveled to South Africa with a fever; a nurse who assisted in a cutdown on the physician developed Ebola hemorrhagic fever and died despite intensive care. The index patient was identified retrospectively on the basis of serum antibodies and virus isolation from semen. No additional cases arising from care of the primary or secondary case were detected, nor did any secondary cases follow care of an unsuspected Côte d′Ivoire Ebola case in Switzerland. Thus, distant transport of Ebola virus is an established risk, but limited nosocomial spread occurs under proper hygienic conditions."

  11. It is important to understand the difference between viruses that are prominently spread through nocosomial means and Ebola/Marburg. Norwalk Virus (i.e. norovirus - for one nocosomial example) is eliminated by bleach and Betadine, but totally unaffected by "antibacterial" soaps, chlorhexidine gluconate and benzethonium chloride. Norovirus is present in feces, sputum and vomitus; it survives dry cool air, boiling water, ether, and acids, but to date it cannot be easily grown in cell culture.

    The "filioviruses" of which Marburg, Ebola/Zaire, Ebola/Reston, etc. are members are susceptible to: bleach, alcohols, ethers, acids, lyes, lipid solvents (soaps), detergents, UV radiation, high temperature (60 degrees C) - it *can* survive drying if it is still in a cellular medium (dried blood) but on the whole, these viruses are extremely fragile compared to the types of viruses most commonly found in "hospital" infections.

    So yes, the basic principles of handwashing, not sharing needles, and cleaning up body fluid spills will go a long way to containing an Ebola outbreak.

    I'm not saying that Ebola is not dangerous. I am saying that FEAR-MONGERING and fueling the growing public PANIC that is leading to people picketing the CDC because we transported two patients to the U.S. is IRRESPONSIBLE. We need to be *educating* people, not simply scaring them!

  12. I am also not making light of the effort required to keep a patient alive that has gone into end-stage disease. Antivirals don't work, but the main treatments are platelets and keeping blood volume elevated. The primary cause of death is low blood pressure and NOT blood loss. Supportive therapy is just that - keep the patient supported while their own immune system counters the disease.

    In that respect, in western medicine it very likely will be the case that an Ebola/Marburg outbreak will be similar to other viruses in that among those with access to supportive care, the predominent victims *will* be the young, elderly and immune compromised.

  13. Speaker et al., how much of a concern is the report that Mt. Sinai Hospital in NYC is testing for Ebola someone recently come from W. Africa? Could just be he has an ordinary flu—but is this news something to follow closely, or is it a “we’ll hear about it if it becomes a problem” thing?

  14. Then there was the woman on the flight that landed at Gatwick. But she didn't die from ebola, she died of "natural causes" - even as she was shitting and vomiting as she got off the plane. And what happens to those who (unprotected) get to clean up the mess in the plane? Same for the guy in New york.

  15. Mt. Sinai is reporting that they do not suspect Ebola in their patient but are running the tests based on his recent travel to be sure. As for the British case the Public Health officials descended on Gatwick and put in place protocols to handle the situation and have the information for everyone that not only was aboard the plane but was in any way associated with the plane.

    Mind you that the airline industry has protocols in place for dealing with body fluids on a plane.

  16. Hmm, I thought I'd posted, but apparently not. So I'll try again, and then it will probably show up twice.


    Chill, folks. I was a Certified Respiratory Therapy Technician in the early AIDS era. There was all kinds of worry about the risks to health care workers, and the risks to the general public. In fact, aside from people who caught bad blood transfusions, almost all AIDS patients were gay/bisexual men, needle sharing drug users, women in long term relations with men in the first two groups, and children of women in the first three groups. And none of us health care workers got sick from on the job exposure.

    People LIKE to panic about epidemics, even when the epidemics aren't real. The LIKE to overemphasize threats. Recall that the guy in THE HOT ZONE who started vomiting blood on an airplane, iirc. No one caught it from him.

    Nothing is going to happen this time, either.

  17. Humanity has dodged MANY bullets in regards to infectious diseases....HIV is one where the vector mechanism made the spread difficult and easily preventable. Other diseases such as cholera etc. are easily controlled with good hygiene practices.....and some like influenza are simply beyond our ability to prevent, all we can do is treat the symptoms and hope for the best. In the case if influenza pandemics CAN occur and HAVE occurred. There are other diseases that can travel quickly and kill quickly that to date have NOT succeeded in reaching their complete lethal potential, SARS/MERS, Hantavirus and Ebola/filo virii are in this group. Sooner or later one of these or a similar one WILL make the jump from potential pandemic to real pandemic. Acting like Ebola is "No big deal, this is Merica we can handle anything" is a good way to give this one a chance to achieve the status of society killer.

  18. I don't believe I have said "This is 'Merica we can handle anything." What I am *trying* to do is provide calm rational information - so much so that I corrected and posted a new version of this blog - expanded, revised, and yes, I acknowledged and corrected mistakes.

    I acknowledge that Ebola is scary - however, if all a person knows of the virus is The Hot Zone - then they know only partial, out-of-date information. Given that you have spent 37 years in healthcare compared to my 35 years in medical research, you *also* know the danger of panic. People are panicking. If we allow folks to picket CDC through ignorance, called for strict isolationism and block scientific inquiry that can prevent the spread and develop treatments, then we truly will *not* have a chance. In fact, we will get exactly what we deserve.


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