2014-08-23

Ebola 9: Practically airborne - additional vectors of ebola infection confirmed by CDC and practice

ver. 1.1.3

Have you heard of Cassandra? I sometimes feel like one, when warning people here against the advice of "all will be fine, nothing here, pass on" doled out by governmental propaganda epidemic PR specialists.

Here's another case.
Real ebola quarantine zone

In September 2014 the CDC recently indirectly confirmed some of the previously denied vectors of ebola infection, of which I had been warning about here since July 2014.

Highlights:
  • For practical purposes, now CDC treats ebola as a Level 4 non-enveloped virus (more resistant), despite it being enveloped
  • Ebola is nigh impossible to remove from porous surfaces
  • Ebola remains active up to six days, especially in organic debris.
  • Ebola can also survive on solid surfaces, like tables, bed frames, especially in dark places, up to a day
  • Cleaning ebola-contaminated dust makes it airborne ("aerosolised", "droplet-borne" or whatever they may call it) and thus contagious
  • In the dark, ebola is "aerostable".
Airborne Biological Containment System, ABSC,
used to fight ebola

Read this:

Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. 
[...]
Ebola transmission chains:
doctors and hospitals as the nodes

Avoid contamination of reusable porous surfaces that cannot be made single use. Use only a mattress and pillow with plastic or other covering that fluids cannot get through. Do not place patients with suspected or confirmed Ebola virus infection in carpeted rooms and remove all upholstered furniture and decorative curtains from patient rooms before use.

To reduce exposure among staff to potentially contaminated textiles (cloth products) while laundering, discard all linens, non-fluid-impermeable pillows or mattresses, and textile privacy curtains as a regulated medical waste
[...]
This study found that under these ideal [for persistence] conditions Ebola virus could remain active for up to six days.
[...]
With consistent daily cleaning and disinfection practices in U.S. hospitals the persistence of Ebola virus in the patient care environment would be short – with 24 hours considered a cautious upper limit.
[CDC guidelines]

Read also this study: Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces.

Preliminary studies indicate that Ebola is aerostable in an enclosed controlled system in the dark and can survive for long periods in different liquid media and can also be recovered from plastic and glass surfaces at low temperatures for over 3 weeks (Piercy, et al., 2010).
DEFENSE THREAT REDUCTION AGENCY  BROAD AGENCY ANNOUNCEMENT   HDTRA1-15-EBOLA-BAA (source), referring to Piercy, T., et al. (2010).The survival of filoviruses in liquids on solid substrates and in a dynamic aerosol. Journal of Applied Microbiology. (109), 1531–1539




[Ebola] is, however, droplet-borne — and the distinction between the two is crucial.
Doctors mean something different from the public when they talk about a disease being airborne. To them, it means that the disease-causing germs are so small they can live dry, floating in the air for extended periods, thus capable of traveling from person to person at a distance. When inhaled, airborne germs make their way deep into the lungs.
Chickenpox, measles and tuberculosis are airborne diseases. Droplets of mucus and other secretions from the nose, mouth and respiratory tract transmit other diseases, including influenza and smallpox.
When someone coughs, sneezes or, in the case of Ebola, vomits, he releases a spray of secretions into the air. This makes the infection droplet-borne.  Some hospital procedures, like placing a breathing tube down a patient’s air passage to help him breathe, may do the same thing
Source


We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.

The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.


Infection of all four macaques in an environment, preventing direct contact between the two species and between the macaques themselves, supports the concept of airborne transmission.

 ...

Inhalation of viral doses as low as 400 plaque-forming units of virus caused a rapidly fatal disease in 4-5 days. The illness was clinically identical to that reported for parenteral virus inoculation, except for the occurrence of subcutaneous and venipuncture site bleeding and serosanguineous nasal discharge. Immunocytochemistry revealed cell-associated Ebola virus antigens present in airway epithelium, alveolar pneumocytes, and macrophages in the lung and pulmonary lymph nodes; extracellular antigen was present on mucosal surfaces of the nose, oropharynx and airways. Aggregates of characteristic filamentous virus were present within type I pneumocytes,macrophages, and air spaces of the lung by electron microscopy. Demonstration of fatal aerosol transmission of this virus in monkeys reinforces the importance of taking appropriate precautions to prevent its potential aerosol transmission to humans.
Source

In an observational study from The Democratic Republic of Congo, of the 19 EVD cases who visited the home of an EVD patient, 14 had contact with the infected case while the remaining five had no history of any contact, which points to transmission through some other mode (Roels et al., 1999)

In one study, six monkeys were divided into three groups and each group was exposed to low-dose or high-dose aerosolized EV and aerosolized uninfected cell culture fluid (control), respectively. All four monkeys exposed to EV developed infection (Johnson et al., 1995). Jaax et al. found that two of three control monkeys caged in the same room as monkeys with EVD, 3 m apart, died of EVD (Jaax et al., 1995).

The first infection occurred in a monkey caged near the air ventilation system and positive air samples identified through real time polymerase chain reaction (PCR), which raised the possibility of airborne transmission.
...
The experimental studies on EV transmission were conducted at low temperature and humidity, which might have favoured aerosol transmission.
...
Aerosols may be created in the absence of aerosol-generating procedures. Evidence suggests that aerosols from vomitus can transmit norovirus, and SARS was likely transmitted via faecal aerosols (Barker et al., 2004, Marks et al., 2003, McKinney et al., 2006, Yu et al., 2004).

Source
The Ebola virus.
Ebola virus


HUMANS: The most infectious form of Ebola is via the aerosol form. Particles of size 1-10 micrometers are small enough to be inhaled and trapped in the lungs or upper airways. (Bray, 2003; Casillas et al., 2003).
Source (great non-PC ebola info)


In South Africa one HCW contracted EBV when using normal surgical attire during placement of a central line in a patient with undiagnosed EBV.

This occurred despite no obvious lapse in infection control. In contrast, once EBV had been diagnosed in the HCW, respirators, impermeable one-piece suits and visors were used (according to South African guidelines), and no further infections occurred despite procedures such as intubation, mechanical ventilation, dialysis, central line placement and the insertion of a Swan Ganz catheter

Where uncertainty exists, the precautionary principle (that action to reduce risk should not await scientific certainty) should be invoked and guidelines should be consistent and err on the side of caution. Moreover, a clear description of risk should be provided to HCWs (Jackson et al., 2014). Given the predominant mode of transmission, every HCW death from Ebola is a potentially preventable death. It is highly concerning that a recent commentary suggests HCWs do not need a mask at all “to speak with conscious patients, as long as a distance of 1–2 metres is maintained”(Martin-Moreno et al., 2014). This fails to consider the changeability and unpredictability of the clinical environment and disregards the rights of the HCW. It is also unrealistic to believe a HCW can constantly keep track of their distance from a patient in the hectic acute care setting.
Source

I have updated the other entry about the right protection for medical workers, of which national authorities, the Polish ones included, keep mum.



Another survivor, Dr. Fadipe Akinniyi, also of the First Consultant Medical Centre said he was happy to be alive after surviving the deadly disease, saying that he contacted the disease by simply opening the door.

“I am most happy here today because as a matter of fact, when everyone was running helter-skelter, I told myself, I only opened the door and by the virtue of that, nothing should happen to me, I never knew I was deceiving myself until the day I recorded my temperature ...

Even with the symptoms I did not believe I had Ebola. After all, my contact with Sawyer was minimal. I only touched his I.V. fluid bag just that once without gloves. The only time I actually touched him was when I checked his pulse and confirmed him dead, and I wore double gloves and felt adequately protected.
Source

Compare this with contact management as exercised by the CDC for the sake of their own workers:

An employee with the Centers for Disease Control and Prevention has been flown back to the USA from West Africa on a charter flight after being exposed to Ebola.
...
The CDC says the employee in question had a "low-risk contact" with an international health worker who tested positive for Ebola, working within three feet of the sick person 
while the sick person had symptoms.
[source]

If they had this "low risk contact" only, ebola is not airborne etc., why the heck should s/he fly back just because of "being exposed" all that on a Level 4 medvac airplane?

Meet the Cleaning Guys team from Dallas, USA:


Note that when handling a regular flat with an ebola case already hospitalized, they don a Level B suit (there are levels A to D of hazard materials PPE), with a positive pressure, full face-piece self contained breathing apparatus (SCBA):





[Update October 2014:]
From left to right: changing CDC recommended level of protection when treating ebola cases
It took them some months and deaths for the CDC to come to their senses...


Read this.

CDC admits defeat:
catching ebola without touching
[Update 25 OCT 2014]

The CDC  finally admits you can get ebola without touching a person, via "droplet spread" or even by touching door knobs.

Notice other doublespeak: "protect yourself by not coughing."

CDC source









And here is how "contacts management" works in practice, on site:


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