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Wednesday, November 12, 2014

Ebola Today 11/12

The Ebola Virus

US is Ebola Free
Today, the news is better than last week, or the week before, but the struggle continues.

We’ll start with some good news, in fact, the best news. The only patient with Ebola in the United States, for the last couple of weeks or so, has been the subway riding, bowling doctor, who traipsed around New York City after returning from working with Ebola patients in Guinea. Spencer, 33, was infected with Ebola while working for Doctors Without Borders.

Well today, after receiving excellent care at Bellevue Hospital Center in New York City, Dr. Craig Spencer has been deemed free of the Ebola virus, and was released from Bellevue to much hugging and fanfare.

“It’s a very, very good day,” Mayor Bill de Blasio said in a press conference Tuesday. “Dr. Spencer is Ebola-free, and New York City is Ebola-free.”

Mayor Bill de Blasio hugging Dr. Craig Spencer
Ebola Survivor.
As a reminder, although Spencer wandered around the city that doesn’t sleep, he did so feeling and showing no symptoms. Only after feeling and then reporting symptoms of Ebola on Thursday, Oct. 23rd, was he transported to an isolation ward by ambulance, later testing positive for the virus.

"I’m elated,” said Ram Raju, M.D., president of the New York City Health and Hospitals Corporation, “because we were able to treat and cure a hero.”

That news out of New York brings the grand total of Ebola cases currently in the U.S. back down to zero. ZERO. In the United States, there are currently ZERO cases of Ebola. It bears repeating.

For now, the hysteria that began with the arrival, diagnosis, and subsequent death, of Thomas Eric Duncan in Dallas is resembling so many other Fox “news” crises of the moment, in with a bang and out with a “squirrel!” While the U.S. response faltered at the outset, with the misdiagnosis of Duncan and sending him home, and then with existing federal and state public-health protocols being inconsistent, the nation’s superior medical care ultimately prevailed: All three Ebola patients, whose infections were quickly and properly diagnosed, have been cured, and no one they came into contact with has reported symptoms.

Struggling with the losses.

Back In Africa
What’s happening in the rest of the world? So far, almost 5000 have died from Ebola during this outbreak. The death toll will go higher once they discover all the small villages and towns completely wiped out by the virus, ones that could not get to help that was 2 or more hours away. According to the CDC, the disease itself has been around since 1976, killing 431 that year. What you need to understand, is that there is a reason that Doctors Without Borders exists. This Ebola virus is just one of many diseases that have taken hold in the western part of Africa over the decades. And to understand Ebola, you need to understand that.

For instance, let’s talk about measles for just a moment. Ya know, the disease no one gets anymore. It has a .2% fatality rate, and since the endemic spread of measles was eliminated in the United States (2000), rates of measles had been fairly low. However, before the routine use of the measles vaccine (1963) and the MMR vaccine (1971), measles cases — and complications from those cases — were really high. There used to be about 500,000 cases of measles and 500 measles deaths each year in the United States.

Today, with vaccinations, no one needs to die from the measles. Or even suffer from it. Nonetheless, this year, in the United States, we had 600 cases of the vaccine-preventable disease, and no reports of deaths from measles. In comparison, in the poorest regions of Africa, 122,000 people died of the measles in 2012. DIED. 122,000 people died of a vaccine-preventable disease in one year. Let that soak in. Although that sounds like an incredibly grim death toll, health experts hail the figures as a sign of success of the U.N.’s mass vaccination programs, since the number has plummeted since the 1990s, when more than 500,000 people a year, or about 1,300 a day, died of measles.

What’s our point? We’ve lost 5000 total in this epidemic. Not 5000 a day. To put things in perspective, this isn’t our first rodeo, and it’s not as bad as many others we’ve fought before. And every one who has come to the United States, except for poor Thomas Eric Duncan, has been cured, so we are getting a hold on it.

Ebola Robot Zaps Virus To Instantly Clean.

Technological Solutions
What makes these patients so dangerous to treat is the big messes that are made. Liquids everywhere have to be cleaned up, and removed safely. We’ve found some help in that area from the technology sector.

The Xenex robot, from a company in San Antonio, was first introduced years ago, and it is capable of using ultraviolet light to mess with the virus’s DNA, thereby damaging it enough to essentially make it harmless. This is a clean up robot and, now that healthcare workers have a way to quickly kill off the virus in certain locations, entire parts of hospitals can be cleaned with it. This robot has been sent to 250 hospitals, and is actively being used at this time to keep medical workers out of harms way when cleaning up after one of these highly contagious patients.

When most people hear the word Ebola, they envision hazmat suits and quarantined hospital rooms. But UC Berkeley engineering professor Ken Goldberg envisions robots also helping with specific tasks. In fact, the White House Office of Science and Technology Policy reached out for Goldberg’s expertise in robotics, encouraging him and three other researchers and research centers to hold brainstorming sessions on ways to enlist robots in the fight against this deadly disease.

“People have an expectation that the robots are going to go in and do something dramatic.” Goldberg explained. “The capabilities are limited right now. There’s a lot of research that needs to be done. These are some tools that we hope will be useful in both the near term and long term.”

Goldberg sees at least two ways robots may be redeployed in the next three to six months to help contain the spread of Ebola. First, telepresence robots, with cameras and screens that allow doctors to remotely communicate and get a visual read of patients, could be useful in the diagnosis phase.

“When you’re trying to diagnose a patient, there’s a lot of nuance,” Goldberg said. “You want to be able to look from different angles, look at different parts of the patient. You also want to be able to have some kind of intervention. You want to be able to zoom in or hopefully touch, palpate part of a patient. So, there’s a lot of interesting research. How can you do that from a distance?”

Goldberg also sees robots being helpful in the near term with clean up and decontamination. But there’s one major obstacle to overcome: most robots have wheels that would immediately get contaminated. Goldberg explains,

“We don’t know, actually, how to sterilize them. There’s too many intricate, moving parts. So essentially, you’d have to throw the robot out afterward.”

First, engineers need to improve robots’ abilities to perceive clear objects. All the glassware used in labs, like test tubes, beakers and slides, can currently confuse robots.

The second way Goldberg says robots can play a part in the Ebola fight in the long term is by inserting IVs either for drawing blood or providing intravenous hydration. Technology could help cut down on the occurrences of patients being poked multiple times to tap a good vein.

“We use new imaging techniques to be able to find the vein more accurately,” Goldberg said, “and a robotic device that would be able to position the needle more accurately.”

According to Goldberg,

“It could be a couple of years before robots play an expanded role in the fight against Ebola. We’re looking beyond this current health crisis so we’re ready for the next one. Some of us feel this is the end of the world. But those on the forefront of technology know this stuff comes in waves, it has before, it will again, and this is not the biggest monster we’ve defeated.”

Ebola Affecting World Events
In Africa, because of the drastic numbers, there are also drastic results. When talking about soccer (football) “drastic” might be a big word, but not if you live in Africa. Well, things have gotten so bad there that the Moroccan government urged African soccer’s governing body to delay its flagship bi-annual continental competition over Ebola fears. To be clear, Morocco is reported to be Ebola free at this time.

Morocco was slated to host the African Cup of Nations, organized by the Confederation of African Football (CAF), from Jan. 17th to Feb. 8th 2015. The 16 team competition has run since 1957, and the north African country has already spent millions of dollars upgrading its stadiums for this event and December’s FIFA Club World Cup. But the outbreak of Ebola in west Africa has raised fears in Morocco that traveling fans and players could help spread the disease further, so Morocco wanted the cup delayed until June 2015 or early 2016.

As of today, Morocco has been removed as host of the 2015 Africa Cup of Nations and expelled from participating in the biennial championship. No replacement host has yet been named for the 3 week tournament. Any postponement could be financially crippling for the CAF. So, that happened.

Back In Maine
The boyfriend of Kaci Hickox, the nurse who defiantly refused to self-quarantine after she returned from West Africa, says the couple will move out of Maine this week after a state court order restricting their movement expires. Ted Wilbur, Kaci’s brave boyfriend, withdrew from his nursing program at the University of Maine at Fort Kent, where the couple lives, and said Friday that he and Hickox were “going to try to get our lives back on track” by leaving the state. So, as of now, her saga is over. Although, we wouldn’t be too surprised if she ended up testifying before Congress one day.

What Is Ebola Again?
Don’t be ashamed to ask. If you haven’t had to time to really learn about this particular disease, this is your chance, as Scientific American has published some insights under What You Need To Know that might be handy. If not, just skip down to the next section, if you please.

How does Ebola actually get a hold of your health? The Ebola virus gives itself a head start when it first slips into a human body by disabling parts of the immune system that should be leading the charge against the invader. It hijacks the functions of certain defense warriors known as dendritic cells—whose primary function is to alert the immune system of the incoming threat. Other targets include monocytes and macrophages, types of white blood cells whose job is to absorb and clear away foreign organisms. These are the first cells Ebola infects, and bends to the process of making more Ebola viruses. The maneuver is the viral version of invading a country by hypnotizing the army, and turning it against its own people. Then, having kicked the immune system’s feet out from under it, Ebola takes off in a run.

Although it only has seven genes, Ebola is an exquisitely effective killer of humans, once it enters a body. Unlike the spiky sea urchin that is influenza, or the golf-ball shaped poliovirus, Ebola resembles noosed ropes under the electron microscopes used to capture viral images. Classified as a filovirus, Ebola is one of two members of that family; the other is Marburg virus, named after the German city where it was first seen in researchers who caught it from imported non-human primates. Both pathogens are among the most lethal viruses that afflict people, but it is Ebola that has become the recognized and dreaded face of the filovirus family.

According to the Mayo Clinic, these are the symptoms, and they happen quickly once a high fever is detected.
  • Nausea and vomiting.
  • Diarrhea (may be bloody)
  • Red eyes.
  • Raised rash.
  • Chest pain and cough.
  • Stomach pain.
  • Severe weight loss.
  • Bleeding, usually from the eyes, and bruising (people near death may bleed from other orifices, such as ears, nose and rectum)
One of the things that makes the spread in Africa travel so fast is their burial customs. Once someone with Ebola dies, they are still quite toxic. It is customary to hold the dead person, to embrace them, etc. before burial, and that behavior, unsafe burial practices, is one of the major things that our military, and the west African governments are working to educate the public on at this time.

Can’t Africa Do Something On Their Own?
Africa’s wealthiest companies and individuals have clubbed together to raise $28.5 million for a fund to fight Ebola. African Union officials and business executives gathered in the Ethiopian capital Addis Ababa on Saturday, Nov. 8th to launch the emergency response fund, which they said would be distributed immediately.
New York's Keeping Track Of Those Possibly Exposed.

Really? No More Cases In The United States?
Monitor operations are working round the clock to keep track of West African visitors who have returned to The States. The New York Times reports today, November 11th:

“Hundreds of workers drawn from all corners of NY City’s Health Department are brought together on the 12th floor of the dept.’s headquarters to doggedly call one telephone number after another like telemarketers in an effort to find anyone who may have recently come to New York City from Guinea, Sierra Leone and Liberia. As you walk across the room, you can hear them speaking French, and at least five dialects of West African languages like Mandingo and Pulaar, to track these people down. This is a 24 hour a day operation now keeping track of almost 300 people, and is believed to be the largest monitoring effort in the country. Up to now, no one being monitored has registered any symptoms worrisome enough to prompt testing for Ebola.”

And that’s just one city, and one team. There are monitoring operations like this happening all over the country, and again, at this time, we have no active cases of Ebola in the United States.

That’s something to celebrate. Even if it might just be a brief respite.

Stay with us daily as we report what we find, and vet what we can.

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