Bringing Ebola Patients To The U.S.- Not A Very Good Idea!

Researcher working with Ebola using a BSL-4 positive pressure suit

"The road to hell is paved with good intentions"- John Ray, 1670

Murphy's Laws:

1)  "If anything can go wrong it will"

2)  "If there is a possibility of several things going wrong, the one that will cause the most damage will be the one to go wrong"

3) "If anything just cannot go wrong, it will anyway."

4) "If you perceive that there are four possible ways in which something can go wrong, and circumvent these, then a fifth way, unprepared for, will promptly develop"

5)  "If everything seems to be going well, you have obviously overlooked something."

6) "Mother nature is a bitch". (Addendum: "And not an obedient one at that")


At this stage, with one of the Samaritan Purse workers (Dr. Kent Brantly) infected with Ebola en route to the U.S. and Emory University Medical Center's Isolation Ward in Atlanta, one must wonder about the wisdom of the move - as well as that of the 2nd worker (Nancy Writebol), also being flown in via medevac in the subsequent flight.

In general, it is not a good practice to transfer patients infected with one of the most lethal viruses on the planet into a non-infected nation. This is different, materially and substantively, from keeping the virus in a Level 4 containment lab in one of the most secure places on Earth (ok, at least we thought so until cardboard boxes containing Variola (smallpox), Anthrax and a lethal Bird flu were discovered).  In the case of the latter, the actual contact with the virus can at least be controlled - and more importantly  - the risks of contamination don't extend to having to add many more protocols to confine the spread of the contaminated fluids spewed out of actual bodies. Workers need only control their contact with the actual isolated virus and not with the infectious diarrhea, vomit, sweat or blood spewed out.

Hence, there is much greater probability of things going wrong when stringent added protocols are incorporated -  to protect against Ebola-laden fluids - and there is, literally, no margin for error.  Murphy's Laws, which many take only in a facetious or non-serious vein, are actually apropos here. They really do provide a mental caution against adopting hubris or projecting human arrogance, especially the ever present human failing embodied in the misplaced belief that all their systems are "perfect" and "nothing can go wrong."  ("We have it all under control." - perhaps the sorriest words ever written or said.)

Actually, many things can. The transport to Emory itself means a 20 mile trip along a highway to get to the Emory center. Though a police escort is to be provided, the possibility of some kind of accident still exists. But we can concede this is relatively low.

Move now to the Emory Isolation ward itself which will keep each patient separate from the rest of the hospital and with an air-filtered space to boot. Two specially trained nurses will tend to each patient and 4 infectious disease specialist doctors. However, there is no indication whatsoever that any of these Emory people have had previous experience in handling Ebola patients. That implies they will not be as careful as say, a 'Doctors without Borders' specialist in Sierra Leone, who knows every single pitfall and goes the extra mile to avoid human error.

Again, these specialists won't be working with the virus per se but rather treating two symptomatic patients expelling contaminated body products. We can expect as the two patients are attended to, they will still be in the phase of vomiting, diarrhea as well as hemorrhagic release from multiple orifices, so that the slightest drop of any fluid on a pressure suit or even its duct tape will be an alert or alarm point. How will the nurses, doctors deal with it? How intensely will they clean themselves after being in contact with the patients? How sure are they that there are no minute holes in their suits? How will any contaminated clothing, bedding be handled? Even if the doctors themselves work on the patients from outside using robotic type devices, someone will have to go in, collect the fouled bedding, clothing and dispose of it.

It is in the handling and disposal of those contaminants that the real risk inheres and Murphys' laws come to the fore.  While it is true Ebola is "not contagious like the flu" (so far as we know) it is still quite capable of penetrating medical barriers erected against it, as Dr. Brantly found out. Hence, one must exercise constant and meticulous care if error is to be avoided. It only takes one misstep!

This is especially important given we live in a country which already sees something like 98,000 deaths by medical accident or  hospital infection each year. In the case of the latter, most of those deaths  - say from c. diff. or MRSA - could have been easily prevented if proper disinfectant techniques had been observed. But they weren't.

 Many people forget that, especially those who demand we show "compassion" to the two aid workers. (Forgetting that the needs of the few or the one do not exceed the needs of the many.) Well, we do, but also suggest that reasonable compassion can't mean putting many thousands or millions at possible risk, or compassion at any price.

Maybe the Emory specialists and CDC honchos are correct that there's nothing at all to worry about and nothing will go wrong. But having seen a number of Murphy's laws in action in other settings I am not so sure. I definitely lack the hubris or overt self -assurance detected in the words I've beheld uttered by one of the Emory docs who will be treating the patients. ("We know what we have to do and we're confident!")

We've been given all the reasons this move is a great idea, including that the patients can now receive the best of care (of which I have no doubt) and also the protocols are in place to ensure maximum safety (of which I am unsure). We also have been told the protocols in Africa are too difficult to follow because of the lack of supplies, etc. However, I dispute that given the disease has been in the spotlight and studied since 1976, and some of the best specialists have been there to treat and tend to the disease in its actual environs. They have also flown in all the equipment they might need, to specific locations. Yes, the Emory site does afford some extra advantages (more easily controlled temperature environment, more backups) but again, are the risks worth it?

Only time will tell, and if one of Murphy's laws is violated and an outbreak of Ebola occurs in Atlanta, we have to hope it is expeditiously contained and doesn't spread. Bill Maher, as on Real Time last night, may mock "morons" for expressing their fears about the situation and its potential unraveling - but alas, those fears aren't warrantless, they're quite real.  Alas, the real morons will be those who proclaim- in the aftermath of other possible cases in the area weeks later:   "We never knew it could happen!  We thought we'd done everything humanly possible to prevent it!"  

Read each of Murphy's laws again, then think about them. Carefully! Especially the last, recognizing that already in Africa , Ebola is manifesting 'Mother Nature's' fury at its most extreme and is spinning out of control - exceeding all medical efforts to contain it. Then ask if it is truly a good idea, irrespective of any "humanitarian" aspirations, to have brought it to our shores. 

Will our good intentions possibly have visited "hell" upon us? We will see.

What We're Not Being Told About The Ebola Outbreak - And Why a Pandemic Is Not Impossible

The Ebola virus in an electron micrograph

Researcher working with Ebola using a BSL-4 positive pressure suit

Ok, I readily admit my specialty is not biology, viruses or human epidemiology. Hence, you may take this blog post for what you believe it's worth. But I have been following news of the latest Ebola outbreak in West Africa and I become more alarmed with every new report - especially the latest in which an American (Patrick Sawyer) actually got on a plane and flew into Africa's 2nd largest city (Lagos) with 21 million people.

The medical media cognoscenti continue to soft soap the incident and I believe it may be to prevent any public alarm. But I think the public ought to have plenty alarm and here's why:

In the most recent AP report (Denver Post, 'New Fears About Ebola Spread After Plane Scare', July 29, p. 13A), we are informed:

"Witnesses say Sawyer, a 40-year old Finance Ministry employee en route to a conference in Nigeria, was vomiting and had diarrhea aboard at least one of his flights with some 50 other passengers . Ebola can be contracted from traces of feces or vomit, experts say."


I would like you to read that over again and think about it. If a passenger is ill on a plane he or she has two choices, reach for a barf bag or try to make it to the nearest rest room and let it rip. In the last case it is probable no "witness" would have been present to see anything and especially any diarrhea. If the passenger couldn't make it and is constrained to release in his seat - THEN it is likely there would be witnesses to both unfortunate emissions (in the case of the diarrhea, more likely as a god awful odor - which in fact, the Ebola virus produces.)

Now, the fact bio-lab and CDC et al research workers have to wear  BSL-4 positive pressure suits when working with the virus (see above image) means it is no walk in the park for any unprotected people if a guy on a passenger plane displays any eruption of body fluids! I mean, this is serious! It means possibly five or six people might have been affected, if not more. And at the Ebola phase of fluid ejection, even bloody droplets from the victim's eye can cause infection.

Now, here's the bitch. As the article observes:

Sawyer was quarantined upon arrival in Lagos - a city of 21 million people-  and Nigerian authorities say his fellow travelers were advised of Ebola's symptoms and allowed to leave.

Allowed to leave!? WHY?  WTF!  This disease kills 60- 90% of those infected!

They ought to have ALL been quarantined on the spot, given the "authorities" had no a priori clue who had come into direct contact with Sawyer's bodily fluids - if even in a happenstance way  - say him rushing out of his seat to the toilet with drops of virus-laden stool leaking from his spattered trousers (the diarrhea is almost as bad as c.diff. and cholera) onto hapless passengers. Who, may have believed it to be just some juice from a drink (though the odor ought to give it away).

My point is that if those who work with Ebola need positive pressure suits, and people in an airplane have nothing and are exposed and allowed to walk out of the airport - then something is seriously amiss. The "authorities" did not practice due diligence and allowed 5 or more possibly infected sources of the virus to escape!

Then there's the problem with "looking for symptoms".  The sad fact is that they can take up to 21 days (3 weeks) to manifest and some sources cite 25 days. By that time most of the passengers might have forgotten about it. The next thing, the symptoms are initially vague and general - often mistaken for a bad flu.

The symptoms usually begin with severe headache, sore throat and muscle pain accompanied by a burning fever.  As it progresses, hiccups are often soon to follow with severe nausea. By now, it's critical the person get himself to a treatment center to begin prepping for the process of re-hydration, because the explosive vomiting and diarrhea will soon follow, along with hemorrhagic bleeding from multiple orifices. At that phase, the danger for cross infection of others is at a maximum.

In the movie, 'Contagion', many passengers aboard commercial aircraft are infected by the victims of the depicted deadly virus coughing or sneezing. The problem is that they don't turn themselves into hospitals, but they go home to try to recover. There, they infect loved ones, and the epidemic soon turns into a pandemic.

Could it happen with Ebola? If so, it would mean airborne infection is possible in the new outbreak and we're not being informed. Indeed, Canadian scientists believe the disease can now be transmitted through the air, which would explain the rapid spread of this new outbreak and the deaths of 3 doctors (two Americans and an African)  who took every precaution, including positive pressure suits. As reported in the link above:

"Canadian scientists have shown that the deadliest form of the ebola virus could be transmitted by air between species. In experiments, they demonstrated that the virus was transmitted from pigs to monkeys without any direct contact between them.

The researchers say they believe that limited airborne transmission might be contributing to the spread of the disease in some parts of Africa."

If that is the case we're really for the high jump. But let's stay conservative and hope it's no more than a possibility. In that case the spread would require a long chain of total screw ups by everyone involved, from airport authorities to local officials to the CDC. But hey, after several old supply stores of smallpox and anthrax were found improperly stored at the latter, it could happen!

Sawyer, the American working with the Nigerian government, ultimately would have returned home to Minnesota - and indeed was planning to do so next month. So what if, I say IF - he'd have still not shown his symptoms outwardly by the time he got on a jet home. Then, after arriving home had begun dispersing the virus to his family via his bodily fluids - they'd have surely tried to clean up after him.

I would argue all would have been infected.

Well, Sawyer was stopped in his progress at Lagos Airport, but a lot of possibly infected people (who came into contact with him on the plane) are on the loose. The medical authorities insist the risk from any of them - say catching a plane to New York or Chicago - is "low" and they'd "likely report to a medical center if they see symptoms".

Let's hope these medical soothsayers are right.

For my part,  I remain skeptical.  Actually you can call me a pessimist! Reinforcing my pessimist take is this statement from Dr. David Heymann, Professor or Infectious Diseases at the London School of Hygiene and Tropical Medicine, quoted in the Post piece (ibid.):

"The best thing would be if people did not travel when they're sick, but the problem is that people won't say when they're sick. They will lie in order to travel, so it is doubtful that travel recommendations will have a big impact."

I suspect the same applies to those who travel,  then show symptoms, and are supposed to then report to a medical center, pronto.

We have to trust that the medical gurus are right and affected people are cooperative enough to understand the greater good trumps anything else. I am just not so sure that will hold.

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UPDATE: Friday, Aug. 1:

Dr. Jon La Pook informs viewers  (CBS) this a.m. that U.S. entry airports are NOT screening any passengers from West Africa - specifically from  the affected nations.  Need I say, must I, that this amounts to callous oversight for which we may a dear price? By contrast, the Chinese have  sophisticated infrared-thermal detectors trained on all arriving passengers and sequester any with temperature readings above 99.5F. The Chinese take their nation's interests and welfare seriously and we evidently do not. Meanwhile, the words of media medical gurus like LaPook and Richard Besser (from ABC) continue to ring hollow on how they are "certain" any problems can be contained here in the U.S. Sorry, I don't buy it.

Further, I predict this ghastly virus will spawn an outbreak on our shores before the month is out. I also challenge LaPook's and others' claims that "infection can only occur by direct contact with bodily fluids". I challenge it because Canadian drs. have already demonstrated in their labs it can spread by air! Further, the patients being flown to the U.S. for treatment are being contained in AIR TIGHT vestibules and - once they arrive at Emory University in Atlanta for treatment - will be confined to special isolation units with their own air systems and filtration.

Now, you figure it out,  dear reader. Who exactly is being fed a load of bollocks here? Should we be lulled into a sense of false security, or should we ourselves begin taking every precaution we can? You be the judge!

See also:

http://www.smirkingchimp.com/thread/william-rivers-pitt/57242/all-the-blood-in-your-body

and:

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/10998222/Ebola-outbreak-Victim-who-sparked-fears-of-global-epidemic-was-on-way-home-to-US.html