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 photo ebola-suit-1_slide-361a142046f38abb5fe36da77883619cbb68fd2d-s5-c85_zpsd7551d1d.jpgHealth care worker in Kailahun, Sierra Leone wearing protective gear includes goggles and head to toe covering, as well as gloves and boots.

Tommy Trenchard of NPR asks, This Suit Keeps Ebola Out — So How Can A Health Worker Catch It? In response to my article yesterday,
Dr. Sheik Umar Khan, Sierra Leone's top Ebola doctor, contracts virus after treating 100 patients, many have asked, "how could this happen, even though he was taking all the recommended precautions?"  

Dr. Khan is just one of dozens of health workers who have become infected with the virus while caring for patients even while wearing protective gear called PPE, personal protective equipment. Caring for patients requires much contact, and any exposure to bodily fluids of an infected patients can transmit the virus, so this includes vomit, blood, sweat, mucus, diarrhea, semen, spit, etc.    

Dr Khan has said, "Even with the full protective clothing you put on," Khan has said, "you are at risk." Taking these suits off safely after exposure is not easy, and health workers are also vulnerable to needle sticks and other exposures such as with blood samples, hospital equipment, and laboratory tests.  

Tommy Tranchard spoke with Armand Sprecher of MSF, Medecins Sans Frontieres, known also in English as Doctors Without Borders, about the protective gear, known as PPE.

The yellow suit that MSF [Medecins Sans Frontieres] uses is [made of] a woven plastic fiber. And they throw a laminate on it. It's very fluid impervious. But to work, it has to be used in conjunction with a set of behaviors and procedures. ...

The presumed way you get sick is virus gets into a mucus membrane inside your mouth, nose or eyes. If you were very, very good about keeping your hands off your face, you could probably get away with more exposed skin above the neck. But we like to cover [health workers] from the neck up. So when the hand goes to the face in an unconscious movement, it doesn't touch anything.

Although in slang, Africans apparently often call these "moon-suits," the ones pictured here and used in the field fall far short of the "moon suits" used in Biolsecurity Level 4 labs which are airtight, have their own air supply, and kept a positive pressure.

Another issue with the suits are because they are fluid-resistant they are also air-resistant, and they become uncomfortable in the African heat. Sprecher says "(i)t's hotter than hell. You're unable to wear the PPE for more than 30 or 40 minutes in tropical heat."

 photo EBOLATOPDOCTOR_zpsee020698.jpg

Trenchard also asks Armand Sprecher how the West African medical community is reacting to the news of Dr. Khan's infection.

It's shaking things up. A lot of people know Dr. Khan. He is a fun guy. He is fascinated by [Ebola]. He wasn't mailing it in. He wasn't doing his job just to get through the day. ... You'd go visit him in Kenema [where he worked in the hospital], he'd be like, "Hey, take a look at this." And with his digital camera, he'd show you a rash he saw on a patient. He'd say, "I just saw that patient an hour ago. I'm going to write this one up."

He took great pleasure in his work and brought an infectious enthusiasm. He's a pleasant person to talk to. He wasn't one of these people who put on airs. You're familiar with all of the character failings of doctors and the stereotypes — he didn't fit into any of those.

Please get well soon Dr. Khan. We need you back in the field leading efforts to treat patients and contain this virus.

Our prayers and best wishes go out to Dr Khan, and all those afflicted with the Ebola virus, and all the of people of Western Africa who are struggling to stop this terrible outbreak. We also thank all of the courageous health workers of the MSF and WHO who working on the front lines of this important viral battle to keep us safe.

Here are some other recent articles I've written on the Ebola outbreak in Western Africa.  
     

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
Dr. Sheik Umar Khan, Sierra Leone's top Ebola doctor, contracts virus after treating 100 patients
Dr. Sheik Umar Khan, Photocredit: Reuters

Hannah Goldberg of Time Magazine brings us the sad news that Sierra Leone’s Chief Ebola Doctor Contracts ...

HoundDog 07/23/2014 53 131 -
12 Liberian health workers die of Ebola, others flee posts, 539 deaths out of 888 cases
Yesterday, the World Health Organization announced a new total death count of 538 out of 888 total cases of Ebola in Western Africa. This post provides brief paragraphs from, and links to, four ...
HoundDog 07/11/2014 84 134 3
Deadliest Ebola outbreak in history happening now - June 26 WHO update 367 deaths outs of 600 cases
This post is meant as a brief update of my post of Wednesday, June 25, ...
HoundDog 06/27/2014 59 44 2
Ebola "out of control, we have reached the limits of what we can do," says Doctors Without Borders
Dennis Lynch of the International Business Times reports Ebola Outbreak: Doctors Without Borders ...
HoundDog 06/25/2014 203 333 5
Ebola continues to spread in Western Africa, death toll at 337 with 528 cases
    Sylvain Cherkaoui, Cosmos,
     Courtesy of Doctors Without Borders

The World Health Organization announced the combined death toll from the Ebola outbreak in Guinea, Liberia, and Sierra ...

HoundDog 06/18/2014 7 32 1
West African Ebola death toll rises to 193 out of 291 cases, 34 new cases in Sierra Leone
After appearing to be under control with a declining number of new cases, the outbreak of the Ebola virus in Western Africa is spreading in a ...
HoundDog 06/02/2014 16 29 -
350 cases of SARS-like MERS Coronavirus spreads to new countries from Saudi Arabia causes 100 deaths
Egyptian Muslim pilgrims wear masks to protect against MERS: Amr Nabil/AP Photo

Gillian Moheney from ABC News ...

HoundDog 04/28/2014 8 20 -
WHO reports Ebola outbreak spreading: 50 cases in Guinea's capital Conakry including 20 deaths
The United Nation's World Health Organization released new figures today for the death toll from Ebola spreading in Guinea, Mali, and Liberia today. These numbers may not look substantially higher ...
HoundDog 04/22/2014 32 37 -
Ebola outbreak is new strain 97% similar to Zaire strain, blamed for 135 deaths out of 197 cases
Reuters reports that the West African Ebola outbreak ...
HoundDog 04/18/2014 5 20 -
Ebola out in Guinea is a new strain, did not spread from previous outbreak, death toll rises to 120
The Ebola Virus in West Africa Is New Strain, Scientists Say, and the outbreak in Guinea that has killed more than ...
HoundDog 04/17/2014 6 32 -
West African Ebola death toll reaches 121, rate of new cases slows, progress on vaccine in mice
I have three articles for you tonight and for the first time since the outbreak started two bits of good news. Guineas reports that the number of new cases is falling, and our second articles ...
HoundDog 04/16/2014 9 31 -
Ebola outbreak is one of most challenging ever seen, death toll tops 100, will continue for months
Terri Rupar, of The Washington Post reports that Doctors of the World Health Organization announced today ...
HoundDog 04/08/2014 13 43 -
Ebola death toll rises to 95 with 151 suspected cases
My son just told me his girlfriend's sister is in Mali with Médecins Sans Frontières (MSF), Doctor's Without Borders,  helping treat the afflicted and contain this epidemic and he and her family ...
HoundDog 04/08/2014 8 24 -
'Panic' as Ebola virus spreads across West Africa, mob attacks medical center
Different images of the Ebola epidemic in Western Africa emerge depending on which reports you read. The death toll has risen to 90.  The World Health Organization is downplaying concerns ...
HoundDog 04/06/2014 53 119 2
Ebola death toll climbs to 85 out of 137 cases, in Mali, Guinea, Liberia, and Sierra Leone
Two hours ago, Matt Smith, of CNN wrote Ebola toll tops ...
HoundDog 04/05/2014 10 37 -
A new independent outbreak of Ebola occurring in Libera, death toll escalates.
Hi Everyone. In order to get our discussion started earlier tonight I'm going to do things a little bit differently, and post a survey of five articles without my usual pix, to get discussion started,
HoundDog 04/03/2014 112 103 1
West Africa on high alert as ebola epidemic spreads in unusual pattern, Sauda Arabia cancels visas
Concern over Africa's largest outbreak of Ebola in seven years is moving up to a higher level as the death toll rises and the spread of the epidemic moves into an unusual pattern breaking out at ...
HoundDog 04/02/2014 151 93 -
African Ebola outbreak expanding in unusual pattern,  78 deaths out of 122 suspected cases
Linda Poon, of NPR, explains how ...
HoundDog 04/02/2014 39 67 -
Ebola now confirmed to have spread to Liberia and Sierra Leone from Guinea, at least 70 dead
Alphonso Toweh, of Reuters reports the latest update from Liberian health authorities confirm two cases of Ebola: WHO, and left 70 ...
HoundDog 03/31/2014 33 37 -
Senegal shuts border with Guinea to stop spread of Ebola, cases now in  Libera and Sierra Leone
HoundDog 03/29/2014 59 67 1
8 cases of Ebola found in Guinea's capital of Conakry, bats confirmed as viral reservoir, 70 deaths
CBS News confirms that Ebola hits Guinea's capital Conakry, 8 infected Health officials in the West African nation of Guinea say they're now ...
HoundDog 03/28/2014 18 12 -
Bats discovered to be transmission vector in largest outbreak of Ebola in Africa in seven years 64
The BBC is reporting that scientists have finally discovered that bats are the hidden reservoir and transmission vector for spreading Ebola, as reported, in Guinea Ebola outbreak: Bat-...
HoundDog 03/27/2014 35 22 -
Africa's largest outbreak of Ebola in seven years now suspected of spreading  to Liberia (updated)
Update: Bloomberg is now reporting that Africa's largest outbreak of Ebola in seven years is now thought have spread from Guinea to Liberia. The report below develops chronologically from this ...
HoundDog 03/24/2014 63 30 -

4:50 PM PT: Inserm and Institut Pasteur Identify a New Variant of Ebola Virus,



Mobile BSL-4 Response

A mobile BSL-4 laboratory was deployed in Guinea to provide assistance with diagnosis in the field. This mobile laboratory was developed as part of a European project, “EMP4,” coordinated by German researchers, and in which the Jean Mérieux-Inserm BSL-4 Laboratory is the French partner.

Viral RNA was extracted from the blood samples, and then amplified and sequenced. These sequences were finally compared to 48 already known complete Ebola virus genomes. According to results, the analysis showed 97% identity with strains identified in the Democratic Republic of Congo in 1976 and 2007, and in Gabon in 1994 and 1996.

“These results demonstrate that we are facing the emergence of a new “form” of this virus in Guinea,” explains Hervé Raoul, Director of the BSL-4 Laboratory. This form is common to cases discovered since the month of December.


4:53 PM PT: Inserm and Institut Pasteur Identify a New Variant of Ebola Virus,





Mobile BSL-4 Response

A mobile BSL-4 laboratory was deployed in Guinea to provide assistance with diagnosis in the field. This mobile laboratory was developed as part of a European project, “EMP4,” coordinated by German researchers, and in which the Jean Mérieux-Inserm BSL-4 Laboratory is the French partner.

Viral RNA was extracted from the blood samples, and then amplified and sequenced. These sequences were finally compared to 48 already known complete Ebola virus genomes. According to results, the analysis showed 97% identity with strains identified in the Democratic Republic of Congo in 1976 and 2007, and in Gabon in 1994 and 1996.

“These results demonstrate that we are facing the emergence of a new “form” of this virus in Guinea,” explains Hervé Raoul, Director of the BSL-4 Laboratory. This form is common to cases discovered since the month of December.

5:42 PM PT:


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Comment Preferences

  •  You Would Need to Somehow Ensure 100% Killing (32+ / 0-)

    of virus on the suit before removing it, and/or 100% killing of any virus that sheds onto you in the removal process.

    It's one thing to protect from gases and chemicals, but these viruses are not only super tiny but they reproduce. The high mortality rate makes me inquire if probably even one or a tiny few of them, introduced to the body, have a high probability of success compared to many kinds of bacteria and maybe other viruses that the body can contain if the numbers introduced are small.

    Best wishes for everyone doing this dangerous, heroic work, and for those in the background developing tools and protections for them. Given our huge population and the widely cited risks of pandemics in our time, seems to me there's a big need for advancement here.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Jul 24, 2014 at 04:08:57 PM PDT

    •  I'm sure they use multiple ways already... (26+ / 0-)

      but this doesn't mean that a tiny amount of matter with virus particles in it can't slip through in an infectious state. Ebola is incredibly virulent, only a few virus particles are necessary for a person to be dangerously infected. I'd bet they use UV light saturation of the suit surfaces followed by a chemical (most likely bleach) wash and rinse before they or anyone else even handles the exterior of the suit, and that would be done with protective gear as well.

      It's not that they don't take every possible precaution, it's just that no level of precaution will ever be good enough to ensure that you have a 100% safety factor in dealing with a virus like Ebola. The medical personnel who go into these situations know very well the risks they run, protective gear or not, and they go anyway. If you want to see true modern heroes, look no further.

      Strategy without tactics is the slowest route to victory, tactics without strategy is the noise before defeat. Sun Tzu The Art of War

      by Stwriley on Thu Jul 24, 2014 at 04:29:01 PM PDT

      [ Parent ]

      •  I read the book (15+ / 0-)

        The Hot Zone. Even the pros respected those who handled Level V viruses. (AIDS is "only" a III.)

        “You think You're frightening me with Your hell, don't You? You think Your hell is worse than mine.” --Dorothy Parker

        by Ice Blue on Thu Jul 24, 2014 at 04:39:44 PM PDT

        [ Parent ]

        •  I couldnt bring myself to read that... (16+ / 0-)

          At the time it was published I was working with hot viruses and I had seen the few reports of the monkey incidents that were published at the time.

          I didnt want to give myself gibbering nightmares about "what if" scenarios. A really hot variant of one of these bastards gets loose and we are talking "black death" levels of impact - and the black death depopulated europe by HALF. It was over 100 years before the european population recovered to its pre-plague levels.

          •  These viruses can be terrifying. We have MERs in (12+ / 0-)

            Saudi Arabia.

            Apparently the biggest concern is that avian flu mutates to an airborne spread vector.

            Although it only has a "10%" mortality rate, it should take only about 3 months to circle the globe.

            Experts say it is only a matter of when, not if based on probabilities.

            The colocation of chickens, pigs, and humans in South East Asia is a time bomb.

            Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

            by HoundDog on Thu Jul 24, 2014 at 05:19:01 PM PDT

            [ Parent ]

            •  Let me describe the nightmare I was avoiding.. (8+ / 0-)

              Picture a hemorrhagic fever that spreads like MERS. Now picture the scene in "The Hot Zone" (that a colleague described to me after reading it) where one of the protagonists gets the nightmare scenario of a colleague pointing to their glove and saying "hole"... when they already have compromised skin beneath the secondary glove and they patched it and checked themselves out and concluded they were probably ok.

              I was worried that I'd wake up screaming from a nightmare where not only was I responsible for an outbreak but I was the primary case myself and therefore never knew how the story would end.

              I decided right there I'd never read it. Oddly enough I found Tom Clancy's "Executive Orders" a fun read. I guess it was because the description of fighting the virus with top-end medical tech was so believable.

              •  I hear you LimeyExpat (5+ / 0-)

                If we knew each other I might venture a galleys humor joke about the nightmare of being "patient zero," as in, "yeah, I hate it when that happens." (with apologies to SNL)

                One scientist just manage to recreate the genetic code for the 1917 Spanish flu which killed around 17 million in the US.

                I don't think this is wise.

                Because of our increased population densities, experts in probability theory and epidemiology tell us we should be expecting more waves of these highly contagious, deadly, and incurable airborne viral contagion.

                We have a nationwide epidemic of PDS ? Porcine Diarrhea Syndrome, I believe, but I could have the initials wrong. We've lost over 7 million pigs I think in the last two years. If I'm remembering correctly it is a corona virus, of the same class as SARS, MERS, and most flues. It it spread through feces.

                Many US farms are requiring any incoming farm trucks from other areas to undergo a complete chlorine wash which takes hours, and cost over $300.

                One science fiction book I read a few years back was set 20 years in the future after the "St Louis Flu" had wiped out something like 15% of the worlds population in six months, which by then was not an unusual occurrence. I think it was written by that Gibson guy that also wrote Neuromancer????

                Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

                by HoundDog on Thu Jul 24, 2014 at 05:55:22 PM PDT

                [ Parent ]

                •  increased population and shitty sanitation. (0+ / 0-)

                  Pig/bird agriculture in Asia, and industrial feedlot agriculture in the US.  Animals wallowing in shit, antibiotics as growth promoters, all "necessary" to "feed a growing population."

                  Keyword search "gain of function" for the latest news about wackos who think it's cool to build deadlier & more contagious plagues in their labs.  

                  It's almost like these people are zombies in the thrall of some kind of global immune system reaction to overpopulation of humans.

                  We got the future back. Uh-oh.

                  by G2geek on Sat Jul 26, 2014 at 12:09:29 AM PDT

                  [ Parent ]

              •  ohboy, that's getting "personal." (0+ / 0-)

                Since you work in the field, you could see yourself in that situation personally.  

                The most important things people who work with dangerous bugs can do are slow down, pace themselves, always follow procedures, check and double-check, and do not ever multitask or get distracted.  

                I follow those rules when doing critical programming on live systems where one wrong move can take down a machine and lock me out.  When I follow those rules I don't make mistakes.  When I'm doing noncritical work I'm more likely to slack off about those rules, and that's when I make mistakes: small stuff but still annoying.  

                The best way I've found to stick to those rules, is to cultivate the "zen zone" state of mind.  Another useful trick, also for use when driving, is to "say it out loud" before doing it.  For example approaching an intersection, count the pedestrians and bicyclists out loud.  Apply the same idea to lab work.  Don't be afraid to "talk to yourself out loud," and encourage coworkers to do likewise.  Think of it as "pilot to co-pilot" but you're playing both roles.  

                Everyone can find the mental routines that work best for themselves, and keep doing them, and never get complacent.

                We got the future back. Uh-oh.

                by G2geek on Fri Jul 25, 2014 at 11:47:46 PM PDT

                [ Parent ]

            •  SAR In Toronto Was Close To An Epidemic (4+ / 0-)

              It was airborne, it was extremely deadly (the lungs just dissolved), and it was super infectious.  Doctors and nurses were catching it in a modern hospital even when they were taking every precaution. It was infecting people that had never gotten anywhere near a patient or any contaminated surface.  Like smallpox, it was one of those viruses that would go out the door, down the hall, and infect someone on the other side of the building.

              Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

              by bernardpliers on Thu Jul 24, 2014 at 06:33:37 PM PDT

              [ Parent ]

            •  yep, aerosolized bird flu. (0+ / 0-)

              And I bet all the people who hate Big Pharma will be very happy to get the vax when it becomes available.  

              Agreed, pig/bird agriculture in Asia is a time bomb.  The govs of China, Vietnam, and South Korea could and should get together and come up with a joint policy to replace pig/bird agriculture with something else that isn't so bloody red-hot screaming fire alarm dangerous.

              We got the future back. Uh-oh.

              by G2geek on Fri Jul 25, 2014 at 11:27:37 PM PDT

              [ Parent ]

          •  The Level 4 Lab Had "The Submarine" (2+ / 0-)
            Recommended by:
            HoundDog, Ice Blue

            If you got exposed, you had to stay in the lab in a small infirmary and isolation room.  The back door looked like a submarine hatch (IIRC) and "the submarine" was a freezer for the corpses of people who died in the lab.

            Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

            by bernardpliers on Thu Jul 24, 2014 at 06:21:18 PM PDT

            [ Parent ]

          •  We dodged a bullet in thar Ebola reston was not (1+ / 0-)
            Recommended by:
            Ice Blue

            lethal to humans and was more difficult for humans to acquire.  Had it been Zaire ebolavirus, the US could have been decimated.

            A word to the wise is sufficient. Republicans need at least a paragraph.

            by d3clark on Thu Jul 24, 2014 at 07:38:07 PM PDT

            [ Parent ]

          •  One of the women who worked with those (2+ / 0-)
            Recommended by:
            BobTheHappyDinosaur, HoundDog

            hot viruses was an Army veterinarian. Vets who worked with monkeys and other wild exotic animals had to have their rabies shots. One year her booster damn near killed her. She could never get the shot again so she would never be allowed around any of the monkeys again.  Instead she decided to work directly with the hot viruses.

            Her husband, also an Army veterinarian, thought she was nuts.

            “You think You're frightening me with Your hell, don't You? You think Your hell is worse than mine.” --Dorothy Parker

            by Ice Blue on Thu Jul 24, 2014 at 10:36:15 PM PDT

            [ Parent ]

          •  It was one of the things (1+ / 0-)
            Recommended by:
            HoundDog

            that got me interested in viruses. However due to my not wanting to die, I focused on bacteriophage viruses. Much less terrifying.

            Have a lot of respect for anyone who can do that though.

            No light, no dark, no up, no down. No life. No time. Without end. My people called it The Void. The Eternals called it The Howling. But some people call it The Tea Party.

            by kamrom on Thu Jul 24, 2014 at 11:23:15 PM PDT

            [ Parent ]

            •  Did you hear about that gigantic bacteriophage (0+ / 0-)

              that someone reactivated from 30,000 years ago that was exposed after glacier melt.

              I believe I remember that it is now the largest bacterophage ever discovered. About a 1,000 times as big as usual or something incredible like that.

              The idea that millions years of ancient pathogens, viruses, bacteria, and God only knows what could be popping up out of these melting ice caps and glaciers gives me the Heebie Jeebies.

              Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

              by HoundDog on Fri Jul 25, 2014 at 01:59:33 PM PDT

              [ Parent ]

          •  yep. see also "gain of function" research. (0+ / 0-)

            Really what we have today is equivalent to a grass-roots nuclear arms race.

            Rogue scientists who want to "make a name for themselves" being the first to make aerosol-transmissible avian flu and the like.  Everyone wanting "to be the first to publish the genome" for one plague or another.  Terrorists and nihilists lurking in the background, contemplating their options and the ever-decreasing cost of setting up a plague lab.  

            Speaking of 50% depopulation, you might be interested to know that sustainable human population & consumption level is about 3 - 4 billion humans at Western European standard of living.  That would be about 50% of present population level.

            I calculated the above from WWF.org numbers on "ecological footprint."  It would not surprise me if certain three-letter agencies have done a similar exercise (after all, science is convergent), and this is why they're freaked out about "eco-terrorists."  The level of paranoia about eco-terrorists is sufficiently high in certain agencies, that something along those lines would account for it.  

            But rather than have gibbering nightmares, just take a hint from the LDS Church (Mormons) and have a year's supply of provisions, or even six months' worth.  Then you can self-quarantine when the big one gets loose, until the worst is over and a vax is available.  BTW, there are numerous suppliers of MREs online ("meals ready to eat", no-cook food), try a few from each source before deciding which source to buy a large quantity from.  Don't forget a year's worth of toilet paper and ideally a year's worth of water (about 600 - 800 gallons per person, a small backyard swimming pool will do nicely, and don't forget the bleach).  For the cost of a decent vacation, you can be fully equipped.

            "Don't be scared, get prepared!"

            We got the future back. Uh-oh.

            by G2geek on Fri Jul 25, 2014 at 11:24:16 PM PDT

            [ Parent ]

        •  Ebola is usually treated in BioSecurity Level 4 (11+ / 0-)

          labs, and Guinea has at least one. In these the suits are positive pressure and the labs are negative pressure.

          Most of the this field Ebola treatment centers are tents with no electricity, or running water.  They use chlorinated water for disinfecting things.

          Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

          by HoundDog on Thu Jul 24, 2014 at 04:55:54 PM PDT

          [ Parent ]

        •  There's a level 5? (6+ / 0-)
          Recommended by:
          bkamr, atana, wader, defluxion10, Visceral, Ice Blue

          I thought bio safety level goes only to Level 4.

        •  They may have respected it, (7+ / 0-)

          but what I got from the book is that we avoided a superplague largely through dumb luck.  Unlike LimeyExpatDave, I have neither the knowledge nor the courage to work on such things, but I can appreciate the danger.

          I am become Man, the destroyer of worlds

          by tle on Thu Jul 24, 2014 at 04:58:16 PM PDT

          [ Parent ]

        •  When I came across it in a bookstore back when (4+ / 0-)
          Recommended by:
          Pluto, doingbusinessas, HoundDog, Ice Blue

          it first was published and I was reading the first part of it were it was about the man dying I was thinking it so "over the top" and put it back on the selves and so a few days later as I was back in the store I picked it up again and read some more of it since it was an intriguing story-line but still I wasn't going to buy it and so again put it back and well a couple days later I was at the store again and after looking around some I was in the aisle where that book was and decided to read some more to decide if I would get it and that was when I really got scared of a Horror Novel cause I realized this was not a Fiction Horror Novel but that it was Non-Fiction,then I re-read the first part with a cold chill down my spine knowing that it was real.

        •  HIV Squirted in My Eye (4+ / 0-)

          In 1987 during the first peak of media exposure of the "AIDS Epidemic" as it was becoming called, I was a med tech in the blood bank of the AIDS, burn and trauma center for downstate NY (excluding NYC). I separated a lot of fresh blood units for use and storage. The most valuable part was the thin layer of platelets for clotting. I used to squint inches from the bag as I pressed it to get just the platelets, not the fluids separated above and below them.

          One afternoon a bag burst and a hot jet of A+ blood squirted hard into my eye. Not 5 minutes out of an unscreened donor's vein.

          I must have tested that unit for HIV, hepatitis and a few others several dozen times each the rest of the Summer. And followed up for 5 years testing my own blood. Luckily nothing made its home in me.

          I learned the hard way to wear safety goggles. And to take infectious disease risk deadly seriously.

          "When the going gets weird, the weird turn pro." - HST

          by DocGonzo on Thu Jul 24, 2014 at 08:22:04 PM PDT

          [ Parent ]

          •  Scary. You are lucky. (2+ / 0-)
            Recommended by:
            DocGonzo, Ice Blue

            Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

            by HoundDog on Thu Jul 24, 2014 at 08:39:47 PM PDT

            [ Parent ]

      •  They use chlorinated water. Most of these places (8+ / 0-)

        have no electricity, running water, sewers, etc. so UV is beyond their capacity except in some of the big city labs.

        Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

        by HoundDog on Thu Jul 24, 2014 at 04:42:03 PM PDT

        [ Parent ]

        •  let stuff sit out in the sunlight for a period (1+ / 0-)
          Recommended by:
          HoundDog
          so UV is beyond their capacity except in some of the big city labs.
          If your substrate is UV-resistant, then you can just leave it out in the sun all day and it'll be irradiated by UV light.

          Domestic politics is the continuation of civil war by other means.

          by Visceral on Thu Jul 24, 2014 at 08:53:23 PM PDT

          [ Parent ]

          •  Excellent point. I added a pix of gloves and (0+ / 0-)

            boots drying in the sun, so you are ahead of me on appreciating this subtlety I missed on the first pass.

            Thanks for much for sharing this idea. I love learning new things like this and seeing how other people with different perspective see things in a situation I looked at but didn't see.

            I'm trying to learn where my "blind spots" are so I can develop compensating habits to see around them.

            Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

            by HoundDog on Fri Jul 25, 2014 at 01:44:33 PM PDT

            [ Parent ]

      •  someone has to be the last to take off... (0+ / 0-)

        ... their own protective gear, when any group of people are helping each other take their gear off.

        Whoever takes his/hers off last, is at risk for bare skin touching the exterior surface.

        Any skin contact whatsoever with these virus particles is an enormous risk.

        We got the future back. Uh-oh.

        by G2geek on Fri Jul 25, 2014 at 09:49:30 PM PDT

        [ Parent ]

    •  its not just killing them (0+ / 0-)

      Viral particle is in a complex matrix of blood and bodily fluids.  Most enveloped viruses are reasonably susceptible to disinfectants when exposed as a naked virus.  When yo mix them into a matrix of organic material killing is much harder.  Even a tiny amount of substrate left behind is lethal.  Working ins a BSL3 or 4 lab is hard enough when it is set up with negative pressure chambers, fume hoods, decon chambers and you are dealing with cultures (not complex matrices).  Doing decon in a real world setting, especially an improvised ward and adding in the needs of patient care makes this a near impossible task.  If you are in a supplied air pressure suit, and those pictures are not supplied air pressure suits, the safest thing is to keep it on.  the major hazard occurs when you take it off.

      the decon procedures clearly have failed or not been followed, but removal of improperly decontaminated equipment is the single biggest challenge in any bio hazard situation.

      there is only one reality, republicans just forget at times

      by Bloke on Thu Jul 24, 2014 at 08:49:03 PM PDT

      [ Parent ]

  •  I used to wear one of these (28+ / 0-)

    while working in an Intel clean room.

    The suit was important, but that wasn't the half of it. Not even close, actually. No smokers were allowed - particulate smoke was all but impossible to get rid of, and it would instantly contaminate the room.

    You took a "scrubdown" shower before you entered the room, put on clothes that were new out of a package, and took another shower after you finished for the day. There were no food breaks or even bathroom breaks. If you really had to use the bathroom, you clocked out because you were done for the day.

    And you learned a series of hand signals because talking caused spittle which - once again - might contaminate the room.

    My point is that even the best suit is just the start. There's an endless ritual of processes and procedures that need to accompany it.

    Bodhisattva, won't you take me by the hand. Can you show me the shine of your Japan, the sparkle of your China. Show me, and I'll be there, Bodhisattva, Bodhisattva.

    by thenekkidtruth on Thu Jul 24, 2014 at 04:26:12 PM PDT

    •  We have an ISO 7 clean room at work. (1+ / 0-)
      Recommended by:
      thenekkidtruth

      That's like working in the garage compared to your picture. What is that, ISO 9 or 10?

      •  Intel claims it runs the cleanest clean rooms in (1+ / 0-)
        Recommended by:
        BusyinCA

        the world. I didn't work at Fab 32, featured on this fact sheet, but I did work at the newly-opened Fab 12 at Ocotillo. All Intel fabrication clean rooms created over the last 20 years or so are ISO 10 compliant.

        Fab 32 is a rated as a “Class 10” clean room, meaning there are no more than 10 particles measuring 0.5 micron or larger per 1 cubic foot of air. A human hair measures just 80 micron. For comparison,
        hospital operating rooms are “Class 10,000,” meaning that the air inside Intel’s Fab 32 clean room is 1,000 times cleaner than the air in an operating room. Outside air is near “Class 3 million.”
        Two more points - the processes and procedures I spoke to in this comment were just the start. There were many, many more. It took an hour and a half just to prepare to enter the room.

        And it wasn't necessarily fun work. There was lots of turnover. The reason you took a shower after working in the clean room was because you were soaked with perspiration from a suit that practically didn't breathe, and the attached air tubes - while an absolute necessity - didn't help much.

        Bodhisattva, won't you take me by the hand. Can you show me the shine of your Japan, the sparkle of your China. Show me, and I'll be there, Bodhisattva, Bodhisattva.

        by thenekkidtruth on Fri Jul 25, 2014 at 12:17:27 AM PDT

        [ Parent ]

    •  I did the clean room routine a fair amount (1+ / 0-)
      Recommended by:
      thenekkidtruth

      at KLA-Tencor just as a tech writer when I had to use the laser microscope on real wafers to get illustrations for manuals. Nowadays we are well into the UV, which means much hotter lasers than the xenon-fluoride I worked with.

      Nothing whatsoever when compared with these biohazards. And of course we had air conditioning along with the continuous filtration.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Thu Jul 24, 2014 at 10:54:29 PM PDT

      [ Parent ]

  •  So Was First CASE diagnosed in NIGERIA today?? (4+ / 0-)

    Saw tweet they were testing a Liberian man in Lagos Nigeria.

    Proud to be part of the 21st Century Democratic Majority Party of the 3M's.. Multiracial, Multigender and MiddleClass

    by LOrion on Thu Jul 24, 2014 at 04:32:07 PM PDT

    •  I read about the test, I have not heard yet if it (1+ / 0-)
      Recommended by:
      blueoasis

      positive.

      So far as I know the virus started in Guinea and for the first time crossed borders into Sierra Leone, and Liberia.

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 05:10:51 PM PDT

      [ Parent ]

  •  I hope they get this cruel virus (11+ / 0-)

    under control soon. I also hope Dr. Khan and the rest manage to fight it off too.

    Once a patient survives Ebola he/she is immune, right?

    “You think You're frightening me with Your hell, don't You? You think Your hell is worse than mine.” --Dorothy Parker

    by Ice Blue on Thu Jul 24, 2014 at 04:34:07 PM PDT

    •  I'm not sure if we know that yet or not. (6+ / 0-)

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 05:26:16 PM PDT

      [ Parent ]

    •  If that were the case: immunity (1+ / 0-)
      Recommended by:
      HoundDog

      ….then I would guess there's another aspect to this story:  the mad race for a vaccine.


      _______________
      For an idea that does not at first seem insane, there is no hope.
                  -- Albert Einstein:  far left, emo-prog, socialist.

      by Pluto on Thu Jul 24, 2014 at 07:30:46 PM PDT

      [ Parent ]

      •  they suspect antibodies of survivors may cure (1+ / 0-)
        Recommended by:
        Pluto
        the mad race for a vaccine.
        There's a theory that drawing blood from Ebola survivors and (after filtering out the incompatible parts) injecting it into Ebola sufferers (or those suspected of being infected) will prime the victim's own immune system to attack the virus more aggressively.  Unfortunately, the only instance that I know of was done in the field out of desperation so even though the patient recovered, it's not considered a scientifically sound experiment.  And there are ethical issues with potentially infecting people who may not actually have Ebola, especially since any treatment is more effective the earlier you administer it.

        Though I worry that knowledge would lead to so-called "muti murders" as people kill known Ebola survivors for their blood for use in traditional rituals or who knows what else.

        Domestic politics is the continuation of civil war by other means.

        by Visceral on Thu Jul 24, 2014 at 09:06:46 PM PDT

        [ Parent ]

  •  I've worked level 4 biocontainment... (38+ / 0-)

    Every hazard mentioned in the quoted article is true. Ebola is supposedly only transmissible by bodily fluid contact with a mucus membrane but there is a strain, called the Mayinga strain (named after a nurse who caught it by an unknown method) where there has been speculation that it might spread by aerosol.

    You start wearing nothing but long-sleeved scrubs including lightweight foot-coverings. You put on latex gloves  and you tape the cuffs of your gloves to the sleeves of your scrubs and the similarly you tape the top of your foot coverings to the ankle cuffs of your scrubs too. THEN you go into the area where you can put on your main protection. The main suit goes over what you're already wearing and includes full body coverage, with heavier gloves and boots and full head coverage. All seams between components are taped securely.

    Needless to say, even in a temperate environment that suit needs airflow. That's either from a portable aircon unit with 0.2 micron filters on the inflow that you are lugging around on your back or on your belt or it's a sterile cooled airflow through a hose provided by the lab facility, which STILL goes through a 0.2 micron before it enters your suit in case of a hose compromise.  only then do you get to go into the hot zone.

    One you're in that suit you're in hypervigilance mode. Your movements are deliberate, careful. You announce to any colleagues when you are picking up any sharps, and then announce what you are going to do with them before you move to do it. Same for any potentially high-risk objects (where there might be a high virus load) like blood or tissue samples - you announce before you touch them or move them. You watch your colleagues and they watch you, looking for any signs of a suit compromise or actions that might lead to one, calling "hold" (at which point everyone freezes) if you see one.

    Exiting is another procedure you drill until you can repeat it in your sleep. You exit the hot zone into decontam, where the entire exterior of your suit is sprayed down with a liquid that no biomolecule can survive a few seconds contact with un-denatured. After that you move back into the room where you first put on your suit and you strip it off according to a rigorous protocol that means you never touch the outside of it with anything that was ever inside it. Then you exit that room promptly to the area where you put on your scrubs.

    The scrubs go in a biohazard laundry bin that will be autoclaved before it is washed, only then do you put on your regular clothes and walk out.

    Each room going inwards is maintained at a lower pressure than the one before it. When doors between them are open the airflow is always flowing in, never out.

    In the field, the WHO can't do that. They have to improvise and get as close to that standard as they can. Anything short of a true level4 protocol will have cracks in it, and if there are cracks there are risks.

    •  they are such heroes (9+ / 0-)

      you're saying they know, only not when?  If they recover are then then immune? How many recover?

      plus ça change, plus c'est la même chose

      by anna shane on Thu Jul 24, 2014 at 04:43:38 PM PDT

      [ Parent ]

      •  My knowledge is a little out of date but.. (16+ / 0-)

        ...as far as I know nobody has ever been known to be exposed twice so whether immunity from a previous infection persists is a dice roll.

        Thats largely because the hemorrhagic fevers have such a high mortality rate. Thankfully they are not efficient reproducers. Early in an outbreak you are looking at 95+% kill rate. Nothing works, the internal organs are destroyed along with the blood vessels and before long you bleed out internally (while shedding virus-rich blood from every orifice)

        As the outbreak proceeds the virus reproduces imperfectly in each host, like making photocopies of photocopies until you cant tell what the original picture was, so the kill rate goes down based on how many people away from the original case you were. Downside there is that if it's an inefficient reproducer and mutating into a less virulent form, odds are the antigen profile is changing too so you may not be establishing immunity to the original strain even if you are a survivor late in the outbreak.

        Too many unknowns to answer your questions. Hell, we dont even have a clue what the in-the-wild reservoir of the virus is, a monkey? a bug? african bigfoot? No idea. We dont know. it shows up, people die and the outbreak burns out. Nobody has ever proved how the primary case caught it in ANY Ebola outbreak.

        •  The in-the-field reservoir seems to be the fruit (13+ / 0-)

          bat, which caries the virus without becoming infected themselves.

          They can infect primates, and lots of other game animals used as "bush meat" including primates, gazelles, antelope, porcipines, etc. but these animals die from it but can all infect anyone who handles or eats the infected carcass.

          Guinea, Libera, and Sierra Leone have made it illegal to sell or eat fruit bats, and bush meats however, people still do. In some areas this constitutes over 50% of the food supply and is the major export other than mining.

          Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

          by HoundDog on Thu Jul 24, 2014 at 05:31:38 PM PDT

          [ Parent ]

          •  If they are closing in on finding the reservoir (5+ / 0-)

            That's awesome. I really hope they find it and definitively prove it soon! Knowing that is SUCH a huge handle on research to defend against the virus.

          •  Bush meat (12+ / 0-)

            It is a cultural thing in some parts of Africa and still a major source of protein.  Many living in or near the bush eat the bush meat out of necessity.  Those living in cities eat it as a link to their heritage and as a connection to "village life."  (As a side note, in China the reasons for eating exotic animals are different...it is seen as an elite and high class thing to do)  It will take GENERATIONS to get them to switch protein sources.  Many traditional domesticated animals just don't do well in that Western/Central Africa environment.  There have been some programs to introduce new "kinds" of domesticated animals for consumption in that region (such as the grasscutter...a rodent).  Adoption rates are low, but some farm raised fish operations may actually work.

             Many of the drivers from mines and logging operations will purchase extra bush meat and take back to cities to sell to make a little money.  It is supposed to be an illegal practice.  It is clear that some of this meat doesn't stay in places like Kinshasa.  Withing 48 hrs, some of that meat is available in communities in London and Paris...how long before that contaminated meat finds its way to a major city outside of Africa through the illicit food trade?  I once pitched a project to test this illegal meat found in European African communities to determine if there are any bad bugs associated with it.  

            I went into science for the money and the sex. Imagine my surprise.

            by Mote Dai on Thu Jul 24, 2014 at 05:46:35 PM PDT

            [ Parent ]

            •  Thanks for this fascinating and important info. (3+ / 0-)
              Recommended by:
              wader, Mote Dai, doingbusinessas

              In one of my March or April Ebola post we had a number of brilliant questions from a student at the London School of Economics who told us that black market bush meats from Africa were a big trade in London.

              I've been keeping my eyes open for any article about the EU taking measures to crack down on this without luck so far.

              Now you've made me curious.

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              by HoundDog on Thu Jul 24, 2014 at 06:03:30 PM PDT

              [ Parent ]

              •  who's buying the bush meat in London? (0+ / 0-)

                Immigrants from Africa who are accustomed to certain types of meat in their diet?

                Native British who didn't grow up eating any of those meats but are looking for something "adventurous" to eat?

                Each of those scenarios calls for a different set of measures to deal with it.  

                We got the future back. Uh-oh.

                by G2geek on Sat Jul 26, 2014 at 03:17:28 AM PDT

                [ Parent ]

          •  Bush meat export to WHERE? (0+ / 0-)

            As in, uh-oh, does any of that stuff go around the world, and more to the point, does any of it come into the US?

            We got the future back. Uh-oh.

            by G2geek on Sat Jul 26, 2014 at 03:02:09 AM PDT

            [ Parent ]

        •  95% death rate simply isn't true. (0+ / 0-)

          Even Ebola Zaire, the most deadly variant on record, "only" has a ~90% fatality rate.  I believe 40-50% is more typical for ebola - which is still stunningly high, particularly when you consider how fast it kills.

      •  In this outbreak the mortality rate is currently (11+ / 0-)

        58% I believe.  The textbook rates for the Zaire strain is 90%.

        This strain is 3% different genetically.

        But, the primary explanation for improved survival rates seems to be better treatment, and identifying cases early. Intensive hydration, and anti-biotics to treat secondary infections have helped a lot.

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        by HoundDog on Thu Jul 24, 2014 at 05:14:24 PM PDT

        [ Parent ]

      •  Big bets (7+ / 0-)

        Well, the Dept of Defense is betting big that an antibody treatment will work post-exposure.  Not sure how well it really works.  

        In addition, ebolavirus is high on the priority list for vaccines...and there are a few in the pipeline that are currently being tested.  They have taken a few different strategies for the vaccine, so hopefully one of them works well and provides cross protection against multiple ebolavirus strains. There are several strains and a new one, Bundibugyo, was identified just a few years ago

        I went into science for the money and the sex. Imagine my surprise.

        by Mote Dai on Thu Jul 24, 2014 at 05:29:41 PM PDT

        [ Parent ]

        •  There have been a number of successful animal (2+ / 0-)
          Recommended by:
          HoundDog, BusyinCA

          trials of monoclonal antibody treatments for ebola, which were effective at clearing ongoing infections. It looks like the best bet at the moment.

          American Presidents: 43 men, 0 women. Ready for Hillary

          by atana on Thu Jul 24, 2014 at 06:01:29 PM PDT

          [ Parent ]

          •  I recently saw an article with a headline saying (0+ / 0-)

            that some government body declared that the vaccines and a few other experimental treatments being research would not be, or maybe it was should not be used yet in the field with African patients, but I did not get a chance to read it yet.

            Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

            by HoundDog on Thu Jul 24, 2014 at 06:06:11 PM PDT

            [ Parent ]

    •  I was reading about the shortages they face , (5+ / 0-)
      Recommended by:
      sjburnman, HoundDog, lilsky, BYw, WakeUpNeo

      a roll of tape was dropped and it rolled into the wrong place , they would not bring it out of where it came to a stop , they had no more tape , they didn't know what they were going to do without tape .
      They have no air filtration .

      http://www.msf.org/...

      "please love deeply...openly and genuinely." A. M. H.

      by indycam on Thu Jul 24, 2014 at 05:27:41 PM PDT

      [ Parent ]

      •  Thank indy. Many of these tents are made out of (1+ / 0-)
        Recommended by:
        anna shane

        plastic, or thin linen nailed to 7 foot high stakes. Sometime with only three walls, and one side completely or partially open -like an entrance of window cut out.

        Mud floors, and a cot.

        Some of the "upscale" tents will have a folding table and some chairs, and white five gallon buckets of chlorinated water sitting on floors to disinfect things.

        Sometimes one sees the metal poles with a drip IV bag.

        No electricity.  

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        by HoundDog on Thu Jul 24, 2014 at 06:10:26 PM PDT

        [ Parent ]

    •  are there any analogous protocols for... (0+ / 0-)

      .. people working in the field in ebola outbreaks?  Not the complex kit, but the procedures such as verbally alerting and cross-checking each other every time someone touches something hot.

      If not, there probably should be, though understood things are crazy & chaotic when there are patients present who are terribly sick and also terrified.

      We got the future back. Uh-oh.

      by G2geek on Sat Jul 26, 2014 at 03:12:05 AM PDT

      [ Parent ]

  •  Thank you for this diary HoundDog (6+ / 0-)

    It is as distressing as it is informative but sometimes that is just what is needed.

  •  That's not really a moon suit (7+ / 0-)

    The real moon suits (level A) have supplied air and operate under positive pressure. They run about $1500 each and are intended for single use only. With this suit you need to have an airlock for entering, exiting and decon. Even with this process, if there is an emergency, you make need to do a hot cutout which puts everyone involved at risk to exposure. The suits are hot, difficult to work in. The gloves are thick, so handling vials and syringes is practically impossible.

    These suits work well in well funded, well staffed operations with medical support. This is not the case in Africa. They can't afford the setup needed to use level A suits.  

    •  Yes, you are correct. I was using the term too (6+ / 0-)

      loosely and should have sad "moon-like." These here are not pressurized.

      Thanks.

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 05:00:05 PM PDT

      [ Parent ]

    •  I added this change cheminMD. (6+ / 0-)
      Although in slang, Africans apparently often call these "moon-suits," the ones pictured here and used in the field fall far short of the "moon suits" used in Biolsecurity Level 4 labs which are airtight, have their own air supply, and kept a positive pressure.

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 05:15:10 PM PDT

      [ Parent ]

  •  "infectious enthusiasm" (8+ / 0-)

    little high risk compliment no doubt.  They may be risking their lives, but they haven't lost humor.

    plus ça change, plus c'est la même chose

    by anna shane on Thu Jul 24, 2014 at 04:46:24 PM PDT

  •  Thanks for the diary. (7+ / 0-)

    It takes true courage for the doctors and nurses to care for these patients. They know exactly the risks they are taking in treating a viral infection with a case fatality rate of up to 90%. It would be easy for them to walk away, but they don't.

  •  PPE (7+ / 0-)

    The PPE is still fairly basic barrier protection.  It doesn't look like it has a PAPR or any sort of positive pressure.  Also, the materials in those suits are rated for only certain durations and I would assume, if there are failures, it is because the suits are being pushed well passed the usable lifespan.  Of course, they might not have a choice but to reuse the PPE.  

    SL is probably actually better off than they would have been because of the fever hospital at Kenema.  SL is in the hyperendemic region of Lassa fever (an arenavirus that also causes a hemorrhagic fever) and Kenema has experience handling patients and samples with hemorrhagic disease.  

    Dr. Khan is an interesting guy and he did some training and work for an organization where I used to work.  I was also told today that all but a few of the nurses "went on strike" and left.  Three that stayed are now dead.  Trying to confirm that sad bit of news.  

    I went into science for the money and the sex. Imagine my surprise.

    by Mote Dai on Thu Jul 24, 2014 at 05:20:48 PM PDT

    •  Thanks for this informative comment Mote Dai (4+ / 0-)
      Recommended by:
      Mote Dai, JayBat, Cassandra Waites, elmo

      Yes, you are correct that these PPE are low tech, "best-they-can-do-under-the-circumstances" approaches.

      They are not airtight, have not pressurization, nor even isolated breathing apparatus.

      Although the cloth suits, (which have a thin lamenation layer) are burned, the gloves, boots, and eye goggles are reused after being washed with chlorine, and put out to dry on sticks.

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 05:36:07 PM PDT

      [ Parent ]

      •  CIRMF (1+ / 0-)
        Recommended by:
        HoundDog

        I haven't heard much about CIRMF in this outbreak.  It is a very well-established maximum containment lab in Gabon and it served as THE repository and reference lab for viral diseases in West/Central Africa.  Maybe I have just missed mention of them in the reporting.  CIRMF is somewhat well-funded (relatively for Africa) and I thought it had funds from the French oil company Total S.A.  They are usually very active in these outbreaks.

        I went into science for the money and the sex. Imagine my surprise.

        by Mote Dai on Thu Jul 24, 2014 at 05:53:56 PM PDT

        [ Parent ]

    •  High likelyhood (5+ / 0-)
      Also, the materials in those suits are rated for only certain durations and I would assume, if there are failures, it is because the suits are being pushed well passed the usable lifespan.
      I have, for emergency medical response, a jacket that is rated for protection against body fluids and pathogens. Basic high-vis EMT-style jacket. The instructions for it are quite clear that the protection is only rated for a total of 7 washings over its lifetime. After that it's still a perfectly fine jacket, but they won't guarantee it will protect you to the same level because some of the coating is broken down every time it's washed.
  •  Just want to say thanks for posting these diaries. (5+ / 0-)

    Up-to-date, intelligently written articles about the outbreak are hard to find. Please keep them coming.

    •  Thanks so much veuve. Keeping myself motivated (4+ / 0-)

      is sometimes difficult, especially on these exotic topic posts which often elicit few readers.

      Just a few kind encouraging comments like your keeps me going.

      Yesterday's post on Dr. Khan was well received, and this one may be benefiting from "afterglow."  But, often posts about an deadly, incurable virus on a different continent are hard for many to relate to.

      Lassa fever apparently kills 500,000 a year and as far as I know we've never had an article about it. I've mentioned malaria a few times here, but only tangential with regard to a recent genetic engineering breakthrough that might enable us to wipe out the mosquito that spreads them that NPR reported on yesterday.

      My last post on the MERS virus in Saudi Arabia which has killed about 800 in the last two years and has spread to over a dozen countries and is a concern for the Hajj.received only 6 recs.

      So thank a bunch.

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 06:19:29 PM PDT

      [ Parent ]

  •  It is wasn't a needle stick then it was most (3+ / 0-)
    Recommended by:
    barbwires, HoundDog, Pluto

    likely when he was disrobing.

    There is no way to remove even as simple a protection as gloves without touching the glove with another gloved hand. And touching your skin as well.   Eventually someone has to touch the last glove used with a bare hand.  
    In the meantime if there is dried blood or fluid on the other covering of the PPE it can be shedding particles into the air.
    What they need is a level 3 biohazard room with negative air pressure to disrobe in, but I doubt they have access to that.  And even that is not a 100% guarantee of protection.

    •  your point is valid but.. (4+ / 0-)
      Recommended by:
      HoundDog, Pluto, anna shane, cheminMD

      ...here's how to remove a set of gloves without skin contact with the outside.

      (assuming you're right-handed, southpaws may reverse this if they find it easier)

      Between your right thumb and forefinger, pinch the cuff of the left glove at least an inch from its cuff (next stage works best if the place you pinch is on the inside of the wrist)

      Peel the left glove off with your right hand  leaving it held between your thumb and forefinger, it ends up turned inside out apart from the piece still held between your right thumb and forefinger.

      Using sterile forceps in your (uncontaminated) left hand, grasp the cuff of your right glove and peel it back an inch or so that it is folded over itself exposing its interior. Drop the forceps into the hazard bucket as soon as you have a decent fold available.

      Grip the fold with your left hand, being sure to only contact an inside surface. Peel the right hand glove off without letting go of the left hand glove your right hand is still holding.

      Let go with your right fingers once the left hand glove is fully enclosed within the (inside out) right hand one. Drop the entire bundle into the hazard bucket.

      Your hands are free without ever touching a surface exposed to "outside"

      •  "Thanks for this important safety tip, Limey." (1+ / 0-)
        Recommended by:
        anna shane

        (I'm sincere but also trying to make a humorous reference to Ghostbusters after the heros are informed not to "cross the beams" of their "ectoplasmic charge" guns least they destroy the universe as we know it.)

        Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

        by HoundDog on Thu Jul 24, 2014 at 06:23:11 PM PDT

        [ Parent ]

        •  LOL! (2+ / 0-)
          Recommended by:
          Bronx59, HoundDog

          It's just that there is always a way, you just need to LEARN it and then DRILL it until it's second nature before you do it with a potentially lethal pathogen on the other side of the smallest screwup.

          I wouldn't expect a raw beginner to execute a katana technique with a live blade without bleeding all over the dojo floor. I wouldn't expect a raw intern to put on level 4 bioprotection and be confident they hadn't compromised it or take it off without being confident they had never touched the outside of what they were taking off.

          There are well-established techniques for these things, which is why you see surgeons scrubbing up and putting on their scrubs, gloves and masks the same way every time (although that technique is designed to prevent contamination the other way) - learn it, drill it, do it and NEVER depart from the technique.

          Worth pointing out once again that "field techniques" vary - and that sometimes isnt a good thing. An expert who has learned the principles can make an intelligent assessment of the risks involved in what they can do with what they have available.

  •  Thanks for the diary (1+ / 0-)
    Recommended by:
    HoundDog

    and I'm sure we all fervently hope Dr. Khan recovers! But would you please spell Dr. Khan's name correctly? Thanks a lot.

    Formerly Pan on Swing State Project

    by MichaelNY on Thu Jul 24, 2014 at 06:08:06 PM PDT

  •  "We Have To Find Patient Zero!" Stupid Movie Trope (1+ / 0-)
    Recommended by:
    HoundDog

    God I hate that trope in "Outbreak," "Twelve Monkeys," "World War Z."  "Contagion" had a cameo of Gwenyth Paltro as Patient Zero, but nobody pretended that solving her would solve end the epidemic

    "World War Z" was the worst offender in this regard, but I finally figured out that the urgency in identifying Patient Zero did make sense in " Twelve Monkeys" only because they had a freaking time machine.  Maybe in WWZ Brad Pitt was thinking he still had the time machine from "Twelve Monkeys."

    Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

    by bernardpliers on Thu Jul 24, 2014 at 06:48:09 PM PDT

    •  "Finding patient zero" (1+ / 0-)
      Recommended by:
      HoundDog

      AKA the "index case" is actually a real important piece of epidemiology. Not so much because of the movie trope of "find a cure" but more about "where is this bastard going to show up next?"

      Most of the time with a bug like this, identifying "patient zero" means locating a body, or where a body was burned to ashes. If you hit the epidemiology motherlode and find the index case as an asymptomatic carrier (think "Typhoid Mary") you're well on the way to a defense against the disease but patient zero's life from then on is gonna suck because they will be in medical labs forever and restrained if they try to leave - even the most liberal pol will sign off when when hundreds of deaths are weighed against inconveniencing one individual.

  •  The uncomfortable fact is... (3+ / 0-)
    Recommended by:
    ArchTeryx, Naniboujou, HoundDog

    You can't see, smell, or feel if you've touched a contaminated surface, and it only takes a minor lapse to be infected, apparently. The longer the time a person spends working in an environment like this, the greater the odds that something will happen.

    "No special skill, no standard attitude, no technology, and no organization - no matter how valuable - can safely replace thought itself."

    by xaxnar on Thu Jul 24, 2014 at 07:17:11 PM PDT

    •  Exactly. (2+ / 0-)
      Recommended by:
      HoundDog, xaxnar

      Apparently there's a variant of Ebola now that can live on fomites (bits of sputum, skin flakes, etc) and it's HARD to prevent the spread of such viruses, if they can get in via touch rather then, say, being inhaled.

      Fomite-spread viruses look like they are airborne, but technically are not.  They still spread slower then a truly airborne virus like poliovirus.

      But you can't see viral particles.  All you can do is assume that a surface is contaminated by default, and never touch it with anything but gloves or after sterilizing with bleach.  Bleach is the one friend these African medicos have - it's very cheap and it kills EVERYTHING, including Ebola.  Nor can microorganisms evolve resistance to it.

  •  Lots of great comments here. (4+ / 0-)
    Recommended by:
    Naniboujou, HoundDog, anna shane, cheminMD

    I had no idea there were so many well-informed people on virology on this site - this whole thread looks like the sort of discussion you'd have at an American Society of Virologists meeting!

    I'm not sure I have a hell of a lot to add, being late to the thread.  BSL-4 "bunny suit" virology is something I've wanted to do for a while, but never will be able to.  (I have a J-pouch and have to use the bathroom up to 20 times a day.  I would NEVER be able to hold in long enough to do a proper workday in one of those).

    But OT, yes, I'd fully agree with all the commenters that the primary reason is that in primitive third-world conditions, you are never going to be completely safe from a BSL-4 organism like Ebola, even if you undertake all the sprays and layers described above, and even if it's passed primarily by body fluids.  It's still BSL-4 for a very, very good reason.

    I'd add one thing from an epidemiological perspective.  It isn't just the mutation rate that eventually brings Ebola outbreaks to a halt.  It's that the most lethal varieties are also the slowest to spread - they kill people so fast they don't really get a chance to spread it much, even in the final hemhorragic stages.  The rate of quasispecies formation is just the icing on the cake.

    Think of it like a bushfire that burns so incredibly hot it wipes out everything within itself down to the soil, but starves itself of oxygen eventually and burns out.

    •  Thanks ArchTeryx. (2+ / 0-)
      Recommended by:
      ArchTeryx, cheminMD

      Yes, we have some highly educated, experienced and super smart people here. I learn so much every time I post.

      Thank your for commenting on the mutation rate bringing the outbreaks to a halt.

      I'm trying to understand this angle better.

      I read an article asserting that the mortality rate of the avian flue is 10% currently, and it is only a matter of time before it mutates to being capable of airborne spread.

      After than it will take about 3 months to spread around the globe but as it does the fatality rate should drop from 10% to something less as it spreads.

      You mention mutation rate, another expert above used the analogy of making copies of copies so the fidelity to the original degrades.

      This makes sense, but I'd like to understand it better.  

      I remember thinking once there seemed to be three reasons distinct possible reasons for the phenomena;

      My first problem with the xeroxing metaphor is that mutation is different in that mutated variations are just as distinct, and some might even be more lethal.

      More solid seems to be:

      1) The most lethal variants kill off their hosts so fast people with milder strains are outside moving exposing more people, but people exposed to these milder strains will have immunity to any reemergence of later exposure to he harsher strains.

      2) Even though some mutations maybe more lethal, but perhaps some factor like "regression to the means" means most mutations will be less lethal?

      I can't remember what the third idea was.  

      Humor Alert! No statement from this UID is intended to be true, including this one. Intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited. Artistic License - 420420

      by HoundDog on Thu Jul 24, 2014 at 09:12:24 PM PDT

      [ Parent ]

      •  It comes down to what genetic material... (3+ / 0-)
        Recommended by:
        WakeUpNeo, LimeyExpatDave, cheminMD

        ...the virus is using.

        DNA viruses (like herpesviruses) use enzymes with proofreading features to copy themselves.  Their rate of natural mutation (copying errors) tends to be very low.  That actually makes them good candidates for vaccines, and we have vaccines for many, many DNA-based viruses.

        RNA viruses (like Ebola) use a copying enzyme that very often doesn't have a proofreading feature, so errors accumulate much faster.  This is both an advantage AND a disadvantage to a virus.

        The advantage is that the virus can change much faster, sometimes much faster then our immune systems can adopt.  HIV is a classic example of this.

        The disadvantage is that many such viruses are rendered dead because of some fatal error in one of their vital proteins - think of a gear missing spokes, or warped, trying to mesh with neighboring gears.

        It gets complicated when you consider some RNA viruses are more sensitive to errors then others.  Influenza, for example, actually uses a proofreading RNA copying enzyme, and is VERY sensitive to mutation.  (It changes its genome around via an entirely separate mechanism that I won't go into here).  I don't know if the Ebola RNA polymerase also is proofreading, but I don't think it is.  So it may get the worst of both worlds, and thus not be able spread for many generations before it basically bluescreens and dies.

        •  Congratulations... (1+ / 0-)
          Recommended by:
          ArchTeryx

          ...on one of the clearest and most concise summaries of these factors I've ever read that didn't dissolve into bio-jargon. I don't think I could have said it as well as that.

          •  Well, thank you! (0+ / 0-)

            It wasn't the best - there are a few small errors that I'd correct if Kos had a comment-editing feature, but overall, this is what I do best, explain science to non-scientists.

            Now if only I could get a job doing it (or any job at all, for that matter).  But that is a tale for another time.

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