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A new diary to follow in Ebola-savaged Uganda

Posted on Tuesday, December 4, 2007 at 10:42AM by

Scott McPherson in influenza and infectious diseases |

All hands on deck as Ugandan Ebola spreads; all save for one

Posted on Monday, December 3, 2007 at 03:27PM by

2 Comments |

2 References

uganda%20ebola%20nov%202007.jpg The call has gone out for volunteers and equipment to battle an outbreak of a new, unknown strain of Ebola. And the world is responding. The Red Cross is sending a hundred volunteers. The CDC is sending a team of Ebola experts and a field laboratory to assist in testing human fluid samples for evidence of the virus. The CDC will also try and reverse-engineer the outbreak's origins, to learn where this new, unknown scourge emerged from. And MSF, or Doctors Without Borders, is sending yet another team of Ebola workers. No word yet on whether or not Zoe Young will go.

All this is happening as the virus spreads, and people begin to express real concern about the potential for a longer incubation period than normal. Ebola Uganda, as I call it, appears to be less lethal than normal Ebola, which is small consolation to those sufferers who are left to rejoice over a 50% case fatality rate as opposed to a 90% one.

In the meantime, several new media reports are leaving ample cause for concern. The first is an AFP story that amplifies the descriptive accounts of health care workers fleeing by the dozens in the African nation. Here is the story:

Ebola outbreak spreading in Uganda: officials

by Vincent Mayanja

KAMPALA, Dec 2, 2007 (AFP) - The Ebola outbreak that has killed 18 people in western Uganda appears to be spreading, officials said Sunday, as authorities examined a sample taken from a patient who died in the south of the country.

Government officials told AFP that the disease, which flared in September, had spread to three new zones in the poor Bundibugyo district near the border with the Democratic Republic of Congo (DRC), where it killed 26 recently.

Virologists were meanwhile examining a sample taken from a suspected victim who died overnight in Mbarara region, 160 kilometres (100 miles) south-east of the affected district, said Sam Zaramba, the director of medical services.

Health officials said several dozen medics and support staff had fled the Bundibugyo area when their co-workers became infected with the virus in an outbreak that has already killed 18 people and infected 61 others.

But Ambrose Amumpe, a local adminstrator, spoke of a higher death toll, telling AFP: "We started seeing strange illnesses and deaths in the first week of Novemeber. We suspect that up to 30 have died."

Virologists were also investigating an isolated patient in the neighbouring Port Portale district as well as the fatality in Mbarara, near Rwanda which has boosted border surveillance.

"There are fears that the disease has spread," said a top health ministry official, who requested anonymity.

"We are waiting for the results from the samples," he said of the two cases that have spread panic in the east African nation, where an ebola outbreak killed at least 170 people in 2000.

Meanwhile, a doctor who contracted the virus while treating others in Bundibugyo was under observation in the capital's main Mulago hospital, colleagues said.

A team from the Atlanta-based Centres for Disease Control (CDC) is expected in Uganda on Tuesday with equipment to help contain the disease and further the studies on the mystifying virus, the health ministry announced.

The disease, which is fatal in 90 percent of cases, is spread by contact of body fluids, primarily contamination of blood.

Previous Ebola fatalities among medical workers have been blamed on poor sanitation and hygiene in health centres not equipped with protective suits, respirator masks, latex gloves and other necessary safety gear.

Meanwhile, epidemiologists and virologists are in Bundibugyo district to try to trace backwards the source of the virus as part of a campaign to avoid future outbreaks.

"A health ministry team is going round villages educating the public on mode of transmission," Kizanga explained.

Authorities say the outbreak was an unknown strain after analysis was done on tissue samples at the CDC laboratories.

Known Ebola subtypes usually attack capillaries and blood vessel linings, draining the body of blood through openings, leaving the patient to die in shock, doctors say.

But the new Uganda subtype, which provokes high fever, kills victims without much loss of blood.

Generally, patients of all Ebola strains complain of headaches, abdominal pains, fevers, hiccups and bleeding from all body openings and many patients get deranged before they die, doctors say.

The Ebola virus has remained rare and mystifying since it was first discovered in the DRC and Sudan in 1976 and other outbreaks have since hit Ivory Coast and Gabon.

Experts have said the disease, which strikes with an initial ferocity but fades away in months, is usually containable because it kills its victims faster that it can spread to new ones.

Luckly, the virulence of the disease slashes its chances of multiplying and spreading further, they say.

vm-bkb/boc AFP 021534 GMT 12 07

http://www.reliefweb.int/rw/RWB.NSF/db900SID/KHII-79J2YP?OpenDocument

A Reuters story confirms the fears:

UGANDA: Fears of Ebola spread as more cases reported

03 Dec 2007 15:12:23 GMT

KAMPALA, 3 December 2007 (IRIN) - Medical authorities in Uganda have expressed concern over the possible spread of the deadly Ebola disease in the western region after suspected cases were reported in two neighbouring districts.

Sam Zaramba, the director of medical services in the health ministry, told IRIN on 3 December that a patient with symptoms similar to those reported in Bundibugyo district, the epicentre of the outbreak, died on 2 December at Mbarara hospital, farther southwest, causing fears that the disease was spreading out of Bundibugyo.

Another suspected case had also been isolated at Virika hospital in Fort Portal district, next to Bundibugyo, Zaramba said.

"We are waiting for the results of the samples for the two suspected victims," he told IRIN by telephone.

Another medical official, who requested anonymity, said: "There is cause to worry when we start getting these cases overshooting and appearing in other areas because this complicates contact surveillance. One medical officer who worked on the first cases but moved to Kampala [the capital] to attend to personal issues has also fallen sick and was admitted to Mulago [the main hospital in Kampala]; we are trying to follow his contacts."

Several dozen medics and support staff have fled western Uganda after their co-workers became infected with the virus in an outbreak that has already killed 16 people and infected at least 58 others.

A government official in Bundibugyo, Samuel Kazinga, said a quarantine had been declared in all homes in the district that had registered a case in order to control contacts and ease monitoring.

"We are mobilising the public to take precautionary measures through public announcements on the radio and talking to people through community [leaders]," Kazinga said.

He said Bundibugyo had appealed for help but efforts to contain the outbreak, which began in September although it was only identified as Ebola last week, have been hampered by lack of medical personnel.

"We have a shortage of health workers and we need more because those who were there on the ground have been infected: two doctors, a medical officer and a nurse. We are trying to get more medical workers to go to the region and help in the fight," said Zaramba.

Zaramba had initially said two more patients succumbed to the virus on 1 December, bringing the toll to 18. But the health ministry on 3 December revised the number back to 16, saying the two deaths had since been confirmed as due to other causes.

"Cumulatively, we now have 16 deaths and 58 cases," he said.

Patients were quarantined in Bundibugyo hospital's isolation ward near the border with the Democratic Republic of Congo (DRC), which has had outbreaks of the virulent disease in the past.

"Those admitted are mainly health workers and those who attended to the patients," Zaramba said.

Previous Ebola fatalities among medical workers have been blamed on poor sanitation and hygiene in health centres that lack protective suits, masks, latex gloves and other equipment.

Ebola spreads through body fluids, particularly blood, putting health workers without protective gear at risk. Ebola sub-types usually attack capillaries and blood vessel linings, so patients lose blood rapidly, and die of shock, doctors say.

The new Uganda subtype kills patients by provoking high fever, but without much loss of blood. There is no vaccine or cure for Ebola.

"The situation is not yet under control," Zaramba said. "The main challenge we are facing is detecting cases and following up on those who had contact with the patients."

A team of epidemiologists and virologists arrived in the region on 1 December to try to retrace the source of the virus as part of a campaign to avoid future epidemics.

Authorities said a team of pathogen experts from the Centers for Disease Control in the US were expected in the country on 4 December to beef up the local response to the disease, including bringing laboratory facilities to detect infections more easily.

An outbreak killed at least 170 people in Uganda's northern Gulu district in 2000. Another recent outbreak killed at least 26 people in DRC's West Kasai region.

The Ebola virus was first identified in 1976 in Sudan and in a nearby region of DRC, then Zaire. Outbreaks of Ebola have also occurred in the Ivory Coast and Gabon.
http://www.alertnet.org/thenews/newsdesk/IRIN/ff3ff6324a4c21610e994ccf2bca140a.htm?&_lite_=1

And New Vision reports on the spread of Ebola Uganda to two cities:

Ebola - Mbarara, Fort Portal Put On High Alert
New Vision (Kampala)

NEWS
2 December 2007
Posted to the web 3 December 2007
Kampala

SIX more people have been confirmed infected with the deadly Ebola virus, health officials said yesterday. This puts the number of infected people at 58, sixteen of whom have died since the outbreak of the deadly disease in August.

The Commissioner for Health Services in the health ministry, Dr. Sam Okware, said the six new cases were admitted at Bundibugyo Hospital after they attended the burial of an Ebola victim. Another two suspected cases were yesterday reported in Fort Portal.

A 13-year-old school boy came from Kyenjojo district with the mother yesterday morning and was admitted to Virika hospital, according to the Kabarole district director of medical services, Dr. Joa Okech. The boy, who was only identified as Katusabe, was temporarily admitted to Virika, where he was resuscitated and transferred to Buhinga Hospital.

At Virika, the outpatient room was turned into an emergency ward to accommodate the boy. When the New Vision visited the ward, the door to the room bore a warning: "Do not enter unprotected".

The second patient, a woman, also reported to Virika late afternoon, but she was sent to Buhinga hospital, according Dr. Musa Walakira, who is handling the cases. The woman's identity could not be readily established.

"She was vomiting blood when she went to Virika, so they suspected Ebola and sent her to Buhinga Government Referral Hospital where an isolation centre has been set up. Another suspected patient bled to death in Mbarara yesterday," Dr. Okware said.

He said ministry of health officials picked blood samples for testing. He said he had also instructed a quick burial of the body.

Meanwhile, the head of Nyahuka Health Centre 4 in Bundibugyo district, Dr. Richard Ssesanga Kaddu, his deputy Jonah Kule and two medical officers have been isolated after they complained that they felt unwell.

Okware, explained that Ssesanga was isolated at his home in Bundibugyo, while Kule who had traveled to Kampala, was put in the ministry's isolation facility in the city.

He could not say whether Ssesanga, Kule, Kisughu, an enrolled nurse and Amon Kule, an ophthalmic officer, were infected with Ebola.

"We have taken specimen from them and it will be sometime before we can tell," he said, before adding that the medical officers were improving steadily.

He lamented that there was a shortage of medical personnel in Bundibugyo, affecting the out-patients department most. "We need additional personnel to run the hospitals."

Dr. Scot, a missionary, now heads the case management unit, while the two isolation units have each got seven personnel.

In Fort Portal, a district task force has been set up comprising the top district officials, medical personnel and some NGOs to handle the Ebola emergency.

In addition, two isolation centres have been set up, one at Buhinga in Fort-Portal town, the other at Bukuku, about 10km on Fort-Portal Bundibugyo road.

The RDC, Kakonge Kambarage, said they suspected that there could be more infected people who are still in the incubation period.

An official from the US Centre for Disease Control in Atlanta is set to collect samples from the patients in Fort-Portal today for testing.

The Minister of Defence, Dr. Crispus Kiyonga is also in Fort-Portal and Kasese to sensitise the population about the virus.

Kiyonga on Saturday asked local leaders to start public awareness campaigns.

"Once infected with Ebola, chances of survival are 50%," the former health minister told sub-county and town council leaders at Virina Gardens in Kasese town.

He advised that Ebola victims be buried in fluid-proof bags soon after they die. He asked the public to look out for such symptoms as headache, high fever, a rash, red eyes, bleeding, diarrhoea and vomiting.

Participants expressed fear that the virus could be incubating in Kasese and Kabarole among people who have been going Bundibugyo to bury their relatives since the disease outbreak in August.

Meanwhile, the UN Children's Fund (UNICEF) has given sh45m to Bundibugyo district to fight the disease, the chief administrative officer, Elias Byamungu, said on Saturday. Byamungu said other agencies, including Oxfam, had agreed to offer more support.

Uganda was last hit by an Ebola epidemic in 2000, when 425 people caught it and just over half of them died, including Dr. Mathew Lukwiya. An outbreak in neighbouring Congo this year infected up to 264 people, killing 187.

Reported by Anne Mugisa, John Thawite, Matthias Mugisha and Bizimungu Kisakye

http://allafrica.com/stories/200712030011.html

One doctor who will NOT be making the trip -- unless he goes to collect samples to kill us all -- is Dr. Eric F. Pianka. Dr. Pianka, an ecologist (of course), belongs to this curious and extremely dangerous group of people who think the only good human is a dead human. Remember the recent news story about a woman who aborted her fetus and then had herself sterilized, because she thought childbirth was selfish and she wanted the human race to depopulate and ultimately disappear? To her, Dr. Pianka must be a God-like character. Dr. Pianka teaches at the University of Texas, which could learn a thing or two from Colorado about running nutcases out of its institutions.

Anyway, this Dr. Pianka believes that an easily transmissible, human-to-human Ebola strain; a mutated Ebola Reston, which is considered the only airborne variant -- would do Gaia a favor by killing off 90% of the Earth's population.

Thankfully, someone in Washington heard about this idiot, and now the Feds are paying close attention to him. Of course, this means we all are doomed. Here is a story from last year regarding this dangerous person:

FBI Interested in Texas “Doomsday” Ecologist who said Ebola the Solution to Human Overpopulation

Students being influenced and agree with him and some might eventually act on his suggestions

AUSTIN, April 6, 2006 (LifeSiteNews.com) – Ebola, a form of hemorrhagic fever in which the internal organs of the victim liquefy, has one of the highest rates of fatality of any known contagious disease at approximately 80-90% and is one of the most contagious diseases known to medical science. It is also high on the list of possible bio-terror weapons of concern to international law enforcement and military security agencies. Tom Clancy’s thriller novel, Rainbow Six describes a group of radical environmentalists that wants to rid the world of people using a modified version of Ebola.

All of which is why the FBI is interested in talking to Texas ecologist and herpetologist, Dr. Eric R. Pianka, who suggested at a meeting of the Texas Academy of Sciences that an airborne version of Ebola that would wipe out 90% of the human population was the solution to the human “overpopulation problem.”

This week, Pianka has been in the Texas media saying that he was not advocating bio-terrorism, but also told the Austin Statesman that he is meeting with local FBI officials in response to complaints that he is advocating biological terrorism.

“Someone has reported me as a terrorist,” he said. “They think I'm forming a cadre of people to release the airborne Ebola virus into the air. That I'm the leader and my students are the followers.”

On the day he was named by the Academy as 2006 Distinguished Texas Scientist, Pianka declared that AIDS was not killing off the surplus human population fast enough. What is needed, he said, is Ebola to kill 5.8 billion of the world’s 6 billion plus humans. The speech received a prolonged standing ovation at the Academy’s annual meeting at Lamar University in Beaumont.

The Seguin Gazette quotes Pianka saying, “Every one of you who gets to survive has to bury nine.”

“[Disease] will control the scourge of humanity,” Pianka said in his March 3 speech. “We're looking forward to a huge collapse.” He said, “We've grown fat, apathetic and miserable,” and described the world as a “fat, human biomass.”

The syllabus for one of Pianka’s courses reads, “Although [Ebola Zaire] Kills 9 out of 10 people, outbreaks have so far been unable to become epidemics because they are currently spread only by direct physical contact with infected blood…Ebola Reston, is airborne, and it is only a matter of time until Ebola Zaire evolves the capacity to be airborne.”

The speech was first reported by popular science and computer writer, Forrest Mims III on the website of the Citizen Scientist. Mims said he was concerned that in this age of international security tensions, “fertile young minds,” might take Pianka’s assertions as suggestions.

One class evaluation for one of Pianka’s courses shows the enthusiasm with which his ideas are received by ‘fertile young minds. Two quoted by the Seguin Gazette read, “the most incredible class I ever had” and “Pianka is a GOD!”

After the talk, student blogger, Brenna McConnell, who attended the Academy talk wrote, “He’s basically advocating for the death for all but 10 percent of the current population. And at the risk of sounding just as radical, I think he’s right.” (bold mine)

To the possibility that someone would actually go with the idea, Pianka said, “Good terrorists would be taking [Ebola Reston and Ebola Zaire] so that they had microbes they could let loose on the Earth that would kill 90 percent of people.”

http://www.lifesite.net/ldn/2006/apr/06040603.html

I draw attention to the fact the good Doctor Pianka has not taken the step himself to reduce the human population by one. Of course, he won't. Neither will Osama bin Laden, nor any other coward. They will simply try to influence these impressionable young people to do it themselves, while they stand in the shadows, claiming no responsibility whatsoever.

http://www.sas.org/tcs/weeklyIssues_2006/2006-04-07/feature1p/index.html has the story and commentary. The caption from the Website is evidence enough that the state of Texas has gone MAD.

pianka%20photo.jpg Dr. Eric R. Pianka and an unidentified woman from the University of Texas at Arlington following a recent speech before the Texas Academy of Science in which Pianka endorsed airborne Ebola as an efficient means for eliminating 90 percent of the world's population. Pianka received an enthusiastic and prolonged standing ovation. Later he received more applause from a banquet hall filled with more than 400 people when the president of the Texas Academy of Science presented him with a plaque naming him 2006 Distinguished Texas Scientist. Photograph copyright 2006 by Forrest M. Mims III.

12%20monkeys.gif 12%20monkeys.jpg

No doubt Dr. Pianka's favorite movie is 12 Monkeys, the chilling Terry Gilliam post-apolcalyptic sci-fi classic starring Bruce Willis and Brad Pitt. Recall the plot?

From IMDB: An unknown and lethal virus has wiped out five billion people in 1996. Only 1% of the population has survived by the year 2035, and is forced to live underground. A convict (Willis) reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (who he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates so that scientists can study it.

Sounds like Dr. Pianka is a budding general in the army. Hope the Feds' wiretaps are digital quality. I normally don't advocate such government behavior, and after all, peoples' ideas are theirs. But this guy deserves watching. He is ultimately more dangerous than bin Laden, because at least bin Laden wants to convert us all to Islam and take us all to the Eighth Century. Pianka simply wants eons of non-human bliss and is telling anyone who will listen how to do it. This all should serve as evidence that the most dangerous people to our way of life are right here, in our own neighborhoods, and some of them are indoctrinating our children. The problem is, some of these kids might change their majors and take up careers as microbiologists.

Update on Monday, December 3, 2007 at 04:47PM by

Scott McPherson

I know many of my new friends in academia may be troubled by my support of the FBI's interest in Dr. Pianka. Ideas alone should never be the basis of such "interest," and we have to tread lightly on the good Doctor's right to speak his mind.

The problem is that this person is not just teaching ecology; he is advocating the extermination of 90% of our planet's population. If we substituted "Jews" or "homosexuals" or "Intellectuals" for "population," this guy couldn't get a job at a Dairy Queen. But he is being (apparently) indiscriminate about who should die, as long as they indeed die. I suspect, however, that he would also advocate a serum antidote for select friends of his.

Nature, of course, would ultimately play a cruel trick on him; kind of like when Burgess Meredith's glasses break at the end of that classic Twilight Zone episode. Meredith realizes thermonuclear war has left him the Last Man Alive, and he has all the time in the world to read all the books he ever wanted to read. But he is blind as a bat, and when his glasses break, he realizes he is truly alone.

Perhaps Dr. Pianka's fate would be that the surviving 10% are religious zealots who believe they are the 144,000 and Dr. Pianka is Satan incarnate.

Thinking the unthinkable: Asymptomatic or Airborne Ebola in Uganda?

Posted on Monday, December 3, 2007 at 09:49AM by

Scott McPherson in influenza and infectious diseases |

2 Comments |

1 Reference

Something is going on in Uganda, and it is causing health care workers to flee in panic.

First, some background on the current outbreak, from Reuters:

Death-toll rises from Uganda's Ebola outbreak
Sat Dec 1, 2007 10:43 AM ET
By Francis Kwera

KAMPALA (Reuters) - Two more Ugandans have died of a new strain of the deadly Ebola virus in an outbreak near the border with Democratic Republic of Congo, bringing the death-toll to 18, health officials said on Saturday.

"We have had two more deaths in the last 24 hours, and the disease continues to spread," Sam Zaramba, the Ugandan Health Ministry's director of health services, told Reuters.

Zaramba said World Health Organization (WHO) officials had teamed up with local experts to draw up a strategy to contain the outbreak of the hemorrhagic fever in the western Bundibugyo region. More than 50 people are also infected.

"We have set up isolation wards where all those who have been diagnosed with Ebola have been quarantined, and are being monitored closely," Zaramba added.

Genetic analysis of samples taken from some of the victims shows it is a previously unknown type of Ebola, making it the fifth strain, U.S. and Ugandan health officials say.

Ebola can cause internal and external bleeding. Victims often die of shock, but symptoms can be vague, including fever, muscle pain and nausea. It is known to infect humans, chimpanzees and gorillas.

Uganda was last hit by an epidemic of Ebola in 2000, when 425 people caught it and just over half of them died.

An outbreak in neighboring Congo this year infected up to 264 people, killing 187, the World Health Organization says.

Ugandan health officials originally suspected Marburg, a close Ebola cousin that infected three people in a different part of western Uganda the month before, killing one.

But samples had tested negative.

(Writing by Andrew Cawthorne; Editing by Michael Winfrey)

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2007-12-01T154333Z_01_L0114732_RTRUKOC_0_US-UGANDA-EBOLA.xml

Now, we get the "boots on the ground" view, from FOCUS Information Agency:

Kampala. Several dozen medics and support staff have fled western Uganda after their coworkers became infected with the Ebola virus in an outbreak that has already killed 18 people, officials said Saturday.
Ugandan officials clamped a quarantine on the Bundibugyo region and appealed for help in dealing with the outbreak of Ebola, a contagious disease that kills up to 90 percent of those infected, AFP reported.
However efforts to contain the outbreak, which began in September but was definitively identified as Ebola only last week, have been hampered by medical personnel becoming infected and others fleeing.
"We have a shortage of health workers and we need more because those who were there on the ground have been infected: two doctors, a medical officer and a nurse," said Sam Zaramba, the country's top government physician.
"Health workers are terribly afraid. They have abandoned patients in health units for fear of being infected," a government official told the state-owned New Vision newspaper.

There is a theory among microbiologists -- not much more than that, but a theory nonetheless -- that in order for a lethal disease to proliferate, it must reduce its lethality in order to spread more easily. We have discussed this time and again regarding the case fatality rate for H5N1. We have discussed this on this Blogsite. Could there be some kind of counterbalance in Nature, a biological "haggling session" that allows diseases to become more widespread in exchange for a reduction in lethality?

If these forces are at work in Uganda today, they may have produced a mutation that is less deadly yet much more easily transmitted. With the apparently easy transfer of what I will christen Ebola Uganda to health care workers, enough to cause a stampede out of the affected region, we should be very concerned.

Easy transfer? Since the outbreak was discovered in September, health care officials originally suspected Marburg virus, a hemorrhagic cousin of Ebola, they would have used protocols similar to those of Ebola. They are or should not be surprised by the diagnosis of Ebola, since much of sub-Saharan Africa has seen outbreaks over the years.

So what would cause them to flee in panic? How about Ebola that defies protocols and may actually be airborne or transmitted by asymptomatic human carriers?

I found a nifty, short description of the four previously known strains of Ebola from the Website of one Bret Russell (http://www.brettrussell.com/personal/what_strains_exist_.html

Ebola Zaire - The virus discovered in Zaire in 1976 - the first known occurrence of the Ebola Virus.
Ebola Sudan - Initially discovered in western Sudan in 1976. This type of Ebola virus resurfaced again in 1979 in Sudan.
Ebola Reston - This is the variation of the Ebola virus discovered in the African monkeys imported to the United States. This particular type is not believed to cause health problems in Humans.
Ebola Tai - This is the most recently discovered type of the Ebola virus. Discovered in 1995 on the Ivory Coast of West Africa, in the Tai Forest. A Swiss researcher was the first infected human, but survived the infection.

Ebolas Zaire, Sudan, and Tai cause illness in humans as well as primates (monkeys). Ebola Reston does not cause illness in humans, but does cause illness in monkeys. Ebola Reston is suspected to be airborne (transmitted by the air) where the other strains are not transmitted by air. As for their structure, they are all quite similar in (string-like) shape, but have different gene sequences in places, and therefore different properties.

hot%20zone%20book.gif Note that Ebola Reston is named after the city of Reston, Virginia -- site of the book "The Hot Zone." Its origin appears to be from the Philippines, since that is where the imported infected monkeys came from.

While trolling the Internet on the subject of potential airborne transmission of Ebola, I found an interesting article from a biology student at Bryn Mawr University Jennifer L. Wilson. Ms. Wilson writes:

Secondly, one must consider epidemiological factors. For a major epidemic of the virus, conditions include: " Presence of the animal or insect vectors, whatever they may be, in proximity to a human population; 1) exposure of even a single infected human to others, by traveling from a remote setting, to a population center after exposure to a vector and/or reservoir in that remote setting; 2) deficient sanitation and hygiene among the population (lack of clean water supplies, sewage disposal & treatment, etc.) which increases the chance of bodily fluid contact (e.g., contact with fresh sewage containing wastes from Ebola victims); 3) decreased immune response in members of the population, whether from malnutrition or other disease burdens, especially AIDS; 4) social customs which increase bodily fluid contact between people (e.g., burial customs, multiple-partner sex); 5) inadequate public health infrastructure (hospitals, staff, equipment - e.g., enough syringes to prevent their re-use, isolation facilities, barrier supplies); 6) lack of awareness of the disease and its symptoms among the population; 7) access to transportation systems; 8) poor communications infrastructure, resulting in delays in medical response and public notification & education; 9) the mutation of Ebola so that a strain that is dangerous to humans becomes airborne." (12) While the last condition is currently not an issue, it is also the most grave of the conditions, and would allow an epidemic of the Ebola virus to reoccur in vast proportions. Furthermore, it may be assumed that airborne transmission is the best possible trait for the virus, as a mutation of this degree would ensure its continued evolution and progression.

Many Ebola researchers believe that apes are simply a short-term vector of the disease, and that the ultimate host is unknown but could be something along the lines of a tick or other small, pesky insect. Otherwise, they postulate, how could Ebola ever continue to exist? If apes die from Ebola (and certain African gorillas are now in danger of extinction because of Ebola), then how could they possibly be the long-term host?

So, while trolling the Net, you can imagine my surprise as I came across a Website dedicated to the Bible Code. I am fascinated by such attempts to prove prophecy, so I throw this in just to entertain and enlighten. Anyway, a gentleman found this passage at the intersection of a few Hebrew letters:

It may indicate a major Ebola epidemic in year 2007-2010.... The next two matrices are from a -300,000 to 300,000 Old Testament search for ARTHROPOD and EBOLA, since Arthropods are the family of animal life that includes ticks, mites, spiders, and insects, which are possible Ebola vectors. So we will try to see if an Arthropod is the Ebola vector host.

God, I love this stuff. The Website is located at: http://www.angelfire.com/zine2/Number666/KingJames10.html

Turning back to science, I found a 2003 Powerpoint from one Risha Patel, hosted by the University of Southern California (Go Trojans!). Patel's presentation also mentions possible permanent reservoirs of Ebola, including bats, plants, arthropods. Patel further writes that the "Wide range of potential reservoirs makes identification more difficult." Further trolling confirms the potential for insects and bats to transmit Ebola and Marburg. And just this past August, researchers at the Centers for Disease Control and Prevention (CDC), Atlanta, GA, and the Centre International de Recherches Médicales de Franceville (CIRMF) and the Institut de Recherche pour le Développement, Franceville, Gabon, confirmed the presence of Marburg in African fruit bats, so one vector has now been proven.

Patel's presentation can be viewed at: bioweb.usc.edu/courses/2003-spring/documents/bisc419-r.patel.ppt .

Question of the Millennium: If Reston Ebola can be considered airborne, even though it only impacts apes, could a new, previously undetected strain of Ebola "go airborne and become a flyer?"

Stranger things have happened.

Giving the "other side" an opportunity to weigh in, I deliver the rebuttal: An article from Probe, the Columbia University journal. Titled "Airborne Ebola? A theory that won't fly," the article's author, David R. Zimmerman, is an adjunct professor at the Columbia Graduate School of Journalism and is the editor of Probe, a newsletter of science and media criticism. He writes:

Popular culture has a recurrent fascination with doomsday pathogens. Michael Crichton's The Andromeda Strain was a classic incarnation of this scary scenario.... In Richard Preston's book The Hot Zone and the film "Outbreak," we're frightened by real viruses, specifically Ebola.... The ostensibly responsible media are not immune to the temptation to stir these fears. In a May 12 editorial, the New York Times declared: "A modest genetic change might enable Ebola to spread rapidly through the air..."

That very same day, in the news section, Times reporter Lawrence K. Altman, M.D., handled the matter more soberly. Reporting from the Centers for Disease Control and Prevention in Atlanta, he wrote, "The deadly Ebola virus continues to spread in Zaire, chiefly affecting health care workers... [It] apparently spread initially among [doctors] and nurses who operated on a patient in Kikwit." Dr. Altman, an infectious-disease specialist who once worked at the CDC, added, "Transmission presumably was through contaminated blood..."

Can a bloodborne or body fluid-borne virus be transformed by a single mutation into an airborne agent (a "flyer"), as the scare scenarios imply? It's conceivable. But it's "probably unlikely," according to virologist Beth Levine, M.D. , director of virology research in the infectious diseases division at Columbia University's College of Physicians and Surgeons. "Single amino acid mutations can change the tropism [the residential preference] of a virus" in some experimental situations, Dr. Levine says, "but there haven't been any examples of such mutations actually occurring in nature, changing a virus from a bloodborne or bodily fluid route of transmission to a respiratory route."

So, says Dr. Levine, "The media's claim is not totally without scientific basis. But there are no precedents for it, and it's unlikely.

"I think it's irresponsible to raise that concern," she added, "because in general viruses are very well-adapted to their milieuand they don't just suddenly change their environment." Will this kind of level-headed assessment quell media hysteria? Stay tuned.

Indeed, stay tuned.

Finally, from Florida1, the founder and president of FluTrackers: A Lancet journal article from 2000, presenting very persuasive evidence that there are human asymptomatic carriers of Ebola. There are people who apparently are immune from the effects of the worst disease you can think of.

The Lancet 2000; 355:2210-2215
DOI:10.1016/S0140-6736(00)02405-3

Human asymptomatic Ebola infection and strong inflammatory responseDr EM Leroy DVM a , S Baize PhD a, VE Volchkov PhD b, SP Fisher-Hoch MD c, M-C Georges-Courbot MD a, J Lansoud-Soukate PhD a, M Capron PhD d, P Debré MD e, JB McCormick and AJ Georges MD a

SummaryBackground

Ebola virus is one of the most virulent pathogens, killing a very high proportion of patients within 5–7 days. Two outbreaks of fulminating haemorrhagic fever occurred in northern Gabon in 1996, with a 70% case-fatality rate. During both outbreaks we identified some individuals in direct contact with sick patients who never developed symptoms. We aimed to determine whether these individuals were indeed infected with Ebola virus, and how they maintained asymptomatic status.
MethodsBlood was collected from 24 close contacts of symptomatic patients. These asymptomatic individuals were sampled 2, 3, or 4 times during a 1-month period after the first exposure to symptomatic patients. Serum samples were analysed for the presence of Ebola antigens, virus-specific IgM and IgG (by ELISA and western blot), and different cytokines and chemokines. RNA was extracted from peripheral blood mononuclear cells, and reverse-transcriptase-PCR assays were done to amplify RNA of Ebola virus. PCR products were then sequenced.

Findings
11 of 24 asymptomatic individuals developed both IgM and IgG responses to Ebola antigens, indicating viral infection. Western-blot analysis showed that IgG responses were directed to nucleoprotein and viral protein of 40 kDa. The glycoprotein and viral protein of 24 kDa genes showed no nucleotide differences between symptomatic and asymptomatic individuals. Asymptomatic individuals had a strong inflammatory response characterised by high circulating concentrations of cytokines and chemokines.

Interpretation
This study showed that asymptomatic, replicative Ebola infection can and does occur in human beings. The lack of genetic differences between symptomatic and asymptomatic individuals suggest that asymptomatic Ebola infection did not result from viral mutations.

Elucidation of the factors related to the genesis of the strong inflammatory response occurring early during the infectious process in these asymptomatic individuals could increase our understanding of the disease. (bold Sharon's).

Airborne? Or asymptomatic? Whatever the situation, or the cause, the situation is rapidly devolving in Uganda. Now MSF, home to Ebola worker Zoe Young, has been called in. We will see what transpires.

What Momma taught us -- NOT Tamiflu or vaccine -- will save the most lives in a pandemic

Posted on Friday, November 30, 2007 at 04:28PM by

Scott McPherson in Politics and government, influenza and infectious diseases |

Handwashing, Masks Beat Drugs at Fighting Flu

Data review finds they're best at keeping individuals safe

Posted 11/29/07

THURSDAY, Nov. 29 (HealthDay News) -- When it comes to fighting the spread of influenza and other respiratory viruses, physical barrier measures -- such as handwashing and wearing masks, gloves and gowns -- may be more effective than drugs.

That's the conclusion of new research by experts who reviewed 51 published studies on the topic.

While many nations are stockpiling antiviral drugs to prepare for a possible future flu pandemic, there's increasing evidence that such drugs and vaccines won't be sufficient to block the spread of a major outbreak, noted a team led by Chris Del Mar of the faculty of health sciences and medicine at Bond University, Gold Coast, Australia.

On the other hand, there's clear evidence of a link between personal and environmental hygiene and infections, the researchers said. However, until now, there haven't been any comprehensive reviews of this evidence.

The studies examined by the review authors compared interventions to prevent viral animal-to-human or human-to-human transmission of respiratory viruses -- isolation, quarantine, social distancing, barriers, personal protection and hygiene -- to other kinds of interventions or to doing nothing. These studies did not include antiviral drugs or vaccines.

Handwashing and wearing masks, gloves and gowns were effective individually in preventing the spread of respiratory viruses, and were even more effective when all three were used in combination, the review authors found. Combining these measures may be more effective than antiviral drugs in fighting a pandemic, they said.

The review was published online Wednesday in the British Medical Journal.

Readers of this column know that I have been preaching this for months. The quick summary is that a vaccine, if ever effective at all, will not arrive until the Second Wave of a pandemic. So the First Wave of 8-12 weeks will already have happened, and a significant portion of the Earth's population will already be immune to the virus, strong drift and/or shift notwithstanding. And there are just not enough antivirals to go around; and Los Alamos even says that antivirals such as Tamiflu only forestall the pandemic; it will not eliminate it, according to supercomputer-driven exhaustive scenario after scenario.

So what Momma taught us, plus the application of PPEs and Non-Pharmeceutical Interventions, are our best hope for saving lives and delaying a pandemic. Government and corporate leaders would do well to heed this advice and do the following:

1. Stockpile the cheaper solution: masks, gloves, hand sanitizer, cleaning supplies and disinfectants.

2. Stockpile knowledge: Teach people to wash their hands, sneeze correctly, cough properly, and how to clean up after themselves.

3. Teach janitorial concerns how to clean hard surfaces -- and how NOT to vacuum in a pandemic.

4. Remind everyone what Momma taught us: Wash your hands, exercise proper hygiene, and keep a respectable distance from strangers.

5. Begin this TODAY, when the ROI from such matters can be applied to seasonal flu and other maladies.

We need to shift this debate away from stockpiling antivirals and toward doing the things we know we can do and the things we know we can count upon. You want a quick way to double antirivals? Stockpile cheap, plentiful Probenecid and administer it alongside Tamiflu (see my earlier posts and Google "probenecid" as well).

Why telecommuting will probably fail in a pandemic, Vol. 1

Posted on Wednesday, November 28, 2007 at 04:39PM by

Scott McPherson in Information technology, Politics and government, Popular Culture, influenza and infectious diseases |

Video, interactivity could nab Web users by '10

By David Lieberman, USA TODAY

NEW YORK — Enjoy your speedy broadband Web access while you can.
The Web will start to seem pokey as early as 2010, as use of interactive and video-intensive services overwhelms local cable, phone and wireless Internet providers, a study by business technology analysts Nemertes Research has found.
"Users will experience a slow, subtle degradation, so it's back to the bad old days of dial-up," says Nemertes President Johna Till Johnson. "The cool stuff that you'll want to do will be such a pain in the rear that you won't do it."
Nemertes says that its study is the first to project traffic growth and compare it with plans to increase capacity.
The findings were embraced by the Internet Innovation Alliance (IIA), a tech industry and public interest coalition that advocates tax and spending policies that favor investments in Web capacity.
The findings were embraced by the Internet Innovation Alliance (IIA), a tech industry and public interest coalition that advocates tax and spending policies that favor investments in Web capacity.

"We're not trying to play Paul Revere and say that the Internet's going to fall," says IIA co-Chairman Larry Irving. "If we make the investments we need, then people will have the Internet experience that they want and deserve."

Nemertes says that the bottleneck will be where Internet traffic goes to the home from cable companies' coaxial cable lines and the copper wires that phone companies use for DSL.

Cable and phone companies provide broadband to 60.2 million homes, accounting for about 94% of the market, according to Leichtman Research Group.

To avoid a slowdown, these companies, and increasingly, wireless services providers in North America, must invest up to $55 billion, Nemertes says. That's almost 70% more than planned.

Much of that is needed for costly running of new high-capacity lines. Verizon is replacing copper lines with fiber optic for its FiOS service, which has 1.3 million Internet subscribers.

Johnson says that cable operators, with 32.6 million broadband customers, also must upgrade. Most of their Internet resources now are devoted to sending data to users — not users sending data. They'll need more capacity for the latter as more people transmit homemade music, photos and videos.

"Two years ago, nobody knew what YouTube was," Johnson says. "Now, it's generating 27 petabytes (27 million gigabytes) of data per month."

Schools, hospitals and businesses could add to the flood as they use the Web for long-distance education, health care services and videoconferencing.

Service providers might not appreciate how fast Web demand is growing, Johnson says: "Comcast doesn't know what's going on in AT&T's network, and vice versa. Researchers are increasingly shut out. So nobody's getting good, global knowledge about the Internet."

One of the best-kept secrets in netland is the existence of LambdaRail, an educational network that makes broadband seem as slow as dialup. First, some history: What we know today as the Internet was actually built by the US military during the Cold War. It was a data communications network called ARPANET; a network so resilient that it could survive multiple nuclear strikes. After the US military surrendered ARPANET to Higher Education, the colleges and universities turned it into what we know today as the Internet (sorry, Al, you didn't do a damn thing to build it). And then the planet took the Internet over from academia.

Academia never really got over that idea, so they built their own, faster, better net, called LambdaRail. It travels orders of magnitude faster than the public Internet does. And it has relatively few users; so few, in fact, that state university systems are now trying to resell LambdaRail bandwidth to anyone who technically qualifies (you have to have some serious jack, plus a smidgen of an educational purpose, so most need not even bother to apply). In my day job, I am seriously considering moving my organization to LR as a way to fuse our disaster recovery network planning with our daily net business model. If we move to LR, we hypothetically should avoid the wobbles, crunches and squeezes the rest of you peons will face when the pandemic arrives. HAHAHAHAAAAAAA!

Anyway, this LR stuff may all sound good, but the impact of a pandemic to global commerce, globalization itself, and the just-in-time economy will be sudden and devastating. The same Internet that carries your Flikr photos and YouTube videos also carries banking information, billions and billions of transactions, and literally trillions of dollars move on it annually. So the idea that during a pandemic, Johnny's game of Assassin's Creed for the 360, coupled with Mom's need to log in and hit the corporate mainframe via a Web portal cumulatively causing a global financial meltdown is more than just the stuff of fiction.

Booz Allen Hamilton came to this conclusion last June, when they predicted the Internet would collapse in the EU in Day Four of a severe pandemic. So the lesson is to watch the Internet this holiday season, study how it slows down, then envision this scenario being the New Normal during a pandemic. Or anytime in 2010, according to Gannett.

Happy shopping.

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