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A reminder about ebola treatment

There are a couple of articles about the guy who arrived from Liberia who turned up at a Dallas hospital with ebola.  One is from the DailyMail (UK), which sounds like breathless hysteria inducing gossip mongering, and the other is from Reuters.  I’m going with Reuters for veracity.  In either case, it sounds like this could be serious.  Wait, here’s one more from NBC.

The patient, Thomas Duncan (I’m not using the middle name because he’s not a criminal), reportedly carried an infected pregnant woman to a hospital in Liberia.  That woman later died from the illness.  Then, he takes a flight to Texas.  He’s allowed on the flight because he is symptom free.  Ok, that’s mistake number one.  He probably should have been held in quarantine for the length of time of the incubation period, which can be up to 21 days.  Actually, it probably doesn’t matter if the quarantine happened in Liberia or Texas, though presumably it mattered a great deal to his fellow passengers.  Nah, I’m going with my gut here.  If you’re trying to leave Liberia or one of the other most heavily infected countries, you should be subjected to a quarantine to prove you’re not a carrier.  If Liberia couldn’t do it, Texas, or some other connecting way station in the US, should have.  But then, this is Rick Perryland.  My condolences to relatives that live there.  I know they didn’t vote for him.

Come to think of it, there’s probably going to be a backlash against the African community in Texas that Perry will likewise fail to prevent.  And Texas has all those gun totin’, constitution wavin’, do gooders.  If there is a spread of ebola, plugging one of the patients and allowing infected blood to spill all over Dallas is probably only going to exacerbate the problem.

Which leads to the next issue.  According to the DailyMail (remember, gossip mongering), Mr. Duncan went to a hospital in Texas complaining of symptoms and told the health care workers that he had just arrived from Liberia.  That’s L-I-B-E-R-I-A.  You know, the place with all the sick and dying ebola victims?  That have the same symptoms that he was displaying?  They sent him home with antibiotics.

Now, either somebody wasn’t listening to him or they have the stupidest treatment team in the world in Dallas.  Antibiotics are completely useless against viruses.  I’m going with option one- someone wasn’t listening.  Well, you know, there was probably a language barrier.  I’ll leave it at that.

The NBC article says that Mr. Duncan’s nephew had to call the CDC after the initial treatment in Dallas.  Even he figured out that the health care professionals in Dallas weren’t taking this seriously:

Health officials have acknowledged that Thomas Eric Duncan, 42, was initially sent home from Texas Health Presbyterian Hospital in Dallas when he showed up on Sept. 26 complaining of fever and abdominal pain. He had to return two days later in an ambulance.

That was the day “I called CDC to get some actions taken, because I was concerned for his life and he wasn’t getting the appropriate care,” Duncan’s nephew, Josephus Weeks, told NBC News on Wednesday night. “I feared other people might also get infected if he wasn’t taken care of, and so I called them to ask them why is it a patient that might be suspected of this disease was not getting appropriate care?”

Weeks added that he hoped “nobody else got infected because of a mistake that was made.”

Maybe the insurance time clock alarm went off and the hospital thought he looked remarkably well that morning.  It was probably just a coincidence.

So then Mr. Duncan’s condition worsens.  His family calls an ambulance to take him to the hospital. Before he gets into the ambulance, he vomits all over the sidewalk.  His family is screaming their heads off in panic.  We have no direct evidence that the ambulance team recognized the danger to themselves or others or whether they called a HazMat team or whether they sprayed the area with chlorine and took all of the family members immediately into quarantine.

Hey, this is a convenient time to remind all those right wingers out there that even if you don’t have insurance, the ER is not allowed to turn people away!  Yes, a man in Duncan’s condition can make repeat visits to the ER and vomit all over the chairs while he patiently waits there for hours to see a doctor while the other health care workers obliviously prepare another dose of antibiotics.

Do we know whether Mr. Duncan has insurance?  He’d better because no one in Texas without insurance is allowed to get ebola.  Perry didn’t expand Medicaid. Update: Duncan is not an American citizen.  He’s just here for a visit.  So, we can guess that one of the reasons why the hospital didn’t keep a sick Liberian who was showing signs of possible ebola infection when he first showed up is because they were concerned with the costs.  Oh, yes, my best beloveds, hospitals are more than willing to toss sick people out when it starts to get too expensive for the insurance company.  We have been there.

We really need an investigation of the behavior of the hospital that discharged Mr. Duncan to discover whether this was the result of a bad cost-benefit calculation.  Did the hospital just take a wild bet that Mr. Duncan did not have ebola so they wouldn’t have to keep him in an expensive isolation unit?  Enquiring minds want to know.

Now we come to the treatment phase for Mr. Duncan.  It turns out that ZMapp, the monoclonal antibody (not antibiotic, pay attention, there is a difference), is no longer available.  The DailyMail calls it a “miracle” treatment.  That’s not surprising for the DailyMail but it is misleading, stupid and demonstrates a complete lack of understanding on the part of the “journalist”.  ZMapp is an experimental treatment that had an n of 7 primates before it was thrown into humans.  If the barrier for proving efficacy was that low when I was still in drug design, my project teams would have made the companies I worked for billions several times over by now and would have cured obesity, depression, alzheimer’s disease, multiple sclerosis and several different kinds of cancer.  In other words, there’s not much evidence that ZMapp has cured anything yet.  Sure, a couple of patients took the drug but they had excellent care here in the US and that alone might have been enough to cure them.  The body *will* recover on its own if it can stay well enough to mount a vigorous immune response.

Anyway, ZMapp monoclonal antibodies are grown in tobacco plants.  My lab partner had more experience in growing proteins in plants so she could probably talk about this in more detail.  But from my own experience growing proteins in insect cells and e coli, I can tell you that the amount of protein recovered could be minute and the amount varied based on the conditions the cells were grown under.  Grow them too fast or neglect them for even half an hour and you might have to start all over again.  Growing in tobacco plants would seem to give the company a little more control over the product but it still takes time.  Then there is the issue of purification, which still can seem like an art form in some cases.  And the damn things have to fold properly AND they have to not aggregate, which I understand is an issue with antibodies.  They loves to aggregate.  Even if they grow the tobacco at lightening speed and collect as much ZMapp as they can, it’s going to be small quantities of an unproven drug.

Come to think of it, you have to wonder why governments, including our own, are not calling on all of the out of work drug discovery professionals to lend a hand.  Oh, that’s right.  We’d have to be paid and as we all know, government isn’t good for anything.

So, don’t count on Mr. Duncan to receive any miracle cures.  Let’s just hope he gets decent care in Texas to help his body ride out the storm.

In the meantime, I have read that Glaxo Smith Kline (GSK) is trying out a vaccine.  I haven’t heard a lot about this but vaccines are generally good things, unless you’re Jenny McCarthy or some clueless control freak, overeducated but bored, suburban helicopter mom who managed to get through college without ever taking a basic biology course.  How much you wanna bet a whole lot of them in Texas suddenly get religion when it comes to vaccines, demanding on TV with righteous indignation that GSK provide freebies of an almost untested, non-FDA approved vaccine? There’s a satire just waiting to be written but it really isn’t funny.  Anyway, I hope it can produce some kind of immune response but it’s probably too late to help Mr. Duncan.

As for the rest of Texas, let’s hope it can survive the bumbling first responses.  Since Mr. Duncan returned to the US, he has had ample opportunity to infect his girlfriend’s kids- who go to school. (See paragraph above)  His poor girlfriend is probably in jeopardy if they had sex without a condom because the virus can persist in semen for a time even after the patient recovers. Well, I’m still not panicking but I’d feel a lot more confident about a vigilant response if Mr. Duncan had landed in Hawaii where everyone is insured, there’s a whole ocean separating the islands and there’s a history of treating people with infectious disease.

Somedays, it just seems like Texas is giving the rest of the country the finger.

 

28 Responses

  1. He (Thomas Duncan) doesn’t speak the same language. His is probably English while those in Texas speak Teabag. Since the AIDs outbreak all bodily fluids are treated as bio-hazards by health care professionals. Lets hope they didn’t allow family members do the clean up.

    The problem will be the AM Hate Radio hosts doubling down on the stupid for audience share by repeating any and all of the myths surrounding Ebola transmission. Anybody remember killer AIDs mosquitoes?

    For the rest of us wash your hands regularly and avoid restroom sex with republicans.

    • Another report from CNN says that the ambulance has been isolated. ??? Does that mean it’s been banished to the other side of the parking lot or that the crew in the ambulance was isolated or what exactly?
      It might be common practice to treat bodily fluids as bio-hazards but I’m going to bet that the ambulance crew that picked up Mr. Duncan didn’t give that vomit very much thought once they left the scene. That’s probably why the family was freaking out. They were taking it much more seriously than the paramedics. Besides, we associate AIDS with blood and semen, not vomit. It’s easy to let your guard down.

      • Stuff Anderson Cooper is saying right now is kind of scary. That the sheets are still on the guys bed in the apartment. That they shared a bathroom, and who knows what. It doesn’t sound as if the apartment has had a good cleaning.

        • I kinda don’t blame anyone for not wanting to touch them. But I think it’s ok if they wear lots of protection and use bleach. Lots of bleach. Like, everywhere.

          • Oh, I don’t either. I just wonder though how she (Just realized I left off the information that this was an interview with girl friend of patient who slept with him until he was taken in the ambulance. She’s the one who took him to hospital the first time) could have avoided direct contact with fluids under those circumstances.

          • Here’s what I’m thinking. He lands in Dallas, he’s feeling fine the first day, he recovers from jet lag long enough to have a nice relaxing evening with her, next morning, he starts to feel sick.
            She must be sweating bullets right now.
            The whole family has been ordered to stay at home for 21 days. Like I said before, I hope they have the employers on board for this because up to 100 people may have to stay home for awhile. If anyone is worried about losing their job in the interim, there could be problems.

    • Next thing you know, Old Rushbo will be hawking forsythia as a cure-all.

  2. Riverdaughter does it make sense for the family to be quarantined in the apartment where the patient was sick? Or would it have made more sense to move them to a clean residence?

    In my ignorance, I’m imagining that they’d have more chance of getting ill by living in the vicinity of (possibly) live virus in drops of bodily fluids.

    How possible is that?

    • From what I understand of this kind of virus, it doesn’t live outside the body for very long. It’s not like anthrax, which isn’t a virus anyway. And it’s not like small pox or measles that can linger around in the air. So, it’s probably fine for them to be confined at home as long as the source of the infection is no longer there.
      I’d be more worried about the people who walked through his vomit in the confusion and panic just after the ambulance came.

      • I was thinking about the vomit too — kids I know are often dragging their shoe laces around….

      • SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C) Footnote 52 Footnote 61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature Footnote 61. In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20 and 250C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days Footnote 61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting.

        http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

        • I was really hoping to find a link for “survival of Ebola virus on a Texas sidewalk in October”, but apparently nobody’s done that experiment yet.

          Regardless, the alleged news photo of a cleaning crew washing down the sidewalk outside the affected apartment with a pressure washer doesn’t exactly give me warm fuzzies:

          • Considering that the health care workers in Liberia at least wear masks and gloves, no that is not reassuring. Then there’s the woman in the far left who looks like she’s going to walk right through the stream. It could be that health officials told them that there was little to no risk but I wouldn’t take any chances.

    • On second thought, I’d definitely isolate the mother from the rest of the kids. JMHO.

  3. Always on the money RD, I’m your number-one fan.
    “He’d better because no one in Texas without insurance is allowed to get Ebola….. hospitals are more than willing to toss sick people out when it starts to get too expensive for the insurance company. “

  4. CNN is doing a pretty good job of covering this without (I think) being wack-jobs.

  5. If Liberia couldn’t do it, Texas, or some other connecting way station in the US, should have

    That would have been Dulles (IAD), which was where he entered the US. Alternatively, he could have been quarantined in Brussels (which was he embarkation point for the US).

  6. Am I being too cynical to think that maybe the medical mutts Mr Duncan first saw at the Dallas hospital could not find Liberia on a map with both hands? And that his ethnic persuasion may have disincentivized (is that a word?) them from being overly helpful and attentive. And don’t get me started on the multiple sins and shenanigans of the US health insurance criminal enterprise? Or is this just a perfect storm of Texas nincompoopism? It is beginning to feel like we are living in a Gong Show.

    • word. It seems the “Hippocratic Oath” is optional for US physicians? Unreal.

      g0d forbid if anyone is hurt by this, that “karmic justice” applies, & it is an 1%er that also a member of the Medical Industrial Complex Mafia that is anti-Medicare For All.

      Hopefully 1 of the DC politicians like B Sanders will re-push the Medicare For All bill (HR676 iirc) in a press conference with media, alongside a Public Health expert (epidemiologist?) noting how Medicare For All’s existence would greatly lower the probability-based expected deaths, in a public health crisis like this TX Ebola case. F a “too soon”, “take the opportunity with this crisis”, expect this time to actually push for beneficial public policy.

      • fw: http://www.nakedcapitalism.com/2014/10/can-commercialized-health-care-system-contain-ebola.html

        A physician/health policy expert opines on how the US Health System (American Exceptional-ly Crappy & Barbaric) is NOT capable of handling an epidemic like the W African style Ebola or the prior Spain bird-flu.

        good article. RD I’d encourage u to read it & opine about it.

        • I read that article and posted about it this afternoon. But I disagree with you about whether the author thought we weren’t up to handing ebola. We can handle it- provided the people who are running the health care system sit on their hands and let the professionals handle this.
          I am disturbed to learn that so many public health departments in Texas are underfunded and laying off. But there are more health concerns than ebola.

  7. Flashback April 2010: Obama Kills Bush Quarantine Rules
    From an April 2010 archives of the USA Today:
    Obama administration scraps quarantine regulations
    By Alison Young, USA TODAY | 4/1/2010

    http://tinyurl.com/nk8oswj

    • I read part of your link and I think you make a good point about the Obama admin lack of foresight.
      However, as I stated above ZMapp has not been proven to be a miracle cure for anything. It’s in short supply because growing and purifying antibodies is time consuming and variable. There is no conspiracy to deprive anyone of a cure. The stuff is simply unavailable and its virtue is still not proven.
      I’m not sure who wrote that post but I don’t approve of conspiracy theories especially when I know they can’t possibly be true.

  8. Are we supposed to believe that this family’s quarantine experience is a workable template for future Eboloa cases. I’m not talking about epidemic levels, just individual cases…..

    How many families will willingly stay in their contaminated homes?

    This happens to be a family with one adolescent child and he seems to be complying with the quarantine (for how long though — I’m trying to imagine myself at 13 being stuck in an apartment for a month.) But what about families with more children. Or the adults.

    These are (so far) healthy people and they have no access to an exercise area (or libraries — I would go insane without access to library books). This family has a balcony. But, whose to say the next family will — are we seriously thinking we can lock people in apartments without access to fresh air? Or exercise? No exercise for a month?

    And just living. This family is staying out of the contaminated bedroom and sleeping in the living room. Who came up with THIS idea?

    What is the REAL plan for this? Did all those disaster plans that were developed after 9/11 really leave these issues (and the dozens I haven’t thought of yet) unaddressed?

    • Living in a cramped apartment for a month with an antsy adolescent sounds like a Jean Paul Sartre play.

      • It does to me too.

        But, I’m told that there are a couple of police cars outside the apartment to enforce the quarantine. So THAT’s OK then.

  9. Ah, Just in time!

    How To Protect Yourself Against Ebola

    This week saw the first confirmed case of Ebola virus within the United States, the latest development in an outbreak that has already claimed over 3,000 lives. Here are some ways you can protect yourself against this deadly disease:

    • ** Boil all bodily fluids before consumption.
    • ** Regularly examine your DNA under an electron microscope for any indication that Ebola has attached itself to your cell membranes.
    • ** Recognize the symptoms of Ebola, which include fever, chills, and developing symptoms too late to do anything about them.
    • ** Cover the nose and mouth of Ebola patients when they sneeze to avoid spreading germs.
      Avoid eating bat soup, which is actually pretty sound advice whether there’s an ongoing Ebola outbreak or not.
    • ** Ebola can only be spread once patients are symptomatic, so if you believe you’ve been exposed, get all your errands and public trips out of the way before your symptoms start showing.
    • ** Be sure to stay up to date on developments by signing up for the official CDC phone tree.
    • ** Try being born one of the 15 percent of rural Gabonese citizens with natural immunity to the virus.
    • ** Give billions of dollars to pharmaceutical companies.
    • ** If you see a suspicious-looking filamentous virus particle roughly one micron in length, stay away.
    • ** Continue following lifelong plan of avoiding Dallas, TX at all costs.

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