INFECTED MAN
FROM MONROVIA
MISDIAGNOSED
IN DALLAS E.R. DESPITE SHOWING
SIGNS OF
EBOLA
THOMAS
DUNCAN THE MAN WHO CARRIED
EBOLA FROM
LIBERIA TO TEXAS.
PATIENT “X” IF
EBOLA SPREADS IN AMERICA.
Authorities
weigh the options of indicting him as a criminal
for falsifying
his travel documents.
TAGS:
EBOLA, EBOLA IN UNITED STATES,
THOMAS
DUNCAN CARRIED EBOLA FROM MONROVIA TO DALLAS,
DOZENS
OF OTHERS IN ISOLATION,
HOW
MANY PEOPLE DID INFECTED DUNCAN INTERACT WITH?
SIMILARITY
TO AIDS CRISIS, TRAVEL BAN CONSIDERED
(Friday October 3, 2014 NYU
Medical Center, NYC) On Wednesday Dr. Jay Varma the Deputy Commissioner of the
New York City Health Department told the New York Daily News that “The way to
control Ebola is the same way we control measles or syphilis — we diagnose,
isolate and treat them.” Dr. Varma
continued that if there was an outbreak of Ebola within City limits, "We
have an army of disease detectives whose job it is to stop disease from
spreading.” That sounds reassuring but pathogens
such as viruses like Ebola are among the
most mysterious and deadly semi-life forms on Earth.
Aside from being transmitted
via direct contact with the blood or other body fluids of an infected
individual, studies have shown the virus can exist outside a human body on a
surface such as an armrest, airplane seat, door handle or any other solid
surface for up to two hours. Now that is
something to consider.
EBOLAVIRUS IN THE UNITED STATES
This is literally the fodder
of nightmares and horror films. A virus,
a primitive microscopic cluster of proteins infects a local population in some
of the deepest, darkest jungle environments in Africa and it is carried
unknowingly by a single individual, Patient “X”, who has been positively
identified as Thomas E. Duncan, into the United States. Patient X had direct contact with who knows how
many people in airports and on the four flights that brought him from Monrovia,
Liberia, via Brussels and Dulles Airport outside Washington, DC and ultimately
to his final destination of Dallas, Texas.
There remains a fair amount of
confusion regarding Patient X and his initial visit to the emergency department
at Texas Health Presbyterian Hospitals in Dallas shortly after his arrival in
Texas. For whatever reason (s) he was
sent home from that emergency department visit with an antibiotic and some pain
relievers. He returned within 30 hours
to the emergency department this time presenting with florid symptoms of the
deadly disease. As epidemiologists and
other CDC investigators are engaged in the daunting task of locating those who
may have had some degree of contact with Patient X during his lengthy,
multi-leg travels home, many others at the CDC and NIH virology and infectious
disease departments are working on the many and clinical, treatment, and
societal aspects a wide scale Ebola outbreak would present. As they work on the problems, the challenges
are daunting.
1982
Those of us of a certain age can
recall a similar medical mystery, an outbreak of a “new” disease that was as
frightening as it was clinically confounding.
Physicians in New York City and San Francisco initially began reporting
increasing numbers of young homosexual men presenting with an odd malignancy -
Kaposi’s Sarcoma – as well as an ill-defined syndrome that included
deficiencies in their immune systems.
The immune cells that were depleted were of a specific variety, T-cells,
cells vital to the effectiveness of the entire immune system. Some of this growing patient population
exhibited other uncommon symptoms particularly PCP pneumonia– a typically
benign organism that lives in all of our lungs without event but in the men
with compromised immune systems, this opportunistic disease was often proof
positive of the presence of what would later be known as Acquired Immune
Deficiency Disease or, commonly, AIDS.
At the time the AIDS crisis
hit full force in NYC there was much misinformation and disinformation that it
created confusion and fear among professions from Police and Fire Fighters,
EMT’s, funeral parlor morticians, nurses and other health care workers as well
as among a general public looking for some place to assign blame. The word AIDS was enough to strike fear in
the hearts of many in the “vulnerable “populations who were assigned to care
for them and handle their bodies once they died. It seemed that every new missive from a
public health official only created a host of new fears. The protective
standard observed by health care professionals and those who came into contact
with such people like Cops, was “BBF” – the acronym for Blood and Body Fluid
Precautions. This proved to be an
inadequate protocol in the face of what felt like an ever expanding epidemic,
and eventually it gave way to the practice of “Universal Precautions”: treat
every person you came in contact with as if they were infected.
1983
AIDS was now a household word
especially for young sexually active people be they heterosexual or
homosexual. Condom sales went through
the roof and, as the population of those stricken and dying continued to escalate,
there was backlash against specific groups based largely on the rampant
disinformation. Certainly, homosexual
men bore the brunt of the scorn, intravenous drug abusers who tended at that
time to be predominately Black and Latino were ostracized and at one time a
dubious theory blaming recently arrived Haitian immigrants were designated as
the carriers of this yet to be identified pathogen.
There have literally been
volumes written about how the HIV virus, a rare “retrovirus” was identified as
the causative agent. To this day many
eminent doctors and scientists do not believe HIV causes AIDS. There remains almost as much unknown at this
point about the etiology of Ebola and where ever a gap of clear cause and
affect exists, it is filled rapidly with bad pseudoscience, half-baked theories
and conspiracies. Yes, more is known about Ebola at this time than was known
about AIDS in a similar time line but that will do little to allay the concerns
of the public. But through stringent
efforts in the homosexual community to stop the transmissibility of AIDS by
some of their promiscuous behavior, as well as doctors and researchers in
America and France, the outbreak became contained. Or so it was thought until young children,
hospital surgical patients who had received blood transfusions or other blood
products began presenting with the sure signs of AIDS. AIDS had gotten into the blood supply and
blood itself as well as several products derived from it such as lifesaving
clotting factor to treat hemophiliacs opened the public and what had been up to
that point, a Presidential administration that had not dared to so much as
utter the word “AIDS” publically. Once
the face of AIDS changed from gay sexually active men and minority IV drug
addicts, to young children living with a deadly disease infected by AIDS via
the sera used to treat them, the entire public was forced to recognize the
folly of believing a pathogen of any kind would remain isolated to one or two
marginalized segments of the population.
EPIDEMIOLOGY 101
The reports that have been
dispatched by the media from Liberia, Sierra Leone, and Guinea are enough to concern even the most skeptical
among us. Oddly, it was only 16 days ago
we wrote in this space about
the health care surveillance system in New York City and other large
America cities. The fact that this
traveler from the “hot zone” was not truthful in providing answers to some of the questions
asked along his way is not to be unexpected.
Perhaps Patient X already had an inkling that he had been exposed to the
lethal virus. His natural instinct would
likely have been to get home to America as fast as possible. This begs the question, who can we monitor
all the points of entry be they international airports or the notoriously
porous southern border we share with Mexico?
As every detective knows,
tracking down leads, trying to locate individuals, the movements, transactions and interactions of
a wanted person and his or her known associates, or simply a “person of
interest” in the parlance of the day, is a time consuming, man-hour chugging
matter of shoe leather investigating.
The Field Epidemiology Teams that are dispatched to places an outbreak
has occurred are medical detectives.
Typically, in the past, within the first weeks of signs of an outbreak
of Ebola or one of its related illnesses, the World Health Organization (WHO)
often working with our CDC and Doctors Without Borders (DWB) arrive on the
scene as quickly as possible to do the all-important, elementary steps of
isolating the town or village where Ebola has struck and quarantining those
most obviously infected. In almost
every case in the past it was relatively simple to cordon off the town and then
begin to treat as best they could those suffering the wasting ravages of a
disease that can have a mortality rate of 90%.
That is a staggering statistic.
Once these initial steps are
taken those most sickened by the virus die and those who were infected but
managed to survive appear to have “immunity” to it. With no new unexposed potential victims to
infect, that particular outbreak burns itself out. The Ebola virus is left to return to its
natural host to await another chance to cause an outbreak.
EBOLA AND NATIONAL SECURITY
Viruses, as far as pathogens
are concerned, are very different from bacteria, fungi, and parasites. They are small collections of amino acid
produced proteins assembled not by cellular DNA material but rather by RNA, the
pseudo-negative template of raw DNA.
They cannot live by any definition of the word except in a host’s
cell. They insinuate their way into
cells, use that cells genetic machinery to replicate themselves until they are
of sufficient quantity to fully crowd that cell to the breaking point when all
those untold copies of that virus are released into the host blood stream. This method of subatomic machination makes
viral borne illnesses among the most difficult for medical science to treat.
Viruses can be as difficult to
identify due to the fact that they remain hidden as they replicate in the host
cells. Each cell they infect becomes a
virtual clandestine virus factory and will not be vacated until the virus, now
exponentially multiplied, vacates the now useless host cell. But, as with other pathogens, there is a wide
variety of viruses. They range in
severity from the “common cold” causing rhinovirus, up through the spectrum of
mortality to the hemorrhagic viruses including Lassa fever, Dengue fever and
Ebola.
Viruses’ can also present a
particular diagnostic challenge. While
replicating in the host cells, the outer membrane of those infected cells serve
as “good cover” for the virus factory just beyond that thin membrane. But, it is that membrane and its receptors
and other immune system gadgetry that is more than adequate to protect the
immune system from any suspicious intracellular activity. As in Ebola, this “latency” period, the time
between acquiring the infection until the onset of the initial symptoms can be
as long as three weeks. With a three
week head start, once symptoms are obvious the disease process is already well
established and replicating at an exponential rate. The virus has the upper hand in this scenario
and typically always does.
Ebola as it is in nature is
not a likely choice for bio-terrorism; it is too fragile outside its host and
native environs and requires “blood to blood” contact for
transmissibility. But it does represent
the potential of what a similarly lethal pathogen could do to a wide population
if deployed.
Already some experts in CDC
and NIH are ringing the warning bells that this “strain” of Ebola, more robust
than that which caused the most previous outbreak may have in fact already
mutated simply as a result of its generational development. If this is the case, and if this new strain
of Ebola has acquired new RNA components, it could become an epidemic of epic
proportions if it reaches the United States.
It has already killed almost 4,000 people in its native environs of
Africa. If such a strain was introduced
into the American population the majority of whom have absolutely no immune
protection from other Africa-based illnesses, the mortality rate could be
higher than anyone or any specific computer model has predicted.
DUNCAN IN DALLAS
IT’S A SMALL
WORLD AFTER ALL.
PATIENT "X”,
THOMAS DUNCAN TRAVELED FROM THE
HOT ZONE OF
MONROVIA TO DALLAS TEXAS
WITHIN 33
HOURS
Yes, Ebola is here. Thomas Duncan was not the first Ebola
stricken patient to arrive in the United States; there have been several
doctors and health care providers who became infected while toiling in the hot
zone who have been transported back to the United States for life saving
treatment. Duncan is, however, the first
private citizen to depart from a hot zone bound for America. This simple fact, and this fact alone, places
him, at this time, in a category all his own.
He came here of his own volition totting along a lethal virus; a virus
with the potential to kill millions of Americans. Again, we do not know if he was aware that he
was infected, serving as a new age “Typhoid Mary” but the fact remains he came
here travelling through some of the busiest airports in the world. How are his contacts ever to be tracked? What about their contacts? The epidemiology becomes an exponentially
increasing radius of people interacting with other people be they family,
neighbors or friends and coworkers. This
is the nightmare scenario. This is the
reality of a virus from far away coming into an entirely different environment,
a completely new ecological system populated by people with no natural immunity
or previous exposure to Ebola.
Hopefully Mr. Duncan recovers
and is able to provide some of the much needed answers to the many questions surrounding
his exposure in Liberia, his travels from Monrovia, and the initial onset of
his symptoms. Just having identified Mr.
Duncan as the vector of the dissemination of this Ebola outbreak which is
spreading at a never before seen rate through at least three West African
countries, is of vital import.
We do not intend to be
redundant but it seems some serious issues need to be addressed time after
time. The very fact that Ebola is in the
United States illustrates weaknesses in our national security. This past week has blackened the eyes of our
national security in more than one way.
We have learned of amazingly disturbing truths regarding the actual
personal security of our President and his family. Moreover, the media, particularly the
Washington Post has reported in detail the blatant errors of the Secret Service
and how close to real deadly peril our President has been in. We have heard the news that Ebola is here
and, given all the systemic failures of our federal government we have no
reason to believe their reports and trust them after having been misled in
matters as serious as preemptive war and now an ill-defined mission fought from
the air against the Islamic State in Iraq, Syria and most likely Turkey.
A linked chain is only as
strong as the weakest link. We have many
adversaries; some more formidable than others, some more visible than others. Ebola demands as much attention from our
national security apparatus as does ISIS, ISIL or the Islamic State. Those barbarians who decapitate innocents to
incite a wider war with us possess a lethality as acute as Ebola but on a more
limited scale. In any event, we are in a
state of war; our homeland remains vulnerable to an array of threats straight
out of Dante’s Inferno.
Vigilance, in every setting,
in every sense of the word, in all aspects of affairs, foreign and domestic
remains the watchword of the day. “See Something,
Say Something.”
http://www.motherjones.com/politics/2014/08/new-drugs-and-vaccines-cant-stop-ebola-outbreak
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Brooding Cynyx 2014 © All Rights Reserved
