NBC News freelancer in Africa diagnosed with Ebola - now in US for treatment - free of Ebola - discharged

[AnnaLisa]

Re: NBC News freelancer in Africa diagnosed with Ebola

Is it just THAT prevalent in the area, that one could get it if they are not wearing PPE? Could there be that much virus in the environment on fomites? Is it just that crowded that it is impossible to not touch others? Given this news and the rate of infection in Sierra Leone, it is concerning. I wish we had a better handle on incubation period and what kind of contact can cause infection. Until we know, I wish that the message to the public would be, that there are things about Ebola that we do not know. I just think to maintain credibility agencies need to be as honest as possible and as consistent in approach as possible.

[Dani]

Re: NBC News freelancer in Africa diagnosed with Ebola

Interesting they are moving away from major metropolitan areas.... entirely sensible.

I don't know with any certainty that they intend to treat a case there, but it makes sense. The Rocky Mountain Lab is in Hamilton, MT. and the unit in Missoula exists to support that lab in case of an infection in personnel. It's reasonable that they take care of an Ebola patient under slightly more controlled conditions than what might happen if there were a lab accident. When I saw it mentioned in the paper today, I thought perhaps it was perhaps because they were gearing up to actually use the unit. That is why they sent Dr. Sacra to Nebraska- to make sure that their facility was also up to speed.

[AlaskaDenise]

Re: NBC News freelancer in Africa diagnosed with Ebola

Article about Montana that supports level 3 and 4 materials for vaccine development, etc.:

(snipped)

.....Missoula’s St. Patrick Hospital is one of four medical facilities in the United States authorized to handle patients with active Ebola infections. The viral hemorrhagic fever has killed more than 3,000 people in the current West African epidemic. There is no clinically proven vaccine or treatment for the disease, although several therapies are showing promise. Victims who receive common life-support measures in time have upward of an 80 percent chance of survival.

Some of those treatments are being developed at the federal Rocky Mountain Laboratories in Hamilton, which is part of the reason that St. Patrick Hospital opened its Sensitive Care and Isolation Unit in 2007. The Hamilton facility routinely handles Level 3 and Level 4 materials as it explores new vaccines and treatments for diseases like hemorrhagic fevers and plague.

The Missoula hospital has a three-room wing of its intensive care unit already equipped for handling Level 4 infectious disease patients —.....


Read more: http://billingsgazette.com/news/stat...#ixzz3F2kLOXna

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[MHSC]

Re: NBC News freelancer in Africa diagnosed with Ebola

Article about Montana that supports level 3 and 4 materials for vaccine development, etc.:

(snipped)

.....Missoula?s St. Patrick Hospital is one of four medical facilities in the United States authorized to handle patients with active Ebola infections

The other U.S. sites cleared for Ebola treatment are in Bethesda, Maryland; Atlanta; and Omaha, Nebraska.



This from the CDC in this article and yesterday in his news conference.
Frieden has said that any hospital with the ability to isolate patients can treat Ebola patients

http://www.usatoday.com/story/news/nation/2014/10/01/hospital-ebola-patient/16527143/

[JJackson]

Re: NBC News freelancer in Africa diagnosed with Ebola

I am not happy with the symptom onset/infectiousness line. They are gradual and come on together but are not joined at the hip. Bodily fluids of concern are blood, feces, vomit and sweat. The popular targets are dendritic cells and macrophages in early infection which matches the fluids but which builds viral load first and fastest? I would be grateful if anyone has a link to any papers covering rates of viral load over time if these have been done in an animal model.
Following on from the discussion on 'what are we missing' in the significant routes of transmission. What effect is the sheer scale of the outbreak having. Routes of transmission that were insignificant may now not be. If you are in a very badly infected area you may be getting lots of low risk contacts from low viral load sources to a point it becomes a significant factor in the overall transmission rate. We are in new territory and the phase one trials Ebola performed on humans previously may not have fully forewarned us now we have jumped straight to phase 3.

[hawkeye]

Re: NBC News freelancer in Africa diagnosed with Ebola

Possibly Montana. Believe it or not, there is a level 4 lab there and a treatment unit in Missoula to go with it. They haven't had any Ebola cases to care for, yet.

If one of the big four is used I wonder if the public will react negatively with respect to Mr. Duncan being at a public hospital? Seems fair to ask why not bring the cameraman to a public hospital with the equivent facilities and staff as Texas?

Also will the medical staff treating the cameraman only need to wear the same protective gear as those being recommended by Dr. Edward Goodman such as two waterproof gowns, gloves, surgical masks, eye protection and shoe protection?

Additionally I would like to applaud the cameraman for being not only being careful but also responsible for himself and those around him.

[Dani]

Re: NBC News freelancer in Africa diagnosed with Ebola

If one of the big four is used I wonder if the public will react negatively with respect to Mr. Duncan being at a public hospital? Seems fair to ask why not bring the cameraman to a public hospital with the equivent facilities and staff as Texas?

Also will the medical staff treating the cameraman only need to wear the same protective gear as those being recommended by Dr. Edward Goodman such as two waterproof gowns, gloves, surgical masks, eye protection and shoe protection?

Additionally I would like to applaud the cameraman for being not only being careful but also responsible for himself and those around him.

It does seem that there is a bit of a disconnect between what is done for people who are known to be infected with Ebola and are cared for at a special facility, vs. Mr. Duncan who showed up at a community hospital. Since Ebola isn't airborne, although I'm not an ID doctor I'd say any good community hospital in the US is capable of taking care of an Ebola patient. That is the saving grace- it's not airborne.

In the end we will also probably find out that Ebola is probably much less lethal in this setting as well, not due to any change in the virus, but just having readily available IV fluids and anticoagulants to tide a patient over until they recover on their own.

I do hope Mr. Duncan survives, not only because that is the decent thing to wish but also because of the very thing you mention regarding potential discrimination. I'm sure Texas Presbyterian didn't worry about his immigration or insurance status, but who needs to give naysayers any reason to think otherwise?

[AlaskaDenise]

Re: NBC News freelancer in Africa diagnosed with Ebola

.........I'd say any good community hospital in the US is capable of taking care of an Ebola patient. That is the saving grace- it's not airborne.

In the end we will also probably find out that Ebola is probably much less lethal in this setting as well.....

Perhaps most, but I've visited patients in community hospitals where I was shocked at the poor infection control practices. While they may contain most/some infections, I just pray they'll go into hyper-vigilant mode for Ebola.

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[AlaskaDenise]

Re: NBC News freelancer in Africa diagnosed with Ebola

....... What effect is the sheer scale of the outbreak having. Routes of transmission that were insignificant may now not be. If you are in a very badly infected area you may be getting lots of low risk contacts from low viral load sources to a point it becomes a significant factor in the overall transmission rate. We are in new territory and the phase one trials performed on humans previously may not have fully forewarned us now we have jumped straight to phase 3.

Yes - very uncharted territory. The complexities of modern urban life in developed countries does not compare to life in remote African villages.

Your point about lots of low risk contacts becoming significant might be applied to both total case numbers and opportunties for viral adaptation.

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[Laidback Al]

Re: NBC News freelancer in Africa diagnosed with Ebola

. . . . What effect is the sheer scale of the outbreak having. Routes of transmission that were insignificant may now not be. If you are in a very badly infected area you may be getting lots of low risk contacts from low viral load sources to a point it becomes a significant factor in the overall transmission rate. We are in new territory and the phase one trials performed on humans previously may not have fully forewarned us now we have jumped straight to phase 3.

This is an important question regarding transmission of Ebola. Data from influenza studies are probably not relevant to filoviruses but one article from 2011 notes:

Abstract

Mean viral loads for patients with pandemic (H1N1) 2009 were ≈1 log₁₀ times lower than those for patients with seasonal influenza within the first week after symptom onset. Neither pandemic nor seasonal influenza viral loads correlated with clinical severity of illness. No correlation was found between viral loads and concurrent illness.

from:
Comparison of Pandemic (H1N1) 2009 and Seasonal Influenza Viral Loads, Singapore

[Emily]

Re: NBC News freelancer in Africa diagnosed with Ebola

Yes, it's a staggering development. It's hard to imagine any scenario where a cameraman would have had anything in the way of direct or high-risk exposures. The PPE I've seen in several taped segments looked pretty reasonable.

Community transmission at a guesthouse? Droplets in a hospital?

I can imagine desperate people running up to American journalists, grabbing them saying, "Please help my sick mother/sister/brother/child, etc!" It would be all too easy for the journalists to get infected and add to problems in Liberia and here at home.

I don't see any change in transmission ability in what little we know about this case. I hope this journalist recovers and was glad to see that NBC didn't use his freelancer status, (most news photographers have been forced into that status lately), to avoid covering his medical bills. (Or at least they say they will pay his bills in the first post.)

[AlaskaDenise]

Re: NBC News freelancer in Africa diagnosed with Ebola

R.I. journalist headed to Nebraska for Ebola treatment

.....scheduled to leave Liberia on Sunday night to fly to the Nebraska Medical Center in Omaha......

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Utilizing one of the level 4 facilities, I presume.

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[AlaskaDenise]

Re: NBC News freelancer in Africa diagnosed with Ebola

NBC's Dr. Nancy Snyderman: We Present 'Minimal Risk'

.....Snyderman said she "suggested and requested he self-quarantine. He continued to check his temperature overnight, and this morning he went to the clinic run by Doctors Without Borders to be checked with malaria and also tested positive for Ebola," she said......

......"We all have thermometers on us at all times, we are required not to shake hands, we wash our hands and feet with bleach," Snyderman said.

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[Dani]

Re: NBC News freelancer in Africa diagnosed with Ebola

The cameraman doesn't know how he acquired Ebola, thinks perhaps while decontaminating a car. Makes me concerned for the Dallas side-walk washer:

http://boston.cbslocal.com/2014/10/0...ed-with-ebola/

Again, I just think that this virus is a bit easier to get than the CDC says. I don't know why they persist in saying one must have direct contact with a symptomatic individual.

[Pathfinder]

Re: NBC News freelancer in Africa diagnosed with Ebola

NBC News Freelancer Diagnosed With Ebola Headed to U.S.

The freelance NBC News cameraman who was diagnosed in Liberia with the Ebola virus will leave that country Sunday and head to the United States for treatment at an Omaha hospital, the Nebraska Medical Center said. Ashoka Mukpo is due to depart Liberia on a specially-equipped airplane at 4:15 p.m. ET (8:15 p.m. local time), NMC spokesman Taylor Wilson told NBC News.
...

http://www.nbcnews.com/storyline/ebola-virus-outbreak/nbc-news-freelancer-diagnosed-ebola-headed-u-s-n218746