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Ebola: Discussion of Treatments

Shannon Bennett

Well-known member
While Ebola is easy to identify and quarantine in its hemorrhagic phase, it is invisible during the incubation period. The disease is also confusing as it occasionally never becomes hemorrhagic. It has an incubation period of two to twenty-one days. And like another scourge, HIV, it can be passed through sex.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

It would only take one infected sex worker to be the first super-spreader of Ebola. One visit to a brothel by someone visiting an affected country then returning home via plane could potentially have the same effect as original HIV spread.

With this in mind it would behoove all governments worldwide, to alert hospitals of the potential introduction of Ebola. Ebola, while not airborne, is still a threat. Given the horrific case fatality rate, as well as the hideous suffering of its victims, we should demand increased surveillance by all government organizations responsible for public health.
http://www.who.int/mediacentre/factsheets/fs103/en/
 
Re: Ebola: Discussion

Re: Ebola: Discussion

30 June 2014, 17:00

Ebola: Is the virus attracting the wrong kind of attention?

The outbreak of Ebola in West Africa has been described as ?out of control? by Medecins sans Frontieres. VoR?s Tim Ecott hosts a discussion with four expert guests on a virus which is thought to have killed more than 400 people this year.

Joining Tim in our London studio were:
Dr. Mahlet Zimeta, lecturer in Philosophy at University of Roehampton, honorary research associate at Department of Science and Technology Studies, UCL
Sulayman Jeng, assistant editor of Kibaaro News (Gambia)
Dr Ben Neuman,virologist from the University of Reading's School of Biological Sciences
and by Skype from Liberia:
Agnes Umunna, journalist and founder of human resources development project Straight from the Heart

Soundbites:

BN: "On a case by case basis, Ebola is one of the most deadly pathogens that we know about. In the current cases it affects and actually kills somewhere between 50 percent and 90 percent of the people who are infected. However, the good side is that the virus doesn?t spread very well. When it does spread it actually makes your body essentially attack itself: the white blood cells that would normally be cleaning up the virus infection are provoked into releasing a lot of harmful chemicals that degrade the inner lining of your blood vessels, and this is what eventually causes death due to organ failure.

"In a hospital, as I understand it, the treatment is generally bed rest, you try to keep the patient well-hydrated and comfortable for the duration of the virus, which sometimes can last as much as a month.

"In the laboratories people have found some drugs that seem at least in cell culture to be effective against the virus, but, as far as I?m aware, these haven?t been used in a clinical setting and we don?t know if the damage they will do to the people will be preferable to the disease."
...
BN: "What happens is that as the disease progresses the person starts to feel worse and worse, and it?s about the time when person starts feeling really bad they are most likely to be able to transmit the disease. These people wouldn?t want to move, from what I understand, you just want to lie down and be still during this time. So it may be that people are incapacitated enough that they don?t spread it, but there is certainly no physical barrier to spreading the virus overseas by air travel."
...
BN: "Africa is where the disease always comes back, and about every 2 years it seems to rear its ugly head again, so people in Africa have a vested interest. These are the people who are going to be infected, and these are the people who I would think, would most want to do research. Yes, it?s really a shame that there are no more category 4 high containment laboratories there to enable them to do this.
...
BN: ...this is a very controllable and very potentially curable problem. You?ve got a virus that is always going to be in a band, it runs right through the middle of Africa, it?s going to keep coming back, but each time it comes into people, it burns itself out in a few months, the studies have shown that you only need to control a little bit of the virus, if we knock back 90 percent of the virus with a drug or something, and the person can potentially survive."
"Lots of small labs around the world are already putting their money and time into coming up with possible solutions, and there?s a wide range of these, things from antibodies, little proteins, lots of different drugs that seem to be at least promising, it?s just at the next step, getting it to something that we know is safe to use and effective in the clinic. This is very, very expensive. And, frankly, I?m not sure whether individual countries can afford this or would have a reasonable vested interest in putting in that kind of money. And I think it?s a much easier problem to solve than HIV which, once you have it, is yours forever, cancer, which is basically a mutation of you, it's almost too much life, or even something like tuberculosis, which hides inside our cells, and is very difficult to root out. Yes, Ebola can be fixed.

MZ: "I thought what Dr. Neuman said was very interesting, and it was new to me. He said that it may not be affordable to individual countries, and if that?s right it means the Ebola virus recurs, and recurs in Africa. And what would be a shame is if each time we got this kind of hysterical media frenzy, this fancy of Africa, the Dark Continent from which death is going to come.
...
SJ: "It is a two-way: the West is tied to Africa, and Africa always relies on the West to resolve their problems for them, personally I think Africans should step up and try to resolve their problems without relying much on external forces or agents like the western world.
...
BN: "I suppose that?s the problem, I may not care where a particular virus comes from, I?m interested in a virus, but my funding body probably does. If it?s a UK-funding body, they only want to fund things affect the UK interests.
...
"There?s this thing called the Nagoya Protocol, to follow Dr. Neuman?s point about funding for certain kinds of research, the Nagoya Protocol was set to protect biodiversity and insure that the benefits of this kind of research were shared internationally and equally, the idea would be that would motivate the indigenous peoples in rural areas to cooperate with big pharmaceuticals or governments of other countries or international organisations. The actual agreement of the protocol has been widely spread in the so-called developing world, and very minimally taken up in the developed world, they are not interested in equal sharing of resources or mutual benefits. A county in South East Asia (I believe it was Indonesia) refused to handle over samples of the most recent version of bird flu to the WHO, because it was trying to sign an agreement with a drug company to develop a vaccine with a cure suitable to its own population. Because if they hand it over to the WHO, and then the international cure is developed, they are not going to be the first country that gets it and they won?t be able to afford it. So I think we are seeing interesting reactions from the countries in so-called developing world, and there?s a reason for this. We mustn?t forget the history of exploitation, and its current history isn?t being addressed.

BN: "The main cost is in people, as I suppose every aspect of research is.
Somewhere around $100 million to $200 million will be the low end and it can go a little higher than that. It?s the cost of getting doctors to the right place, renting hospitals, putting all that equipment there, manufacturing the drug, making a factory to manufacture the drug, yes, there?s a lot that goes into it, more than just handing a person a pill and see if it works.
...
MZ: ... I think if a government spends that money on an Ebola cure, then they might be criticised for not spending it on education or on famine and malnutrition, or sexual health. So in the context of all other problems governments have to deal with ? ... what I think would be good is if the attitude towards the victims was closer to empathy and compassion rather than seeing them as a spectacle.""
(VoR)

Full text and audio:
http://voiceofrussia.com/uk/news/20...-attracting-the-wrong-kind-of-attention-6429/
 
Re: Ebola: Discussion

Re: Ebola: Discussion

I have to question if the current epidemiology supports the hypothesis that individuals are only infectious when in the final stages of the disease. I dont think we know the answers to this as yet. Complete contact tracing is proving difficult, and until the data is analysed, we cannot be certain that this pattern has been maintained. From observation and news reports, some patients have been well enough to travel unaided and have caused further infections during thier travels, and this does not marry well with the suppositions made above.

As any novel virus adapts to humans, the theory goes that it may lessen in severity but increase in infectivity.

As I understand it from current data, this version of the Zaire virus currently has a case fatality rate iro 60% which is lower than the more established mortality rate of 90% for this strain which may indicate increased adaptation or an increased infectivity at the price of a reduction in mortality rates.

I also do not believe that we have any specific research on the strain currently circulating in West Africa, which has origins in the zaire strain, but is genetically distinct (as I understand it) so I question how safe is it to base such conclusions on earlier research?

The longer this outbreak is allowed to continue in humans, the greater the risk of additional adaptation?
Just saying...
 
Re: Ebola: Discussion

Re: Ebola: Discussion

It will be very hard to do anything about the Ebola outbreak I am afraid.

West African societies have been in a continuous process of destruction, starting several hundreds of years ago, with the (t)raiders coming in from Europe, looking for gold, ivory, slaves and more. Families, villages, entire tribes were torn apart, social and cultural structures crumbled. This process never stopped untill today, many now live in slums, desperately trying to survive.

Nothing left to bind or guide the people, no church strong enough, no tribe, no community, no government, no law. Especially in Liberia and Sierra Leone, not long ago there were terrible wars, adding to the chaos.

I am not sure we'll see the end of the outbreak in this year.
 
Re: Ebola: Discussion

Re: Ebola: Discussion

I think that a greater concern for the world is that if this outbreak is allowed to continue unabated, there is considerable risk of two events:-

1. Spread to other countries in the region, including - eventually - Nigeria, which has a large and dense population, considerable international traffic due to its popualtion size, an oil rich economy (set to equal that of the UK in terms of GDP) and porous borders. Should this happen there is considerable risk of export to more developed nations outside the immediate region of west africa.

2. The more sequential passages this ebola strain has through human hosts, the greater the risk of increased adaptation, infectivity and easier spread. Whilst the data suggest that ebola does not have that high a mutation rate, it is a virus in its early zoonotic stage. This is not a virus that anyone wants to see go pandemic.

Therefore, there is a global interest to throw all the resources necessary at this problem to bring this outbreak under control, and quickly IMHO
 
Re: Ebola: Discussion

Re: Ebola: Discussion

Doctor, Missionary Battling to Survive Ebola

August 1, 2014
Liberia
...
On Thursday, Dr. Brantly received a remarkable gift from a patient he had helped to save.

?Dr. Brantly received a unit of blood from a 14-year-old boy who had survived Ebola because of Dr. Brantly?s care,? Graham said. ?The young boy and his family wanted to be able to help the doctor that saved his life.?
...

http://www.samaritanspurse.org/arti...liberia-west-africa-tests-positive-for-ebola/
------------------------------------------------------------------------------
Treatment of Ebola Hemorrhagic Fever with Blood Transfusions from Convalescent Patients
K. Mupapa,
M. Massamba,
K. Kibadi,
K. Kuvula,
A. Bwaka,
M. Kipasa,
R. Colebunders and
J. J. Muyembe-Tamfum on behalf of the International Scientific and Technical Committee
+ Author Affiliations

Kinshasa University, Ministry of Public Health, and Kikwit General Hospital, Kikwit, and National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo; Institute of Tropical Medicine, Antwerp, Belgium
Reprints or correspondence: Dr. R. Colebunders, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerpen, Belgium (bcoleb@itg.be).
Next Section

Abstract
Between 6 and 22 June 1995, 8 patients in Kikwit, Democratic Republic of the Congo, who met the case definition used in Kikwit for Ebola (EBO) hemorrhagic fever, were transfused with blood donated by 5 convalescent patients. The donated blood contained IgG EBO antibodies but no EBO antigen. EBO antigens were detected in all the transfusion recipients just before transfusion. The 8 transfused patients had clinical symptoms similar to those of other EBO patients seen during the epidemic. All were seriously ill with severe asthenia, 4 presented with hemorrhagic manifestations, and 2 became comatose as their disease progressed. Only 1 transfused patient (12.5%) died; this number is significantly lower than the overall case fatality rate (80%) for the EBO epidemic in Kikwit and than the rates for other EBO epidemics. The reason for this low fatality rate remains to be explained. The transfused patients did receive better care than those in the initial phase of the epidemic. Plans should be made to prepare for a more thorough evaluation of passive immune therapy during a new EBO outbreak.
...
? 1999 by the Infectious Diseases Society of America
Full text:

http://jid.oxfordjournals.org/content/179/Supplement_1/S18.full

--------------------------------------------------------------------

This treatment is discussed at the end of this video (at around 41:00)

EBOLA: THE PLAGUE FIGHTERS - NOVA - Discovery/Science/History (documentary)
Published on Feb 22, 2014

https://www.youtube.com/watch?v=4YYskFkqoyI
 
Re: Ebola: Discussion

Re: Ebola: Discussion

Fighting Ebola is 'like trying to change a tire in a hurricane'
...

"What's going on is unprecedented," Thomas Hope, a virologist at Northwestern University Feinberg School of Medicine, tells us. "Usually these things last two or three weeks and then get isolated." Not this time. And, Hope says, usually the virus grows less lethal as it passes from person to person, so people get less and less sick from it. Not this time. "That is more than a little unnerving to me as a virologist because it suggests that maybe this strain is a little different or has adapted in a different way to cause disease in humans."

Infectious disease expert Dr. Michael Osterholm of the University of Minnesota tells us that this strain of Ebola isn't likely to be much different than others, but that international public health and local government officials "were slow to understand how fast the virus was spreading." That's why doctors and other health professionals are struggling to contain the disease. "This is like trying to change a tire in a hurricane," he says.
...
http://www.chicagotribune.com/news/...demic-africa-edit-0803-jm-20140803-story.html
 
Re: Ebola: Discussion

Re: Ebola: Discussion

I found this message #8 quite interesting. I had given a few minutes thought to what I would try if I was a doc on the scene with Ebola, and concluded that passive immunity using a transfusion of plasma from patients who recovered seemed like the simple strategy most likely to work. Gratifying to know it has been tried and there is some indication it may help. I'm not even an M.D. - just a retired biochemist who once spent a couple of years in med school back in the '70s before doing my doctorate in biochem. It occurred to me that you could use normal AB blood to adsorb out any RBC targeted Abs in the plasma.

The question arises why no vaccine or treatment has been developed when the knowledge is available, but for the people who are infected now, or will be soon, the more pertinent question is what can be done simply and quickly to give them a better shot at surviving. Transfusion with plasma from recovered patients (with whatever pre-treatments of the plasma a competent hematologist/immunologist would deem necessary) seems like perhaps the best option.
 
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Re: Ebola: Discussion

Re: Ebola: Discussion

Not sure where to ask this--Sharon, please move it if it's not the most appropriate place.

One meme that keeps popping up is that Ebola is "just" a very fast developing form of scurvy, and that vitamin C administered by IV will cure it. I can find nothing in the mechanism of infection that suggests that the virus somehow metabolizes VitC, and I've been reading about this until my eyes are bloodshot. Am I missing something, or is it more likely that the people flogging this are the same ones pushing colloidal silver and eating salt?
 
Re: Ebola: Discussion

Re: Ebola: Discussion

There is a lot of stupid stuff going around right now.

I have seen no reliable reports/studies that anything works on ebola.

As far as I know there is no proven treatment or vaccine for ebola. There are some experimental treatments and vaccines but they are not proven to work.

The only effective treatment at this time is prevention.
 
Re: Ebola: Discussion

Re: Ebola: Discussion

Agreed, although there is some headway being made on the mechanisms by which ebola causes illness. This may help us find interventions that might work or be of some benefit.

See http://www.trust.org/item/20140813155202-vrckk
Scientists find how "nefarious" Ebola disables immune response

A group of scientists in the United States found that Ebola carries a protein called VP24 that interferes with a molecule called interferon, which is vital to the immune response.

The team, lead by Gaya Amarasinghe from Washington University School of Medicine, found that VP24 works by stopping something called "transcription factor STAT1" - which carries interferon's antiviral message - from entering the nucleus of a cell and initiating an immune response.

So if we can find something that runs interference with VP24 or amplifies STAT1 it could (theoretically) help negate this aspect of ebolas function. However, there are also other factors at play in the disease aetiology, including immune system dysregulation aka a 'cytokine storm'.
 
Re: Ebola: Discussion

Re: Ebola: Discussion

Yes, thank you. I'm very familiar with all of that. Which is wny I said I could see nothing to warrant any suggestion that Ebola "metabolizes all the body's reserves of Vitamin C," and so forth. But I'm willing to suppose I had missed something. Continuing to knock my head against the various brick walls of ignorance out there :)
 
Re: Ebola: Discussion

Re: Ebola: Discussion

I couldn't find any research supporting ebola virus consuming vitamin C, either, Liz. (But I'm just keyword searching with Google Scholar so I think only and ebola expert could really put this to rest.)

I did find that vitamin C was given to an ebola patient for some reason though.

Treatment of Ebola Hemorrhagic Fever with Blood Transfusions from
Convalescent Patients


It doesn't say if it was high dose IV, or orally dosed. It doesn't sound like she got better until after she got a transfusion 2 days later. She survived but so did another 6 out of the 8 transfusion patients and it is not reported that the other 6 survivors got vitamin c therapy.

It certainly is a rough recovery, even with the transfusion therapy.
 
Re: Ebola: Discussion

Re: Ebola: Discussion

Emily, the link just refers back to your comment. Could you check that?

ETA--never mind, I found it, thanks!
 
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