Announcement

**wander** · 09-05-2014, 09:16 AM

Sigh. Dunno if you know this, but there are no organism tests really. If you really worked in an ER/ICU, you'd know you don't put blood in a vial and send it to the lab saying "tell me if this patient has XXX". It just doesn't work that way. You get blood chemistry, run a battery of reagent tests against the blood, feces, urine, etc, and do a variety of cultures. The lab will laugh at you (and yes this happens) when you stick a patient, draw blood, throw it in any old vial, and ask them to see if it's Ebola or whatever you want to know.

From the Mayo Clinic:

Ebola and Marburg hemorrhagic fevers are difficult to diagnose because early signs and symptoms resemble those of other diseases, such as typhoid and malaria. If doctors suspect you have Ebola or Marburg viruses, they use blood tests to quickly identify the virus, including:

Enzyme-linked immunosorbent assay (ELISA)
Reverse transcriptase polymerase chain reaction (PCR)

The Centers for Disease Control and Prevention monitors the United States for conditions such as Ebola infection, and its labs can test for the Ebola virus. Mayo Clinic does not test for the Ebola and Marburg viruses.

Neither of those tests specifically target Ebola, but instead rule out other organisms. Doctors make a diagnosis based on what is ruled out and what is symptomatic. Then they treat based on whatever their diagnosis is. Sometimes it's not conclusive, and they treat for a broad spectrum of things. In labs, there are no black and whites on organisms... unless you can see the organism (sometimes not even then) it's difficult to discern exactly what it is. In most cases, they can identify it based on how it reacts to different stains or chemical reagents, but in the case of viruses... not really.

Also, I've worked in an ER for years. There are lists of tests that can be performed, but few of them were organism specific. When it comes to organisms, you can order wound, urine, fecal cultures, or rapid flu, strep, staph tests. Pretty much it.

And YES there is a lot they can do if Ebola makes it into the country. But they aren't doing squat because they aren't going to spend money on something that might happen. At least at the state level. The feds are already doing it - getting FEMA stocked up and ready to quarantine entire cities.

People die from lack of perfusion. Every time. Heart stops, blood can't circulate and purfuse oxygen into your brain - dead. Gunshot would causes organs to go into shock and shut down, blood pumps onto the ground, oxygen can't get to your brain - dead. Ebola causes your body to bleed internally, and lose fluids like crazy, it can cause organ failure. Lack of perfusion.

Treatment is always based on this principal, that your body must have oxygen to survive. If you can't breathe, you can't get o2. If your bleeding or heart is stopped, you can't get o2. This is what is treated - keeping the lungs and airway functional, keep the heart beating, keep the blood inside your body. Fluids and o2 are administered to maximize survivability.

**jimmyd** · 09-05-2014, 09:50 AM

Sigh... LOL.

Of course blood tests, at least the rapid ones, are for the viral antibodies (or anitgens, or RNA) in the blood - no one said any different. But it is for the specific virus - not to rule out others. In this case for ebola the ELISA and PCR are the reactive tests of for the virus (again not to rule out other virus) - available from the CDC - and you do draw a tube of blood; the yellow topped SST. The lab spins it down to separate the serum. And off it goes to the specialty lab. With an accompanying order for 'xxx test'. Whether it be HIV, Hep, chickenpox, or other known catalogued viruses. This is exactly how it works. Here's a couple of lab order codes that even include the type(s) of blood tubes needed;

Page Not Found | Labcorp

https://www.labcorp.com/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP3I1JT8YquyzNTykNTiEqdKEOlXmpuUWqQfDlJeguBHGlgYWxiZ6Bfk5joCAOJg4Us!/

404 Page Not Found We are sorry. The requested page can not be found. It might have been removed, changed or temporarily unavailable.� Please try the following to find the page you are looking for: Enter a search term in the search field at the top of the site. Use the main navigation to find...

Page Not Found | Labcorp

https://www.labcorp.com/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP3I1JT8YquyzNTykNTiEqdKEOlXmpuUWqQfDlJeguBHmpoaGFga6Bfk5joCAIx2trw!/

404 Page Not Found We are sorry. The requested page can not be found. It might have been removed, changed or temporarily unavailable.� Please try the following to find the page you are looking for: Enter a search term in the search field at the top of the site. Use the main navigation to find...

I don't think the State level can really do much more than they are already doing/have done to prepare? Monitoring the local populations for early catches of common complaints and preparing by getting involved with USA Med Corps and other organizations to have lists of medical professionals and medical manufacturers for hard assets. I don't think it's the States responsibility to do more - not feasible financially speaking - it makes more sense geographically and financially for the Fed level to have quantities of vaccines for hcp and ring inoculations to prevent the spread (not in the case of Ebola obviously).

**wander** · 09-05-2014, 10:15 AM

Yes - rapid tests identify viruses based on their antigens. But Ebola cannot possibly be identified in such a manner now nor will it be anytime in the foreseeable future. The virus is currently unstable and is undergoing a massive mutation rate. There are as of last week, almost 100 separate strains of EVD.

I sighed because I relayed a second hand account and you made it seem like either I'm lying or my wife is a complete idiot. I'm an old combat medic, not a lab tech. If you want to nitpick my limited knowledge of laboratory procedures, fine. Go ahead. I guess you are better and smarter than little old me. I guess there is no room on this forum for discussion or opinion.

**angeryamerican** · 09-05-2014, 10:22 AM

There is plenty of room for civil divisions so let's keep it that way. Both you guys are giving considerable insight to those of us with limited knowledge in the infectious disease world. I appreciate the insight.

**jimmyd** · 09-05-2014, 10:59 AM

Originally posted by wander View Post

Yes - rapid tests identify viruses based on their antigens. But Ebola cannot possibly be identified in such a manner now nor will it be anytime in the foreseeable future. The virus is currently unstable and is undergoing a massive mutation rate. There are as of last week, almost 100 separate strains of EVD.

I sighed because I relayed a second hand account and you made it seem like either I'm lying or my wife is a complete idiot. I'm an old combat medic, not a lab tech. If you want to nitpick my limited knowledge of laboratory procedures, fine. Go ahead. I guess you are better and smarter than little old me. I guess there is no room on this forum for discussion or opinion.

I'll apologize. But I'm just trying to keep the mis-information down.

Like you just saying that Ebola can't be identified because of the documented mutations - that is NOT the case(as of right now - it could happen but it hasn't happened that they are aware of yet). Here is a CDC conference on the Ebola outbreak - long and lots of info but it is current for this week saying there have been no significant mutations in the cases id'd, so far.

Page Not Found | CDC

http://www.cdc.gov/media/releases/2014/t0902-ebola-outbreak.html

Page Not Found | CDC

The mutations that everyone is speaking of is this:

http://www.sciencedaily.com/releases/2014/08/140828142738.htm

The mutations can affect PCR testing, but not ELISA testing, but with the id'd mutations they can alter the PCR specific to this outbreak and once mod'd use the new PCR - and it shouldn't take that long to develop the new PCR (days, not months like a vaccine).

**wander** · 09-05-2014, 01:33 PM

Okay, my apologies for overreacting.

My point isn't to create panic or stir trouble. My point is that the information being released is intentionally being doctored as evidenced by the conversation my wife had with the public facing epidemiologist in state health relative to the conversation she had with the mother of an epidemiologist working in the same office.

Publicly they are calm and stating everything is fine, nothing to see here.

Privately they are terrified and are planning for mass casualty.

This is classic government misinformation. When a purely scientific study comes out and says infections are doubling every 38 days, and the CDC says it's nearly impossible to contract, one of the two is lying. I don't know one way or another what this outbreak is going to do. However, the infection rates are going hockey stick... and that means nothing can be done about it. In exponential functions like this, by the time you recognize there is a problem, you are a few doubling periods away from being overwhelmed.

**jimmyd** · 09-05-2014, 02:29 PM

Originally posted by wander View Post

Okay, my apologies for overreacting.

My point isn't to create panic or stir trouble. My point is that the information being released is intentionally being doctored as evidenced by the conversation my wife had with the public facing epidemiologist in state health relative to the conversation she had with the mother of an epidemiologist working in the same office.

Publicly they are calm and stating everything is fine, nothing to see here.

Privately they are terrified and are planning for mass casualty.

This is classic government misinformation. When a purely scientific study comes out and says infections are doubling every 38 days, and the CDC says it's nearly impossible to contract, one of the two is lying. I don't know one way or another what this outbreak is going to do. However, the infection rates are going hockey stick... and that means nothing can be done about it. In exponential functions like this, by the time you recognize there is a problem, you are a few doubling periods away from being overwhelmed.

Let's keep in mind that the undocumented/anecdotal words of one person isn't really evidence of some vast conspiracy.

And when you consider an incubation period of 21 days it only goes to reason that there is and will always be a sudden rise in cases, a crest before the downward trend of the outbreak. And lets not forget about the sanitary conditions on that continent which greatly add to the spread...

Originally posted by wander

It's only sorta airborne. It's still not really infectious compared to the Flu or the cold. It's spreading in Africa among medical personal because they have almost no supplies, the sanitary conditions are terrible, and the ignorance of the locals is beyond astounding. I have done medical humanitarian missions to Angola and Niger, they barely have electricity, they don't treat their water supplies, and they burn their garbage (including medical waste) in the street. The cities don't have sewer systems, or if they do, they are limited to the richest 1%, which are corrupt government officials. The people dump their body waste in the street or ally.

Africa doesn't compare to anywhere else in the world that I've been.

All I'm saying is... the flu is more concerning right now. Especially with the CDC doing stupid things with their experiments.

Here in America we won't see person to person transmission or especially vectored transmission like is being seen in Africa.

There is no doubt that it is out of control in Africa - the main goal now should be to control it inside the continent. And if/when cases reach other shores to quarantine those cases and their close contacts.

**wander** · 09-05-2014, 03:14 PM

Really. This thread started by citing anecdotal commentary. I supplemented this with my own anecdotal commentary. Suddenly I've been called out as saying there is some sort of vast conspiracy.

Originally posted by angeryamerican View Post

I've had a very interesting week, got to meet some real interesting folks too. I spoke with a high profile NYC doc about ebola, he knows his stuff about infectious disease, he treated the first case of SARS in the US. He said it will make it here, without a doubt. However, he is very optimistic that we can handle it as we have the technology and material to deal with it. He also said the situation on the ground over there is many folds worse than we are getting from the MSM, much worse. This was confirmed by a SF gent I got to know, he will soon be over there on the ground to work with local health folks. He said it's a damn nightmare. Just thought I'd pass this along to you guys, keep your eyes open.

So I guess I'm giving up on this forum as apparently I have nothing useful to add here.

**angeryamerican** · 09-05-2014, 03:27 PM

Wander, I don't see where you're coming from. I thought I clearly stated you both were offering some great info. I did give some anecdotal conversational info I received. You guys are offering some great info and I asked you keep it up. How that offended you cannot imagine. I'm not a medical professional and don't pretend to be one. If you're giving up on the board over this so be it, but it certainly isn't because you have nothing useful to add.

**jimmyd** · 09-05-2014, 03:50 PM

Originally posted by wander View Post

Really. This thread started by citing anecdotal commentary. I supplemented this with my own anecdotal commentary. Suddenly I've been called out as saying there is some sort of vast conspiracy.

So I guess I'm giving up on this forum as apparently I have nothing useful to add here.

Again, I'll apologize as I wasn't attempting to offend - but words like 'classic gov't misinformation' again do nothing but add to the hysteria and are misplaced since the CDC and WHO have been saying all along that the cases would rise dramatically within 3 weeks - and will continue to do so - if they can't get containment on the disease outbreak... http://www.cdc.gov/media/releases/20...-outbreak.html first page, second commenter.

AA's post was anecdotal but it was in lockstep with what the CDC and WHO have been saying all along. The main stream media isn't paying the story any attention, the world is sort of ignoring the situation... but who can blame groups for not wanting to go to Africa - the logistics of making a secure camp for your personnel, and a secure medical facility, both with power and proper hygiene is immense - the politics of the eventual dead attackers of those facilities is a political nightmare for any gov't or charitable organization that would undertake it... the world already gave the US crap over not providing Africa with the experimental drug - and if that drug didn't work then we'd be the bad guys for experimenting on poor Africans ... damned if you do, damned if you don't.

**Sacajawea** · 09-05-2014, 03:54 PM

And lets not forget about the sanitary conditions on that continent which greatly add to the spread... Here in America we won't see person to person transmission or especially vectored transmission like is being seen in Africa.

Well, you seem awfully SURE that everything here is so much cleaner, and that we're all so much more civilized here. That the experts wouldn't have some reason -- like being broke (WHO) or not wanting to panic the sheep or interfere with "someone's" golf game -- for trying to spin this as "nothing to see here", "don't worry - we're not superstititous or uneducated like Africans". Been to Walmart lately? How clean was it, really?

Some of us aren't quite so sure, given that our experience and ability to question and reason, is telling us to be very wary and prepare ourselves, to take care of ourselves the best we can - because it's pretty clear that it's NOT being contained in Africa, too well. And we no longer trust our institutions to tell the truth, the whole truth and nothing BUT the truth anymore. We won't be on the short list for ZMAPP.

There is already a serious question about whether this virus has mutated in some way that people can be contagious before they experience or show symptoms.

http://www.broadinstitute.org/blog/e...leone-outbreak

And according to some experts the odds that there will be someone (unknown at the time) enter the US with ebola has risen from 5% at the beginning of Sept -- to 18% at the end of the month. The odds are higher for the UK. How many flights arrive here from the UK every day?

TPTB have repeatedly said that strict quarantines and cancelling flights will have a negative economic impact on the W. African countries. They are correct. But if there are too many people breaking quarantine and infecting NEW geographical areas - well, then those countries will overwhelmed, also. The WHO is having trouble coming up with $600 million dollars from it's donor nations (there's that pesky economic "recovery" again) and that estimated amount increases every week - to pay for supplies and help pay health care workers. The food aid is considered a separate expense.

Here's what the MSM is reporting:

403 Forbidden

http://www.newsweek.com/ebola-outbreak-completely-out-control-nih-says-268536

and if you read the MSF and CDC and WHO reports from last week, you'll see that they are doing their best to tone the urgency of the situation and the danger to those of us who feel a false sense of security -- because we live in a developed country.

However: the GOOD NEWS is - it's not airborne yet! (unless you count sneeze, vomit & airplanes)

**angeryamerican** · 09-05-2014, 04:09 PM

We live a far more hygienic life than those people in Africa, as the doctor I spoke to that sparked this said, the exam gloves he wore when I saw him would be coveted there, the fact that he would wash his hands with soap and hot water would be exceptional there. I'm referring to the general medical facilities, not those treating the ebola patients. On another note, I know for certain things are ramping up in Africa. An unknown organization is currently sourcing totally self contained clean labs that can be dropped in, they have to be totally self contained and airlift capable. Not sure who's looking for them but it seems a little late in the game.

**jimmyd** · 09-05-2014, 04:30 PM