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Tuesday, August 12, 2014



These are my thoughts, written down, simply so that I can reflect back on them as the Ebola crisis unfolds.  While I have a few minutes, I figured I would jot down some notes, but make them public as well.  In doing so, not only myself, but others can chime in with their own thoughts, and possibly we can collectively come up with a plan that would work to figure out the Ebola mystery.  With the help of folks like +Jason Knight , +Jason A , +tracehd1  and others that are systematically using science and historical fact as the basis for their new hypothesis and theories, this system of "collective thought" or "crowd-sourcing" may allow us to assist those with Public Health responsibilities think of treatments or plans they might otherwise have missed.

Let's start with what we "know" :

1.  Ebola and the filovirus class of pathogens that are related to the EVD / VHF diseases surrounding Ebola (collectively, I will simply use the term "Ebola" to cover the entire spectrum of the 4 known pathogenic viruses even though they are different strains... they all share similar properties of filoviruses as demonstrated by an article shared with me by +Jason Knight )... are all part of the Filovirus family.  The CDC lists the Ebola virus as such:

Filoviruses belong to a virus family called Filoviridae and can cause severe hemorrhagic fever in humans and nonhuman primates. So far, only two members of this virus family have been identified: Marburgvirus and Ebolavirus. Five species of Ebolavirus have been identified: Ta├» Forest (formerly Ivory Coast), Sudan, Zaire, Reston and Bundibugyo. Ebola-Reston is the only known Filovirus that does not cause severe disease in humans; however, it can still be fatal in monkeys and it has been recently recovered from infected swine in South-east Asia.

2.  Structurally, filovirus virions (complete viral particles) may appear in several shapes, a biological features called pleomorphism. These shapes include long, sometimes branched filaments, as well as shorter filaments shaped like a "6", a "U", or a circle. Viral filaments may measure up to 14,000 nanometers in length, have a uniform diameter of 80 nanometers, and are enveloped in a lipid (fatty) membrane. Each virion contains one molecule of single-stranded, negative-sense RNA. New viral particles are created by budding from the surface of their hosts' cells; however, filovirus replication strategies are not completely understood.

3.  NATURAL HOST:  It appears that Filoviruses are zoonotic, that is, transmitted to humans from ongoing life cycles in animals other than humans. Despite numerous attempts to locate the natural reservoir or reservoirs of Ebolavirus and Marburgvirus species, their origins were undetermined until recently when Marburgvirus and Ebolavirus were detected in fruit bats in Africa. Marburgvirus has been isolated in several occasions from Rousettus bats in Uganda.

4.  TRANSMISSION: In an outbreak or isolated case among humans, just how the virus is transmitted from the natural reservoir to a human is unknown. Once a human is infected, however, person-to-person transmission is the means by which further infections occur. Specifically, transmission involves close personal contact between an infected individual or their body fluids, and another person. During recorded outbreaks of hemorrhagic fever caused by a Filovirus infection, persons who cared for (fed, washed, medicated) or worked very closely with infected individuals were especially at risk of becoming infected themselves. Nosocomial (hospital) transmission through contact with infected body fluids - via reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids - has also been an important factor in the spread of disease. When close contact between uninfected and infected persons is minimized, the number of new Filovirus infections in humans usually declines. Although in the laboratory the viruses display some capability of infection through small-particle aerosols, airborne spread among humans has not been clearly demonstrated.

DEFINITIONS:  Ebola, appears to be highly transmittable, more so than is being publicly announced.  IT IS A BIOHAZARD LEVEL 4 PATHOGEN, meaning, it is at the HIGHEST RISK CATEGORY for viral pathogens.  For a pathogen to be listed as a BSL4 (Bio-safety Risk Level 4), at least one of the criteria must be met:

           1.  Agents likely to cause serious or lethal human disease for which preventive or therapeutic interventions are not usually available (high individual risk and high community risk).  (NATIONAL INSTITUTE OF HEALTH / NIH)  or...

             2. (High individual and community risk)  A pathogen that usually causes serious human or animal disease and can be readily transmitted from one individual to another, directly or indirectly. Effective treatment and preventive measures are not usually available. (WORLD HEALTH ORGANIZATION / WHO)

The problem, as it stands now, is that Ebola appears to be bypassing all known methods of transmission, bypassing the known host of the pathogen, appears to be a zoological pathogen that is being easily crossed over into people, appears to carry an extremely high virulent effect, appears to be associated with an extremely high mortality rate, appears to have no known treatment other than symptomatic support and appears to have MULTIPLE SITES OF ORIGIN, or, "Ground Zero."  

Because the actual components of virology and mutation of viruses is a highly complex science, the dissection and microanalysis of the Ebola class virus, is better left to those who have a full working knowledge of the virus;  it is not a simple science, and requires extensive hands-on experience as well as PhD level of study and practicum.  However, even with that being the case, there is still plenty that laypersons as well as experienced medical / healthcare professionals (I will lump together in this group all persons licensed or certified to carry out healthcare tasks and diagnosis, including Certified Nursing Assistants, EMT's, First Responders, Licensed Practical / Vocational Nurses, Registered Nurses, Physicians (both MD & DO), as well as DMD's, DVM's, and Advanced Practice Nurses (Nurse Practitioners / NP's and Clinical Nurse Specialists / CNS's).  To be included in this group, will also be Laboratory Professionals whose scope and practice is to deal with viruses and other pathogens that require any rating higher than BSL1 (BSL2 - BSL4).

PROBLEM STATEMENT:  Ebola is a rapidly transmittable, highly pathogenic virus with a known vector but the epidemiology of the EVD appears to be crossing over species much more readily than expected, in a manner inconsistent with known transmission theories and producing a potential world-wide public health threat, for which there is no known cure (to date) and carries a high mortality rate.


1.  It is not known with certainty where the current "outbreak" started. 
2.  It is not known with certainty which strain of Ebola virus is responsible for the current outbreak.
3.  It is not known with certainty the exact number of persons infected.
4.  It is not known with certainty the exact number of persons deceased as a result of Ebola.
5.  It is not known with certainty the exact number of persons who may have travelled outside of the initial site of infection zone(s).
6.  It is not known with certainty the natural host of the Ebola virus.
7.  It is not known with certainty the exact method of transmission.
8.  It is not known with certainty the exact reason some may be infected, yet show no symptoms.
9.  It is not known with certainty how many persons are in fact hosts vs. victims.
10. It is not known with certainty the extent of actual contamination zones.
11. It is not known with certainty if the natural host (African Fruit Bat) is the only natural host or if other species may in fact carry the virus class in a natural setting.  ( )
12.  It is not known with certainty if current "Universal Precautions" are adequate to protect healthcare workers.
13.  It is not known with certainty if current decontamination techniques are adequate to destroy the Ebola pathogen in the healthcare or community setting.
14.  It is not known with certainty if air travel is a method of carrying the virus from one location to another well outside the natural environment of initial contamination.
15.  It is not known with certainty the level of training provided to those entrusted with "Ebola Screenings" in the US or other countries.
16.  It is not known with certainty if any restrictions put into place now (even if mandatory) are too little, too late.
17.  It is not known with certainty, the actual or estimated Rate of Infection (ROI).
18.  It is not known with certainty the safety zone needed to protect a person from "casual contact" (i.e. is the virus able to transmit within a certain amount of centimeters by talking, coughing, sneezing).
19.  It is not known with certainty if food preparation (i.e. cooking food / water to a certain temperature) will be effective in killing the Ebola pathogen.
20.  It is not known with certainty if US hospitals are properly staffed and trained to deal with an Ebola Pandemic.
21.  It is not known with certainty if enough healthcare professionals are willing to deal with an Ebola outbreak in the US, accounting for potential personal risk vs. fulfillment of obligations of licensing requirements.
22.  It is not known with certainty if First Responders have the resources needed to handle an Ebola outbreak in the US.
23.  It is not known if the Ebola class virus has already been moved via other methods of transportation from the initial infection sites (via boat, rail, private vehicles etc.)
24.  It is not known how many air assets or other advanced medical transportation services are available in the US to transport BSL4 patients to BSL4 facilities equipped to handle such cases.
25.  It is not known with certainty how the structures at the 20 known CDC "Quarantine Centers" (aka "QC's") are built to handle the Ebola BSL4 class pathogen in terms of prevention of transmission and/or mitigation of further transmission to the surrounding communities of each QC.
26.  It is not known with certainty how Law Enforcement or State National Guard Units will handle a potential Ebola Outbreak, and to what degree will Constitutional Liberties be suspended in the US or similar nations.
27.  It is not known with certainty which other species of animals or insects will be able to become "natural" or otherwise HOSTS OR VECTORS for the Ebola class virus, thus introducing multiple vectors simultaneously, producing an "uncontrollable" pandemic event.
28.  It is not known with certainty what, if any, species of ARTHROPODS are capable of being VECTORS for the Ebola class virus (i.e. mosquitoes, flies, ticks, etc.)
29.  It is not known with certainty if the Ebola class virus can withstand oceanic transmission, or if it can cross into oceanic aquatic species.
30.  It is not known with certainty if enough supportive treatment supplies even exist for a pandemic from the Ebola class virus (i.e. IV fluids, blood products, antipyretics, coagulation agents, respirators, dialysis machines / facilities, laboratory services, PPE including N95 masks, nitryl gloves, gowns, eye shields, etc.).
31.  It is not known with certainty if safeguards are in place to protect inherently hazardous locations such as nuclear power plants, BSL2-BSL4 laboratories, or to safeguard personnel in critical public service sectors such as Government, Law and Public Safety, Public Health sectors, and what backup plans are actually or potentially in place should first line officials become infected / succumb to the Ebola class virus.
32.  It is not known with certainty if current PPE are effective in the prevention of accidental infection with the Ebola class virus.

Before we can proceed further, we need to establish the answers to some of the above unknown variable questions.  If we, as a society, are unable to establish the answers to most of the above, then moving forward with the exercise if futile... therefore, experts with experience and/or knowledge of the above are encouraged to share your knowledge so that we can start to formulate a plan of action.
-SA  8/12/14


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