October 24, 2014

Ebola and the wet-dry distinction:

From the excellent New Yorker article "The Ebola Wars":
There are two distinct ways a virus can travel in the air. In what’s known as droplet infection, the virus can travel inside droplets of fluid released into the air when, for example, a person coughs. The droplets travel only a few feet and soon fall to the ground. The other way a virus can go into the air is through what is called airborne transmission. In this mode, the virus is carried aloft in tiny droplets that dry out, leaving dust motes, which can float long distances, can remain infective for hours or days, and can be inhaled into the lungs. Particles of measles virus can do this, and have been observed to travel half the length of an enclosed football stadium. Ebola may well be able to infect people through droplets, but there’s no evidence that it infects people by drying out or getting into the lungs on dust particles. In 1989, a virus known today as Reston, which is a filovirus related to Ebola, erupted in a building full of monkeys in Reston, Virginia, and travelled from cage to cage. One possible way, never proved, is that the virus particles hitched rides in mist driven into the air by high-pressure spray hoses used to clean the cages, and then circulated in the building’s air system. A rule of thumb among Ebola experts is that, if you are not wearing biohazard gear, you should stand at least six feet away from an Ebola patient, as a precaution against flying droplets.
Did you understand that wet/dry was the relevant distinction in the communicability of ebola? Do you think this distinction has been effectively, clearly, and honestly conveyed by the various experts and officials who are trying to keep us informed and at the right level of vigilance? I sure don't.

AND: This is what Rand Paul was talking about:



WaPo's FactChecker Glenn Kessler analyzed Paul's statement and gave him 3 Pinocchios!

SO: "ZWZCYZ Children fashion PM2.5 anti-fog haze antibacterial ventilative mask Ebola disease prevention... Ideal for Dust, Germs, Allergies, Smoke, Pollution, Ash, Pollen, Crafts, Gardening, Travel, Anonymity... Kids Size, Made In China..."

123 comments:

RecChief said...

I sure don't.

Citizen, that sounds like you doubt the authorities' reassurances that you have nothing to worry about.

Bob Ellison said...

Do I have confidence that this wet/dry distinction is settled science that all infectious-disease experts are 100% clear on? I sure don't.

We have lost faith, and an essay in The New Yorker ain't gonna restore it.

Nonapod said...

Did you understand that wet/dry was the relevant distinction in the communicability of ebola?

I had a rough idea that there was a distinction, but I have taken college level courses in immunology and microbiology before (18+ years ago now, but still).

Do you think this distinction has been effectively, clearly, and honestly conveyed by the various experts and officials who are trying to keep us informed and at the right level of vigilance?

Not clearly, no. There've been a ton of officials, experts, and doctors on various news shows who have said and implied the idea that it's not believed to be contracted like the Flu. And I swear I've heard the phrase "not airborne" in reference to Ebola a bunch.

PB Reader said...

Not that confident when they claim "there's no evidence" that Ebola can travel dry, given their shifting stance on "established protocols" or relying on the judgement of medical personal who have experience (we presume the doctor in NYC had experience).

The gold standard for prediction in epidemiology is the 95% confidence interval, and I don't think these folks have enough data points on there people, capabilities, and procedures to be making statements that could be viewed in that same class of confidence.

CStanley said...

I laughed (gallows humor) at this frim the WaPo fact check article:

"People who are diagnosed with Ebola generally don’t circulate at cocktail parties."

Of course not...they go bowling.

PB Reader said...

Actually I should have said the 95% confidence interval is the minimum necessary level to determine causality, or in this case make predictions of safety.

Chance said...

I would've hoped this "distinction" had been made clear in high school biology courses....

Big Mike said...

If he's writing about a Republican, Glenn Kessler starts with 3 Pinocchios. So he's actually saying that Rand Paul is being truthful.

The Drill SGT said...

The droplets travel only a few feet and soon fall to the ground

That statement implies that the risk drops when the droplets drop.

What isn't said is that, those drops remain on surfaces and can infect others for hours or days later.

BFD

PS: "If the plan is to convince me that the don't know WTF they are doing, the plan is working"....

Diogenes of Sinope said...

Keep in mind there is nothing which magically makes media "fact checkers" politically non-partisan.

jr565 said...

How many people a the bowling alley stood less than 6 feet away from him and how many times did he cough!
And the media is going after Rand Paul and giving him 3 pinocchios?

I'm not always a fan of Rand, but he knows what he's talking about here. The people giving him pinocchios are playing political games and because of thst allowing the diseas to spread.

By the way Ebola now spread to Mali. So that's another country we have to worry about of people potentially flying here,

Bill Harshaw said...

How many days was Duncan symptomatic and living in close quarters with his relatives? Maybe 5, maybe 8. How many of those relatives caught Ebola from him? Zero. Repeat zero.

How many American civilians have caught Ebola in the US? Zero

How many American health care workers have died in the US. Zero.
Worry about whether you've gotten your flu shots--that's the real health danger this year.

Rumpletweezer said...

Glenn Kessler isn't clear on the true/false distinction.

James Pawlak said...

Is it possible that AIDS/HIV can be transmitted by such "wet" means as sneezes as can "project" far further than a cough?

jr565 said...


"The droplets travel only a few feet and soon fall to the ground"
OR you are sitting at a table and the droplets hit the table. It you cough and before the droplets drop they adhere to a surface like a pane of glass. Droplets don't always just fall to the floor. Maybe if you are standing in an empty room and there is no furniture or any object at 8 feet around you then you can be certain droplets will hit the floor. Otherwise droplets will spread like all other droplets spread.

jr565 said...

Bill harsh aw wrote:
How many days was Duncan symptomatic and living in close quarters with his relatives? Maybe 5, maybe 8. How many of those relatives caught Ebola from him? Zero. Repeat zero.

How many American civilians have caught Ebola in the US? Zero

How many American health care workers have died in the US. Zero.
Worry about whether you've gotten your flu shots--that's the real health danger this year.


How many people died of aids THE FIRST MONTH WE HEARD ABOUT AIDS? The guy just got admitted to a hospital yesterday.
And go bowling at the bowling alley. Sit at the same table and touch some surfaces. Maybe bowl with the same ball. Let us know how it goes.

I do to care if more people die of flu. Your eyeballs don't bleed when you get a flu and you can get a flu shot.

Nonapod said...

That statement implies that the risk drops when the droplets drop.

What isn't said is that, those drops remain on surfaces and can infect others for hours or days later.


Dropplets less than 100 μm in diameter generally dry out before they even hit the ground

Darrell said...

It's more complicated than that, given there is already moisture in the air in many environment and there are factors in play like laminar flow. Everyone has experienced smells being conveyed across a large space in a short amount of time, so the apprehension is understandable. Viruses themselves are practically weightless and could ride dust particles in a Bernoulli scenario.

phantommut said...

Yes, I understood the distinction. No, it has not been adequately conveyed.

And the infuriating thing is that it isn't hard to explain, and anybody should be able to "get" the wet/dry distinction. (For Ebola, Slimey = bad, dusty = not dangerous).

There are two assumptions made by politicians and their groupies in the press that are kind of analogous to this: (1) People are scientifically ignorant and (2) People are stupid. The first is accurate and dangerous. The second isn't accurate, and if politicos and their enablers would stop making it the very real danger from ignorance could be abated.

End of rant.

RecChief said...

have to give Chinese manufacturers and marketers props for their entrepeneurial spirit.

It even has a cute little panda face on it.

joking aside. there is a difference between taking precautions such as a travel ban, or actually effective screening, and giving in to panic.

Indicators (one of many) such as the White House editing Obama's "unpaid bills on my desk" joke out of a transript, cause skepticism of any pronouncement from anyone associated with this administration.

Darrell said...

Plus we know the CDC most likely has at least one employee shitting in the hallways--like most government agencies.

jr565 said...

Bill Harshaw takes the statistics of flu over the course of a year and compares it the the spread of infection from two people over the course of a month.
We aren't quarantining all the people that come down with flu are we. We don't shut down bowling alleys because someone had the flu there.


Let's see if more people get into the country and spread Ebola or if some people this guy came into contact with DO get Ebola before we say there is no threat of Ebola spreading

Smilin' Jack said...

Ebola may well be able to infect people through droplets, but there’s no evidence that it infects people by drying out or getting into the lungs on dust particles.

And absence of evidence is always evidence of absence!

the virus particles hitched rides in mist driven into the air by high-pressure spray hoses used to clean the cages, and then circulated in the building’s air system. A rule of thumb among Ebola experts is that, if you are not wearing biohazard gear, you should stand at least six feet away from an Ebola patient, as a precaution against flying droplets.

Then you'll be perfectly safe! (Unless you're in a building with an "air system"....)

Henry said...

Did you understand that wet/dry was the relevant distinction in the communicability of ebola?

Not in technical terms, though a little Googling turned up the risk of droplets and the idea of a 3 to 6 foot radius.

Do you think this distinction has been effectively, clearly, and honestly conveyed by the various experts and officials who are trying to keep us informed and at the right level of vigilance?

Absolutely not. What I find truly appalling is the weird vagueness of the administration's pronouncements. How hard is it to do a little research and utilize clear and specific nouns, verbs, and units of measurement?

Rand Paul is too kind.

For example, when Dr. Tom Frieden talked about the risk of getting ebola on the bus (remember that?), he didn't talk about fluids, droplets, and distances. He signed off on the President's wrongheaded assurance to people in West Africa that they "cannot get [Ebola] through casual contact like sitting next to someone on a bus."

Then Dr. Friedman clarified, "If you are sick and you may have Ebola, should you get on a bus? And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you."

You might have a problem? What kind of problem, doctor?

Why not use words like "vomit" or "sneeze"? Why not specify "droplets" and 6 foot radius?

Because if Dr. Frieden had used the word "sneeze" it would have put the lie to the president's reassurance.

A sneeze is casual contact.

Shanna said...

I understand the distinction between droplets and airborne, but yes, they have been so concerned about tamping down panic (or maybe they think people are too stupid to understand the distinction) that they have de-emphasized that droplets part of it. That is why all this 'don't worry about sitting next to someone with ebola' stuff has been driving me crazy.

Just be honest with people and include all relevant details. Is that so hard?

jr565 said...

"ny days was Duncan symptomatic and living in close quarters with his relatives? Maybe 5, maybe 8. How many of those relatives caught Ebola from him? Zero. Repeat zero."
How many days was this doctor dealing with Ebola patients and got Ebola? How much contact did Duncan have with the person he came into contact with.

He helped her get into a car, meaning he touched her and she touched him and then sat with her at the hospital. He wasn't sharing needles and pouring her bodily fluids on himself.

Dad said...

Hysteria is a communicable disease.

I miss Pogo at times like this.

Shanna said...

How many American civilians have caught Ebola in the US? Zero

2, actually. So far. From one patient.

I think probably everyone on the subway/bowling alley will be ok since we are early in his infection. It seems that you have to worry most about getting infected later on in someone's disease progression...

Mark O said...

The NY'er article is compelling. Rand Paul graduated Duke Medical School. It's not as if he did not know what he was talking about.

These same false and lulling assurances were given by the government in 1918.

The Drill SGT said...

Nonapod said...
That statement implies that the risk drops when the droplets drop.

What isn't said is that, those drops remain on surfaces and can infect others for hours or days later.

Dropplets less than 100 μm in diameter generally dry out before they even hit the ground


Your point about drying out is?

Here is what the CDC Q&A says today.

How long does Ebola live outside the body?

Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dry surfaces, such as doorknobs and countertops, can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature.

EDH said...

Did you understand that wet/dry was the relevant distinction in the communicability of ebola?

"How did you know I have dry leprosy -- that it isn't contagious?"

"I didn't."

Henry said...

Mr. Kessler approvingly quotes the President:

“Second, the most common way you can get Ebola is by touching the body fluids of someone who’s sick or has died from it — like their sweat, saliva or blood — or through a contaminated item, like a needle. (my emphasis)

What word is missing from the President's pablum?

Sneeze.

Consider the shout-outs to "blood" and "needles" and no mention of the common sneeze.

Rand Paul was too kind.

jr565 said...

, "If you are sick and you may have Ebola, should you get on a bus? And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you."

If its true for a bus its also true for a bowling alley.

Shanna said...

What word is missing from the President's pablum?

Sneeze.


To be fair, sweat and saliva are more likely symptoms of ebola than sneezing. But if you have comorbidities during cold and flu season?

m stone said...

"Because if Dr. Frieden had used the word "sneeze" it would have put the lie to the president's reassurance.

A sneeze is casual contact."

A good point Henry makes.

It appears that the White House information is being used to refute Paul's claim the WH/Administration is not being forthright.

Henry said...

And since when is sweat on a bus in West Africa not a possibility for casual contact?

phantommut said...

Now there are real questions about modes of infection that should be asked and answered.

(1) Can the virus be shed through sweat? (Important because when patients spike fevers they will sweat and skin-to-skin contact becomes an important factor.)

(2) How temperature-resistant are the virus particles? Even in a sneeze that produces significant large droplets, the temperature of those droplets will drop dramatically with exposure to the atmosphere. In this case cold weather is very much our friend. But I don't know and I don't know if anyone is looking at it.

(3) How important is total viral load in exposure? Some viruses (for instance, Norovirus which I've had the distinct displeasure of experiencing) are similar to Ebola in being bourne by fluid droplets but are infections at rates as low as five total virus particles of exposure. In theory it's easy to avoid norovirus. In practice it's very contagious because it's so hard to totally sanitize an environment.

We don't have many cases to go on from environments outside of Africa, but it seems like overall Ebola isn't currently easy to get outside of a hospital environment. (If the virus were hardy and contagious in small viral loads the guy who cleaned up the vomit outside of Duncan's residence would probably have killed 70% of that neighborhood with that pressure washer.) So right now, based on NOTHING the CDC or anyone else has been saying in the press, my working hypothesis is that the folks who bowled with the Doctor or rode the subway with him are probably safe.

Still and all, if I were one of those people I'd take a long staycation and monitor myself closely. Because the cost of being wrong are extraordinarily high.

Nonapod said...

The thing that disturbs me the most is that two of the infections in this country have been on health care workers who did really, really silly things during a window of time when they knew there was a possibility that they could've had Ebola. We had a nurse who got on a plane and a Doctor who went bowling and clubbing. These are health professionals, people you would think should damn well know better. But human beings do dumb things.

phantommut said...

He wasn't sharing needles and pouring her bodily fluids on himself.

She was dead later that same day, meaning she was almost certainly throwing up and voiding herself before, during, and after the trip Duncan took with her.

Experiencing that close up and personal must have been absolutely horrifying and terrifying.

kcom said...

"Keep in mind there is nothing which magically makes media "fact checkers" politically non-partisan."

Or scientifically capable. The lack of basic understanding of numbers and math, let alone science and technology, displayed by so many reporters over the years is enough to appall someone who has a smidgen of education in these areas. Glenn Kessler has a Masters in International Relations. The bio didn't say what his undergrad degree was but I'd bet heavy money it wasn't microbiology. These political fact checkers probably ought to stick to politics. I'm not saying Rand Paul was right or wrong, but I certainly wouldn't make Glenn Kessler my go-to guy to decide the question.

Browndog said...

Althouse-nice work, however there is one more little thing you should clear up.....since nobody else seems to want to:

Just because you haven't had obvious symptoms of ebola, DOESN'T MEAN YOU DON'T HAVE EBOLA.

It's seems that the talking heads are deliberately confusing the difference between being infected and being contagious.

Hey, no symptoms, no ebola!

RecChief said...

It appears that the White House information is being used to refute Paul's claim the WH/Administration is not being forthright

And this is where this White House's desire to "quell panic" falls apart. At this point, I don't think there are a large number of people who are at risk, but they are actually failing in their mission of reassuring the public as they don't seem to be forthright as you said.

Darrell said...

A degree in Ecologically Sustainable Development. Who knew? End times. . .

RecChief said...

The lack of basic understanding of numbers and math, let alone science and technology, displayed by so many reporters over the years is enough to appall someone who has a smidgen of education in these areas

Citizen, this appears as if you doubt our Comrades in the Ministry of Truth. Kessler has been a reliable voice for settled science such as global warming. your lack of faith is....disturbing

jr565 said...

Its I sweat. He had a fever. When you get a fever you start sweating. He also jogged three miles and so worked up a sweat. After sweating did he touch any surfaces that other people might touch a short time later? While also potentially coughing and sneezing?
I've coughed sneezed and sweated at times in my life. And I couldn't tell you where it landed, or if I gave somebody a cold. Because you can't check it. We don't have microscopes in our eyes.

Shanna said...

In this case cold weather is very much our friend.

Actually my understanding is the opposite. Heat kills the virus, it can live on surfaces for days in colder weather.

The Drill SGT said...

I'm not a bio-scientist, but viral disease infection rates are not a step function, but a continuum of risk.

The moment you get infected, you have ebola RNA in your system, which IMHO reflects a chance of infecting somebody.

Over time, that viral load is expanding exponentially, but there is NOT magic point, the hour before you show a fever where you aren't infectious and an hour after you show a fever, you are.

phantommut said...

It's seems that the talking heads are deliberately confusing the difference between being infected and being contagious.

Available evidence indicates that Ebola victims are only contagious while showing symptoms.

You are making a good point, but the contagious period for viruses really is very virus-dependent. (HIV is very contagious before any symptoms manifest, for instance.)

Again, this is a case of poor communication from the Authorities. (And that fact that no one trusts them much doesn't help.)

Todd said...

phantommut said...

Still and all, if I were one of those people I'd take a long staycation and monitor myself closely. Because the cost of being wrong are extraordinarily high.
10/24/14, 10:55 AM


Not for them. They are either already infected or they are not.

Them staying in self quarantine does nothing for their personal risk. Not self-quarantining is extremely selfish and irresponsible but not unexpected.

Diogenes of Sinope said...

The Obama CDC is a political organization whose primary function is to support Left-wing political goals.

lemondog said...

Scenario: Primary Doc treats a patient for seemingly a cold/flu but unknowingly is Ebola. Lots of coughing, sneezing. Then the next patient walks in.........

Shanna said...

The idea of someone not being contagious until showing symptoms apparently comes from epidemiological review of cases. Given the experience with Duncan and the nurses, I think it seems mostly on target but I don't think I would want to bet my life on it.

phantommut said...

Actually my understanding is the opposite. Heat kills the virus, it can live on surfaces for days in colder weather.

Depends on the virus. Yes, heat it enough and any virus particle will "die". How much and how long you have to heat it is the question.

As for cold weather, I just don't know how resistant to cooling Ebola is. (For the record I'd assume you could freeze the damn stuff and it would still be active just to be safe. But it would be nice to actually know what works for us and what works against us.) The virus has until now thrived in equatorial Africa. If it gains a foothold outside the region, it would be nice to know if setting the heat to 68 might at least shift the odds in our favor.

Shanna said...

I'm not a bio-scientist, but viral disease infection rates are not a step function, but a continuum of risk.

The Drill Sgt, this is my understanding of it as well. The chances of infecting someone grows the longer you have the virus because your viral load increases as time goes on, but in theory you could probably infect someone very early - especially considering that you may develop symptoms as early as 2 days and as late as 21 (or maybe 25). I suspect this is due to factors like how much virus you were exposed to, and your own personal response to it (immune system, etc).

phantommut said...

Selfish reason to self-quarantine: If you do come down with Ebola, do you want to have the Ebola ward (and its resources) to yourself, or do you want to have to share with 50 of your closest friends?

Shanna said...

Depends on the virus.

Yes, I am talking about this specific virus. They have done studies on this sort of thing, just look it up.

Ken B said...

Kessler's headline is a lie. Paul said people listening to reassuring comments conclude it's like AIDS. That is not what the headline claims.

richard mcenroe said...

How many Africans live/work/play in environments where air that is constantly, artificially circulated from one part of a room or building to another?

MathMom said...

I understood it, because it is my job to understand this. But it doesn't take a genius to figure out the danger of droplets - just watch one of those videos of a sneeze, in which the droplets come out at 90 mph and spray all over, or look at your hand after you sneeze and see the wet goop that came out.

Of COURSE that is infectious.

Now, think about a nice, juicy sneeze on board an airliner, where all that air is just recycled for hours. You think that's going to be safe to breathe? You think you can only get Ebola from a passenger on a plane if he barfs in your lap?

$#!+ is gonna hit the fan, and it's gonna spread the Ebola.

Shanna said...

Don’t worry, it’s only mixture of bodily fluids through direct contact.’ So what are you thinking? I’m thinking like AIDS, you don’t get AIDS at a cocktail party so my level of alarm goes down

Paul is dead on here. I had this exact type of conversation that Paul is talking about with a coworker. People think it's basically like AIDS, you have to have a needle stick or eat a bat or something to get it. You don't.

richard mcenroe said...

Please drop "that" in previous comment.

What gets me is that they speak with such certaintly about how ebola is circulated when, first, it is one of the most mutatable of viruses and second, they seem to pay no attention to the idea of multiple transmission avenues possibly involved.

The most I think they claim with certainty is that they have not yet discovered ebola transmission in any environment where other transmission avenues were not also present.

And isn't it interesting that the first transmission avenues that sprang into Obama's mind were the ones on the AIDS warning posters? Guess he does read some things put in front of him. Although he actually stands above the self-appointed NYC experts warning people not to lick subway car handrails or eat feces.

Okay, there are bars in NYC that probably need signs about those too...

Ignorance is Bliss said...

The Drill SGT said...

Over time, that viral load is expanding exponentially, but there is NOT magic point, the hour before you show a fever where you aren't infectious and an hour after you show a fever, you are.

This sounds likely, however there may be additional factors. For example, you are supposedly not able to get it through unbroken skin, but you can get it through a cut or through mucous membranes. So the same barrier that keeps it from getting in through you skin when you are uninfected might keep it from getting out through your skin early in your infection. ( That could break down later as the disease takes its toll. ) Likewise, you might be able to spread small amounts from mucous membranes while asymptomatic, but much more ( out of proportion to the viral load ) when the membranes start to break down.

HoodlumDoodlum said...

The funny part, to me, is that Kessler's explanation seems to suggest that unless someone has been confirmed to have an active Ebola infection they can't be contagious. "Uh-uh, virus, you can't get out of my body, I don't have a stamp from a Dr. yet!"

Henry said...

Ken B wrote: Kessler's headline is a lie.

Yes. The Kessler analysis is spectacularly bad. His job is to fact check, not analogy check. He makes an inference (Paul is saying "the administration equated Ebola to AIDS") and accuses Paul of making an implication.

For the difference between "imply" and "infer" I've always liked this scene from the otherwise unmemorable Dennis Quaid version of D.O.A.:

Bernard: I don't think I like what you're inferring, Mr. Cornell...
Dexter Cornell: [condescendingly] Implying. When I say it, that's implying. How you take it, that's inferring.
Bernard: I see. Infer this.
[punches Dexter]


Just think of Kessler as Bernard.

phantommut said...

Shanna, thanks for the kick in the pants:

Ebolavirus - Pathogen Safety Data Sheets

SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C) Footnote 52 Footnote 61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature Footnote 61. In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20°C and 25°C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days Footnote 61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting.

So in the lab findings are all over the place, from no survivability of the Ebola virus on dried hard surfaces at room temperature to several hours in the dark to 50 days in dried growth medium at 4 degrees C.

Ken B said...

Paul is right, abd Kessler is lying.
Here is an excerpt from last week’s report from the CDC (my bold):
“ CDC infection control recommendations for U.S. hospitals, including recommendations for standard, contact, and droplet precautions for general care, reflect the established routes for human-to-human transmission of EVD and are based on data collected from previous EVD outbreaks in Africa in addition to experimental data. “
This is from the WHO two weeks ago, again my bold:
“The Ebola virus is transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious being blood, faeces and vomit.”

kcom said...

"Lots of coughing, sneezing."

Everything I've read says coughing and sneezing are not symptoms of Ebola. It's not the flu. Just because you have a fever does not mean the rest of your symptoms are flu symptoms. All illness is not the same. Ebola is not a respiratory disease. It's a disease of endothelial cells lining your organs. Hence the bleeding when those tissues break down. Tell me how many orifices you bleed from the next time you get the flu. Different diseases, different symptoms.

Look at the pictures from West Africa. You don't see people coughing and sneezing. You see them laying there listlessly doing nothing. Did you see Nina Pham coughing or sneezing in her video? Her voice sounded perfectly normal. Plus, good news - she's virus free.

Browndog said...

So far, professional healthcare workers with possible exposure/exposure to ebola have:

-rode on a train
-rode on a plane
-rode on a cruise ship

(I MUST ride along to get soup! not withstanding)

protocols....

Henry said...

Good thing no one ever vomits on a bus.

Or sweats.

kcom said...

Malaria - high fever, no coughing.

Browndog said...

Henry said...

Good thing no one ever vomits on a bus.


You cannot get ebola from riding on a bus.

The science is clear, there is no debate.

consensus...

kcom said...

-put their fingers bowling ball holes

-put their feet in bowling shoes

Shanna said...

For example, you are supposedly not able to get it through unbroken skin, but you can get it through a cut or through mucous membranes.

YEah, but look at this article. Basically, you can easily have microabrasions that cannot be seen from scratching skin, shaving, etc. It's not so easy as covering cuts you can see.

http://www.virology.ws/2014/10/19/can-ebola-virus-infect-via-the-skin/

Shanna said...

Shanna, thanks for the kick in the pants:

Heh, sorry. That may have been a little terse. But you're right, the answers are kind of all over the place, it's just that for sure colder is not better. The devil's in the details.

Shanna said...

Ok, one more comment before I stop. I can't believe you posted this and didn't mention it was written by Richard Preston!!!

kcom said...

Here's a very interesting Ebola page I found a few weeks back.

It's fairly technical but still understandable by most, I would think.

It had lots of information I hadn't heard before.

jr565 said...

Kcom wrote:
"Everything I've read says coughing and sneezing are not symptoms of Ebola. It's not the flu. Just because you have a fever does not mean the rest of your symptoms are flu symptoms. All illness is not the same. Ebola is not a respiratory disease. It's a disease of endothelial cells lining your organs. Hence the bleeding when those tissues break down. Tell me how many orifices you bleed from the next time you get the flu. Different diseases, different symptoms."


Well then you didn't read this:

How Do People Catch Ebola Fever?

"The Ebola virus is spread from person to person through contact with infected blood and body fluids. Doctors also believe that it passes through the air when an infected person coughs or sneezes. Hospital workers are at high risk for Ebola during outbreaks, because they come into contact with blood and body fluids when they care for infected patients. Infected patients often die very quickly, limiting the opportunity for the virus to be transmitted to many other people. This may be why Ebola outbreaks have not become widespread."

also because they arsnt traveling to US. Until they do. There may be a short window but they are in a city of millions. And this guy was at a bowling alley, took the subway etc.

So what are the symptoms?

What Are the Symptoms?
"About 5 to 10 days after infection, people with Ebola get a fever, headache, and body aches. Frequently there is nausea, vomiting, diarrhea, cough, chest pain, and sore throat. Often there is sensitivity to light, swollen lymph glands, rash, as well as other symptoms."

So, one if the symptoms is COUGH.
Therefore, why are you trying to bamboozle people into thinking coughs can't possible spread transmission?

And when you see Ebola patients are you in the room with them so you can see their symptoms? or are you basing it off of a thirty second news segment where the person you saw didn't happen to cough?

http://www.humanillnesses.com/original/E-Ga/Ebola-Fever.html#ixzz3H5Ms8anZ

pm317 said...

Wet and dry distinction goes for everything sanitation related and why would it not go for ebola? A wet sneeze/cough is a wet sneeze/cough releasing wet particles into the air. The question is how far and for how long and the critical mass -- there we may see an exponential decay and therefore, low risk and high manageability. Obama cronies have been disputing airborne and aerosol effect for a while. A bully on Bret Bair shushed George Will who didn't have his facts ready, very effectively. But as Kent Brantly said, if he thinks he got infected when he was not wearing his suit and examining people in ER who were not yet diagnosed as having ebola, it is possible that close physical proximity to the infected person is enough.

Julie C said...

Ebola patients don't cough? Read the freaking article!

As Shanna pointed out, it was written by the author of the Hot Zone, so this guy has a lot of knowledge about this topic.

The details about Khan, Brantley and Writebol was fascinating, terrifying and tragic all at once.

pm317 said...

Everything I've read says coughing and sneezing are not symptoms of Ebola.

What if the infected person gets pneumonia? But that may happen at later stages when the patient is effectively isolated.

kcom said...

I'm basing it on the totality of everything I've ever read or seen. Including reports from doctors serving in Liberia recently. Your post made it sound like the flu, with coughing and sneezing as the primary symptoms. It doesn't present like that from all the reports I've read. Those are flu symptoms or cold symptoms.

CDC: Ebola
•Fever
•Severe headache
•Muscle pain
•Weakness
•Diarrhea
•Vomiting
•Abdominal (stomach) pain
•Unexplained hemorrhage (bleeding or bruising)

I'd be much more concerned with a patient with those symptoms than a patient coughing and sneezing with the flu.

CDD: flu
•Fever* or feeling feverish/chills
•Cough
•Sore throat
•Runny or stuffy nose
•Muscle or body aches
•Headaches
•Fatigue (tiredness)
•Some people may have vomiting and diarrhea, though this is more common in children than adults.

Every single patient we've heard about so far presented with fever and other non-respiratory complaints, like fatigue. Frequently, the only reason they knew they were sick was from taking their temperature and finding out it was slightly elevated. Otherwise they had no overt symptoms. They didn't present like they had flu because they didn't.

Can an Ebola patient cough or sneeze? Yes, of course, they can. But so can a cancer patient. It's not diagnostic for Ebola.

Hiccups, on the other hand, seems to go with Ebola a fair amount of the time.

"The Ebola virus had been circulating in Guinea for roughly three months before doctors and international aid organizations finally detected it.

It was hiccups that eventually gave it away, journalist Jeffrey Stern wrote in Vanity Fair this weekend.

To find out why the virus eluded detection for so long, Stern went to Meliandou, a remote Guinean village where Patient Zero is thought to have lived, to investigate.

Ebola, he writes, isn't easy to diagnose in its early phase.

"Most of us think of Ebola as sort of the cinematic portrayal of it — you know, bleeding out of the eyes and ears," Stern tells NPR's Audie Cornish in an interview today on Morning Edition. "That happens, but it doesn't always happen, and it doesn't happen until the later stages of the virus."

In the early stages, he says, symptoms can look a lot like cholera and malaria. And since Guinea had never experienced Ebola, no one knew to look for it — not even people in the medical community.

Then Dr. Michel Van Herp, an epidemiologist with Doctors Without Borders, noticed something odd. Half the patients listed on a medical report from Guinea had the hiccups.

"Hiccups is something that's associated — for reasons we're still not entirely sure of — with hemorrhagic fever, but especially with Ebola," Stern says.
"

David said...

In better news, Nina Pham has survived her case of Ebola and is now symptom free and not contagious.

kcom said...

Malaria:

More commonly, the patient presents with a combination of the following symptoms:

Fever
Chills
Sweats
Headaches
Nausea and vomiting
Body aches

CDC: Cholera

•profuse watery diarrhea, sometimes described as “rice-water stools,”
•vomiting
•rapid heart rate
•loss of skin elasticity
•dry mucous membranes
•low blood pressure
•thirst
•muscle cramps
•restlessness or irritability

pm317 said...

Yes, lucky Nina Pham. Or should I say lucky CDC.

kcom said...

Don't see much coughing and sneezing there.

David said...

Ebola is a greater transmission risk than aids simply because aids requires a voluntary participatory act and a disregard of available safety measures during that voluntary act. Because sex is pervasive and people are fools aids nevertheless gets transmitted, but an individual can always protect him or herself from the disease. And when knowledge and responsible activity are combined, the spread of the disease can be stopped at a societal level.

Ebola on the other hand seems possible to spread without voluntary interaction between two humans. It can be spread from the unsuspecting to the unsuspecting and from the irresponsible to the unsuspecting. It is therefore more fear inducing and (depending on what the transmission mechanisms really are) could potentially be more widespread. The fact is there is a lot we do not understand about Ebola, and our leaders are acting as if they understand it. Just how much we actually know will become evident over the next year or less.

Right now we have an Ebola risk not an Ebola epidemic. The level of risk is very unclear, and we do not (and should not) trust those who are purporting to clarify it.

Peter said...

"I'm not a bio-scientist, but viral disease infection rates are not a step function, but a continuum of risk."

And I'd expect the probability of viral survival (in saliva or sweat) on some surface (at a specified temp. and humidity) is not going to be step function either but more like an exponential decay.

Ken B said...

Cough need not be a symptom of ebola for coughing to be a worry. People cough. People with ebola will also cough.

Sneezing need not be a symptom of ebola for sneezing to be a worry. People sneeze. People with ebola can sneeze.

Spitting slightly when you talk or yell need not be a symptom of ebola for it to be a worry. Many people expel spittle on occasion. So will people with ebola.

Being as stupid as some of the Kessler apologists here need not be a symptom of ebola for such stupidity to be a problem.

dreams said...
This comment has been removed by the author.
traditionalguy said...

DeNile and Ebola are both the names of rivers in Africa.

Bill Harshaw said...

I repeat my assertion: the only Americans to get infected on American soil were health care workers caring for a patient, not ordinary civilians who had contact with someone with Ebola. Even Duncan's relatives, living in the same rooms with him over a period of days did not get Ebola. That's fact, not Internet truthiness, but fact from which one can infer some realism about the infectiousness of the disease.

I'd almost make this bet: the number of Americans infected on US soil and dying of the disease during 2014 will be smaller than the number of victories the Washington football team posts in their 2014 NFL season. :-)

kcom said...

"Being as stupid as some of the Kessler apologists here need not be a symptom of ebola for such stupidity to be a problem."

I'll charitably assume that's not directed at me even though you're responding to my comment because I have no doubt you saw my earlier post where I said I wouldn't trust a journalist as likely to be innumerate as not (or probably more likely) like Glenn Kessler to "fact check" a medical question. He should stick to politics. I'll give him four Pinocchios for thinking he's qualified to give an absolute answer in this case.

But at the same time, saying someone with Ebola is presenting with coughing and sneezing as their primary and perhaps only symptoms is not supported by any facts I've read. Remember, I was responding to a specific comment with the implicit premise that an Ebola patient is going to the doctor with those symptoms and not Ebola symptoms. No patient we've seen reported on so far has done so. And no patient has passed on Ebola that we've seen that didn't have Ebola symptoms. In fact, the only people who have gotten it in the US so far have been swimming in the body fluids *(i.e. blood, feces, vomit from deep in the body) of known, diagnosed, symptomatic, late-stage (probably, depending on the time of infection) Ebola victims. So worrying about some non-symptomatic snot from a flu case is not going to keep me awake at night worrying about Ebola.

AReasonableMan said...

Peter said...
"I'm not a bio-scientist, but viral disease infection rates are not a step function, but a continuum of risk."

And I'd expect the probability of viral survival (in saliva or sweat) on some surface (at a specified temp. and humidity) is not going to be step function either but more like an exponential decay.


But it is not a continuous problem. It is a stochastic problem, individuals either do or do not get sick. In a finite population with a sufficiently low risk no one gets sick, irrespective of whether or not the risk is distributed exponentially.

kcom said...

And, by the way, I agree with you on this:

"Kessler's headline is a lie. Paul said people listening to reassuring comments conclude it's like AIDS. That is not what the headline claims."

Glenn Kessler was completely misrepresenting what Rand Paul said, either through stupidity or partisan bias.

Here's the direct quote from Rand Paul: "So what are you thinking? I’m thinking like AIDS, you don’t get AIDS at a cocktail party so my level of alarm goes down."

Nowhere, exactly nowhere, does he make any claim about the White House and AIDS. He clearly says, "I'm thinking", not "they're thinking".

kcom said...

Glenn Kessler is fact-checking a straw man.

Big Mike said...

I'd almost make this bet: the number of Americans infected on US soil and dying of the disease during 2014 will be smaller than the number of victories the Washington football team posts in their 2014 NFL season.

Even the way the team is playing so far this season? You must b every confident.

kcom said...

"In a finite population with a sufficiently low risk no one gets sick, irrespective of whether or not the risk is distributed exponentially."

Can you expand on this or reword it? It's a little confusing. What do you mean by "distributed exponentially"?

There is a risk here that I might actually agree with you on something. But my symptoms are still vague at this point. :)

Shanna said...

Nowhere, exactly nowhere, does he make any claim about the White House and AIDS.

Indeed. He is talking about how people are interpreting what the white house has said. And as mentioned, this is absolutely how people are interpreting it. And in large part, that is because they are emphasizing transmission through fluids, without really getting into this meaning sweat, and droplets, landing on skin. Even if the CDC has things listed correctly on a website, the way it is being reported is meant to downplay easy transmission - people talking about ebola being 'hard' to catch.

Shanna said...

Or rather, interpreting not just the white house, but also the CDC and the media in total.

pm317 said...

@kcom,.. ARM does not know what he is saying..it is confusing for him too.

hombre said...

Of course the three Pinocchios weren't based on what Paul said, but on what the WaPo said he said.

Pretty sloppy for a fact checker, but par for the lefty mediaswine.

AReasonableMan said...

kcom said...
Can you expand on this or reword it?


The original poster is trying to argue that the risk never falls to zero, but this is irrelevant since it is not a continuous system. It is a quantum problem, there are a finite number of viral particles and a finite number of people who can be infected. From the perspective of the virus, at some level of decreasing continuous risk there are no longer any viral particles to infect, you can't have a half a viral particle or 1/10 of a virus. Similarly, in a finite population the risk falls so low that no one actually gets infected even if the risk is technically not zero for that population.

Hope I did a better job this time.

Bill Harshaw said...

Big Mike: Very confident on Ebola, not so confident on football. If it were 2012 I'd be happy to make the bet.

But let me be halfway serious: if by the time I do my Christmas shopping (late Dec.) more than 3 Americans have died in the US from Ebola contracted in the US I will shop Amazon through the Althouse blog, thereby benefiting Ann. (Caveat: someone needs to remind me of this in case I lose.) I'm sure the Skins can eke out one more victory, can't they?

pm317 said...

Look what I found!

Airborne or aerolsized Ebola particles falling to the ground and disappearing..to go with what I said in my previous comment: A wet sneeze/cough is a wet sneeze/cough releasing wet particles into the air. The question is how far and for how long and the critical mass -- there we may see an exponential decay and therefore, low risk and high manageability.

kcom said...

"The original poster is trying to argue that the risk never falls to zero."

Two points.

The person making that particular follow-on argument was a commenter to the original comment, so I hope we are attributing the arguments properly.

Second, and more important, I don't think that's what he's really saying. I think he's just making the basic, common sense argument that the risk doesn't go directly to zero past a certain set time. Not all the viruses (virions, if you prefer) self-destruct in coordination with each other simultaneously. They fall by the wayside on an exponential curve so that the more vulnerable ones (based on environmental conditions or whatever) disappear first and fastest and others are longer-lived. But eventually, they all decay away and the risk is eliminated. Basically, the same as radioactive decay. There's a half-life involved and not a step.

kcom said...

Although if you added some bleach, I think that would introduce a very definite step.

kcom said...

"But let me be halfway serious: if by the time I do my Christmas shopping (late Dec.) more than 3 Americans have died in the US from Ebola contracted in the US..."

Which means so far we're at 0 and not likely to get an example any time soon since our two US-contracted patients are both being released. Everyone else currently hospitalized (is the new doctor the only one left with an active infection?) acquired the virus overseas.

I'd be with you on that bet but make no promises about my Christmas shopping. That's not my forte.

tim in vermont said...

I guess we need to think about at what levels of ebola we raise the drawbridge and blow the other bridge and live on perch and cow corn for the winter.

It's a joke ARM, a joke! Obviously people could walk here on the ice by late January.

Shanna said...

"The original poster is trying to argue that the risk never falls to zero."

I see where the confusion is, ARM.

The Drill Sgt was originally talking about when someone becomes infectious, so the risk starts out very small, almost nothing and then as the disease progresses it grows. The risk is zero when the person has no ebola.

Then Peter I guess started talking about how long virus could last out of the body, but the continuum of risk was actually about a single infected patient.

Brent said...

Mythbusters showed how far a sneeze can travel and the mess it makes. To get a good idea of just how easy it would be to get ebola from a sneeze (despite the often repeated claim that it isn't airborne), check out the video:

http://www.discovery.com/tv-shows/mythbusters/videos/slow-motion-sneezes.htm

Original Mike said...

Not sure when @Glenn Kessler became a doctor.

kcom said...

"It's a joke ARM, a joke! Obviously people could walk here on the ice by late January."

I've walked the ice bridge from Africa. It's fun to say hi to the tropical fish along the way.

kcom said...

"Not sure when @Glenn Kessler became a doctor."

I see what you did there. :)

Loving it.

kcom said...
This comment has been removed by the author.
kcom said...

"To get a good idea of just how easy it would be to get ebola from a sneeze"

Actually, it doesn't really tell you that. It just tells you how easy it is to get sneezed on. That's step 1. Step 2 is to determine how infectious Ebola is in that scenario. From what you've described, the episode presents no evidence for that answer.

Let's do an experiment. I'll let you take a cupful of anopheles mosquitoes filled with malaria parasites and lob them at me in handfuls. I'm betting I won't get malaria. So there's more to infection than just proximity. Again, Eric Duncan's family lived in the same apartment with him for four days while he had serious Ebola symptoms. None of them got sick. It might be possible to get Ebola by being sneezed on from 100 yards away but to say it's easy is an unproven assertion. A blood, vomit and feces cocktail in a Super Soaker, though, might give me pause.

Big Mike said...

@kcom, ARM is in the mainstream of 21st century liberalism. Consequently his sense of humor and ability to tolerate ideas that differ in even the slightest scintilla from the ones he has been given to believe in have been surgically excised.

AReasonableMan said...

Big Mike said...
@kcom, ARM is in the mainstream of 21st century liberalism.


We covered this before. I'm a moderate.

Big Mike said...

We covered this before. I'm a moderate

The drivel you type shows the rest of us that you are an extremist. If you really think that you're a moderate then you need to meet some real human beings. But I think you know that you are an extremist and are merely lying, because that's what 21st century liberals do.

HT said...

We may have a little ways to go in our education of certain medical personnel on transmission-based precautions. (As to your question, no I don't think they are telling us everything but not because they are hiding it; but rather they don't know. And the journalists look like such poor sops in all this, just over their heads. But it's not totally their fault, it's a fast-moving story, so to speak.)

Believe it or not, many are taught that the viral hemorrhagic fevers are contact precautions - take contact precautions that is. Here's a sentence on that: "Masks are not needed, and doors do not need to be closed." Obviously, they were talking out their butts, and this is from a textbook.

But, does that mean the VHF should be airborne precautions? (Airborne precautions in this country are usually reserved for measles, TB and chcikne pox - transmitted by airborne droplet nuclei which are less than 5 microns. Droplet precautions for greater than 5 microns. No I don't totally understand exactly what I just wrote). No. Although when you look at proper protocols for PPE it looks like airborne precautions on supersteroids.

So obviously, while VHF may still be contact, there needs to be a new level of contact precaustions because lumping Ebola in with C dif just ain't gonna cut it!

HT said...

interesting. I see CDC recently updated their Ebola precaution page on Oct 20. They say it is contact AND droplet. I wonder if they always classified it as droplet. My books don't.

http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Anonymous said...

...if you are not wearing biohazard gear, you should stand at least six feet away from an Ebola patient...

Only six feet? I'm warned to stand beyond eight feet from the entrance of Costo just to smoke a cigarette!

HT said...

From the New Yorker article:

"The question often asked is whether Ebola could evolve to spread through the air in dried particles, entering the body along a pathway into the lungs. Eric Lander, the head of the Broad Institute, thinks that this is the wrong question to ask. Lander is tall, with a square face and a mustache, and he speaks rapidly and with conviction. “That’s like asking the question ‘Can zebras become airborne,’ ” he said. In order to become fully airborne, Ebola virus particles would need to be able to survive in a dehydrated state on tiny dust motes that remain suspended in the air and then be able to penetrate cells in the lining of the lungs. Lander thinks that Ebola is very unlikely to develop these abilities. “That would be like saying that a virus that has evolved to have a certain life style, spreading through direct contact, can evolve all of a sudden to have a totally different life style, spreading in dried form through the air. A better question would be ‘Can zebras learn to run faster?’"

tim in vermont said...

"I've walked the ice bridge from Africa. It's fun to say hi to the tropical fish along the way."

You should have taken the "intercontinental railroad."