Ebola update: CDC moves to rarely-used highest level of alert

The NYC patient, who was thought to possibly have Ebola, does not.

The CDC said that tests show that he is not infected with the virus.  He had been isolated since it was first suspected that he might have Ebola after showing up in the ER at Mount Sinai Hospital.

The repatriated Spanish priest is now in isolation at a hospital in Spain, and is reported to be ill, but stable.

Brantly and Writebol are still in Emory University Hospital in quarantine.  Emory is prevented from releasing much information on patients’ conditions due to privacy laws.  But Nancy Writebol’s son said that he and other members of the family visited with her yesterday.  He says she is very tired and still fighting the disease. Brantly has apparently requested that no information be released about his condition.

The CDC has moved the Ebola outbreak status to its highest level of alert.  It declared the outbreak a Level 1 activation.  Level 1 activations are only rarely used. In the past, the CDC has declared such high level alerts after Hurricane Katrina and during severe flu pandemics.  This upgrade in classification will allow the CDC to increase its degree of response to the emergency.  It will be sending an additional 50 CDC staff to the area over the next 30 days.

who-logoThis move was sparked by the disease outbreak reaching Nigeria.  The World Health Organization is considering classifying the outbreak as an international public health emergency.  If it does so, that can lead to policies that could cause quarantine procedures to be enforced, halting air travel to affected areas, etc.

ZMapp, the experimental drug that was given to the two US healthcare personnel infected with Ebola, is being sought after by Nigeria and other countries involved in the outbreak.  It is in very limited supply.  More can be made, but it will take time.  In the meantime, the WHO is going to convene a panel of bioethicists to help decide how the drug should be apportioned.

A Saudi has died in Jeddah from a viral hemorrhagic fever, like Ebola.  He had recently returned from a business trip to Liberia.  He was hospitalized and quarantined, but continued to deteriorate and died. It is unknown if he did have Ebola, tests are still pending.

In the three nations most severely affected (Liberia, Guinea and Sierra Leone) there is continuing social upheaval, to a degree.  The local police and military are being used to enforce quarantine and screening policies, protect clinics and healthcare workers.  In some areas of these countries they are being used to do a house to house check to see if there may be Ebola patients being kept at  home.  In other areas, they are blockading off Ebola-infected villages to prevent further spread of the disease.

Some families have dumped the bodies of relatives who have (presumably) died from Ebola in the streets rather than calling the health ministry officials to pick them up for cremation.  In other instances, families will drop of a patient suspected of having Ebola at a clinic and then the family will leave the area.  People are afraid of being sent off to be quarantined, fearing that they will get the virus there.  Governments are doing outreach/education campaigns to get the information on the virus out to the citizens.  They have set up hotlines and are posting signs and showing videos to try to get information out to help with containment.

Nigeria, as well as the other countries hard hit with Ebola,  has publicly asked for volunteer healthcare workers to come to Nigeria to help them in case more Ebola cases appear.  Right now, there have been two deaths in Nigeria that may be due to Ebola and about 8 other patients now in quarantine with suspected Ebola.  Sierra Leone, Guinea and Liberia, are very much strapped by this outbreak.  They were poor before the disease started and are in even worse shape now.  All have appealed for help from outside sources.  The WHO will try to increase funding to these countries, or help in sending them medical supplies, food, medications and other necessary supplies.

As of yesterday, there are about 1,700 suspected or confirmed cases of Ebola in the affected regions. There have been about 932 fatalities. That means that about 56% of patients who get Ebola, and are treated in Africa, die from the disease.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • MJ

    I believe everything you learned in grad school was correct. But also, like Naja said, in the later stages of the disease it entered the lungs and did become airborne, which was probably why it wiped out half (?) of Europe.

  • arleeda

    I thought bubonic plague was spread via bite of rodent fleas, at least that’s what I learned in grad school in the 1960s. It’s a bacteria that is or was fairly easily controlled with standard antibiotics. It’s zoonotic in many woods and forests of the US, so people who go hiking in the wilderness are the most likely to get it. But yeah, you can also get from bodily fluids of an infected person.

  • MaxBangayvef

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  • Zorba

    LOL!
    Fortunately, he doesn’t bring that kind of work home with him. ;-)

  • docsterx

    That’s way cool! I’m sure that you’re an appreciative audience and have a lot of great questions. That’s great just so long as you don’t touch those funny looking little bottles he has behind the furnace. And those glass flasks with the red liquid in the medicine chest. And those tubes in the freezer under the popsicles. Oh, and those mice you’ve seen? The ones that don’t have any hair? Keep the cat away from them. http://www.accurobio.com/images/flask.jpg http://www.usascientific.com/productimages/organizers/lg/27471033.jpg

  • MJ

    I should have specified I meant the 1300’s bubonic plague. (Thanks).

  • GarySFBCN

    Some may consider death as a symptom of disease. :-)

  • Zorba

    You want to be terrified? Try being married to a molecular virologist/molecular biologist, as I am. Who talks a whole heck of a lot about his work. ;-)
    People seem to be frightened of stuff that won’t necessarily effect them, and not frightened of stuff that may well be more dangerous.
    And, BTW, Mr. Zorba is also an expert on drug resistance and mutations, not just of viruses, but of bacteria as well. He has been asked for advice by both the CDC and the World Health Organization.

  • docsterx

    Sorry, didn’t see your post before I replied to Gary.

  • docsterx

    Ebola can be “alive” on surfaces for at least 3 days. Depends on things like if it’s exposed to UV radiation, cleaning agents, etc. 10% bleach in water will kill it on surfaces.

    Ebola mutates but slowly. So far, in this outbreak, no, no evidence of mutation.

    Yes, infectious only when showing symptoms. Usually symptoms progress fairly rapidly, but not always. And not every patient gets all, or even the same, symptoms. Some bleed, some don’t, some go into shock, some develop organ failure (kidneys and liver) others don’t.

  • docsterx

    I read that, and other virus novels. Terrifying and fascinating both.

  • docsterx

    Body fluids from people who are ill (sweat, feces, saliva, blood, etc.) or instruments, hands contaminated with the same. They need to come in contact with mucous membranes, broken skin, etc.

  • http://wicca.com/celtic/wicca/wicca.htm Colin

    “He open his mouth and gasps into the bag, and the vomiting goes on endlessly. It will not stop, and he keeps bringing up liquid, long after his stomach should have been empty. The airsickness bag fills up to the brim with a substance known as the vomito negro, or the black vomit. The black vomit is not really black; it is a speckled liquid of two colors, black and red, a stew of tarry granules mixed with fresh red arterial blood. It is hemorrhage, and it smells like a slaughterhouse. The black vomit is loaded with virus.” The connective tissue in his face is dissolving, and his face appears to hang from the skull. He open his mouth and gasps into the bag, and the vomiting goes on endlessly. It will not stop, and he keeps bringing up liquid, long after his stomach should have been empty. The airsickness bag fills up to the brim with a substance known as the “vomito negro”, or the black vomit. The black vomit is not really black; it is a speckled liquid of two colors, black and red. The black vomit is loaded with virus.” The Hot Zone

  • http://www.americablog.com/ Naja pallida

    Even the bubonic plague, under normal circumstances, is not airborne. Again, it is transmitted by coming into contact with bodily fluids. But in the later stages the infection can enter the lungs and become pneumonic plague. If someone with pneumonic plague coughs, they potentially aerosolize droplets containing the bacterium, which can then infect anyone who breathes them in. Not unlike influenza or the common cold. Not to mention, vomiting blood can also be a symptom. In an era with little or no proper sanitation, and little concern for personal hygiene, much less adequate medical isolation, almost anyone who entered a house with plague would have a good chance of contracting it.

    Today, it’s surprising, but there are still around a dozen cases of plague in the US each year, thousands around the world, but prompt and proper medical care makes it less of a threat than it has been in history. Not to mention, antibiotics. Ebola, being a virus, is that much more difficult to treat.

  • http://www.rebeccamorn.com/mind BeccaM

    http://americablog.com/2014/07/serious-ebola-outbreak-africa.html

    …and Mark’s other posts on the subject.

  • MJ

    Okay. Thanks for the info. As long as it doesn’t pull an airborne on us (a la bubonic plague) we should be able to control it.

  • MJ

    But if I do that I’m also getting the loons saying it was created in a lab, etc.

  • http://www.rebeccamorn.com/mind BeccaM

    Um, well, a dead person isn’t technically symptomatic, and unfortunately, close contact with a dead body that died from Ebola is one of the ways it can be transmitted.

    I’ve read a number of reliable accounts to indicate that, for example, Ebola can be transmitted sexually up to several weeks after a person has recovered from it. It is possible also to be asymptomatic. It’s just that when someone is having severe symptoms, that’s when the body is throwing off the maximum amount of transmissible fluids in all directions — vomit, perspiration from fever, blood, fecal matter, etc.

    Incubation period has been reported from many sources as being between 2 days and 3 weeks.

  • http://www.rebeccamorn.com/mind BeccaM

    Plug that question into Google and you can find reams and reams of information.

  • Indigo

    My impression is that the water shortage has already gone horribly wrong. The media haven’t yet said so in so many words, just as the media, possibly at government prodding, still pretends the economy is just fine, and here we are in the middle of a Depression the authorities continue to paper over.

  • http://www.americablog.com/ Naja pallida

    Also consider water shortages in the south and southeastern US. While here bottled water is relatively easy to come by, at some point there will be cases where people or communities cannot afford it, and resort to getting their drinking water from ever smaller reservoirs of water. Sources which can easily become contaminated resulting in the spread of all sorts of things. There are already cases in Texas where people living on public waterways are pumping water directly from the lake/river, instead of using what is available through their tap. We’re looking at a third world situation, and it’s only a matter of time before something serious goes horribly wrong.

  • http://www.americablog.com/ Naja pallida

    Ebola is acquired through direct contact with bodily fluids of an infected person or animal. It is not airborne, though there was some fears stirred up when scientists couldn’t adequately explain how the virus jumped the species barrier from pigs to macaques. More recent research hasn’t been able to find any cases of airborne transmission between primates nor humans.

  • MJ

    So…how is Ebola spread anyway ? I’m assuming (hoping) it’s not airborne…(?)

  • Indigo

    “Continuing social upheaval” strikes me as even more worrisome than the ebola outbreak. Like the danger on our southern border of outbreaks of contagious disease because of the overcrowding of the child immigrants is another example of the danger and then there’s the politically incorrect to mention danger in bombed out Gaza where food and water and contagion and the threat of typhoid and cholera and the bottom line results of the Israeli decision in favor of relentless bombing. Oh, yes. “Continuing social upheaval” is the bottom line here.

  • GarySFBCN

    Questions:

    On one of the morning news shows, someone implied that people with Ebola are only ‘infectious’ when they are symptomatic. Is that true? Does that mean that one goes from being infected to being symptomatic very quickly?

    Is there any data regarding how long the virus can survive outside of the host?

    Is there any indication of the virus mutating?

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