Ebola Update: Situation worsens in Africa, untested drug out of stock

The priest evacuated to Spain for medical treatment, Fr. Parajes, died of Ebola in a Madrid hospital.

He had been infected with Ebola while ministering in Liberia. He was supposed to have been given the experimental treatment, ZMapp at some point before he died, but there is some controversy as to whether he did. His body will be cremated tomorrow.

Several missionaries from SIM, who were in Liberia, have returned to the US. None has Ebola, but they will remain in quarantine at a location in North Carolina for 21 days. Their temperatures will be monitored 4 times/day. If anyone develops a fever, he will be removed to a hospital for isolation and treatment.

Kent Brantly and Nancy Writebol continue to improve in Emory Hospital’s isolation unit.

The number of Ebola patients in Nigeria varies, depending on the source. There may be 10 or 13. They are quarantined and being treated in Nigeria. So far, all of them have had direct contact with the Nigeria’s index case, Patrick Sawyer. They were healthcare professionals involved in his treatment.

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

The World Health Organization has approved the use of ZMapp, the monoclonal antibody drug that is currently untested in humans, for treatment of Ebola patients. Use of untested therapies can pose a risk to patients. Any patient who gets ZMapp will have to be informed of possible complications and other consequences of trying an unproven therapy. There has been an ethical debate about using the drug under these circumstances. In addition to the question of “should it be used,” bioethicists were also looking at which people should get it. Should it be only used for patients near death? Should it be used earlier, before the patient was in extremis? Should it be used only in the country (-ies) where it had been developed? Could it be given to pregnant women, knowing that there might be a risk to the fetus? These and other questions were considered. Some are still under study.

Unfortunately, the bioethicists will have some time to consider them because the manufacturer of ZMapp has exhausted its supply. Two doses of ZMapp have been sent to the affected area to treat two African physicians infected with Ebola. The company says that it will now take several months to produce even a small amount of additional drug.

One trial of an anti-Ebola vaccine may begin as early as next month. Other vaccines are in the drug development pipeline and could begin testing as early as next year. But even if drug tests go very well, it will still take some time for the vaccine to be produced in large quantities and made available for use.

The situation in the three most affected countries, Sierra Leone, Liberia and Guinea, continues to worsen. Some religious charities, like SIM, are evacuating most of their medical personnel. With the number of cases of Ebola increasing, decreasing medical personnel, the rainy season beginning, unwillingness of some healthcare personnel to treat patients, lack of funds and supplies, conditions will continue to get worse. These areas have very few of their own Western-trained physicians. Even at the best of times, without an outbreak such as this, medical care is stretched thin. In many cases it is totally unavailable.

Some physician-members or the nationwide medical organization on strike in Nigeria, voted to end the strike and return to work. Others refused stating that the Nigerian government is not even considering their demands. So the physicians’ strike in Nigeria continues.


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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  • jorgemandrews

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  • SnakeUSMC

    very easy method of testing if the mosquito I mentioned, NOT any type of mosquito but the Tiger Mosquito which at first only carried Dengue Fever. Now it carries 4 other viruses and the canine heart worm. If it has the ability to adapt to carrying 4 other viruses then it may have the ability to adapt and carry any other viruses. So let’s set up and experiment.

    1. Equipment : Modified 55 gallon plastic aquarium, dish pan, two plastic separations with holes near the top which are large enough to allow tiger mosquitoes to pass through all three chambers. Bedding material, secure food and water founts for hairless mice.

    2. Two sets of hairless mice groups at either end of the aquarium. One infected with Ebola, the other not.

    3. Dish pan in the middle chamber filled with non chlorinated water. Amplified with food for the larva of the Aedes albopictus mosquitoes.

    4. After three weeks, from date of infection the non infected mice are tested for antibodies of Ebola.

    This is how science works.

    Now just because a study is 2 years old, does NOT by any means lessen the findings. The second link does NOT counter the first link but if YOU and others reread the link then you shall find the CDC is still up in the air concerning the transmission.

    If you are SO sure concerning your last paragraph, then I suggest you replicate the yellow fever study which was conducted in the 1900’s.

    h t t p : / / y e l l o w f e v e r . l i b . v i r g i n i a . e d u / r e e d / c o m m i s s i o n . h t m l

    And because you are so SURE this type of mosquito CANNOT carry the virus, you should be the first to step up and allow yourself to be bitten.

    Lastly, in full rebuttal of your statement “You see, when you keep two animals less than a foot apart, even if they
    don’t physically touch, bodily fluids can still be exchanged.” When other people reread the links, you and they will NOTICE the animals were kept ACROSS the room, not a foot apart as you claim. Where did you come up with that figure?

    h t t p : / / w w w . c d c . g o v / v h f / e b o l a / p d f / f a c t – s h e e t . p d f

    h t t p : / / t h e c o n s e r v a t i v e t r e e h o u s e . c o m / 2 0 1 4 / 0 8 / 0 5 / t h e – c u r r e n t – e b o l a – s t r a i n – i t s – a i r b o r n e – f o l k s – e i g h t – n i g e r i a n – m e d i c a l – w o r k e r s – w h o – t r e a t e d – i n f e c t e d – u – s – p a t i e n t – p a t r i c k – s a w y e r – h a v e – c o n t r a c t e d – e b o l a – v i r u s /

    You will NOTICE and all that take time to read the last link, the CDC does not know the mode of transmission of the virus to the doctor, BUT cited a case study of primates from the PI passing the virus to humans who became sick but did not die in the air.

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

    You could at least offer a vinaigrette to go with your word salad.

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

    Your first link is ~2 years old, and the situation described has already been studied extensively. You see, when you keep two animals less than a foot apart, even if they don’t physically touch, bodily fluids can still be exchanged… and in pigs, the virus attacks the lungs, causing them to expel much more of the virus than primates do when they are infected.

    Your second link is going out of its way to misrepresent the facts. The CDC recommendations it references say the exact opposite of what the blog post says, and clearly spells out that Ebola is not airborne, but people come into contact with each other in other ways – especially when crammed in a flight cabin.

    Mosquitoes are not known to be a risk factor for Ebola. Studies have yet to show the virus replicating in a mosquito host, but there are plenty of other reasons to do everything you can to avoid bug bites.

    So yes, don’t hide from facts. The chances of anyone catching Ebola without getting the bodily fluids of a known infected person on them is slim to none. The fear mongering is unnecessary, the situation is concerning enough all by itself.

  • SnakeUSMC

    So you may wish to read these articles to counter your statements. Unless you have worked in a lab and tested your theory regarding air borne transmission, you might wish to read scientific studies. IF and I say again IF their studies prove to be correct or even as a vector the Aedes albopictus which has adapted to carry up to 4 different viral strains when it was first discovered could carry only ONE, Might and I say again MIGHT be the vector which would be required to spread it. Both ways are a possibility. Since we have this mosquito in FL and CA, it does require a terrorist mental genius to already figure this out. So when you make a statement such as yours, please do not shy away from data which might prove otherwise your statement has failings. The more you know about an illness, the better you can protect yourself. Don’t hide from facts as long as those facts come from a scientific source.

    h t t p : / / w w w . b b c . c o m / n e w s / s c i e n c e – e n v i r o n m e n t – 2 0 3 4 1 4 2 3

    h t t p : // w w w . d c c l o t h e s l in e . c o m / 2 0 1 4 / 0 8 / 0 5 / a i r b o r n e – c d c – n o w – c o n f i r m s – c o n c e r n s – a i r b o r n e – t r a n s m i s s i o n – e b o l a /

  • SnakeUSMC

    beccam, you may believe AC was the first to think about these possibilities. But we have a group of people who toss around these exact same ideas YEARS and MONTHS ago. In order to defeat and enemy you must first THINK like one. This goes along with the Sun Tzu art of war of Knowing your enemy. So AC is not posting anything that has not thought of already. It will hit because of obamass open borders. Where it hits would be NYC first target, then SF and LA. NYC would be the prime target because the islamics hate the Jewish RELIGION. Judaism is a religion, NOT a race. They the islamics believe their reward for murdering millions of people is an eternal supply of virgins to give relief to their base desires. So your reply is so far out of line, and spoken from and UNKNOWING and UNTHINKING person who like We Have peace in our time Chamberlain, will sit with their thumb up their hine quarters when this does occur and wonder, HOW DID THIS HAPPEN? Oh we GAVE them the idea….

    So you can take your peace symbol which is the foot print of the American Chicken when the event happens, raise it proudly as you and others die of this and other means by these terrorists.

    Try to have a nice sleep after reading this.

  • just_AC

    Well, this is actually a “thank you” to all of the repliers, but Becca, you KNOW we don’t live in an uninformed world in regards to terrorists. I’m NOT sending them advice they didn’t already know about, but hopefully making one person just a little bit more aware. You never know

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

    #2 of your questions depends on whether and exactly how much Murdoch and the rest of the wingnut clowns decide they want to whip up irrational hysteria.

    And by question #3, you are NOT helping.

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

    Which is pretty much in line with the price of most experimental biologic medications. You’re not talking about just pouring a few compounds together and precipitating out a magical pill they can hand someone. The biochemistry is very complex, and takes the growing of plants and the raising of animals in the lab. All of which takes time, and expertise.

  • jacobmccandless

    So hows Cholera been doing?

  • jacobmccandless

    The cost of producing the vaccine illustrates why supplies of experimental Ebola products are in such limited supply. Taylor said the price for producing this batch was between $1,000 and $1,400 per dose.

    hmm

  • jacobmccandless

    Is this outbreak going to delay crucifixions? I have an Crucifier group on tour in Africa and I’m wondering if he should cancel his shows. The bands name is Evola. ft. Torri Amos. They bite the heads off of chicken pox victims. Torri Amos is so cool.

  • jacobmccandless

    “The Tekmira drug targets three of the seven genes of the Ebola virus. (Yes, the deadly Ebolavirus wreaks its havoc with only seven proteins.”

    I’ll wreak havoc with 6!

  • Hue-Man

    “Canada is donating several hundred doses of a made-in-Canada experimental Ebola vaccine to help in the West African outbreak response, the federal government revealed Tuesday [Aug 12/14].”

    “The news came hours after the World Health Organization announced that apanel of experts it convened had decided that it would be ethical to use untested drugs and vaccine in this epidemic, which is several times larger than any previous outbreak and is proving hard to contain.”

    “To that end, the Public Health Agency got a German vaccine production facility to make doses — somewhere around 1,500 — of the experimental vaccine earlier this year. The vaccine, which is not linked at this point to a major drug company, goes by the name VSV-EBOV. Canada owns the intellectual property.

    The cost of producing the vaccine illustrates why supplies of experimental Ebola products are in such limited supply. Taylor said the price for producing this batch was between $1,000 and $1,400 per dose.” http://www.vancouversun.com/health/untested+Ebola+drugs+ethical+moral+duty+gather+data+says/10111199/story.html

    “In contrast, at least two other companies have products that have already been subject to Phase 1 safety trials. Most widely publicized has been TKM-Ebola, a lipid nanoparticle, RNA-interference drug being developed by Vancouver-based, Tekmira Pharmaceuticals, together with a division of the Department of Defense.

    Single-dose and multiple ascending dose studies have been progressing and the company announced on July 21 that the FDA was placing a hold on the trials as they conducted an interim analysis of the drug’s safety profile.

    However, Tekmira just announced today [Aug 7/14] that the FDA verbally confirmed the modification of the trials’ status to a “partial hold,” thereby allowing the drug to be used in people infected with Ebola.”

    “The Tekmira drug targets three of the seven genes of the Ebola virus. (Yes, the deadly Ebolavirus wreaks its havoc with only seven proteins.” http://www.forbes.com/sites/davidkroll/2014/08/07/fda-moves-on-tekmiras-ebola-drug-while-sareptas-sits-unused/

    Media coverage is treating Ebola as a brand-new disease, whereas I’ve known about it for nearly 40 years (through my family’s frontline involvement in Zaire). Scientists around the world having been performing the research, investigating avenues of treatment and prevention, and developing drugs for evaluation. This is demonstrated by the availability of (limited) stocks of drugs although it also shows that Ebola never received the funding levels it needed because it was one of those far-off “African diseases.”

  • docsterx

    1. The people in Africa who got it may not have been able to take proper precautions. Difficult to take proper precautions if you don’t ave running water, electricity, plumbing, good decontamination equipment and supplies to do it properly, etc. Also, it’s thought that Brantly and Writebol got it from contact with people (not diagnosed Ebola patients) when they weren’t wearing protective clothing.

    2. The hysteria has already broken out. Look at comments posted on various websites with Ebola stories. Ebola will mutate, it will become aerosolized, S. American immigrants carrying Ebola, don’t release anti-Ebola meds to anyone else, Ebola is God’s punishment for . . .
    So far, Ebola has remained remarkably localized. But it will probably not remain that way.

    3. Ebola has been available as a terror weapon for 40 years since it was first discovered. Why use Ebola when it is less easy to contract than other diseases? There are other, more efficient and more sure ways to kill or incapacitate large numbers of people with little risk to the terrorists. Those don’t need to be discussed here.

  • bkmn

    Ebola requires virus penetration through a mucus membrane. It is NOT airborne. Patients infected with Ebola can be effectively isolated using standard hospital isolation techniques as practiced here in the US.

    These poor African countries do not have an ample supply of negative airflow isolation rooms or sufficient supplies of gloves, masks and other isolation barriers. Presently families with a member with Ebola may treat them at home, as a way of trying to avoid being placed in isolation, but end up infecting other family members. Some families are delivering the corpses of deceased family members in town squares at night so that they can try to avoid being subjected to isolation.

    IF Ebola does come to the US it will most likely not be a large outbreak due to our better healthcare facilities and procedures.

  • just_AC

    my questions are
    1: if Medical experts, who should know how to take proper precautions, are STILL getting it, what does that say about the average person chances?
    2: how long do you think that it will be before the usa gets its first victim and how long after that will mas hysteria break out?
    3: you gotta believe that terrorists are closely following this to look for opportunities. If they can have suicide bombers, why not suicide sick people and Ebola seems tailor made – no symptons for days, ability to pass it on to victims and high mortality rate

  • docsterx

    Some of the links in the article may not be working/
    A short video of a village trying to recover from the devastation of Ebola http://www.nytimes.com/video/world/africa/100000003050318/a-village-devastated-by-ebola.html

    A village paralyzed by fear and death http://www.nytimes.com/2014/08/12/world/africa/at-heart-of-ebola-outbreak-a-village-frozen-by-fear-and-death.html?module=Search&mabReward=relbias%3Ar&_r=0

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

    Kind of hard to say an experimental drug only ever created in small amounts for laboratory testing is ‘out of stock’. It was never in stock. People are freaking out about how it was given to Americans and not to Africans, but if they had given it to Africans and found out later it wasn’t effective – or worse, was more harmful than helpful, they would have been accused of using desperate African victims as medical test subjects.

    Yay for GMO tobacco and mouse spleens.

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