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Ebola in danger of never going away? - Laurie Garrett

AlaskaDenise

AlaskaDenise

In Memoriam
Ebola in danger of never going away?

.....is Ebola in danger of becoming a normal disease in West Africa? NBC?s Mark Potter, Laurie Garrett from the Council on Foreign Relations and Frankie Edozien, Director of the Reporting Africa Program at NYU?s Journalism School, discuss with Dorian Warren

(view video)

----------------------------------------------------

This possiblity is one more reason the do everything we can to contain ebola in Africa ASAP.

I wonder if it may become permanently endemic not only because of the numbers, but also because of non-human species that live in urban African locations, which may harbor the disease.

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Re: Ebola in danger of never going away? - Laurie Garrett

The part of the video that really shocked me was when Laurie said that NGOs are searching for doctors - they need 300 and got 7! UK can hardly find any and France has sent only 20 people.

(update - UK report posted below mentions that the UK is committing 100+ medical professionals from their NHS)

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Re: Ebola in danger of never going away? - Laurie Garrett

Ebola could become a 'permanent human feature', WHO warns

.....Phillip Hammond, the Foreign Secretary, said: ?This outbreak has wide-ranging humanitarian and security consequences for the region, and the world.

?Defeating this disease will need a global coalition, as well as innovative approaches to reducing the spread of the virus in communities.?.....

.....Prof Peter Piot, the director of the London School of Hygiene and Tropical Medicine, a member of the team that discovered Ebola in 1976, said the current outbreak was very different from the 24 others that had preceded it.

?It?s the first time that entire nations are involved and affected; it?s the first time that capital cities are involved with huge urban populations,? he said. ?The result is that we have something that I think is a humanitarian crisis. It?s no longer a disease outbreak.?.....
 
Re: Ebola in danger of never going away? - Laurie Garrett

The woman interviewed in the linked video seems to be emphasizing the idea of mobilizing a huge response, as if that could prevent Ebola from becoming endemic. Based on the cultural and logistical issues in West Africa, I think we're well past that point. The focus should be on containment at this stage, IMO.

One thing they didn't discuss is the risk that Ebola will find a new carrier, other than fruit bats. If it gets into the environment as infections appear outside of its home area, it could be impossible to remove.
 
Re: Ebola in danger of never going away? - Laurie Garrett

Interesting article here about why bats are natural mammal carriers for zoonotic viruses:

Emerg Infect Dis. 2014 May;20(5):741-5. doi: 10.3201/eid2005.130539.

Bat flight and zoonotic viruses.

O'Shea TJ, Cryan PM, Cunningham AA, Fooks AR, Hayman DT, Luis AD, Peel AJ, Plowright RK, Wood JL.


Abstract


Bats are sources of high viral diversity and high-profile zoonotic viruses worldwide. Although apparently not pathogenic in their reservoir hosts, some viruses from bats severely affect other mammals, including humans. Examples include severe acute respiratory syndrome coronaviruses, Ebola and Marburg viruses, and Nipah and Hendra viruses. Factors underlying high viral diversity in bats are the subject of speculation. We hypothesize that flight, a factor common to all bats but to no other mammals, provides an intensive selective force for coexistence with viral parasites through a daily cycle that elevates metabolism and body temperature analogous to the febrile response in other mammals. On an evolutionary scale,
this host-virus interaction might have resulted in the large diversity of zoonotic viruses in bats, possibly through bat viruses adapting to be more tolerant of the fever response and less virulent to their natural hosts.

PMID: 24750692 [PubMed - in process] PMCID: PMC4012789 Free PMC Article

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So, can we assume that efforts to ensure ebola doesn't travel further and infect bats on other continents may be an important prevention strategy?

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Re: Ebola in danger of never going away? - Laurie Garrett

AlaskaDenise said:
Interesting article here about why bats are natural mammal carriers for zoonotic viruses:
Click to expand...

Interesting; thanks. Perhaps the bat's relatively high body temperature prevents them from becoming symptomatic.

I think it's also noteworthy that fruit bats are also one of the few mammals that don't make their own Vitamin C. It's interesting that Ebola Zaire in guinea pigs is also symptomatic, as in apes in humans, but not in dogs, which are asymptomatic carriers.

http://jid.oxfordjournals.org/content/179/Supplement_1/S203.long

The bat's body temperature makes me wonder whether survival rates in humans might, at least in part, be related to how high their body temperature goes. If a person's immune system is strong enough to muster a significant fever, perhaps survival rates improve.

This might also suggest that antipyretics (fever-lowering drugs), such as acetominophen, could be contraindicated with Ebola infection.
 
Re: Ebola in danger of never going away? - Laurie Garrett

Sharky said:
.........This might also suggest that antipyretics (fever-lowering drugs), such as acetominophen, could be contraindicated with Ebola infection.
Click to expand...

Long ago when I was a child, our family doc said to NOT give aspirin (only
antipyretic available then) until our fever went over 102F. He said the heat "drove out" the pathogen.

Letting fevers go high does damage teeth that are still forming, however.

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Re: Ebola in danger of never going away? - Laurie Garrett

Chris said:
Fascinating. .....
Click to expand...

I really enjoyed it too. Pathogen evolution/adaptation, transmission, & infection are clearly not as simple as we assume. It's amazing how natural adaptation can both help and harm. I hope you read the related article concerning European bats acquiring more of these diseases.
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Re: Ebola in danger of never going away? - Laurie Garrett

This is completely my own experience, but when I am sick (as in go to the doctor and get confirmation) my temperature goes down. I'm normally 97.5 and run a 'negative fever' of 96.0-96.3, usually when I feel hot & feverish, and assume when I take my temp it will actually break 98. Even home remedies like hot bath/shower and bundling up for bed to 'sweat it out' often do nothing to raise my temp.

I saw mention on another thread here that airport screeners in one of the affected countries were writing down temperatures below the alert threshold, with the assumption that they were incorrect. But maybe they weren't.

Are there any papers on how a low temperature might affect the course of a disease?
 
Re: Ebola in danger of never going away? - Laurie Garrett

I have that same issue - very low temps when ill. It runs in our family. It's difficult to convince HCW that you're actually ill. My normal temp is also low.

Given that the virus carried by bats actually tolerate a wide range of temperatures (from hybernation to flying in hot climates), perhaps it's a matter of mutations within each pathogen?

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Re: Ebola in danger of never going away? - Laurie Garrett

Hmmm... http://www.ncbi.nlm.nih.gov/pubmed/17705968

I will more research from work tomorrow, but hopefully there is good data here on this forum on temperature ranges during the EVD infections, duration, and whether the patient recovered.

"Abstract

There is a constant increase in hospitalizations and mortality during winter months; cardiovascular diseases as well as respiratory infections are responsible for a large proportion of this added morbidity and mortality. Exposure to cold has often been associated with increased incidence and severity of respiratory tract infections. The data available suggest that exposure to cold, either through exposure to low environmental temperatures or during induced hypothermia, increases the risk of developing upper and lower respiratory tract infections and dying from them; in addition, the longer the duration of exposure the higher the risk of infection. Although not all studies agree, most of the available evidence from laboratory and clinical studies suggests that inhaled cold air, cooling of the body surface and cold stress induced by lowering the core body temperature cause pathophysiological responses such as vasoconstriction in the respiratory tract mucosa and suppression of immune responses, which are responsible for increased susceptibility to infections. The general public and public health authorities should therefore keep this in mind and take appropriate measures to prevent increases in morbidity and mortality during winter due to respiratory infections."
 
Re: Ebola in danger of never going away? - Laurie Garrett

That article is about cancer patients and yes, they can get very cold during treatment and get cold more frequently after treatment!

Many elderly have low body temps.

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Re: Ebola in danger of never going away? - Laurie Garrett

Low body temp seems to be associated with suppression of immune system responses in a certain number of people or with certain types of illness or other upset. I saw a few mentions of low body temp in a few dengue cases, and also in some viral infections with infants and elderly.

I am curious if people who have a naturally low body temp might fare differently with EVD, and also if a low body temp would be enough not to trigger screening criteria for EVD, if the other criteria were met.
 
Re: Ebola in danger of never going away? - Laurie Garrett

AlaskaDenise said:
I'd say that's an issue, but how should that be identified?
Click to expand...

Another problem with using body temperature as a screening tool is that it can be manipulated with antipyretics, at least temporarily. That's in addition to the basic inaccuracies of using skin temperature as an indication of core body temperature.

I was reading recently about something the HCWs in West Africa are apparently calling "Ebola tongue" -- a thick, white coating with a line down the middle -- that's indicative of an active infection. Heavily bloodshot eyes are also very common. I wonder if a quick look at people's tongues and eyes might be a more accurate screening method than skin temperature scanners? Of course the staff would need protection of some kind; could be done remotely using a camera, or from behind a glass window.
 
Re: Ebola in danger of never going away? - Laurie Garrett

For those with a low body temp, you should have your thyroid checked. Yes there is evidence that thyroid problems run in families. Message me if you want a list of tests to ask for, having just a TSH test doesn't cut it.
 
Re: Ebola in danger of never going away? - Laurie Garrett

The thyroid issue crossed my mind, and I think I've only had the TSH done. But my veins go into hiding in a medical setting, so it takes me a few years to get up the nerve for bloodwork.

I'm still mulling over the temperature swings in bats being a factor in their virus hosting. If ebolavirus can handle rapid swings of temps in bats, I guess that's yet another variable to ponder in transmission in this outbreak.

I need to read more about it...
 
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