Civil Defense Perspectives September 2014 Volume 30 No. 6
[published November 2014]
In March, a devastating Ebola epidemic was building up in Guinea, Sierra Leone, and Liberia, and was belatedly recognized as an international emergency by the World Health Organization only on August 6. At the Doctors for Disaster Preparedness meeting in Knoxville, Tenn., July 25-28, Steven Hatfill, M.D., gave an in-depth presentation on Ebola and other emerging diseases (http://tinyurl.com/mb3ftzo).
Some key take-home lessons:
Of the more than 1,400 organisms, including fungi, bacteria, parasites, protozoa, and viruses, that can infect humans, about 58% are zoonotic—animal diseases that have jumped species. About 177 pathogens are considered to cause newly emerging or reemerging diseases. The majority of these are viral. During the past 30 years, 41 previously new, unrecognized human infectious diseases have jumped from their normal animal host to human beings. The risk continues to grow globally. One familiar example is measles virus, which comes from dog distemper.
Of particular concern are RNA viruses, including Ebola and other hemorrhagic fevers. The RNA polymerase enzyme is not very accurate; there are frequent transcription errors, and thus very rapid mutations. A form that does not cause recognized human diseases can turn into something very virulent.
Viruses can exist for thousands of years in reservoir hosts and amplifier hosts before spilling over into human populations. Bats, which make up 25% of all species of mammals, have a long association with RNA viruses. Sociable small bats can form huge community sizes with 300 bats per square foot at some roosting sites. They may fly dozens of miles each night and hundreds of miles in a season between summer and winter roosting sites. Some species of bats can live for 25 years. Fruit bats are especially important for Ebola.
In Africa, human populations are settling in wild areas and living in close association with animals. Hunting wild game provides an important source of protein (“bush meat”). The first case of Ebola in Guinea was in a family that hunted and ate bats.
Ebola can infect some domesticated animals, notably pigs and dogs. Once introduced, a disease could become endemic.
Because of their high lethality—up to 90%—and lack of specific treatment, hemorrhagic fever viruses have been of intense interest as a potential biological weapon. During the Cold War, the Soviet Union weaponized Marburg, a relative of Ebola. Marburg was injected into guinea pigs as they passed along an assembly line, and then the virus was harvested later. This continued until one of the scientists accidentally injected himself and died, and he became the source for the weaponized strain. The Russians still refuse to release a sample, Hatfill stated.
Biological warfare agents were placed in warheads of intercontinental and intermediate range ballistic missiles. Such warheads were designed to be multipurpose. They could be used to carry a chemical agent or biological bomblets, which contained a small explosive device. They would spin as they were dropped from a warhead, spread out laterally, and detonate when they hit the ground. They released an aerosol of the 1-5 micron size range, which would be taken into the lungs and retained to cause an infection. The Soviet did not succeed in weaponizing Ebola.
We have frequently heard assertions from federal officials about how you can’t get Ebola. Here we will focus on some Frequently Unasked Questions.
When does an Ebola victim start to shed virus? The orthodoxy states that a person is not contagious before fever or symptoms develop. As the temperature rises, how do we know there is no shedding before the CDC’s threshold, 100.4 °F, is reached? Moreover, fever does not occur in 12% of patients. Could there also be some mild or asymptomatic cases?
Ebola virus proliferates in the Langerhans cells in the skin and at some point can be recovered by swabbing the skin. Shouldn’t serial skin swabs be taken from exposed persons?
When does an Ebola victim stop being contagious? Nurses who recovered from Ebola in the U.S. have been pronounced cured and virus free, presumably based on negative polymerase chain reaction (PCR) tests. Note that PCR tests are also negative early in infection, and that one man reportedly infected his wife 72 days post recovery. She died.
The CDC warns that virus can hide in sexually transmitted fluids for “as long as 90 days.” In West Africa, patients are told to abstain from sex for 90 days (WSJ 11/4/14). How do they know it is safe at 91 days? The possibility of a chronic carrier state cannot be ruled out, and many survivors are ill for a long time.
How did nurses get infected despite following CDC protocol … [if it is very hard to catch]? Modified CDC guidance is much more rigorous than when Thomas Eric Duncan was admitted to Texas Health Presbyterian Hospital in Dallas. Now the skin must be entirely covered. The skin contains Ebola receptors, and the infective dose is 10 or fewer particles.
The procedure for donning and removing (“doffing”) protective gear is elaborately choreographed (http://tinyurl.com/o5ja8tr). There are many steps involving hand hygiene—a brief rub with alcohol-based sanitizer. This is assumed to work because Ebola is an enveloped virus, and thus easier to destroy than non-enveloped viruses such as norovirus. A 1979 NIH monograph on disinfectants for use in biological research lists contact times of 10–30 minutes, not a few seconds. There is no head-to-toe spraying with chlorine disinfectant as is done in Africa—where more than 300 medical workers have died nonetheless.
The CDC transiently admitted that aerosol transmission is possible (http://tinyurl.com/lh7lpzd), but this material quickly vanished from its website. Aerosols are generated by coughing, sneezing, invasive procedures, vomiting, diarrhea, flushing a toilet, and common laboratory equipment. Aerosol droplet transmission of Ebola has been demonstrated in animals. Ebola is classified as a biosafety level 4 (BSL-4) virus, and workers in BSL-4 facilities need to be protected from airborne organisms.
How long do contacts need to be monitored? About 95% of patients will become sick within 2 standard deviations of the mean incubation period: that is 25 days, not 21. Some reported cases have occurred 42 days after the last exposure.
Is hospital protective equipment adequate? A lawsuit against Kimberly Clark (http://tinyurl.com/ms7nuzq) alleges that many “impermeable” gowns fail industry tests.
- The scientific data that is not being discussed, by Steven J. Hatfill, M.D., with link to article interviewing him in The Atlantic: www.ddponline.org.
- Letter to House Government Oversight and Government Reform Committee (http://tinyurl.com/k5s35dg). Watch www.aapsonline.org for updates.
- The Truth about Ebola: Protect Yourself and Your Family by Jane M. Orient, www.wnd.com/wnd-special-reports/.
- Spillover: Animal Infections and the Next Human Pandemic by David Quaamen, Norton, 2012.
Ebola Experience in West Africa
Chertow et al. offer observations after treating more than 700 patients with Ebola in Monrovia, Liberia this year (NEJM 11/5/14, http://tinyurl.com/koj5bxb):
- A negative PCR could not be counted on to rule out disease until 72 hours after symptom onset.
- Neurologic symptoms include confusion, slowed cognition, agitation, and occasional seizures.
- Aggressive early use of antiemetics, antidiarrheal medications, and oral rehydration helped reduce fluid loss, hypovolemic shock, and environmental contamination.
- Nearly all patients who lived to day 13 ultimately survived.
ISIS Biowarfare Ambitions
Hidden files in a laptop seized from an ISIS (Islamic State of Iraq and al-Sham) hideout in Syria contained instructions for weaponizing bubonic plague from infected animals, and for testing it in mice. Work is possibly being carried on at the ISIS-controlled University of Mosul or at a lab in the de facto ISIS capital, Raqqa in Syria (http://tinyurl.com/lz7nvoe).
The government of Spain is monitoring online ISIS chat rooms where Ebola is being discussed as a bioterror weapon. U.S. Homeland Security Secretary Jeh Johnson denies the existence of “credible intelligence” that ISIS plans to use any sort of disease against the U.S. (RT 11/1/14, http://tinyurl.com/k4unpmu).
The dreaded radioactive dispersal device (RDD) is different from a potential device to spread Ebola-infected body fluids in many ways. While tens to hundreds of people might be killed by the conventional explosion of an RDD, few if any would die from the radiological effects. The LD50 (dose that would kill about half the persons exposed) is about 450 rads, vs. about 10 Ebola virus particles. A NukAlert ER can instantly detect a dose rate of 1 μR/hr; detecting Ebola requires time, appropriate biological systems, and a BSL-4 laboratory. A firefighter’s protective gear provides complete protection against external alpha and beta radiation and almost complete protection against ingestion or inhalation of radioactive material. It is effectively decontaminated by washing with soap and water. The worst effect would be panic and economic costs, magnified by greatly exaggerated fears of long-term health effects of radioactive contamination.
Ebola virus is inactivated by heat, ultraviolet radiation, and many other factors, but can persist in the environment for days to weeks. Once established in a suitable host (human, pig, dog, bat, etc.) it has a doubling time, not a half-life.
Technical expertise and access to radioactive materials would be needed to make an RDD. Access to one infected patient could create many human carriers, who could travel far and wide before becoming ill. How many could be infected using a suicide vest?
[For a brief updated summary on radiation preparedness, see Allen Brodsky’s new, compact Handbook for Survival, available for $3.99 at amazon.com.]
Airport Screening Doesn’t Work
A study of screening at Sydney Airport in New South Wales, Australia, during the 2009 H1N1 influenza pandemic showed that screening for fever at the airport had a sensitivity of less than 7%. Of 557 confirmed cases in NSW, 290 were detected at emergency departments, 135 at general practices, and only 3 at the airport
(Med J Aust 2014;200:290-292).
Can Hospitals Handle Ebola?
None of Boston’s hospitals want to be the primary Ebola treatment center; 40-60 staff members were needed for each case at Nebraska Medical Center (http://tinyurl.com/knwtuyj).
Long-time emergency physician Louis Profeta, M.D., asks why Ebola patients should come to the hospital. The hospital can prepare for a bomb in a crowded area or other extreme trauma scenarios. But a bad pandemic? “The goal should be to protect your hospital from it.” Why risk the medical infrastructure for a few patients who will either do OK at home with fluids and supportive care, or die no matter what? One suggestion is a mobile Ebola van (http://tinyurl.com/ldfbeuz). Far fetched?
The Winner Is…FWS
“Several colleagues have been speculating on which US government agency will be the first to claim a link between Ebola and global warming/climate change,” writes Ken Haapala. The apparent winner is the U.S. Fish and Wildlife Service of the Department of Interior: “Ebola appears to be a direct consequence of deforestation and human disturbance…. Outbreaks are linked to long dry seasons (a consequence of deforestation and climate change), during which there is scarcity of food in the forest” (TWTW 10/18/14, www.sepp.org).
Work-Years Instead of Light-Years
Another proliferating threat is our epidemic of debt.
To help humans comprehend the vastness of the universe, German astronomer Friedrich Bessel came up with a time measure for distance: how long it would take for light to travel that distance. Simon Black suggests describing U.S. government debt in terms of the time it would take to pay it off: the number of years working at the average wage, now about $45,000. The current public debt of about $18 trillion could be expressed as 398 million work-years. If every man, woman, and child worked for a full year at the average wage, taking nothing for basic needs, it would not be enough. The unfunded liabilities, about $116 trillion, amount to 2.4 billion work-years (Sovereign Man 10/22/14).
Civil Defense Perspectives 30(6): September 2014 (published November 2014)