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Ebola- facts and questions

Fact 1: Not much is known about the Ebola, even to most physicians.

Fact 2: It is an RNA virus that is very hardy and has ability to invade all cell lines in primates and some mammals but it is especially known to attack and replicate in the immune cells called macrophages - the first cells to respond in a new infection, in the immediate phase of infectious process. And it takes a very small viral copies to infect someone.

Fact 3: Epidemiological facts are not well documented or revealed to the public in this recent outbreak in West Africa, 2014 that started in Guinea in February 2014.

Fact 4: Reservoir for the virus is not confirmed ( thought to be bats) and mode of transmission not well explained to the public but transmission through fomites (phones/door handles etc.) certainly plausible and so is droplets from cough/sneezes and even aerosol is confirmed in animals models in lab setting. Human to human transmission not yet documented in the field but possible if aerosol mist is created through a medical procedure/autopsy ( i.e using bone saws or drills at high revolutions.)The incubation period is from 5-21 days.

Fact 5: it kills by inducing overwhelming inflammatory reaction in the human body with release of massive amounts of cytokines that cause multi-organ failure and irreversible circulatory collapse. There is also coagulation disorder with a drop in platelet count, so you start oozing blood in the mucosa/intestines/eyes when it gets low enough.

Fact 6: It targets the immune system, causing apoptosis of healthy lymphocytes and invading lymph nodes soon after it enters body so immunity can NOT develop. This means that vaccines have little chance to work since it takes time for the body to mount a defense and it is usually too late within 48-72 hours of viral replication in the body. By that time it would have completely wiped out almost all the cell mediated immune system.

Fact 7: Diagnosis is difficult since there are too many similar febrile viral diseases with almost identical symptoms: high fever, rash, headaches, muscle aches and diarrhea ( influenza/ malaria/dengue/ measles) You diagnose Ebola by rapid ELISA test or PCR for confirmation of viral antigens. Those are not widely available and exclusive to CDC- you send samples by AIR.

Fact 8: ZMAPP is a cocktail of 3 monoclonal antibodies that aggressively bind the Ebola RNA particles in the blood to prevent them from entering the immune and other cells to allow the natural immune response to kill the virus while giving maximal supportive therapies to keep the victims alive.

Fact 9: ZMAPP is time sensitive! Effectiveness drops precipitously if administered over 24 hours post-exposure: dropping from 100% protection if given after 24 hours to 50% after 48 hours.. I believe this is meant to be a prophylaxis to be given to the military in case of bio-terrorism, that begs the questions..

Question 1: How did they know the 2 Americans who is now being treated in Emory hospital, Atlanta has EBOLA in the first place so quickly? They should not be both recovering so quickly if they are past incubation and then tested positive after showing symptoms days after exposure at least 5 days- way past the effectiveness limit of the drug.

Fact 10: the recovery phase of being cured from Ebola is very protracted- weeks to months. By the end you would have lost significant muscle mass and will not regain strength for months and will need a lot of rehabilitation time. You would shed copious amount of dead peeling skin and hair from the infectious ordeal.

Here is the scenario from a physician perspective in a real outbreak: most ER physicians/staff won't wear full PPE/suits when working. They will be the first casualties.
There is not enough isolation rooms to contain all the infected.
There is not enough stock pile of high level protective equipment for anything more than a few days of chaos in even the best hospitals.
Each infected requires a huge amount of expert care and equipment: ICU physicians will be giving vasopressors medications and IV fluids to support dropping blood pressure, ventilators to keep the lungs working, blood products to transfuse. which are all limited resources.
Not all nurses or even doctors are trained to manage all these cases. ICU beds are a tiny proportion of the total available beds.(15-40 rooms in a 500-700 bed hospital)
The only plausible way to control the epidemic once it starts in more than a few US cities is complete quarantine: either voluntary or involuntary with suspension in all travel activities for at least a few days or even weeks.

Sorry for the long post but I felt that it needed to be shared. This is all the time I have for tonight..will keep updating this thread as events unfold. I did my best using the literature I have access to. I will verify and add more facts as they become available.

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