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Thursday, October 09, 2014 3:45 PM

Panic Over Ebola: Airline Strikes, Banned Flights, Experimental Drugs

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Ebola Epidemic Spreads

Panic is in the air in some places over the deadly ebola virus. Is the panic justified? Is there any cure? How deadly is ebola compared to other viruses? How many have died so far? What can be done to stop the spread?

Let's take a look at these questions starting with the number of deaths.

In Ebola Epidemic Spreads – In Pictures The Guardian reports "The Ebola epidemic has killed more than 3,700 people in west Africa. Dozens of British military personnel are due to fly to Sierra Leone next week to help build medical facilities to combat the epidemic."

First US Patient Dies

More Fears, More Measures as First Patient Diagnosed in the U.S. Dies

Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, died Wednesday, 10 days after he was admitted to a Texas hospital. His family wonders if the outcome would have been different if doctors had admitted Duncan to a hospital on September 25, the first time he showed up with a fever and stomach pain.
Quarantine Stations, Ebola Questions, and Thermometers

At major US airports, Quarantine Stations, Ebola Questions, and Thermometers Coming.
Anyone traveling from ebola hotspots in Africa, Guinea, Liberia, and Sierra Leone, to select US airports will get special screening and have their temperatures taken. The five airports are: New York's JFK, Washington Dulles, Newark, Chicago O'Hare and Atlanta international airports.

Given the virus can incubate for up to 21 days, it is questionable how much good taking temperatures will do. Screening would not have saved the life of Thomas Eric Duncan who did not show any symptoms for days after his arrival.
Majority Want Flights Banned From Ebola Countries

An NBC survey shows Majority of Americans Want Flights Banned From Ebola Countries.
A majority of Americans support banning all flights to the United States from countries experiencing an Ebola outbreak, an exclusive NBC News online survey reveals.

The survey, which was conducted by SurveyMonkey and then weighted for age, race, sex, education and region to match U.S. Census data, found that 58 percent of Americans want a ban on incoming flights from West African countries hardest hit by the virus, such as Liberia, Guinea, and Sierra Leone. Twenty percent of respondents opposed a travel ban, and the rest said they didn’t know.
La Guardia Airport Cleaners On Strike

The Financial Times reports Airline Cabin Cleaners Strike Over Ebola Fears.
Up to 200 airline cabin cleaners were expected to strike on Thursday over concerns that they might be exposed to Ebola as US authorities try to contain alarm over the virus.

Cabin cleaners who work for Air Serv walked off their shifts at La Guardia airport, according to union representatives, the day after the US said it would step up health screenings of air travellers in the coming days.

La Guardia does not receive international flights, but a union official said workers were worried about international travellers arriving at the airport via domestic flights.
Elboa Treatment

The Financial Times reports Chinese Company Develops Ebola Treatment.
One of China’s leading generic pharmaceutical companies has purchased the rights to commercialise an experimental drug developed by the Chinese military for treating Ebola, though medical experts said the drug is still at an early stage of development.

The new drug is one of 15 or so experimental medicines that have shown some success against the Ebola virus, which has killed nearly 4,000 in west Africa, in laboratories tests with cell cultures and animals around the world. In addition, a dozen vaccines to prevent infection are being evaluated for safety and efficacy.

The World Health Organisation is working with international partners to fast-track the most promising treatments into clinical trials in the worst affected countries of Liberia, Sierra Leone and Guinea, though details of the trial procedures and the pharmaceuticals to be tested are not yet known.

“The news that Sihuan is commercialising jk-05 could speed up its timetable to be used in Africa but I still don’t think it could be available within six months,” said Yang Zhanqiu from the Institute of Medical Virology, School of Medicine, Wuhan University.

“China has no live Ebola virus to be researched on and it is forbidden to import live viruses to China for research. What the Chinese scientists are doing is based not on the live virus but on a cloned virus based on the gene sequence available from GenBank (a public database)”, he said.

George Baeder, an expert on the Chinese pharmaceuticals market, said: “Under typical circumstances, simply getting the drug into clinical trials and through registration – even if fast -racked by CFDA and even if it aims only at Chinese local approval – would normally take a minimum of five years.”
How Deadly is Ebola?

With fear and hype spreading, let's take a step back with a basic question: Just how deadly is the virus, where will the outbreak spread to next – and how can it be stopped?
The world is facing an unprecedented outbreak of the Ebola virus, with more than 3,400 deaths so far and an estimated five new cases being reported every hour in Sierra Leone. Infections and potential cases have now been reported as far afield as the Australia, Spain and the US – which this week also suffered its first death.

But as the Government resists calls for major British airports to follow the American lead and start screening incoming passengers for the disease, just what are the risks to Britain, West Africa and the rest of the world?

Just how deadly is the Ebola virus?

The strain of the Ebola virus involved in the current outbreak in West Africa has a mortality rate of 50 per cent – though rates for the outbreaks since 1976 have varied from 20 to 90 per cent.

Since then, we have developed strategies of barrier nursing, quarantine, protective equipment and contact tracing – and we know that these are enough to contain outbreaks if they are employed early enough.

That’s because of the way Ebola is spread. Though highly contagious if it is given the chance to enter the body, it can only do so through the direct transferral of bodily fluids such as vomit, sweat or blood – making it much easier to contain than air-borne viruses like avian flu.

The reason the current outbreak has become so vast is simple – it was left unchecked for at least three months before being reported to the World Health Organisation.

The fact that it has been allowed to get a major foothold in West Africa – sprouting up in countries without the medical infrastructure to deal with it – is the reason it has become such a deadly prospect there.

Dr Edward Wright, a senior lecturer in Medical Microbiology at the University of Westminster who has been working to develop harmless versions of viruses like Ebola for the past 10 years, admits that “we have no experience of dealing with anything like this before”.

But there is no risk of something similar happening in the UK, Europe, the US or anywhere where systems of isolation and treatment are more established and – now – alert to the danger.

Deadliest Viruses

But while we can be confident about stopping outbreaks outside West Africa, Dr Wright says the disease has likely got beyond the point where traditional strategies alone can stop the virus in the affected region – and that’s where vaccines and drugs come in.

Dr Wright is one of a number of scientists around the world working on producing a drug that can provide antibodies to help fight the disease, similar to the ZMapp treatment already being used in a limited number of cases.

Ultimately, the only way to stop Ebola cases emerging around the world is to tackle it at source in West Africa. Britain has just sent around 750 soldiers and officials to help bolster the infrastructure required – and Dr Wright says “feet on the ground” is probably the best way we can help tackle the disease right now.
Fears Overstated

While the disease is serious, the above article suggests risk in the US of a viral spread as happened in Africa is very unlikely.

Focus on ZMapp

Finally, please consider Experimental Drug Likely Saved Ebola Patients
On Thursday, Dr. Kent Brantly thought he was going to die. It was the ninth day since the American missionary worker came down sick with Ebola in Liberia. His condition worsening by the minute, Brantly called his wife to say goodbye. Thankfully, the call was premature.

Brantly is back on his feet -- literally -- after receiving a last-ditch, highly experimental drug. [Nancy Writebol] Another American missionary with Ebola got the same.

The experimental drug, known as ZMapp, was developed by the biotech firm Mapp Biopharmaceutical Inc., which is based in San Diego. The patients were told that the treatment had never been tried before in a human being but had shown promise in small experiments with monkeys.

According to company documents, four monkeys infected with Ebola survived after being given the therapy within 24 hours after infection. Two of four other monkeys that started therapy within 48 hours after infection also survived. One monkey that was not treated died within five days of exposure to the virus.

Brantly and Writebol were aware of the risk of taking a new, little-understood treatment and gave informed consent, according to two sources familiar with the care of the missionary workers. In the monkeys, the experimental serum had been given within 48 hours of infection. Brantly didn't receive it until he'd been sick for nine days.

The Ebola virus causes viral hemorrhagic fever, which refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding.

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. They later progress to vomiting, diarrhea, impaired kidney and liver function -- and sometimes internal and external bleeding.

Brantly asked that Writebol be given the first dose because he was younger and he thought he had a better chance of fighting it, and she agreed. However, as the first vial was still thawing, Brantly's condition took a sudden turn for the worse.

Brantly began to deteriorate and developed labored breathing. He told his doctors he thought he was dying, according to a source with firsthand knowledge of the situation.

Knowing his dose was still frozen, Brantly asked if he could have Writebol's now-thawed medication. It was brought to his room and administered through an IV. Within an hour of receiving the medication, Brantly's condition dramatically improved. He began breathing easier; the rash over his trunk faded away. One of his doctors described the events as "miraculous."

By the next morning, Brantly was able to take a shower on his own before getting on a specially designed Gulfstream air ambulance jet to be evacuated to the United States.

Writebol also received a vial of the medication. Her response was not as remarkable, according to sources familiar with the treatment. However, doctors on Sunday administered Writebol a second dose of the medication, which resulted in significant improvement.
Good Enough For me

The above results are good enough for me.

This is not a case where someone might take a drug and die from it. This is a case if nothing is done, the patient will die.

Nonetheless, World Health Organization spokesman Gregory Hartl cautioned that health authorities "cannot start using untested drugs in the middle of an outbreak, for various reasons."

"As doctors, trying an untested drug on patients is a very difficult choice since our first priority is to do no harm, and we would not be sure that the experimental treatment would do more harm than good."

That view, while arguably reasonable in some cases, seems preposterous in the case at hand, especially given the success rate in monkeys.

Ultimately there must be human trials. What better tests can there actually be than from willing participants who are on the deathbed?

Mike "Mish" Shedlock

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