Ebola Information - Post here (NO POLITICS, NO JOKES, NO FUD)

[AMProducts]

Hey guys, there are more than a few threads on ebola going on, much of it consists of commentary, blame, and jokes. While I think there needs to be an outlet for these things, existing threads already meet these needs. However for those of us who are looking for actual information, we have to weed through the junk.

So if you have some actual information, a real case report, or some other information, post it here. If you have a joke, a comment, use one of the other threads for it.

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[AMProducts]

Washington Post has some updated information about possible means of spreading. While there are some of the obvious things (touching contaminated blood, and then sticking your hand in your mouth, eyes, nose or ears) there is some additional information about what is "contaminated material".

http://www.washingtonpost.com/news/...from-the-cdc-on-how-ebola-can-be-transmitted/

By Eugene Volokh October 4 Follow @volokhc
As has often been reported, Ebola apparently can't be spread through the air simply by suspended particles remaining in the air after a cough or sneeze. But if infected sweat, mucus or saliva gets on doorknobs or countertops, the Ebola virus can be spread "for several hours" by someone touching the surface and then touching their eyes, nose, mouth or an open cut. Presumably it can be spread by handshaking as well, if the infected person had gotten his saliva or mucus on his hands. Not terribly reassuring, sad to say. Here's the CDC Q&A.

Q&As on Transmission

Ebola has been detected in blood and many body fluids. Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen.

Can Ebola spread by coughing? By sneezing?

Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person's eyes, nose or mouth, these fluids may transmit the disease.

What does "direct contact" mean?

Direct contact means that body fluids (blood, saliva, mucus, vomit, urine, or feces) from an infected person (alive or dead) have touched someone's eyes, nose or mouth or an open cut, wound or abrasion.

How long does Ebola live outside the body?

Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola dried on surfaces such as doorknobs and countertops can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature …

If someone survives Ebola, can he or she still spread the virus?

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months.

Can Ebola be spread through mosquitoes?

There is no evidence that mosquitoes or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.

Thanks to InstaPundit for the pointer.

UPDATE: I've revised the first sentence to expressly note what the quoted CDC text notes, which is that Ebola apparently can't be spread through the air simply by suspended particles remaining in the air after a cough or sneeze. (I had originally just said it "can't be spread through the air by coughing or sneezing.") As later passages in the post make clear, it can be spread through the air if someone sneezes or coughs on someone else, or if infected saliva or mucus is deposited on a surface, and is then picked up by someone else during the virus's survival window.

 

[maxisback]

Not sure of the Washington Post article is misinformation, information control, or just bad information. I found this...

According to the Center for Aerobiological Sciences, U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Maryland:


(1) Ebola has an aerosol stability that is comparable to Influenza-A


(2) Much like Flu, Airborne Ebola transmissions need Winter type conditions to maximize Aerosol infection


"Filoviruses, which are classified as Category A Bioterrorism Agents by the Centers for Disease Control and Prevention (Atlanta, GA), have stability in aerosol form comparable to other lipid containing viruses such as influenza A virus, a low infectious dose by the aerosol route (less than 10 PFU) in NHPs, and case fatality rates as high as ~90% ."


"The mode of acquisition of viral infection in index cases is usually unknown. Secondary transmission of filovirus infection is typically thought to occur by direct contact with infected persons or infected blood or tissues. There is no strong evidence of secondary transmission by the aerosol route in African filovirus outbreaks. However, aerosol transmission is thought to be possible and may occur in conditions of lower temperature and humidity which may not have been factors in outbreaks in warmer climates [13]. At the very least, the potential exists for aerosol transmission, given that virus is detected in bodily secretions, the pulmonary alveolar interstitial cells, and within lung spaces"


Its clear that when Ebola is in the air it is at least as hardy as Influenza. Its also clear that coughing and sneezing is what makes Influenza airborne; the same should be expected of Ebola.

FWIW, I wont plan on bunkering down until the gov't says we have no reason to panic...uh, wait, they already said that, didn't they?

 

[7SFCW4]

Over at GuerillAmerica, forums, search for "Stable Phantom" Sam is crowd sourcing OSINT related to the emerging threat.

 

[rick benjamin]

There is success in Liberia, A private corporation has stopped Ebola.
http://www.npr.org/blogs/goatsandso...ernments-have-not-stopped-ebola-in-its-tracks

 

[7SFCW4]

Rick, is this serious? NPR, reporting all is well?

 

[rick benjamin]

All is not well. In fact, Things are way bad, except in one place.
Firestone Tire Co has a 185 square mile rubber plantation inside Liberia.
http://online.wsj.com/articles/liberian-rubber-farm-becomes-sanctuary-against-ebola-1412629331
"The workers and their families make up a community of 80,000 people across the plantation."
In March, when Ebola began to spread, the plantation isolated itself and instituted strict controls. <broken link removed>
"as the worst Ebola outbreak ever recorded rages all around them, Firestone appears to have blocked the virus from spreading inside its territory."

 

[rick benjamin]

MCB Camp Pendleton, CA is approximately 195 square miles.
Mighty big tree farm, Firestone has 185 square miles...inside Liberia.
http://www.thenation.com/slideshow/37157/slide-show-firestones-state-within-state-liberia
Liberia is about 43000 square miles in size.
http://fortune.com/2014/08/08/africa-ebola-corporations/

 

[AMProducts]

Over at GuerillAmerica, forums, search for "Stable Phantom" Sam is crowd sourcing OSINT related to the emerging threat.

Also, in the case of stories or press releases, please post a link to the article, and the article with any attribution in a quote block.

Good link thus far. Direct Link: http://guerrillamerica.com/exercise-stable-phantom/

Stable phantom seems a bit large and seems to be going constant amendments.

Also another valuable link for "all hazards information"

http://hisz.rsoe.hu/alertmap/index2.php

 

[bolus]

Just for the local perspective, in case anyone is wondering what us healthcare people are doing.

We are getting regular updates from the Oregon Health Authority. Most recent update includes risk assessment. For example, there are no direct flights into Oregon from the affected countries. There are protocols at PDX for rapid isolation and evaluation of sick patients. We have rapid testing protocols with the CDC and specific reporting protocols if there are any suspected cases.

Then my hospital system in Portland has new workflows for questioning on travel history from the front staff up. (Downside, is if you get the flu and go to a Portland hospital, a bunch of people will probably ask your travel history over and over). These are the kind of required workflows where if you dont ask these questions to a sick patient your job is at risk so we should see good compliance with staff.

So basically, whole staff education and preparedness so that it makes it much less likely we will miss a case if it happens to show up here.

And I still think my chances of getting killed by a patient cranked up on meth because I dont give them a pile of oxy's is still way higher then getting ebola

 

[7SFCW4]

Notes from an Army buddy, and USAMRIID alumni:

Ebola and all it's varients like zaiere etc, is a self limiting disease. In a static human environment like a village in Africa where no one travels more than a few miles and with no outside contacts, it will burn through the populace and die out. The onset is rapid and the time frame where it is communicable is parallel pretty much to the time frame that the patient is flat on his back bleeding out. Those flat on their backs are not going anywhere to infect others and human nature is to stay away from those in this condition. Conversely with air travel a patient who is just barely showing signs of infection can board a flight and with the rapid onset time of the disease arrive in a clean zone and rapidly become a " patient zero " in a new country. With all the media I am sure you know all this already. What the CDC people want to create is a stop gap of time. with this stopgap in place and the known fact that ebola will burn itself out quickly, this firewall of time will stop indigenous vectors from infecting others and they can then concentrate on stopping inbound vectors. It is like with the life cycle of the flea. if you poison them throughout the timeline of one life cycle they stop existing as there are no breeding parents alive, and the newborns are hatched into a poison environment and die out, ergo, no one to lay an egg so the flea meets his waterloo in the timeframe of one life cycle. What I see happening that worries me is he return of missionaries to facilities that are not 100% equipped to contain the contagion. ie no HEPA filtration and proper disposal of infectious waste. The waste needs to be autoclaved, as do the bodies that don't survive. autoclaves big enough for this are far and few between. Our borders are so porous though that the vectors could be a person coming illegally into this country also. The worry there would be that any exposures to others would be not reported until the patient is near death or dead. With that time frame extended thus due to the secretive nature of illegal immigration, the array of secondary and beyond exposures multiply at rates too frightening to contemplate. With the military going to send troops over to help in large numbers, it is opening us up to exposure on a much larger scale. All those who deploy should go through a 21 day quarantine in a remote location before rejoining their families. Another worry is the infection of animals not indigenous to Africa. Some virus mutate while in an animal host and only then become virulent to humans. Rift valley fever does this. you could eat the stuff in it's virgin form with no issues, but get near an infected cow and you are a goner. There are so many animals here in the states different from those in Africa that I have to wonder if this might come into play. All of this I have written is just my opinions and I am just a no one with little knowledge of medicine. I would not disseminate it to any one else in case I am wrong on any thing. I don't hear from anyone I worked with at USAMRIID. Most are retired.

 

[AMProducts]

Bolus,

The biggest issue with Ebola so far is the "I don't know factor", CDC, and public health depts have been very lax in disseminating information such as what's contained in this post to the public at large. Which is leading to calls of incompetence. A "don't worry about it" in the face of a disease that even has a 10% mortality rate is alarming, however an exotic disease that there is no cultural awareness of (people avoid transmitting the flu by staying home from work, handwashing, covering their face.) that also has a mortality and morbidity rate of 60% is terrifying.

One of the major concerns I have is what's happening right now in africa and why we're seeing people showing up in the US with ebola. That is, if someone fears they may be contaminated, or is already contaminated but doesn't know it and "squirts" trying to avoid the fate of those around them, this could easily spread the virus to other places in the world that have similar problems with hygiene the virus could again find fertile ground much closer to our shores, as others have pointed out. While I agree that it's a lower but more abstract threat, than many of the more common diseases we may be exposed to, by comparison measles and complications can have fatality rates as high as 30% on the other hand, most of us are already vaccinated against it and as long as you stay away from places with high immigrant populations, or large numbers of unvaccinated individuals it's much less of an issue. However, there is no vaccine for ebola, at least yet.


CDC "Signs and Symptoms" of Ebola infection http://www.cdc.gov/vhf/ebola/symptoms/index.html

Signs and Symptoms
Symptoms of Ebola include

• Fever (greater than 38.6°C or 101.5°F)
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient's immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

Recommended PPE for handling Patients and Contaminated Materials (various sources):

PPE For handling materials or persons contaminated by Ebola:

Gloves
Gown or Suit (Non-Permiable)
Shoe Covers
N-95 Full face Respirator

Source Material: http://www.apic.org/Resource_/TinyMceFileManager/epublications/EbolaPS1403-FALL-FINAL.pdf

Wear appropriate PPE:
Healthcare providers enteringthe patients room should wear:
gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask. Additional protective equipment might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.

• Restrict visitors:
Avoid entry of visitors into the patient's room. Exceptions may be considered on a case by case basis for those who are essential for the patient's wellbeing. A logbook should be kept to document all persons entering the patient's room. See CDC's infection control guidance (page 61) on procedures for monitoring, managing, and training of visitors.

• Avoid aerosol-generating procedures
Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N-95 or higher filtering facepiece respirator) and the procedure should be performed in an airborne infection isolation room.

• Implement environmental infection control measures
Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is of paramount importance, as blood, sweat, vomit, feces, urine, and other body secretions represent potentially infectious materials should be done following hospital protocols.

SOURCE: http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html#e

II.E. Personal protective equipment (PPE) for healthcare personnel
PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents. The selection of PPE is based on the nature of the patient interaction and/or the likely mode(s) of transmission. Guidance on the use of PPE is discussed in Part III. A suggested procedure for donning and removing PPE that will prevent skin or clothing contamination is presented in the Figure. Designated containers for used disposable or reusable PPE should be placed in a location that is convenient to the site of removal to facilitate disposal and containment of contaminated materials. Hand hygiene is always the final step after removing and disposing of PPE. The following sections highlight the primary uses and methods for selecting this equipment.

II.E.1. Gloves
Gloves are used to prevent contamination of healthcare personnel hands when 1) anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin and other potentially infectious material; 2) having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route e.g., VRE, MRSA, RSV [559, 727, 728]; or [3]) handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces [72, 73, 559]. Gloves can protect both patients and healthcare personnel from exposure to infectious material that may be carried on hands [73]. The extent to which gloves will protect healthcare personnel from transmission of bloodborne pathogens (e.g., HIV, HBV, HCV) following a needlestick or other pucture that penetrates the glove barrier has not been determined. Although gloves may reduce the volume of blood on the external surface of a sharp by 4686% [729], the residual blood in the lumen of a hollowbore needle would not be affected; therefore, the effect on transmission risk is unknown. Gloves manufactured for healthcare purposes are subject to FDA evaluation and clearance [730] . Nonsterile disposable medical gloves made of a variety of materials (e.g., latex, vinyl, nitrile) are available for routine patient care 731. The selection of glove type for non-surgical use is based on a number of factors, including the task that is to be performed, anticipated contact with chemicals and chemotherapeutic agents, latex sensitivity, sizing, and facility policies for creating a latex-free environment [17, 732-734]. For contact with blood and body fluids during non-surgical patient care, a single pair of gloves generally provides adequate barrier protection [734]. However, there is considerable variability among gloves; both the quality of the manufacturing process and type of material influence their barrier effectiveness [735]. While there is little difference in the barrier properties of unused intact gloves [736], studies have shown repeatedly that vinyl gloves have higher failure rates than latex or nitrile gloves when tested under simulated and actual clinical conditions [731, 735-738]. For this reason either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity and/or will involve more than brief patient contact. It may be necessary to stock gloves in several sizes. Heavier, reusable utility gloves are indicated for non-patient care activities, such as handling or cleaning contaminated equipment or surfaces [11, 14, 739].

During patient care, transmission of infectious organisms can be reduced by adhering to the principles of working from "clean" to "dirty", and confining or limiting contamination to surfaces that are directly needed for patient care. It may be necessary to change gloves during the care of a single patient to prevent cross-contamination of body sites [559, 740]. It also may be necessary to change gloves if the patient interaction also involves touching portable computer keyboards or other mobile equipment that is transported from room to room. Discarding gloves between patients is necessary to prevent transmission of infectious material. Gloves must not be washed for subsequent reuse because microorganisms cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Furthermore, glove reuse has been associated with transmission of MRSA and gram-negative bacilli [741-743].

When gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist are preferred for use with an isolation gown because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands. Gloves that are removed properly will prevent hand contamination (Figure). Hand hygiene following glove removal further ensures that the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could contaminate the hands during glove removal [559, 728, 741].

II.E.2. Isolation gowns
Isolation gowns are used as specified by Standard and Transmission-Based Precautions, to protect the HCW's arms and exposed body areas and prevent contamination of clothing with blood, body fluids, and other potentially infectious material 24, 88, 262, 744-746. The need for and type of isolation gown selected is based on the nature of the patient interaction, including the anticipated degree of contact with infectious material and potential for blood and body fluid penetration of the barrier. The wearing of isolation gowns and other protective apparel is mandated by the OSHA Bloodborne Pathogens Standard [739]. Clinical and laboratory coats or jackets worn over personal clothing for comfort and/or purposes of identity are not considered PPE.

When applying Standard Precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated. However, when Contact Precautions are used (i.e., to prevent transmission of an infectious agent that is not interrupted by Standard Precautions alone and that is associated with environmental contamination), donning of both gown and gloves upon room entry is indicated to address unintentional contact with contaminated environmental surfaces [54, 72, 73, 88]. The routine donning of isolation gowns upon entry into an intensive care unit or other high-risk area does not prevent or influence potential colonization or infection of patients in those areas365, [747-750].

Isolation gowns are always worn in combination with gloves, and with other PPE when indicated. Gowns are usually the first piece of PPE to be donned. Full coverage of the arms and body front, from neck to the mid-thigh or below will ensure that clothing and exposed upper body areas are protected. Several gown sizes should be available in a healthcare facility to ensure appropriate coverage for staff members. Isolation gowns should be removed before leaving the patient care area to prevent possible contamination of the environment outside the patient's room. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin (Figure). The outer, "contaminated", side of the gown is turned inward and rolled into a bundle, and then discarded into a designated container for waste or linen to contain contamination.

II.E.3. Face protection: masks, goggles, face shields
II.E.3.a. Masks
Masks are used for three primary purposes in healthcare settings: 1) placed on healthcare personnel to protect them from contact with infectious material from patients e.g., respiratory secretions and sprays of blood or body fluids, consistent with Standard Precautions and Droplet Precautions; 2) placed on healthcare personnel when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a healthcare worker's mouth or nose, and 3) placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others (i.e., Respiratory Hygiene/Cough Etiquette). Masks may be used in combination with goggles to protect the mouth, nose and eyes, or a face shield may be used instead of a mask and goggles, to provide more complete protection for the face, as discussed below. Masks should not be confused with particulate respirators that are used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route as described below. Masks should not be confused with particulate respirators that are used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route as described below.

The mucous membranes of the mouth, nose, and eyes are susceptible portals of entry for infectious agents, as can be other skin surfaces if skin integrity is compromised (e.g., by acne, dermatitis) 66, 751-754. Therefore, use of PPE to protect these body sites is an important component of Standard Precautions. The protective effect of masks for exposed healthcare personnel has been demonstrated 93, 113, 755, 756. Procedures that generate splashes or sprays of blood, body fluids, secretions, or excretions (e.g., endotracheal suctioning, bronchoscopy, invasive vascular procedures) require either a face shield (disposable or reusable) or mask and goggles 93-95, 96 , 113, 115, 262, 739, 757 .The wearing of masks, eye protection, and face shields in specified circumstances when blood or body fluid exposures are likely to occur is mandated by the OSHA Bloodborne Pathogens Standard 739. Appropriate PPE should be selected based on the anticipated level of exposure.

Two mask types are available for use in healthcare settings: surgical masks that are cleared by the FDA and required to have fluid-resistant properties, and procedure or isolation masks 758 #2688. No studies have been published that compare mask types to determine whether one mask type provides better protection than another. Since procedure/isolation masks are not regulated by the FDA, there may be more variability in quality and performance than with surgical masks. Masks come in various shapes (e.g., molded and non-molded), sizes, filtration efficiency, and method of attachment (e.g., ties, elastic, ear loops). Healthcare facilities may find that different types of masks are needed to meet individual healthcare personnel needs.

II.E.3.b. Goggles, face shields
Guidance on eye protection for infection control has been published 759. The eye protection chosen for specific work situations (e.g., goggles or face shield) depends upon the circumstances of exposure, other PPE used, and personal vision needs. Personal eyeglasses and contact lenses are NOT considered adequate eye protection (www.cdc.gov/niosh/topics/eye/eye-infectious.html). NIOSH states that, eye protection must be comfortable, allow for sufficient peripheral vision, and must be adjustable to ensure a secure fit. It may be necessary to provide several different types, styles, and sizes of protective equipment. Indirectly-vented goggles with a manufacturer's anti-fog coating may provide the most reliable practical eye protection from splashes, sprays, and respiratory droplets from multiple angles. Newer styles of goggles may provide better indirect airflow properties to reduce fogging, as well as better peripheral vision and more size options for fitting goggles to different workers. Many styles of goggles fit adequately over prescription glasses with minimal gaps. While effective as eye protection, goggles do not provide splash or spray protection to other parts of the face.

The role of goggles, in addition to a mask, in preventing exposure to infectious agents transmitted via respiratory droplets has been studied only for RSV. Reports published in the mid-1980s demonstrated that eye protection reduced occupational transmission of RSV 760, 761. Whether this was due to preventing hand-eye contact or respiratory droplet-eye contact has not been determined. However, subsequent studies demonstrated that RSV transmission is effectively prevented by adherence to Standard plus Contact Precations and that for this virus routine use of goggles is not necessary 24, 116, 117, 684, 762. It is important to remind healthcare personnel that even if Droplet Precautions are not recommended for a specific respiratory tract pathogen, protection for the eyes, nose and mouth by using a mask and goggles, or face shield alone, is necessary when it is likely that there will be a splash or spray of any respiratory secretions or other body fluids as defined in Standard Precautions Disposable or non-disposable face shields may be used as an alternative to goggles 759. As compared with goggles, a face shield can provide protection to other facial areas in addition to the eyes. Face shields extending from chin to crown provide better face and eye protection from splashes and sprays; face shields that wrap around the sides may reduce splashes around the edge of the shield. Removal of a face shield, goggles and mask can be performed safely after gloves have been removed, and hand hygiene performed. The ties, ear pieces and/or headband used to secure the equipment to the head are considered "clean" and therefore safe to touch with bare hands. The front of a mask, goggles and face shield are considered contaminated (Figure).

II.E.4. Respiratory protection
The subject of respiratory protection as it applies to preventing transmission of airborne infectious agents, including the need for and frequency of fit-testing is under scientific review and was the subject of a CDC workshop in 2004 763.

Respiratory protection currently requires the use of a respirator with N95 or higher filtration to prevent inhalation of infectious particles. Information about respirators and respiratory protection programs is summarized in the Guideline for Preventing Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005 (CDC.MMWR 2005; 54: RR-17 12).

Respiratory protection is broadly regulated by OSHA under the general industry standard for respiratory protection (29CFR1910.134)764 which requires that U.S. employers in all employment settings implement a program to protect employees from inhalation of toxic materials. OSHA program components include medical clearance to wear a respirator; provision and use of appropriate respirators, including fit-tested NIOSH-certified N95 and higher particulate filtering respirators; education on respirator use and periodic re-evaluation of the respiratory protection program. When selecting particulate respirators, models with inherently good fit characteristics (i.e., those expected to provide protection factors of 10 or more to 95% of wearers) are preferred and could theoretically relieve the need for fit testing 765, 766. Issues pertaining to respiratory protection remain the subject of ongoing debate. Information on various types of respirators may be found at <broken link removed> and in published studies 765, 767, 768. A user-seal check (formerly called a "fit check") should be performed by the wearer of a respirator each time a respirator is donned to minimize air leakage around the facepiece 769. The optimal frequency of fit-testng has not been determined; re-testing may be indicated if there is a change in facial features of the wearer, onset of a medical condition that would affect respiratory function in the wearer, or a change in the model or size of the initially assigned respirator 12.

Respiratory protection was first recommended for protection of preventing U.S. healthcare personnel from exposure to M. tuberculosis in 1989. That recommendation has been maintained in two successive revisions of the Guidelines for Prevention of Transmission of Tuberculosis in Hospitals and other Healthcare Settings 12, 126. The incremental benefit from respirator use, in addition to administrative and engineering controls (i.e., AIIRs, early recognition of patients likely to have tuberculosis and prompt placement in an AIIR, and maintenance of a patient with suspected tuberculosis in an AIIR until no longer infectious), for preventing transmission of airborne infectious agents (e.g., M. tuberculosis) is undetermined. Although some studies have demonstrated effective prevention of M. tuberculosis transmission in hospitals where surgical masks, instead of respirators, were used in conjunction with other administrative and engineering controls 637, 770, 771, CDC currently recommends N95 or higher level respirators for personnel exposed to patients with suspected or confirmed tuberculosis. Currently this is also true for other diseases that could be transmitted through the airborne route, including SARS 262 and smallpox 108, 129, 772, until inhalational transmission is better defined or healthcare-specific protective equipment more suitable for for preventing infection are developed. Respirators are also currently recommended to be worn during the performance of aerosol-generating procedures (e.g., intubation, bronchoscopy, suctioning) on patients withSARS Co-V infection, avian influenza and pandemic influenza (See Appendix A).

Although Airborne Precautions are recommended for preventing airborne transmission of measles and varicella-zoster viruses, there are no data upon which to base a recommendation for respiratory protection to protect susceptible personnel against these two infections; transmission of varicella-zoster virus has been prevented among pediatric patients using negative pressure isolation alone 773. Whether respiratory protection (i.e., wearing a particulate respirator) would enhance protection from these viruses has not been studied. Since the majority of healthcare personnel have natural or acquired immunity to these viruses, only immune personnel generally care for patients with these infections 774-777. Although there is no evidence to suggest that masks are not adequate to protect healthcare personnel in these settings, for purposes of consistency and simplicity, or because of difficulties in ascertaining immunity, some facilities may require the use of respirators for entry into all AIIRs, regardless of the specific infectious agent.

Procedures for safe removal of respirators are provided (Figure). In some healthcare settings, particulate respirators used to provide care for patients with M. tuberculosis are reused by the same HCW. This is an acceptable practice providing the respirator is not damaged or soiled, the fit is not compromised by change in shape, and the respirator has not been contaminated with blood or body fluids. There are no data on which to base a recommendation for the length of time a respirator may be reused.

OSHA Guidelines for decontamination:
https://www.osha.gov/Publications/OSHA_FS-3756.pdf

CDC Poster for putting on your PPE:
http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf

CDC Guidance for handling of human remains:
http://www.cdc.gov/vhf/ebola/hcp/gu...s-ebola-patients-us-hospitals-mortuaries.html

Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries
These recommendations give guidance on the safe handling of human remains that may contain Ebola virus and are for use by personnel who perform postmortem care in U.S. hospitals and mortuaries. In patients who die of Ebola virus infection, virus can be detected throughout the body. Ebola virus can be transmitted in postmortem care settings by laceration and puncture with contaminated instruments used during postmortem care, through direct handling of human remains without appropriate personal protective equipment, and through splashes of blood or other body fluids (e.g. urine, saliva, feces) to unprotected mucosa (e.g., eyes, nose, or mouth) which occur during postmortem care.

• Only personnel trained in handling infected human remains, and wearing PPE, should touch, or move, any Ebola-infected remains.
• Handling of human remains should be kept to a minimum.
• Autopsies on patients who die of Ebola should be avoided. If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions.

Definitions for Terms Used in this Guidance
Cremation: The act of reducing human remains to ash by intense heat.

Hermetically sealed casket: A casket that is airtight and secured against the escape of microorganisms. A casket will be considered hermetically sealed if accompanied by valid documentation that it has been hermetically sealed AND, on visual inspection, the seal appears not to have been broken.

Leakproof bag: A body bag that is puncture-resistant and sealed in a manner so as to contain all contents and prevent leakage of fluids during handling, transport, or shipping.

Personal protective equipment for postmortem care personnel

• Personal protective equipment (PPE): Prior to contact with body, postmortem care personnel must wear PPE consisting of: surgical scrub suit, surgical cap, impervious gown with full sleeve coverage, eye protection (e.g., face shield, goggles), facemask, shoe covers, and double surgical gloves. Additional PPE (leg coverings, apron) might be required in certain situations (e.g., copious amounts of blood, vomit, feces, or other body fluids that can contaminate the environment).

• Putting on, wearing, removing, and disposing of protective equipment: PPE should be in place BEFORE contact with the body, worn during the process of collection and placement in body bags, and should be removed immediately after and discarded appropriately (see Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus). Use caution when removing PPE as to avoid contaminating the wearer. Hand hygiene (washing your hands thoroughly with soap and water or an alcohol based hand rub) should be performed immediately following the removal of PPE. If hands are visibly soiled, use soap and water.

Postmortem preparation

• Preparation of the body: At the site of death, the body should be wrapped in a plastic shroud. Wrapping of the body should be done in a way that prevents contamination of the outside of the shroud. Change your gown or gloves if they become heavily contaminated with blood or body fluids. Leave any intravenous lines or endotracheal tubes that may be present in place. Avoid washing or cleaning the body. After wrapping, the body should be immediately placed in a leak-proof plastic bag not less than 150 μm thick and zippered closed The bagged body should then be placed in another leak-proof plastic bag not less than 150 μm thick and zippered closed before being transported to the morgue.
• Surface decontamination: Prior to transport to the morgue, perform surface decontamination of the corpse-containing body bags by removing visible soil on outer bag surfaces with EPA-registered disinfectants which can kill a wide range of viruses. Follow the product's label instructions. the visible soil has been removed, reapply the disinfectant to the entire bag surface and allow to air dry. Following the removal of the body, the patient room should be cleaned and disinfected. Reusable equipment should be cleaned and disinfected according to standard procedures. For more information on environmental infection control, please refer to "Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus" (http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html).
• Individuals driving or riding in a vehicle carrying human remains: PPE is not required for individuals driving or riding in a vehicle carrying human remains, provided that drivers or riders will not be handling the remains of a suspected or confirmed case of Ebola, and the remains are safely contained and the body bag is disinfected as described above.

Mortuary Care

• Do not perform embalming. The risks of occupational exposure to Ebola virus while embalming outweighs its advantages; therefore, bodies infected with Ebola virus should not be embalmed.
• Do not open the body bags.
• Do not remove remains from the body bags. Bagged bodies should be placed directly into a hermetically sealed casket.
• Mortuary care personnel should wear PPE listed above (surgical scrub suit, surgical cap, impervious gown with full sleeve coverage, eye protection (e.g., face shield, goggles), facemask, shoe covers, and double surgical gloves) when handling the bagged remains.
• In the event of leakage of fluids from the body bag, thoroughly clean and decontaminate areas of the environment with EPA-registered disinfectants which can kill a broad range of viruses in accordance with label instructions. Reusable equipment should be cleaned and disinfected according to standard procedures. For more information on environmental infection control, please refer to "Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus" (http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html).

Disposition of Remains

• Remains should be cremated or buried promptly in a hermetically sealed casket.
• Once the bagged body is placed in the sealed casket, no additional cleaning is needed unless leakage has occurred.
• No PPE is needed when handling the cremated remains or the hermetically sealed closed casket.

Transportation of human remains

• Transportation of remains that contain Ebola virus should be minimized to the extent possible.
• All transportation, including local transport, for example, for mortuary care or burial, should be coordinated with relevant local and state authorities in advance.
• Interstate transport should be coordinated with CDC by calling the Emergency Operations Center at 770-488-7100. The mode of transportation (i.e., airline or ground transport), must be considered carefully, taking into account distance and the most expeditious route. If shipping by air is needed, the remains must be labeled as dangerous goods in accordance with Department of Transportation regulations (49 Code of Federal Regulations 173.196).
• Transportation of remains that contain Ebola virus outside the United States would need to comply with the regulations of the country of destination, and should be coordinated in advance with relevant authorities.

References
CDC. Medical Examiners, Coroners, and Biologic Terrorism A Guidebook for Surveillance and Case Management. MMWR 2004;53(RR08);1-27. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5308a1.htm)

 

[bolus]

Just like you posted, the information is out there and easily found on the web. I dont recommend anyone get their information from news. They are there to make a profit, not inform anyone with correct information. I've never seen a news story that was completely correct with medical information. They are just not trust worthy when your health or lives are on the line.

 

[AMProducts]

So to give some updates on a few things I've been looking into are PPE and decontamination procedures, both for people and for "contaminated material". Somewhat alarmingly there seem to be relatively few sources for this information.

PPE:

What I do know, is the yellow suits are relatively standard Dupont Tychem suits, Uvex lab goggles and tyvek hoods as well as N95 masks seem to be the most common.

In the cleanup cases (shown here http://www.usatoday.com/story/money/business/2014/10/15/ebola-protective-gear/17307415/) a variety of full-face respirators are worn, most likely using N95 or N99 filters. Most of the ones I've seen are the relatively conventional 3m 6 and 7000 series respirators.

As far as gloves, double gloving seems to be the standard (makes removing PPE easier), I havn't found any specifics, but nitrile or latex gloves seem to be acceptable. (4-8mil thickness)

Rubber boots are standard for the feet. I have seen some people using tyvek covers, however according to most of the manufacturer documentation, tyvek is not recommended for wet environments as there is a high incidence of bleed through. This is why tychem is recommended.

Decontamination:

So far information is rather limited, but a .5% bleach solution is recommend for decon, that is normal household bleach 1gal to 10gal water. I havn't found any other recommendations as of yet. There is also limited information available for decontaminating personnel, both with and without PPE.

It seems to me, that a bleach shower followed by a clean water shower would be the preferred method for decontaminating personnel, however I havn't found any recommendations that are this specific.

http://time.com/3509980/ebola-protection-mistakes/

Why Protective Gear Is Sometimes Not Enough in the Fight Against Ebola

• Aryn Baker @arynebaker

Oct. 15, 2014

Health workers receive assistance with putting on their protective gear before entering the high-risk zone at the Bong County Ebola Treatment Unit near Gbarnga in rural Bong County, Liberia, Oct. 5, 2014. Daniel Berehulak—The New York Times/Redux
Human error can endanger even the most experienced health care workers in the fight against Ebola

More
U.S. Scrambles to Contain Ebola
Second Texas Health Care Worker Tests Positive for Ebola
Ebola Advice From Atlanta and Nebraska Doctors Fails to Ease Fears
When it comes to Ebola, the full-body Personal Protective Equipment [PPE] suit is probably the best way to prevent infection. But a PPE can also be one of the easiest ways to get Ebola. A PPE is usually made up of a full-body, impermeable suit with a hood, rubber boots covered by Tyvek booties, multiple pairs of surgical gloves, a surgical mask over the nose and mouth, a plastic bib, goggles, a plastic apron and a lot of duct tape. There is a reason why they are nicknamed moon suits: worn properly, they shouldn't show an inch of skin. Putting them on right requires two people and about 10 minutes. Taking them off, in even the best of circumstances, is a clumsy, arduous process with multiple opportunities to make a lethal mistake.

It is not yet clear how, exactly, two health care workers at a Dallas hospital tending Thomas Eric Duncan, the first man to be diagnosed with Ebola in the United States, caught the disease, but health authorities are looking closely at the protective measures used at the hospital, and whether or not they were sufficient. Meanwhile, in Spain, where a nurse, Teresa Romero Ramos, is being treated for Ebola that she caught from a patient recently returned from Sierra Leone, officials are questioning whether or not she wore her PPE properly. On a Spanish television program quoted by the New York Times, Madrid's regional health minister, Javier Rodríguez, questioned the need for extensive training on using the PPEs. "You don't need a master's degree to explain to someone how you should put on or take off" a protective suit, he said.

Maybe not, but no matter how experienced and qualified you are in putting on and taking off a PPE there is always room for error. I recently spent two weeks in Monrovia, Liberia, reporting on Ebola, and climbing into, and out of, PPEs on a regular basis, and I am still not sure I ever got it right. I was trained by the best, too: the Red Cross Dead Body Management teams, the guys responsible for picking up deceased Ebola victims and transporting them to the crematorium for safe disposal. An Ebola patient is at his most infective in the hours and days after death, when the virus swarms the skin and bodily fluids.

When the Dead Body Management team workers finish zipping a corpse into a double-sealed body bag they undergo an extensive decontamination process that best resembles a military drill in its precision and attention to detail. Each worker is paired with a sanitizer, a man wearing a backpack sprayer filled with a chlorine and water solution. The process is initiated with a good dousing of chlorine solution and a vigorous washing of the gloved hands. The worker removes his goggles, which are sprayed thoroughly and then discarded. His hands are sprayed again. Then the hood goes down, and the zipper is sprayed, as are the hands for another time. He unzips, and his hands are sprayed yet again. Then he has to shrug out of the suit without allowing any of the external surfaces to come into contact with his hands or the clothing underneath. And so it goes, layer after layer until the worker is left standing in boots, medical scrubs, and the last pair of gloves. Again he is liberally sprayed down with the chlorine solution, at which point he has to jigger off his gloves in a way that ensures that the surface does not come into contact with the skin.

 

[AMProducts]

Decontamination of Vehicles & Equipment Used for
Transportation of Potential Ebola Virus Disease (EVD)
Patients or Related Equipment

<broken link removed>

File attatched.

 

[rick benjamin]

Obola has mobilized Reserves and NG to fight Ebola.
http://www.nbcnews.com/storyline/eb...s-national-guard-reserves-ebola-fight-n227336
http://www.nbcnews.com/storyline/eb...nd-two-schools-shut-nurses-paid-leave-n227096
How deeply is deeply?
http://www.nbcnews.com/storyline/eb...al-we-are-deeply-sorry-ebola-mistakes-n227031
But they LIE!?
http://www.cbsnews.com/news/ebola-nurse-called-cdc-several-times/
Where is the Outrage!? Where is the Media?!
Those numbers are similar to US green kid casualties!!
http://www.nbcnews.com/storyline/eb...oll-passes-4-500-including-236-health-n227291
My mistake, it was Chicago
http://www.huffingtonpost.com/2012/06/16/chicago-homicide-rate-wor_n_1602692.html

 

[PiratePast40]

Looks like friends and family of the first ebola victim to die in the US don't have any symptoms: <broken link removed> .

Lab worker on "ebola ship" tests negative: http://www.usatoday.com/story/news/...sample-from-woman-monitored-on-ship/17543409/

Ebola patients, including Spanish nurse released: http://www.usatoday.com/story/news/nation/2014/10/20/ebola-patient-emory-discharged/17625303/

It's not all doom and gloom.

 

[AMProducts]

I'll take good news whenever I can find it. However, I tend to expect the worst, hope for the best. I'll be honest, pandemic ebola is right up there next to global thermonuclear war on my "bad things" list. For a long time, that possibility seemed so remote as to be laughable. With the major outbreak in west africa, and people showing up in the states with the disease the possibilities engendered have taken hops skips and jumps closer to reality.

 

[erudne]

 

[PiratePast40]

Nurse released from forced isolation and soldiers returning from Africa placed in isolation:
http://www.reuters.com/article/2014/10/27/us-health-ebola-usa-newyork-idUSKBN0IG12920141027