Experts on disease transmission: Ebola may be spread through the air. Respirators ARE necessary.

[pnwmom]

The face masks currently recommended by the CDC do not supply enough protection from the Ebola virus.

Please, if you are going to dispute that Ebola may be aerosolized , read the article and not just this post. There is much more at the link that supports the authors' arguments.

http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

Editor's Note: Today's commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago.

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.1

The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.

There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids2,3 and that the only modes of transmission we should be concerned with are those termed "droplet" and "contact."

These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) "direct" contact with the body fluids of an infected person.

This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.

SNIP

[uppityperson]

1. Healthcare workers are in a class of their own and need protective equipment. Majority of cases

inW Africa countries are spread from the contagious ill to their caregivers. I can not imagine watching sick loved ones and be able to help, touch, comfort due to the contagious part.

[pnwmom]

2. But the CDC is not requiring they be given this equipment, without which their risk of

being infected is increased.

[Agschmid]

10. While I agree with the general idea...

I don't see what control the CDC has over facilities outside the U.S.

[pnwmom]

11. They don't. The WHO should also change their recommendations, according to these experts.

But until we make sure all our hospitals are supplied with this equipment, we cannot say they are ready to handle Ebola patients.

[Agschmid]

16. I generally agree.

[cali]

3. and dealing with the bodies of those who have died.

[uppityperson]

4. Indeed, they also. High risk groups including dealing with highly infectious dead need better

protective equipment to avoid infecting themselves, which is unfortunatley not often the case (adequate protective gear).

[AverageJoe90]

36. Can't argue with that.

But it does bother me a little that it seems that so many people are jumping to these wild conclusions simply because they feel cynical about authority, or whatever.

I'm not one to automatically believe everything myself, but the WHO and other organizations have studied Ebola for *decades*.....

[Kalidurga]

5. given that some caregivers have contracted the disease after all known precautions...

were taken it's almost certain that being near someone with ebola who has coughed or sneezed might have been how they got infected.

[zazen]

6. more from link on concept of "aerosol transmissible" to replace outdated paradigm

Thanks for posting. Also from link:

"Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data. In the 1940s and 50s, William F. Wells and other "aerobiologists" employed now significantly out-of-date sampling methods (eg, settling plates) and very blunt analytic approaches (eg, cell culturing) to understand the movement of bacterial aerosols in healthcare and other settings. Their work, though groundbreaking at the time, provides a very incomplete picture.

Early aerobiologists were not able to measure small particles near an infectious person and thus assumed such particles existed only far from the source. They concluded that organisms capable of aerosol transmission (termed "airborne&quot can only do so at around 3 feet or more from the source. Because they thought that only larger particles would be present near the source, they believed people would be exposed only via large "droplets" on their face, eyes, or nose.

Modern research, using more sensitive instruments and analytic methods, has shown that aerosols emitted from the respiratory tract contain a wide distribution of particle sizes—including many that are small enough to be inhaled.5,6 Thus, both small and large particles will be present near an infectious person.

. . . . It's time to abandon the old paradigm of three mutually exclusive transmission routes for a new one that considers the full range of particle sizes both near and far from a source. In addition, we need to factor in other important features of infectivity, such as the ability of a pathogen to remain viable in air at room temperature and humidity and the likelihood that systemic disease can result from deposition of infectious particles in the respiratory system or their transfer to the gastrointestinal tract."

[librechik]

9. this ^^^

[pnwmom]

13. Thank you, zazen, for posting more about the "outdated paradigm" some are using to back up

a claim that transmission through the air is not possible.

[AverageJoe90]

23. See post 7. "Outdated paradigms" you've been hearing about are not actually a problem. nt

[pnwmom]

35. One study doesn't prove anything. The point is that the scientific experts disagree on this,

and some of the top experts believe that health care personnel should be using respirators. Until it can be proven that no airborne transmission is possible -- which the study in Nature does not do -- then the conservative approach is for healthcare personnel to use respirators, just as the research scientists do.

[Dr Hobbitstein]

7. Not according to this study published this year.

http://www.nature.com/srep/2014/140725/srep05824/full/srep05824.html

[librechik]

8. thx for the access! n/t

grt article!

[pnwmom]

12. The authors in the OP dispute the conclusion of your study, and explain why in their article.

The paradigm that the Nature authors use on aerosolized transmission dates back to the 1940's and has been shown to be inadequate in terms of what we know today.

It seems to me that when experts differ and the health of our medical personnel is involved, we ought to take the most conservative approach to protecting them.

[dixiegrrrrl]

14. As I commented on another post about this:

I predict this will create time wasting arguments back and forth among the "experts",
when what should happen is, on the chance this info is correct, health workers should act as it is.

Oooops, I am sorry won't cut it if these guys above are correct.

[pnwmom]

15. Right. We should take the most conservative approach to protecting our health care personnel. n/t

[AverageJoe90]

17. Good article, thanks for posting.

For goodness sakes, folks, it's pretty clear that there's no clear evidence of airborne transmission(and evidence that indicates that it is not!). So why are people still trying to argue otherwise?

[pnwmom]

18. What is clear is that there is no proof that it cannot be transmitted through the air.

And in the absence of such proof, the conservative approach to protecting healthcare personnel should be followed -- and respirators should be used.

120 healthcare workers have died in the current epidemic. Doesn't it seem wrong to you that scientists who study the virus always use respirators, and yet some of them insist that healthcare workers -- who can be exposed to much higher quantities of virus -- don't need them?

[AverageJoe90]

19. I'm all for taking as many precautions as possible.

But in virtually every case we know of, all the evidence has pointed to somebody having some into contact with non-aerosolized contaminants, usually thru direct contact with urine, feces, etc. So, I dunno what else to tell you, other that's where the evidence points.

[pnwmom]

20. Except that the evidence you discount is that 120 healthcare workers have gotten

the virus during the current epidemic, and in many of them there was no known means of transmission. How can we be confident that our current protective requirements are enough -- especially since scientists themselves use respirators because they don't trust face masks to protect themselves from the virus?

[AverageJoe90]

21. I didn't discount anything, actually.

However, though, the real problem is, many healthcare workers in West Africa simply don't have adequate protection, period(ain't got a darn thing to do with face masks, btw!), and some hospitals just don't operate to the basic decent standards that they should. And then there's the individual slip-ups by individual nurses, doctors, etc., in either Africa or the West that can and do happen, which only complicates matters(like what happened here in the D/FW area). And *that's* where we should be looking for problems, at least as far as the West is concerned.

[jeff47]

24. And if airborne transmission actually occurred, that number would be 120,000.

You can't just claim airborne transmission is possible because of a small number of unknown cases. Airborne transmission would mean you get all the results of airborne transmission. So lots and lots more cases thanks to the easier transmission mode. And significant numbers of cases with no close contact to an ill person.

That hasn't happened. That doesn't mean we've proven airborne transmission is utterly impossible, but we also have no evidence that it actually happens - the people "just asking questions" stop asking questions when it starts showing their model isn't fitting reality.

[pnwmom]

25. No, airborne transmission could be unlikely but POSSIBLE. That is clearly what the scientists who

work with it think, and that is why they themselves use the respirators they don't think health care workers need.

But I think the lives of health care workers should be as scrupulously protected as those of scientists.

[jeff47]

31. No, they really don't.

The scientists who actually work with it publish studies. Not commentaries.

Also, Biohazard level 4 labs have stricter rules because they don't only have ebola in them.

Again, we have hundreds of thousands of cases of ebola over four decades. We've found exactly zero cases proving airborne transmission. If airborne transmission is actually POSSIBLE, how come nobody can show it has ever happened?

[pnwmom]

32. Because whenever there is a case where it might have happened, such as with Dr. Brantley

Last edited Tue Oct 7, 2014, 10:04 PM - Edit history (4)

or the Spanish medical worker, it is immediately dismissed as impossible.

How come no one can show how Dr. Brantley was infected?

And the fact is that Ebola IS classified as a Level 4 hazard, so scientists are fully protected when they work with it. Health care workers deserve as much protection.

http://en.wikipedia.org/wiki/Ebola_virus_disease

In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required, since Ebola viruses are World Health Organization Risk Group 4 pathogens. Laboratory researchers must be properly trained in BSL-4 practices and wear proper personal protective equipment.

Biosafety level 4


This level is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections, agents which cause severe to fatal disease in humans for which vaccines or other treatments are not available, such as Bolivian and Argentine hemorrhagic fevers, Marburg virus, Ebola virus, Lassa virus, Crimean-Congo hemorrhagic fever, and various other hemorrhagic diseases. This level is also used for work with agents such as smallpox that are considered dangerous enough to require the additional safety measures, regardless of vaccination availability. When dealing with biological hazards at this level the use of a positive pressure personnel suit, with a segregated air supply is mandatory. The entrance and exit of a level four biolab will contain multiple showers, a vacuum room, an ultraviolet light room, and other safety precautions designed to destroy all traces of the biohazard. Multiple airlocks are employed and are electronically secured to prevent both doors from opening at the same time. All air and water service going to and coming from a biosafety level 4 (or P4) lab will undergo similar decontamination procedures to eliminate the possibility of an accidental release.

Agents with a close or identical antigenic relationship to biosafety level 4 agents are handled at this level until sufficient data are obtained either to confirm continued work at this level, or to work with them at a lower level.

Members of the laboratory staff have specific and thorough training in handling extremely hazardous infectious agents and they understand the primary and secondary containment functions of the standard and special practices, the containment equipment, and the laboratory design characteristics. They are supervised by qualified scientists who are trained and experienced in working with these agents. Access to the laboratory is strictly controlled by the laboratory director.

The facility is either in a separate building or in a controlled area within a building, which is completely isolated from all other areas of the building. A specific facility operations manual is prepared or adopted. Building protocols for preventing contamination often use negatively pressurized facilities, which, even if compromised, would severely inhibit an outbreak of aerosol pathogens.

Within work areas of the facility, all activities are confined to Class III biological safety cabinets, or Class II biological safety cabinets used with one-piece positive pressure personnel suits ventilated by a life support system.

[hobbit709]

26. When in danger or in doubt. run in circles, scream and shout.

[neverforget]

33. I agree

[scarystuffyo]

27. The CDC is lying to us...they really can't say 100% it can't go airborne

They say no virus that they know of ever has , well this is like no other virus we have dealt with.





.


Scientists have said for some time that Ebola may be spread through coughing, sneezing and other aerosol transmission.

The top American health agency - the U.S. Centers for Disease Control - has denied this for months. But CDC has finally been forced to admit that it's true.

The Los Angeles Times reports today:






Some scientists who have long studied Ebola say such assurances are premature — and they are concerned about what is not known about the strain now on the loose.



***



Dr. C.J. Peters, who battled a 1989 outbreak of the virus among research monkeys housed in Virginia and who later led the CDC’s most far-reaching study of Ebola’s transmissibility in humans, said he would not rule out the possibility that it spreads through the air in tight quarters.



“We just don’t have the data to exclude it,” said Peters, who continues to research viral diseases at the University of Texas in Galveston.



Dr. Philip K. Russell, a virologist who oversaw Ebola research while heading the U.S. Army’s Medical Research and Development Command, and who later led the government’s massive stockpiling of smallpox vaccine after the Sept. 11 terrorist attacks, also said much was still to be learned. “Being dogmatic is, I think, ill-advised, because there are too many unknowns here.”



***



“I see the reasons to dampen down public fears,” Russell said. “But scientifically, we’re in the middle of the first experiment of multiple, serial passages of Ebola virus in man…. God knows what this virus is going to look like. I don’t.”



Tom Skinner, a spokesman for the CDC in Atlanta, said health officials were basing their response to Ebola on what has been learned from battling the virus since its discovery in central Africa in 1976. The CDC remains confident, he said, that Ebola is transmitted principally by direct physical contact with an ill person or their bodily fluids. [Well, yes ... everyone knows that physical contact with the victim or their fluids is the prime route of exposure.]



***



Finally, some also question the official assertion that Ebola cannot be transmitted through the air. In late 1989, virus researcher Charles L. Bailey supervised the government’s response to an outbreak of Ebola among several dozen rhesus monkeys housed for research in Reston, Va., a suburb of Washington.



What Bailey learned from the episode informs his suspicion that the current strain of Ebola afflicting humans might be spread through tiny liquid droplets propelled into the air by coughing or sneezing.



“We know for a fact that the virus occurs in sputum and no one has ever done a study [disproving that] coughing or sneezing is a viable means of transmitting,” he said. Unqualified assurances that Ebola is not spread through the air, Bailey said, are “misleading.”



Peters, whose CDC team studied cases from 27 households that emerged during a 1995 Ebola outbreak in Democratic Republic of Congo, said that while most could be attributed to contact with infected late-stage patients or their bodily fluids, “some” infections may have occurred via “aerosol transmission.”



Skinner of the CDC, who cited the Peters-led study as the most extensive of Ebola’s transmissibility, said that while the evidence “is really overwhelming” that people are most at risk when they touch either those who are sick or such a person’s vomit, blood or diarrhea, “we can never say never” about spread through close-range coughing or sneezing.



“I’m not going to sit here and say that if a person who is highly viremic … were to sneeze or cough right in the face of somebody who wasn’t protected, that we wouldn’t have a transmission,” Skinner said.



Peters, Russell and Bailey, who in 1989 was deputy commander for research of the Army’s Medical Research Institute of Infectious Diseases, in Frederick, Md., said the primates in Reston had appeared to spread Ebola to other monkeys through their breath.

[zazen]

29. “Being dogmatic is, I think, ill-advised, because there are too many unknowns here.”

I sure as hell hope it isn't aerosolized in the sense we traditionally understand it. But as this scientist says, there are a lot of "unknowns here."

Panic? Not necessarily. Humility? Highly recommended.

Why some posters are insistent on shaming people who pose balanced, legitimate questions is beyond me.

[scarystuffyo]

30. I haven't been here long enough to notice the shaming but

when posters say that they feel the CDC is telling us 100% everything they know should be viewed with some
skepticism . Since when do we believe 100% what our government tell us every time ?

I must have missed that memo

[AverageJoe90]

37. Oh boy, here we go again with the fearmongering.....nt

[sadoldgirl]

28. Considering what a grizzly epidemic this is,

as well as not thorough enough studies have been done with this virus, I think that every precaution should be taken. After all we know from HIV how quickly a virus can mutate, which should give us enough reason to be extra careful, imo. Even here we need yearly flu shots, which differ slightly each time.

[riverwalker]

34. "healthcare workers should be wearing respirators, not (N95) facemasks"

This is the N95 mask we use now for airborne, and TB



This is the powered air-purifying respirator (PAPR

?itok=AhdUpI60