NPR This Morning: What we DON'T know about Ebola

[adigal]

A virologist from Columbia University was on this morning. He spoke of the fact that there is much we don't know about Ebola. This particular strain, the West African strain, is acting differently than prior strains. Even though Ebola is a hemorrhagic fever, it isn't acting that way because people who are infected and dying aren't bleeding out.

The researchers interviewed all agreed that there is much not known; another researcher said we don't even know how Ebola attaches to our cells. The subtext was that caution should be taken because it is a deadly disease.

Here's the link. It was an interesting listen.

http://www.npr.org/blogs/health/2014/10/31/359837446/virus-sleuths-chip-away-at-ebola-mysteries

[unblock]

1. i thought it messes up blood clotting

and the tiny clots wreak havoc on all sorts of body systems, blocking pathways that should be open and increasing pressure elsewhere, opening up pathways that should be closed. so you bleed out if important blood pathways get holes in them, or you die of organ failure if makes swiss cheese of your liver or whatever first.

[adigal]

2. Yes, but this strain is acting differently. I found the link

http://www.npr.org/blogs/health/2014/10/31/359837446/virus-sleuths-chip-away-at-ebola-mysteries

[B2G]

4. Only 18% even bleed with this strain. nt

[magical thyme]

15. it causes DIC (disseminated intravascular coagulation), which does cause bloodclots throughout

The "break out" of the initial infection causes a cytokine storm, which causes a massive, generalized inflammatory response. And once the virions break out, wrapped in the patient's own cell linings, they attack and infect the endothelial cells that line the blood vessels.

The inflammatory response plus the direct attack on the blood vessels triggers the DIC.

Eventually, the blood vessels start to break down and leak blood internally, and because the the DIC ultimately leads to lack of platelets to clot, the patient also becomes prone to bruising and bleeding through minor injuries.

The patients doen't die from bleeding out. They die of hypovolemic shock and ensuing organ failure, which is due to loss of blood pressure. When the blood is leaking out internally, the body initially tries to replace the blood, but can't keep up. IOW, the lack of volume (hypo vol) of blood (emia) drops blood pressure to the point where the heart can't pump enough blood through the circulatory system to keep organs functioning. And so organs begin to fail.

[B2G]

3. Yeah well, some of us have been saying this for awhile now

But we're constantly being shouted down here and told that the science is settled, we know everthing there is to know about transmission, contagion and how to handle it. There's nothing more to learn and there's no room for any doubt on how things are being handled.

Frankly, I've grown weary of the argument and being told I'm some sort of 'panic monger' for questioning authorites and trying to have a rational conversation on the matter.

Honestly, it seems to me that the ones who are so despertely seeking to shut off all discussion about the things we don't know are the ones who are terrified. I can just picture a few here with their hands firmly placed over their ears shouting 'lalala...I can't hear you!".

Thanks for the link...going to check it out now.

[ecstatic]

6. +1. nt

[prayin4rain]

7. Agreed. n/t

[Crunchy Frog]

8. Totally agree with you.

A mob mentality has developed on DU that's made intelligent, respectful discussion virtually impossible.

[snappyturtle]

22. +1 nt

[distantearlywarning]

9. Totally agree.

I've stopped participating in or even reading most of the Ebola threads because of the nasty invective. There's no way to even have a rational or thoughtful discussion about it anymore on DU. I couldn't believe the thread yesterday in which people who didn't perfectly agree with the OP in every way were told they were crazy, panicking children who needed to sit down and shut up and let the "grownups" (i.e., other people who agreed with the OP's viewpoint) talk. I couldn't believe the OP didn't get hidden for some of the personal invective s/he was spewing at other posters in that thread. It was incredibly rude and divisive. I seriously don't understand why it needs to be so personal all the time around here now. Can't two people talk or disagree about something without one of them always having to be denigrated as "panicked" or "immature" or "a cowering child" or "crazy" or whatever?

[Eugene Stoner]

11. Totally agree

now waiting for riqster to go on a tirade

[adigal]

14. Dailykos was just as bad. If everyone is so sure it's safe

why the hysteria when others disagree?

[adigal]

12. I'm with you...I think denial is a sign of greater fear

It's better to be realistic.

[upaloopa]

26. How close are you to an Ebola patient?

Geez! Two or three people in this country
We are spending way too much fear and anxiety over Ebola!

[B2G]

29. Which has what to do with what I said? nt

[B2G]

5. Interesting article on the role genetics may play

in determining who gets sick and dies from the virus.

http://www.nytimes.com/2014/10/31/health/genes-influence-ebola-infections-in-mice-study-suggests.html?_r=0

[adigal]

13. Very interesting in that they may be able to fight it that way

Thanks!

[B2G]

16. It could also explain the difference in lethality

here and in W. Africa. Perhaps Africans are more suseptible gentically.

The fatality rate over there is 70% while we've only had one death here, a native Liberian.

I'm sure the quality of care has something to do with it, but given the fact all they can really provide is supportive care, I'm not convinced that's the entire reason for the high survival rate. They've also received experimental drugs and survivor plasma, but no one knows if either of those 2 measures actually make a significant difference.

At this point, I'm more inclined to think genetics plays a major role.

[badtoworse]

10. The science is settled and there's nothing to worry about. No need to quarantine unless symptomatic

Disagree with that and you get shouted down as a Tea-Bagger or an idiot.

[B2G]

17. Silly me, they're right of course

Which is why we have a cure, a vaccine, know why some are immune, why some get better and some ultimately die.

[Man from Pickens]

27. It's Hero Science

Never mind the reckless disregard of people in this country that these Heroes are exhibiting.

There's no way for them to know 100% that they don't have it until 3 weeks have passed from last known contact.

It should not be too much to ask for these Heroes to sequester themselves for three weeks.

Unless and until someone can tell me that there's something special about the Heroes that doesn't apply to the doctors and nurses who caught the disease, their failure to take every precaution is staggeringly irresponsible.

One single case is so expensive and disruptive that it would be better to pay them to stay home than take the risk.

[upaloopa]

28. You can think anything you want. But reality is reality

You as well as I know the history of Ebolla in this country for the last few weeks. Nothing like what the hair on fire crowd thinks is anywhere near reality. So yeah you get called out on unfounded statements.
The people who are fighting this disease act on fact and ignore the hysteria.

[B2G]

30. And it wasn't a crisis the first few weeks in Africa either

It's taken 8 months to get to that point.

There is no hysteria on this board. Although several here verge on hysterical denials that this is a non-issue outside of Africa.

[badtoworse]

31. Here is what I think people who discount the Ebola threat here are overlooking

Posted in another thread:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5740577

[magical thyme]

18. That is presenting a grossly oversimplified picture

Survival of the younger versus over 45 is not a big mystery -- it depends on surviving long enough for the immune system to be able to fight it off. As you get older, your immune system becomes less robust. You don't bounce back from anything. It's always possible they'll find some mysterious difference, but the most likely explanation is that one.

There is much that is known about Ebola in general, and there is much that is being learned about this particular outbreak. The Harvard team has already been sequencing and tracking its mutations for some months now.

The most important thing, to me anyway, is that this is the first large outbreak, which is giving the virus opportunity to mutate within humans.

The long term trend in mutation is toward a less lethal infection. Very simply, the longer the host survives, the longer the host survives to pass the virus to somebody else.

[adigal]

19. You are misrepresenting the quote

The researcher states that viruses MAY get less virulent, but generally they remain the same.

[magical thyme]

20. I wasn't referring to the quote at all. I was referring to generally known microbiology

that I learned in pre-med Microbiology.

Mutation of pathogens in general tends toward less virulent. That is a known. It has to do with the mechanics of mutation.

All kinds of random mutations happen. Most of them have no impact on anything. A few make things more virulent. A few make them less virulent.

The ones that make them less virulent also make them more pervasive because the longer the host survives, the longer it survives to allow more replication and the longer it survives to infect more hosts.

A highly lethal pathogen destroys its hosts so quickly, it doesn't get to pass itself to many people.

A less or non-lethal pathogen replicates longer, passes to more people, and so ultimately out-survives the highly lethal pathogen.

That is why once Spanish flu was done, it never came back. That is why regular flu persists and returns year after year.

[B2G]

21. I will say that you are one of the few here

who presents actual facts and doesn't insult those who question.

A couple of questions for you. If the virus is indeed signficantly mutatating, can we draw any conclusions from the numbers WHO is reporting in terms of number of cases/deaths, or would the mutations occur over a longer period of time? Can this give us any insight into changes in lethality and communicablilty?

Do you have any thoughts on genetic factors that could make this virus more lethal to Africans vs non-Africans? Is that perhaps why we've only had one death (of a Liberian native) here in the US?

[magical thyme]

23. I think trends in mutations would appear over a longer period of time...

it's all happening real time right now, with random mutations probably appearing and disappearing before they are ever found. Even with the limited sampling done, they had found something like 300 mutations. Here is a link to an interesting article on their work:
http://www.newyorker.com/magazine/2014/10/27/ebola-wars

RNA viruses have a lot more mutations than DNA viruses because they lack the "proofreader/spellcheck" capabilities that DNA (fortunately) comes with.

I think underlying health factors into survival, and the fact that all of the Americans were treated aggressively right from the start, and by people who were trained specifically for this type of disease. The healthcare workers immediately know they are sick, know they've been exposed and know how to self-treat from the get-go.

Duncan's treatment started very late -- iirc he had already been symptomatic at least 2 days before he went to the ED the first time, so 4-5 days before treatment started -- and his treatment was headed by a doctor not trained specifically in this or similar pathogens. Also, they were out of ZMapp and experimental drug they finally gave him was only approved for use the day they gave it -- very late in his illness. It's been used a couple times since successfully, but in much earlier stages.

Even if all other things were equal, a few patients is not a representative sample to draw conclusions from, such as African versus non-African.

[adigal]

25. Thank you for this information - very informative nt

[Mojorabbit]

24. I read yesterday on promed that they are finding a lot of seropositive

people that never exhibited symptoms. They are guessing they were not ever infectious because they did not have symptoms. The only good thing about this outbreak is that they are learning a lot of new things about the virus and that may help down the road to have better means to fight it.