Ebola!

http://www.naturalnews.com/046275_Ebola_victim_air_transport_continental_USA.html
Click the above link for maximum LOLs.

So, there's a lot of fear flying around about this big Ebola outbreak that's going on in west Africa, and it's only gotten worse since the transport of an infected American doctor back to the US. The popular thing seems to be preparing for a massive stateside Ebola outbreak, which, once you learn a little about Ebola, you will see has a laughably abysmal chance of happening. How about we fly some facts back with him?

First, let's start with a question: What is Ebola, anyway? Ebola is a virus, meaning that it requires a susceptible host cell to be 'alive' and replicate, it is otherwise inert in the environment. That also means that Ebola is affected by antibiotics about as much as it is by Benadryl (see also: not at all), as antibiotics only affect bacteria. Ebola has various strains that are recognized by the US CDC, not all of which are pathogenic in people (Ebola Reston). The virus typically arises in human populations due to an introduction from a wild animal, and is classically native to central Africa; though some non-pathogenic strains have been identified in animals from the Philippines. The virus can transmit person to person, but historically, this has always been by fluid transmission, not airborn transmission (airborn transmission has been noted in pigs and monkeys with Ebola Reston). The virus also has a very lengthy incubation period, making it highly susceptible to public health measures like quarantine and isolation. The severe virulence combined with the fact that the virus spreads by fluid contact means that most outbreaks since we started keeping track in the 70's have simply burned themselves out in one hundred victims or less.[1] Note that in the first two outbreaks, the case load was quite severe, in part due to the fact that nobody knew much of anything about Ebola at the time.

Second, what makes Ebola so dangerous? That's a difficult question to answer, because the exact mechanism of the hemorrhagic part of the hemorrhagic fever isn't known yet, at least to my knowledge. Also, some strains are more virulent (cause worse disease) than others. The basic answer, though, is that in some- not all- patients, the virus causes severe internal bleeding, and the patient dies of hypovolemic shock. To an individual, an Ebola infection is a life threatening event. To a population, however, the story is a little different. The outbreak of Ebola Zaire in Guinea, Liberia, and Sierra Leon has been recognized since march. As of 7/28, there have been a cumulative total of 1201 suspected cases and 672 casualties. That's 672/1201= 55% of reported cases resulting in a fatality, which is still pretty awful, but nowhere near the slate-wiping pandemic it's cracked up to be. Also, with 1201 recognized cases, minus 86 at the time of the initial announcement divided by 120 days (four months between march and July at 30 days each, roughly) equals 9.3 new infections a day, assuming that all infections are cases (symptomatic)- which they aren't.[2] This is in countries that don't have average healthcare, good infection control standards, good sanitation, or even good public health or education measures in place. On the 2000 WHO ranking of 191 countries' healthcare systems, Guinea comes in at #161, Liberia is #186, and Sierra Leon didn't even rank.[3]

In general, the spread of Ebola is facilitated by cultural practices that aren't preformed in the first world. Family members, not trained morticians, handle the bodies and prepare them for burial, and many of these people do not have access to the kind of protective equipment or even basic clean running water and soap necessary to prevent exposure of mucous membranes and open cuts to infected bodily fluids. Another reason that Ebola spreads so easily in these countries is in part due to subpar healthcare systems, where healthcare workers also lack basic body substance isolation equipment like disposable gloves, and needles can get re-used among patients. Symptomatic healthcare workers then come into contact with other uninfected patients and may transmit the disease to them as well.

Now, to consider the case of the good doctor. He's being flown back in field biohazard containment, and he will remain in biohazard containment for the duration of his disease. We actually have a really good track record of disease containment in this country, and even if Ebola did get out, we'd be able to stop its spread fairly easily with basic public health measures such as isolation procedures and quarantines. As Ebola is not a persistent infection, he should be okay for release back into the public once his symptoms resolve. What if the plane crashes? His body, and his Ebola, would likely be incinerated in the subsequent fire. Even if there wasn't a fire and the plane magically broke apart over Manhattan, it's unlikely that the resulting aerosol would pose a hazard to anyone.

What about terrorists? What about terrorists. It's not like there's an epidemic going on in Africa where anyone could just walk in, find an infected person and walk right back- oh wait, yeah, just kidding. Also, the US isn't the only nation with stockpiles of Ebola, you can believe that the Russians have it too, and they aren't exactly known for incredible security in the early post-soviet era. It's pointless to fret about someone nabbing the doctor here in the US and using him to create a biohazard incident. Besides, if you're afraid, the terrorists win, and that's not an America I want to live in.

Why bother taking him over here? I don't know, maybe because our healthcare facilities are just a little better than what Guinea's got going on. That's just a guess, though.

How do you know if you have Ebola? You don't have Ebola, get over yourself.

Ebola's a zombie virus?! Not even kind of close. The victims are alive until they're dead, and then they stay dead. Nobody gets aggressive, nobody tries to eat anyone, people mostly just lay around and die. The video game series Resident Evil did, however, base their zombie-making T-Virus off of Ebola.

Someone told you they could treat Ebola with colloidal silver. And when did they work in a BSL-4 lab, or treat Ebola in the field? This statement is so full of shit, it could be a septic tank. Save your hard-earned money. There's no evidence to date that colloidal silver would have any effect on Ebola virions in the body, and there are no approved antivirals or vaccines available at this time, though there is one in the works. In fact, there's no peer-reviewed evidence to my knowledge that colloidal silver works on anything at all, except to turn you into a smurf.

So let me lay the cards on the table right here and now: you are a hundred a thousand times more likely to die from the emergence of a novel pandemic coronavirus or pandemic antibiotic resistant pneumonia/tuberculosis than you are to catch some magic superstrain of Ebola that somehow escapes biohazard confinement in Atlanta. Questions, comments, ragemail? Leave it here, or on our facebook page.

[1]http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Ebola_Fact_Booklet.pdf
[2]http://www.cdc.gov/vhf/ebola/outbreaks/guinea/recent_updates.html
[3]http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems

Evolution

Wow, what a scary picture.

Credit to Wikipedia

Shaking in your boots at this pink slime? You ought to be, this isn't the Ghostbusters' pink slime, this is Klebsiella Pneumoniae. Why is Klebsiella scary enough to put on then horror blog? The story all starts with Alexander Fleming, the Scottish biologist who officially discovered penicillin in 1928. Before the discovery of penicillin, people died of bacterial infections all the time- tuberculosis, pneumonia, urinary tract infections, infected pimples or sores, sore throats, food poisoning, small cuts to surgeries. The very first patient to receive purified penicillin succumbed to his infection, because what was then the world's supply of purified penicillin was not enough to rid him of the infection he got from a rosebush scratch. When Alexander Fleming received his nobel prize for the discovery of antibiotics, he made a speech in which he warned that resistance would eventually occur. I hate to ring the 'we didn't listen' bell, but fast forward seventy years to the 90's, and we were partying pretty hard with antibiotics- not to imply that we still aren't.

Antibiotics didn't get their real boom until the second world war, around which time we figured out how to scale up and mass produce penicillin. After that, the availability of antibiotics skyrocketed, prices dropped, and we started handing them out like candy. Doctors gave pushy patients with viral respiratory infections antibiotics, when a placebo would have done the patient just as much good; We gave antibiotics out freely as preventative measures; The livestock industry is overflowing with inappropriate use of antibiotics to encourage growth, enough that they're suspected to use more antibiotics on the whole than the healthcare industry. And then, there was MRSA.

MRSA stands for Methicillin Resistant Staphylococcus Aureus. You're probably familiar with it, as the media's had a field day trying to scare the pants off of everyone with ramblings about this 'new superbug', never mind that it's been around since the 1962 (just two years after the introduction of Methicillin). S. Aureus has been blow-for-blow with us since the introduction of antibiotics, with Penicillin resistant strains showing up three years before we began mass-producing Penicillin in 1943- all the way to Vancomycin (1972) resistant strains in 2002. [2]The mechanisms of resistance vary from excreting enzymes that actually destroy antimicrobial compounds (Penicillinase), to alteration of surface proteins and development of specialized outer membranes that block antibiotic contact, to developing molecular pumps that selectively remove uptaken antimicrobials. These mechanisms are often seen in other antimicrobial resistant microbes[3]. How did these microbes develop resistance?

We did it to them- we put them under what's called selective pressure, and caused evolution. When you take an antibiotic, you don't ever quite manage to wipe out all the bacteria- especially if you don't take them like you're supposed to and don't finish the prescription out. The weaker bacteria are culled off, leaving the more resistant bacteria to reproduce and repopulate. After a few passages like that, you eventually end up colonized with something that's a lot tougher than your starting product. That then gets passed along from patient to patient, to healthcare worker, to family, and out to the community. What's more is that bacteria are actually capable of sharing genes among one another, so resistance can be conferred both intra- and inter-species of bacteria. It's not hard to imagine that, on its own, S. Aureus may not have developed some of its present resistance mechanisms, but perhaps coming in contact with a few other naturally occurring bacteria in your body that had also survived, it may have borrowed some resistance genes. Think you don't have a lot of natural bacteria? In fact, at any given time, you have ten times as many bacteria in and on you than you have cells in your body.

This all ties back to K. Pneumoniae, which, with Carbapenem resistance, had a small epidemic in 2011 at the US National Institutes of Health. In the end, 18 people became infected, and 11 people died from pneumonia. The CDC currently ranks this pathogen as an 'urgent' threat to public health, stating that "these bacteria are immediate public health threats that require urgent and aggressive action". There are three other bacteria in this category, and Klebsiella does not have the highest body count. Drug resistant K. Pneumoniae comes in at a modest 9,000 infections and 600 deaths, with the kicker that there are Carbapenem Resistant Enterobacteriaceae with resistance to all presently available antibiotics. The worst offender is Clostridium Difficile at 14,000 deaths and over $1,000,000,000 in medical expenditures.[2] In addition to all this, we have Tuberculosis that is resistant to every antibiotic we can throw at it. Today, in the United States, we are watching patients die from infections we could treat just five years ago.

It gets better, because AstraZenica, Pfizer, and other drug companies have either substantially reduced their research into new antibiotics, or have closed their antimicrobial research divisions altogether. The reasons are mainly a question of cost-benefit, given that the market forces typically value an antibiotic in the tens to low hundreds of dollars. With all the low and even medium-hanging fruits picked, a lot of drug companies feel that the reward isn't worth the effort, and they're probably right. We've seen resistance to every drug presently available, and even to novel drugs we've never used before. Resistance is developing faster and faster to fewer and fewer drugs, and bacteria are starting to gain broadly neutralizing defenses against antimicrobials, possibly rendering future drugs completely worthless.

 

To put things bluntly, the age of antibiotics is over. And the CDC agrees with me.

 

Fight the Fear

 

All hope is not yet lost, stay your hand a while longer, preppers! Do I come bearing a miraculous herbal remedy, or a secret celebrity diet? No, just good science! There is hope in fighting microbes with microbes. The Russians and east Europeans have been working with something known as phage therapy in the realm of antimicrobials since the early 1900s. The idea is simple- you use several lytic viruses that are tuned to infect bacteria (henceforth, bacteriophages), and use it to wipe out the target pathogen. It's a lot more specific than antibiotics, with the added advantage that the viruses are evolving to remain competitive against the bacteria at the same time bacteria are evolving to compete against them. In a series of studies done in the former Soviet Union by Slopek et al, researchers utilized a few select bacteriophages per patient to fight infections, including those caused by Staphylococci, Pseudomonas, Escherichia (E. Coli), Klebsiella, and Salmonella. The results were actually really good. Utilizing orally, topically, and mucosally administered lytic phages, they attempted to neutralize the infection. During the course of treatment, the researchers obtained cultures during both the symptomatic and post-symptomatic period to determine the presence or non-presence of the pathogen. Once negative cultures were obtained, they continued to administer the phage for 14 days, and if phage resistance was noted, then they switched phages. In the studies, success rates (determined by improvement concurrent with negative cultures) varied from 75% to 100%. In these studies, among 518 antimicrobial resistant infections, the success rate of antimicrobial phage therapy was near 94%. [4]Efficacy could potentially be boosted by attenuating bacteriophages to a person's individual strain of pathogenic bacteria, by administering phages as a cocktail, and/or by administering the phages concurrently with antimicrobial agents.

Unfortunately, the USDA's policy on phage therapy of any kind if very limited. I don't know why, perhaps because they feel that viruses are too poorly understood- and they aren't. The official policy on phage therapy in the United States maintains that any virus utilized pharmaceutically must be of one specific genome with no mutations allowed, and no cocktails allowed. What this translates into, when presented in the light of clinical trials in which phages cannot be swapped when resistance is noted, is not very good success rates. It also means that even if you did get a good success rate, we'd just circle back to our present chemical antimicrobial resistance issue.

There's more good news. With the encouragement of the CDC, a lot of hospitals are adopting antimicrobial stewardship programs, which are interdisciplinary teams of healthcare professionals that monitor antibiotic use to determine how appropriate the use of a given antibiotic is, viewed through the lens of the patient and the bacteria in question. It's a Band-Aid on the face of 'too little too late', but it will help slow the rise of antimicrobial resistance.
One of the best new hopes on the horizon for controlling resistant pathogens is the emerging science of the human microbiota. In and on all of us live trillions of bacteria, which can contribute to our health in exchange for us giving them some place safe to live. Research indicates that a healthy gut microbiota can contribute to controlling flare-ups of irritable bowel syndromes, ulcers, and even obesity (not to imply that an unhealthy microbiota is the cause of obesity). There's some speculation going on that a healthy microbiota may help prevent establishment of bacterial pathogens in your body.

What Can I Do?First and foremost, listen to your doctor. If you're prescribed antibiotics, take them, and take them all. Second, support science and public health research, and support politicians that support that. Third, practice good hygiene, such as washing your hands, regular showers, covering coughs and sneezes, etc. Avoid products that advertise that they contain antibiotics, and choose small-farm, locally raised livestock if possible. Get vaccinated, and follow the CDC on your social media network of preference- they'll provide you with accurate news and good suggestions when things are happening. The most important thing you can do is get educated on the subject, and share the knowledge you gain here.

 

 

 

1. http://stm.sciencemag.org/content/4/148/148ra116

2. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=41

3. http://www.ncbi.nlm.nih.gov/pubmed/17661706

4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC90351/