CDC Plans To Route Future U.S. Ebola Patients To Specially Trained Hospitals

Huffington Post

In the event that another person in the United States tests positive for Ebola, they could be re-routed to one of a handful of hospitals that are specifically equipped and trained to deal with deadly viruses like Ebola, confirmed Centers for Disease Control and Prevention director Dr. Tom Frieden during a press conference on Oct. 20.

“There’s a need for specialized centers when there is a patient with confirmed Ebola, or a number of patients if that were to happen in the future,” said Frieden, though he did not specify which hospitals would be among the designated group. “We need to increase the margin of safety.”

So far during this outbreak, only four hospitals across the United States have experience treating Ebola patients: Nebraska Medicine, Emory University Hospital, the National Institutes of Health Clinical Center and Texas Health Presbyterian Hospital Dallas.

“There are many hospitals in the country that are already in the process of becoming proficient in care of patients with Ebola,” said Frieden. “We’re focusing first on Dallas, where they’ve been dealing with Ebola, and in case there are additional cases that arise there, they’ll be ready to care for them.”

In addition to announcing the hospital plan, Frieden also confirmed significant changes to safety protocol for U.S. health workers who are caring for Ebola patients. The changes were reached by consensus among “all people in the U.S. with experience with Ebola,” as well as Doctors Without Borders (MSF).

The changes include: rigorous and repeated training of the donning and doffing of personal protective equipment (PPE), to the point that the steps become “ritualized,” no skin exposure when PPE is worn, and a trained hospital staff monitor that oversees health workers putting on and removing PPE.

The CDC also now recommends that health workers wear a respirator — either an N95 respirator or powered air purifying respirator (PAPR) — while with the patient in his or her isolation unit. This doesn’t mean that the virus is airborne, Frieden explained, but that procedures that are undertaken in the U.S., like intubation or suctioning — procedures that require close contact with the nose and mouth of patients — may pose a higher risk to health workers than the supportive care measures conducted in West Africa.

The CDC has faced increased scrutiny and criticism over their recommended safety protocols after Texas Health nurses Nina Pham and Amber Joy Vinson contracted Ebola from Thomas Eric Duncan, the first person to be diagnosed with the virus in the U.S. Pham was later transferred to NIH Clinical Center for Ebola treatment, while Vinson was transferred to Emory University Hospital. These changes are in a response to Pham and Vinson’s positive diagnoses, said Frieden.

“We may never know exactly how [transmission] happened, but the bottom line is that the guidelines didn’t work for that hospital,” said Frieden. “Dallas shows that taking care of Ebola is hard.”

Ebola Cases Rise Sharply in Western Sierra Leone

ABC News

by CLARENCE ROY-MACAULAY

After emerging months ago in eastern Sierra Leone, Ebola is now hitting the western edges of the country where the capital is located with dozens of people falling sick each day, the government said Tuesday. So many people are dying that removing bodies is reportedly a problem.

Forty-nine confirmed cases of Ebola emerged in just one day, Monday, in two Ebola zones in and around the capital, the National Ebola Response Center, or NERC, said. Lawmaker Claude Kamanda who represents a western area said more than 20 deaths are being reported daily.

Kamanda told the local Politico newspaper that authorities are experiencing challenges collecting corpses from both quarantined and non-quarantined homes.

Authorities say the uncontrolled movement of people from the interior to Waterloo which is the gateway to Freetown, the capital, has fueled the increase of Ebola cases in the west. There is a strong feeling that people are violating the quarantines elsewhere and coming to Freetown through Waterloo.

There are 851 total confirmed Ebola cases in the two zones, called Western Area Urban and Western Area Rural, the NERC said. In numbers of cases, they may soon surpass a former epicenter of the outbreak in the country, the eastern districts of Kenema and Kailahun where there have been a total of 1,012 confirmed cases.

No new cases were reported Monday in Kenema and Kailahun but a World Health Organization spokeswoman said it is too early to declare that the epidemic has burned itself out in the east.

“There was a drop in new cases in Kenema and Kailahun and fingers were crossed but there has been a bit of a flare up thanks to a couple of unsafe burials,” said Margaret Harris, WHO’s spokeswoman in Sierra Leone. “So it’s too early to say we have a real decline … definitely too early to say it’s been beaten there.”

A local newspaper suggested Tuesday that authorities quarantine Waterloo. The World Food Program over the weekend delivered emergency food rations to people there.

“The growing fear has left the public with no choice but to call on the Government for Waterloo to be quarantined as was done to other places including Kailahun, Kenema, Bombali, Port Loko and Moyamba Districts,” the Exclusive newspaper said.

Many residents of the capital note that Ebola has followed the same route across the country as rebels who in 1991 started a savage war in Kailahun district. The war ended in Freetown a decade later where the final battle was fought. Now the enemy is a disease, and the president is putting in place a more military-style response.

President Ernest Bai Koroma last week appointed Defense Minister Alfred Palo Conteh as CEO of the National Ebola Response Center, whose headquarters are being placed at the former War Crimes Tribunal for Sierra Leone in the west end of Freetown together with the United Nations Mission for Ebola Emergency Response.

The West African nations of Sierra Leone, Liberia and Guinea — where the outbreak first emerged 10 months ago — have been hit hard by Ebola with more than 4,500 deaths, according to WHO estimates. A few cases have also emerged in the United States and Spain.

In Guinea on Tuesday, hundreds of residents in the Conakry suburban neighborhood of Kaporo Rail protested the construction of an Ebola treatment center nearby.

“We don’t want the hospital here. They want to infect our neighborhood,” said Binta Sow, the spokesman of the group. Kaporo Rail has a thriving market for ice cream and milk that employs hundreds of women and youth. There were worries this could harm the local economy.

“No one will buy anything here if they erect the center,” said a local ice cream vendor.

On Tuesday the East African nation of Rwanda was singling out travelers from the U.S. and Spain for special screening. A Rwandan Ministry of Health document says all passengers from the U.S. and Spain will have their temperatures taken upon arrival. If the passenger has a fever he or she is denied entry. If there is no fever, the visitors still must report their health condition daily to authorities.

The U.S. Embassy in Rwanda on Tuesday urged Americans who may have a fever or who have traveled to Ebola countries “to weigh carefully whether travel to Rwanda at this time is prudent.”

“Please note neither the Department of State’s Bureau of Consular Affairs nor the U.S. Embassy have authority over quarantine issues and cannot prevent a U.S. citizen from being quarantined should local health authorities require it,” the embassy said.

No Ebola cases have emerged in Rwanda.

Map Of Ebola Quarantine Stations: Here’s Where They’ll Send Those Suspected of Ebola or “Respiratory Illnesses”

SHTF Plan

Despite concerns around the globe that the Ebola virus may continue to spread and mutate into something even more deadly, the director of the CDC attempted to assuage fears about the possibility of an outbreak on U.S. soil.

“It is not a potential of Ebola spreading widely in the U.S.,” director Thomas Friedman told reporters on a conference call Thursday. “That is not in the cards.”

But while the CDC downplays the potential threat, emergency planners behind the scenes have been getting ready since as early as April of this year. In a report presented to Congress while the virus was spreading in West Africa, the Department of Defense said that it has dispatched biological detection kits to National Guard units in all 50 states with the capability of diagnosing the virus in infected patients in as little as 30 minutes.

And, in a move that raised some eyebrows this morning, President Obama amended a 2003 Executive Order that gives the Federal government, as noted by Paul Joseph Watson, the power to “mandate the apprehension and detention of Americans who merely show signs of respiratory illness.”

Although Ebola was listed on the original executive order signed by Bush, Obama’s amendment ensures that Americans who merely show signs of respiratory illness, with the exception of influenza, can be forcibly detained by medical authorities.

Though the government and media are doing everything in their power to keep the panic to a minimum, going so far as to suggest that the possibility of Ebola spreading in the United States is almost non-existent, the fact that over 750 people in six West African countries have died from the virus suggests otherwise.

Even the World Health Organization recently claimed that the virus is out of control and all attempts to contain it thus far have failed.

Michael Snyder’s recent analysis on what is going to happen if Ebola comes to America sheds some light on how the government might behave. Though Obama didn’t sign the Executive Order allowing for the rounding up and detention of Americans suspected of respiratory illnesses until today, Snyder correctly pointed out just 48 hours before the order that “isolation would not be a voluntary thing.”

The federal government would start hunting down anyone that they “reasonably believed to be infected with a communicable disease” and taking them to the facilities where other patients were being held. It wouldn’t matter if you were entirely convinced that you were 100% healthy. If the government wanted to take you in, you would have no rights in that situation. In fact, federal law would allow the government to detain you “for such time and in such manner as may be reasonably necessary”.

And once you got locked up with all of the other Ebola patients, there would be a pretty good chance that you would end up getting the disease and dying anyway.

It turns out that not only is the government prepared to identify, isolate and detain potentially contagious individuals, but they already have the facilities in place.

According to the Centers for Disease Control there are twenty (20) quarantine centers actively prepared to accept patients as of this writing.

The following map provided by the CDC shows where these centers are located.

President Obama’s recently updated Executive Order gives the organization the authorization to detain anyone suspected of having been infected with a contagious disease.

CDC has the legal authority to detain any person who may have an infectious disease that is specified by Executive Order to be quarantinable.

Such “quarantinable” diseases may include Cholera, Smallpox, Plague, SARS, Hemorrhagic fevers (like Ebola), and now even “respiratory illnesses” that may have symptoms similar to those of deadly viruses.

It was no accident that President Obama added the Executive Order amendment this morning. They can downplay the seriousness of Ebola all they want, but the fact is that hundreds of medical workers, including the World Health Organization, have failed to contain its spread.

In anticipation of the virus hitting U.S. shores, President Obama has set the legal authorization to essentially declare martial law in stone. The U.S. military, including the National Guard, also has contingency plans in place.

The minute this virus is detected in “the wild” on U.S. soil these directives will be executed.

Though what happens next is unpredictable, preparing for a pandemic ahead of time may be the best way to not only avoid contracting a deadly virus, but staying out of a government run quarantine station.

Related:   Ebola outbreak may already be uncontrollable; Monsanto invests in Ebola treatment drug company as pandemic spreads

Swine to Human Transmission Not Supported By USDA Data

Recombinomics

Overall, 73 H3N2 positive submissions were detected in FY2011 (October 1, 2010 to September 30, 2011) and 138 in FY2012 from October 1, 2011 to July 31, 2012. 57 Of the 138 H3N2 cases identified in FY2012 and tested to date contain the pandemic M gene and were classified as H3N2pM.

The above USDA update from the CDC website confirms that the bulk of the USDA data has already been made public at Genbank and the discordance between the human and swine sub-clades in circulation in FY2012 does not support swine to human transmission.

As seen in the above numbers, as well as larger collections described at the CDC site, most swine influenza is not H3N2 and most H3N2 does not have the H1N1pdm09 M gene. However, of greater significance is the number of isolates (57) with H1N1pdm09 M gene in recent collections (FY2012). In this collection period the CDC has released 45 sets of sequences with the H1N1pdm09 M gene (which is heavily weighted with H3N2pM isolates).

Thus, sequences from only 12 H3N2pM have not been made public, and these sequences are likely either non-matches or recent, and therefore of little significance in the analysis since the number of reported human cases exploded in July, and swine isolates from that time period may have been due to human to swine transmission.

Although there are 45 H3N2pM sequences collected in FY2012, only 19 of these sequences have HA and NA sequences that match the human cases from 2011/2012 and only 2 of the 19 match the 2012 human cases (see list below). Thus, the widespread H3N2v in swine cited by the CDC per USDA are largely matches with the human sub-clade from 2011 and none of the 2012 human cases match this sub-clade.

In contrast, the 20 most recent human sequences, which were all collected in FY2012, match the 2 cases with N2 from a swine H3N2 lineage. This discordance is even more dramatic for the most recent isolates from Indiana and Ohio. Since March 2012 there have been 9 swine isolates and 8 of the 9 match the sub-clade in last year’s human cases. Moreover 8 of these 9 collections were from Indiana or Ohio.

Thus, of the 8 most recent isolates from Indiana and Ohio, only one matches the human 2012 cases, while the seven that match the 2011 cases, but have not produced any reported human cases in 2012.

Therefore, the CDC claim of USDA support for swine to human transmission is refuted by the public data, which represents the key data generated by the USDA.

The only real support for the CDC position is their heavily biased sample collection which creates a link with swine because testing is largely limited to samples collected from patients with swine exposure.

CDC False Statements On Swine H3N2v Matches Raise Concerns

Recombinomics


“Human infections with an influenza A (H3N2) variant (H3N2v) virus that contains the M gene from the influenza A(H1N1)pdm09 virus (2009 H1N1 pandemic virus) were first detected in 2011. Notably, a large increase in cases of H3N2v virus infection has been identified since July 2012. (This virus has been circulating among pigs in the U.S. since 2011, has been detected in pigs in many states, and appears to be circulating widely in swine in the U.S.)”

The above comments from the CDC H3N2v August 10, 2012 update for physicians are false. The H3N2v that has increased in humans since July 2012 has not been circulating in many states and data supporting wide circulation is clearly lacking. The July 2012 H3N2v sequences from cases matches the earlier sequences from Utah in March, as well as the West Virginia cases in November and December, 2011. The H3N2v detected in many states has not been reported in a human since November, 2011.

The CDC claims represent pseudoscience and raise serious concerns about the CDC’s abiity to analyze its own data. Moreover, false statements, such as those in the physician’s update are accepted as evidence that the latest H3N2v cases are due to H3N2 jumping from swine to humans, even though the swine distribution supports the jumping of H3N2v from humans to swine.

The H3N2v detected in the initial human cases has not been identified in any swine isolate collected prior to the first human case in July 2011. A recent Journal of Virology paper, “The evolution of novel reassortant A/H3N2v influenza virus in North American swine and humans, 2009-2011”, described 674 MP sequences from swine collections from 2009-2010, as well as 388 HA and NA sequences from these isolates. The extensive survey of USDA public sequences as well as a large series generated by the authors of the paper, identified one match with the H3N2v identified in the first 10 human cases in 2011. This isolate, A/swine/NY/A01104005/2011, was from a September 17, 2011 and was initially noted in November, 2011.

More recently released sequences identified additional matches. However, the earliest matches, A/swine/Iowa/A01202529/2011 and A/swine/Iowa/A01202530/2011, were collected on August 22, 2011 which followed the first human case, A/Indiana/08/2011, which was from July, 2011.

Thus, the extensive USDA surveillance failed to identify any examples of the matching H3N2v in swine prior to the first human case.

Subsequent sequences identified a total of 24 swine isolates from 6 states (Illinois, Indiana, Iowa, New York, Ohio, and Texas) which matched (based on HA, NA, MP sequences) the H3N2v from the first 10 human cases. However none of the 2012 human H3N2v cases, including the sequences from July collections from four outbreaks in three states (Hawaii, Indiana, Ohio), matched the constellation in the 24 swine isolates above (or the first 10 reported human cases in 2011). The July, 2012 H3N2v sequences matched a novel constellation (with an N2 from H3N2 swine), first identified in a large human cluster in at a West Virginia day care center, where the confirmed cases had no swine contact or exposure.

This novel sub-clade has only been identified in two swine isolates from samples collected prior to the July, 2012 cases. These two isolates, A/swine/North Carolina/A01203272/2012 and A/swine/Indiana/A01203509/2012, were collected in 2012, well after the West Virginia cluster from November and December cases.

The absence of any human 2012 cases which match the swine sequences described by the CDC cast serious doubt on the CDC position of swine H3N2 jumps to humans are a major cause of human cases, and instead supports the jump of human H3N2v into swine, leading to widespread detections in swine that follow novel constellations or sequences in humans.

Thus, the false statements by the CDC to physicians and the media continues to raise pandemic concerns and highlights the need for an independent investigation into the ability of the CDC to analyze its sequence data and convey those results to decision makers and the public.

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