UPDATE: CDC Expands Risk Factors to Include Airborne Infection [WAS] Alert! CDC Removes FEVER from Ebola Case Definition & Adds Fatigue As A Symptom

The CDC has removed fever from the Ebola Case Definition, and replaced it with the a more nebulous definition of "Elevated body temperature or subjective fever or symptoms". The CDC has also added "Fatigue" to the case definition. 

Here is the relevant part of the prior case definition: 

Person Under Investigation (PUI)A person who has both consistent symptoms and risk factors as follows:

1. Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND

1. epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

Here is the relevant part of the current case definition: 

Person Under Investigation (PUI):
A person who has both consistent signs or symptoms and risk factors as follows:

1. Elevated body temperature or subjective fever or symptoms, including severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND

1. An epidemiologic risk factor within the 21 days before the onset of symptoms.

Other important changes have also been made to loosen up CDC's Ebola case definition; we will update this post as time permits:

UPDATE 1: The CDC's new Ebola case definition greatly increase the category of persons who may be forcefully quarantined to anyone who was in proximity of an Ebola case even if the Ebola victim was not actively showing symptoms at the time of proximity. (more to follow)



UPDATE2: 

After a more detail reading, the CDC has greatly increased the at risk Ebola category to include the following:

1) Direct contact (hand shake) with Ebola victim 21 days PRIOR to symptom onset

2) Airborne contact, ie even "brief proximity" (such as being in the same room for a brief period of time) with an Ebola victim AFTER their symptom onset

Any person who meets those two above definitions and in the subject eyes of an examiner has any "signs" of concern such as elevated body temperature (98.7 deg F) is now defined as a "Person Under Investigation" for Ebola. And as such, that person is subject to forceful quarantine 

Source:

http://www.cdc.gov/vhf/ebola/hcp/case-definition.html

Archived CDC webpage from Oct 25

ONE DROP OF AEROSOLIZED EBOLA BLOOD CAN INFECT 1,104 SqFt Room Such That Only 1 Breath Inhaled Can Result In Infection

Department of Defense Says EBOLA IS "AEROSTABLE"; Fears Persistent Sewer System Contagion

US ARMY Says EBOLA = FLU in Airborne Stability, Needs Winter Weather To Go Airborne

Department of Defense Says EBOLA IS "AEROSTABLE"; Fears Persistent Sewer System Contagion

The Defense Threat Reduction Agency [DTRA], in a just released a broad agency announcement seeking rapid assistance against Ebola's weapon of mass destruction [WMD] capability, stated that

  "Ebola is aerostable in an enclosed controlled system in the dark and can survive for long periods in different liquid media"

The short of it is that DTRA's WMD arm sees a massive potential for Ebola to persist in sewage systems in Airborne, Waterborne, and BioFilm form.


The obvious dangers are multifold.

1) Severe Acute Respiratory Syndrome (SARS) spread in the Amoy Gardens high-rise apartment complex via a similar plumbing related infectious route

2) CDC's current guidance encourages untreated EBOLA waste discharge into sewer systems

3) Dr. Craig Spencer has already potentially infected NYC sewer system despite his 21 day "home quarantine"

4) Sewers may be a reoccurring source on #Ebola infection

5) CDC's assurances that Ebola can not be spread via Air, Water, or Sewer places people at great risk

Specifically, DTRA wants answers in 3 to 6 months regarding environmental conditions that allow to Ebola to persist in an airborne state, and persist on surfaces after precipitating out of the air.
DTRA is also looking for genetic weaponization markers that elucidate that persistence.

Interestingly enough, DTRA's solicitation also seeks Africa specific data that will allow them to use a a NATO Biowarfare Ebola simulation to predict the flow Ebola infection in Africa; we'll have more on that in a separate video/analysis.

As we have reported in previous posts, the US Army says that Ebola has an airborne stability similar to Influenza and that winter weather conditions may allow to spread via the airborne route. Apparently what the Army has found is that sewer systems also offer an ideal environment for longer term Ebola persistence.

Sources:

Chemical/Biological Technologies Department Ebola Broad Agency Announcement


DEFENSE THREAT REDUCTION AGENCY BROAD AGENCY ANNOUNCEMENT

Aerosolizing ONE DROP of Ebola Infected Blood Can Kill 500,000 People

US ARMY Says EBOLA = FLU in Airborne Stability, Needs Winter Weather To Go Airborne

Inadequate plumbing systems likely contributed to SARS transmission

Hong Kong seals apartment building to contain SARS

http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html

Veterans Hospital Orders Emergency Installation of HEPA Air Filters to Create A Multi-person Ebola Quarantine Ward

The Veterans Administration hospital in San Juan, Puerto Rico, is expecting the near term arrival of a number of Ebola patients and is creating an entire Ebola Ward to handle the infected patient inflow. It is unclear if Puerto Rico is the defacto "leper colony" for US Service Men who become infected with Ebola in Africa via Operation United Assistance, or if its for a purely Puerto Rican Ebola outbreak.

The hospital is fearful that the Airborne spread of Ebola out of their quarantine ward will "create a situation where an outbreak of Ebola may happen to patient, guest or employees". The Veterans Administration has categorized this as an emergency situation, and has awarded a no-bid emergency contract to install HEPA air filters in the Ward's return air HVAC ducting.

The Ebola Ward will be located on the 2nd floor of South Bed Tower, identified as building 8 in this Va Map.

The Hospital states:

"As such this situation is considered an emergency and prompt attention is a required delaying repair will create a situation where an outbreak of Ebola may happen to patient, guest or employees." 

"San Juan needs to conduct emergency installation of HEP Filters at the HVAC line that serves Ward 2K of the South Bed Tower" 

"The vendor must provide and install a filter frame for the return duct and HEPA filters for the return and supply systems. Once completed the Contractor must test and Balance the area (ward 2K of the South Bed Tower)"

"This emergency service is for the creation of a Ward to attend suspected patients with the Ebola Virus that have to be quarantine. "

 "Ward 2K of the South Bed Tower must be prepared to attend patients that have acquired or are suspected of being a carrier of the Ebola Virus. Engineering work needs to be done to mitigate and prevent further exposure to the virus."

 "These changes to the HVAC system are needed at once to preclude impairment of healthcare delivery capabilities or mission performance in case of a patient contaminated with the Ebola Virus."

" Prior authorization was obtained to process this emergency and is filled on the briefcase under P11 approve emergency order."

 Facility is working with the Ward to make a long term care unit for any other outbreak"

Sources:

https://www.fbo.gov/index?s=opportunity&mode=form&tab=core&id=27f96d73a7d08beb9c22d0ac2fe3a533

Outbound Ebola Air Flight Indicates Another Ebola Victim Is Headed To USA For Treatment (UPDATE: Inbound Flight Points to Europe)

Update 10/27/14:
Based on flight routes it now appears Air Ebola took a patient out of Africa and delivered him/her somewhere in Europe. The flight to Africa disappeared off of flight tracker shortly before it reached it supposed destination airport Dakar. Two days later the flight reappeared in at London's Stansted airport headed back to Georgia via Bangor International airport in Maine. That flight path is indicative of an Ebola delivery to Europe.

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Phoenix Air Group's 2nd ABCS equipped Gulfstream Jet is on its way to Africa. Its following a flight plan which has previously used by its sister aircraft to return Ebola infected personal to the USA for treatment. The flight is scheduled to arrive in Senegal at 3:33pm GMT.

CDC Releases Epidemiological Analysis of Dr Brantly & Writebol Ebola Transmission In Africa- Says Aerosol To Us

The CDC has released their epidemiological investigation of how Dr Brantly and Nancy Writebol became infected with Ebola while in Liberia. Basically CDC could find no transmission chain among the 5 people in that Ebola cluster.

CDC's analysis is that nothing out of the ordinary happened, ie nothing directly points to airborne.
Of course nothing points to contact transmission either, butCDC assumses direct contact caused this Ebola cluster. Our suspicion has been that Brantly & Writebol became infected as Writebol sprayed Brantly with Clorox water; that spraying action aerosolized the contamination on Brantly's protective suit.

Sources:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a3.htm?s_cid=mm641a3_w

National Institutes of Health Orders a One Year Stockpile of "EMERGENCY DISASTER EVENT PREPARATION FOR PERSONAL PROTECTIVE EQUIPMENT"

The National Institutes of Health [NIH] just placed a solicitation  to stockpile an entire year's worth of Personal Protective Equipment [PPE] to support eight agencies inside of NIH. They are placing the massive order in case there is a disruption in supply of medical goods like goggles, gloves, gowns, masks, spacesuits.

The NIH's rationale is that the animal testing they are doing is so vitally important that no disruption in supplies can be risked. Apparently the disruption in PPE supply is expect to last at least one full year, and they have an option to carry it on for four more years.

"This Sources Sought Notice has been posted to establish, provide, and maintain a laboratory animal personnel protective equipment (PPE) resource to ensure the accessibility and availability of essential supplies throughout an emergency/disaster, government shutdown, or any other interruption of regular deliveries. These supplies support irreplaceable multidisciplinary animal research, which is critical to the mission of eight institutes at the National Institutes of Health."

 "During emergency/disaster events, the normal supply and distribution channels will most likely be unavailable/or protracted due to the impact of the emergency and the rush of immediate orders. Our program's disaster plan takes these factors into account; it is therefore our intention is to establish an offsite source of critical supplies with an established, laboratory animal PPE vendor with a proven track record of providing quality products and services. As outlined in our emergency plan it is the intention of our program to be able to house up to a one year's supply of PPE products with a local vendor within a 90 mile radius of NIH in Bethesda, Maryland."

A few near term risks that potential could make PPE unavailable for an entire year are:

1) EBOLA
2) H7N9 BirdFlu
3) MERS-CoV

The POTRBLOG team believes that this contract clearly indicates that the Government expects a protracted shortage of medical PPE, and that the window of opportunity for individuals to purchase needed PPE at reasonable prices is now at a close.

Sources:

Solicitation Number: HHS-NIH-OD-OLAO-SBSS-15-001

Aerosolizing ONE DROP of Ebola Infected Blood Can Kill 500,000 People

US ARMY Says EBOLA = FLU in Airborne Stability, Needs Winter Weather To Go Airborne

Ebola Bodily Fluids Readily Weaponizable Using An Ultrasonic Humidifier

Ebola Emergency ZMAPP Production Rates & Costs

CDC's "Lesser Of Evils" Double Standard On Health Care Worker Protection Indicates They Expect a Large Ebola Outbreak In USA

CDC Warns Hospitals On EBOLA "CONTAMINATED AIR" and Directs use of "Airborne Infection Isolation Room"s

Inhalation Ebola: Governments Ready For World War Ebola

CDC Sees AIRBORNE EBOLA Transmission, Issues Guidance For Aircraft Flight Crews, Cleaning & Cargo Crews

 CDC is already evacuating DOUBLE the number of expected Ebola infected personnel at a rate of 7 doctors per month

US Military Already Having Katrina Like Logistics Issues With Ebola "Operation United Assistance"

The headline on Drudge today is MILITARY ARRIVES IN HOT ZONE the story is mostly a puff piece devoid of any useful content. The truth of the matter is that the US Military's capability to perform this sort of a mission is merely a shadow of what it once was, it's as if they learned nothing from Hurricane Katrina.

The Department of Defense is in such poor shape logistically that they had to place an emergency solicitation seeking companies in Europe to rent them Rough Terrain forklifts. Its the functional equivalent of trying rent tanks on the open market after the war has started.

This DoD photo from Liberia captures one of the few military fork trucks available working with one of the rental fork trucks.

The sad state of affairs is that DoD actually brags about its minuscule capability in one of their own press releases, trumpeting the fact that they only have one National Guard unit ( "the only unit of its kind") with such capability.

Frankly it is shocking that DoD has let itself degrade to this point. Certainly fork trucks aren't as sexy as aircraft or tanks, but a military runs on logistics and DoD used to have the brains to know that. Fork trucks are often the primary constraint in any such sort of operation, either military or commercial. Its a lack of $10K fork trucks that keeps Billions of dollars of aircraft and goods clogged up on airfields.

Of course the USA is not alone in this mess; the reason the Australians aren't responding to Western Africa is that they remember their own Fork Truck short comings when they tried to respond to West Timor in the 1990's. The only thing more militarily emasculating then barely being able to get your troops somewhere overseas, is not being able to get them back.

Of course, this sorry state of affairs doesn't just end with fork trucks. The US Military no longer has the smaller remote strip aircraft it needs to move cargo and personnel around deep woods Africa. The military gave those planes away, many to smoke jumper fire fighter units across the country.

So what does the does the Government do when it realizes it needs back the planes it gave to Smoke Jumper units? The answer is convoluted but simple, the Government mobilizes Alaskan Smoke Jumper Units to respond to West Africa via DART (Disaster Assistance Response Team). The end result is a Command and Control Cluster Mess with little to zero insightful press coverage.

Sources:

Rough Terrain Container Handler required immediately for Ebola support Solicitation Number: SP3300-15-SS-7000

http://www.cbsnews.com/news/u-s-military-planes-arrive-in-liberia-epicenter-of-ebola-outbreak/

http://www.af.mil/News/ArticleDisplay/tabid/223/Article/504250/kentucky-ang-establishes-cargo-hub-in-senegal-for-ebola-response.aspx

USAID DART: Alaska SmokeJumpers Deploying to Liberia Ebola Crisis

Aerosolizing ONE DROP of Ebola Infected Blood Can Kill 500,000 People

Fighting Ebola: why Australia can't send troops

US Government Seeks To Award You $100K to $1Million For Your Ideas To Fight Ebola

USAID put out a Challenge solicitation today seeking ideas to help in the fight against Ebola; the award amount is $100,000 to $1,000,000.

Submissions maybe made to:

Email: EbolaEOI@usaid.gov  prior to October 20th
or
ebolagrandchallenge.net after October 20th

Solutions Sought:

For the purposes of this Addendum USAID and partners specifically seek solutions that address the two focus areas below.2
1) STRENGTHEN HEALTHCARE CAPACITIES:

 Approaches to enhance the protective equipment, care setting and tools used in the field to empower and protect healthcare workers
• Personal Protective Equipment (PPE): Developing, testing, and scaling entirely novel PPE or modifications to current PPE that address issues of heat stress and comfort for healthcare workers
• Care Setting: Accelerating the development and scale-up of approaches to enhance the physical and procedural care environment relating to heat stress, comfort and the safety of healthcare workers and patients
• Health Care Worker Tools: Accelerating the development and scale of tools that improve the delivery of care to patients (e.g. rapid, point of care diagnostics or more efficient ways of moving samples and communicating results back to health care workers quickly)

2) CARE-SEEKING:
Approaches that ensure communities receive and respond to timely, accurate, and actionable information about Ebola prevention and treatment

• Developing and scaling behavior change approaches to encourage— and dispel myths and misconceptions that discourage—care-seeking or interacting with health care authorities
• Improved information management and communication to the community on availability of beds in community care centers or emergency treatment facilities

Sources:

The USAID Development Innovation Accelerator BAA for Fighting Ebola: A Grand Challenge for Development

https://www.fbo.gov/utils/view?id=7f57615dc2df7808cfa462ea0c04ded0

https://www.fbo.gov/utils/view?id=5e5759f2e6d0640c2987fd7610f2f984

MAX ALERT: Carolina Hospital Connected To Texas Ebola Victim's Sister Readies 19 Ebola Beds

A Carolina hospital connected to the sister of the Texas Ebola victim is spooling up 19 Ebola Beds

  "At Carolinas Medical Center (CMC), they have 19 beds set aside in case they have to treat Ebola patients" 

Whats not being reported is that Texas Ebola victim Thomas Duncan's sister worked for Carolina Healthcare Systems in Charlotte as a health care worker. This information according to her LinkedIn page and also by photos from her Facebook page.

What her current connection is to Carolina is not completely understood, in fact it appears she may be currently working for the Texas Hospital where her brother is located. But, the actions of the Carolina Medical Center may indicate that person there did have had some sort of contact with the Texas Ebola patient.

Sources:

http://www.myfoxphilly.com/story/26692910/north-and-south-carolina-hospitals-prepare-for-ebola-threat

http://www.wsoctv.com/news/news/local/area-hospitals-prepare-potential-ebola-cases/nhZWw/

MAXIMUM ALERT: DALLAS EBOLA VICTIM MOST LIKELY ACQUIRED HIS INFECTION ON HIS FLIGHT