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Book Review: Ebola: Understanding And Preparing For An Outbreak

What does Drudge, PBS, The Mayo Clinic and Reddit have in common?  Ebola.  It’s everywhere – well, not literally anyway.  But it is How to Survive Eboladominating the media, and for good reason.  People are scared.  They see the authorities saying one thing, and events unfolding that say another.  News channels show “experts” making the completely illogical case that closing our borders will make us less safe.  Reason has been relegated to the back of the bus, the same place we’ve been told that we can give, but not receive Ebola.  You know from reading Survival Cache and SHTFBlog that our team is not into hype and “End of the World” predictions.  We are more into common sense preparedness and reality.  With that said, we wanted to know more about Ebola and how worried we should be about this virus.

By Mark Puhaly, a contributing author to Survival Cache & SHTFBlog

So What Is One To Do?

That is a question Alex Smith attempts to answer in his latest book, Ebola:  Understanding how to survive ebolaand Preparing for an Outbreak.  In it, he  discusses topics such as:  symptoms, transmission, treatment, the history of the virus, the current outbreak, how to prepare, what to have on hand, measures to take if the worst is realized (quarantines, isolation rooms, cleaning procedures, etc.) and more.  Until about three months ago, I would have accused someone of being a doomsday prepper dork if you were getting ready for quarantines, now I see things in a slightly different light.  Quarantines are now a reality for a small group of Americans and Europeans who have come into contact with Ebola patients.  Although I am not quite ready to get my isolation room ready, I am starting to rethink some of my preps (or lack there of).

At 116 pages (paperback version), the book is short and concise.  There is no filler to pad the length.  Every page contains well researched information.  Speculations by the author are backed up by studies that he references in the book.

The following is an excerpt from the section on transmission of the disease that I found particularly interesting:

[From Book]
Airborne droplets (Not  Confirmed by Authorities):
The CDC makes no mention of transmission through airborne droplets in humans.  Because of the severity of the current outbreak, however, transmission through airborne droplets seems like a possible explanation.  Note that the author says airborne droplets and not simply airborne.  There is a huge difference.  Airborne implies that a disease can be spread through the inhalation of tiny, dry particles that remained suspended in the air for long a period of time.  These particles could also theoretically be transferred through air currents.  Ebola is not airborne in this sense.  The rate of infection is much too low.  If Ebola was truly airborne, it should spread at a rate similar to tuberculosis, chickenpox or measles.  One person with measles, on average, infects 12 to 18 people.  The current Ebola outbreak appears to spread, on average, to one to two people.  This value is known as the Basic Reproductive Number, R(0).  The following is a chart of the Basic Reproductive Numbers for various diseases.

ebola outbreak book review

Airborne droplets, however, is a different story.  Airborne droplets are relatively large (when compared to the dry particles that are suspended in the air by an airborne disease), wet particles, propelled through the air by way of coughing, sneezing or violent vomiting, that land on walls, floors, or other people.  It is entirely possible that Ebola is spread via airborne droplets.  The CDC still denies this.  The WHO downplays the probability.  Other experts, especially those who are independent of governmental organizations, are not as quick to dismiss this.

Despite CDC claims that droplet transmission is not possible, it has been shown that VHFs have an infectious dose of 1 to 10 How to Survive Ebolaorganisms by airborne droplets in non-human primates.

1.    Source:  Franz, D. R., Jahrling, P. B., Friedlander, A. M., McClain, D. J., Hoover, D. L., Bryne, W. R., Pavlin, J. A., Christopher, G. W., & Eitzen, E. M. (1997).  Clinical recognition and management of patients exposed to biological warfare agents.  Jama, 278(5), 399-411.)

Additionally, laboratories have been able to demonstrate that primates exposed to airborne droplets from pigs have become infected.
1.    Source:  Twenhafel, N. A., Mattix, M. E., Johnson, J. C., Robinson, C. G., Pratt, W. D., Cashman, K. A., Wahl-Jensen, V., Terry, C., Olinger, G. G., Hensley, L. E., & Honko, A. N. (2012).  Pathology of experimental aerosol Zaire ebolavirus infection in rhesus macaques.  Veterinary Pathology Online, 0300985812469636.
2.    Source:  Mwanatambwe, M., Yamada, N., Arai, S., Shimizu-Suganuma, M., Shichinohe, K., & Asano, G. (2001).  Ebola hemorrhagic fever (EHF): mechanism of transmission and pathogenicity.  Journal of Nippon Medical School.68 (5), 370-375.
3.    Source:  Plague.  (2004). In R. G. Darling, & J. B. Woods (Eds.), USAMRIID’s Medical Management of Biological Casualties Handbook (5th ed., pp. 40-44).  Fort Detrick M.D.: USAMRIID.
4.    Source:  Reed, D. S., Lackemeyer, M. G., Garza, N. L., Sullivan, L. J., & Nichols, D. K. (2011).  Aerosol exposure to Zaire ebolavirus in three nonhuman primate species: differences in disease course and clinical pathology.  Microbes and Infection, 13(11), 930-936.
5.    Source:  Feigin, R. D. (Ed.).  (2004). Textbook of Pediatric Infectious Diseases (5th Ed.).  Philadelphia, USA: Elsevier, Inc.
•    Aerosol Transmissibles (Not Confirmed by Authorities):  According to The Center for Infectious Disease Research and Policy (CIDRAP),

“We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol How to Survive Ebolaparticles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.”  They continue, “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.  Thus, both small and large particles will be present near an infectious person.  The chance of large droplets reaching the facial mucous membranes is quite small, as the nasal openings are small and shielded by their external and internal structure.  Although close contact may permit large-droplet exposure, it also maximizes the possibility of aerosol inhalation.  As noted by early aerobiologists, liquid in a spray aerosol, such as that generated during coughing or sneezing, will quickly evaporate, which increases the concentration of small particles in the aerosol.  Because evaporation occurs in milliseconds, many of these particles are likely to be found near the infectious person.  The current paradigm also assumes that only “small” particles (less than 5 micrometers [mcm]) can be inhaled and deposited in the respiratory tract.  This is not true.  Particles as large as 100 mcm (and perhaps even larger) can be inhaled into the mouth and nose.  Larger particles are deposited in the nasal passages, pharynx, and upper regions of the lungs, while smaller particles are more likely to deposit in the lower, alveolar regions.  And for many pathogens, infection is possible regardless of the particle size or deposition site.”

CIDRAP concludes:
“To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:
o    Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
o    All sizes of aerosol particles are easily inhaled both near to and far from the patient.
o    Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
o    Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
o    Experimental data support aerosols as a mode of disease transmission in non-human primates.”
The author tends towards CIDRAP’s stance.  Infection through Direct Contact is certain, and airborne droplet seems likely, but aerosol transmissibles for up to 90 minutes appears possible as well.
The complete CIDRAP article (with multiple sourced studies) can be found here (Click Here):
[End From Book]

Bottom line, it sounds like the Ebola virus is a little easier to catch than what the government is telling us. It is sort of funny, Tom survive ebolaFrieden, the Chief of the CDC, goes out to all of the major TV News channels, (FoxNews, CNN, MSNBC) and says Ebola is really hard to catch, you basically have to eat someone’s diarrhea to catch it (I am exaggerating a little but you have heard his propaganda as well).

But on the flip side, the CDC and the US Government are both trying to track down 800 people who “could” have came in contact with a nurse who flew on an airplane from Cleveland to Dallas and on top of that, they pulled the airplane from service.  Sounds like they are not telling us the exact truth.  Back to the book, Alex Smith provides the reader with a good history of Ebola.  At first, I expected the section on the history of Ebola to be dry, but I was surprised to find it an interesting read.  The following is an excerpt from the book that you might find surprising, I sure did:

[From Book]

The Reston Outbreak

“Though many believe we have never had an Ebola outbreak in the United States, this is not necessarily true.  The virus, named afterHow to Survive Ebola Reston, Virginia where it was first discovered, experienced an outbreak at Hazelton Laboratories in 1990.  Located within the D.C. metropolitan area, Reston is at the foot of our nation’s capital.  Richard Preston’s 1995 book, The Hot Zone, dramatized the outbreak with terrifying success.

While investigating an outbreak of Simian hemorrhagic fever in November 1989, Thomas Geisbert discovered viruses similar in appearance to Ebola in tissue samples taken from Crab-eating Macaques imported from the Philippines to Hazleton Laboratories.  The monkeys’ name is derived from the fact that they can often be seen foraging the beaches of Southeast Asia.  Over a span of three months, more than a third of the monkeys died at a rate of two to three a day.

Blood samples were taken from the animal handlers during the incident.  Of the nearly 180 people, six tested positive using the ELISA method.  Nonetheless, they remained asymptomatic.  In January 1990, an animal handler at the lab cut himself while dissecting the liver of an infected macaque.  The CDC placed him under surveillance, but he also remained asymptomatic.  The CDC concluded that this particular strain of the Ebola Virus had a low potential to cause disease in humans.

Hazelton abandoned the lab that same year.  In 1995, the facility was demolished.  As of 2009, the site housed a daycare.  Little remains of the Reston outbreak save for the memories of those that worked there.  Had the Reston strain had a slightly different molecular makeup, perhaps we all would know its story, and have the scars to show for it.

The Reston Virus appeared again in Italy in 1992.  In 1996, it reemerged at an export facility in the Philippines.  A second American outbreak occurred in Texas later that year.  The animals were from the same Philippine supplier as the original outbreak in Virginia.
In 2008, pigs in Manila tested positive for it.  In 2009, Philippine health officials announced that a hog farm worker had been infected with the virus.  The man remained asymptomatic. Reston is the only known strain of Ebola that did not originate in Africa.”
[End From Book]

I had never heard of the Reston Virus until I read this book, scary stuff.  Everyday I am getting a little more concerned about pandemics and a little less concerned about asteroids hitting the earth or zombies rising from their graves.

Also Read: 6 Ways to Prepare for Ebola

One concern that I have with these Ebola-related books that are currently being released, is that as studies are performed and new findings are released, the books may become outdated.  Alex had the following to say:

[From Book] “Very true.  However, I’m treating my book as a living document.  As the book requires updates, I will make them.  For instance, 2 – 21 days has been incubation period touted in the news.  Recently, however, the World Health Organization has conceded that 95% of individuals have an incubation period of 2 -21 days and 3% go as long as 21 – 42 days.  The remaining 2% are mysteriously omitted as of now.  Perhaps a person may become symptomatic even after 42 days.  Amazon allows users to update their kindle versions through the Manage Your Kindle page on Amazon.com.  Through this, kindle versions will remain up to date.” [End From Book]

All in all, I found the Ebola, Understanding and Preparing for an Outbreak to be well-researched and definitely worth your time.  The How to Survive Ebolahistory is engaging, information about the virus is sound and the preparations are complete.  For now, the ebook is priced at 99 cents.  In several days, the price will be jumping to $3 or $4.  Get it while it’s cheap.

Knowledge is power and right now our President looks like Kevin Bacon at the end of the movie “Animal House” where Mr. Bacon plays a young ROTC cadet during an episode of civil unrest.  In the middle of the riots Kevin Bacon’s character just stands there yelling “Remain calm.  All is well” while people are screaming in terror all around him (See Animal House Video).  Like I said, it reminds me of our President.  If you are like me and have eaten a healthy helping of skepticism from our government’s propaganda on Ebola, you might want to check out this book.  The paperback is currently listed for $9.49 on Amazon.

Remain calm.  All is well,
Mark

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