VIRUSES -- POLIO,
HIV, RABIES, EBOLA, HANTA VIRUS, ZIKA AND NOW COVID-19
COMPILATION AND
COMMENTARY
BY LUCY WARNER
MAY 7, 2020
LOOKUPS
https://www.cbsnews.com/news/trump-administration-coronavirus-vaccine-researcher-covid-19-cure-60-minutes/
-- ALSO DISCUSSES
NIPAH VIRUS
THE CORONAVIRUS
GROUP
Human
Coronavirus Types
Coronaviruses
are named for the crown-like spikes on their surface. There are four main
sub-groupings of coronaviruses, known as alpha, beta, gamma, and delta.
Human
coronaviruses were first identified in the mid-1960s. The seven coronaviruses
that can infect people are:
Common human
coronaviruses
229E (alpha
coronavirus)
NL63 (alpha
coronavirus)
OC43 (beta coronavirus)
HKU1 (beta
coronavirus)
Other human
coronaviruses
MERS-CoV (the
beta coronavirus that causes Middle East Respiratory Syndrome, or MERS)
SARS-CoV (the
beta coronavirus that causes severe acute respiratory syndrome, or SARS)
SARS-CoV-2 (the
novel coronavirus that causes coronavirus disease 2019, or COVID-19)
People around
the world commonly get infected with human coronaviruses 229E, NL63, OC43, and
HKU1.
Sometimes coronaviruses
that infect animals can evolve and make people sick and become a new human
coronavirus. Three recent examples of this are 2019-nCoV, SARS-CoV, and
MERS-CoV.
Page last
reviewed: February 15, 2020
Content source:
National Center for Immunization and Respiratory Diseases (NCIRD), Division of
Viral Diseases
Coronavirus Home
Coronavirus
Disease 2019 (COVID-19)
Human
Coronavirus Types
Resources and
References
FOR THOSE OF US
WHO SPEND A LOT OF TIME ON A COMPUTER, “GOING VIRAL” IS A COMMONLY UNDERSTOOD
TERM. IT MEANS THAT A STORY OR MEME SPREADS NOT MERELY IN A DIRECTIONAL WAY,
ONE PERSON AT A TIME, BUT RADIATES OUTWARD WITH A MINIMUM OF INITIAL CONTACT.
WITH PANDEMIC COVID-19 DISEASE, IT IS TRANSMITTING MORE AND MORE VIRUSES IN A
WIDESPREAD WAY, AT THIS MOMENT, AT THIS HOUR, AND MAYBE IN THIS PLACE, UNTIL
LARGE NUMBERS OF PEOPLE CARRY IT OR DEVELOP SYMPTOMS. BECAUSE OF THAT, IT HAS
THE CAPABILITY TO SWAMP HOSPITALS WITH MORE PATIENTS THAN THEY CAN TREAT OR EVEN
HOUSE, AND THAT CAN HAPPEN ON A DAILY BASIS.
THE SPEED WITH
WHICH THIS CORONAVIRUS INFECTS, AND SOMETIMES KILLS, IS ONE OF THE MOST
FRIGHTENING PARTS OF THE COVID-19 VIRUS PANDEMIC. ALSO, LIKE THE OTHER SEVERE
VIRUSES MENTIONED IN THE BLOG TITLE, IT HAS OTHER AND MORE SURPRISING SYMPTOMS.
THE MOST RECENT TO BE REPORTED IN THE NEWS IS A STRANGE SET OF CONDITIONS THAT
ARE SHOWING UP IN CHILDREN, BUT NOT SO FAR IN MATURE ADULTS. IT IS CALLED
KAWASAKI DISEASE. IT IS UNCOMMON, BUT CAN BE LETHAL, AS IT AFFECTS SWELLING IN
ORGANS INCLUDING THE HEART AND BLOOD VESSELS.
AS COMPARED TO THE
FLU OR THE COMMON COLD, ONE OF THE THINGS THAT MAKES COVID-19 DANGEROUS IS THE
FACT THAT IT, TOO, CAN BE SPREAD BY CONTACT WITH VIRUS LADEN DROPLETS FROM THE
MOUTH OR NOSE, AND BY CONTACT ON SOLID SURFACES. THAT’S WHY THE “SOCIAL
DISTANCING,” MASKS, HANDWASHING AND SANITIZER ARE SO IMPORTANT. IT IS
UNFORTUNATE INDEED THAT THOSE THINGS ARE ALMOST THE ONLY EFFECTIVE PRACTICES
THAT ARE HELPING SO FAR. THE SCIENTISTS ARE AT WORK ON BETTER TREATMENTS AND
HOPEFULLY EVEN A VACCINE. THE TIME PERIOD NEEDED TO DEVELOP THOSE THINGS IS
DAUNTING, THOUGH, SO WE ARE ALL WAITING FOR THE NUMBER OF NEW CASES TO GO DOWN
RATHER THAN UP.
THE GOOD THING
ABOUT RABIES OR EBOLA, IF THERE IS SOMETHING GOOD, IS THAT IT IS NOT SPREAD BY THE
AIR AS COVID IS. IT TAKES CLOSE CONTACT, AND IN THE CASE OF RABIES IT USUALLY
REQUIRES A BREAK IN THE SKIN OR MUCOUS MEMBRANE, MOST OFTEN A SCRATCH OR BITE.
EBOLA, HOWEVER, IS SPREAD BY SIMPLE PHYSICAL CONTACT WITH A PATIENT, AND ONE
THING THAT CAUSED IT TO SPREAD SO RAPIDLY IN AFRICA WAS THE TIME HONORED CULTURAL
HABIT OF WASHING AND MAKING CLOSE PHYSICAL CONTACT WITH THE DEAD PRIOR TO THE
FUNERAL. WHOLE FAMILIES AND NEIGHBORS WERE BEING INFECTED.
FINALLY,
COMPARED TO INFLUENZA, COVID KILLS AT A HIGHER RATE, ALTHOUGH PEOPLE ALSO DIE
FROM INFLUENZA EVERY YEAR. ON DEATH AND INFECTION RATES, SEE THE ARTICLES FROM ALJAZEERA
BELOW, THE CDC COMPARISONS AND THE ONE FROM LIVESCIENCE.COM ON THOSE STATISTICS
AND SYMPTOMS. THE CDC ARTICLE IS PARTICULARLY GOOD AS A SOURCE FOR BASIC
INFORMATION, HOME CARE, ETC.
AS WITH THE
INFAMOUS CASE OF TYPHOID MARY, SOME PEOPLE CAN CARRY COVID-19 AND SPREAD IT BUT
NOT BECOME ILL THEMSELVES, SO THAT THEY HAVE NO IDEA THEY ARE THE CAUSE OF
OTHER PEOPLE’S SICKNESS. TYPHOID FEVER IS NOT CAUSED BY A VIRUS, BUT RATHER BY
A FORM OF THE SALMONELLA BACTERIA AND SPREADS FROM CONTAMINATED FOOD OR WATER,
BUT IT IS DEADLY NONETHELESS IN “UP TO 10%” OF THOSE WHO CONTRACT IT. FOR
TYPHOID, WE DO HAVE AN INJECTABLE VACCINE AND A PILL FORM TO PREVENT THE
ILLNESS BY STIMULATING ANTIBODY FORMATION, BUT IT WORKS FOR A RELATIVELY SHORT
PERIOD OF TIME – A FEW YEARS. WITH THAT DISEASE, PUBLIC SANITATION IS KEY. WHEN
MY PARENTS WERE GROWING UP, TYPHOID WAS AN ILLNESS AS FRIGHTENING AS COVID-19
IS NOW. SEE: https://www.passporthealthusa.com/vaccinations/typhoid/
COMPARATIVE INFORMATION
ON CORONAVIRUSES, INCLUDING DEATH RATES
https://www.aljazeera.com/news/2020/04/coronavirus-comparing-covid-19-sars-mers-200406165555715.html
Coronavirus:
Comparing COVID-19, SARS and MERS
A comparison of
COVID-19 data to similar recent diseases with global impact caused by the
coronavirus.
by Umut Uras
8 Apr 2020
PHOTOGRAPH -- As
of April 7, the number of global COVID-19 cases was more than 1,360,000 with
over 76,000 deaths [Brendan Mcdermid/Reuters]
The new
coronavirus outbreak has spread rapidly around the world, affecting more
than 183 countries and territories, infecting over a million and killing more
than 80,000 people.
It is reported
to have emerged in China's Hubei province late last year.
On March 11,
the World Health Organization (WHO) declared the outbreak of the coronavirus a
pandemic, which it defines as "global spread of a new disease".
More:
*Timeline: How
China's new coronavirus spread
*What we know
so far about coronavirus
*Coronavirus:
All you need to know about symptoms and risks
Governments
have imposed tough measures, including travel restrictions and curfews, to
contain the spread of the virus as scientists worldwide race to find a vaccine.
This is not the
first time an international health crisis occurred due to the spread of a novel
coronavirus or other zoonotic (animal-originated) viruses, such as influenza
that created the swine, bird and seasonal flu epidemics in recent history.
Seasonal flu
alone is estimated to result in three to five million cases of severe illness,
and 290,000 to 650,000 respiratory deaths annually.
INTERACTIVE:
Coronavirus outbreaks April 8 2020
Here is a comparison
of the information and data we have on COVID-19, the disease caused by the
new coronavirus, with similar recent coronavirus-related diseases.
COVID-19
As of April 7,
2020, the number of global COVID-19 cases was more than 1,290,000 with over
76,000 deaths.
While a few
regions, such as China's Hubei province and South Korea, report falling numbers
of new local cases, the number of infections keeps rising across the world.
Although the
source of the virus is suggested to be animals, the specific species is yet to
be confirmed.
The main
symptoms of COVID-19 are fever, tiredness and dry cough, the WHO said, adding
that some patients may have aches and pains, nasal congestion, runny nose, sore
throat or diarrhoea.
According to
the WHO, approximately one out of every six infected people becomes seriously
ill and develops difficulty in breathing.
R0
The R0
(pronounced R-naught), is a mathematical term to measure how contagious
and reproductive an infectious disease is as it displays the average number of
people that will be infected from a contagious person.
The WHO puts
the R0 of COVID-19 at 2 to 2.5.
SARS
Severe acute
respiratory syndrome (SARS), also caused by a coronavirus, was first reported
in November 2002 in the Guangdong province of southern China.
The viral
respiratory illness spread to 29 countries across multiple continents before it
was contained in July the following year.
Between its
emergence and May 2014, when the last case was reported, 8,098 people were
infected and 774 of them died.
Various studies
and the WHO suggest that the coronavirus that caused SARS originated from bats,
and it was transmitted to humans through an intermediate animal - civet cats.
Symptoms of
SARS are flu-like, such as fever, malaise, myalgia, headache, diarrhoea, and
shivering. No other additional symptom has proved to be specific for the
diagnosis of SARS.
The R0 of SARS
is estimated to range between 2 and 4, averaging at 3, meaning it is highly
contagious.
MERS
The Middle East
respiratory syndrome (MERS) is a still active viral respiratory disease first
identified in Saudi Arabia in 2012.
Approximately
80 percent of human cases were reported by the kingdom, but it has been
reported in 27 countries.
As of March
2020, 2,521 MERS cases were confirmed globally with 866 deaths due to
the illness, mainly in Saudi Arabia.
According to
WHO, dromedary camels are a large reservoir host for MERS and an animal
source of MERS infection in humans.
However, human
cases of MERS infections have been predominantly caused by human-to-human
transmissions.
MERS might show
no symptoms, mild respiratory symptoms or severe acute respiratory disease
and death. Fever, cough and shortness of breath are common symptoms.
If it gets
severe, it might cause respiratory failure* that requires mechanical
ventilation.
R0 of MERS is
lower than one, identifying it as it is a mildly contagious disease.
SOURCE: AL
JAZEERA
RESPIRATORY
FAILURE*
IN SHORT, RESPIRATORY
FAILURE IS THE CONDITION OF LOW OXYGEN OR HIGH CARBON DIOXIDE IN THE
BLOOD, CAUSED BY SEVERAL BREATHING RELATED ISSUES, AND IS THE CONDITION
WHICH NECESSITATES A VENTILATOR. A LACK OF SUCH VENTILATORS WAS THE
REASON WHY SO MANY HOSPITALS HAVE BEEN UNABLE TO PROPERLY CARE FOR COVID
PATIENTS OVER THE LAST FEW MONTHS. READ THIS INTERESTING AND WELL-EXPLAINED
ARTICLE.
Respiratory
Failure
Summary
What is
respiratory failure?
Respiratory
failure is a condition in which your blood doesn't have enough oxygen or has
too much carbon dioxide. Sometimes you can have both problems.
When you
breathe, your lungs take in oxygen. The oxygen passes into your blood, which
carries it to your organs. Your organs, such as your heart and brain, need this
oxygen-rich blood to work well.
Another part of
breathing is removing the carbon dioxide from the blood and breathing it out.
Having too much carbon dioxide in your blood can harm your organs.
What causes
respiratory failure?
Conditions that
affect your breathing can cause respiratory failure. These conditions may
affect the muscles, nerves, bones, or tissues that support breathing. Or they
may affect the lungs directly. These conditions include:
*Lung diseases
such as COPD (chronic obstructive pulmonary disease), cystic fibrosis,
pneumonia, and pulmonary embolism
*Conditions
that affect the nerves and muscles that control breathing, such as amyotrophic
lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
*Problems with
the spine, such as scoliosis (a curve in the spine). They can affect the bones
and muscles used for breathing.
*Damage to the
tissues and ribs around the lungs. An injury to the chest can cause this
damage.
*Drug or
alcohol overdose
*Inhalation
injuries, such as from inhaling smoke (from fires) or harmful fumes
What are the
symptoms of respiratory failure?
The symptoms of
respiratory failure depend on the cause and the levels of oxygen and carbon
dioxide in your blood.
A low oxygen level
in the blood can cause shortness of breath and air hunger (the feeling that you
can't breathe in enough air). Your skin, lips, and fingernails may also have a
bluish color. A high carbon dioxide level can cause rapid breathing and
confusion.
Some people who
have respiratory failure may become very sleepy or lose consciousness. They
also may have arrhythmia (irregular heartbeat). You may have these symptoms if
your brain and heart are not getting enough oxygen.
I HAVE BEEN
HEARING THE TERM “RESPIRATOR” BEING USED IN TWO WAYS, AS AN AIR CIRCULATING MACHINE
AND AS A SPECIALIZED MASK. THE N95 IS SUCH A MASK. THE OTHER TERM IS “VENTILATOR.”
FROM THE POLIO YEARS, THE TERM “IRON LUNG” WAS USED ON SOME NEWS REPORTS. SO
HERE IS A RUNDOWN ON THOSE THREE TERMS.
THE OTHER DEVICE
WHICH HAS BEEN USED FOR COVID-19 PATIENTS DUE TO THE LACK OF VENTILATORS AROUND
THE COUNTRY IS THE SMALLER AND MORE WELL-KNOWN “CPAP” MACHINE THAT IS USED FOR
A COMMON, BUT SOMETIMES DANGEROUS CONDITION CALLED SLEEP APNEA, WHICH CAN LEAD
TO A TYPE OF HEART ATTACK. SO, SEE THIS FROM WIKIPEDIA.
Ventilator
From Wikipedia,
the free encyclopedia
(Redirected from Medical ventilator)
This article is
about one type of machine used to assist breathing. For the broader article, on
both positive- and negative-pressure devices, see Mechanical ventilation. For
respiratory PPE worn on the face, see Respirator. For ventilation subjects, see
Ventilation. For other uses, see Ventilator (disambiguation).
A ventilator is
a machine that provides mechanical ventilation by moving breathable air into
and out of the lungs, to deliver breaths to a patient who is physically
unable to breathe, or breathing insufficiently. Modern ventilators are
computerized microprocessor-controlled machines, but patients can also be
ventilated with a simple, hand-operated bag valve mask. Ventilators are chiefly
used in intensive-care medicine, home care, and emergency medicine (as
standalone units) and in anesthesiology (as a component of an anesthesia
machine).
Ventilators are
sometimes called "respirators", a term commonly used for
them in the 1950s (particularly the "Bird respirator"). However,
contemporary hospital and medical terminology uses the word "respirator"
to refer to a protective face-mask.[1]
IRON LUNG
Iron lung
From Wikipedia,
the free encyclopedia
An iron lung,
also known as a tank ventilator or Drinker tank, is a type of negative pressure
ventilator, a mechanical respirator which encloses most of a person's body, and
varies the air pressure in the enclosed space, to stimulate
breathing.[1][2][3][4] It assists breathing when muscle control is lost, or the
work of breathing exceeds the person's ability.[1] Need for this treatment may
result from diseases including polio and botulism and certain poisons (for
example, barbiturates, tubocurarine).
The use of iron
lungs is largely obsolete in modern medicine, as superior breathing therapies
have been developed[citation needed], and due to the eradication of polio in
most of the world.[5] However, in 2020, the COVID-19 pandemic revived some
interest in the device as a cheap, readily-producible substitute for
positive-ventilation ventilators, which were feared to be outnumbered by
potential victims temporarily needing artificially assisted
respiration.[6][7][8][9]
N95 Respirators
and Surgical Masks (Face Masks)
N95 respirators
and surgical masks (face masks) are examples of personal protective equipment
that are used to protect the wearer from airborne particles and from liquid
contaminating the face. Centers for Disease Control and Prevention (CDC)
National Institute for Occupational Safety and Health (NIOSH) and Occupational
Safety and Health Administration (OSHA) also regulate N95 respirators.
It is important
to recognize that the optimal way to prevent airborne transmission is to use a
combination of interventions from across the hierarchy of controls, not just
PPE alone.
N95 Respirators
An N95
respirator is a respiratory protective device designed to achieve a very close
facial fit and very efficient filtration of airborne particles.
The 'N95'
designation means that when subjected to careful testing, the respirator blocks
at least 95 percent of very small (0.3 micron) test particles. If
properly fitted, the filtration capabilities of N95 respirators exceed those of
face masks. However, even a properly fitted N95 respirator does not completely
eliminate the risk of illness or death.
MICROPROCESSOR
Microprocessor
A
microprocessor is an electronic component that is used by a computer to
do its work. It is a central processing unit on a single integrated
circuit chip containing millions of very small components including
transistors, resistors, and diodes that work together. Some microprocessors
in the 20th century required several chips. Microprocessors help to do
everything from controlling elevators to searching the Web. Everything a
computer does is described by instructions of computer programs, and
microprocessors carry out these instructions many millions of times a
second. [1]
Microprocessors
were invented in the 1970s for use in embedded systems. The majority are
still used that way, in such things as mobile phones, cars, military weapons,
and home appliances. Some microprocessors are microcontrollers, so small
and inexpensive that they are used to control very simple products like
flashlights and greeting cards that play music when you open them. A few
especially powerful microprocessors are used in personal computers.
THE CDC ON
CORONAVIRUS
Symptoms of
Coronavirus
Older adults
and people who have severe underlying medical conditions like heart or lung
disease or diabetes seem to be at higher risk for developing more serious
complications from COVID-19 illness.
Chat icon
Self-Checker
A guide to help
you make decisions and seek appropriate medical care.
Watch for
symptoms
People with
COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms
to severe illness.
Symptoms may
appear 2-14 days after exposure to the virus. People with these symptoms or
combinations of symptoms may have COVID-19:
Cough
Shortness of
breath or difficulty breathing
Or at least two
of these symptoms:
Fever
Chills
Repeated
shaking with chills
Muscle pain
Headache
Sore throat
New loss of
taste or smell
Children have
similar symptoms to adults and generally have mild illness.
This list is
not all inclusive. Please consult your medical provider for any other symptoms
that are severe or concerning to you.
When to Seek
Medical Attention
If you have any
of these emergency warning signs* for COVID-19 get medical attention
immediately:
Trouble
breathing
Persistent pain
or pressure in the chest
New confusion
or inability to arouse
Bluish lips or
face
*This list is
not all inclusive. Please consult your medical provider for any other symptoms
that are severe or concerning to you.
Call 911 if you
have a medical emergency: Notify the operator that you have, or think you might
have, COVID-19. If possible, put on a cloth face covering before medical help
arrives.
Caring for
yourself or others
Learn how to
protect yourself
How to care for
someone who is sick
What to do if
you are sick
Caring for
Someone Sick at Home, or other non-healthcare settings
Advice for caregivers
If you are
caring for someone with COVID-19 at home or in a non-healthcare setting, follow
this advice to protect yourself and others. Learn what to do when someone has
symptoms of COVID-19. or when someone has been diagnosed with the virus. This
information also should be followed when caring for people who have tested
positive but are not showing symptoms.
*Note: Older
adults and people of any age with serious underlying medical conditions are at
higher risk for developing more severe illness from COVID-19. People at higher
risk of severe illness should call their doctor as soon as symptoms start.
Provide support
and help cover basic needs
Help the person
who is sick follow their doctor’s instructions for care and medicine.
For most people,
symptoms last a few days, and people usually feel better after a week.
See if
over-the-counter medicines for fever, such as acetaminophen (sometimes called
Tylenol), help the person feel better.
Make sure the
person who is sick drinks a lot of fluids and rests.
Help them with
grocery shopping, filling prescriptions, and getting other items they may need.
Consider having the items delivered through a delivery service, if possible.
Take care of
their pet(s), and limit contact between the person who is sick and their pet(s)
when possible.
Watch for
warning signs
Have their
doctor’s phone number on hand.
Use CDC’s
self-checker tool to help you make decisions about seeking appropriate medical
care.
Call their
doctor if the person keeps getting sicker. For medical emergencies, call 911
and tell the dispatcher that the person has or might have COVID-19.
People who have
emergency warning signs for COVID-19 should
call 911 right away. Emergency warning signs include*:
Difficulty
breathing or shortness of breath
Persistent pain
or pressure in the chest
New confusion
or inability to wake up
Bluish lips or
face
*This is not
every emergency symptom or sign.
Protect
yourself when caring for someone who is sick
people arrows
icon
Limit contact
COVID-19
spreads between people who are in close contact (within about 6 feet) through
respiratory droplets, created when someone talks, coughs or sneezes.
The caregiver,
when possible, should not be someone who is at higher risk for severe illness
from COVID-19.
Use a separate
bedroom and bathroom. If possible, have the person who is sick stay in their
own “sick room” or area and away from others. If possible, have the person who
is sick use a separate bathroom.
Shared space:
If you have to share space, make sure the room has good air flow.
Open the window
and turn on a fan (if possible) to increase air circulation.
Improving
ventilation helps remove respiratory droplets from the air.
Avoid having
visitors. Avoid having any unnecessary visitors, especially visits by people
who are at higher risk for severe illness.
food icon
Eat in separate
rooms or areas
Stay separated:
The person who is sick should eat (or be fed) in their room, if possible.
Wash dishes and
utensils using gloves and hot water: Handle any dishes, cups/glasses, or
silverware used by the person who is sick with gloves. Wash them with soap and
hot water or in a dishwasher.
Clean hands
after taking off gloves or handling used items.
no icon
Avoid sharing
personal items
Do not share:
Do not share dishes, cups/glasses, silverware, towels, bedding, or electronics
(like a cell phone) with the person who is sick.
head side mask
icon
When to wear a
cloth face cover or gloves
Sick person:
The person who
is sick should wear a cloth face covering when they are around other people at
home and out (including before they enter a doctor’s office).
The cloth face
covering helps prevent a person who is sick from spreading the virus to others.
It keeps respiratory droplets contained and from reaching other people.
Cloth face
coverings should not be placed on young children under age 2, anyone who has
trouble breathing, or is not able to remove the covering without help.
Caregiver:
Wear gloves
when you touch or have contact with the sick person’s blood, stool, or body
fluids, such as saliva, mucus, vomit, and urine. Throw out gloves into a lined
trash can and wash hands right away.
The caregiver
should ask the sick person to put on a cloth face covering before entering the
room.
The caregiver
may also wear a cloth face covering when caring for a person who is sick.
To prevent
getting sick, make sure you practice everyday preventive actions: clean hands
often; avoid touching your eyes, nose, and mouth with unwashed hands; and
frequently clean and disinfect surfaces.
Note: During
the COVID-19 pandemic, medical grade facemasks are reserved for healthcare
workers and some first responders. You may need to make a cloth face covering
using a scarf or bandana. Learn more here.
hands wash icon
Clean your
hands often
Wash hands:
Wash your hands often with soap and water for at least 20 seconds. Tell
everyone in the home to do the same, especially after being near the person who
is sick.
Hand sanitizer:
If soap and water are not readily available, use a hand sanitizer that contains
at least 60% alcohol. Cover all surfaces of your hands and rub them together
until they feel dry.
Hands off:
Avoid touching your eyes, nose, and mouth with unwashed hands.
Clean and then
disinfect
Around the
house
Clean and
disinfect “high-touch” surfaces and items every day: This includes tables,
doorknobs, light switches, handles, desks, toilets, faucets, sinks, and
electronics.
Clean the area
or item with soap and water if it is dirty. Then, use a household disinfectant.
Be sure to
follow the instructions on the label to ensure safe and effective use of the
product. Many products recommend keeping the surface wet for several minutes to
kill germs. Many also recommend wearing gloves, making sure you have good air
flow, and wiping or rinsing off the product after use.
Most household
disinfectants should be effective. A list of EPA-registered disinfectants can
be found hereexternal icon.
To clean
electronics, follow the manufacturer’s instructions for all cleaning and disinfection
products. If those directions are not available, use alcohol-based wipes or
spray containing at least 70% alcohol.
Bedroom and
Bathroom
If you are
using a separate bedroom and bathroom: Only clean the area around the person
who is sick when needed, such as when the area is soiled. This will help limit
your contact with the sick person.
If they feel up
to it, the person who is sick can clean their own space. Give the person who is
sick personal cleaning supplies such as tissues, paper towels, cleaners, and
EPA-registered disinfectantsexternal icon.
If sharing a
bathroom: The person who is sick should clean and then disinfect after each
use. If this is not possible, wear a mask and wait as long as possible after
the sick person has used the bathroom before coming in to clean and use the
bathroom.
washer icon
Wash and dry
laundry
Do not shake
dirty laundry.
Wear disposable
gloves while handling dirty laundry.
Dirty laundry
from a person who is sick can be washed with other people’s items.
Wash items
according to the label instructions. Use the warmest water setting you can.
Remove gloves,
and wash hands right away.
Dry laundry, on
hot if possible, completely.
Wash hands
after putting clothes in the dryer.
Clean and
disinfect clothes hampers. Wash hands afterwards.
trash icon
Use lined trash
can
Place used
disposable gloves and other contaminated items in a lined trash can.
Use gloves when
removing garbage bags, and handling and disposing of trash. Wash hands
afterwards.
Place all used
disposable gloves, facemasks, and other contaminated items in a lined trash
can.
If possible,
dedicate a lined trash can for the person who is sick.
digital
thermometer icon
Track your own
health
Caregivers and
close contacts should monitor their health for COVID-19 symptoms.
Symptoms
include fever, cough, and shortness of breath but other symptoms may be present
as well. Trouble breathing is a more serious warning sign that you need medical
attention.
Use CDC’s
self-checker tool to help you make decisions about seeking appropriate medical
care.
If you are
having trouble breathing, call 911.
Call your
doctor or emergency room and tell them your symptoms before going in. They will
tell you what to do.
How to
discontinue home isolation
house leave icon
People with
COVID-19 who have stayed home (home isolated) can leave home under the following
conditions**:
If they have
not had a test to determine if they are still contagious, they can leave home
after these three things have happened:
They have had
no fever for at least 72 hours (that is three full days of no fever without the
use of medicine that reduces fevers)
AND
other symptoms
have improved (for example, symptoms of cough or shortness of breath have
improved)
AND
at least 10
days have passed since their symptoms first appeared
If they have
had a test to determine if they are still contagious, they can leave home after
these three things have happened:
They no longer
have a fever (without the use of medicine that reduces fevers)
AND
other symptoms
have improved (for example, symptoms of cough or shortness of breath have
improved)
AND
they have
received two negative tests in a row, at least 24 hours apart. Their doctor
will follow CDC guidelines.
People who DID
NOT have COVID-19 symptoms, but tested positive and have stayed home (home
isolated) can leave home under the following conditions**:
If they have
not had a test to determine if they are still contagious, they can leave home
after these two things have happened:
At least 10
days have passed since the date of their first positive test
AND
they continue
to have no symptoms (no cough or shortness of breath) since the test.
If they have
had a test to determine if they are still contagious, they can leave home
after:
They have
received two negative tests in a row, at least 24 hours apart. Their doctor
will follow CDC guidelines.
Note: if they
develop symptoms, follow guidance above for people with COVID19 symptoms.
For ALL people
When leaving
the home, keep a distance of 6 feet from others and wear a cloth face covering
when around other people.
**In all cases,
follow the guidance of your doctor and local health department. The decision to
stop home isolation should be made in consultation with their healthcare
provider and state and local health departments. Some people, for example those
with conditions that weaken their immune system, might continue to shed virus
even after they recover.
Find more
information on when to end home isolation.
Q&A FROM
THE WORLD HEALTH ORGANIZATION
Q&A:
Similarities and differences – COVID-19 and influenza
17 March 2020 |
Q&A
As the COVID-19
outbreak continues to evolve, comparisons have been drawn to influenza. Both
cause respiratory disease, yet there are important differences between the two
viruses and how they spread. This has important implications for the public
health measures that can be implemented to respond to each virus.
How are COVID-19
and influenza viruses similar?
Firstly,
COVID-19 and influenza viruses have a similar disease presentation. That is,
they both cause respiratory disease, which presents as a wide range of illness
from asymptomatic or mild through to severe disease and death.
Secondly, both viruses are
transmitted by contact, droplets and fomites*. As a result, the same public health measures, such
as hand hygiene and good respiratory etiquette (coughing into your elbow or
into a tissue and immediately disposing of the tissue), are important actions
all can take to prevent infection.
How are
COVID-19 and influenza viruses different?
The speed of
transmission is an important point of difference between the two viruses.
Influenza has a shorter median incubation period (the time from infection to
appearance of symptoms) and a shorter serial interval (the time between
successive cases) than COVID-19 virus. The serial interval for COVID-19 virus
is estimated to be 5-6 days, while for influenza virus, the serial interval is 3
days. This means that influenza can spread faster than COVID-19.
Further,
transmission in the first 3-5 days of illness, or potentially pre-symptomatic
transmission –transmission of the virus before the appearance of symptoms – is
a major driver of transmission for influenza. In contrast, while we are
learning that there are people who can shed COVID-19 virus 24-48 hours prior to
symptom onset, at present, this does not appear to be a major driver of
transmission.
The
reproductive number – the number of secondary infections generated from one
infected individual – is understood to be between 2 and 2.5 for COVID-19 virus,
higher than for influenza. However, estimates for both COVID-19 and influenza
viruses are very context and time-specific, making direct comparisons more
difficult.
Children are
important drivers of influenza virus transmission in the community. For
COVID-19 virus, initial data indicates that children are less affected than
adults and that clinical attack rates in the 0-19 age group are low. Further
preliminary data from household transmission studies in China suggest that
children are infected from adults, rather than vice versa.
While the range
of symptoms for the two viruses is similar, the fraction with severe disease
appears to be different. For COVID-19, data to date suggest that 80% of
infections are mild or asymptomatic, 15% are severe infection, requiring oxygen
and 5% are critical infections, requiring ventilation. These fractions of severe
and critical infection would be higher than what is observed for influenza
infection.
Those most at
risk for severe influenza infection are children, pregnant women, elderly,
those with underlying chronic medical conditions and those who are immunosuppressed.
For COVID-19, our current understanding is that older age and underlying
conditions increase the risk for severe infection.
Mortality for
COVID-19 appears higher than for influenza, especially seasonal influenza. While
the true mortality of COVID-19 will take some time to fully understand, the
data we have so far indicate that the crude mortality ratio (the number of
reported deaths divided by the reported cases) is between 3-4%, the infection
mortality rate (the number of reported deaths divided by the number of
infections) will be lower. For seasonal influenza, mortality is usually well
below 0.1%. However, mortality is to a large extent determined by access to
and quality of health care.
What medical
interventions are available for COVID-19 and influenza viruses?
While there are
a number of therapeutics currently in clinical trials in China and more than 20
vaccines in development for COVID-19, there are currently no licensed vaccines
or therapeutics for COVID-19. In
contrast, antivirals and vaccines available for influenza. While the influenza
vaccine is not effective against COVID-19 virus, it is highly recommended to
get vaccinated each year to prevent influenza infection.
FOMITES*
CONTEXT:
“Secondly, both viruses are transmitted by contact, droplets and fomites*.”
DICTIONARY
fomite
noun
fo·mite | \
ˈfō-ˌmīt \
plural fomites\
ˈfō-ˌmīts ; ˈfä-mə-ˌtēz , ˈfō-
\
Definition of
fomite
: an object
(such as a dish, doorknob, or article of clothing) that may be contaminated
with infectious agents (such as bacteria or viruses) and serve in their
transmission
Did You Know?
Disinfectant on
your hands keeps us healthier and fomites no longer foment as much disease.
Australian newspaper contributor Peter Goers was likely going for alliteration
when he paired up "fomite" and "foment," a verb meaning
"to promote the growth or development of"-but, whether he realized it
or not, the words "fomite" and "foment" are also related.
"Fomite" is a back-formation of "fomites," the Latin plural
of "fomes," itself a word for tinder. (Much like tinder is a catalyst
of fire, a fomite can kindle disease.) "Fomes" is akin to the Latin
verb fovēre ("to heat"), an ancestor of "foment."
First Known Use
of fomite
1803, in the
meaning defined above
History and
Etymology for fomite
back-formation
from fomites, from New Latin, plural of fomit-, fomes, from Latin,
kindling wood; akin to Latin fovēre to heat — more at FOMENT
THERE IS A VERY
INTERESTING ARTICLE ON RABIES BELOW, WHICH IS PROBABLY THE MOST SHOCKING OF ALL
THE VIRUSES DUE TO ITS EFFECTS AND THE NEAR INEVITABILITY OF CONTRACTING THE
DISEASE IF BITTEN BY ANY NUMBER OF MAMMALS, NOT JUST DOGS OR CATS AND THEN OF
DYING FROM IT. A FEW PEOPLE WHO DO DEVELOP SYMPTOMS OF RABIES HAVE ACTUALLY
SURVIVED IT, THOUGH, WHICH IS THE SUBJECT OF THE ARTICLE.
FOR THOSE WHO
ENJOY SUCH MATERIAL, THERE IS A VERY READABLE AND EVEN ENTERTAINING NONFICTION
STUDY OF RABIES RELATED LITERATURE BOTH TODAY AND DOWN THROUGH TIME, INCLUDING
MENTIONS IN WRITTEN SOURCES OF CLASSICAL TIMES, SEE THE AUTHORS BILL WASIK AND
MONIKA MURPHY’S “RABID: A CULTURAL HISTORY OF THE WORLD’S MOST DIABOLICAL
VIRUS,” AVAILABLE FROM AMAZON AT https://www.amazon.com/Rabid-Cultural-History-Worlds-Diabolical-ebook/dp/B0072NWKG0 .
THE SURVIVAL OF
A FEW PEOPLE ILL WITH A USUALLY DEADLY DISEASE IS TRUE ALSO ABOUT EBOLA, AS THE
GREAT NON-FICTION BOOK ON THE SUBJECT, “THE HOT ZONE,” TELLS. THAT AUTHOR IS
RICHARD PRESTON. IT DESCRIBES, AMONG MANY OTHER PIECES OF INFORMATION, HOW ONE
AFRICAN DOCTOR USED A NON-APPROVED METHOD OF TREATING EBOLA. HE TRANSFUSED THE
BLOOD OF ONE OF THE FEW RECOVERED PATIENTS INTO THE ARM OF A NEWLY ILL PATIENT,
AND IT SEEMED TO MITIGATE THE SYMPTOMS AND POSSIBLY HELP THAT PERSON TO
SURVIVE. THAT TRANSFUSION METHOD HAS BEEN TRIED WITH COVID ALSO. FOR THAT
ARTICLE, GO TO LANCET: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30173-9/fulltext .
ACCORDING TO
ONE RECENT NEWS REPORT, COVID IS NOT DEPENDABLY PROVIDING FUTURE IMMUNITY IN
ALL CASES, THOUGH, WHICH IS DISCOURAGING. THE LANCET ARTICLE DESCRIBES A
SUCCESS RATE OF SOME 73.7% AMONG A SAMPLE OF JUST 34 ADULT PATIENTS. THE
WHOLE ARTICLE IS TECHNICAL, BUT I BELIEVE MY GLEANING OF INFORMATION IS
CORRECT. IT IS SHORT, AND ANYONE WITH SOME MEDICAL TRAINING SHOULD BE ABLE TO
READ IT WITH FULL UNDERSTANDING.
THIS ITEM OF
INTEREST IS ABOUT THE KNOWN SURVIVORS OF RABIES, OF WHICH THERE HAVE BEEN VERY
FEW. THIS NEWS STORY IS FOR THOSE WHO HAVE A TOLERANCE FOR SOME GRISLY MATERIALS,
SUCH AS OLD MOVIES ABOUT COUNT DRACULA OR WEREWOLVES MOVIES RATHER THAN
REACTING IN TERROR OR DISGUST – OR, OF COURSE, THOSE WHO MIGHT WANT TO ATTEND
MEDICAL SCHOOL.
HEALTH
Medical
Mystery: Only One Person Has Survived Rabies without Vaccine--But How?
ScientificAmerican.com
talks with the first known survivor of rabies four years later
By Jordan Lite
on October 8, 2008
PHOTOGRAPH –
JEANNA GIESE WITH DOG Credit: AP
Photo/Morry Gash
Four years
after she nearly died from rabies, Jeanna Giese is being heralded as the first
person known to have survived the virus without receiving a preventative
vaccine. But Giese (pronounced Gee-See) says she would gladly share that
honor with others if only doctors could show that the treatment used to save
her could spare other victims as well. "They shouldn't stop 'till it's
perfected," said Giese, now 19, during a recent interview about
physicians' quest to refine the technique that may have kept her alive.
Giese's wish
may come true. Another young girl infected with rabies is still alive more than
a month after doctors induced a coma to put her symptoms on hold, just as
they did with Giese. Yolanda Caicedo, an infectious disease specialist
at Hospital Universitario del Valle in Cali, Colombia, who is treating the
latest survivor, confirmed reports in the Colombian newspaper El País that the
victim is an eight-year-old girl who came down with symptoms in August, about a
month after she was bitten by an apparently rabid cat. Caicedo said that
the family had sought treatment for the bite in Bolivar, at a hospital about
three hours by foot from their rural home, but that the child, Nelsy Gomez,
did not receive the series of vaccines that can prevent the virus from
turning into full-blown rabies.
The five shots
contain minute amounts of the dead rabies virus and are designed to nudge
the body into developing antibodies to fight it. Patients are also given a
shot of immunoglobulin (in this case a synthesized rabies antibody) to
protect them while their immune systems produce antibodies to the vaccine
virus. But the combination is only effective within six days of infection,
before symptoms show up; when Gomez developed signs of the disease, it was
too late for the shots. With no other options available, doctors induced a
coma.
Caicedo is
hopeful, but indicated that Gomez will face a long, slow recovery. She would
not say how long Gomez was comatose but told ScientificAmerican.com that she
had been awake for "a few days" and is stable. The child can
move her fingers but cannot walk or eat on her own, and her eyes are open but
she cannot speak yet and physicians are not sure if she can see, Caicedo
says.
Giese, informed
of the case, says that she "hopes and prays" that Gomez will survive.
Giese was the
keynote speaker at a conference last week in Atlanta, where scientists gathered
to discuss the latest research being conducted on ways to battle the deadly
disease. During her talk, she urged physicians to continue efforts to pin down
treatments that work.
Giese was 15
when she was infected after being bitten by a rabid bat she had picked
up outside her church in her hometown of Fond du Lac, Wisc.
Her parents
cleaned the superficial wound and she says they did not believe it was
necessary to seek further medical treatment. "We never thought of
rabies," she says. By the time Giese began displaying signs of rabies
three weeks later—fatigue, double vision, vomiting and tingling in her left
arm—it was too late for the antirabies vaccine cocktail.
Instead of
giving her up for dead, the doctors decided to "shut the brain down and
wait for the cavalry to come" by inducing a coma to give her own immune
system time to build up antibodies against the virus, says Rodney Willoughby,
an infectious disease specialist who treated Giese at the Children's
Hospital of Wisconsin in Milwaukee. Willoughby devised the treatment credited
with saving Giese there, which has since become known as the Milwaukee
protocol*.
Rabies kills by
compromising the brain's ability to regulate breathing, salivation and
heartbeat; ultimately, victims drown in their own spit or blood, or cannot
breathe because of muscle spasms in their diaphragms. One fifth die from fatal
heart arrhythmia. Doctors believed that Giese might survive if they
suppressed her brain function by sedating her while her immune system
attacked the rabies virus.
This was the
first time the therapy was attempted, and doctors had no clue if it would work
or, if it did, whether it would leave her brain damaged. But Willoughby says it
was the only chance doctors had of saving her.
When she arrived
at the hospital, Giese couldn't talk, sit or stand and fell in and out of
consciousness—she also needed to be intubated to help her breathe. "She
was critically ill," Willoughby recalls, "and looked as if she might
die within the day."
In addition to
inducing the coma, doctors also gave her the antivirals ribavarin and
amantadine. They tapered off the anesthetics after about a week, when
tests showed that Giese's immune system was battling the virus. For about
six months after awakening from the coma, physicians also gave her a compound
called tetrahydrobiopterin that is chemically similar to the B-complex vitamin
folic acid, which may have improved her speech and ability to eat,
Willoughby says.
He notes that
physicians gave her the supplement after tests showed that she had a
deficiency of the compound, which is known to boost production of
serotonin and dopamine neurotransmitters needed to perform motor, speech and
other routine bodily functions.
Remarkably,
Giese survived. She recovered most of her cognitive functions within a few months,
and other skills within a year, Willoughby says. She got her driver's
license and is now a sophomore at Marian University in Fond du Lac, where
she is majoring in biology. There are lingering signs of her illness: Giese,
once an avid athlete, says she now lists to one side when she runs and walks
and no longer plays volleyball, basketball and softball as she once did.
She also speaks more slowly and sometimes not as clearly as before her
illness, but Willoughby says these effects may fade over time.
Giese is
"pretty much normal," says Willoughby, an associate professor of
pediatrics at the Medical College of Wisconsin in Milwaukee. "She
continues to get better, counter to conventional medical thinking."
Rabies has an
incubation period of two weeks to three months and kills within a week of the
symptoms showing up. The vaccine series and other immune therapies are useless
at this point and may even speed up and increase the severity of the symptoms.
Usually, patients are made as comfortable as possible in the hospital or, in
countries without sophisticated health care, sent home to die an agonizing
death.
Antiviral drugs
and immune therapies including steroids, disease-fighting interferon-alpha and
poly IC (which stimulates the body's own production of interferon-alpha) have
been tried, but none have been shown to be lifesaving on their own, Willoughby
says.
Over the past
four years, the Milwaukee protocol to differing degrees has been used a dozen
times, but until now Giese was the sole survivor. Exactly why she lived—and
the others died—is still a mystery.
In a 2005
report on her case in The New England Journal of Medicine, Willoughby speculated
that she may have been infected with a rare, weakened version of the virus.
Today, he chalks Giese's survival up to aggressive intensive care, the
decision to sedate her "and 10 percent sheer luck." Which element
of that combination made the difference, and whether the antivirals she was
given helped save her is unknown.
"In all
honesty, we were probably just pretty lucky," he says. Only another
survivor, and then animal and clinical trials, will show if the therapy works,
and why, he says. The U.S. Centers for Disease Control and Prevention (CDC)
plans to test the protocol on rabies-infected ferrets; Thai and Canadian
doctors, who unsuccessfully treated a 33-year-old man with rabies with the
Milwaukee protocol, recommended in the Journal of NeuroVirology two years ago
that physicians exercise "caution" in using the treatment, because
it is too expensive and lacks " a clear scientific rationale."
Willoughby says it cost about $800,000 to treat Giese.
A Field Guide
to Bats
Read more from
this special report:
A Field Guide
to Bats
Rabies is 100
percent preventable with vaccinations if patients receive them before the onset
of symptoms, including hallucinations, delirium, muscle spasms, paralysis and
hydrophobia. Yet an estimated 55,000
people, mostly in Asia and Africa, die from it annually because of
misdiagnosis or because the illness is not recognized until it has taken hold,
according to the journal Neurologic Clinics. Often, patients dismiss the
potential seriousness of bites, cannot afford follow-up medical treatment or,
in some situations, are unaware they've been bitten, as was the case of a
13-year-old Connecticut girl who died of rabies in 1995.
Vaccine
shortages as one manufacturer, Bridgewater, N.J.–based sanofi–aventis, upgrades
its factory to meet U.S. Food and Drug Administration requirements, and chronic
shortfalls of immunoglobulin also play a role in the fatalities. The
vaccine-immunoglobulin regimen costs $1,200 to $2,000 in industrialized nations
and $100 to $300 in developing countries—an out-of-reach sum for many people,
Willoughby says.
Though it's
promising that Gomez is still alive, "The hope that the outcome will
necessarily be the same as with Jeanna, particularly in a developing country,
is expecting a bit much," laments Charles Rupprecht, chief of the CDC's
Rabies Program
Willoughby
acknowledges that even if Giese's success is reproducible—and the Milwaukee
protocol perfected—it likely will only be available for use in 10 percent of
cases, because of limited medical facilities in developing countries.
"Re-creating
that in a place stricken with poverty, you get into ethical issues of whether
we should do this when we should be about prevention; and does that society
have the ability to rehabilitate a patient who may survive but with severe
[side effects]?" Rupprecht says. "Jeanna created several ethical
issues for all of us to deal with this bug."
Giese says that
the fourth-year anniversary of her illness has brought up some bitter memories
that she'll probably never shake, but she's glad to be alive—and doing as well
as she is.
"It takes
some getting used to, but I've kind of come to terms with the fact that I'm the
only…[survivor]," she says. "At 15, I never would have thought that
anything like this would ever happen, and that I lived is just amazing."
An animal lover
who owns a dog, two rabbits and six birds, she hopes to one day open a
sanctuary in Fond du Lac for endangered animals, including "big predators
like lions and tigers and wolves," and maybe even bats, too.
"I'm not
scared of them at all," Giese says of bats. "I'm more passionate
about animals than I was before. Animals are my happiness and reason for
living."
Additional
reporting by Barbara Juncosa
ABOUT THE
AUTHOR(S)
Jordan Lite
Recent Articles
MIND Reviews:
The (Honest) Truth about Dishonesty
MIND Reviews:
The Emotional Life of Your Brain
MIND Reviews:
The Power of Habit
THE MILWAUKEE
PROTOCOL*
How to cite this
article:
Agarwal AK. The
'Milwaukee protocol' (MP) hope does not succeeds for rabies victim. Med J DY
Patil Univ 2017;10:184-6
Introduction
The Milwaukee
protocol (MP), a procedure reported to prevent death after the onset of
rabies symptoms, has been performed over 26 times since its inception in
2004 but has only saved one life. Overwhelming failure has lead health
officials to label the protocol, a red herring.[1],[2]
Rabies is
caused by the rabies virus, an RNA-based virus in the genus Lyssavirus.
Transmission typically occurs when virus-laden saliva from a rabid animal enters
a wound or mucous membrane. Infection typically occurs from a rabid animal
bite. The virus travels along peripheral nerves until it reaches the brain
and salivary glands. A characteristic rabies symptom is aversive behavior
toward water or water consumption called hydrophobia. Individuals demonstrating
hydrophobia will generally avoid water and resist drinking it. Other symptoms
include anxiety, nerve pain, and itching, impaired sensation of touch,
convulsions, paralysis, and coma. Cases among unvaccinated individuals
almost always result in death.
The MP was
conceived in 2004 by a team of medical professionals, led by Dr. Rodney
Willoughby, after a 15-year-old girl was admitted to a Milwaukee hospital
after a rabies diagnosis. After consulting with researchers at the Centers
for Disease Control and Prevention in Atlanta, the team formulated and
implemented a novel procedure. The patient was placed in a drug-induced coma
and given an antiviral cocktail composed of ketamine, ribavirin, and amantadine.
Considering the theory that rabies pathology stems from central nervous
system neurotransmitter dysfunction, doctors hypothesized suppressed brain
activity would minimize damage while the patient's immune system developed
an adequate response.[3],[4]
The patient was
discharged from the hospital 76 days after admission. She demonstrated speech
impediment and difficulty walking during a clinic visit of 131 days after
discharge. It is unclear how long those conditions persisted. In subsequent
years, the patient attended college. She remains the only MP
success.[4]
There has been
confusion regarding the efficacy of the MP.[1]
Case Report
We report the
treatment of a child with rabies, who received the timeliest and complete
application of the original MP to date, and compare this case with other MP
attempts, discussing implications for advancement in the field.
In Jan 2016, a
10 year-old male from the Morena, India, presented to the Intensive Emergency
Unit (IEU) of our J.A. Group of Hospital, Gwalior, 30 km far from Morena, with
symptoms suggestive of furious rabies. Six months earlier, the patient
had been bitten by a dog in the Morena, and did not receive rabies vaccine or
other postexposure prophylaxis (PEP); clinical presentation had been
reported with sore throat, fever, and fatigue followed by progressive
shortness of breath, dysphasia, and insomnia. In the IEU, he developed
irregular mouth movements, visual hallucinations, agitation, aerophobia, and
hypersalivation on the 2nd day. Marked heart rate and blood pressure
variability were compatible with severe dysautonomia. He was intubated for
airway protection. Following thiopental for sedation, he became severely
bradycardic, requiring brief cardiopulmonary resuscitation. Neuromuscular
blockade was administered because of pharyngeal and diaphragmatic spasms. Coma
was induced with ketamine and midazolam infusions as recommended in the MP
(version 1.1)[1] for presumed rabies.
. . . . Conclusion
Top
As one of the
oldest and deadliest infectious diseases, rabies is long overdue for the
development of a successful treatment. Six years ago, when the first rabies
survivor (without PEP) was described, there was new hope for rabies victims.
Unfortunately, subsequent cases illustrate the uncertainties surrounding rabies
management and the tremendous resources expended in aggressive supportive
care.[8] This case, when taken together with other MP cases to date,
suggests that an early immune response may be better correlated with
survival, the efficacy of MP antiviral activity is unclear, and ribavirin
itself may be immunosuppressive. Aggressive supportive care has resulted in
longer survival times and consequently a wealth of clinical and laboratory
data, helping to better understand the natural history of rabies and develop
specific questions regarding its pathophysiology. Animal models are urgently
needed to address these questions, which may ultimately lead to successful
outcomes in rabies.
In conclusion,
the MP is not an ideal treatment. The low success rate, high costs, and ethical
issues surrounding it make it unlikely to ever be extensively used or accepted
as an effective treatment. Moreover, new developments to better diagnosis
techniques and cheaper vaccines may make rabies a disease of the past.
Financial
support and sponsorship
Nil.
Conflicts of
interest
There are no
conflicts of interest.
#
THIS WIKIPEDIA
PIECE REFERS TO A KNOWN 14 HUMANS WHO DID SURVIVE RABIES AFTER DEVELOPING
SYMPTOMS. IT DOESN’T MENTION THE MILWAUKEE PROCEDURE.
Rabies
From Wikipedia,
the free encyclopedia
Rabies is a
viral disease that causes inflammation of the brain in humans and other
mammals.[1] Early symptoms can include fever and tingling at the site of
exposure.[1] These symptoms are followed by one or more of the following
symptoms: violent movements, uncontrolled excitement, fear of water, an
inability to move parts of the body, confusion, and loss of consciousness.[1]
Once symptoms appear, the result is nearly always death.[1] The time period
between contracting the disease and the start of symptoms is usually one to
three months, but can vary from less than one week to more than one year.[1]
The time depends on the distance the virus must travel along peripheral nerves
to reach the central nervous system.[5]
Rabies is
caused by lyssaviruses, including the rabies virus and Australian bat
lyssavirus.[3] It is spread when an infected animal bites or scratches a human
or other animal.[1] Saliva from an infected animal can also transmit rabies if
the saliva comes into contact with the eyes, mouth, or nose.[1] Globally, dogs
are the most common animal involved.[1] In countries where dogs commonly have
the disease, more than 99% of rabies cases are the direct result of dog bites.[6]
In the Americas, bat bites are the most common source of rabies infections in
humans, and less than 5% of cases are from dogs.[1][6] Rodents are very rarely
infected with rabies.[6] The disease can be diagnosed only after the start of
symptoms.[1]
Animal control
and vaccination programs have decreased the risk of rabies from dogs in a
number of regions of the world.[1] Immunizing people before they are exposed
is recommended for those at high risk, including those who work with bats or
who spend prolonged periods in areas of the world where rabies is common.[1]
In people who have been exposed to rabies, the rabies vaccine and sometimes
rabies immunoglobulin are effective in preventing the disease if the person
receives the treatment before the start of rabies symptoms.[1] Washing bites
and scratches for 15 minutes with soap and water, povidone-iodine, or detergent
may reduce the number of viral particles and may be somewhat effective at
preventing transmission.[1][7] As of 2016, only fourteen people had survived
a rabies infection after showing symptoms.[8][9][10]
Rabies caused
about 17,400 human deaths worldwide in 2015.[4] More than 95% of human deaths
from rabies occur in Africa and Asia.[1] About 40% of deaths occur in children
under the age of 15.[11] Rabies is present in more than 150 countries and on
all continents but Antarctica.[1] More than 3 billion people live in regions of
the world where rabies occurs.[1] A number of countries, including Australia
and Japan, as well as much of Western Europe, do not have rabies among
dogs.[12][13] Many Pacific islands do not have rabies at all.[13] It is
classified as a neglected tropical disease.[14]
Duvenhage
lyssavirus
From Wikipedia,
the free encyclopedia
Duvenhage
lyssavirus (DUVV) is a member of the genus Lyssavirus, which also
contains the rabies virus. The virus was discovered in 1970, when a
South African farmer (after whom the virus is named) died of a rabies-like encephalitic
illness, after being bitten by a bat.[2] In 2006, Duvenhage virus
killed a second person, when a man was scratched by a bat in North West
Province, South Africa, 80 km from the 1970 infection.[3] He developed a
rabies-like illness 27 days after the bat encounter, and died 14 days after the
onset of illness. A 34-year-old woman who died in Amsterdam on December 8,
2007 was the third recorded fatality. She had been scratched on the nose by a
small bat while travelling through Kenya in October 2007, and was admitted
to hospital four weeks later with rabies-like symptoms.[4]
Microbats are
believed to be the natural reservoir of Duvenhage virus. It has been
isolated twice from insectivorous bats, in 1981 from Miniopterus
schreibersi, and in 1986 from Nycteris thebaica,[3] and the virus is
closely related to another bat-associated lyssavirus endemic to Africa, Lagos
bat lyssavirus.
VIDEO ON A HISTORY
OF 1918 SPANISH FLU
39:35 MIN.
DURATION
1918 Spanish
Flu historical documentary | Swine Flu Pandemic | Deadly plague of 1918
9,027,054 views
• Oct 2, 2018
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Historical
documentary about 1918 Swine Flu or Spanish Flu and the role of World War I in
spreading the disease among troops making it into a worldwide plague of
devastating proportions. The video covers where it began, how and where it
spread, the symptoms, how it affected America and whether it could happen
again. The music is “Blood and Ivory Keys”
by 19between. Used with Permission.
Category People & Blogs
FOR MORE
DETAIL, THESE ARE SUGGESTED:
Origin of the
Spanish flu pandemic
John M. Barry,
Distinguished Visiting Scholar, the Center for Bioenvironmental Research of
Tulane and Xavier Universities, New Orleans, Louisiana, concluded that Haskell
County was the location of the first outbreak of the 1918 flu pandemic
(nicknamed "Spanish flu"), which killed between 21 and 100 million
people.[4] Dr. Loring Miner, a Haskell County doctor, warned the editors of
Public Health Reports of the U.S. Public Health Service about the new and more
deadly variant of the virus. It produced the common influenza symptoms with a
new intensity: "violent headache and body aches, high fever,
non-productive cough. . . . This was violent, rapid in its progress through the
body, and sometimes lethal. This influenza killed. Soon dozens of patients—the
strongest, the healthiest, the most robust people in the county—were being
struck down as suddenly as if they had been shot." [5] Barry writes that
in the first six months of 1918, Miner's warning of "the influenza of a
severe type" was the only reference in that journal to influenza anywhere
in the world.[6]
Haskell County,
Kansas, is the first recorded instance anywhere in the world of an outbreak of
influenza so unusual that a physician warned public health officials. It remains
the first recorded instance suggesting that a new virus was adapting,
violently, to man.
If the virus
did not originate in Haskell, there is no good explanation for how it arrived there.
There were no other known outbreaks anywhere in the United States from which
someone could have carried the disease to Haskell and no suggestions of
influenza outbreaks in either newspapers or reflected in vital statistics
anywhere else in the region. And unlike the 1916 outbreak in France, one can
trace with perfect definiteness the route of the virus from Haskell to the
outside world.[7]
Miner's report
was not published until April 1918 and it failed to collect the attention it
needed. It was not until after 2000 that historians' research revealed the
origin of one of the deadliest epidemics in human history.
Historians have
generally reported that the path of the disease from Haskell to the world
occurred when newly inducted soldiers from the county traveled 200 miles from
the county to Camp Funston (now Fort Riley) and were then deployed to Europe at
the beginning of United States involvement in World War I.[7]
. . . .
How Boston
Reacted To The 1918 Flu Pandemic
AUDIO 05:37
MIN. DURATION
March 11, 2020
Jack Lepiarz
PHOTOGRAPH -- Red
Cross volunteers assemble gauze masks at Camp Devens (Courtesy the Fort Devens
Museum)
VIDEO -- Play
It was late
September in 1918 when a doctor at what was then Camp Devens in Ayer
summed up the new disease that was killing thousands.
"Two hours
after admission they have the mahogany spots over the cheek bones, and a few
hours later you can begin to see the cyanosis extending from their ears and
spreading all over the face," the doctor said. "It is only a
matter of a few hours then until death comes, and it is simply a struggle for
air until they suffocate. It is horrible."
Devens was not
the first place to see an influenza outbreak that year, but it was one of the
hardest hit. It's estimated about a third of people at the camp came down
with the flu — a little more than 15,000. Of those, more than 800 died.
"That
happening really overwhelmed the hospital here," said Kara Fossey, the
executive director of the Fort Devens Museum. "They pulled in some
nurses in from other places. There were some nurses and doctors that died here
as well. They had to use barracks for makeshift morgues to even deal with all
the people."
The 1918 Flu
Pandemic Memorial is located in nearby Rogers Field in Devens. (Jesse
Costa/WBUR)
What was
happening in Devens — where the Army surgeon general observed bodies
"stacked about the morgue like cordwood" — was a snapshot of what was
happening at the same time in Boston.
There, the
virus appears to have started among sailors at Commonwealth Pier in late
August. And it spread quickly. On September 6, 1918, the Boston Daily Globe
reported that there were 300 cases of the flu at Commonwealth Pier.
Four days
later, the number had risen to 1,100, prompting this warning: "Boston
health authorities who are combating the grippe ask the cooperation of girls
who have sailor friends, requesting them to refrain from kissing."
On September
23, the Globe noted that all hospitals were "taxed to their limits."
Two days later, Boston Public Schools were shut down and the emergency health
committee banned all public gatherings.
In the days
that followed, the city health commissioner ordered all places of amusement
closed, the sheriff quarantined the Charles Street Jail and the governor made a
desperate call for more health care workers.
"I most
strongly urge that the public authorities release nurses engaged in work not at
this time pressing and that householders dispense with all non-emergency
service so that additional nurses may be available for the more serious cases
of influenza," read a proclamation by the governor at the time, signed by
the lieutenant governor and future president, Calvin Coolidge.
"It is
earnestly requested that everyone who has had medical or nursing experience or
who can assist in any way communicate with the Commissioner of Health at the
State House," the proclamation continued.
The WWI
temporary grave marker of Herbert O. Gilman who died on September 27, 1918 of
influenza at Camp Devens. (Jesse Costa/WBUR)
The worst of
the epidemic lasted for about four weeks. In that time, there were multiple
days with more than 150 dead from flu or pneumonia. It wasn't until the number
of deaths in Boston dipped below 100 for the second time in three days that the
mayor allows bars and theaters to reopen.
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The current
coronavirus outbreak has not created the same sorts of conditions the 1918 flu pandemic
did in Boston.
But Alex
Navarro, the assistant director of the University of Michigan's Center for the History
of Medicine said there is good reason to look back at 1918.
"It was a
global pandemic," Navarro said. "It was one of incredibly high death
toll, and caseload, and one also in the quote-unquote, modern era."
Navarro, whose
research looked at the flu outbreak in dozens of American cities, including
Boston, said the most effective tools governments were able to use were those
that isolated the sick and prevented infection — like Boston's ban on public
gatherings.
"Timing is
really key," he said. "Our study found that association between
cities that acted early, that kept many different non pharmaceutical
intervention and social distancing measures in place, and that kept them in
place for longer fared better."
In other words,
telling people to stay home or avoid people who are sick works.
But, he
acknowledged, that's not always possible — especially for public leaders who
face a skeptical public that might want restrictions to end. Indeed, Navarro
said that was the case in some cities that saw a second wave of influenza after
lifting bans too early.
"So as a
historian, I can tell you that the data suggests that they work, but as a
public health official having to make these decisions, they're in a really
difficult spot," he said.
It's estimated
the 1918 flu killed about 2.5% of those infected. We still don't know how
deadly the new coronavirus really is. Germany has reported just two deaths out
of more than a thousand cases. South Korea's case fatality rate is about 0.7%.
But in Italy,
the death rate has been closer to 6%.
"We don't
want to be alarmist and we don't want to say the sky is falling,” said Navarro.
“But if you look at the data we have so far, we have a disease that has about
the same transmissibility rate as influenza and has a case fatality ratio that
is probably on par with what the 1918 epidemic was."
This segment
aired on March 11, 2020.
Jack Lepiarz Reporter and Anchor
Jack Lepiarz is
a reporter and anchor at WBUR.
The son of a
circus performer and an anthropology professor, Jack Lepiarz received his
broadcasting degree from Emerson College, where he worked as an anchor,
producer and news director for WERS 88.9 FM.
He joined WBUR
in the spring of 2010, and maintains a healthy love for performing and the
circus.
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How Boston
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