l. ABC News reports that Mr. Duncan in Texas Health Presbyterian Hospital has been placed on the experimental drug called brincidofovir, a prodrug (inactive drug converted to active form in the body; e.g., by hydrolysis of ester form of inactive drug). This drug is produced by Chimerix for treatment of CMV virus, primarily a DNA virus. The drug acts by inhibiting DNA polymerases. Chimerix says on-line that the drug has shown test-tube evidence of activity against EBOV, a RNA virus. The drug is an oral nucleotide analog. See http://www.chimerix.com for details on the drug. Its use in Mr. Duncan is with the approval of the CDC.
2. Becker’s Infection Control and Clinical Quality reports that a survey of 400 RN’s in 24 states showed 60% of the nurses queried said U.S. hospitals are not ready for EBOV admissions. Why? 80% of nurses said they had received no communication on admission policies; 85% of nurses said they had received no education on EBOV; 30% of nurses said their hospitals had insufficient eye protection and insufficient fluid resistant gowns. See http:/www.beckershospitalreview.com/quality/murse-survy-hospitals-are-not-ready-for-ebola.html for details.
3. Boston.com reports that Dr. Sacra who just recovered from EBOV does not have a recurrence of EBOV. He was admitted to a Maine hospital yesterday with fever and cough. I would like to know if Dr. Sacra has a persistent neutropenia from his bout of EBOV.
4. NY Times reports that needed supplies for EBOV treatment and protection of HCW is sitting on the docks in Sierra Leone or in the U.S. awaiting ‘paperwork’. This delay is all about politics. The Sierra Leone president, Mr. Koroma, does not want Mr. Bah, who organized for these shipments, to get any boost in popularity from the people of Sierra Leone. Mr. Bah is President Koroma’s political opponent. So the supplies just sit on docks and EBOV patients and HCW die in Sierra Leone.
5. Reuters reports that a 38 y.o. radiographer in Kampala, Uganda, has died of Marburg virus. His 80 contacts are being traced. Marburg virus is a filovirus like EBOV, but MARV and EBOV have 55% differences in their nucleotides and amino acids. The symptoms produced by MARV and EBOV are similar; but MARV has an incubation period of 3-9 days during which the patient is not infectious. The radiographer became symptomatic on September 28th. Counting backwards, any patient he radiographed between September 21-25th (28th for safety) could be the index case or lead to the index case. Public health in Sierra Leone or WHO need to contact trace all the patients that the radiographer radiographed in this time period, esp. patients with fever or abdominal symptoms (exams would be CXR, KUB, or barium studies). No media indication that radiographed patients are being traced. All radiographic tables should be cleansed with household bleach in a 1:10 dilution with water throughout Africa, and radiographers protected by PPE suits if EBOV suspected. (See excellent discussion of disinfection for EBOV on Google; enter ‘Kimberly-Clark Ebola Virus Disease Brief’)