l. WHO reports that EBOV deaths in West Africa have topped 4000 persons. U.N.’s Nabarro says that EBOV caseloads are doubling every 2-3 weeks in West Africa. Lancet letter asks for storage of convalescent whole blood and serum from EBOV survivors for use in Sub-Saharan Africa should the EBOV spread south and east.
2. The Lancet published a letter on-line October 10th re: randomized clinical trials of EBOV vaccines from 17 EBOV physicians and scientists. These scientists, including Professor Peter Piot, who discovered EBOV, maintain that the usual ethical arguments for randomized trials do not hold for EBOV vaccines because the EBOV case mortality rate without treatment is 70%. The authors insist that no one in an EBOV vaccine trial should go without the EBOV vaccine. They recommend a stepped-wedge clinical trial where each EBOV treatment center(s) receives the vaccine(s) at different times. Effectiveness of the EBOV vaccine(s) is evaluated by comparing infection rates at each treatment center pre and post vaccination. See the entire letter at DOI: 10.1016/A0140-6736(14)61734-7
4. Please note the Figure 1 in the NEJM Perspective yesterday on EBOV vaccines shows how the two vaccines incorporate EBOV proteins into their structure. Figure 2 diagrams how a step-wedged clinical trial is performed. See DOI: 10.1056/NEJMp1412166 for the Perspective and Figures.
5. NY Times reports that President Koromo of SIerra Leone spoke before the World Bank yesterday and asked for the following supplies for West Africa: 1500 beds in EBOV treatment centers; 750 physicians; 3000 nurses; 1500 support people; 200 ambulances; 1000 motorcycles for contact tracers.
6. Texas Presbyterian Hospital reports that Mr. Duncan was treated with the experimental drug brincidofovir, an anti-DNA polymerase at the hospital. The hospital is being criticized on TV and radio for discharging the patient from the ER two days prior to admission despite a fever of 103 degrees F.