Transcription
Well, warm welcome to this talk. Now, I want to do an update on the Ebola virus situation in Africa. It's actually shaping up to be quite a bad situation, worse than I'd anticipated, actually. Although, if you haven't got time to watch the video, it's not going to be spreading person-to-person in Western countries. It's not going to be a pandemic in that sense, although there could be sporadic cases.
But before we do that, let's quickly review Hanta virus because we turned out that the predictions we made about that a couple of weeks back were so far completely accurate, actually. Uh, so we predicted that there've been no cases unrelated to the motor vessel Honduras, the cruise ship, of course, small cruise ship. There has been recent additional confirmed cases. I think there's something like 13 cases now, but it's only from people that were passengers and crew, people identified during repatriation quarantine after being on board. So, it's only people that have been on the ship. It is not spreading. It is not spreading beyond the ship, which is uh, is what we predicted and is, is good news. Although the incubation period is long, we can't yet be certain, but it's looking more and more likely with every day that passes. There was a Spanish evacuee from the ship tested positive while already in quarantine in Madrid. We expected some of this because we know there was person-to-person spread, or it's very likely there was person-to-person spread on the ship, although that is still debated. Um, I think it's likely there was some person-to-person spread on the ship, but no further spread. So, so far, and we don't really expect anymore. Canadian passenger tested positive after returning home. So, very bad for these people, but, but uh, good in terms that we're not going to get a larger outbreak. Crew member repatriated to the Netherlands later tested positive. I think that brings us up to about 13 cases now. Um, which is appalling for the people concerned. It's a horrible disease, but um, it's not going to be a widespread outbreak. No confirmed community spread cases reported in people who were not on the ship. So, uh, pretty good news really in terms of Hantavirus.
So, um, having got that one pretty well right uh, so far, uh, let's move on to Ebola, um, which is a more serious situation. So, we're talking about the uh, Bundibugyo strain of the uh, filovirus family, the Ebola virus. This uh, Bundibugyo strain is uh, not a common one. It hasn't. I think it's caused one previous outbreak, but the other ones have been different outbreaks. Bundibugyo is a province in western Uganda, of course, which is named after, in the good old days, where we used to name viruses after the places where they originated. Um, in fact, we still do apart from one or one exception which we won't talk about. Won't get distracted. The, the good right, the good news um, this will not be a pandemic. This is not going to spread uh, in your street if you live in the United States or the United Kingdom. There will be some sporadic cases though. I think a few people will go on airplanes and will develop the disease once they're in the uh, in the western countries, but I don't expect them to spread it dramatically. One reason I don't expect them to spread it dramatically. Well, there's quite a few reasons, but one reason is when Fman first gets symptoms, they are infectious but not highly infectious. Then as time goes on, they become more and more and more infectious. But as time goes on, it becomes obvious what's wrong with them. And by the time they die, they're massively highly infectious. And of course, in the West, we don't have a lot of touching funeral rites like they do in in the African situation. So, it's not going to be a pandemic, which is just as well because it's a 30 plus% infection fatality rate. Very dangerous disease indeed. So, I'm afraid that's the good news. That hasn't taken very long at all. So, that's the good news on Ebola.
Uh, the bad news, third largest outbreak so far, although I believe it will be the biggest outbreak sadly so far. There's millions of people moving around due to unrest, border crossings, all sorts of things going on. A lot of uh, military unrest, civil unrest. It's a very troubled part of the world. Someone said it's the worst disease in the worst part of the world. Relatives wash the dead who are highly infectious. So the most infectious people or entities are are the bodies of the dead. So the most infectious time is when someone is very ill or immediately after the person has died. That is the most highly infectious time for this virus. Um, there's many unknown co-cases and many more unknown contacts. So to get on top of a disease, we'd have to know what the cases were. And having knowing what the cases are, we'd have to look after their contacts and quarantine their contacts. Not only do we not know how many cases we are, that those probably thousands of unknown cases have potentially um, many many more thousands of contacts and we simply don't know who these are. So the disease is spreading still unabated to a large extent. High positivity rate. Um, so a lot of the testing that is being done is is very limited, but the people that are being tested um, a high percentage of them, maybe up to 60%, are testing positive, meaning there's a lot of the virus around because anytime we sample it, we tend to find the virus, which is bad, meaning there's a lot of people still uh, incubating it and catching the disease. It's still spreading in the community settings. Um, a disease focus has been allowed to be established. So because of the unrest in the situation, because of the lack of facilities, because it's the uh, Bundibugyo and not the you more usual Zaire strain of the virus, there's now a cluster of people, quite a big cluster. And that cluster is unknown and it's still spreading. It's going to be very hard to close that down. And we have been informed that there's been two cases in Kampala out of the DRC, out of the Democratic Republic of Congo. Couple of cases we believe in in Kampala, Uganda. Now WHO and CDC have warned about neighboring countries as the news continues to be bad. Neighboring countries that are increased risk. The countries that are mentioned are Rwanda, Kenya, Ethiopia, South Sudan, Burundi, United Republic of Tanzania, Republic of Congo, Central African Republic, Zambia and Angola, all at uh, significant increased risks. And of course, places like Kenya, Ethiopia, you've got Nairobi in Kenya, you've got Addis Ababa in uh, in Ethiopia. Um, South Sudan, of course, you've got many centers of very large population and that, that's that's the concern about getting into a Kampala. Um, because it's a large center of population, about 4 million people living pretty close together. Um, the, the, the probability of spread there is really quite significant, unfortunately. Um, and the, the other thing that's kind of bad news in a sense really is non-specific symptoms come first and more diagnostic symptoms later. So when someone first gets ill of this, the symptoms are fairly non-specific. It could be a wide variety of infectious diseases. So um, they get things like fever, fatigue, pains, headaches. Uh, the thing that is diagnostic though is the bloodshot eyes. If that's spotted, bloodshot eyes should be very suspicious. Patient should be isolated if they have bloodshot eyes. The incubation period from what I can gather from people on the ground who have actually looked after patients with Ebola is incubation period is a bit longer than in the books, in the textbook. So probably 2 to 21 days incubation period. So there could still be a lot of people still incubating unfortunately. Uh, so you get these non-specific symptoms to begin with. Then day seven to eight, people can even start feeling a bit better and maybe have something to eat. But then the, the more diagnostic features start on day 9 to 11 with the epistaxis, the nosebleed, emesis, which is vomiting up of blood, melena, uh, diarrhea, blood, blood in the blood in the stools, bloody looking diarrhea, gum bleeds um, and and P per PV bleeding in between menstruation um, is another possibility. These hemorrhagic symptoms make it obvious because it's a hemorrhagic fever, but they present later and of course, by that time, the patient's very ill and they typically die within a couple of weeks, unfortunately, going into shock and hypovolemia. Um, so very often fairly non-specific. Combine that with the very limited amount of tests available and we've got this big sort of nidus of the disease. There's a big collection of people with the disease which is going to make it even harder to stop. So, this is going to get bigger and I, I'm afraid it's going to, I think it's going to be the biggest outbreak there's ever been, potentially killing many, many, many thousands of people locally, potentially tens of thousands, but as I've said, not spreading to be a general pandemic.
The other thing that has been concerning reports from Reuters and Wall Street Journal, patients are being uh, nursed on normal wards in DRC, partly because the symptoms are non-specific, partly because of lack of testing, but largely because of just completely inadequate facilities. That there is no isolation facilities for the number of people. Hospitals and clinics are overcrowded. Isolation capacity is greatly uh, inadequate. Um, some facilities are are full of suspect cases. So we're dealing with very poor conditions here. Um, many hospitals in this area um, I haven't been in hospitals in DRC, but other African hospitals I've been to, the conditions are are remarkably, remarkably challenging and um, we just don't have the, the isolation facilities are simply uh, not available and patients are being managed on another ward, on on wards with other patients, which means spread is likely, for example, through diarrhea, which tends to get everywhere, where um, vomit, blood, body fluids. Yeah, it's uh, it's a bit of a recipe for for spread, unfortunately. Uh, there's also been attacks on treatment centers. More bad news to have been set on fire. The problem here is relatives have been demanding the bodies to carry out their funeral rites. Healthcare workers have refused to give the bodies, rather calling for for burial teams who take appropriate uh um safeguards when dealing with the dead. But it goes against deeply ingrained culture. So people mistrust and uh, attack the hospital facility rather than uh, just say rather than rather than submitting themselves to the authority of people in the area that actually understand it, doctors and nurses and burial teams in the area. So a really unfortunate, unfortunate situation altogether, really. This is me talking. I expect a lot of nosocomial, or that's hospital-acquired infections, because of the very limited PPE. A lot of healthcare workers are going to get this. Some of the burial teams are probably going to get it as well. These people know they're at risk, yet are still working with these patients, which of course makes their activities very noble uh, indeed. They know the risks that they're taking. More, more Um, more bad news, it can be spread by vectors and fomites. So, vectors of course are living things, human beings, for example. Um, and fomites are contaminated items such as pens, stethoscopes, um, surfaces. So the body, the, the virus can get from the body fluids of an infected person onto a surface, onto the hands of someone else, and then that can get into their body, normally through the eyes, nose, and mouth. Um, so this transmission is going to occur there, even although there's not the respiratory transmission that we get with other viruses such as measles or or um, what's that other one called? COVID. That was it. Um, so it's not being transmitted like that, but there has been a lot of deaths, there has been a lot of cases confirmed, and as, as I say, this is the absolute tip of the iceberg, absolute tip of the iceberg.
United States has also imposed travel restrictions, which shows it is being taken seriously from Uganda, Democratic Republic of Congo, and South Sudan. Uh, non-US citizens, including green card holders, who've been in those countries within the previous 21 days, temporarily banned from entering the United States. So people can't get back to work, even though they have residency and work rights in the states. They're still going to be stuck in these countries. US citizens are still allowed to return, but they undergo enhanced screening and are routed through designated airports. So flights have been rerouted to people, places like Washington, Dallas, Atlanta, Houston, where they have the special facilities or or enhanced facilities for screening and uh, isolation if necessary. And of course, the World Cup, 11th of June, is going to be held in Mexico, United States, and Canada. People coming from all over the world. Another opportunity for viral spread of this uh, this Ebola virus, the, the Bundibugyo strain. Unfortunately, although it's unlikely that it's going to get spread via the World Cup because we have these travel bans in place from these high-risk countries. Um, I suspect if the disease spreads to these other countries, like I suspect there could well be cases in Rwanda, Kenya, Ethiopia, South Sudan, Burundi, United Republic of Tanzania, Republic of Congo, Central African Republic, Zambia and Angola. I expect they'll be added to the exclusion list, and I would expect the Mexican and the Canadian authorities to go along with that. Although having said that, lots and lots of people moving around the world, opportunities for all sorts of viral spread. So actually pretty bad news really on Ebola. I'm, I'm afraid I'm expecting this to kill a lot of people locally, but it won't be causing a pandemic.
What do we need to do? Well, we need to get resources into the area. We need to get tests into the area. We need to get medical equipment into the area. We need to get rehydration facilities, intravenous fluids into the area. And also, we need to be open to the possibility of antiviral therapeutics. Now, there are no antiviral therapeutics officially recognized for Bundibugyo strain, but I think we've got a pretty good idea that certain repurposed drugs might be useful, and certain repurposed drugs are remarkably safe to take. Ivermectin, for example, we know it has antiviral properties in some some viruses, and one of the world's safest drugs. I can't prescribe it, but uh, hopefully local doctors will start considering it. Hydroxychloroquine, zinc, and other things that have general antiviral properties should be considered. I've never heard any news reports at all that says they are being considered. Um, but let's hope local nurses and doctors do start considering anything to save the lives of these poor people that are going to be dying in large numbers. And let's hope uh, no financial interests of international agencies become uh, involved. We'll leave it there for now. Bad news on Ebola, good news on Hanta. I suppose you could say good news on Ebola that's not going to be a pandemic, but it is a bad viral situation with a lot of deaths in an already very troubled part of the world. Um, we'll leave it there. Thank you for watching.