CIDRAP: "We Believe There Is Scientific Evidence Ebola Has The Potential To Be Airborne"

When CDC Director Tim Frieden first announced, just a week ago and very erroneously, that he was "confident we will stop Ebola in its tracks here in the United States", he hardly anticipated facing the double humiliation of not only having the first person-to-person transmission of Ebola on US soil taking place within a week, but that said transmission would impact a supposedly protected healthcare worker. He certainly did not anticipate the violent public reaction that would result when, instead of taking blame for another epic CDC blunder, one which made many wonder if last night's Walking Dead season premier was in fact non-fiction, he blamed health workers for "not following protocol."

And yet, while once again casting scapegoating and blame, the CDC sternly refuses to acknowledge something others, and not just tingoil blog sites, are increasingly contemplating as a distinct possibility: namely that Ebola is, contrary to CDC "protocol", in fact airborne. Or as, an article posted by CIDRAP defines it, "aerosolized."

Who is CIDRAP?  "The Center for Infectious Disease Research and Policy (CIDRAP; "SID-wrap") is a global leader in addressing public health preparedness and emerging infectious disease response. Founded in 2001, CIDRAP is part of the Academic Health Center at the University of Minnesota."

The full punchline from the CIDRAP report:

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.

In other words, airborne. And now the search for the next LAKE, i.e., a public company maker of powered air-purifying respirator (PAPR), begins.

Here is the full note: we hope the CDC will take the time to read it.

Health workers need optimal respiratory protection for Ebola

Today's commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago.

Healthcare workers play a very important role in the successful containment of outbreaks of infectious diseases like Ebola. The correct type and level of personal protective equipment (PPE) ensures that healthcare workers remain healthy throughout an outbreak—and with the current rapidly expanding Ebola outbreak in West Africa, it's imperative to favor more conservative measures.

 

The precautionary principle—that any action designed to reduce risk should not await scientific certainty—compels the use of respiratory protection for a pathogen like Ebola virus that has:

• No proven pre- or post-exposure treatment modalities
• A high case-fatality rate
• Unclear modes of transmission

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.¹

The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.

There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids^2,3 and that the only modes of transmission we should be concerned with are those termed "droplet" and "contact."

These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) "direct" contact with the body fluids of an infected person.

This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.

The second line of reasoning is that respirators or other control measures for infectious aerosols cannot be recommended in developing countries because the resources, time, and/or understanding for such measures are lacking.⁴

Although there are some important barriers to the use of respirators, especially PAPRs, in developing countries, healthcare workers everywhere deserve and should be afforded the same best-practice types of protection, regardless of costs and resources. Every healthcare worker is a precious commodity whose well-being ensures everyone is protected.

If we are willing to offer infected US healthcare workers expensive treatments and experimental drugs free of charge when most of the world has no access to them, we wonder why we are unwilling to find the resources to provide appropriate levels of comparatively less expensive respiratory protection to every healthcare worker around the world.

How are infectious diseases transmitted via aerosols?

Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data. In the 1940s and 50s, William F. Wells and other "aerobiologists" employed now significantly out-of-date sampling methods (eg, settling plates) and very blunt analytic approaches (eg, cell culturing) to understand the movement of bacterial aerosols in healthcare and other settings. Their work, though groundbreaking at the time, provides a very incomplete picture.

Early aerobiologists were not able to measure small particles near an infectious person and thus assumed such particles existed only far from the source. They concluded that organisms capable of aerosol transmission (termed "airborne") can only do so at around 3 feet or more from the source. Because they thought that only larger particles would be present near the source, they believed people would be exposed only via large "droplets" on their face, eyes, or nose.

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.^5,6 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,⁷ 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.

It's time to abandon the old paradigm of three mutually exclusive transmission routes for a new one that considers the full range of particle sizes both near and far from a source. In addition, we need to factor in other important features of infectivity, such as the ability of a pathogen to remain viable in air at room temperature and humidity and the likelihood that systemic disease can result from deposition of infectious particles in the respiratory system or their transfer to the gastrointestinal tract.

We recommend using "aerosol transmissible" rather than the outmoded terms "droplet" or "airborne" to describe pathogens that can transmit disease via infectious particles suspended in air.

Is Ebola an aerosol-transmissible disease?

We recently published a commentary on the CIDRAP site discussing whether Middle East respiratory syndrome (MERS) could be an aerosol-transmissible disease, especially in healthcare settings. We drew comparisons with a similar and more well-studied disease, severe acute respiratory syndrome (SARS).

For Ebola and other filoviruses, however, there is much less information and research on disease transmission and survival, especially in healthcare settings.

Being at first skeptical that Ebola virus could be an aerosol-transmissible disease, we are now persuaded by a review of experimental and epidemiologic data that this might be an important feature of disease transmission, particularly in healthcare settings.

What do we know about Ebola transmission?

No one knows for certain how Ebola virus is transmitted from one person to the next. The virus has been found in the saliva, stool, breast milk, semen, and blood of infected persons.^8,9 Studies of transmission in Ebola virus outbreaks have identified activities like caring for an infected person, sharing a bed, funeral activities, and contact with blood or other body fluids to be key risk factors for transmission.^10-12

On the basis of epidemiologic evidence, it has been presumed that Ebola viruses are transmitted by contaminated hands in contact with the mouth or eyes or broken skin or by splashes or sprays of body fluids into these areas. Ebola viruses appear to be capable of initiating infection in a variety of human cell types,^13,14 but the primary portal or portals of entry into susceptible hosts have not been identified.

Some pathogens are limited in the cell type and location they infect. Influenza, for example, is generally restricted to respiratory epithelial cells, which explains why flu is primarily a respiratory infection and is most likely aerosol transmissible. HIV infects T-helper cells in the lymphoid tissues and is primarily a bloodborne pathogen with low probability for transmission via aerosols.

Ebola virus, on the other hand, is a broader-acting and more non-specific pathogen that can impede the proper functioning of macrophages and dendritic cells—immune response cells located throughout the epithelium.^15,16 Epithelial tissues are found throughout the body, including in the respiratory tract. Ebola prevents these cells from carrying out their antiviral functions but does not interfere with the initial inflammatory response, which attracts additional cells to the infection site. The latter contribute to further dissemination of the virus and similar adverse consequences far beyond the initial infection site.

The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out by the observed risk factors or our knowledge of the infection process. Many body fluids, such as vomit, diarrhea, blood, and saliva, are capable of creating inhalable aerosol particles in the immediate vicinity of an infected person. Cough was identified among some cases in a 1995 outbreak in Kikwit, Democratic Republic of the Congo,¹¹ and coughs are known to emit viruses in respirable particles.¹⁷ The act of vomiting produces an aerosol and has been implicated in airborne transmission of gastrointestinal viruses.^18,19 Regarding diarrhea, even when contained by toilets, toilet flushing emits a pathogen-laden aerosol that disperses in the air.^20-22

Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces.²³ Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively.²³

In still air, 3-mcm particles can take up to an hour to settle. With air currents, these and smaller particles can be transported considerable distances before they are deposited on a surface.

There is also some experimental evidence that Ebola and other filoviruses can be transmitted by the aerosol route. Jaax et al²⁴ reported the unexpected death of two rhesus monkeys housed approximately 3 meters from monkeys infected with Ebola virus, concluding that respiratory or eye exposure to aerosols was the only possible explanation.

Zaire Ebola viruses have also been transmitted in the absence of direct contact among pigs²⁵ and from pigs to non-human primates,²⁶ which experienced lung involvement in infection. Persons with no known direct contact with Ebola virus disease patients or their bodily fluids have become infected.¹²

Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity.²⁷ However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols.^25-27

Altogether, these epidemiologic and experimental data offer enough evidence to suggest that Ebola and other filoviruses may be opportunistic with respect to aerosol transmission.²⁸ That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.

Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)

Facemasks, however, do not offer protection against inhalation of small infectious aerosols, because they lack adequate filters and do not fit tightly against the face.¹ Therefore, a higher level of protection is necessary.

Which respirator to wear?

As described in our earlier CIDRAP commentary, we can use a Canadian control-banding approach to select the most appropriate respirator for exposures to Ebola in healthcare settings.²⁹ (See this document for a detailed description of the Canadian control banding approach and the data used to select respirators in our examples below.)

The control banding method involves the following steps:

1. Identify the organism's risk group (1 to 4). Risk group reflects the toxicity of an organism, including the degree and type of disease and whether treatments are available. Ebola is in risk group 4, the most toxic organisms, because it can cause serious human or animal disease, is easily transmitted, directly or indirectly, and currently has no effective treatments or preventive measures.
2. Identify the generation rate. The rate of aerosol generation reflects the number of particles created per time (eg, particles per second). Some processes, such as coughing, create more aerosols than others, like normal breathing. Some processes, like intubation and toilet flushing, can rapidly generate very large quantities of aerosols. The control banding approach assigns a qualitative rank ranging from low (1) to high (4) (eg, normal breathing without coughing has a rank of 1).
3. Identify the level of control. Removing contaminated air and replacing it with clean air, as accomplished with a ventilation system, is effective for lowering the overall concentration of infectious aerosol particles in a space, although it may not be effective at lowering concentration in the immediate vicinity of a source. The number of air changes per hour (ACH) reflects the rate of air removal and replacement. This is a useful variable, because it is relatively easy to measure and, for hospitals, reflects building code requirements for different types of rooms. Again, a qualitative ranking is used to reflect low (1) versus high (4) ACH. Even if the true ventilation rate is not known, the examples can be used to select an appropriate air exchange rate.
4. Identify the respirator assigned protection factor. Respirators are designated by their "class," each of which has an assigned protection factor (APF) that reflects the degree of protection. The APF represents the outside, environmental concentration divided by the inside, facepiece concentration. An APF of 10 means that the outside concentration of a particular contaminant will be 10 times greater than that inside the respirator. If the concentration outside the respirator is very high, an assigned protection factor of 10 may not prevent the wearer from inhaling an infective dose of a highly toxic organism.

Practical examples

Two examples follow. These assume that infectious aerosols are generated only during vomiting, diarrhea, coughing, sneezing, or similar high-energy emissions such as some medical procedures. It is possible that Ebola virus may be shed as an aerosol in other manners not considered.

Caring for a patient in the early stages of disease (no bleeding, vomiting, diarrhea, coughing, sneezing, etc). In this case, the generation rate is 1. For any level of control (less than 3 to more than 12 ACH), the control banding wheel indicates a respirator protection level of 1 (APF of 10), which corresponds to an air purifying (negative pressure) half-facepiece respirator such as an N95 filtering facepiece respirator. This type of respirator requires fit testing.

Caring for a patient in the later stages of disease (bleeding, vomiting, diarrhea, etc). If we assume the highest generation rate (4) and a standard patient room (control level = 2, 3-6 ACH), a respirator with an APF of at least 50 is needed. In the United States, this would be equivalent to either a full-facepiece air-purifying (negative-pressure) respirator or a half-facepiece PAPR (positive pressure), but standards differ in other countries. Fit testing is required for these types of respirators.

The control level (room ventilation) can have a big effect on respirator selection. For the same patient housed in a negative-pressure airborne infection isolation room (6-12 ACH), a respirator with an assigned protection factor of 25 is required. This would correspond in the United States to a PAPR with a loose-fitting facepiece or with a helmet or hood. This type of respirator does not need fit testing.

Implications for protecting health workers in Africa

Healthcare workers have experienced very high rates of morbidity and mortality in the past and current Ebola virus outbreaks. A facemask, or surgical mask, offers no or very minimal protection from infectious aerosol particles. As our examples illustrate, for a risk group 4 organism like Ebola, the minimum level of protection should be an N95 filtering facepiece respirator.

This type of respirator, however, would only be appropriate only when the likelihood of aerosol exposure is very low. For healthcare workers caring for many patients in an epidemic situation, this type of respirator may not provide an adequate level of protection.

For a risk group 4 organism, any activity that has the potential for aerosolizing liquid body fluids, such as medical or disinfection procedures, should be avoided, if possible. Our risk assessment indicates that a PAPR with a full facepiece (APF = 50) or a hood or helmet (APF = 25) would be a better choice for patient care during epidemic conditions.

We recognize that PAPRs present some logistical and infection-control problems. Batteries require frequent charging (which requires a reliable source of electricity), and the entire ensemble requires careful handling and disinfection between uses. A PAPR is also more expensive to buy and maintain than other types of respirators.

On the other hand, a PAPR with a loose-fitting facepiece (hood or helmet) does not require fit testing. Wearing this type of respirator minimizes the need for other types of PPE, such as head coverings and goggles. And, most important, it is much more comfortable to wear than a negative-pressure respirator like an N95, especially in hot environments.

A recent report from a Medecins Sans Frontieres healthcare worker in Sierra Leone³⁰ notes that healthcare workers cannot tolerate the required PPE for more than 40 minutes. Exiting the workplace every 40 minutes requires removal and disinfection or disposal (burning) of all PPE. A PAPR would allow much longer work periods, use less PPE, require fewer doffing episodes, generate less infectious waste, and be more protective. In the long run, we suspect this type of protection could also be less expensive.

Adequate protection is essential

To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:

• Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
• All sizes of aerosol particles are easily inhaled both near to and far from the patient.
• 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.
• Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
• Experimental data support aerosols as a mode of disease transmission in non-human primates.

Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.

Acknowledgements

We thank Kathleen Harriman, PhD, MPH, RN, Chief, Vaccine Preventable Diseases Epidemiology Section, Immunization Branch, California Department of Public Health, and Nicole Vars McCullough, PhD, CIH, Manager, Global Technical Services, Personal Safety Division, 3M Company, for their input and review.

References

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2. CDC. Ebola hemorrhagic fever: transmission. 2014 Aug 13 [Full text]
3. ECDC. Outbreak of Ebola virus disease in West Africa: third update, 1 August 2014. Stockholm: ECDC 2014 Aug 1 [Full text]
4. Martin-Moreno JM, Llinas G, Hernandez JM. Is respiratory protection appropriate in the Ebola response? Lancet 2014 Sep 6;384(9946):856 [Full text]
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6. Chao CYH, Wan MP, Morawska L, et al. Characterization of expiration air jets and droplet size distributions immediately at the mouth opening. J Aerosol Sci 2009 Feb;40(2):122-33 [Abstract]
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8. Bauchsch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis 2007;196:S142-7 [Full text]
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Comments

[dojufitz]

When do the jihadis contract the virus and start spreading it where it can do the most damage?

[tony wilson]

do you mean the cia jihadis of isis.

israel secret intel service.

the ebola has a dose patent and a bill gates vaccine cure patent.

shit kicker the cowboys and the rabbi already have this shit covered

[ZippyBananaPants]

Soylent Green is people!

[gwar5]

And.... we told them so!

[DipshitMiddleCl...]

LONG FEMA PLASTIC COFFINS

[CosmicDebris]

http://www.cnn.com/2014/10/13/health/ebola-nurse-how-could-this-happen/i...

Big media still not uttering the "A" word as a possibility. Cowards.

[Cabal Watch]

Is nobody even slightly concerned that now at least a couple of people infected with ebola have been crapping and puking into the Dallas sewer system? Surely there are all manner of critters down there, some of which would likely be carriers of the disease.

[Infinite QE]

Most people care about nothing and assume someone "official" is taking care of it all. In other words, it's fecked.

[SquirrelButtDan]

Wastewater is treated with sodium hypochlorite (aka bleach) before releasing to a body of water. 

[Cabal Watch]

Discovered this after posting:

http://thewatchers.us/book/ebola-in-america.html

Dunno ... definitely an interesting read. Seems to claim some waste water is treated with bacteria (which viruses can insert themselves into).

You might be right about the bleach for water being released into a larger body of water, but what about the solid waste being used for crops?

[SquirrelButtDan]

No, solid wastes are not used for crops at least in my city; it's taken to a landfill. And bacteriophages are the only viruses that can infect bacteria--not Ebola that infects animal cells.

[seek]

Not to mention the toilet is filled with water that typically is ~ 4 ppm free chlorine.

I won't drink tapwater without filtering/processing, but god knows chlorinated tap water and sanitary sewer systems have probably saved more lives in the past 100 years than any other invention of man.

[SquirrelButtDan]

I hear ya. It's a facinating process to treat waste water and turn it into something that can potentially be drinking water.

[q99x2]

I want a blue and yellow Nike protective suit

[q99x2]

That's ok ebola couldn't live in the bus I ride on.

[Kyddyl]

  We may also need to consider infection via insect vectors like houseflies landing on infected fluids and then vectoring the viral particles hither and yon, either landing on the uninfected or on surfaces.

[AgentScruffy]

From the research I've read, it can stay alive on room temperature surfaces for up to 90 minutes.
Counterintuitively, turns out it stays alive much longer on surfaces in cold climates (from 2-3 weeks).

[Dude-dude]

This is deflationary

[Grams Gold]

Of course the nurse caught it, because they aren't following the CDC's protocols for Biosafety Hazard 4, the most dangerous microbe, of which Ebola is. There are only several authorized locations to safely handle the virus. 

http://www.gramsgold.com/news/only-these-4-hospitals-are-truly-equipped-...

Just read the CDC website. It tells how to handle Ebola, which the CDC website states is more dangerous than the Bubonic Plague. All others are putting their staff at risk, as they don't have the decontamination rooms and other equipment to handle Ebola. 

[lakecity55]

Bingo.

It is a Level 4 Pathogen.

Full 'space suit,' external air supply or full scuba respirator. Passive respirators are OK if the filter is capable of stopping the size of the pathogen.

To wit: if this really is "ebola," and there are a number of strains, this type may be highly capable of existing intact for long distances before  it destructs. We do not know that yet. We may never know.

If I were in the US, I would begin preparations for isolation. Find the best gear and hold on. You won't get it if you do not panic, imo, but if there are more patients, you will have to take immediate steps.

The CDC is either incompetent or is lying. Those are the only two possibilities.

[Kprime]

welllll, actually, there is a third possibility.

They are both incompetent and lying. 

Thaaaat sums it up right there.

[lakecity55]

Yes!

[AgentScruffy]

Exactly. You need air-locked chambers, full spray decontamination (not friggin' clorox wipes as one hospital bragged they had for post-contact decontamination), full 'space suits.' http://en.wikipedia.org/wiki/Biosafety_level#Biosafety_level_4

Observe all the news photos of "prepared" hospital workers and clean-up crews in garb: they are all wearing different garb. Some have just a surgical mask with googles, some have a "welder's shield" (open at the sides and bottom), and a very few have sealed respirator gear.

[Popsicle .]

U.S. needs to rethink Ebola infection controls, says CDC chief

Looks like Frieden pissed off the nurses association

Frieden also apologized for remarks on Sunday, when the nurse's infection was first disclosed, that suggested she was responsible for a breach in protocols that exposed her to the virus. Some healthcare experts said the comments failed to address deep gaps in training hospital staff to deal with Ebola. [ID:nL2N0S8014]

"I'm sorry if that was the impression given," Frieden said. He said the agency would take steps to increase the awareness of Ebola at the nation's hospitals and training for staff.

The Texas Nurses Association defended Pham in a statement, saying it was wrong to assume the nurse was to blame.

SO the head of the CDC didnt feel that high level of awareness was nessasary, until he pissed off the nurses Association ? Does he even know anything about Ebola? Or any version of it for that matter? Hell I learned how deadly Ebola was when I was 18 in a movie for fucks sake!

http://www.reuters.com/article/2014/10/13/us-health-ebola-idUSKCN0I21M02...

[astitchintime]

Have not waded through the comments yet < over 400 - 500 IIRC > but just had to directly comment ....

Tylers, please quit with the sensationalist journalism ... it is destroying y'alls credibility.

Follow it through to its logical conclusion.

Just say'n ......

EDIT:  9 pages so far of comments versus me reading them ... nah, not so much!  I think sleep is a better choice at this point in time  ;)

EDIT2:  Y'all take good care of yourselves and yours ... get some sleep, seriously.  It is the single-most BEST thing y'all can do, given the circumstances.

[NOTfromSanFrancisco]

I am not sure what your motive is in calling this "sensationalist journalism". This was a well written, well referenced and documented article.

The intention of the article is to give discerning minds something to consider without being emotional and sensationalist about it, as you put it.

The Tylers do not need me to defend their articles. They do just fine without me, but I am tired of reading snippets like yours where you make empty comments and ignorant accusations without any reasonable assertions or arguments.

Perhaps you were hoping to gain a little attention, because you sure did not gain any credibility with your comment.

Jus' sayin'...

[Supernova Born]

If anyone destroyed credibility when it was most needed it is that POS Friedan and his already discredited and dangerous lies.

[IridiumRebel]

So an academic think tank that publishes a well thought and well researched paper upon the possibility of aerosolized particulated pathogens from a Level four microbial badass with 30 refernces cited by a collective hundred plus years field research and it sensationalist?
I suggest Yahoo. Let the adults have a conversation here. You are unneeded.

[css1971]

They quote from several scientific papers which directly contradict current government policy. It isn't remotely sensationalist.

[holdbuysell]

The CDC is very close to losing credibility. They'd better step up, for if others do their job for them and are deemed credible, the CDC will effectively be fired by public opinion.

That's not a good place to be.

Step up CDC. Speak straight or you lose your status. Tell econo-politics to pound sand.

[Supernova Born]

Frieden has no credibility.

A mayor Bloomberg appointee in NYC. A grandstanding, showboating douchebag has now brought Ebola to the US and infected health care professionals via HIS incompetence while daring to blame THEM.

This POS needs to get the boot RFN.

[847328_3527]

Denmark Moves to Ban Animal Sex Due to Rise in Bestiality Tourism

Banning sex with animals seems like a pretty obvious move in any civilized society, but it took a rise in bestiality tourism for Denmark to make a move.

Norway, Sweden and Germany have outlawed bestiality in the past three years, which has led to an increase in underground animal sex tourism in Denmark, according to The Independent.

http://mashable.com/2014/10/13/denmark-bestiality-tourism/

A new method of catching diseases!

[OhNo]

Go to VICE- youtube. Great 20min vid on donkey love.The young guy says he's got heaps of girlfriends, Yeah says his friend there all Donkeys. Oh one more - Difference between donkey and woman- donkey carnt suck cock.

[pupdog1]

CINC Obola learned, while on the golf course, that Ebola had become airborne.

His response? 700 of the 4000 troops doomed to Africe will be from the Army's legendary 101st Airborne Division.

Treason.

I say send the 535 motherfuckers from Congress who are enabling this with their silence.

[Sid James]

If the Russians sent 4000 of their best troops on a suicide mission you might speculate that it was to prevent them from attempting a coup d'etat...

Just sayin.....

[Rootin' for Putin]

So, the people who know best didnt know jack shit again.

Color me not surprised at all.

[lakecity55]

What were you promised, Bath House, to kill millions of people?

Just curious.

[Dublinmick]

And maybe it is all bullshit.

http://jimstonefreelance.com/ebolie.html

[Kprime]

whaaat?  CCrap doesn't know how it might be spread?  Obola the queen will save us!

[spqrusa]

Having worked often with level 2 and level 3 pathogens during the '90s, we were all keenly aware of the hazard of Ebola as a level 4 pathogen. We knew back then that Ebola lacks the spiky structure necessary to make it "airborne" in the classic sense but we already knew that it spread easily from sputum, aerosolized sputum (sneezing) and bodily fluid contact to immunologically exposed areas on your body (nose, mouth, eyes, exposed cuts, exposed follicles, etc...). We also knew that some patients exhibited longer incubation and infectious periods. These patients were particularly dangerous to the spread of the disease. It is not hard to imaging a new Ebola with a longer sustained incubation period. That the CDC and Obola is ignoring these basic scientific truths would make me think they want to have a new crisis. "Never let a crisis go to waste..."

[smacker]

Whatever the knowledge was of Ebola in the 90s, it is known to be mutating, which usually means finding ways around the measures being taken to control/eradicate it.

IMHO this means it can easily now not just be "aerosolized" but actually "airborne" and spreading itself in water vapour in the air we breath.

This is the nightmare scenario.

Go long on top-dog respirator manufacturers.

[q99x2]

Print the paper BTFPAPR

[AgentScruffy]

Personal flamethrowers, bitchez.

[mccvilb]

Ebola virus possibly airborne in aerosol form? It's a blood pathogen isn't it? Forget sneezing, I guess the brainiacs at the CDC have never heard of mosquitoes.

[joego1]

Translation- Ebola really really mean shit go to defcon 10 for all government personal all others go to sheeple con 1.

[talisman]

To think about:
  
low cost weaponization possibility of Ebola

Terrorist organization recruits small group of suicide guerilla terrorist operatives with one cell situated in the target country.  One of the suicide operatives then deliberately contracts ebola, and before becoming symptomatic immediately travels to join the pre-positioned cell group. The infected operative then infects the remainder of then cell group who then-as soon as their contracted disease becomes virulently transmissible- go out into the target country's general population to deliberately disseminate and transmit ebola as widely as possible before the disease brings them to a halt.

[fredquimby]

I tweeted this on Sept 23rd.

Sir Fred Quimby ‏@FredQuimby123 Sep 23

"To summarize, we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection"

and

Sir Fred Quimby @FredQuimby123  ·  Sep 23

Previous quote came from here:  http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola …

Do keep up Tyler ;)

#PAPR #N95 #N100 #preppertalk

[Sid James]

Isn't that Fred Quimby, the creator of Tom and Jerry cartoons?

[Supernova Born]

Ebola patient just died in Germany per Bloomberg.

Tip of the iceberg.

It's serious. They are lying. Frieden first and foremost.

If they can just silence the nurses they can get this genuine, literal shitstorm to hit the fan just after the November election.

[css1971]

If through the knowing spread of misinformation the leadership of the CDC caused or allowed even one person to die. Wouldn't they be guilty at a minimum of manslaughter?

[russwinter]

I have to admit I was being sucked in on this Ebola hoax.  It is a good one.  I do think they have a larger plan, no fucking way I get vaccinated or taken away anywhere.   This has a very Stalinist feel to it. 

Ricoman nails it it, you have hear this spoof to the end:
https://www.youtube.com/watch?v=aN31E-O89UY

[Thomas the Crane]

Perhaps, Ebola (as with other viruses) transmits on a frequency range . . . 

[Sid James]

And if you live in an apartment block, watch out for this:

"Inadequate plumbing is likely to have been a contributor to the spread of SARS in residential buildings in Hong Kong, the World Health Organization concluded  in 2003. The outbreak resulted in 321 people infected with SARS and 65 deaths." 

http://www.who.int/mediacentre/news/releases/2003/pr70/en/
 
In other words, when that diarrhea and vomit is flushed down the toilet, the virus particles can spread throughout the entire waste water system in a block carried by the aerosol particles and warm vapour created by mixing human waste with hot water.

Oh shit indeed.

[smacker]

Sounds disgusting.

The real scary thing is when a blockage occurs and you find the neighbours waste sewage backs up into your own WC. At that point you know he ate a vindaloo the previous night!

[Last of the Mid...]

Shhhhh, captain obvious, we're trying to keep this on the down low, you know what i'm sayin?

[kenezen]

have we checked to see how many transfer programs in our Colleges have allowance from these countries.

My understanding is they are many!  have we tested these students?  If you are a parent with children or know a friend with children in college Especially large universities please have them check. You will probably find a significant amount that have these programs of transfer!

THINK OF OUR CHILDREN AND DEMAND FEDERAL AND STATE GOVERNMENTS CHECK THIS IMMEDIATELY! PHONE YOUR FRIENDS AND TELL THEM!!

[Peter Pan]

It is a horrible thing to say, but the hundreds of thousands of innocent lives taken in Iraq, Afghanistan and elsewhere by needless US interference may well be matched by a similar number of innocent lives in the US by the hand of Ebola.

If this is Karma, we had all better take care.

[Hurdy Gurdy Man]

Listen, I know this is a little late.  But let's not say "in other words, airborne."  

There are 3 classes of droplets:

HEAVY: DROPLET

MEDIUM: AEROSOLIZED - which just means "in the act of flying through the air usually due to gravity (drip from a bat-corpse in a tree to a live animal's mouth below, for example) or a sneeze

LIGHT: AIRBORNE - like weaponized anthrax, can float in subtle air currents after a room is empty, floating around like a drone until someone inhales it just for being in the same room.

Droplet and Aerosolized are similar: Aerosolized just means a drop with some velocity. Yes it can enter the airway, and has been proven to, but nobody has proven Airborne Ebola exists.