Regular commentor LAMH36 has volunteered to help us out:
So, with all this talk of Ebola and health care workers, of which I have been one for the past 10+ years, I would be willing to answer serious questions from commenters in the comments section to the best of my knowledge as an active Microbiology Medical Laboratory Scientist.
So, what many already know, I’m originally from New Orleans, so I began my career working in the state run public health laboratory. My primary work at the public health lab was in Bacteriology, including work involving many of the Bioterrorism organism most people know and some they don’t, but also regular old outbreak-y bugs like Salmomella, E.coli, Pertussis, etc.
Thanks to Katrina I evacuated to DFW and I ended up living and working there for 7 years. I worked for 6 years at a large public teaching hospital in Microbiology and 2 years (one of which concurrently) at a small private hospital that I believe I’ve mentioned is a sister hospital to Presby Dallas.
After close to 8 years I finally made it home back to NOLA, or rather to Baton Rouge, where I worked at a large private Catholic hospital, until this past February when I was finally able to make my way back to New Orleans where I now work at another large public teaching hospital which is soon to be to part of an even larger for property entity, yet still “public” here in NOLA.
All of my experience is in Microbiology with a little bit of Biological research thrown in and some other colorful careers from my college years.
I figured when you have experienced knowledge about some subject, it always better to help spread factual information rather than allow misinformation to become embedded in the psyche.
Any questions I cannot answer or that is outside my purview of knowledge, I can ask some of my other friends who are currently working in the hospital laboratory, CDC and beyond.
Any questions?
Hawes
Is it true you can get Ebola by voting for Republicans? And is there any way to get that onto NewsMax?
Specifically, that Obama weaponized Ebola to only attack white people over the age of 65?
GHayduke (formerly lojasmo)
How contageous is ebola?
I understand it has approximately a 50% fatality rate when contracted (in African nations) what do we suspect the fatality rate with full and modern (US, or other developed nations) medical support?
chopper
what is the bare minimum in terms of lab and personal protective equipment necessary when working with ebola samples such as blood or other bodily fluids? i know what goes into a BSL-4 lab environment, but i’m not sure they go anywhere near that far in any hospital lab that may be working with a patient’s blood etc.
mikefromArlington
How rediculous is this? http://www.arlnow.com/2014/10/20/acfd-vhc-refused-ebola-patient/
Best part of the story is this…
“The tipster also claims hospital administration worried it would lose business if it came to be seen as an “Ebola hospital.””
Lol
lamh36
Evening folks.
This morning when I got into work and checked my email, I noticed a new in-service on Ebola. The hospital sent out a shit load of information on Ebola included a required online assignment with the hospital’s internal policy on Ebola Preparedness.
I’m calling it the “Let’s Not Be Like Dallas” CYA plan.
So it just so happens I have a lot of information at my disposal right now.
All recommended by CDC, from what to do when a patient enters the ER/Clinic, down to waste disposal.
So ask away.
Oh and it doesn’t have to be Ebola related. As I’ve said before, there a lot of bugs that are more commonly infectious to us all than Ebola.
peggy
How is the test for Ebola done? How much blood is required? How long to perform the test? Hours or days?
How difficult is the test? Could any major hospital do it or need they send off the sample?
chopper
@Hawes:
you have to work ISIS in there if you want your headline on the marquee.
Chris
Two questions:
1. Not exactly up your alley, since this is a Virology question, maybe your CDC buddies know if you don’t, but what about Nina Pham’s poor dog, Bentley? Is it possible for a canine to get (or at least carry) ebola? Obviously it can pass to animals because fruit bats are the primary vector for Ebola… but what about doggies? I hope that little guy is OK.
2. More up your alley, but sort of open-ended… how terrified are you and your colleagues of MRSA and other anti-biotic resistant bugs? Do you think we will soon going to be living in a post-antibiotic world, where people die from infections that would have been treatable today or ten years ago? Does it enrage you and you colleagues that feed animals are pumped full of prophylactic antibiotics that may contribute to the growth of resistant strains of bacteria?
Thanks!
wmd
Could you comment on these two peer reviewed studies
Aerosol transmission from pigs to non human primates (Note this is Zaire Ebola, not Reston).
and
No aerosol transmission from non human primate to non human primate
In particular has there been an attempt to duplicate the swine transmission of Zaire Ebola to NHP, using stronger controls against possible cross contamination?
lamh36
@GHayduke (formerly lojasmo):
Ok, bottom line, Ebola is definitely deadly; but the risk in U.S. is low, because we have all the available supplies needed to contain the disease.
Now in West Africa, its is already considered the largest outbreak in history. The last I read, the total cases were upwards of 8400 and climbing, and the toal deaths were about 4033 and upwards. The mortality rate is just about below 50% (last numbers I read were 48%)
Basically in Africa, it has become widespread due to a lack of medical supplies and equipment.
Brother Dingaling
Can Drew Brees be cured?
Baud
@lamh36:
In that case, what virus from the depths of hell has infected our Saints?
Chris
@mikefromArlington: I am also from Arlington… I’m really impressed that ARLNow was able to put together an moderately cohesive piece of reporting. Usually it’s just a mouthpiece for upper class NIMBYers in North Arlington who don’t like us hippies south of Route 29 that like transit and sidewalks.
Violet
Hi, lamh! Thanks for doing this! Wanted to make sure suzanne‘s questions got in the thread. She isn’t able to be here tonight but wondered about building design:
lamh36
@chopper: @chopper:
Ok, I believe I’ve said before that the majority of hospital labs have at least a BS2 hood. These hoods are able to be used to manipulate and handle infectious materials on a daily basis. Usually you use just “standard” PPE. That means a gown and gloves. The hood have a shield, so there is no need for a mask.
In patient rooms, there are isolation room specifically designed for TB are airborne isolation. In those cases, you have standard PPE, but you also are required to wear a specialized mask (N95, I think) along with standard PPE.
In the case of Ebola, you get the patient into an isolation room and you are required to have standard, contact and airborne PPE. Standard: gown, gloves, face mask, basically you want every bit of exposed flesh/skin to be covered when working with an Ebola patient.
Airborne isolation is required especially if patient in undergong ANY aerosilizing respiratory treatments (intubation, suctioning, etc).
When you are donning PPE, you MUST HAVE A 2ND PERSON OBSERVE YOU PUTTING ON AND TAKING OFF PPE. That’s the buddy system, in effect.
In the case of Ebola,
scav
Two questions, or rather consistent areas of uncertainty that come up when dealing with panicky people involve a) the “airborne / sneezy” issue and b) the increasing contagious / Interferon thingy. I think I understand them, but I’m nowhere comfortable with them enough to be able to explain them. What is it about the little virus beasts that allows some types to stay in the floating microdroplets but others not to? Or have I really misunderstood the mechanism and it’s something else about viability?
for a longer term issue fishing question, I’d love to know if there is any large scale predictive planning disease diffusion models being built based on usual patterns of traffic. Something like the predictive models they build for likely contaminant spills, toxic releases.
We should be nearly at the stage where we’ve enough data to build baseline models and run scenarios for likely entry points and disease types. But this is likely to be entirely early stages, and nowhere near your area of expertise, although possibly handy for targeting surveillance efforts. So, this last should be written in hopeful, yet grey deal with me later only if you get bored or feel kind, font.
Mnemosyne
@mikefromArlington:
I thought this part was fascinating:
ulee
It was http://www.youtube.com/watch?feature=player_detailpage&v=OMy8GzeHBGkbetter in 1973.
aimai
No questions but I just thought I’d say how much I appreciate all of your comments, Lamh, and the occasional links to family pictures. You are definitely one of the highlights among the commenters here and I always enjoy the things you say.
Violet
This is really cool. It’s like a Balloon Juice AMA!
Wondered about the Dallas hospital’s accusations regarding improper handling of the sample. Something about how it wasn’t secured properly as it went through the tube system.
Are there specific precautions for specimen handling for something like Ebola?
lamh36
@peggy:
In the hospital lab, there is not going to be any “Ebola testing”, but what you are doing is testing to rule out other possible diseases than Ebola symptoms mimic.
the primary specimen is blood. The testing done in the lab is gonna consist of a CBC, Malaria, HIV, and platelet counts.
If the testing rules out other non HFV diseases, the blood is then prepared for shipment to state Public Health labs or directly to CDC.
The testing can be done as POC (Point of Care, which is the bed side), but the specimen must be forwarded to CDC and that is done by the lab.
There is no “quick” Ebola test available for most hospitals, that I know of
lamh36
@wmd: the only thing I can tell you is what the CDC is now advising hospitals.
That what we know now is the Ebola isn’t airborne and as of now we are being told that it’s only transmitted from human to non-human primates
Felanius Kootea
The hospital in Dallas got dinged for allowing the index patient’s sample to be put through the system with all other samples. Why was this an issue? Aren’t blood samples handled cautiously anyway? Just want to understand more about that. Do lab personnel have the same risk of contracting Ebola as the nurses or doctors treating the patient or was the panic about the employee who went on a cruise an overreaction?
kc
Thanks, LAM36! It’s great to hear from someone with access to the most current info.
I understand that Ebola is transmitted through contact with infected body fluids. I have two questions:
1) Can the Ebola virus can penetrate intact, healthy skin or does it have to come in contact with a cut, scrape, etc?
2) How long does the Ebola virus live on surfaces outside the human body?
wmd
@lamh36: Hospital labs aren’t equipped to do PCR? Or is the problem with not having sequencing equipment?
Elie
Thanks for doing this lamh36!
Do you know what the length of time required to get an Ebola test result back? I think its at least 24 hrs for the first test and another 24 hours for the confirmation — or more. Aren’t there a number of tests including those that assess the viral “load” of the patient? Can you give us some info on that? Some parts of the testing sound similar to that done for HIV which also calculates a “viral load”
Thanks!
RepubAnon
Two questions:
1) In the hospitals where you work, are there adequate supplies of personal protective equipment (PPE) for health care workers exposed to contagious diseases?
2) Have you noticed hospitals cutting back on preparedness as a cost-saving measure?
Damned at Random
Not a microbiology question or ebola specific, but I noticed PCR is the “gold standard” for ebola diagnosis. I still think of PCR as a research tool. Is it something you would find in a large hospital or commercial reference lab nowadays?
JPL
Thanks lamb. It seems that you have plenty of questions to answer so I’m not going to add to the list, but instead read your answers.
BAtFFP
1) what’s the survival time outside the human body? How long can it live on surfaces?
2) was Louisiana’s decision to reject Mr. Duncan’s incinerated belongings — even though they were going to a hazmat waste facility, and even though they had been incinerated — profoundly stupid or merely incredibly stupid?
ETA: kc got there first, dammit.
lamh36
@Chris:
The Virology question isn’t really in my wheel house, but I can answer your second question.
I am not “terrified” per se, but we are required to notify our Infection Control department about any INPATIENT, who we have isolated MRSA, VRE (Vancomycin Resistant Enterococcus), or MDRO (Multi-Drug Resistant Org). Firstly, because the spread of these bugs, can be prevented by something as simple as proper hand-hygiene, i.e. washing hands between patients. “Clean ” hands prevents alot of nocosomial infections (hospital-acquired infections).
As for MDRO, what most hospitals try to do is limit the actualy antibiotic susceptibilities they release to physicians as appropriate to use for a particular bug. In other words, we want to minimize the mutations of resistant bugs, so we tell the doctors, the minimum antibiotics to be used for any particular bug, and we try our best to not release what’s called “broad spectrum” antibiotics, which can be used to just about “kill” any bug including normal flora.
We are not yet at the point where people will die from previously “curable” pathogens, but it’s imperative that physicians and clinicians NOT overly drug a pathogenic bug just to appease a patient. It’s ups to them guide the patients correctly.
But there are still some doctors who like to just through antibiotics at any infection,
lamh36
@Baud:
I have no idea, but it seems like a case of “we can’t win shit”-ITIS!
Jay C
OK: first, thanks to lamh for this BJ Ebola conference!
Two questions: first: leaving the hysteria of the hair-on-fire media panic-mongers aside, is there any serious danger of belated transmission/infection beyond the “standard” 21-day quarantine period? Something I read this morning said that 98% of suspected Ebola infections prove out (one way or another) within that 21-day timeframe, but is there a possibility that among that 2%, a “cleared” patient might still develop Ebola symptoms, and thus, become infectious, after the 21 days have passed (and said patient presumably going back home, to work, school, etc).??
Secondly: do we know exactly what went wrong at the Dallas hospital that two nurses got Ebola from nursing the late Mr. Duncan??
Pogonip
@Chris: I’d also like to know about the likelihood of a post-antibiotic world. Also, a few days ago Ian Welsh said pigs could transmit aerolsolized Ebola; several people wrote in and said that was wrong. Do you have the straight poop on pigs?
lamh36
@Violet:
I did see her question last night, and I’ll admit, I can’t really give too much info on the building themselves, but I can say how the majority of the labs I’ve worked in are designed.
I do know that airborne isolation rooms in the micro lab are primarily used in the Mycobacteriology (i.e. TB/AFB) lab. The room is designed with negative pressure ventilation. So that air goes in, but it does not go out when the room is completely sealed off (i.e. all doors closed). Some of these rooms also have “anterooms” which is usally a small room in between the main parts of the lab, and the actual TB lab. The anteroom has two doors, one leading into the TB room, the other leading into the main lab room. For proper negative pressure to occur, both anterooms shoudl be closed a majority of the time (i.e. going in and out, but never having doors proped open) or the AFB room isn’t “technically” negative pressure.
The TB labs are also equipped with BS2 hood, that circulates air from outside the hood into the hood and releases it through an exhaust above the hood, where the air is “filtered” out and released. The BS2 Hood in AFB shouldn’t blow air back into the room as long as the doors are closed and there is room underneath the hood for the air to circulate.
Chris
@lamh36: Thanks for the reply! That makes sense, target your antibiotics, use the broad-spectrum stuff as a last resort. It’s also heartening that the spread of most of these can be prevented by observing good hygiene.
I have had a doc like you mentioned at the end, that throws antibiotics at everything. I had a nasty bout of something a few years ago, and after visiting my doctor she literally said “I think you have a viral infection, it should go away in a few days, come back if it doesn’t. Here, I’m prescribing you a Z-Pack.”
Maybe she suspected I might have had a bacterial infection but wasn’t sure, in which case I’m not sure why she didn’t just say that. Maybe she was trying to prevent me getting a bacterial infection because my immune system was busy fighting the virus? Either way, I’m pretty sure she just threw some Azithromycin at me so that I would feel like I was taking something that’ll make me feel better.
scav
Thought of a longer term useful question. Could some of you with qualifications provide links to solid sources of information that you trust? I know about the MMWR because of a medgeo colleague with a thing for Hanta and then there’s the CDC but after that it’s just google and gut-reactions about the site quality. Thanks.
Pogonip
And a round of applause for Lamh36!
MomSense
I’m late to the thread so my questions have been asked and answered ably by Lamh36. Thank you so much for doing this.
Violet
@lamh36: Thanks for answering! Do you know how often the vent hoods and other essential equipment like that are required to be inspected?
lamh36
@scav:
Okay, I can’t really give you too much on the viral methodology, but I can give you an example how a true “airborne” respiratory virus mode of transmission occurs.
So the easiest and buzzy word one is Influenza. Okay, so Influenza is transmitted via airborne droplets. When someone has the flu, they are prone to sneezing, and coughing and congestion, etc. All of these acts produce aerosilized droplets, some visible to naked eye, some not. The Flu viral particles can survive in this droplets as they are “floating in the air” and on surfaces where this droplets are deposited after they “fall” or when a person who is symptomatic wipes their hands on a door handle, on touches a keyboard, or any surface they touch without washing their hands.
These surfaces if not wipe down to decontaminate them, are then touched by someone who may not have the flu and they may touch there hands, or stratches the ear, or more likely cover they mouth to yawn, sneeze, etc, the viral particles are therefore introduced into the nasal mucosa or when breathing in air after some has sneezed or coughed. If you aren’t vaccinated, then there is a possibility that you will contract the flu.
Ebola virus is spread via CONTACT with any part of the body. Airborne pathogens, have to be “breath” in and settle in the respiratory tract.
pat
Wow how times change. I graduated from the University of Minnesota school of Medical Technology (the Gold Standard at that time) in 1966. We were still pipetting blood by mouth, I kid you not. In micro we learned to wash our hands all the time, but I don’t recall any containment hoods.
I went into basic research and missed the following 50 years of development, and I am not sorry! Thanks, lamh, for giving me a bit of an update.
Oh, and when I spent a few days in the hospital this year, there were signs on the wall (over the gel dispenser) that said Gel In Gel Out. Without my glasses I read this as Get In, Get Out, meaning that the nurses shouldn’t linger to chat….
Omnes Omnibus
@lamh36: Thanks for doing this.
Linda Featheringill
Thanks, lamh.
It’s good to have real information!
lamh36
@Violet:
@Felanius Kootea:
Sending the samples via tube system is a big no-no for Ebola, or for any extremely possibly infectious material.
For example, whenever someone has to get blood for surgery or procedures, that have to come down to the lab and physically bring the blood products to the OR. Firstly because it’s a checks and balances (things have been known to get stuck in tube system). Secondly because the tube system is a pressurized system and so some specimen containers will “pop” open in transit and can cause an very bad breach. Thirdly, alot of the specimen for Ebola testing is blood, and blood products and specimen have temperature requirements that can’t be sustained via the tube station.
Also too, you want to minimize the number of people that the possibly infectious samples can come in contact with.
Mnemosyne
@lamh36:
Okay, I think that makes sense — so if, say, somebody with Ebola sneezes on you and it gets in your nose or eye, the problem is that the virus can get in through your mucous membrane, not that it travels to your lungs like flu virus does. So getting into the lungs via air is what makes something technically “airborne”?
scav
@lamh36: Thanks, I think I’m getting the mechanics of it and know where to poke next. And still more thanks again for the influenza anchor, people generally get that and the brain gets engaged. Conversations with my aunt may get unbelievably calmer.
schrodinger's cat
How long does the virus survive, after an infected patient dies?
lamh36
@wmd: the equipment and reagents and materials for PCR is VERY expensive. The majority of hospitals, particulary public hospitals, just can’t afford smart-cycler type PCR machines. Also, the actual number of things you would use PCR for can just as easily be done with regular lab practices for cheaper cost to both patient and hospital supplies.
Some things like say MRSA, or C Difficile infections have PCR done only as apart of infection control surveillance practices because these particular pathogens are commonly hospital-acquired pathogens and so most hospitals weekly or regularly collect and send specimens to lab to keep abreast of a possible outbreak of these bugs within the hospital.
Ash Can
Many thanks for doing this, lamh36!
Through various online sources, we’ve been through/resolved/debunked what seems to be the gamut of issues regarding Ebola — how it’s transmitted, what’s effective in fighting its spread, when to stop worrying re quarantine periods, who dropped the ball on addressing the problem and how, how that’s being rectified, how loudly to laugh at the hair-on-fire corporate media and right wing, etc. In your estimation, are there any significant gaps that remain in the body of information we Joe-in-the-street laypeople currently have access to? In other words, is there anything we (probably) don’t know that you think we should?
lamh36
@kc: Ebola virus can infect any part of the body that it comes in contact with. So even if you don’t have open sores, or broken skin, you can get infected via anywhere that the virus comes in contact with.
Now most normal bacteria, do not penetrate the skin, in fact your skin, has likes of normal flora that may never infect you, but when injured or wounded, your own personal flora can become infectious when it’s introduced to an area that it doesn’t normally populate.
I’ll have to look into how long it survives outside the body, but I do know that it can be “killed” with a bleach solution, but you must still dispose of the materials that have come in contact with the virus with care and caution.
Technically though, bleach kills a lot of different viruses from the surface of objects. Most viruses outside of the body, do not survive.
Interesting enough, a bug like Clostridium difficile can survive for weeks on inanimate objects, so a person who positive for C diff has to have their rooms completely cleaned more extensively.
peggy
@scav: scav asked about reputable information.
As you said, the CDC is a good starting point along with NIH. PLOS is a repository of reputable scientific papers which are free to read. NEJM and the Lancet are top notch, but usually expensive.
I did an Ebola search on PLOS and got 3700 results.
Damned at Random
There was a great article about the Emory Highly Infectious Disease unit in Time this week. They spent 12 years developing this unit before it was used for the first Ebola doctor from Liberia. They have a special ambulance that is sanitized after every use, dedicated ductwork for venting the rooms, negative air pressure, a lab for that unit only, all kinds of goodies. They had a conference call organized by CDC for hospitals across the country and quote a participant as saying “I really appreciate this helpful information. But practically speaking, I think what you just described would probably bankrupt our hospital.”
Violet
Can you speak to the issue of the virus being evident in breast milk and semen for up to three months after an infected person has recovered? I don’t know if by “recovered” they mean the virus isn’t found in the blood anymore–do you know what that means?
If the virus can be found in breast milk and semen for longer periods, is there a chance it’s also in other body fluids? Sweat or saliva or urine or (sorry guys) cervical mucous? And how transmissible is it from those sources?
polyorchnid octopunch
@chopper: Okay, how’s this one? “ISIS labs under Obama’s direction weaponize ebola to target true patriot Americans!”
lamh36
@kc: @Elie:
I’m sorry, but I don’t know the length of time for confirmation of Ebola diagnosis.
The test performed at Point of Care like CBC, or Platelet counts, or HIV or Malaria testing, can be performed as ‘STAT” test, so at least within an hour.
Quick diagnosis of Ebola is done through PCR, and that in only gonna be done at the CDC or the 3 hospitals that have been approved for Ebola patients.
a hip hop artist from Idaho (fka Bella Q)
Thanks for doing this.
JPL
Thank you lamb for your answers and thanks to the great questions.
@Damned at Random: It would probably bankrupt most hospitals but I still believe we need more than the few rooms available now. Gee, I wonder who could provide the money necessary?
lamh36
@RepubAnon:
I can say that in all the labs I’ve worked in, the amount of PPE available is def cataloged and tracked, but I’ve never known of a problem where basic PPE was not regularly available.
I sorry, but I cannot say for certain that the same situation occurs outside the lab. Within the lab though PPE is required, NOT recommended. We work with infectious substances all the time, so PPE is the only thing preventing us from directly contracted some pathogenic disease.
I'mNotSureWhoIWantToBeYet
Can you comment on Figure 1 at this CDC Link:
The graph indicates the detection limit is about 3.8 (units). The graph has day 0 as being the number of days “post onset of symptoms”.
I think part of the confusion in the public is due to things like this:
a) Is “the first 3 days of illness” the same as “the first 3 days post onset of symptoms”? If so, the graph doesn’t make much sense to me (as it shows a huge virus load by day 3).
b) Do you have any information on how long it takes, post-exposure, for any virus to be detectable by RT-PCR? Given the experience in Dallas, it seems to take around 10+ days (Pham’s diagnosis). If that’s the case, why should people be isolated until the virus is detected if (as I keep reading) the virus cannot be spread without symptoms.
c) Can the Ebola virus be detected by RT-PCR without a fever or any other symptoms (in someone who has not successfully recovered)? I would assume not.
d) Given what it says about RT-PCR not being 100% reliable in the first 3 days (either post-exposure or post-onset-of-symptoms), what does that mean in terms of figuring out who should be isolated? Would the protocol say “Repeat test every 12 hours until a positive result is found if suspicious” or something?
tl;dr – Are the symptoms (high fever, vomiting, etc.) a more reliable indicator of Ebola infection than RT-PCR, or does isolation, etc., only make sense after a positive RT-PCR result? If the symptoms come first, then when should isolation start? If RT-PCR comes first, then when should isolation start?
I hope the questions make sense. :-)
Thanks!
Cheers,
Scott.
SiubhanDuinne
@lamh36:
Just want to add my own thanks to you, lamh36, for doing this ebolatorial.
lamh36
@Damned at Random: PCR is too expensive.
The majority of the PCR I have done, has been for hospital-acquired surveillance and not for routine testing.
But in hospitals that have a patient population that required a larger number of PCR testing, then they may have PCR done routinely.
Damned at Random
@JPL: Well, don’t the insurance companies in the greatest health care system in the world provide such things as a public service?
I’m
geg6
lamh, you rock.
I'mNotSureWhoIWantToBeYet
It looks like some of the following has been answered – if so, don’t repeat yourself. (FYWP is fighting me.)
Can you comment on Figure 1 at this CDC Link:
The graph indicates the detection limit is about 3.8 (units). The graph has day 0 as being the number of days “post onset of symptoms”.
I think part of the confusion in the public is due to things like this:
* Is “the first 3 days of illness” the same as “the first 3 days post onset of symptoms”? If so, the graph doesn’t make much sense to me (as it shows a huge virus load by day 3).
* Do you have any information on how long it takes, post-exposure, for any virus to be detectable by RT-PCR? Given the experience in Dallas, it seems to take around 10+ days (Pham’s diagnosis). If that’s the case, why should people be isolated until the virus is detected if (as I keep reading) the virus cannot be spread without symptoms.
* Can the Ebola virus be detected by RT-PCR without a fever or any other symptoms (in someone who has not successfully recovered)? I would assume not.
* Given what it says about RT-PCR not being 100% reliable in the first 3 days (either post-exposure or post-onset-of-symptoms), what does that mean in terms of figuring out who should be isolated? Would the protocol say “Repeat test every 12 hours until a positive result is found if suspicious” or something?
tl;dr – Are the symptoms (high fever, vomiting, etc.) a more reliable indicator of Ebola infection than RT-PCR, or does isolation, etc., only make sense after a positive RT-PCR result? If the symptoms come first, then when should isolation start? If RT-PCR comes first, then when should isolation start?
I hope the questions make sense. :-)
Thanks!
Cheers,
Scott.
lamh36
@Jay C:
Okay, here is what we have been told.
A person infected with Ebola CAN’T spread the disease until symptoms appear. The time of exposure to when signs or symptoms of disease appear (incubation period) is 2 to 21 days, but the average time is 8 to 10 days. The majority of the symptoms occur during this time. Within the 21 days, you will either live or die based on treatment. The systems don’t go away and then come back. It’s just that what we know now is that within 8-10 days of exposure if you are infected, you will start to show symptoms.
As for what went wrong with Mr Duncan’s care, it’s only speculation at this point, but what we know is that the initial contact in the ER was totally botched by not only triage, but doctors and nurses who were apart of the medical team for Mr Duncan. They all signed off on his release.
Damned at Random
@geg6:
Ditto lamh. I am enjoying this SO much more than the football game.
Appreciate you making yourself available.
lamh36
@Violet: at least yearly, or in cases of maximum used 2x a year
I'mNotSureWhoIWantToBeYet
Bah. I had a bunch of questions, but FYWP made them disappear, then said I already posted on trying again.
Can you comment on Figure 1 and the discussion here – http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html
The graph indicates the detection limit is about 3.8 (units). The graph has day 0 as being the number of days “post onset of symptoms”.
I think part of the confusion in the public is due to things like this:
* Is “the first 3 days of illness” the same as “the first 3 days post onset of symptoms”? If so, the graph doesn’t make much sense to me (as it shows a huge virus load by day 3).
* Do you have any information on how long it takes, post-exposure, for any virus to be detectable by RT-PCR? Given the experience in Dallas, it seems to take around 10+ days (Pham’s diagnosis). If that’s the case, why should people be isolated until the virus is detected if (as I keep reading) the virus cannot be spread without symptoms.
* Can the Ebola virus be detected by RT-PCR without a fever or any other symptoms (in someone who has not successfully recovered)? I would assume not.
* Given what it says about RT-PCR not being 100% reliable in the first 3 days (either post-exposure or post-onset-of-symptoms), what does that mean in terms of figuring out who should be isolated? Would the protocol say “Repeat test every 12 hours until a positive result is found if suspicious” or something?
tl;dr – Are the symptoms (high fever, vomiting, etc.) a more reliable indicator of Ebola infection than RT-PCR, or does isolation, etc., only make sense after a positive RT-PCR result? If the symptoms come first, then when should isolation start? If RT-PCR comes first, then when should isolation start?
I hope the questions make sense. :-)
Thanks!
Cheers,
Scott.
I'mNotSureWhoIWantToBeYet
@lamh36:
Bah. I had a bunch of questions, but FYWP made them disappear, then said I already posted on trying again. Here I try one more time…
Can you comment on Figure 1 and the discussion here – http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html
The graph indicates the detection limit is about 3.8 (units). The graph has day 0 as being the number of days “post onset of symptoms”.
I think part of the confusion in the public is due to things like this:
Is “the first 3 days of illness” the same as “the first 3 days post onset of symptoms”? If so, the graph doesn’t make much sense to me (as it shows a huge virus load by day 3).
Do you have any information on how long it takes, post-exposure, for any virus to be detectable by RT-PCR? Given the experience in Dallas, it seems to take around 10+ days (Pham’s diagnosis). If that’s the case, why should people be isolated until the virus is detected if (as I keep reading) the virus cannot be spread without symptoms?
Given what it says about RT-PCR not being 100% reliable in the first 3 days (either post-exposure or post-onset-of-symptoms), what does that mean in terms of figuring out who should be isolated? Would the protocol say “Repeat test every 12 hours until a positive result is found if suspicious” or something?
I hope the questions make sense. :-)
Thanks!
Cheers,
Scott.
lamh36
@Mnemosyne: correct, the respiratory viruses such as Influenza, Cold, RSV, etc mechanism of infection is via respiratory/nasal mucosa.
kc
@lamh36:
Thank you!
I just googled “Clostridium difficile.” Yikes!
lamh36
@schrodinger’s cat: Ya know what, I’m not sure about that. I do know though, that the virus is highly infectious within the body after death.
Therefore usual post-mortem care is NEVER done, i.e. no autopsies, the body should not have lines/drains/tubes removed. it has to be wrapped in a special plastic, double-bagges,and left in the room for coroner pickup.
In patients who die of Ebola, the virus can be detected throughout the body. Ebola can be transmitted postmortem via laceration and puncture thorugh direct handling of the contaminated remains without appropriate PPE and splashes of body fluid that can occur with post mortem analysis
JCJ
@Violet:
I don’t want to speak for lahm, but as to your question regarding how long ebola could persist in semen I think the example of how long a man is still potentially able to have sperm in the ejaculate after vasectomy explains it. I don’t remember exactly, but I believe men are advised on continuing other forms of birth control for about six weeks after the procedure. Sperm must persist in the vas deferens during this time, so I would assume anything else in the fluid could also persist. I don’t think cervical mucus persists as long.
schrodinger's cat
@lamh36: Was watching BBC News tonight and the doctor they had on said, that one of the major ways, Ebola was spread in West Africa was through the handling of the dead bodies of Ebola patients, preparing them for funeral, etc.,
ETA: Thanks for taking these questions and answering them!
aimai
@lamh36: I’ve been wondering whether anyone is working on an air tight sealant or spray coffin that would entomb the victims before their remains can be incinerated? Sort of along the same lines as sealing a nuclear reactor.
Damned at Random
@I’mNotSureWhoIWantToBeYet:
Day 0 of that graph is not onset of symptoms, but the day enough virus is presentt in the blood to register as an unambiguous positive by PCR. The text indicates that may be as much as 3 days after onset of symptoms.
Violet
@lamh36: Thanks. Interesting. I mentioned the crappy vent hood in one of the labs at the biomedical research place I used to work–they found it vented into the women’s restroom only after having fire/smoke. Sheesh. You should have seen the faces on the people in charge when that came up in conversation. About a zillion health and safety violations. All the rest of us peons were wondering what we were inhaling/ingesting on a regular basis that we had no idea we were being exposed to.
JCJ
@lamh36:
Good evening Lamh! Your seminar only adds to the high regard I have always had for you. Do you have any idea how frequently PPE is improperly used and/or removed? I would imagine most people can put it on properly, but removing it is where I have seen people remove gloves like they remove winter gloves. This would absolutely allow contamination with an infectious agent. I have to do those computer based education things every year, but to me there is nothing like actually being observed periodically to make sure it is being done properly.
lamh36
@I’mNotSureWhoIWantToBeYet:
Ok, from how I’m reading it, let’s say you were exposed on day X….within 2-21 days (on average 8 to 10 days) if you are infected, symptoms will occur. Day 0 on that graph as I understand it is the day at which the common symptoms occurs if you have EVD. Those commons symptoms are, fever higher than 101.5F, severe headache, muscle pain, vomitting diarrheas, stomach pain, bleeding, etc. The big symptom is the 101.5. When you are self-monitoring, it is your temperature that you are monitoring.
Within those 8-10 days, the viral load in detectable. This makes sense to me because viral infections tend to involve elevated temperatures. So if you temperature is the 101.5+ range, then I do expect your viral load to be elevated. So Day 0, you notice an elevated temperature, remember the RN has 99.5 I think. Alot of viral infections cause your temp to go up, so 99.5 temp without the other symptoms tells you that something is going on. As the viral infection progresses, you temp begins to rise exponentially within the first 8-10 days. As you can see the “detectable” viral load increases withing than 0 – 5 and continues until about day 10. I suspect you are still fevered, but you may not be at +101.5, but you are by then exhibiting the other symptoms like vomiting, severe headache, diarrhea, stomach pain, bleeding, etc.
Damned at Random
mNotSureWhoIWantToBeYet::
sorry, I didn’t read your question right. I should shut up and watch the game. This half ass stuff makes me act trollish
Another Holocene Human
LAMH, thanks for doing this, this is a really exciting day on BJ.
@Violet: motherfucker!
I am still curious about Enterovirus68. Is it one of these endemic things, I understand it’s related to polio so, scary, is it being spread by summer camps (church camps, etc), does it get in the water supply, and what is the animal reservoir?
Also, you never hear about norovirus in a hospital. Is it just as simple as … handwashing? Nursing homes, cafeterias, carnival cruises … soap and water?
Another Holocene Human
Okay, ebola question, I take it ebola is not spread by insects. However, a lot of viruses are. Is there something that distinguishes insect-borne from non-insect borne diseases?
Violet
@JCJ: That makes sense. I wonder about breast milk. Must be something about how long it takes for it to be made or something.
lamh36
@I’mNotSureWhoIWantToBeYet:
Ya know, I’m not sure, but the isolation is due to the possibility of exposure. The only real way to monitor without symptoms is temperature. As the temperature increases, the viral load increases. So monitoring the temperature 2x a days, you can see if the temperature is changing exponentially. If so, they you collect blood, and that blood will be tested. If the viral load is high enough, then it will be detected. The onset of symptoms once you notice the temperature rise is fairly quick, I think.
So temperature is the canary in the coalmine of Ebola infection.
Not sure if that answered your question or not.
But from what I understand for Ms Pham, she wasn’t quarantined after coming in contact. So we don’t really know when the onset of her symptoms started, since she was self-monitoring. You’d have to go by when she says they started, i guess.
lamh36
@Another Holocene Human: My understanding is that a majority of insect-transmitted diseases, the insect has to be able to acts as transitional host for the virus/pathogen. They are essentially just “carriers”.
For example in the case of West Nile viruses, which can be spread by mosquitoes. The mosquitoes ingests the blood of a person infected with West Nile. The mosquited flies away and bites another person. In the process of ingesting the new person’s blood, some of the blood from the infected person is transferred into the non-infected person Bip, bam boo, the new person has now contracted West Nile.
The insects are therefore just “vectors” (I believe thats the term) for the pathogens real prey.
Violet
@lamh36: I read that the second nurse, Amber Vinson, was feeling “off’ while on her trip. She didn’t yet have a temperature but had to rest more than usual. So symptoms could start but be vague and be easily attributable to something else or nothing at all–just tired.
Valdivia
Thanks Lamh! This was very very interesting and enlightening.
DanR2
If someone survives from being infected with the ebola virus, is that person “immune” from then on, or can he/she become reinfected?
Thanks, Iamh36!
I'mNotSureWhoIWantToBeYet
@lamh36: Thanks very much to you (and Damned at Random) for the replies. It’s much clearer to me now.
Now if the CDC would make their web pages as clear, things might settle down a little faster. :-)
[ETA:] Sorry for the multiple posts – I guess things were ending up in Purgatory or something.
Cheers,
Scott.
lamh36
Ok, guys, I hope I answered everybody’s questions.
I’ll be back in a minute with a “What You Need To Know About Ebola” in a minute.
Omnes Omnibus
@I’mNotSureWhoIWantToBeYet: No, there is a set of people who simply react to everything emotionally. They will continue to do so. Unfortunately, some of them have good sized megaphones.
lamh36
Ok.
What you need to know about Ebola.
1)The 2014 Ebola epidemic is the largest in history. The outbreak is affecting multiple countries in West African. The first “travel-associated case of Ebola in US” was Mr Duncan which was confrimed by CDC. About 1/2 of the people who have gotten Ebola in this outbreak has died and although the risk of spreading it US is low, hospitals (let’s forget about Presby for a minute) along with the help of the CDC are taking precautions to make sure it doesn’t spread in the US.
2)A person infected with Ebola can’t spread the disease until symptoms appear. Time from exposure to when signs and symptoms appear (incubation period) is 2 to 21 days, but on average, they occur between 8-10 days from exposure. Signs of Ebola: fever (+101.5F), Symptoms of Ebola: severe headaches, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
3)Ebola is spread through direct contact (thorough broken skin or mucous membranes) with blood and body fluids (urine, feces, saliva, vomit, sweat and semen) of a person with Ebola. Also too, objects like needles, that have been contaminated with blood/body fluides of Ebola patiend can also spread the virus.
EBOLA IS NOT SPREAD THROUGH AIR, WATER OR FOOD.
4)If you someone or someway have to be in contct with a person who is suspected of having Ebola, protect yourself. There is no FDA-Approved vaccine available. Experimental vaccines and treatments are under development, but they have not yet been fully tested for safety and effectiveness. DO wash your hands often with soap and water or use an alcohol-based hand sanitizer. DO NOT touch blood or bodily fluids of people who are sick. DO NOT handle items that may have come in contact with sick person’s blood or body fluids. DO NOT touch the body of a person who has died of Ebola.
lamh36
@DanR2: Ya know, I’m not sure about that. I know that with viruses that like Varicella Zoster (Chickenpox) being infected as a child minimizes the possibility of infection as an adult, but the VZV antibodies stay in your system, so it’s less likely you will be infected.
I’m not sure if that’s absolutely true of Ebola. I think in theory it may work, that’s why its still considered experimental.
Omnes Omnibus
@lamh36: It is also my understanding that having had chicken pox at a very early age doesn’t create immunity. (I have no source; it was something I was once told. It stuck with me because I had CP when I was about a year old, and, if that is true, I am still at risk for CP but also have an increased chance of getting Shingles. Woo, as they say, hoo.)
Violet
@DanR2: @lamh36: Here’s a pretty good summary of what happens after someone recovers from Ebola–can they get reinfected, how long immunity lasts, longer term health issues, etc.
DanR2
@lamh36: Again, thanks for sharing your insight and for the work you do.
lamh36
@Omnes Omnibus: Correct, it minimizes the likelihood, but doesn’t completely given “immunity”,
And yep, it cause Shingles in adults. It not like the MMR vaccine (Measles, Mumps and Rubella) vaccine does help against infection, but you have to get boosters after childhood vaccinations.
The Flu vaccine doesn’t give you immunity either, but it does decrease the likelihood of contracting it.
piratedan
since these are rational questions from rational people (well kinda sorta anyways) I went ahead and linked this thread to my facebook page for anyone wanting to actually read relevant questions and hear relevant answers.
ty lamh36 and JC for the forum for the discussion….
piratedan
@lamh36: @#93 if there was a way to pin this to the top, I would heartily recommend it being done….
Ruckus
@Omnes Omnibus: @lamh36:
My understanding is that shingles (had a huge interest – had CP and decades later, shingles) is the dormant virus becoming active. With an active case of shingles you can infect someone with CP who has not had it. Once the active case is resolved you are no longer infectious. I was told by my Dr at the time that shingles can reoccur, you never actually kill the virus. My understanding is that if you have had CP you don’t catch it again, the virus you carry protects you from CP. I don’t know if this is accurate. You are susceptible to developing shingles however.
karen
I think that ebola wouldn’t be getting the fearful notoriety and “worst thing ever” media coverage if it had been ravaging Europe. It’s yet another thing that can be blamed on black people. In fact, I totally predict that it’ll be considered to be a SYG excuse.
Tell me I’m wrong. Please.
Omnes Omnibus
@karen:
Quoi?
Violet
@Ruckus: My dad is still recovering from shingles. According to his dermatologist, that is correct. If you had chicken pox you are at risk for shingles. If you have an active case of shingles–and that is while the lesions are oozing and before the scab over–you are able to infect someone who either has never had chicken pox or who has not been vaccinated. It is not airborne, however. The person would have to come in contact with the lesion on the shingles patient.
There is now a shingles vaccine. My dad’s dermatologist was kind off fifty-fifty on it. Said it’s expensive, it’s effectiveness isn’t as high as expected, and she’s seen it cause other problems for people who get it. She doesn’t tell her patients not to get but she also doesn’t urge them to get it. She explains her position on it and leaves it up to them.
lamh36
@lamh36:
From CDC PDF: http://www.cdc.gov/vhf/ebola/pdf/what-need-to-know-ebola.pdf
Mnemosyne
I wish I could find it, but I heard part of an interesting story on KPCC tonight about Nina Pham and how, in an odd way, she’s become a source of pride for Vietnamese-Americans since she risked her life to take care of an ebola patient. If they post the story and/or a transcript, I’ll post a link. I’m pretty sure it was a local story since they mostly talked to people in places like Monterey Park.
Violet
@lamh36: Thanks again for doing this. Really interesting. Appreciate you taking the time and your knowledge and insight.
I'mNotSureWhoIWantToBeYet
@Mnemosyne: I think it was this story on All Things Considered this evening.
HTH.
Cheers,
Scott.
rikyrah
Lamh, thank you for this. I learned a lot tonight.
Paul Orwin
@wmd: I hope you don’t mind a comment from a different microbiologist than the host of this thingy here. I will add my $0.02 from a quick perusal of the 1st article (Im a bacteriologist, not a virologist, and not an ID expert exactly, but know a bit about this). That first paper seems to be a “proof of concept” type of experiment that shows that if you rig the conditions just right you can get Ebola Zaire to be transmitted from pigs to monkeys. This could explain how the virus moves through animal populations from the bat reservoir into other animals and perhaps game animals eaten by hunters (and no, I’d rather not call it “bushmeat”!) I don’t know of any evidence of Ebola in the noses of patients during asymptomatic or even early symptomatic stages (in the late stages it’s everywhere, from what i know), so regardless of their claims, I’m not sure this really has much impact on public health protocols.
As a side note, there is a lot of history of various infectious diseases shifting their mode of transmission or changing their level of virulence over time. (for example, pneumonic plague) It is certainly possible that Ebola could do either of these things, but the more cases there are without a major shift in virulence and transmission, the more likely it seems that it will not do this.
Hope this helps!
PhoenixRising
@Mnemosyne: Yep. We’re praying for her, at the Buddhist temple my family attends. It’s funny how the internecine battles in Vietnamese America, in which Catholic and Buddhist divisions are proxies for political divisions predating the French War, are mended by ethnic pride.
Nina’s boyfriend (I think? may be another friend) is a longtime volunteer for a cultural camp run by & for VN-American adopted children. It’s a close-knit community.
PhoenixRising
@I’mNotSureWhoIWantToBeYet: thanks! Loading it onto my kid’s podcast list.
sharl
@lamh36:
I’m just gonna do what so many others have done in this thread already, and express my gratitude for you taking your time to do this. It’s very informative, and has given me some issues for follow-up when I have the time to do some further searching on the innertoobz.
Thanks so much!
Ruckus
@Violet:
I’m not getting the singles vac. If you know what you have and you seek treatment asap after activity starts, you cut down the “fun” dramatically. Less than 12 hrs seems to be the best number I’ve heard. Once you’ve gone more than about 20-24 I’ve been told the treatment is about useless and it has to run it’s course. Don’t do this. I was at about 16-18 hrs from first sign to treatment and I paid for that. Fortunately my case didn’t involve any optic details but the level of nerve pain is amazing. And I’ve had a number of occasions of some pretty good bouts of pain, from lifelong conditions and from accidents. Not the worst I’ve had but most assuredly in the top 5.
Ruckus
@Violet:
I’ll add my name and an apology for somewhat sidetracking the post.
Xenos
Thanks, lamh36, for taking the time to do this.
My question may be too far out there, but it comes from a friend who has a cousin living in the Central African Republic. People there believe they may have some resistance to Ebola as their fruit trees, commonly grown in back yard, are often visited by fruit bats. The thought is that ongoing trace exposure from the food would give their bodies some resistance.
This goes against what we read about health workers in West Africa getting very slight exposure and then proceeding to get fully sick. I can certainly see that if your first exposure to the disease it contact with billions of viruses absorbed into your body while providing care for a terminal-stage patient, you could get fatally sick very quickly (something analogous to pneumonic versus bubonic y. pestis), so you could have an untreatably fast version of the illness happening at the same time as a three-week-incubation version of the illness with a decent survivability rate with modern medicine.
Any indication this is what is happening?
karen
@Omnes Omnibus:
Stand Your Ground.
gmann
A lot. You are hot, tired, thirsty. Respirators are almost not used anymore in nukes because of many issues including contamination. Granted a contamination event only generates some paperwork, a lecture and a good scrubbing with cold water, but…
When many workers leave a reactor at the same time, it’s SOP to have someone watch, verbally assist with removals. Most nukes have a large sign near the step off pad which shows what is removed first, second, third. Easy Peasy
Violet
@Xenos: The last bit of the article I linked above discusses people who seem to have immunity from symptoms:
jheartney
@Ruckus: Had shingles, went in right away for the treatment. Shingles itself wasn’t bad, but it did give rise to a case of conjunctivitis that left corneal scarring in one eye. Now at night that eye sees giant sprays off any light source, and during the day, the affected eye is nearly useless (iris contracts down to just the scarred part). Heard there’s surgery to peel off the scarring, may look into that.
Anyway, shingles, bad news.
scav
@Violet: The Lancet has an article more or less along the lines of my longer, grayed out question: Abstract: Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak. I had been thinking within US and combining multiple modes of travel, but this is actually probably better for this exact situation. Found it via the good old, sometimes also appears rational, Guard: Only three Ebola-infected travellers per month are likely to fly from west Africa
Mnemosyne
@I’mNotSureWhoIWantToBeYet:
Yep, that’s the one — thanks!
suzanne
I’m late, but thank you, lamh!
Many of the hospitals who are my clients would not be able to afford a bio containment unit in a million years. Hell, they object to two handwashing sinks per room and ADA toilets. Because to a variety of factors, it is likely that new hospital construction will slow down dramatically, and renovation is very hard and expensive. I do not think that America’s healthcare facilities are up to the job.
Van
@mikefromArlington: I suspect what really happened is that the ER nurses and doctors didn’t want to take the patient. I’m a nurse in an urban hospital and despite the statements by administrators we’ve not yet had specialized training in proper donning and doffing of Personal Protective Equipment. Sure we are trained to do this for routine diseases, but Ebola requires that you make no mistakes. Most of the infectious diseases that US healthcare workers deal with we have vaccines for, or they are not that deadly. Isolation procedures are more geared toward preventing the spread of things like MRSA and C-diff from patient to patient. If a nurse gets exposed to small amounts of these it’s unlikely to cause a problem. TB is an exception, but you don’t get a lot of TB patients and all it requires is negative isolation and a N-95 respirator(mask).The worst problem I can think of spreading around in recent years is Norovirus, which is a bitch and spreads like wildfire. But it’s not deadly for most people and the illness is short.
debbie
@Violet:
Think twice about shingles vaccine. My doctor told me because it’s a live virus, there’s a chance (esp. if you have any autoimmune issues) it can cause a diffuse version of shingles. Not as painful, but very difficult to treat. The regular form of shingles can be treated if caught early. Or so I”m told.
debbie
Thanks for this thread, lamh36. You’ve answered the questions no one in the media has taken the time to ask or answer.
I did hear someone on Face the Nation say that the incubation period should be extended to 31 days, but I haven’t heard anyone else agree with him yet.
Larv
@lamh36:
Do you have a source for that? That’s not what I’ve read; my understanding is that it needs a break in the skin or a mucous membrane just like most viruses or other infectious agents. The problem with Ebola is the sheer number of viral particles shed by patients combined with the high infectivity rate. That is, on average only one or a very few exposure events are required to lead to an infection. This is in contrast to say, HIV, which has a fairly low rate of infection per exposure event.
Chad
This is a dumb question, but is using a commercially available hand sanitizer like Purell an effective way to stop transmission of the virus? Just curious.
Larv
@Chad:
It’s better than nothing. Purell is ethanol-based, and ethanol is a decent viricide for lipid-enveloped viruses, which I believe includes Ebola. It’s a pretty good choice for emergency disinfection when you have no access to a sink. But I think thorough washing with soap and water is still superior. And an iodine-based antiviral cleanser is even better. Also, ethanol-based products can dry out your skin, which could cause cracking and give viruses like Ebola a route into the body. So I wouldn’t use Purell as a routine disinfectant if I was in an area where Ebola is common, but for occasional or emergency use it’s ok. As a caveat, IANAD, just a lab tech who works with viruses.
Bob Nolan
There is a strong possibility that copper and copper alloys kill the Ebola virus. Why doesn’t someone test for this so healthcare facilities and individuals can protect themselves by replacing common surfaces with ones made with copper?
https://www.linkedin.com/groups/antiviral-efficacy-copper-surfaces-versus-4490348.S.5906040110838743044