Diary Prequel Package — page 359

Much press interest today with appearances on: Fox News Radio; Hearst TV; WTOP; MSNBC with Ronan Farrow; NBC Nightly News; The NewsHour; Cox TV; 24/7 National News Radio; CNN Anderson Cooper; Local Channel 9 News; AP TV. August 29, 2014 - UK raises terror threat to Level 4 (of 5) due to activity of ISIS in Syria and Iraq, who are threatening the West. They have been brutally assassinating free Syrians (beheadings) and have shown a beheading of an American journalist (James Foley) on You Tube. Ebola - outbreak raging. Tom Frieden is obviously distraught. I am concerned about him as he is having a very emotional reaction to this. He wrote me an e-mail yesterday from Liberia saying that the situation is completely out of control and that health care workers are getting infected and we should distribute the vaccine even without Phase 1 safety data. This is not correct. We have to do at least a modicum of safety data before we distribute it. I am beginning to get concerned that transmissibility is not just confined to people who take care of sick people and who have "direct contact with bodily fluids such as Feces, Vomitus, blood, and urine". There have been some situations that have me believe that fomites and hand contact inadvertently with fomites outside of the "direct" healthcare setting might also spread the virus. Some examples: Dr. Brantley and Nancy Brighthol were both infected and Brantley was experienced in PPE. Of note, no MSF person who used PPE has ever gotten infected over years of taking care of Ebola patients. Nancy never directly took care of Ebola patients. the WHO person, likely got infected while taking care of patients, but did not tell anyone he was feeling poorly. He went to meetings with people from WHO, MSF, and other organizations and two of these people got sick and they did not breach any PPEs. got sick from his sister in Liberia, got on a plane and flew to Nigeria. Got sick in Nigeria and several health care providers who took care of him without PPE (~12) got sick and 8 died. One of the people who did not know he was sick went to Port Harcourt, got sick saw a physician. The physician got infected and ultimately died, but not without infecting his wife. The August 28, 2014 Nature paper on deep sequencing by Pardis Sabeti from the Broad in Boston showed phylogenetic origin of virus as a single point source. In the paper, the woman who brought the virus from Guinea to Sierra Leone got is at a funeral where she tended to a body; however, 12 people from that funeral got infected from 2 lineages, probably all having gotten infected at the funeral. It seems to me that these women did not all touch "macroscopically visible feces, blood or vomitus on the body. Someone or more initially cleaned the body, but certainly some kissed or otherwise touched what appeared to be a clean body and got infected. Conclusion, it is likely than microscopic contamination with residual bodily fluids on what appears to be clean skin or surfaces could spread the virus. Hypothetical scenario → person is infected and in early stage, get diarrhea and wipes his anal area, contaminates his hands with microscopic fecal material and virus, washes or not his hands, but virus remains and he then shakes someone's hands, serves someone food, etc. and transmission occurs I do not believe at all that it is transmitted by the respiratory route; however, inadvertent