Wednesday, September 03, 2014

The Maritime Ebola Vector

UPDATE 2: (MIAMI HERALD, Oct 17, 2014)
Ebola Scare Sends Caribbean Cruise Ship Back Home
A Carnival ship has been carrying a health care worker who may have handled lab samples from the deceased Ebola-infected man in Dallas. 

"In a statement, Doral-based Carnival Cruise Lines said the Carnival Magic had been waiting off the coast of Cozumel to dock Friday morning, but still had not received clearance by noon. The cruise line decided to send the ship back to its home port in Galveston “to ensure the ship arrives there on time on Sunday morning.”

Read more here:

UPDATE 1:  DALLAS (CBSDFW.COM) – "The CDC has announced that the second healthcare worker diagnosed with Ebola — now identified as Amber Joy Vinson of Dallas — traveled by air Oct. 13, with a low-grade fever, a day before she showed up at the hospital reporting symptoms."  source

Question:  How much longer will the CDC "fiddle" before mandating precautions for cruise ships? ( Nero is infamously known as the Emperor who "fiddled while Rome burned"[6] )

Background  (Hat Tip to Gus Van Horn for  Exactly How Dangerous Is Ebola?

Scott Holleran interviewed Dr. Amesh Adalja on the subject of the Ebola virus threat to Americans"I have very little concern that Ebola will be able to spread in a modern, industrial country like the U.S. chiefly because of the way it spreads. You really have to work to become infected --it's not like measles--and you have to be in very close contact while not wearing personal, protective equipment like gowns, gloves and masks. In a U.S. setting, a patient with Ebola would be placed under protection and we wouldn't expect it to spread. We've had eight importations, such as lassa fever, another viral hemorrhagic fever spread in the same manner as Ebola, and the Marburg [virus] is in the same family as Ebola--and we've had no secondary spread." Read it all!

Molten Eagle's Commentary

Generally speaking, Dr.Amesh can hardly be faulted for his comforting opinion.  He fails, however, to note one of the most threatening avenues for Ebola spread.

According to the CDC, the average incubation period for norovirus-associated gastroenteritis is 12 to 48 hours, with a median period of approximately 33 hours.  However, people with compromised immune systems (for example, those receiving chemotherapy or organ transplants) can spread the virus for months.

Any U.S. headline reader is familiar with the awful practices that have allowed thousands of paying cruise ship passengers to be sickened at sea by passageways of rank vomit and contagion spread by multinational food service employees (et cetera) or infected passengers.

After days at sea with a noroviruse's short incubation period, repetitive episodes of sickness still seem relatively common.  The weak link is simply in the personal hygiene habits of some crew and passengers.

Fast forward to the Ebola Hemmorhagic Fever Virus of which Dr. Amesh speaks. According to the CDC, Ebola's incubation period ranges from 2 to 21 days (overlapping a norovirus).  According to The World Health Organization (WHO) [color emphasis added]:
In 2008, 13 million passengers worldwide travelled on cruise ships. Cruise itineraries cover all continents, including areas that are not easily accessible by other means of travel. The average duration of a cruise is about 7 days, but cruise voyages can last from several hours to several months. A typical cruise ship now carries up to 3000 passengers and 1000 crew.
Molten Eagle believes most readers can now recognize the inherent and immenint hazard of Ebola spread via the cruise ship vector.  If not, here is more.

According to the CDC's Ebola HF Health Packet: "How is Ebola hemorrhagic fever prevented?"
... [H]ealth-care providers must be able to recognize a case of Ebola HF should one appear. They must also have the capability to perform diagnostic tests and be ready to employ practical viral hemorrhagic fever isolation precautions, or barrier nursing techniques. These techniques include the wearing of protective clothing, such as masks, gloves, gowns, and goggles; the use of infection-control measures, including complete equipment sterilization; and the isolation of Ebola HF patients from contact with unprotected persons. The aim of all of these techniques is to avoid any person’s contact with the blood or secretions of any patient. If a patient with Ebola HF dies, it is equally important that direct contact with the body of the deceased patient be prevented.
Sanity check:  Where do passengers return when their cruise is completed?  Do some reside on the U.S. mainland? Planning on taking a cruise? Is your neighbor or co-worker? Already have reservations? Planning to buy stock in a cruise line?

Submarines are always silent and strange.

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