Wednesday, November 12, 2014

As I predicted, Ebola was in Mali, but health care officials just didn't know about it

    On Oct. 29 I wrote that the Ebola virus was certain to spread to Mali due to the fact that people were being allowed to travel freely into that country from infected areas with only a temperature check.
    The Ebola virus usually has an incubation period of from 4-21 days, so a temperature check is as useless as teats on a boar hog in preventing infected people from entering an uninfected area. A temperature check only catches those who are actually sick, not everyone who is infected.
    Well, no sooner than Mali had been declared "Ebola free" following the death some weeks ago of a young girl who traveled into the country and died from Ebola, we've learned that there is a more serious outbreak caused by a religious figure -- a grand iman -- from Guinea who traveled to Mali for better medical care. Neither he nor the clinic which treated him understood that he was suffering from an Ebola infection. The iman died and his body was washed at the local mosque before being returned to Guinea. A number of the iman's relatives in Guinea have died, as has one nurse in Mali who treated him. The total number of people infected in unknown, but it is potentially a substantial number.
    All of this happened almost a month ago, and authorities are just now figuring out that the string of deaths that have followed in the iman's wake meant that he was suffering from Ebola. I suspect there are a number of other outbreaks throughout Mali that haven't grown to the point that they've been identified as Ebola.
    On Oct. 29 I wrote the following:
    My guess is that Mali may already have an Ebola outbreak, authorities just don't know it yet. The nature of Ebola is that there is one death from an unexplained cause, often thought to be malaria or some other malady; three weeks later two or three additional people die; in three more weeks that total might jump to six. It can take two or three months for authorities to even become aware of an outbreak.
    Even when villages might suspect Ebola they might be afraid to alert authorities for fear of being quarantined with no food or having their loved ones carted away. So an initial, isolated outbreak often goes undetected by authorities until a village is completely decimated, perhaps even abandoned.
    Most people have all been indoctrinated with the notion that people should have the right to go wherever they want whenever they want. But no one should be allowed to leave an area with an uncontrolled Ebola outbreak without a mandatory quarantine. Nobody has a right to infect the world.
    The world needs to create a cordon sanitaire around those areas with uncontrolled Ebola outbreaks; nobody leaves without a quarantine. If it requires massive numbers of troops standing shoulder-to-shoulder to enforce, then troops we should send. If the only way to stop people from leaving is to shoot them, then shoot.
    The real risk of Ebola isn't that we might get a few cases or even a few hundred cases here in the United States. The risk is that it will continue to slowly creep into poverty-stricken areas with poor communication, poor education, and poor medical facilities, where it will successfully take root before anyone even knows it's there.

Tuesday, November 4, 2014

I hope the voters send the race-baiters of 2014 a message from the ballot box

    This has been the season of the race-baiting advertisement, with candidates or their supporters running some pretty reprehensible ads equating conservatism with racism. Some candidates are so extreme that they even aligned some themselves with attempted-cop-killer Michael Brown of Ferguson, Mo.
    Among the worst race-baiters of 2014 (or those who declined to denounce race-baiting on their behalf) are Mary Landrieu of Louisiana, Kay Hagan of North Carolina, Michelle Nunn of Georgia, Mark Pryor of Arkansas, and Thad Cochran of Mississippi. These types of racialist campaigns harm our democratic system, and I hope voters will send these candidates a message today.

Democrats who had Obama amnesia ended up looking silly, hurting their campaigns

    Now that the election is almost over, here's a note to really stupid Democrats: Don't deny voting for your party's president, particularly when he was at one time the blank slate upon which almost every American projected their hopes and dreams.
    As a Democrat, you darn well better have voted for the man unless you can articulate a good reason not to have. Most Democrats voted for Barack Obama. Most independents did, too. That's why he won.
    When a Democratic candidate was asked whether or not he (or she) voted for Obama the answer should have been "Yes!" This should be followed by whatever statement the candidate wished to make explaining reservations and disappointment about the president. In other words, "Yes, I voted for him, but like many of you, I've been disappointed."
    Instead we've had these debates where Democratic candidates have looked like absolute fools as they've tried not to answer questions about whether or not they voted for Obama. Of course they voted for him. And I have far more respect for the candidate who would say, "Of course I did."
    I disagree with much of what Barack Obama has done, as do most Americans, both Republicans and Democrats. But the fact is that he has advanced what is supposed to be the Democratic agenda. That doesn't mean he should be immune from criticism, because he deserves a lot.
    I'm not suggesting that Democrats should have embraced Obama this election. But those who refused to even admit they voted for him looked like idiots. If they can't be honest about whether or not they voted for a man who was awarded a Nobel Prize just for being elected, can they be honest about anything?

Friday, October 31, 2014

If no Mississippi university offers your major, you can go elsewhere at in-state tuition rates

    Between Ole Miss and Mississippi State a prospective college student has his choice of just about any major out there. Almost any major, but not every major.
    Some majors just aren't available in Mississippi. For example, no Mississippi university offers majors in either petroleum or nuclear engineering.
    But that doesn't mean students wanting to major in some of these more esoteric fields have to pay expensive out-of-state tuition. A consortium of Southeastern state universities known as the Academic Common Market allows students from most Southeastern states to attend out-of-state universities at in-state rates if they major in a program not offered by a university in their home state.
    The course I've heard mention of in the past is the PGA Golf Management course at Mississippi State. Other State courses which attract Common Market participants from out of state include Broadcast Meteorology, Aerospace Engineering, Veterinary Medicine, Agricultural Information Science, and Poultry Science.
    At Ole Miss popular courses include Geological Engineering and Forensic Chemistry.
    Taking advantage of this program isn't as simple as simply showing up at one's desired out-of-state university and demanding a tuition break. One must fill out an application and be certified by one's state as eligible to participate. But I suspect it's a fairly painless process. However, things do take time, so don't wait until June if you are wanting to start school in September!
    North Carolina doesn't participate in the Common Market. Florida and Texas participate only at the graduate level.
    This PDF report on Mississippi activity in the Academic Common Market does a really good job of showing where both Mississippi and out-of-state students are going as a result of the Common Market. It's worth looking at, even though it hasn't been updated since 2011.
    One big question that comes to mind is what happens if a student changes his mind mid-way through his coursework? From the FAQ:
"Most ACM institutions will not require you to pay back tuition for the years that you received ACM benefits if you change your major or program to one that is not approved for the ACM or is available in your home state. However, if you change your major during a semester, the institution may charge you the out-of-state tuition rate for that semester. If you change your major to a different program that is included in the Academic Common Market, you must be recertified by your state coordinator."
    Notwithstanding the above, I would resist the temptation to abuse the program. I suspect they reserve the right to demand reimbursement in cases where they believe a person declared and later changed a major simply to evade tuition.
    So if Mississippi doesn't have your major, don't worry about having to pay out-of-state tuition. With a little advance planning, you won't have to.

Wednesday, October 29, 2014

Unreported by media, 2013 study found estrogen blockers highly effective against Ebola virus

    I'm aware that my blog has become Ebloa-central for the past few weeks. It's a subject of national interest, and each time I research one thing I stumble onto something else.
    I recently found a study published in the June 19, 2013 edition of Science Translational Medicine which strongly suggests that currently approved Selective Estrogen Receptor Modulators (estrogen blockers, for short) would be effective in inhibiting the Ebola virus. Presumably these drugs would be effective if taken either prophylactically before and during exposure or as a treatment after the onset of symptoms.
    I did a Google search, and I can find no news story containing either the words "ebola" and "clomiphene" or "ebola" and "toremifene. I find this pretty amazing, especially in light of the mouse study, which I describe below.
    The drugs which were tested in vitro and in a mouse study are clomiphene (Clomid) and toremifene, both of which are estrogen blockers. Some other estrogen blockers were also considered, but these two were apparently considered the ones with the most promise. The drugs appear to interfere with the Ebola virus in a method not related to the traditional estrogen pathways. From the study: "Although we initially identified the ER antagonist compounds on the basis of their collective known mechanism of action, our results indicate that these compounds are mediating their antiviral effects through cell-based mechanisms unrelated to the classical estrogen signaling pathway."
Click to enlarge
    I am not smart enough or educated enough to understand much of the scientific language in this study. What I could understand was the chart showing the mortality rates of mice treated with each of these drugs. Mice were intentionally infected with the Ebola virus through injection. A control group received no treatment and had a 100 percent mortality rate.
    Mice treated with toremifene had a 50 percent survival rate. For clomiphene, 90 percent of the treated animals survived. This is nothing short of amazing. The drugs were equally effective in both male and female mice.
    Mice aren't humans, but it would seem to me that a drug designed for humans that inhibits virus reproduction in mice would do the same in humans. In light of this study, I know that if I were to be exposed or infected with the Ebola virus I would definitely want to be placed on clomiphene. (Sadly, clomiphene requires the CYP2d6 enzyme to be fully effective, so I'm probably out of luck, as is about five percent of the population).
    Some people say we should never take a drug without endless double-blind studies. I say that I don't want to be the mouse that's left in the "control" group with a 100 percent fatality rate. If any of you want to be the dead mouse, feel free to volunteer.
    We don't know whether these drugs are being used for recent Ebola patients or not. In fact, we've only been given sketchy details about what treatments various Ebola patients have received, some of which have been "experimental." Surely these doctors are just as good at surfing the Internet as I am.
    On the downside, widespread prophylactic use of estrogen blockers is likely to result in a viral mutation that will manage to overcome the interference caused by the drugs. This is the story of all antivirals or antibiotics -- the public health footrace we can never win but hope not to lose.
    But whatever treatments are being used, no media outlets have reported the fact that these estrogen blocking drugs have demonstrated a high degree of effectiveness in stopping reproduction of the Ebola virus. So tell your friends, ColRebSez had it first.

    ADDENDUM, 10/29, 8:57 P.M.: Given that the mortality rate of Ebola infections is as much as 80 percent in West Africa, I'm surprised that massive quantities of clomiphene or other estrogen blockers haven't been shipped over. No, it's not tried and true, but how much worse can the outcomes be? There is really nothing to lose.
    As I mentioned, even if effective there may be a limited window in which these drugs will be effective before the Ebola virus mutates and develops resistance to it. Amantadine, for example, used to be effective against the flu; all flu strains are now resistant. Tamiflu remains mostly effective against the flu, although resistant strains have appeared.
    In any event, it would seem to me to be helpful to try to use any weapons we might have against the virus. Better to stop it now and worry about antiviral resistance later.

If residents of Ebola-infected areas are allowed to leave with only a fever check, the virus will spread

A woman traveling from Guinea into Mali has her temperature
checked at the border in an effort to screen for Ebola.
    I read with some concern recently about the young girl who was carried into Mali while infected with the Ebola virus. One hundred eleven Malians who had exposure to the girl are now being tracked by the World Health Organization.
    As a practical matter the actual number of people actually at risk from developing Ebola from contact with the girl is probably fewer than 30 and perhaps only a dozen. But that's still a lot of people.
    The two-year-old girl apparently never had her temperature checked when entering Mali as she was being carried in a sling on her grandmother's back. She was already ill with Ebola symptoms at the time, and a screening would have detected it.
    What concerns me is that Mali is letting in streams of people from Guinea with only a temperature check to screen for Ebola. The virus has a typical incubation period of 4-21 days (and up to 45 days), so a temperature check is of little use in keeping out those infected with the disease but still asymptomatic.
    My guess is that Mali may already have an Ebola outbreak, authorities just don't know it yet. The nature of Ebola is that there is one death from an unexplained cause, often thought to be malaria or some other malady; three weeks later two or three additional people die; in three more weeks that total might jump to six. It can take two or three months for authorities to even become aware of an outbreak.
    Even when villages might suspect Ebola they might be afraid to alert authorities for fear of being quarantined with no food or having their loved ones carted away. So an initial, isolated outbreak often goes undetected by authorities until a village is completely decimated, perhaps even abandoned.
    Most people have all been indoctrinated with the notion that people should have the right to go wherever they want whenever they want. But no one should be allowed to leave an area with an uncontrolled Ebola outbreak without a mandatory quarantine. Nobody has a right to infect the world.
    The world needs to create a cordon sanitaire around those areas with uncontrolled Ebola outbreaks; nobody leaves without a quarantine. If it requires massive numbers of troops standing shoulder-to-shoulder to enforce, then troops we should send. If the only way to stop people from leaving is to shoot them, then shoot.
    Make no mistake, the developed world should send far more aid to areas affected by the Ebola outbreak. We should send medical help. We should immediately step up and start paying all of the health care workers a risk bonus. We should do far more than we are doing. But we should not allow any potentially infected person to leave the area without a quarantine, period.
    Sadly, the world isn't willing to commit the resources or make the hard choices necessary to control contagion, so Ebola will, in all likelihood, continue to slowly spread. At some point it is likely to spread into rebel-controlled areas of Mali or Nigeria where even Doctors Without Borders has been able to operate with only the greatest of difficulty. Eventually Ebola is likely transform from an epidemic to a pandemic affecting all of the undeveloped world.
    I should note, as I always do, that my views are perhaps overly gloomy. There is evidence that new cases are dropping in Liberia, although some say they are merely going into hiding to avoid cremation. As I have pointed out many times, viruses often burn out of their own accord. Many Africans have developed antibodies to Ebola despite never having been infected, perhaps through exposure to bat saliva on gathered fruit. And the virus tends to spread so slowly that there may still be time to implement a mass-vaccination program.
    I have high hopes for both vaccination and medicines that will be effective against Ebola. As for containment, I fear the battle is either already lost or being lost. Should Ebola become a true worldwide scourge, it won't be from a lack of resources, but rather a lack of will.

Tuesday, October 28, 2014

Pestilence, War, Famine, and Death -- Ebola's story is that of the Four Horsemen of the Apocalypse


--Revelation 6:1-8
    As the Ebola crisis continues to unfold in West Africa we would do well to remember the prophecy of the Four Horsemen of the Apocalypse. And no, I'm not foretelling the end of the world; these horsemen have appeared many times throughout history.
    The meaning of the white horse has been debated, but in recent years it has commonly been called Pestilence, or disease. The red horse is clearly war.
    The black horse is said to symbolize famine and want; but the instruction to spare the oil and wine is a suggestion that the famine's hardship will fall primarily on the poor.
    The pale horse is Death, always a traveling companion to Pestilence, War, and Famine.
    War and Death had already destroyed the infrastructure of West Africa. The reason there are so few doctors and health care workers in Liberia is because they all left or were killed during that country's brutal civil war. And so following in the footsteps of War has been Pestilence -- the Ebola virus. Ebola is also preventing almost all other diseases from being treated, so the death rate is magnified.
    Soon we will have Famine. In Sierra Leone, as many as 40 percent of farmers have abandoned their fields. Presumably a large number have done likewise throughout the region. Trade has come to a standstill and food is already in short supply. These supplies will get shorter still as untended farms produce no crops.
    I've made it clear that I'm more than irritated with the fact that our government has repeatedly given the public false information that the Ebola virus poses virtually no risk to any American and is incredibly hard to catch. This isn't true. But with that said I believe the chances of a major Ebola outbreak in the United States are quite low. It may sound like a quibble, but I object to the government claiming "absolutely no risk" in cases when there is "an overwhelming likelihood that there is no risk." There is a difference.
    But the real Ebola story is in Africa. Unfortunately, I've concluded that based on current efforts the Ebola virus will not be contained; it eventually will spread throughout the undeveloped world. I don't know what the eventual death toll will be, but unless a vaccine is developed I can't imagine that it will be less than 10 million people and could easily top 100 million or more.
    That's a lot of dead people, and even if not a single American dies it will have some major effects on our lives. A recent blog post by Jody Lanard and Peter M. Sandman entitled Ebola: Failure of Imagination sums up my view of the situation quite well. Essentially the authors say that the worst-case scenarios for the Ebola virus are so awful that we are refusing to even contemplate them, and yet by our very refusal to do so are failing to make rational choices that might stave of potential disaster.
    The United States has sent 4,000 troops and various countries are expected to send $1 billion in aid to the region. Certainly this is noble, but it's not going to be enough to stop this epidemic. Perhaps 40,000 troops and medics and $20 billion might do the trick, but there is no national or international will to do this.
    And so Pestilence will very, very slowly continue its march around the globe, often following the Horseman of War. Soon after will come Famine for the poor amid plenty for the rich. And always with them Death.