A Blogger’s Dilemma – What To Do About `Suspect’ Ebola Cases

 

# 9173

 

Over the past 48 hours I’m aware of perhaps a dozen suspected Ebola `scares’ around the world (outside of Western Africa) where one or more persons has displayed symptoms consistent with the disease – resulting in hospitalization and/or testing.

 

Recent locations have included Paris, Macedonia, Texas,  Brazil, and  Prague.

 

I’ve not blogged any of these cases because:

• Most, I believe, will turn out to be false alarms
• They are already well covered  by the media and Flublogia (Crofsblog, FluTrackers, the Flu Wiki)
• And realistically, there is little of value I can add beyond saying `We’ll have to wait to see’.

 

As I written before, whenever surveillance (whether for Ebola, Avian Flu, or MERS) works – we tend to see a lot of `suspect cases’ – although the vast majority will turn out to have something far less concerning – like seasonal flu, rhinovirus, or malaria.  

 

This fall and winter  – we’ve not only Ebola to screen for, it’s a fair bet we’ll see the return of MERS and avian flu – meaning that the number of `suspect cases’  in the news only likely to rise even further. 

 

If I tried to blog on each one of these reports, soon I’d have time for little else. None of this is a pledge that I won’t cover suspect cases – only that I feel I need more of a reason than `it has been reported somewhere in the world that . . . ‘ – before I’ll  write about it. 

 

If it is an extraordinarily unusual or potentially high-impact report, then yes, I may blog it.  And If I can add context, or additional value – then once again, I’ll probably include it. 

 

It’s a personal choice, but I’ll leave the reporting of individual suspect cases to those who do that sort of thing much better than I, and try to concentrate on more macro infectious disease and preparedness issues, to which I can hopefully add some value.

Ireland: HSE Statement – Suspected Ebola Case Tests Negative

Credit Wikipedia

 

 

# 8986

 

Yesterday (see HSE Statement: Ireland Testing Deceased Traveler From West Africa) we saw an investigation launched into the death of a recently arrived traveler from West Africa.  Today, the HSE has announced that tests have come back negative for Ebola.

 

22nd August 2014

HSE Statement

The HSE has confirmed that laboratory test samples for an individual, who had recently returned from Africa, has proved negative for Ebola Virus.

Infection control procedures, which had been put in place as a precautionary measure, will now be stepped down.

The HSE expressed its condolences to the individual’s family and friends for their loss.

 

It has been widely reported this week that more than 5 dozen people have been recently hospitalized, and either examined or tested for Ebola in the United States.  

 

Of those, none have tested positive for the disease.

 

Frankly, this is exactly what we want to see.  Aggressive testing, an abundance of caution, and lots of negative results.   

 

With the threat of a return of MERS this fall with the Hajj, an expected resurgence of avian flu this fall and winter in Asia, and the ongoing Ebola outbreak in Africa – we need to be prepared to see a lot of `suspect cases’ being tested both here in the United States, and around the world.  

France: Update On Coronavirus Suspect Cases

 

 

# 7261

 

Welcome to the new normal, where we find ourselves waiting for hours, or sometimes even days, for test results on isolated suspected nCoV and H7N9 cases.

 

For veteran H5N1 avian flu watchers, this is familiar territory.

 

This morning the French press is reporting that three of the `contacts’ of France’s nCoV case who had displayed `symptoms’ have initially tested negative for the novel coronavirus, while the status of the fourth requires further testing. 

 

A fifth case, that of a "a man, relatively young"  with mild symptoms who is currently staying at home, is also under investigation.

 

This (machine translated) report from 20Minutes.fr.  

 

Coronavirus: A fifth suspect identified

 

Updated on May 11, 2013 at 11:06.

Health A new suspect has been identified in the entourage of the patient with the novel coronavirus, SARS close, announced Saturday the Minister of Health, Marisol Touraine.

The Minister of Health, Marisol Touraine went Saturday morning at University Hospital of Lille, where four cases of coronavirus had been suspected. The Minister announced the presence of a fifth case in the entourage of the sick patient. "A fifth case contact was identified in the entourage of the sick patient. Samples were made that we know the results at the end of the day," said the minister at a press briefing.

<SNIP>

"One hundred and twenty persons identified, three (one patient who had rubbed the patient, a doctor, a nurse), and a fourth in the 10th of May had symptoms that led to virological sampling and placing them under observation in isolation, infectious diseases service, "says the ministry. "For three people, negative results are to be confirmed by the national reference center of the Pasteur Institute in Paris."

(Continue . . .)

 

 

 

As concerns over the emergence and spread of both H7N9 and nCoV grow, we are sure to see an expanding list of `suspect cases’ isolated and tested around the world.

 

Some will have a recent travel history to Asia or the Arabian peninsula, while others may have had contact with a diagnosed case. Their symptoms may range from severe, to a mild ILI (Influenza-Like-Illness). Some may even be asymptomatic. 

 

And  not surprisingly, many will test negative.

 

Some of these `negative’ findings may be the result of deficits in the procedures; a lack of sensitivity on the part of the test, the method of sample collection, the timing of sample collection, or even problems in the shipping and handling of specimens.

 

But in all likelihood, most of these negative tests will probably be correct.

For now (and hopefully well into the future) infections with more mundane seasonal respiratory viruses (Rhinoviruses, seasonal influenza, Adenovirus, RSV etc.) far exceed the number of human infections with exotic and emerging viruses like nCoV and H7N9.  

 

We get a good example of this in Hong Kong, where from yesterday’s report Update on number of suspected human cases of avian influenza A(H7) notified to CHP we learn:

 

This brings the total number of notifications received by the CHP since March 31 of cases fulfilling reporting criteria of suspected human cases of avian influenza A(H7) to 22, and the total number of notifications not fulfilling reporting criteria to 84.

<SNIP>

"Influenza A(H7) is a statutorily notifiable infectious disease in Hong Kong. Locally, no confirmed human cases of avian influenza A(H7N9) have been recorded so far," the spokesman stressed.

 

During the first couple of weeks of the H7N9 outbreak on the mainland, every `suspect’ case tested in Hong Kong was big news. 

 

Now – and until a positive case shows up – it’s the subject of a routine daily update.

 

None of this is meant to minimize the risks of these viruses spreading, or to suggest that it isn’t prudent to isolate and test any and all suspect cases. 

 

While the odds that individual ILI case might be nCoV or avian flu may be small, health officials know it only takes one super-spreader (see Influenza Transmission, PPEs & `Super Emitters’) to jump start an epidemic.

 

But even if nCoV and H7N9 prove themselves not ready for primetime, they are unlikely to fade back into the woodwork anytime soon. Additional human cases are likely, and so limited human-to-human transmission is certainly possible.

 

Which means, concerning as they may be, we might as well start getting used to seeing headlines about the testing of suspected cases around the globe, as this is a situation we are apt to be dealing with for some time.