DIYbio against Ebola!

[Patrik D'haeseleer]

We had a nice meetup talking about Ebola here at Counter Culture Labs last week (recording coming...), and I know La Paillasse in Paris is really interested in the topic as well. 

Last week, President Obama announced a Grand Challenge for Development on Fighting Ebola:

http://www.usaid.gov/grandchallenges/ebola

So, how can we as DIYbio community contribute to the fight? 

- Protective equipment is a huge issue, with health workers needing to wear head-to-toe protective suits in 100+ F heat all day long. Can we learn anything from how sports mascot suits are constructed with built-in ventilation, for example? Just a wild idea...

- They seem to be wearing isolation suits designed to protect against aerosols, but Ebola is not aerosol transmitted. Can the suits be simplified, so health workers no longer need to choose between dying of heat exhaustion of infection.

- Taking *off* those protective suits turns out to be a major source of infections for hospital personnel. Could they be redesigned to be more inherently safe to take off? NASA's new Z-1 Z-1 space suit has a hatch on the back that allows the suit to dock with a portal on a spacecraft or rover so an astronaut can crawl through without letting dust in or air out. Probably overkill, but perhaps there's something to treating the entire suit as a "glove" that you can take off. Does anyone have access to design info on the current suits, and maybe a video showing how to put them on & take them off?

- There are at least 99 viral genomes available from just the current epidemic, containing hundreds of mutations for which we have no clue what (if anything) they do. Can we learn anything about those by studying them computationally? How about experimentally (preferably without tripping all sorts of alarms by ordering Ebola genes to be DNA synthesized!)

Discuss!

Patrik

[André Esteves]

A newsclip related to your first point.

Cheers, Andre Esteves

http://edition.cnn.com/2014/09/25/health/ebola-fatu-family/

(CNN) -- It can be exhausting nursing a child through a nasty bout with the flu, so imagine how 22-year-old Fatu Kekula felt nursing her entire family through Ebola.

Her father. Her mother. Her sister. Her cousin. Fatu took care of them all, single-handedly feeding them, cleaning them and giving them medications.

And she did so with remarkable success. Three out of her four patients survived. That's a 25% death rate -- considerably better than the estimated Ebola death rate of 70%.

Fatu stayed healthy, which is noteworthy considering that more than 300 health care workers have become infected with Ebola, and she didn't even have personal protection equipment -- those white space suits and goggles used in Ebola treatment units.

Woman cares for her family with EbolaThis team picks up Ebola's deadEbola overwhelms new hospital in LiberiaDesperation grows in heart of Ebola zone

Instead Fatu, who's in her final year of nursing school, invented her own equipment. International aid workers heard about Fatu's "trash bag method" and are now teaching it to other West Africans who can't get into hospitals and don't have protective gear of their own.

Every day, several times a day for about two weeks, Fatu put trash bags over her socks and tied them in a knot over her calves. Then she put on a pair of rubber boots and then another set of trash bags over the boots.

She wrapped her hair in a pair of stockings and over that a trash bag. Next she donned a raincoat and four pairs of gloves on each hand, followed by a mask.

It was an arduous and time-consuming process, but Fatu was religious about it, never cutting corners.

UNICEF Spokeswoman Sarah Crowe said Fatu is amazing.

"Essentially this is a tale of how communities are doing things for themselves," Crowe said. "Our approach is to listen and work with communities and help them do the best they can with what they have."

Two doctors for 85,000 people

She emphasized, of course, that it would be better for patients to be in real hospitals with doctors and nurses in protective gear -- it's just that those things aren't available to many West Africans.

No one knows that better than Fatu.

Her Ebola nightmare started Juy 27, when her father, Moses, had a spike in blood pressure. She took him to a hospital in their home city of Kakata.

A bed was free because a patient had just passed away. What no one realized at the time was that the patient had died of Ebola.

One woman walked in, and the Ebola nightmare began

Moses, 52, developed a fever, vomiting and diarrhea. Then the hospital closed down because nurses started dying of Ebola.

Fatu took her father to Monrovia, the capital city, about a 90-minute drive via difficult roads. Three hospitals turned him away because they were full.

She took him back to another hospital in Kakata. They said he had typhoid fever and did little for him, so Fatu took him home, where he infected three other family members: Fatu's mother, Victoria, 57; Fatu's sister, Vivian, 28, and their 14-year-old cousin who was living with them, Alfred Winnie.

Guilty of Ebola until proven otherwise

While operating her one-woman Ebola hospital for two weeks, Fatu consulted with their family doctor, who would talk to her on the phone, but wouldn't come to the house. She gave them medicines she obtained from the local clinic and fluids through intravenous lines that she started.

At times, her patients' blood pressure plummeted so low she feared they would die.

"I cried many times," she said. "I said 'God, you want to tell me I'm going to lose my entire family?' "

But her father, mother, and sister rallied and were well on their way to recovery when space became available at JFK Medical Center on August 17. Alfred never recovered, though, and passed away at the hospital the next day.

"I'm very, very proud," her father said. "She saved my life through the almighty God."

Now he's working to find a scholarship for Fatu so she can finish her final year of nursing school. He has no doubt his daughter will go on to save many more people during her life.

"I'm sure she'll be a great giant of Liberia," he said.

Ebola patients left to lay on the ground

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[Alex]

Very interesting thoughts and topic Patrik! So far, I've only got one thought on the matter and I've written it below.

On Oct 2, 2014 6:35 AM, "Patrik D'haeseleer" <pat...@gmail.com> wrote:
>
> - They seem to be wearing isolation suits designed to protect against aerosols, but Ebola is not aerosol transmitted. Can the suits be simplified, so health workers no longer need to choose between dying of heat exhaustion of infection.

I have a very low amount of knowledge about viruses but isn't it entirely possible for it to mutate to be transmitted through the air? If so, I think I'd rather suffer in a ridiculously hot suit than take the chance of the next patient that I treat having an aerosol transmitting mutation.

Changing the suit as such would also be a huge problem if the virus did mutate as we'd have a huge percentage of doctors that would have insufficient suits for the new mutation.

For ventilation, aerosol or not, it doesn't seem like it'd be a good idea to take the air in a sick patient ward and concentrate it into a single suit for someone to breath. What about an internal active cooler of some sort?

A hacky way to do it could just be a Peltier module with the heat sync portion on the outside of the suit and a fan internally to attempt to force the cool air around? Maybe based on top of a foot? (Minimal accidental movement from swaying etc+extra weight wouldn't really be an issue) Not to mention there may be something to the "one foot out" ventilation method people use when too warm in bed!

Just some random thoughts that I had! Interested to see some others passed around!

Alex
>
> Discuss!
>
> Patrik

[André Esteves]

From the news clip we gather that remedial isolation suits can be successful.

The question is: How to test your contraptions without being in the field?

There must be quantitative protocols and procedures to test suits.

Can they be used by the DYI community? Could they be simplified to that measure?

NATO probably has published  protocols for testing HASMAT equipment for chemical and bacterial war...

Cheers,

Andre Esteves

2014-10-02 11:35 GMT+01:00 Patrik D'haeseleer <pat...@gmail.com>:

[Patrik D'haeseleer]

On Thursday, October 2, 2014 4:40:30 AM UTC-7, ­­Alex P wrote:

I have a very low amount of knowledge about viruses but isn't it entirely possible for it to mutate to be transmitted through the air?

Good question, and this is actually something that there is a lot of fearmongering around. In fact, this same question came up back in the day when we had just learned about HIV as well!

The Ebola virus is actually very unstable, and does not seem able to survive in the high-oxygen, low-moisture environment that you find in the tiny aerosol droplets that are able to float in the air. It's not totally understood what mechanisms are involved to allow viruses to survive in aerosols (or on surfaces, for that matter), but all evidence suggest that this is a very non-trivial change.

In fact, there are NO known examples of a natural virus switching from a different transmission route to being transmissible by aerosol! That's not just "it's never been seen in other Ebola outbreaks" - this has never been seen in ANY virus.

(The gain-of-function experiments with H5N1 flu in ferrets don't really count here. Most flu strains are transmissible through the air, so we already know that they have the mechanisms to do so. And even then it took several rounds of literally stuffing the virus into ferret's lungs for it to become adapted to its new host species. Oh, and it actually stopped making the ferrets sick once it evolved to be able to infect them through the air, suggesting there is soem significant cost associated for the virus.)

Here are some excellent resources about Ebola:

• Is Ebola virus going to kill me? - If you’re asking that question, this is for you.

• TWiV 297: Ebola! Don’t panic, and TWiV 302: The sky is falling - two outstanding episodes of Patrik's favorite hard-core science podcast, This Week in Virology. Also contains tons of useful links.

• CDC page on 2014 Ebola Outbreak in West Africa 

• WHO page on Ebola Virus Disease

Patrik

[Alex]

Awesome information, thanks Patrik!

Alex

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[Patrik D'haeseleer]

Forgot to mention one more point:

The Russians actually tried to weaponize Ebola, back when they still had a big bioweapons program! But they gave up on it because they weren't able to keep it alive for long enough in the air...

Patrik

[Alex]

That's very interesting!

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[Patrik D'haeseleer]

On Thursday, October 2, 2014 5:34:41 AM UTC-7, aife wrote:

From the news clip we gather that remedial isolation suits can be successful.

The question is: How to test your contraptions without being in the field?

There must be quantitative protocols and procedures to test suits.

Can they be used by the DYI community? Could they be simplified to that measure?

NATO probably has published  protocols for testing HASMAT equipment for chemical and bacterial war...

All great points! Does anyone know where to look up this type of information? Got some video links to share?

Anyone know where we could get our hands on a few isolation suits that are representative of the ones currently in use in Africa? Maybe we can set up a "give one, get one" program for DIYbio labs...

I would assume these suits are tested using nanoparticles, or innocuous viral particles or bacterial spores - not too dissimilar to the discussion we've had here on testing HEPA filters. But (a) that seems overkill for a virus that can only spread through direct contact or large (non-aerosol) liquid droplets, and (b) it doesn't necessarily account for ease of avoiding contamination during removal.

[Yuriy Fazylov]

Heat synch and a an absorbent chemical that increases it's surface area would do the job, I think.
Someone recently came up with a personal AC system. It fits on a wrist, and cools body much like a kenguroos would. I think it even came out on Make issue. What if the heat could be made to escape outside the suit instead of into body's immediate surrounding?

As for the chemical see space suits equipment that soak up moisture. SO4 looks good.

There is a question that's been nagging on my mind & I'd like to ask/propose it here. Do you think Gatorade could help Ebola patients?

[Bryan Bishop]

On Thu, Oct 2, 2014 at 5:35 AM, Patrik D'haeseleer <pat...@gmail.com> wrote:

- Protective equipment is a huge issue, with health workers needing to wear head-to-toe protective suits in 100+ F heat all day long. Can we learn anything from how sports mascot suits are constructed with built-in ventilation, for example? Just a wild idea...

You may be interested in looking into how astronauts keep cool. They have reduced maneuverability but there's all sorts of strange materials to help with heat management issues. Also, consider flipping it around where instead of isolating healthcare workers from patients, the patients should be the ones under isolation (and from each other, and don't contaminate different patients with the same hazard suits, etc). Unfortunately the cost of per-patient isolation is high. I am not sure how to solve that. Isolation tanks, flush to clean? https://www.kickstarter.com/projects/1070936311/zen-float-tent-first-affordable-isolation-tank-for Needs some rubber glove attachments, larger windows, temperature sensors, communication, entertainment/music, secure draining (or just constant flow of water), feeding, wash cycle, some way of keeping comfortable during dry cycles, etc. I haven't put much thought into this.

 

- Taking *off* those protective suits turns out to be a major source of infections for hospital personnel. Could they be redesigned to be more inherently safe to take off? NASA's new Z-1 Z-1 space suit has a hatch on the back that allows the suit to dock with a portal on a spacecraft or rover so an astronaut can crawl through without letting dust in or air out. Probably overkill, but perhaps there's something to treating the entire suit as a "glove" that you can take off.

I think overkill is better in this situation, since the alternative means possible infection. Start with overkill, then back off from there.

 

- Bryan
http://heybryan.org/
1 512 203 0507

[Cathal Garvey]

IIRC, Ebola is enveloped. Usually, this means "highly susceptible to
solvents and detergents", so I wonder if the real area worth addressing
is trivial spray-down equipment?

That is, rather than changing suits between patients and isolation
units, why not design suits to be extremely efficiently spray-able
(highly wetting), and design an easily DIYable sprayer rig for cheap
detergent or alcohol?

Also interesting would be the nanotech approach, of designing an active
surface which behaved like a static "detergent", perhaps a hyper-wetting
surface that sort of "splats" the envelope on contact, leaving naked
viral capsids that can't adhere to cells.

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[Jonathan Street]

There seems to be a big disconnect between the solutions being proposed here and what is viable/needed on the ground. Much of the discussion has been focused on improving isolation suits. Although occasionally shown in the media as I understand it these are not what is typically used in the epidemic area. Patrik was spot on when he said,

"- They seem to be wearing isolation suits designed to protect against aerosols, but Ebola is not aerosol transmitted. Can the suits be simplified, so health workers no longer need to choose between dying of heat exhaustion of infection."

They aren't needed so more efficient solutions are used. Wearing multiple layers, gloves, apron, face mask etc is still very hot though.

Cooling the healthcare worker may still be beneficial but it would probably need to be something like the cooling vests bikers sometimes use rather than an air conditioning system.

This page summarizes the key aspects for how ebola patients should be managed - http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Some more details on the PPE being used - http://www.who.int/features/2014/ebola-liberia/en/

This video gives a good overview of the situation on the ground - http://videocast.nih.gov/launch.asp?18628

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[Patrik D'haeseleer]

On Saturday, October 4, 2014 12:34:07 PM UTC-7, Cathal Garvey wrote:

IIRC, Ebola is enveloped. Usually, this means "highly susceptible to
solvents and detergents", so I wonder if the real area worth addressing
is trivial spray-down equipment?

That is, rather than changing suits between patients and isolation
units, why not design suits to be extremely efficiently spray-able
(highly wetting), and design an easily DIYable sprayer rig for cheap
detergent or alcohol?

They are already doing tons of spraying in all areas that ebola patients have passed through. Not sure exactly what they are spraying - bleach? Also not sure whether lack of availability of the sprayers and/or the chemical to be sprayed is a significant issue.

An idea that was sparked by an off-hand comment on - I think  - This Week in Virology: part of the reason why some viruses don't survive in aerosols is that a rapidly drying droplet creases a high-salt environment. So could some of these viruses be defeated by a simple salt spray? If so, that is potentially a treatment that even people in remote villages could use to reduce the risk of infection.

 

Patrik

[Patrik D'haeseleer]

Thanks Jonathan - lots of really useful info there! 

On Saturday, October 4, 2014 12:52:05 PM UTC-7, Jonathan Street wrote:

There seems to be a big disconnect between the solutions being proposed here and what is viable/needed on the ground. Much of the discussion has been focused on improving isolation suits. Although occasionally shown in the media as I understand it these are not what is typically used in the epidemic area. [...] 

They aren't needed so more efficient solutions are used. Wearing multiple layers, gloves, apron, face mask etc is still very hot though.

Cooling the healthcare worker may still be beneficial but it would probably need to be something like the cooling vests bikers sometimes use rather than an air conditioning system.