Doctor: NYC case shows Ebola could transmit by air

Hear the interview with Dr. Joseph Frager:

New York City's first Ebola case, Dr. Craig Spencer, could demonstrate that the virus can be transmitted to humans when a patient self-aerosolizes, or vaporizes, it with a strong projection from the body.

This according to Dr. Joseph Frager, practicing physician and clinical assistant professor at the Einstein School of Medicine in New York.

Frager on Sunday night called into “Aaron Klein Investigative Radio” on New York’s AM 970, The Answer, when the host was discussing how Spencer, trained in infectious diseases, contracted the virus.

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Spencer was treating patients in West Africa with the non-profit charity Doctors without Borders, which specializes in the utilization of protective gear.

Scientists have not confirmed that the current strain of Ebola can be spread through airborne particles. But that may be due to the inability to conduct controlled human experimentation, which would require actually infecting people with an aerosolized Ebola virus.

There have been studies, including one conducted by scientists from the Centers for Disease Control and Prevention, that found strains of aerosolized Ebola were transmitted to monkeys.

Frager told Klein he believes the infection of Spencer was "an aerosolized or vaporized type of situation, and a mask was inadequate."

Frager contended that if an infected patient vaporizes enough bodily fluid – for example, through a strong sneeze, projectile vomiting or the flushing of a toilet after having had diarrhea – then particles of the disease can spread.

Frager explained that in West Africa, Spencer was likely not wearing a Level 3 respirator mask, which, he said “does not allow the particles of air to enter into a person’s mucous membranes.”

Instead, Frager surmised, Spencer was most likely utilizing Level 2 gear, which is designed for moderate protection against fluid penetration and does not fully protect against vapor.

Frager told Klein he believes that “if you vaporize enough vomit or diarrheal fluid, with flushing the toilet even … that goes into the air and at that moment there are droplets that are essentially airborne and can potentially penetrate certain types of masks.”

Frager stressed he is not an infectious disease expert but is a practicing physician with more than 35 years of experience. He pointed out he treated AIDS patients when the virus first came to the U.S. in March 1981 in New York, “so I know pretty well viral disease and its manifestations … and understanding some of the dynamics here.”

Frager wrote a brief blog post Sunday at Israel National News in which he said "it is my contention that the disease can be spread" when a patient self-vaporizes Ebola."

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Numerous studies, including one by CDC scientists, found strains of aerosolized Ebola transmittable to monkeys.

On its website, the CDC is non-committal in its response to whether or not Ebola can be spread by coughing.

The website states:

Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease.

Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.

The CDC website does not conclusively say Ebola cannot be transmitted by virus particles that remain suspended in the air after a strong cough or sneeze.

A U.S. Army Research Institute article from October 2012, titled “A Characterization of Aerosolized Sudan Virus Infection in African Green Monkeys, Cynomolgus Macaques, and Rhesus Macaques,” states human aerosol transmission of Ebola is “thought to be possible.”

The study found some of its monkeys were diagnosed with a rhesus form of the disease following aerosol transmission.

It stated: “To summarize, exposure to aerosolized SUDV results in a disease course with numerous similarities among AGMs, cynos, and rhesus: with decreased platelets, kidney and liver injury, likely leading to reduced blood volume, followed by altered blood pressure and heart rate in the final stage.”

The article abstract concluded: “There is no strong evidence of secondary transmission by the aerosol route in African filovirus outbreaks; however, aerosol transmission is thought to be possible and may occur in conditions of lower temperature and humidity which may not have been factors in outbreaks in warmer climates.”

The article related that Ebola falls within the filovirus category and that “intentional direct aerosol exposure resulting in productive infection of NHPs with filoviruses has been demonstrated in a number of studies.”

Dr. Craig Spencer in Guinea with Doctors Without Borders

A 1999 study titled “An Introduction to Ebola: The Virus and the Disease” was published in the Journal of Infectious Diseases by C. J. Peters and J. W. Peters of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention.

The study found that the "data on formal aerosol experiments leave no doubt that Ebola and Marburg viruses are stable and infectious in small-particle aerosols, and experience of transmission between experimental animals in the laboratory supports this."

The study documented a 1989–1990 case in which a Reston subtype of Ebola spread amid monkeys in separate units, suggesting “there was circumstantial evidence of airborne spread of the virus.”

The study cited “supporting observations included suggestive epidemiology in patterns of spread within rooms and between rooms in the quarantine facility, high concentrations of virus in nasal and oropharyngeal secretions, and ultrastructural visualization of abundant virus particles in alveoli.”

A 1995 report by scientists at the U.S. Army Medical Research Institute of Infectious Disease, titled “Lethal Experimental Infections of Rhesus Monkeys by Aerosolized Ebola Virus,” allows, as the title suggests, that “aerosol transmission” of Ebola is possible.

That report states the “potential for aerogenic infection by Ebola virus was established by using a head-only aerosol exposure system,” meaning the scientists self-vaporized the virus and confirmed it spread to rhesus monkeys.

The experiments documented the monkeys contracted a “rapidly fatal disease” from the aerosol dose, including from “inhalation of viral doses as low as 400 plaque-forming units of virus.”