Editor's Note #21 Far better resting place I go to than I have ever known...

I've spent all day analysing why the death of a person I never knew makes me sad. And as the day draws to a close, I've settled on the fact that it is what he represented to me, so many years ago, and for so many years since, that makes me sad that he has left the world. So I've devoted my day to remembering Star Trek and Spock - Leonard Nimoy's most iconic of characters, and to being grateful Mr Nimoy put so much of himself into that role so many years ago.

In the passing of Spock I'm revisiting so many things he inadvertently taught me as a younger version of myself; things that have some part in making me who I am today.

Top of the list is science. Spock got to look for stuff, understand stuff, deal calmly and logically (I fail greatly here) with things, and was a valued and integral member of his crew. Of course I'd have loved to be on an Enterprise, seeking, learning and finding stuff in space, too! I can't quantify how much Spock and Star Trek have shaped my drive to search and find some more earthly things - seek new viruses, learn new knowledge and find out how infectious diseases are caused.

From here.

Spock was Mr Nimoy. But more than that-all Vulcans must now have elements of Mr Nimoy's portrayal of this one character or for many, they are not Vulcan at all. That's quite an acting legacy. You can't just write "be logical" down on a script-you have to have seen a Vulcan. A part of Nimoy was given to Spock. Other actors achieve this too of course - to my mind all Klingons are represented by Michael Dorn, Rangers by Viggo Mortensen, Wolverine is Hugh Jackman, Tony Stark is Robert Downey Jr, Batman is Christian Bale...and so on.

As Bones said in Star Trek II: The Wrath of Khan (from which the image above is borrowed): "He's really not dead, as long as we remember him". 

Of course we will remember him. How could we forget the person, the character, the message of hope, tolerance and that use of logic? And the accidental humour. Spock was a perfect foil used so well to look both at, and into, ourselves.

Today I still very much respect and admire the ideals that represent the many iterations of earlier Star Trek voyages - care, knowledge, teamwork and a sense of shared goals chosen for the betterment of us all. 

In a world  that can so often be filled with hate, pettiness, self-interest, fractured communities, an absence of care, a disrespect of knowledge and lack of desire to work together, Trek still contains hope that others who share the mission and vision will eventually rise high enough in their roles, often enough, to make the world a better place. Many already do. Star Trek's creators and those who brought its many stories to us, are owed much.

We should always strive to continue the ongoing mission to explore, seek and boldly go where no-one has gone before, in whatever it is that we choose to do. 

Spock understood the need to work for everyone's benefit. He voiced it so well when he reminded Kirk that he has no ego to bruise and that "The needs of the many outweigh the needs of the few". We should try and stow our own egos more often, and work towards the bigger needs. We should do that as part of the same cree more often too - that of the spaceship Earth.

The ship is not yet out of danger Spock, but you gave us a lot to help make it work better. 

LLAP

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NEURONS IN UNIFORMS: Neurology at the Indian Armed Forces Medical Institution,New Delhi,India

January 24,2015

Week 2 and Beyond

Salient Aspects of Outpatient Department

India has a "bilingual medical system �patient interviews in Hindi and case presentations in English. Unless absolutely needed the CT scans and MRI were not done emergently and this made my brain exercise a lot in localizing lesions based on clinical presentation alone Neurocysticercosis and tuberculous brain abscess were relatively common in far flunked remote areas with limited access to medical care and these people would then come to us with some classic textbook radiology findings. I also saw many seizure patients and all the drugs commonly used in US were freely available at least in this center. If these patients insisted on following up with local Army hospitals (and not the special 8 Neurology Centers) we had to be more judicious in our medication choice for these patients. This was because there was limited variety of antiepileptic medications available at peripheral smaller medical centers.

Didactics and Conferences

Monday Journal Club comprised of discussing about CHANCE and SAMPRISS trials. Tuesday Chief rounds was an interesting case of Peripheral lower extremity tingling which completely resolved in 4 days and what was left was some ankle weakness and minimal limb girdle weakness. Interestingly the nerve conduction studies, Electromyography, Brain and Spine MRI were all normal. CSF analysis was unremarkable as well. Onwards plan was to repeat EMG. A muscle biopsy was to follow suite. Wednesay Neuroradiology conference was again exciting with a case of ring enhancing lesion on MRI Brain. It was really nice of Neuroradiology folks to spend some extra time with me teaching me about some tips and tricks of reading �films�. There was also a joint Neurology and Medicine case conference on approach to Altered Mental status. A round table discussion about a bed bound patient and its prognosis made us all plunge into article review about prognosis of Coma which then was discussed in resident report of the week. I discussed about an article in Journal of Neurology, Neurosurgery and Psychiatry on Medical Coma Prognosis.

Inpatient and Neuroscience ICU cases.

Vascular Neurology cases (stroke, subarachnoid hemorrhage, intracerebral hemorrhage) were the mainstay in the ICU. There was also a case of Guillain-Barre syndrome. We had some great attending inputs on how lack of long term rehab units or acute level rehab facilities tend to cause prolonged stay of some patients in ICU and floors. An interesting case of refractory seizures with normal MRI and not so helpful interictal (inbetween seizure event) EEG was puzzling everyone.24 hour Video EEG was available but not so commonly used and the patient was referred to All India Institute of Medical Sciences for further care.

Visiting All India Institute of Medical Sciences(A.I.I.M.S)

Army Institution did not have an Epilepsy Monitoring unit and not a very aggressive Neuro Intervention team. They referred complex Epilepsy cases to A.I.I.M.S.So, towards the end of my elective my preceptor helped me connect with this hospital and the Neurology faculty there. It is the best public sector Indian hospital with all sub specialties and a huge patient workload. The Epilepsy monitoring unit was pretty similar to what I had seen at Brigham and Women hospital .I spent the morning rounds on these patients with Epilepsy fellow and attending. There was an interesting case of Frontal Lobe seizures which required sharp eyes to decipher the location of seizure onset on EEG. There was another interesting case of what looked like Non epileptic spells and I was part of a long family meeting and patient counseling on this issue.Similar settings like our Neuropsychiatry team at Brigham talking to patients with similar presentations and etiologies.

The Neuroradiology conference was wonderful and I felt �homely� seeing Centricity Software (used at Brigham) being used to see the Neurology Images at A.I.I.M.S..

Epilepsy Surgery case conference were a treat to attend. The residents told me that the reason they went on so well was that the head of Epilepsy division was married to the Head of Epilepsy surgery division. One can understand the popularity of this institution and the huge patient workload by the fact that the wait time for Epilepsy monitoring admissions was close to 1 year.

The Epilepsy clinics were held each day and were blessed with some of the finest cases from the country. Structural lesions causing seizures (prior stroke or hemorrhage, sequlae of brain infections, tumors) as well as childhood syndromes comprised the majority and for many the cause was yet to be determined. My aim in clinic was to learn and understand the selection of anti-epileptic medications based on age, gender, co-morbidities, seizure type and most importantly (believe it or not) cost and availability at patients home city or village.

The rich and poor paradox in India in Healthcare Sector

On my last day, I decided to spend a few hours at the other extreme of Medical care; A super specialty ultra modern western model of corporate hospital called Medanta-The Medicity(A hub of what is popularly called as Medical Tourism).  It had a completely different patient population. Very well to do families from other Asian countries and also Africa were the major clients/patients here in addition to affluent Indians. My aim of visiting this place was to see how choice of anti-epiletic medication or the approach towards Neurology Intervention procedures/surgeries changes when patients are from super well to do families. 

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Neurons in Uniforms: Armed Forces Medical Instituion in New Delhi,India

January 10, 2015

Week 1 Day 1: The Beginning

Finally, after an 18 hour flight and a new year eve somewhere in the skies over the Arabian sea,i joined the Neurology team at Army  hospital. Day 1 was exciting, challenging, demanding and surprising all at the same time.

Monday was a busy outpatient clinic day. No appointments are needed and patients can just show up on Monday, Wednesday or Friday mornings. Together with 3 other residents, I was supposed to see a long queue of patients waiting outside the room. It took me almost 30 minutes to interview, examine and make notes of my first case; what looked like a case of mononeuropathy multiplex. With a list of 40-50 patients (old and new) and limited time(close to 3-4 hours to see all of them) the residents would usually write very small notes and do a quick focused and limited exam. The patient population comprised of Armed forces personal (serving and retired) and their family members. With only 8 defense forces Neurology centers all across the country, the outpatient department gets interesting referrals from hundreds of smaller base hospitals. The clinics were followed by Journal Club on Oral Medications for Multiple Sclerosis. I also shared my experience about the Partners MS Center Clinics and our most current practices.India, although a largely warm country does has its share of high altitudes in Himalayas and Multiple Sclerosis cases are found in this belt. The rest of the day comprised of inpatient bed side rounds which are usually lightning fast on Outpatient Clinic days.

Day 2 and beyond
Day 2 began with a case presentation of distal myopathy. I had presented a similar case of Titin mutation anterior tibial compartment myopathy at Brigham neuropathology conference in 11/2014 and I felt really excited to see a similar case on the other side of the globe. The highlight of Day 2 was my first exposure to their bed side rounds. There is just one team that rounds ED Neurology, ICU Neurology, inpatient consults on other services as well as Neurology inpatient. A typical daily census is 5-6 new floor admits, 3-4 new consults and 1-2 ICU admit daily on Neurology service. In absence of acute rehabs and virtually no step down units, the inpatient stay is usually longer than what it is in US. Also there are lots of outside hospital transfers from smaller district level centers. It took almost 5 hours to round on approx 50 patients. The residents (including) me were asked management pertinent questions and given an assignment during rounds which was discussed the next day. An interesting case i saw was Tubercular Transverse Myelitis which helped me revise Spinal Cord anatomy and syndromes in fine detail.

Day 3 was again the outpatient day. Now i was well versed with the system. Soon i realized that Migraine, Sciatica, Carpal Tunnel Syndrome, Diabetic and Vitamin B12 peripheral neuropathy are the flag bearers of Neurology outpatient cases all over the world. I saw plenty of follow-up intracerebral hemorrhage cases and it is exciting to see CT scans and MRI on �films� rather than computers. Didactics comprised of a presentation on Visual Evoked potential and Brain Stem Auditory evoked potential by a senior resident.

By day 4, I began to appreciate a very strict hierarchical system in the Armed Force Medical wing."Sir" and "Madam" were supposed to be used strictly for anyone senior to you and most of the times also for your colleagues. Among the new admissions overnight the most interesting was a cardioembolic stroke in the left middle cerebral artery territory who presented with right face, arm and leg weakness. He was given IV thrombolytic (tPA) and NIH stroke scale improved from 10 to 5. I realized that intra arterial therapy (tPA) or even mechanical clot retrieval was not well developed in this center and in spite of presenting within 2 hours of presentation a CT angiogram was not pursued emergently.  I gave a brief talk and discussed how intra-arterial treatment was pursued in our system.

Day 5 was again the outpatient clinics. I was more inclined to develop expertise in reading MRI and CT films so requested the Clinic manager(who doubles up as EEG tech in afternoon) to direct all patients who have films in their hands towards my room. It was great discussing all these cases with my attending who shared some very useful tips about these reads.

On Day 6, I decided to ditch my car and took the local Metro train to make it to a Neuroradiology conference. The cases comprised of space occupying lesions, intractable epilepsy and some spinal cord pathologies. It was a completely different cup of tea to look at films and appreciate subtle deficits. I missed our PACS, CAS and Centricity (Computer software based Radiology image viewers) so badly.

Overall, my intial days helped me understand a system which has immense patient load and limited radiology support but lots of clinical marvels to learn Neurology.

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A new Middle East respiratory syndrome coronavirus (MERS-CoV) table of graphs stacks up...

My new favourite graphic. 

This shows MERS-CoV detection by month since the virus was identified in 2012. Detections are further broken down by each region of the Kingdom of Saudi Arabia (KSA) in which they were reported  by the KSA Ministry of Health website here.

At the moment its highlights that the KSA has a real problem in the Eastern region (Ash Sharqiyah) and growing issue in Ar Riyad (as always with MERS-CoV detections) but that Al Quassim region is also of growing concern.

This table of graphs is part of my MERS-CoV static page to be found at... http://newsmedicalnet.blogspot.com.au/2014/08/mers-cov-daily-monthly-and-cumulative.html

I try and update these data as often as possible - at the moment detection are rising and February is currently the 4th largest month for new detections - updates occur every day or two.

References...

1. Kingdom of Saudi Arabia Ministry of Helath MERS-CoV data http://www.moh.gov.sa/en/CCC/pressreleases/pages/default.aspx

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Transmission of Ebola viruses: What we know and jumping the black swan

Last week a review was released entitled Transmission of Ebola Viruses: What We Know and What We Do Not Know. The review, which is listed in the Opinion / Hypothesis section of mBio, was penned by by Michael T Osterholm and a large team of Ebola experts. You may know him from such articles as What We�re Afraid to Say About Ebola and What we should � and shouldn't � be worried about regarding Ebola or his entertaining seminar at the Johns Hopkins Bloomberg School of Public Health Ebola forum.

First up a few random points from me...

• This is basically a good review of the historical literature on transmission of Ebola virus and some other ebolaviruses. By the way, this literature is based on real experience, observation and experimentation, defining our understanding of how Ebola virus has transmitted among humans.
  It's worth noting that there have been no concerns made public, nor any new transmission data from the epidemic in West Africa, which indicate changes in the way Ebola virus spreads from person to person
• This review is an opinion/hypothesis piece so it has a lot of room to move. The language fairly clearly defines where the thinking strays into areas without any actual data to support them. Look for phrases with words like "possible", "could", "postulated", "may", "suggesting" and "can"

A quote from the new review by Osterholm
and experts. Highlighting is mine.

• Does anyone actually care whether we use words like aerosol, airborne, droplet, droplet nuclei, wet droplets or propelled to mean "not by touch"? I'm not sure any more, but I think they should. Words have meaning and slightly different words carry subtley, yet importantly different meanings. It's important to keep in mind who the messages relating to public health should ultimately try and reach - that would be the public. Experts, comparatively few in number, already have an innate sense of the differences between the words above, right? Right?! Well, many do anyway. Trying to change language or redefine a target in the midst of an epidemic, is at best bad timing and at worst it seems self-serving (although to what end I cannot guess). 

Suggested ways in which an ebolavirus can spread from a known EVD case to a new person. The most likely route is suggested by the thickest arrows with solid outlines while the least likely or most improbable route is indicated by the thinnest arrow with a dashed outline.
Click on image to enlarge.

• Ebolaviruses are not just blood-borne viruses in humans like HIV is for example; they are not just gastrointestinal viruses like norovirus (although droplets play a role here too); they are not considered by anyone to be airborne viruses like influenza virus
  What they are, in a transmission sense, is a hybrid of the first two - reaching high loads in the blood and the gastrointestinal system. To me, these shared features make it more clear why a different level of personal protective equipment (PPE) is needed than would be considered essential for caring with patients with just one or other type of virus
• One distinct viral group may remain infectious for a longer period, shorter period, or not at all compared to another distinct viral group, in droplet nuclei - the air-dried (gel-like mix of proteins and salts..and infectious or non-infectious virus) form of droplets that have not yet hit an object or the ground.
• The figure of just 1-10 viruses being required for an infection to take hold has generously been bandied about during the Zaire ebolavirus (the EBOV|Mak variant) epidemic of 2014/2015. But some overlook a simple component of this apparently easy infection process; 1-10 viruses landing on a cell is not the same as 1-10 intact infectious viruses being emitted from an infected host, travelling out of the host's infected cells in a drop of blood, semen, urine, sweat, saliva, diarrhoea or vomit, retaining infectivity while passing through various environmental conditions, onto a new host's mucosal surface, perhaps indirectly via a hard surface, getting past that body's innate immune defences and eventually attaching onto and gaining entry into that new host's cell, successfully replicating within it and then infecting neighbouring cells to establish a new infection. It may take thousands or hundreds of thousands of viruses in that initial drop of infection material to get those 1-10 infectious virus particles to start a productive, symptomatic human infection.
  We know little about this part of the story outside of the laboratory
• On that theme, there is much in general we still do not know about the ebolaviruses and Ebola virus disease (EVD). Direct contact with virus-laden fluids or a needle-stick injury are still considered to be major routes for acquiring an ebolavirus infection but direct mucosal contact with propelled droplets may occur at distance further away than the old 3ft/1m rule.(6)
  Truly airborne dried or semi-dried droplets that contain sufficient infectious Ebola virus, can be inspired and can result in an upper or lower respiratory tract infection that progresses to become systemic EVD in humans....have yet to be found. They may contribute to infections, but it will be very hard to prove that this is a transmission pathway that exists as a thing separate from droplet transmission. The authors sort of note this difficulty too; both droplets and droplet nuclei result from coughs, sneezes and explosive vomiting and diarrhoea.
  The suggestion that droplets are produced from the respiratory tract and then inhaled by another person (6) resulting in EVD is really straining the use of "improbable"
• I've written about some of this stuff before - on the distinct issue of Ebola virus and pigs here, on droplets and droplet nuclei here, the complexities of contact here, on seeking some better words here and on previous versions of this theme by some authors of this latest review here and here and I'm not going to rehash all of that here! I invite you to read those posts

Mixed messages..

A problems I have with this review is this line in the abstract..

We also hypothesize that Ebola viruses have the potential to be respiratory pathogens with primary respiratory spread.

While Osterholm and expert colleagues round off the review by clearly stating that airborne ebolavirus transmission is an "improbable scenario", and that droplet transmission is plausible (I don't disagree with the latter statement), parts of the rest of the review struggle to tow that line quite so clearly. The media seemed to have struggled to find that message too..

It is 'very likely' that the Ebola virus will spread through airborne particles, experts say
Daly Mail

Limited airborne transmission of Ebola is �very likely,� new analysis says
Washington Post

..although one bright light in the gloom managed extremely well..

No, A New Scientific Report Does Not Say That Ebola Is Now Airborne
Vice News

Prof Vincent Racaniello noted in his blog post about the review that we understand what viruses do now, by what we have observed them to be capable of doing in the past. 

Do ebolaviruses actually have the potential to shift to a primary method of spread that occurs via droplets or droplet nuclei and spread like a rhinovirus, influenza virus or the measles..to name a few? If no virus which we humans have ever watched has changed its method of spread so dramatically before, why would this particular one do it now? Well, why wouldn't it, you may well ask? Because it takes more than some genomic mutations and drift to do this. At some point we need to remember that each virus comes with its own toolset and it doesn't usually have a lot of replacement parts or upgrades in a satchel over its capsid. It can only tweak its component parts so much and so far before it reaches the limit of what it "is". Could one virus become another virus? Maybe it could. I look forward to becoming Superman myself. What would it take to overcome whatever biological throttles have existed on the ebolaviruses prior to so much human spread, for a virus to stop spreading primarily by fluids resulting from certain host disease processes, to being spread mostly by inspiration of respirable droplets? Certainly something we've never seen before and something in need of a utility belt and  can of bat EBOla repellent. Again, we're not just talking about some "genotypic changes"; the ebolaviruses would need to accumulate a plethora of stable genetic changes to make that sort of transition, possibly in combination with changes in the disease processes within its host...us.

An opinion by any other title...

Despite the review being an opinion piece, it seems to have some trouble owning up to its own real opinion; that Ebola viruses can spread by a new route and cause new disease. The title really should have reflected the content better in this regard. In approximate number 5,800 words included 440 (8%) on animal transmission studies which are mostly about aerosol spread; 925 (16%) devoted to defining aerosols and droplets and trying to change the paradigm; 670 (12%) about what we need to learn, which includes some content on aerosol transmission; 670 (12%) on a respiratory transmission hypothesis. So a sizable chunk, nearly half of the content, is heavily focussed on educating us abut Ebola and aerosol transmission. The topic is additionally reinforced within every other section as well. So why hide what the article was really focussed on; not the general transmission of ebolaviruses, but transmission via an as yet unproven-route? The authors note that an "aerosol" contains all the different droplet sizes and degrees of droplet wetness and that this entire range is propelled out of us via cough, vomit, diarrhoea and by  aerosol generating mechanical procedures. We agree on that bit. But once the bigger wetter droplets fall away and one is not standing unprotected within their range, is there an infectious virus left in the drier smaller droplet nuclei which are held aloft by air currents until they impact with something or someone? 

Have we ever seen Ebola virus infections caught by people walking into a room after an infected case has left it...as is the case for measles or rhinovirus, truly airborne transmissible viruses? Or is droplet spread only occurring in close proximity to the source? This is another point the authors raise-that being close to someone who just vomited may result in breathing in larger droplets that are infectious but have not yet fallen to the ground. How will we ever know that this is not a propelled droplet instead? Explosively coughed or vomited material can travel a sizable distance as well? So we still await some evidence to support the musing that inhaled droplets carry infectious ebolavirus in them, and that they are distinct from the more likely impacting of propelled droplets. Propelled droplets are likely a key reason that updated PPE guidelines recommend against any exposed skin and the use of eye protection, gloves, boots and a respirator; the yellow suits that will forever be linked to EVD in West Africa. But even those suits don't support that Ebola virus has been, or is showing new signs of, spreading primarily via a respiratory route?

What I could not find in this new review was a more thorough discussion - and some hypothesis and opinion - of the risk associated with how healthcare workers acquired their infections when outside of Ebola treatment units or in western hospitals. Also absent was opinion on the practical risks of semen remaining infectious, or harbouring viral RNA as was found in 2014 in a returning asymptomatic convalescent man [3] (sexual transmission has not been documented [11]). I would very much have liked to read some hypotheses on the role infectious urine might play in urban settings lacking no sewers and with densely co-located populations, since urine has been shown to remain infectious for longer than blood, in a detailed case study from Germany in 2014.[3]

Wrap up...

So to summarize, coming into contact with virus-laden body fluids either by touch, perhaps via an intermediate surface (a fomite; unproven) or by having these fluids propelled onto you (as yet unproven), are considered the main risk factors that comprise the overwhelming majority of human-acquired ebolavirus infections. Current PPE guidelines are designed to combat these and if western hospitals are any guide, they work well - although it's a tough comparison given the different carer-to-patient ratios in western hospitals compared to outbreak conditions in west Africa. 

What role "respirable droplets" or droplet nuclei play in transmitting ebolaviruses between humans awaits evidence but nothing points to a role for an airborne route of infection in west Africa.[6] Hopefully some studies will be looking very hard at this question. Nothing hints at any changes in  EBOV/Mak that could result in it becoming a "respiratory pathogen with primary respiratory spread" capability.

I recommend reading a few other recent reviews and articles to get a more rounded view [7,8,10,12] and if you want to see droplet, aerosol and airborne get smooshed together into an undifferentiated mess, that's in print too.[9]

References...

1. Transmission of Ebola Viruses: What We Know and What We Do Not Knowhttp://mbio.asm.org/content/6/2/e00137-15
2. Experts suspect Ebola virus sometimes spreads by air
   http://www.cidrap.umn.edu/news-perspective/2015/02/experts-suspect-ebola-virus-sometimes-spreads-air
3. A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia.
   Kreuels B, Wichmann D, Emmerich P et al.  N Engl J Med. 2014 Dec 18;371(25):2394-401
   http://www.nejm.org/doi/full/10.1056/NEJMoa1411677
4. Ethical issues in isolating people treated for Ebola
   http://www.ncbi.nlm.nih.gov/pubmed/25588871
5. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settingshttp://www.ajicjournal.org/article/S0196-6553(07)00740-7/pdf
6. Ebola virus disease in Africa: epidemiology and nosocomial transmissionhttp://www.ncbi.nlm.nih.gov/pubmed/25655197
7. Understanding Ebola Virus Transmission
   http://www.mdpi.com/1999-4915/7/2/511
8. Chains of transmission and control of Ebola virus disease in Conakry, Guinea, in 2014: an observational study
   http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71075-8/abstract
9. Ebola, through air or not through air: that is the question
   http://www.ncbi.nlm.nih.gov/pubmed/25646157
10. Review of Human-to-Human Transmission of Ebola Virus from the US CDC
    http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html
11. Sexual transmission of the Ebola Virus : evidence and knowledge gaps
    http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/
12. What we know about transmission of the Ebola virus among humans from the WHO
    http://www.who.int/mediacentre/news/ebola/06-october-2014/en/

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Two tales of the same review...

Could these articles about a recent review on Ebola virus transmission be any more different?

Which do you "believe"?

Limited airborne transmission of Ebola is �very likely,� new analysis says Post
From the Washington Post
http://www.washingtonpost.com/news/to-your-health/wp/2015/02/19/limited-airborne-transmission-of-ebola-is-likely-new-study-says/

No, A New Scientific Report Does Not Say That Ebola Is Now Airborne
From Vice News
https://news.vice.com/article/no-a-new-scientific-report-does-not-say-that-ebola-is-now-airborne

The article being referred to is from a team of "Ebola experts" and is entitled: 
Transmission of Ebola Viruses: What We Know and What We Do Not Know.
http://mbio.asm.org/content/6/2/e00137-15

At this juncture might I just add that I do not consider myself a real Ebola virus disease (EVD) expert. I'm just an interested scientist who blogs about Ebola virus and the most recent outbreaks and epidemic. To be an expert, at least in my opinion, one would have to have one or more of the following under one's belt:

• to have conducted experiments on the Ebola virus and written those up in the scientific literature
• to have generated data from other derivative works with parts of the virus, such as in vaccine works, and written those up
• to have treated or cared for patients with Ebola virus disease (EVD)
• to have worked in a public health capacity managing an outbreak of EVD

The rest of us are interested parties but will likely always miss some aspect of understanding the virus and its disease having not been in close contact with it, its hosts or the response to it.

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