Is Ebola airborne ?

Ebola has become an uncontrolled epidemic in Africa. I have previously posted on Ebola.

UPDATE: A new CDC report has now been provided on precautions. Somebody is worried. The document, itself, is here (pdf)

Now, we are going to send 3,000 military personnel to Africa to help. I sure hope none of these US people are infected. They did not volunteer for this and the training to protect themselves will take time.

Now the German epidemiology community has concluded that Liberia and Sierra Leone are lost.

Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.

“The right time to get this epidemic under control in these countries has been missed,” he said. That time was May and June. “Now it will be much more difficult.”
Schmidt-Chanasit expects the virus will “become endemic” in this part of the world, if no massive assistence arrives.

With other words: It could more or less infect everybody and many people could die.

This, of course, is from a German site and our own CDC is unwilling to say it.

For Sierra Leone and Liberia, though, he thinks “it is very difficult to bring enough help there to get a grip on the epidemic.”

According to the virologist, the most important thing to do now is to prevent the virus from spreading to other countries, “and to help where it is still possible, in Nigeria and Senegal for example.”

Of course, it is already in Nigeria.

In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.

And: This may be a new strain with more virulence.

The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.

Now, we have more news. From 2012, we know transmission in animals may be airborne.

While primates develop systemic infection associated with immune dysregulation resulting in severe hemorrhagic fever, the EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11. The present study was design to evaluate EBOV transmission from experimentally infected piglets to NHPs without direct contact.

The study of this potential explosive development showed:

The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting. Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.

Now we have more articles appearing about this.

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

If the New York Times is publishing this, somebody is worried.

This month, we have a new school year underway with thousands of African students at US colleges.

But overall, we can make a reasonable estimate that around 25,000 Black Africans are currently studying at colleges and universities in the United States.

Among Black African nations, Nigeria in 2010-11 sent the most students to American colleges and universities. In 2010-11, 7,148 Nigerians were studying here. Nigerian enrollments have tripled since 1995.

In 2010-11 Kenya ranked second, sending 4,666 students to the United States. But enrollments from Kenya have declined in recent years.

The epidemic seems limited to West Africa so far but Nigeria has cases of Ebola and large cities where, if it is indeed airborne, there may be hell to pay. All of West Africa is at risk.

Three fruit bat species that are thought to harbor Ebola viruses are found in large parts of West Africa, and the first outbreak in Guinea serves as a warning that the whole West African region is at risk for the disease, the team concluded.

If a case of Ebola occurs at a US college campus, the rape hysteria may seem very tame in comparison.

31 thoughts on “Is Ebola airborne ?”

  1. I’ve certainly grinned at excitable accounts in the US papers of African government announcements: are there really people so stupid that they think that competent government action in West Africa is at all likely?

  2. Everybody’s always been worried about this, but it’s that sort of free-floating anxiety that doesn’t necessarily mean a lot. Viruses mutate, so if you work with viruses you’re always thinking about what they’ll mutate into next. Unless and until it happens, it’s just one of those things that might happen someday but isn’t a problem at the moment. But when an ugly virus like Ebola is in the news, you can expect to see a lot of articles stressing the issue, because it’s exciting. There’s a good reason it’s a favorite plot device for thrillers.

  3. ( )
    === ===
    [edited] Six piglets with Ebola were next to four monkeys separated in cages, 8 inches between the cages. Two of the monkeys caught Ebola, fast enough to know they caught it from the pigs.

    The difference between pigs and people is that pigs sneeze a lot from Ebola, much more than people do.
    === ===

    The confusion seems to be in “airborne”. Flu viruses are truly airborne. Flu survives for days after drying out, both on surfaces and as particles in the air. Flu can float or lie around for days and infect another person.

    Ebola is more delicate; it dies soon after drying. It can be transmitted airborne only while in aerosols, wet droplets just sneezed out. If an ebola sufferer sneezes near you, you will be infected, but not from being in the room 10 minutes later.

  4. Always wipe the shopping cart at the supermarket BEFORE you touch it. Change stores if your store does not give free disinfectant wipes.

    Also its a good idea to wear disposable gloves when in public. Disposable booties too. Of course don’t wear gloves or booties while driving.

  5. “Ebola as a plot device in “Executive Orders”

    Clancy’s imagination was amazing. That was not his only plot device that impressed me. The Japan Airlines 747 used as a flying bomb, although the tanks were near empty, was one. He had a plausible scenario for a Palestinian nuke. Stratfor CEO Friedman has predicted a war with Japan in “The Next 100 Years.” I think Clancy’s scenario is more plausible. It was sad to lose him.

    “The confusion seems to be in “airborne”.

    The question is whether it is transmissible via the air. HIV has not been so far. Ebola seems to be mutating so that it can. It’s not “confusion” just contemplating the consequences of a single US case. The case in the previous post infected a number of health care workers. Nigeria now has 21 cases as of September 12 , which seem to be derived from the one index case.

    We”ll see.

  6. I’ve recently gamed this. There seems to be some guesswork on how transmission is achieved in certain cases. Western healthcare workers with good reputations for maintaining transmission protocols have gotten sick. A quick notation that nobody knows how it happened and then they move on. Knowledgeable people shy away from public curiosity on the subject and, to my personal experience, even private curiosity.

    One possibility to consider is a low efficiency aerosol method, so low efficiency that the dominant public health consequence is panic. The experts would rather have us low panic, but playing russian roulette than high panic and only marginally safer so far as odds go. I don’t know if they are right. I’m not sure that they’re even conscious of doing it. It’s all just air and phantoms.

  7. It’s a bit hard for me to get all ginned up about the latest plague because, as bad as they are the affected, in the grand scheme of things, humanity takes its hits and rolls along.

    There aren’t any historical incidents to suggest that it’s even possible to bring down a society with an infectious disease. Historically, societies with far fewer resources than even those of contemporary sub-saharra Africa, have weathered incidents of overlapping plaque e.g. small pox (95% infection rate, fatality rate 30%) and Black Death (20%-50% infection rat, fatality rate 20%-70%) and continued on. In many cases, the chroniclers of the time barely mention disease as factor in the events of their days.

    I’m not sure what the German’s mean by “lost”. Sadly, 20,000 deaths in three months is just a drop in the bucket for Sub-Saharra Africa. Sub-Saharra Africa suffers somewhere to 1,000,000 to 2,000,000 deaths every year from malaria, tuberculosis, AIDs and a few lesser infectious diseases. Societies evolved to accept such loses will soldier through an additional 1-2 million deaths in a year.

    Neither do I think it likely that virus will become truly “airborne”. A truly airborne viral disease as two attributes:

    (1) The virus can survive and travel on its own without being wrapped in a blob, no matter how small, of body fluid. Influenza, cold and small pox viruses can survive for long times in dry air and on dry surfaces.

    Viruses that must stay in moisture can never be really airborne. They are still transmitted by contact with bodily fluid. The only factor that changes is the size of initial dose of viruses needed to lethally infect a victim. As a virus grows more virulent, it’s initial dose threshold drops and the amount of bodily fluid decreases. At the start you have to have contact with visible amounts of body fluid but as the disease evolves to become more lethal, then the amount of body fluid can drop to size of aerosolized fluids in a sneeze. But such a shift doesn’t have the same the affect on transmission rates as it going truly airborne because the same precautions still provide a high level of protection.

    There is also a negative feedback look that occurs. The increase lethality that lowers infection threshold and makes it pseudo-airborne, also means its symptoms appear quicker and that it kills or incapacitates it’s victims sooner, giving it less time to jump to a new host. Paradoxically, it’s easy to contain a disease that kills in hours or days than one that kills in years (like AIDS.)

    (2) The viral particle must be small enough that it will easily loft and suspend in the air. You wouldn’t think that size would matter much aerodynamically to things measured in hundreds of nanometers but it does. (It’s theorized that the real effect is related to static charges and not mass.) Airborne viruses are small, non-airborne are larger. Influenza runs 80-150nm in longest axis while Ebola runs 850-1,700nm depending on strain. So, it’s unlikely it will ever evolve to shrink down to the true airborne range.

    I am unconvinced that the experiment with pigs tells us anything about how Ebola will spread. Pigs are often used as human analogs because they closer to us biologically than rats and closer in size than monkeys. But they are also substantially different. They sniff, lick, taste and eat almost everything. They excrete massively and forcefully, as anyone whose ever spent much time around a swine pen can tell you. They urinate in high velocity stacco bust seemingly designed for maximum splatter. In particular, they sneeze epically. A friend prize sow once splattered my boots tops with phlegm from a good 20ft (~6-7m).

    Small pox, the champion killer, spreads by cramming itself into skin cells that erupt from the blisters the disease causes on the bodies surfaces. The skin cells, already waxy and water resistant, dry out to become little spore like packages that can persist for weeks in the open (and perhaps indefinitely in frozen graves.) . Until Jenner, probably 95% of the population of Europe caught small pox at some point in their lives. Yet societies survived and even prospered while suffering wave after wave of small pox outbreaks. Ebola will never reach that transmission rate or fatality rate.

    Neither can I get particularly concerned about transmission in the first world. We forget just how much hygiene protection is structurally built into our material world. Every smooth surface you see around you is a mechanism for slowly the spread of disease. Plastics, related polymer paints and abundant metal mean that microbes find far fewer places to survive than in a pre-industrial environment.

    We take things like smooth, easy to disinfect table and cabinet tops for granted but in Africa they don’t. Much of their world consist of unpainted much less unsealed natural wood surface. In a humid environment, even smooth planed and sanded wood, the pinnacle of preindustrial woodwork, is a low grade petri disk. We habitually clean and disinfect everything to a degree unthinkable in Africa. For people living on $2 a day and spending $1.75 of that on food, a five dollar bottle of Lyle is an unattainable luxury. Clean water, cheap soap, cheap energy to disinfect by heat, toilet paper and the excess wealth to pay janitors mean that infectious diseases transmit at rates often hundreds of times slower through the general population.

    We also have reflexive hygiene habits, covering our mouths when sneezing or coughing or not sharing drinking cups, the result of decades of extensive indoctrination and training since birth. Most modern Africans don’t have those habits (just like our first world ancestors didn’t. In the earlier 1900s my great-grandfather launched a campaign to purchase small collapses tin cups for each individual school child in Lovington, NM. Until then, it was common practice for all children to drink from the same ladle from the same bucket of well water. Nobody thought anything of it.)

    We also shouldn’t forget that for every factor in modern world that makes it seem like disease could spread more quickly, like air travel, there are dozens of factors that make it harder, like plastic.

    I also wouldn’t be to concerned about Nigerian students. Most of them are Igbo famous for their lawfulness, self-discipline and ability to succeed in America. Their culture lacks the fatalistic, “things just happen to you and just have weather them,” that most pre-industrial cultures (e.g. the Irish) suffer from. That translate into more dynamic action in response to environmental changes and a greater willingness to learn and adapt. In this circumstance it translate to a better understanding and adoption of modern hygiene practices. Even in Nigeria where they are envied and persecuted, they still have substantially lower disease and mortality rates than other cultures. In the US they have lower infant mortality rates than whites.

    In short, this ebola outbreak will be bad in Africa, a few hundred people might die in the developed world, but Africa and the rest of us go on, just as we always have.

  8. “Yet societies survived and even prospered while suffering wave after wave of small pox outbreaks.”

    Yet the aboriginals in north America did not do well at all since there was no previous contact. That same occurred with syphilis going the other way. Measles wiped out a large proportion of Polynesians.

    North Americans are not prepared for “a few hundred people” to die in an ugly fashion. I’m not saying the disease will wipe us out. The reaction might be even worse.

  9. An Ebola MSDS

    A hidden feature is the ability to pass the virus on through intercourse up to 7 weeks after clinical recovery.

    It may not be a ‘panic Now!!!’, stage yet, but we likely do not know all of the ‘features’ Ebola has as standard equipment. The one noted above seems, to me, to put Ebola into the HIV category as far as killing the host over a longer time frame. Perhaps not the original host, in this case.

  10. Shannon,
    Thanks for the info on the airborne risk and the thoughts on our systemic hygiene advantages. I think I am much better informed than before your post. I have always wanted a pet pig to play with our pit bull, but I’m having serious second thoughts. The back yard is already too much maintenance.

    I promise to behave myself so as not to raise our risk or to set a bad example through loose living. At my age, it shouldn’t be too difficult even if I had that problem.


  11. “I’m not saying the disease will wipe us out. The reaction might be even worse.”

    The Roman Empire didn’t exactly thrive after the Antonine Plague. Although the empire lasted 300 more years, the plague may have been the start of the downfall by ravaging the economy and forcing recruitment of barbarians into the Legions.

    The Byzantines definitely never fully recovered from the Justinian Plague. It prevented them from taking over Western Europe which paved the way for the Barbarian conquests.

  12. “The Byzantines definitely never fully recovered from the Justinian Plague”

    Grurray, just wondering if you read my book.

    I do worry what will happen when something serious happens to a culture that has elevated nonsense like rape culture and gay rights to the level of what religion was 500 years ago.

  13. I haven’t yet, but it’s definitely on my to-read list, which unfortunately is growing pandemic-like.

    Is there a possibility that you could make it available for kindle? I just made several purchases on military history after the posts on the world wars and now there’s some controversy in our house about our shrinking bookshelf space.

  14. Hopefully, if it is going to become much more of a problem it will start to do so in the next couple months since the other thing Ebola doesn’t handle is cold weather.

    At work one of our technicians is from Sierra Leone and one of our junior engineers (formally a technician) is from …. Nigeria, iirc. Both are good workers, came up here to go to the local university (both Petroleum Engineering) and got jobs with us in the summer, one has moved that into a full time position (Civil not Petroleum but its really more contract administration then anything else anyhow). Both seem to have the main goal of NOT going back. If they were representative of immigrants we wouldn’t have an immigration problem. Of course, if they were representative of Africa it wouldn’t be in the mess it is today.

  15. More news we would rather not see.

    The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. (Note for actual epidemiology geeks: The calculation is for the effective reproductive number, pegged to a point in time, hence actually Rt.) They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others.

    You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

    In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

    His second projection is one we have discussed. Airborne.

    The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. This outbreak is very different from the 19 that have occurred in Africa over the past 40 years. It is much easier to control Ebola infections in isolated villages. But there has been a 300 percent increase in Africa’s population over the last four decades, much of it in large city slums…

  16. Shannon Love,

    I can tell that you didn’t go see the C-Span video on the Senate Committee hearing on Ebola yesterday.


    During the second panel Senator Burr said that based on their (the Senate committee staff’s) information, the RO for Ebola in West Africa was 5-20.

    Since “RO” is the disease infection term term meaning for every person who gets infected, how many more do they infect. It means for Ebola in West Africa, for every person reported today having Ebola, in the next 21-23 days another between 5 and 20 will get it.

    This is a flaming datum that Ebola fomite transmission is now the predominant transmission mode in West Africa. The “contamination cross over point” has been passed.

    Too understand what that means, consider that Ebola has an “ID-50” of 10 virons.

    That is 10 viral particles will infect you 50% of the time. As an infection is anywhere from 50% to 90% lethal depending on your medical care, the ID-50 and the LD-50 (Lethal dose = 50% death) are identical at best.

    Ebola’s fomite contamination threat is mind boggling.

    The whole “bodily fluids” thing has been construed to mean a blood borne or sexually acquired pathogen. All the WHO/CDC “messaging” about dead body handling and being puked upon to get Ebola reinforces that perception.

    However, with Ebola, saliva, vomit, mucous, tears, sweat, and feces, along with vaginal secretions and semen, all count as having Ebola pathogens. Contact with these fluids, deposited on a surface (called “fomites”), depending on duration, temperature, direct sunlight, can be enough for you to pick up a viral load that will infect you.

    Let’s say you are walking along and step in puke. Ick. (Most people really don’t watch where they are putting their feet unless they anticipate an obstacle).

    You go into a public restroom and clean off your shoes with a paper towel.

    You reach out grab the handle and turn the water on to wash your hands, wash them, and turn the water off.

    You contaminated the handle when you turned the water on, and recontaminated your fingers when you turned it off.

    It’s not just there for you, but the next person, too.

    If you rub your eye, your nose, pick at your teeth, or any of a number of little things people do, you run a severe risk of being infected.

    That’s how dangerous this disease is.

    Currently no society on Earth is organized to stop a disease that communicable, from merely touching normal daily objects, and that deadly.

    Nigeria has the means, the societal wealth, mass literacy and cohesion, to stop isolated Ebola infections. But large numbers of people running from the Ivory Coast, in a few months time, are going to be more than they can handle.

    We are all now fighting a delay action against a force of nature, trying to buy time for a mass production Ebola vaccine for the entire human race.

  17. Shannon,

    FYI, the Patrick Sawyer RO in Nigeria was an _EIGHT_…assuming,
    1. No one else has slipped the Nigerian Ebola surveillance net like that 2nd ECOWAS diplomat that went to Port Harcourt and
    2. None of the surviving infected has sex with anyone — including his or herself — for the next 8-weeks.

  18. Joe, Shannon,

    What is happening isnt that Ebola is going airborne.

    It is that Ebola is slowing down in the time between initial onset of symptoms and debilitation of the victim.

    See CNN, July 29, 2014

    “Brantly’s family had been with him in Liberia, according to the Centers for Disease Control and Prevention, but left for the United States before he became symptomatic; as such it is highly unlikely that they caught the virus from him. Out of an abundance of caution they are on a 21-day fever watch, the CDC said.

    Nancy Writebol from Charlotte, North Carolina, has also been infected. She is employed by Serving in Mission, or SIM, and had teamed up with the staff from Samaritan’s Purse to help fight the Ebola outbreak in Monrovia when she got sick. She, too, is undergoing treatment.

    It is believed one of the local staff was infected with Ebola and came to work with the virus on Monday and Tuesday, Isaacs told CNN. “We think it was in the scrub-down area where the disease was passed to both Nancy and Kent,” he said. That staff member died on Thursday.”

    This “New Ebola” is leaving people well enough, while they are infectious, to both travel and work without being detected.

    Dr Brantley was an exeperienced Ebola doctor and he could not detect Ebola on the co-worker that infected him.

    That slowing down and its incredible fomite contamination traits makes this new Ebola pandemic-capable.

  19. If Fenn’s Pox Americana, introduction of a new disease to a 3rd world country can change considerably a population’s size and culture. We know more, do more, and are more varied in genes; this isn’t something I know anything about. But surely most of us have not felt the need for precautions our parents would have taken. I’m a good deal less careful about eating others’ food, for instance.

  20. We certainly live in “interesting times.” I went to a lecture by Angelo Codevilla last night. His talk was about Ebola and his recommendation were similar to Spenglers, and, interestingly enough, Sarah Palin’s. “Kill them all and let Allah sort them out .” I apologize if I misquote him.

  21. The PPE/medical industry has come out with a well sourced article reccommending far more than the CDC/WHO levels of protection to deal with Ebola.

    See link, title and closing passage below —

    COMMENTARY: Health workers need optimal respiratory protection for Ebola

    Adequate protection is essential
    To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:

    •Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
    •All sizes of aerosol particles are easily inhaled both near to and far from the patient.
    •Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
    •Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
    •Experimental data support aerosols as a mode of disease transmission in non-human primates.

    Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.


    We thank Kathleen Harriman, PhD, MPH, RN, Chief, Vaccine Preventable Diseases Epidemiology Section, Immunization Branch, California Department of Public Health, and Nicole Vars McCullough, PhD, CIH, Manager, Global Technical Services, Personal Safety Division, 3M Company, for their input and review.”

  22. This will certainly help .

    The bodies of eight people, including several health workers and three journalists, have been found days after they were attacked while distributing information about Ebola in a Guinean village near the city of Nzerekore, according to Reuters.

    “The eight bodies were found in the village latrine,” Albert Damantang Camara, a spokesman for Guinea’s government, told Reuters on Thursday. “Three of them had their throats slit.”

    We’re going to need a bigger boat .

  23. Now we have a ship from Africa with sick crew members docking in Louisiana

    NEW ORLEANS —A crew member who fell ill on a ship from Africa is diagnosed with malaria, Jefferson Parish Councilman at Large Chris Roberts said Wednesday night.

    Marine Phoenix identified as ship from Africa with sick crew
    In a statement released late Wednesday night, the Centers for Disease Control stressed that crew members on a freighter inbound to New Orleans were suffering from malaria and show no traces of Ebola.

    Plaquemines Parish President Billy Nungesser said at least one person was taken from a ship that arrived from Africa to the West Jefferson Medical Center, where he was listed in critical condition. Others from the ship may be transported, Nungesser said.

    The crew member was taken to West Jefferson Medical Center for treatment. At least three more crew members, plus the river pilot who boarded the ship, were also expected to arrive at the hospital Wednesday night.

    The crew member with malaria was listed in critical condition, Plaquemines Parish President Billy Nungesser said before the diagnosis was made.

    Did the river pilot get sick ? That doesn’t sound like malaria.

    Officials in New Orleans confirmed that the Centers for Disease Control and Prevention, the U.S. Coast Guard and various government epidemiologists were at the scene in Belle Chasse, where the vessel, identified as the Marine Phoenix, anchored near the Naval Air Station Joint Reserve Base.

    Late Wednesday, officials told WDSU that another member of the crew — who had left the ship to seek treatment in the Bahamas — had died. That crew member was also diagnosed with malaria.

    Had died from malaria ? Yikes ! This might be worth following, if they tell the truth, of course.

  24. The obvious, practical, and therefore politically impossible response would be this:

    For those who do not recognize this, it is the maritime quarantine flag. All vessels approaching our ports need to anchor offshore under Coast Guard supervision flying this flag. No non-US bills of health accepted. One week for ships not coming from Africa, or taking on cargo/personnel originating in Africa in the two weeks prior to entering quarantine. Two weeks for ships that have touched Africa in the last two weeks. That should cover any Ebola incubation periods aboard.

    Violation of quarantine procedures to be met with immediate sinking and no crew rescue.

    But who am I kidding. As of the 15th, there were 21 daily flights to NYS from Guinea, 9 daily flights to Houston from Guinea, and our southern border has been erased and the Federal government is deliberately scattering disease vectors all over the country from that missing border as fast as they can.

    Subotai Bahadur

  25. I remember the movie well but that was when treatment was less common. California has plague in the ground squirrels and there are one or two cases every year. Fortunately, they are mostly bubonic.

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