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Old 10-15-2014, 04:58 PM   #221
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I appreciate the positive spirit in which this suggestion is made, but the "czar" thing has already been overdone (and not just by the current president). We have a constitution and it is designed to give our legislature "advise and consent" authority over key appointments by the President. There are good and sound reasons for this. The appointment of "czars" is a means of avoiding this process.
The President has all the authority he needs to deal with the present situation. So do the governors of our respective states. Appointing a new person, creating a new office, or convening a special committee is unliekly to be the answer. What we need is competence and accountability--that's not a political indictment at all -- maybe the folks already in their positions are supremely competent and are being held accountable. The judgement on that is left to the reader.
OK, then I hope President Obama will issue executive orders which must be obeyed. However, not being an infection control expert, he will need advisors to guide his orders.
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Old 10-15-2014, 05:11 PM   #222
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Meadbh, does Canada have protocols in place and equipment on hand?
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Old 10-15-2014, 05:13 PM   #223
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The devil is always in the details.
Rich-by-the-Bay posted links to some of the details. Worthwhile to do a full reading.

The part that gets confusing, is the period when the virus can be transmitted. While there are many conflicting stories on this, but a more recent explanation from one of the doctors on AJAM, stated that the point of highest risk was when an infected person was suffering the worst symptoms. He explained that the virus was relatively slow in propagating, but that during the period when the victim's body was beginning to shut down the virus was replicating at a quantum rate, with millions of new virus particles being created.

These two paragraphs from the "Up to Date Pages" get into some of the details that support this.

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Person-to-person — Person-to-person transmission occurs through direct contact of broken skin or unprotected mucous membranes with virus-containing body fluids from a person who has developed signs and symptoms of illness [60]. The most infectious body fluids are blood, feces, and vomit. Ebola virus has also been detected in urine, semen, and breast milk. Saliva and tears may also harbor the virus. Thus, contact with any of these fluids can pose potential risk. At present, it is unclear whether infectious virus exists in sweat [61]. As described below, such person-to-person transmission leads to outbreaks [40].

************************************************** **88
..PATHOGENESIS — Ebola virus enters the body through mucous membranes, breaks in the skin, or parenterally. The pathogen infects many cell types, including monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells, and epithelial cells [88]. Because of the difficulty of performing clinical studies under outbreak conditions, almost all data on the pathogenesis of Marburg and Ebola virus diseases have been obtained from laboratory experiments employing mice, guinea pigs, and a variety of nonhuman primates.

Cell entry and tissue damage — Whatever the point of entry into the body, macrophages and dendritic cells are probably the first cells to be infected. Filoviruses replicate readily within these ubiquitous "sentinel" cells, causing their necrosis and releasing large numbers of new viral particles into extracellular fluid [13,89] (figure 1). Spread to regional lymph nodes results in further rounds of replication, followed by dissemination of virus to dendritic cells and fixed and mobile macrophages in the liver, spleen, thymus, and other lymphoid tissues......................................
Epidemiology, pathogenesis, and clinical manifestations of Ebola and Marburg virus disease

When we get down to the nitty gritty, both in the technical/medical part, it allows for a better understanding of the means, and rate of transmission. The probabiity of quarantining thousands of victims, with a multiple caregivers per patient in some kind of massive concentration facility is nil. The fact that this is not an airborne disease makes that unlikely IMHO, but Public awareness will be a major key.

One of the more interesting facts that is being generally ignored by the media scaremongers, is that the transmission history is that one person (historically) infects one or two others. The image of spreading infection is most commonly described by images of "Typhoid Mary". Not likely.

My two cents.
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Old 10-15-2014, 05:31 PM   #224
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Meadbh, does Canada have protocols in place and equipment on hand?
Major centres do, and there have already been several patients isolated and tested for Ebola. To date, all have been negative. It's only a matter of time. My educated guess is that the level of preparation in Canada is about the same as in the US.

http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-eng.php

Here is a policy example from September 2014. Actually, it's an Operational Directive, which means compliance is mandatory.

http://www.wrha.mb.ca/prog/ipc/files/EVDMgmt-OD.pdf
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Old 10-15-2014, 05:38 PM   #225
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One of the more interesting facts that is being generally ignored by the media scaremongers, is that the transmission history is that one person (historically) infects one or two others. The image of spreading infection is most commonly described by images of "Typhoid Mary". Not likely.

My two cents.
The outbreak in West Africa initially had Ro=2 (one person infect two) it is now down to 1.4-1.8. It was relatively easy to understand why. The caretaker got infected, and the person who washed the body before burial also got infected. (traditional the body washer was not immediate family).

One is beyond disturbing is that first case not handled by a specialized hospital has the same transmission rate.

I am generally not a big fan of unions. But I have noticed that nurses unions have been outspoken critics of our current level of preparedness, and good for them.
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Old 10-15-2014, 05:45 PM   #226
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I opened a good bottle of Pinot tonight, to watch the news, cuz we are all gonna dieeee.....
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Old 10-15-2014, 06:05 PM   #227
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My hope is that President Obama will appoint an Ebola Czar with emergency powers. No "should have" or " could have", just do it right!
There is almost nothing else more likely to bring out the armed militia groups and political opposition than this. Bad idea.
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Old 10-15-2014, 06:26 PM   #228
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There is almost nothing else more likely to bring out the armed militia groups and political opposition than this. Bad idea.
If you were in charge, how would you manage the situation?
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Old 10-15-2014, 06:29 PM   #229
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I opened a good bottle of Pinot tonight, to watch the news, cuz we are all gonna dieeee.....

Known that for years and been doing that for years. Well maybe a bottle of Sangiovese instead of Pinot. :-)
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Old 10-15-2014, 06:32 PM   #230
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If you were in charge, how would you manage the situation?

That's a piker's argument.
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Old 10-15-2014, 06:42 PM   #231
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OK, then I hope President Obama will issue executive orders which must be obeyed. However, not being an infection control expert, he will need advisors to guide his orders.
Actually the states already have those powers. They remain from the early part of the 20th century when they were used for TB among other things. Note that for example the Dallas county judge discussed travel bans for those being watched. Here is a link to the state laws on communicable disease health emergencies: State Quarantine and Isolation Statutes
The federal role is related to interstate travel, mainly.
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Old 10-15-2014, 06:46 PM   #232
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Actually the states already have those powers. They remain from the early part of the 20th century when they were used for TB among other things. Note that for example the Dallas county judge discussed travel bans for those being watched. Here is a link to the state laws on communicable disease health emergencies: State Quarantine and Isolation Statutes
The federal role is related to interstate travel, mainly.

That's good to know, thank you.


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Old 10-15-2014, 06:51 PM   #233
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Major centres do, and there have already been several patients isolated and tested for Ebola. To date, all have been negative. It's only a matter of time. My educated guess is that the level of preparation in Canada is about the same as in the US.

Ebola virus disease - Infectious Diseases - Public Health Agency of Canada

Here is a policy example from September 2014. Actually, it's an Operational Directive, which means compliance is mandatory.

http://www.wrha.mb.ca/prog/ipc/files/EVDMgmt-OD.pdf
Some areas of Canada may be somewhat better prepared due to past experience. The response to the SARS outbreak which killed 44 in the Toronto area in 2003 was very impressive and somewhat frightening. The infectious agent (which was subsequently identified by a research group in British Colombia) originated in China. Although Ebola is much less contagious, it seems unbelievable that an exposed healthcare provider (who was 'being monitored') was permitted to travel on a commercial airliner. Seems like asking for trouble. This thing needs to be taken seriously and nurses and doctors should be raising the alarm if precautions and equipment are not in place. Many health care providers died in the SARS outbreak. Also, in Africa, many of the worse outbreaks of Ebola and Marburg viruses have been the result of medical 'errors'. Talk is cheap, doing the right thing when faced with a crisis - less so.
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Old 10-15-2014, 06:55 PM   #234
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If you were in charge, how would you manage the situation?
I would kick some asses at the CDC and make sure someone competent who takes ebola seriously is in charge. I would NOT do anything that even remotely hinted at imposing martial law.
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Old 10-15-2014, 06:59 PM   #235
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I would kick some asses at the CDC and make sure someone competent who takes ebola seriously is in charge. I would NOT do anything that even remotely hinted at imposing martial law.
Center for Disease Control. We don't need a czar. We don't need anything. We need CDC to do their job. This is their bailiwick!

I'm hoping this current fiasco wakes everyone up and is ultimately a blessing. My best to those who are infected. It is terrible. It sounds like initially they were just wearing the kind of outfit I've seen for other cases like pneumonia or c-diff. Terrible oversight.
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Old 10-15-2014, 07:13 PM   #236
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I am not sure that CDC deserve that much of the blame. If I even a layman like myself understands that when treating a patient from West Africa who is projectile vomiting it is really really important, to not have any skin exposed, than I would think that hospital administrators would make sure such gear is available.

I have been watching Dr. Freiden on the Newshour at least once a week since May sounding the alarm about the Ebola. The US along with Cuba, and of course the remarkable folks at Doctors with Borders, have been at the forefront of trying to do something. It is Dr. Freiden that has send hundreds of CDC workers to the front-line,long before this was headline news. I'm not willing to sacrifice him for one screw up which was only partially his agencies fault.
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Old 10-15-2014, 07:16 PM   #237
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If you were in charge, how would you manage the situation?
I'll take a swing:
1) Go on the offensive. The disease is presently confined largely to West Africa. It is worth it (from a humanitarian perspective but also out of our own national self-interest) to work wth other nations and NGOs to send material aid to assist in slowing the spread of this disease while we work on other approaches. We should continue our present efforts.
b) Those vaccines? That's the best hope for a real solution. If money or expertise is needed (to accelerate the present trials, to explore alternative approaches, etc) then we should do that.
c) Significantly increase the ability to rapidly test for ebola in symptomatic individuals. We should have the capacity to test tens of thousands of people a day for ebola using ELISA.
2) A more effective defense.
a) Send US persons to screen airline passengers bound for the US from all of the affected countries--before they board the aircraft for the US. We issue visas, this is why--so we know who is coming. Eliminate the Visa Waiver program for travel that transits these countries. US passport holders get checked, too. Yes, it would be possible to get around such a system, but it would require intent to do so on the part of the traveler. We're VERY lucky that ebola appears to not be contagious before the patient has a fever, this makes screening much easier.
b) Another screening when people arrive from West Africa
The intent of the screening is just to buy time. They will not be 100% effective, and if the disease is readily communicable then it will eventually reach S America, Mexico, Canada and Europe and screenings will become far less likely to be useful. But for now, while we are working on the next steps (see if it burns out again in Africa, or if it spreads to Europe, etc), they are worthwhile.
c) Regional isolation centers in the US, and a means to get patients to them. We may need more than the 4 presently identified.
d) We certainly need a "worst case" plan that provides for treatment of thousands of cases in the US. I think it is very unlikely we will need this, but it is clearly in the realm of the possible. As presently treated, the disease does not require extremely high-tech approaches. We need good, solid, safe supportive care in settings that don't place health care professionals at risk, that don't degrade the rest of the health care system, and that don't expose other patients or the public to this disease. I don't know if new physical structures are actually needed (it's a lot cheaper and faster to rapidly convert an abandoned industrial site or KMart into a field-expedient hospital than to erect a new structure with HVAC, power, sewer, parking, road access, etc). The US military does have the ability to establish field hospitals (and we do have very well equipped hospital ships), but these are limited in their size, are expensive to deploy, and the personnel which staff them are in large part reservists so calling them up can be expected to reduce the civilian medical system's capacity to some degree.

I'm sure I've left a lot out.
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Old 10-15-2014, 07:19 PM   #238
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I'm not willing to sacrifice him for one screw up which was only partially his agencies fault.
I'm not looking for heads. Too much of that in today's political world.

Just looking for them to do their jobs. Part of their job is to train the hospitals on this. How about training the people in isolation. ("Don't get on a plane.")

Sounds like all this is now happening at a higher intensity now which is good.
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Old 10-15-2014, 07:24 PM   #239
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The second Texas nurse was sent to Emory for treatment, where the first two patients were treated. Perhaps this will be the sop from here in, to be treated at the highest level of hospital. Meanwhile hoping and praying that both nurses recover of course and that Mr. Duncan's family and all the peripheral contacts with the nurses are okay.
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Old 10-15-2014, 07:31 PM   #240
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I'm not looking for heads. Too much of that in today's political world.

Just looking for them to do their jobs. Part of their job is to train the hospitals on this. How about training the people in isolation. ("Don't get on a plane.")

Sounds like all this is now happening at a higher intensity now which is good.
I'll take heads if offered but really I just want the powers that be to stop the gherkin jerking and take this threat seriously. The glaring slip ups tell me that everyone is still doing the bureaucratic hokey pokey. The US populace is frightened and is looking for answers. Why have the clowns running things not got the message?


The incompetence of the gubmint is part of the inspiration for me to learn more self sufficiency.
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