Ebola in Texas

[audreyh1]

I saw an article that said 21 days still has a chance of not being long enough. It said Liberia uses 28 days. I wonder which country knows more about ebola?

21 days is used, but in most cases symptoms show within the first 14 days.

 

[timo2]

Just read a report that Carnival is giving all passengers on the Magic a $200 ship board credit for immediate use plus a 50% off coupon for a future cruise.

DW and mine bar bill on a 7 day cruise is usually about $500, so I'm not sure that ship board credit would be enough for being stuck on the ship.

 

[MooreBonds]

I don't hear anything about the Texas Dep of Health. Aren't they the ones supposed to make sure things are being handled properly?

I would expect that any state's DOH would be dealing with local issues, like licensing of facilities, licensing of healthcare workers, etc.

Something like the containment and treatment of a specific, very lethal virus like this, which involves taking a great deal of care with exposure of the healthcare providers, would naturally be directly overseen by the CDC.

Surely the CDC would communicate with other gov't health agencies and drug companies on matters like caring for such a virus, and share data, procedures, etc.. Not to mention the fact that the CDC has presumably worked with this virus in a lab setting before? I wouldn't expect a state or local DOH agency to have either experience or even the authority to oversee that aspect.

Your same question could be directed at the City of Dallas DOH. Would you expect them to be all over this issue and issuing directives? If not City of Dallas, why the State of TX? This is a virus with clearly national implications. To have each state (or city) DOH determine their own ways of dealing with it seems like a recipe for disaster, given how difficult it is to treat someone with this disease. The biggest issue is the side effects (projectile vomiting, bad diarrhea, external bleeding) which make this particular difficult to treat. With other lethal virus/diseases like AIDS, etc., the patient (for the most part) isn't a time bomb that could easily spread their bodily fluids with the lethal virus onto you or your protective clothing without much warning.

 

[audreyh1]

I would expect that any state's DOH would be dealing with local issues, like licensing of facilities, licensing of healthcare workers, etc.

Something like the containment and treatment of a specific, very lethal virus like this, which involves taking a great deal of care with exposure of the healthcare providers, would naturally be directly overseen by the CDC.

Surely the CDC would communicate with other gov't health agencies and drug companies on matters like caring for such a virus, and share data, procedures, etc.. Not to mention the fact that the CDC has presumably worked with this virus in a lab setting before? I wouldn't expect a state or local DOH agency to have either experience or even the authority to oversee that aspect.

Your same question could be directed at the City of Dallas DOH. Would you expect them to be all over this issue and issuing directives? If not City of Dallas, why the State of TX? This is a virus with clearly national implications. To have each state (or city) DOH determine their own ways of dealing with it seems like a recipe for disaster, given how difficult it is to treat someone with this disease. The biggest issue is the side effects (projectile vomiting, bad diarrhea, external bleeding) which make this particular difficult to treat. With other lethal virus/diseases like AIDS, etc., the patient (for the most part) isn't a time bomb that could easily spread their bodily fluids with the lethal virus onto you or your protective clothing without much warning.

I think actually the states department of health are supposed to handle this type of thing with the CDC operating as a clearing house and in an advisory capacity. The CDC has no authority within the state, and directives are issued by the state department of health.

New document from Oct 16 for exposed health care workers to agree not to travel in public spaces. Who created and signed it? Texas Department of Health. http://www.documentcloud.org/documents/1314636-possible-exposure-to-ebola.html#document/p1

 

[JoeWras]

I think actually the states department of health are supposed to handle this type of thing with the CDC operating as a clearing house and in an advisory capacity. The CDC has no authority within the state, and directives are issued by the state department of health.

The USA federal government and its administrative complex has worked its way into all sorts of forms of authority never envisioned. It is convenient to pass the buck now and the CDC can put the blame somewhere else.

Meanwhile, the feds can withhold funding as a form of extortion to gain control. Please recall the 55mph limit.

Too much blaming going on. Whatever happened to people serving their country? Now, gaining political clout is a form of power and wealth. Since nobody can ever make a mistake, apparently, every governmental entity plays the blame game.

This is serious business. We need people to grow up.

 

[Chuckanut]

Interesting interview on Science Friday last week. According to the researcher interviewed , the #1 thing they need at the moment is a quick, easy test to see who has the virus. With that they can quickly identify those who need to be isolated and treated, and send everybody else on there way. The current system of waiting 10-21 days to see if a person is infected is a huge handicap in trying to control the spread of the virus. She also thought such a test could be developed soon enough to make a difference. A cure or vaccine takes to long.

 

[meierlde]

The USA federal government and its administrative complex has worked its way into all sorts of forms of authority never envisioned. It is convenient to pass the buck now and the CDC can put the blame somewhere else.

Meanwhile, the feds can withhold funding as a form of extortion to gain control. Please recall the 55mph limit.

Too much blaming going on. Whatever happened to people serving their country? Now, gaining political clout is a form of power and wealth. Since nobody can ever make a mistake, apparently, every governmental entity plays the blame game.

This is serious business. We need people to grow up.

Actually the Federal government is only involved in international and interstate issues, so the plane flights would qualify. As to other health issues that is a state responsibility, which is partly delegated to local officials. You run right into the commerce clause here, which says that the federal government only has interstate and international jurisdiction.
States have quarantine powers and note that Dallas county put the ban on public travel for those exposed. Note that several states have declared states of emergency to allow more strict enforcement. The feds only get involved directly if the governor ask for help, see Katrina and the Detroit riots for examples. In both cases the governor asked for federal help.

 

[samclem]

Actually the Federal government is only involved in international and interstate issues . . .

If only. That was the original intent, but it sure isn't true any more. Why do the Feds tell my local burger joint how much they have to pay their workers--because somebody might take that Big Mac across a state line?

 

[Brat]

The Fair Labor Standards Act originally applied only to businesses in interstate commerce. Subsequent amendments expanded its jurisdiction to retail establishments with an ADV over $1M (which was a lot at the time). Most retail enterprises are interstate corporations. Local, low ADV, hamburger joints are usually covered by State labor laws.

Physicians and health care staff are licensed by each State. The States license hospitals and health facilities. Note that in Texas they require physicians performing abortions to have admitting privileges in a local hospital... many of which do not offer admitting privileges to abortion providers.

I think hospitals thought that the odds of an Ebola patient darkling their door were slim to none so didn't prepare for that possibility.

 

[M Paquette]

I think actually the states department of health are supposed to handle this type of thing with the CDC operating as a clearing house and in an advisory capacity. The CDC has no authority within the state, and directives are issued by the state department of health.

New document from Oct 16 for exposed health care workers to agree not to travel in public spaces. Who created and signed it? Texas Department of Health. Possible Exposure to Ebola

Correct!

The CDC/HHS has control of quarantine and such for international movement. That's why they have the lead on checking arrivals at international airports.

States hold the primary right to implement and manage quarantine and isolation. This right falls within the "police powers" reserved to the states under the Tenth Amendment of the United States Constitution. (Gibbons v. Ogden, 1824; yes, a case about steamships set the precedent)

The federal government does have a seldom-used right to impose large scale quarantines, last used during the Spanish Flu pandemic of 1918-1919. The federal government can also isolate and quarantine persons with certain diseases under Executive Order 13295 (a favorite of some conspiracy theorists).

 

[growing_older]

Truthfully, this lab tech should not be a concern at all provided they followed all the usual protocols for dealing with bodily fluids

That's true IF all the applicable protocols were followed and IF they were as effective as expected. But since this is the first time for a lot of these protocols in Dallas, everyone who was on the watch list or the self reporting list should have not been traveling. Further it turns out there actually must be some problems with the protocols as some health care workers thought to be very low risk - not even on the watch lists - became ill and have caught Ebola. I'd much rather be finding that out so it can be investigated while everyone is relatively isolated and staying home (voluntarily, common sense if nothing else) instead of after a bunch of them have been flying on commercial planes, mixing with who knows how many people in close proximity on cruise ships, or making contact with more people in Belize.

Even if it was PROBABLY okay, the downside is so big here it seems prudent to be cautious and not travel. There are too many unknowns in the effectiveness of the isolation, and as more information is coming in it looks more and more like there were problems with the effectiveness of the isolation. The risk doesn't only exist if the bad thing happens, the risk is present when there is a chance that the bad thing will happen. Maybe the lab tech is fine, probably will turn out to be so, but that doesn't mean the RISK wasn't there, just that despite the risk we got the good outcome.

 

[eytonxav]

It seems to me the original lapse in protocol happened when Duncan entered the country with no questions asked, even though he apparently showed no symptoms at that time. Who is responsible for that, CDC/Customs/TSA?

 

[Brat]

What questions could they have asked that would have prevented this situation? As you say he evidently had no symptoms. The person who probably infected him was a pregnant woman in distress who died in her home after being turned away at several health care facilities. He could have appropriately assumed that she died from the complications of pregnancy, if he knew she died.

It is my recollection (perhaps faulty) that his temperature was taken when he arrived in Brussels so no symptoms when he boarded the flight to the US.

Until Ebola is brought under control in west Africa there is still the possibility of an infected person arriving in US. That infected person could have unknowingly contracted it in Europe, north or South Africa and not have ever traveled to west Africa. Should we have every traveler pass a blood test for Ebola before being admitted into the US?

 

[meierlde]

Adding to an earlier post: Here is a link to a robotics conference that asks what can robots do to minimize the need for human to human interaction with Ebola: Researchers to meet with aid workers to build Ebola-fighting robots | Computerworld

 

[eytonxav]

What questions could they have asked that would have prevented this situation? As you say he evidently had no symptoms. The person who probably infected him was a pregnant woman in distress who died in her home after being turned away at several health care facilities. He could have appropriately assumed that she died from the complications of pregnancy, if he knew she died.

It is my recollection (perhaps faulty) that his temperature was taken when he arrived in Brussels so no symptoms when he boarded the flight to the US.

They could have taken his temperature again, asked whether he came from an ebola infected area, did he have contact with any sick individuals and where he was traveling to and by what means.

 

[AnIntentionalRoad]

Until Ebola is brought under control in west Africa there is still the possibility of an infected person arriving in US. That infected person could have unknowingly contracted it in Europe, north or South Africa and not have ever traveled to west Africa

It's a question of degrees of risk. Someone coming directly from an infected area offers a significantly higher risk.

 

[growing_older]

did he have contact with any sick individuals

I suspect this question would be completely ineffective. They already did ask if he had any contact with Ebola affected individuals and he said NO. If you broaden the question to ANY sick individuals then either people will just say "no" regardless of who they have been in contact with, or you will get so many "yes" answers that the question is useless.

Every day at work, in an office not a medical setting, I encounter people with colds, sniffles, and other illnesses. I'm not taking their temperatures to know how sick but if you ask me have I been in contact with any sick person in the last week, I have to answer "yes" virtually every day. Imagine if half the travelers say yes, then this question would not be actionable.

 

[eytonxav]

They already did ask if he had any contact with Ebola affected individuals and he said NO. If you broaden the question to ANY sick individuals then either people will just say "no" regardless of who they have been in contact with, or you will get so many "yes" answers that the question is useless.

I believe that question was asked in Brussels and upon departing Liberia, but nothing was asked when he entered the US. I am sure an improved script of questions can be developed for arrival in the US, but of course the individual could lie. Since the later is a possibility, I am in favor of travel bans for any individuals who originated from west africa.

 

[jon-nyc]

Quarantine Dallas? DS and his wife will have their new baby in [-]Ebola Central USA Division[/-]the Dallas Presbyterian Hospital in early spring.

I was born in that hospital myself! I managed not to catch anything.

 

[spncity]

Burleson, Texas is just south of Ft. Worth, Texas. A relative there says they got automate phone calls and this info:

Letter from Burleson Independent School District

October 17, 2014

Dear Burleson ISD Parents and Guardians:

The health and safety of our students and staff is our most important consideration. We work diligently to keep you informed of important matters affecting our schools and district, and we have information to share with you.

It has been well publicized that a second health care worker was diagnosed with the Ebola virus and traveled on a flight from Cleveland to Dallas earlier this week.

District leaders confirmed today that a parent of a Centennial High School student was aboard that flight.

It is important to note that the parent, student and other family members are not exhibiting any symptoms and are not considered contagious. The parent and BISD have been in contact with the Centers for Disease Control and the Texas Department of State Health Services. Officials from these entities have confirmed the parent’s seating location aboard the flight was in a “low-risk” area. The family is following the Texas Department of State Health Services protocols and has chosen to keep the student at home as a precaution.

The family is cooperating entirely with Burleson ISD and other agencies. There are no other family members at any other BISD campus. Additionally, the district is working with the Centers for Disease Control, Texas Department of State Health Services, County Health & Human Services, and city officials from Burleson.

Our local, state and national health officials assure us there is no significant risk of possible transmission of the virus through indirect contact. The Centers for Disease Control has not recommended we perform additional cleaning or implement specific protocols at this time as they assure us this situation is very low risk. In an abundance of caution, district leaders have decided to proactively implement high-level disinfecting of Centennial High School, beginning this evening. BISD is taking additional measures at all campuses including increased cleaning throughout the weekend.

 

[rodi]

For those wishing to impose a travel ban on all people who's flights originate in western Africa... a question:

- Do we allow our troops being deployed over there to return to the US?
- Do we allow journalists covering to return?
- Do we allow medical personel over there to return?
- Do we allow travelers from Nigeria to return - Nigeria was very effective in quarantining, and minimizing the spread - and is now Ebola free.

How long do we keep the travel ban in place?

Do we impose similar travel bans on people from Dallas?
Do we impose similar travel bans on people from Spain?

 

[M Paquette]

It seems to me the original lapse in protocol happened when Duncan entered the country with no questions asked, even though he apparently showed no symptoms at that time. Who is responsible for that, CDC/Customs/TSA?

The New York Times reported Thursday that Duncan had direct contact with a pregnant woman stricken with Ebola on September 15, days before he left for the United States. Citing the woman's parents and Duncan's neighbors in Monrovia, Liberia, the newspaper said Duncan had helped carry the ailing woman home after a hospital turned her away because there wasn't enough space in its Ebola treatment ward. [1]

Days before he became the first person diagnosed with Ebola on American soil, Thomas Eric Duncan answered "no" to questions about whether he had cared for a patient with the deadly virus.

Before leaving Liberia, Duncan also answered no to a question about whether he had touched the body of someone who died in an area affected by the disease, said Binyah Kesselly, board chairman of the Liberia Airport Authority. [2]

Providing false information would appear to be the initial failure. At the point of leaving Liberia for Brussels, Mr. Duncan did not have a fever. Remember that there is an incubation period between exposure and developing symptoms.

Duncan was screened three times before he boarded his flight in Liberia to Brussels, Kesselly said.
"The first screening was at the gate, before you get to the parking lot. The second time is before you enter the terminal building and the third is before you board the flight. At every point your temperature is scanned."
His temperature at those checkpoints was a consistent 97.3 degrees Fahrenheit, Centers for Disease Control and Prevention chief Thomas Frieden told reporters Thursday. "Basically, he didn't have a fever," Frieden said, noting that the Ebola patient's temperature was taken by a trained CDC health care worker with a thermometer approved by the Food and Drug Administration. [2]

1. Travels, travails of Ebola patient Thomas Eric Duncan - CNN.com
2. Liberian President criticizes Ebola patient in Dallas - CNN.com

 

[eytonxav]

Providing false information would appear to be the initial failure. At the point of leaving Liberia for Brussels, Mr. Duncan did not have a fever. Remember that there is an incubation period between exposure and developing symptoms.





1. Travels, travails of Ebola patient Thomas Eric Duncan - CNN.com
2. Liberian President criticizes Ebola patient in Dallas - CNN.com

Right, I was referring to lapses in the US. As to the Liberia end, I understand that Duncan's relatives said he didn't know the pregnant woman was stricken with ebola, but there is no way to know for sure.

 

[Brat]

In many ways Duncan was similarly situated as the nurses who cared for him and contracted the disease, only he didn't know that the person he attempted to help had Ebola. He tried to get timely help when he got sick, even the physicians initially did not diagnose the condition - should he be held to a higher standard?

 

[samclem]

There's obviously a problem with any self-reporting by travelers of their contacts, locations, etc. A person in West Africa traveling to the US may be signing his own death warrant by saying anything that stops him/her from getting on that plane to the US or Europe and the first-rate care that is there. Similarly, if a person has only a slight feeling of illness ("could be anything, I've felt this way hundreds of times . . . ") is he/she likely to say anything that totally disrupts travel plans--for "nothing"?
The info to date indicates people are generally not contagious yet if they don't have a fever. A fever is relatively fast and easy to determine. We should probably be screening, by temperature, everyone who enters the US after recent travel to a West African nation. It's not a huge number (compared to Europe or Asia). As to what to do with them: TBD. Visibly ill ones would be stopped from further travel until more is known, others might be allowed onward with some info about required reporting and symptoms to watch for, but at least we'd know who and where they likely went.