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Old 10-17-2014, 01:13 PM   #321
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I agree. The lab tech should have virtually zero risk and the maximum incubation period is 21 days, which is nearly here. Since the ship was not allowed to dock in Cozumel, it 's clear that dumb panic is international. No doubt there are planes flying in from west Africa, but the entire cruise ship has the "cooties". I'll bet the lawyers will be out in droves at the end of the cruise. "Ruined vacation" will become "pain and suffering".


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The local mayor made the decision and I agree with his decision. While the lab tech is very low risk the island of Cozumel is almost 100% dependent upon tourism and cannot afford to take any risks in this regard. The swine flu epidemic in 2009 decimated tourism here for almost a year even though there was never a documented case on the island.

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.
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Old 10-17-2014, 01:57 PM   #322
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3. The "system" works in a coordinated fashion.

Hence, leadership and mandatory compliance with infection control procedures are required.
And the next time you go to a movie that shows some gov't outfit in black, unmarked cars and weaponized military vehicles pulling up to an area and 'quarantining' an entire town/city for some "disease", you can with full confidence stand up and say "I realize this is a movie and requires suspension of belief, but the gov't doing this is completely unrealistic!"




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One thing absent from Klain's resume: A medical background. Klain does not have any major public health experience, but the White House is calling the new post an "Ebola response coordinator," suggesting the role is intended more to synchronize the actions of various agencies rather than to weigh in on the specifics of how best to stop Ebola.
Let's see - the CDC themselves completely botched this from the beginning. So let's appoint someone with absolutely no medical training or background to oversee the gov't agency with scientists and medical professionals that is supposed to be overseeing everything to begin with.

Gee, I feel so much safer already!
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Old 10-17-2014, 02:21 PM   #323
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Assumptions that are being proven incorrect include:

1. Hospital administrators have readied their staff and supplies to safely address an encounter with Ebola.
2. Healthcare workers understand incubation periods and will act rationally to protect the public.
3. The "system" works in a coordinated fashion.

Hence, leadership and mandatory compliance with infection control procedures are required.
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?
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Old 10-17-2014, 02:27 PM   #324
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So what do we guess will happen with it returns to Galveston? Sit for 21 days?
Only if the lab tech shows symptoms within the next two days, which seems pretty unlikely.
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Old 10-17-2014, 02:33 PM   #325
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Only if the lab tech shows symptoms within the next two days, which seems pretty unlikely.
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?
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Old 10-17-2014, 02:39 PM   #326
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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.
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Old 10-17-2014, 02:40 PM   #327
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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.
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Old 10-17-2014, 02:54 PM   #328
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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.
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Old 10-17-2014, 03:10 PM   #329
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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/documen...ml#document/p1
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Old 10-17-2014, 03:15 PM   #330
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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.
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Old 10-17-2014, 03:59 PM   #331
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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.
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Old 10-17-2014, 03:59 PM   #332
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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.
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Old 10-17-2014, 04:32 PM   #333
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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?
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Old 10-17-2014, 04:55 PM   #334
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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.
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Old 10-17-2014, 05:44 PM   #335
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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).
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Old 10-17-2014, 08:03 PM   #336
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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.
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Old 10-18-2014, 08:24 AM   #337
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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?
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Old 10-18-2014, 11:27 AM   #338
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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?
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Old 10-18-2014, 11:33 AM   #339
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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
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Old 10-18-2014, 12:30 PM   #340
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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.
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