Ebola in Texas

[Bestwifeever]

In fact the only people in the USA diagnosed with ebola are folks that were helping others. None of the bystanders have contracted it. Even in west Africa many of the cases are cargivers. IIRC something like 40% of the medical personnel in west Africa have died from Ebola.

And everyone, don't forget to get a flu shot...we can get that just by being a bystander.

I misread statistics in something I posted on another random thread, so I may be wrong here, but I think it is 40 percent of the medical personnel who came down with ebola who have died from it, not 40 percent of all the medical personnel helping there (and all of them are heroes in my book).

 

[M Paquette]

New York and New Jersey Governors mandate quarantine for ebola aid workers

Ebola In NYC: Governor Orders All Ebola Aid Workers Into Quarantine. Do You Agree? - Forbes

“It’s too serious a situation to leave it to the honor system of compliance,” according to New York Governor Andrew Cuomo.
Cuomo pointed to news that Dr. Craig Spencer, the doctor who treated Ebola patients in Guinea while working for Doctors Without Borders, was traveling around New York City the night before Spencer was himself diagnosed with Ebola.

And from the non-politicians:

There’s no evidence that quarantining aid workers who fought Ebola in Africa will make any difference in fighting Ebola in America.

“It’s completely unnecessary,” Harvard’s Ashish Jha told Vox’s Sarah Kliff. (Jha’s the director of the Harvard Global Health Institute). “I’m a believer in an abundance of caution but I’m not a believer of an abundance of idiocy.”
Jha and others stress that Ebola is only transmitted when you have close contact with an Ebola patient — say, if you’re a doctor or nurse who’s caring for that patient without adequate protection.

Bear in mind that the amount of ebola virus present in a patient is low at the time of fever and symptom onset, and highest (and most readily transmissible) during the acute phase of illness and in the bodies of recently deceased. Empirically, the virus has only been detected on the skin of patients in the acute phase. Note that patients in the acute phase are like really, really sick, and don't tend to go bowling, jogging, or clubbing. Deceased patients are even less active.


Review of Human-to-Human Transmission of Ebola Virus | Ebola Hemorrhagic Fever | CDC

 

[Fermion]

The penalty for being wrong about the quarantine is an inconvenience for a few dozen people in NYC.

The penalty for being wrong about the ease of transmission is an inconvenience for those who die. (plus a massive inconvenience for millions of people due to the panic it would cause if one person in NYC catches the virus third hand)

When you can cure Ebola (and not just administer phase 1 drugs or blood from a survivor) then we will talk about you really knowing everything there is to know about this virus.

 

[brewer12345]

The penalty for being wrong about the quarantine is an inconvenience for a few dozen people in NYC.

The penalty for being wrong about the ease of transmission is an inconvenience for those who die. (plus a massive inconvenience for millions of people due to the panic it would cause if one person in NYC catches the virus third hand)

When you can cure Ebola (and not just administer phase 1 drugs or blood from a survivor) then we will talk about you really knowing everything there is to know about this virus.

+1000.

 

[Meadbh]

The penalty for being wrong about the quarantine is an inconvenience for a few dozen people in NYC.

The penalty for being wrong about the ease of transmission is an inconvenience for those who die. (plus a massive inconvenience for millions of people due to the panic it would cause if one person in NYC catches the virus third hand)

When you can cure Ebola (and not just administer phase 1 drugs or blood from a survivor) then we will talk about you really knowing everything there is to know about this virus.

+1

 

[M Paquette]

Gosh, it sure looks like folks feel it's important to do everything possible to keep someone else from dying, even going beyond measures recommended by the experts and demanding things that seriously affect folks for weeks.

Does this level of concern apply solely to ebola, or does it apply to other potentially lethal stuff out there?

 

[clifp]

Gosh, it sure looks like folks feel it's important to do everything possible to keep someone else from dying, even going beyond measures recommended by the experts and demanding things that seriously affect folks for weeks.

Does this level of concern apply solely to ebola, or does it apply to other potentially lethal stuff out there?

+1
I think it more than inconvenience for those brave health care work, I think it potentially cost the lives of some Africans.

Imagine you are Doctor volunteering for Doctors without borders, or US public health care professional asked to go to West Africa. During the 9-12 months you'll be overseas, you know you have to come back to or may need to comeback a couple of times to the US, an elder parent, wedding, critical business meeting. The 3 week quarantine, three times extends your tour of duty by 9 weeks. Best case the NIH,CDC, Doctors with Borders, has to find somebody to fill in for the extra 3 weeks you are gone. Which wouldn't be so bad except for no such person exists. The worse case is that you decide that as much as you'd love to help out family comes first and stay home.

Yes this puts Americans at some tiny elevated risk, I still contend its far less than risk than having a 1 million ebola cases in Africa.

 

[Fermion]

+1
I think it more than inconvenience for those brave health care work, I think it potentially cost the lives of some Africans.

Imagine you are Doctor volunteering for Doctors without borders, or US public health care professional asked to go to West Africa. During the 9-12 months you'll be overseas, you know you have to come back to or may need to comeback a couple of times to the US, an elder parent, wedding, critical business meeting. The 3 week quarantine, three times extends your tour of duty by 9 weeks. Best case the NIH,CDC, Doctors with Borders, has to find somebody to fill in for the extra 3 weeks you are gone. Which wouldn't be so bad except for no such person exists. The worse case is that you decide that as much as you'd love to help out family comes first and stay home.

Yes this puts Americans at some tiny elevated risk, I still contend its far less than risk than having a 1 million ebola cases in Africa.

The difference here is the Doctor had a choice by volunteering to go into a very dangerous situation and has a choice of how he or she behaves when they return.

The poor soul who picks up a sweaty bowling ball didn't volunteer for anything.

You are just not understanding the economic ramifications of even a tiny outbreak of Ebola from one of these returning healthcare workers. Billions lost in productivity from panic and shutdowns, all of which could be prevented by choosing not to go to a wedding or business meeting?

 

[Brat]

What would be very useful is a blood test for Ebola that is effective before symptoms are manifest. Someone who comes from an Ebola area or who has been in contact with an Ebola patient can go into quarantine for a couple days pending results of the test.

I agree that requiring health care providers who have been working in Eastern Africa to be quarantined for 21 days would be disastrous.

 

[HFWR]

What we're suggesting is finding a common sense middle-ground between the best practices and accumulated medical/scientific knowledge, and what some wild-eyed political or "news" organization opines. Good luck with that...

 

[eytonxav]

This sums it up pretty well. I still think there could be flights arranged for healthcare workers to come and go without making things in Africa worse, and that non-medical passengers from West Africa be denied entry at this time:

 

[clifp]

The difference here is the Doctor had a choice by volunteering to go into a very dangerous situation and has a choice of how he or she behaves when they return.

The poor soul who picks up a sweaty bowling ball didn't volunteer for anything.

You are just not understanding the economic ramifications of even a tiny outbreak of Ebola from one of these returning healthcare workers. Billions lost in productivity from panic and shutdowns, all of which could be prevented by choosing not to go to a wedding or business meeting?

I think your argument would makes sense if there ever was an example of Ebola being transmitted from sweat. There hasn't been. AFAIK, there are no or almost no example of somebody with early symptoms transmitting the disease.

It somewhat reminds of the hysteria, when AIDs first hit the scene. People with HIV were fired, kids weren't allowed to go to school, lots of bans were proposed with respect to gays. The panic was understandable in many ways, a highly lethal disease with no cure and no treatment. AIDs actually is lot scary than Ebola even today. It appears with prompt medical help in a Western hospital you are very likely to survive Ebola and after a few weeks are pretty healthy again.

The ultimate solution with HIV/AIDs was education, not knee jerk reactions.

 

[razztazz]

I think your argument would makes sense if there ever was an example of Ebola being transmitted from sweat.

Why wait?

AFAIK, there are no or almost no example of somebody with early symptoms transmitting the disease.

More Russian roulette. What you really want to know is that it cannot be spread pre-symptom onset. Short of that proof I believe its borderline attempted manslaughter to let these vectors move freely on the hunch, and that's all it is, the hunch, that it "cannot be transmitted this way or that way" and "as far as we know now nobody has gotten it from this or that". Attempted Manslaughter.

AIDs actually is lot scary than Ebola even today. It appears with prompt medical help in a Western hospital you are very likely to survive Ebola and after a few weeks are pretty healthy again.

I am imputing you meant "AIDS is a lot scarier than ebola."

It is not. It is very hard to spread. The way people think ebola is but isn't.

It appears with prompt medical help in a Western hospital you are very likely to survive Ebola and after a few weeks are pretty healthy again.

Now. Just wait till lots of people get it. And why keep whacking that hornets nest anyway. Why not just keep it from spreading? And I mean without relying on "it appears, ..... it doesn't seem likely...., nobody has yet....., thus far there is no evidence..." BS wishful thinking.

 

[Fermion]

If Ebola is so incredibly hard to get then how did the American journalist in Africa come down with it? He was taking all precautions and did not have the close contact with bodily fluids that you expect with nurses and doctors.

"Mukpo isn't sure how he contracted Ebola because he said he was careful while filming."

You don't really know what you think you know about this virus.

 

[clifp]

Why wait?



More Russian roulette. What you really want to know is that it cannot be spread pre-symptom onset. Short of that proof I believe its borderline attempted manslaughter to let these vectors move freely on the hunch, and that's all it is, the hunch, that it "cannot be transmitted this way or that way" and "as far as we know now nobody has gotten it from this or that". Attempted Manslaughter.

It is hardly a hunch they have been studying this disease from more the 30 years, while there is a lot the don't know. They do know a lot with respect to how its spread.

I am imputing you meant "AIDS is a lot scarier than ebola."

It is not. It is very hard to spread. The way people think ebola is but isn't.

Now. Just wait till lots of people get it. And why keep whacking that hornets nest anyway. Why not just keep it from spreading? And I mean without relying on "it appears, ..... it doesn't seem likely...., nobody has yet....., thus far there is no evidence..." BS wishful thinking.

That is just plan wrong. Let reviews some facts here. HIV/AID and Ebola both hit the radar of western medicine in the 1970. The origins of both are unresolved.

Prior to this outbreak, despite scores of outbreaks primarily in the Congo and central Africa the total number of case of Ebola was less than 2,000 over the last 30+ years . The unique burial procedure of West Africa which involve cleaning and touching corpses were huge contributor to this outbreak.

In contrast 31 million have died of AIDS, and currently 35 million mostly in Africa, have HIV/AIDS disease. In 2011, 1.7 million people died of the disease.

Which means that for every person who has died of Ebola more than 50,000 have died of AIDS, and even if Ebola become the type of crisis that WHO/CDC is forecast 1 million early next year, AIDS will still be more deadly in 2015.

So explain to me how a AIDS a disease that kills almost as many people each day as have died in Ebola outbreak is either more deadly or harder to spread.

I understood why people advocated quarantine folks with HIV back in the 70s and early 80s. Scientist and doctors knew almost nothing about it.

This is not case with Ebola. Doctors and public health official are practically unanimous in calling this quarantine a really bad idea. I think we should listen to them.

 

[samclem]

Possibly bearing on the issue of screening/detection (from the LA Times):

Yet the largest study of the current outbreak found that in nearly 13% of "confirmed and probable" cases in Liberia, Sierra Leone, Guinea and elsewhere, those infected did not have fevers
.
The study, sponsored by the World Health Organization and published online late last month by the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola

. . .

For doctors and nurses fighting the epidemic in West Africa, the risk of encountering Ebola in the absence of fever is more than academic.
Dr. Nick Zwinkels, a Dutch physician, last month closed a hospital he had been running with a colleague in central Sierra Leone after five nursing aides contracted Ebola — possibly from unprotected contact with three patients who were not promptly diagnosed with the virus.
Four of the nursing aides died, as did all three of the patients belatedly found to have Ebola.
Interviewed by email, Zwinkels said that hospital staff members took the temperature of one of the doomed patients four times a day for three consecutive days, and the patient never showed a fever. The readings were taken by a digital thermometer placed in the armpit, he said.
Based on what his staff observed, Zwinkels wrote, "it seems that only measuring the temperature as a form of triage is insufficient."

It is very clear, based on info learned in this Ebola outbreak as well as previous ones, that about 12-15% of those with Ebola have no fever and yet can be infecting others.

 

[meierlde]

+1
I think it more than inconvenience for those brave health care work, I think it potentially cost the lives of some Africans.

Imagine you are Doctor volunteering for Doctors without borders, or US public health care professional asked to go to West Africa. During the 9-12 months you'll be overseas, you know you have to come back to or may need to comeback a couple of times to the US, an elder parent, wedding, critical business meeting. The 3 week quarantine, three times extends your tour of duty by 9 weeks. Best case the NIH,CDC, Doctors with Borders, has to find somebody to fill in for the extra 3 weeks you are gone. Which wouldn't be so bad except for no such person exists. The worse case is that you decide that as much as you'd love to help out family comes first and stay home.

Yes this puts Americans at some tiny elevated risk, I still contend its far less than risk than having a 1 million ebola cases in Africa.

It should be noted that Doctors without borders pays the folks during the any quarantine.

 

[samclem]

The worse case is that you decide that as much as you'd love to help out family comes first and stay home.

I'd say this is far from the worst case. Maybe the worst case is that you do go to Africa, spend time getting splashed with all manner of fluids from very sick people, go home without bothering with a quarantine and then expose a lot of other people to Ebola back in your home town.

We'll probably develop a test that allows surefire detection of the disease in tested individuals before they develop symptoms or become contagious. We don't have such a test now, and it seems prudent and reasonable to ask those who have been at increased risk of getting this communicable and fatal disease to wait before re-entering healthy populations. Heck, if I were in their booties I would want to go through quarantine to make absolutely sure I was clear before getting near my family.

Should this quarantine apply to anyone who has been treating Ebola patients? Maybe not. If the treatment is happening in a US or other hospital that has adequate protective equipment and adequate training and supervision to assure the procedures are known and followed, then we should consider the actual risk before making health care workers stay away from others. But we have zero assurance that these tiny clinics in W. Africa are operated in this fashion, and the number of health care workers who get Ebola in them is adequate testimony to that.

 

[clifp]

It should be noted that Doctors without borders pays the folks during the any quarantine.

Starting pay for doctors in Doctors without Border is <$1800/month and average is in the low $2,000. About what most would earn in 2 or 3 days in their real jobs.

 

[ERD50]

Starting pay for doctors in Doctors without Border is <$1800/month and average is in the low $2,000. About what most would earn in 2 or 3 days in their real jobs.

I'm fine with having our tax dollars support returning health care workers in a manner that rewards them for their service, rather than making it a burden, while they are in some form of quarantine. Take care of them and their families in style, make quarantine as comfortable as we reasonably can, compensate them for lost wages, and/or give them other non-contact work to do.

Like samclem said, infecting others in the US would be a bad thing, not just from a US-centric view, but it would create a real backlash against health care workers, and probably cause more problems than requiring a quarantine.

-ERD50

 

[2B]

It does not mean there will be no Ebola death in the U.S. in the future. I am very disappointed when the two nurses got infected and the government was saying that every hospital in the U.S. was well prepared. They just lost my trust.

Blindly trusting our government has not been the wisest thing to do for at least the last few decades. I'm not sure it was ever very smart. Fortunately, we can still believe in Santa and the Easter Bunny.

 

[2B]

Starting pay for doctors in Doctors without Border is <$1800/month and average is in the low $2,000. About what most would earn in 2 or 3 days in their real jobs.

That would be part of the cost of the doctors or nurses going to aid Ebola patients in Africa. They all take a financial hit by going as do anyone that volunteers.

 

[photoguy]

It is very clear, based on info learned in this Ebola outbreak as well as previous ones, that about 12-15% of those with Ebola have no fever and yet can be infecting others.

Although this is what the LA Time article implies, I don't believe this is a reasonable conclusion based on the original article in the New England Journal of Medicine. However one can read it and decide for themeselves: PDF link


In particular

(1) The study is not trying to see if fever is a reliable indicator of infection. Rather it is collecting observational data and running various regressions/models to understand the course of behavior. Observational data does not typically have very high accuracy and high accuracy is not necessary to get useful information out of their regressions.

(2) The data includes suspected and probably cases. There will be some people without the disease in their data

(3) The presence of fever is not measured accurately at all. From the article "in practice, health care workers at the district level often do not have a medical thermometer and simply ask whether the person’s body temperature is more elevated than usual."

(4) The case reports that are used are pretty long. There are bound to be errors in writing them up especially as the people filling them out are probably extremely overworked and tired. You can see the form here: PDF Link (it's at the end)

(5) The NEJM article does not state or conclude that someone without a fever can be infectious.

I read/skimmed the article pretty quickly (so I might have missed something) but those are my thoughts.

 

[samclem]

Although this is what the LA Time article implies, I don't believe this is a reasonable conclusion based on the original article in the New England Journal of Medicine. However one can read it and decide for themeselves: PDF link

Okay, but the LA times article also cited virtually the same figure (about 15%) based on studies done during previous Ebola outbreaks. And then they cited anecdotal evidence and the direct clinical observations from doctors who had run hospitals there. I think this is about as close to "truth" as we're going to get under the present circumstances -- unless we take steps to assure Ebola gets well established in the US so we can study it with greater precision.

 

[Fermion]

Well it does look like the anti-quarantine folks won, although it remains to be seen what their prize may end up being.

I do wonder what are the legal rights of someone local who gets a Ebola infection from one of these returning healthcare workers? Do they have a right to sue or is it just tough luck?