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Old 10-31-2014, 06:21 PM   #81
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Kaci deserves two medals in my book, one for her work with Doctors without borders in dangerous places, and second for standing up for OUR rights.
The trouble is, some of your fellow citizens would define THEIR rights as not being exposed to people who have recently been in contact with people dying from a high mortality rate disease. One person's perceived 'rights' do not trump another person's perceived 'rights'.

I'm all for proceeding with an abundance of caution until we know more about this disease. While I'm normally one who points to science and logic, we cannot deny that people are afraid, and maybe we need to take that into consideration, even if it means erring on the side of caution.

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Old 10-31-2014, 07:31 PM   #82
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I'm beginning to think that phrases like "an abundance of caution" and "erring on the side of caution" are turning into excuses for basing policy on fear. There is a lot that that is known about dealing with this disease. It has been around for 20 years and MSF and other aid groups have been treating patients all year in west Africa. MSF has had more than 3000 employees working in horrendous conditions. About 30 have fallen ill and some of those have died.

Policies that go against experience and the medicine and the science can do more harm than good. It seems a little odd that we are fearing the people who have shown the courage and compassion to go fight the disease at the source and who know more about treating the disease than the vast majority of the medical profession in this country and certainly more than the politicians. We should be looking to these medical personal who return for advice on how to manage the disease. Instead, we are shunning them.

Why would the people who volunteer to go to west Africa have any interest in endangering their family, friends, and country when they return?
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Old 10-31-2014, 07:43 PM   #83
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I'm beginning to think that phrases like "an abundance of caution" and "erring on the side of caution" are turning into excuses for basing policy on fear.
I'm not saying policy should be 'based on fear', I'm saying we might need to take fear into consideration.


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It seems a little odd that we are fearing the people who have shown the courage and compassion to go fight the disease at the source and who know more about treating the disease than the vast majority of the medical profession in this country and certainly more than the politicians. We should be looking to these medical personal who return for advice on how to manage the disease. Instead, we are shunning them.
I'm not shunning them, I'm saying that maybe a quarantine (on our dime for those meeting the qualifications) should be part of the plan upfront for going there, treating people, and returning.


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Why would the people who volunteer to go to west Africa have any interest in endangering their family, friends, and country when they return?
We can't leave this up to individuals. And we need to consider the fear that they might create, which could do harm regarding others going there and helping.

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Old 10-31-2014, 07:51 PM   #84
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MSF says they have sent about 700 international staff to west Africa. This epidemic has been going on a long time before the first US Dallas patient. It would be interesting to learn what the advice, policy, and the actual behavior and experience has been for all those other workers, worldwide, who have come and gone from the region.
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Old 10-31-2014, 08:05 PM   #85
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MSF says they have sent about 700 international staff to west Africa. This epidemic has been going on a long time before the first US Dallas patient. It would be interesting to learn what the advice, policy, and the actual behavior and experience has been for all those other workers, worldwide, who have come and gone from the region.
It certainly would, we should learn all we can.

In the mean time, two nurses in the US did become infected, despite assurances that the US was prepared for this.

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Old 10-31-2014, 08:11 PM   #86
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Temperature monitoring is an effective measure to determine if someone at risk has the disease before they are capable of infecting others.
But---it's not. We know that 12-15% of people who have Ebola and are capable of spreading it to others do >not< have a fever. That is based on many observations during the present epidemic as well as the previous ones.

A 12-15% false negative rate might be "good enough" for a less lethal disease, but not for this one.
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Old 10-31-2014, 08:22 PM   #87
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The trouble is, some of your fellow citizens would define THEIR rights as not being exposed to people who have recently been in contact with people dying from a high mortality rate disease. One person's perceived 'rights' do not trump another person's perceived 'rights'.

I'm all for proceeding with an abundance of caution until we know more about this disease. While I'm normally one who points to science and logic, we cannot deny that people are afraid, and maybe we need to take that into consideration, even if it means erring on the side of caution.

-ERD50
I don't care how my fellow citizen define their rights. People have been increasingly making up rights like the right to not have to be exposed to offensive speech, or free health care, or the right not have to flying in plane with Muslim etc. Lately its been the right to be protected from anything that could possibly harm you no matter how remote.

Fortunately we live in country which has constitutionally protected rights, and generally we have a judicial branch which protect them. As in this case where people's made up right of not being afraid meet Kaci 5th amendment rights of not being deprived of liberty. The judge ruled correctly and his requirement that she be actively monitor for any signs of illness was an entirely reasonable request.

I remember the hysteria surrounding AIDs patients, and I think my attitude was similar back then You know we really should be cautious and put some reasonable restrictions. Not only was I dead wrong, but a good friend at the time and now one of my best friends was in the closet. To make a matters worse his partner was dying of AIDS. I wonder what stupid things I said back them.

I believe that not catering to peoples irrational fears is not only the fairest thing to do for the admirable medical professional who have help Ebola victims. I also think it is the best way of saving lives not only in Africa but right here in the good old USA. Doctors without Border has been working with Ebola since the beginning, when they say these quarantines is causing problem with recruitment and impacting their mission and cost lives, I see no reason to doubt them.
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Old 10-31-2014, 08:31 PM   #88
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That was the big error, they lost the publics trust. You can do 1000 right things, mess up on one and you've lost credibility. You have to do 10000 things right now to regain that trust. Too bad, I think thats how many folks are wired.


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Well it was error no doubt. However, I don't know why it was so big. Two nurse spent a few weeks in the hospital. Now admittedly it is scary disease, but has been pointed numerous times a huge function of its high lethality is because health care in Africa sucks. It didn't even sound like either nurse become critical ill, and the second nurse was released in less than 2 weeks.

Compared to countless errors by government agency the impact is tiny. Hell GM has recalled 40 million cars this year for errors which have resulted in scores of deaths. Yet millions of people still buy them. Why the double standard?
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Old 10-31-2014, 08:40 PM   #89
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Big error in the sense of what the error cost their credibility.

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Old 10-31-2014, 08:46 PM   #90
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I often hear the "let's stick to the science" appeal made by the same person, at the same time, as they extoll the "admirableness" of the health care workers as some sort of rationale for not imposing a quarantine. Either a quarantine is justified based on the scientific evidence (and the competing civil liberty/secuirty concerns) or it is not. The disease doesn't "care" about the wonderfullness of these people, and we're not talking about punishing them. Yes, let's stick to the evidence, avoid emotionalism, and recognize that biology/epidemiology has a lot more grey areas than "hard" sciences like engineering.

The executive branch of the US government has decided that a quarantine of their travelers (military personnel) who have been in the affected areas but not near Ebola patients is warranted. And the executive branch has also decided that a quarantine of other individuals who have directly been exposed to Ebola patients--their feces, blood, and vomit-- in these same countries is not required. Who is right, the executive branch or the executive branch?
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Old 10-31-2014, 08:55 PM   #91
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But---it's not. We know that 12-15% of people who have Ebola and are capable of spreading it to others do >not< have a fever. That is based on many observations during the present epidemic as well as the previous ones.

A 12-15% false negative rate might be "good enough" for a less lethal disease, but not for this one.
What's your source for this? I tried the google, but couldn't find anything to support this. I must be using the wrong search terms...
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Old 10-31-2014, 09:04 PM   #92
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What's your source for this? I tried the google, but couldn't find anything to support this. I must be using the wrong search terms...

This LA Times article
is one. Link contains further references.

From the LAT piece:
Quote:
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.
Another example of CDC failure to provide accurate information:
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Referring to those who had close contact with Duncan, Frieden said a week ago: "The only thing we need to ensure is that their temperature is monitored, and if they develop a fever, that they are immediately assessed, isolated and if found to be positive, then appropriately cared for."
So, just this outbreak and the info comes from just this survey? Nope, the 12-15% no-fever rate has been known for a long time:
Quote:
Three studies of previous outbreaks, cited in the same World Health Organization report, provide further grounds to question whether fever is a fail-safe signal.
Researchers studying an outbreak in Uganda in late 2000 and early 2001 reported that "the commonest symptom … was fever, which occurred in 85% of the cases."
Another study of that outbreak, focusing on 24 confirmed cases of Ebola, found fever in 88%.
The third study, which examined a 1995 outbreak in the Democratic Republic of Congo, found fever in 93% of 84 people who died and in 18 of 19 individuals who survived.
That's as close to "definitive" as we're likely to get in our present less-than-perfect state of understanding of this disease.
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Old 10-31-2014, 09:09 PM   #93
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I wouldn't have problems serving her -- I believe the science (even though I tend to be very cynical and skeptical).
There is no such thing as "the science". Science is a process, not some sort of "this is the way it is" summary. There are mostly clinical observations, and of course what we know about are the carefully controlled news releases from the CDC plus various self appointed experts.

If any of these people were really experts, there wouldn't be this deadly epidemic going on in West Africa. It might be that they are 100% correct, but if so it might be about the first time.

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Old 10-31-2014, 09:09 PM   #94
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Thank you for the link. Off to go read.
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Old 10-31-2014, 09:17 PM   #95
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'cynical and skeptical' is at the heart of the peer review process, and is what makes science so reliable.
First of all, look only to the way carbohydrates have been pushed on us worldwide, and how many peer reviewed studies seemingly support this. Then dig that it is likely the biggest cause that so many Americans are grossly fat, and a goodly number of them are also diabetic. The famous 7 country study by Ancel keys that started this entire mess was actually fraudulent.

How many controlled, quality "peer reviewed" studies have been published on Ebola?

If there is any advantage to living in an advanced country, it ought to include greater protection from the common messes of the 3rd world

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Old 10-31-2014, 10:36 PM   #96
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There is no such thing as "the science". Science is a process, not some sort of "this is the way it is" summary.
You're right that my use of the phrase "the science" is not really a proper term. I used it as shorthand for "widely accepted conclusions by medical researchers who follow the scientific method".

Quote:
There are mostly clinical observations, and of course what we know about are the carefully controlled news releases from the CDC plus various self appointed experts.
I have to disagree with you here. Although there is probably very little in the way of carefully controlled experiments in the classical sense, there are a huge number of natural experiments (Natural experiment - Wikipedia, the free encyclopedia). For example, every person on the plane with Amber Vinson is a natural experiment that reveals how contagious a person with ebola may be when they have a fever (but not vomiting, diarrhea, etc). The four people living with Duncan is another such experiment. In addition, every prior aid worker (probably several hundred? I'm not sure of the exact number here) that has returned from an outbreak area is a natural experiment that evaluates the overall risk of returning health workers.


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If any of these people were really experts, there wouldn't be this deadly epidemic going on in West Africa. It might be that they are 100% correct, but if so it might be about the first time.
I don't follow this argument. One can be an expert on how a disease is transmitted but be unable to take actions that stop it due to outside constraints (e.g., poverty, cultural traditions, lack of resources)
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Old 10-31-2014, 10:43 PM   #97
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While she was in Africa, Ms Hickox had a roommate who apparently caught Ebola, according to the State of Maine. The roommate didn't know how that happened.

This seems to happen a lot.

People might have more faith in the opinions of health care experts about how to protect ourselves from Ebola if so many health care experts weren't becoming infected themselves. There's either a gap in our knowledge of how the disease is spread or negligence/carelessness in applying this knowledge. None of those available options increases public confidence.
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Old 10-31-2014, 10:45 PM   #98
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Compared to countless errors by government agency the impact is tiny. Hell GM has recalled 40 million cars this year for errors which have resulted in scores of deaths. Yet millions of people still buy them. Why the double standard?
Because (for the most part) people don't make decisions based on logic, even when they think they are.For the long answer, read Thinking Fast and Slow.

For the short answer:

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Old 10-31-2014, 10:49 PM   #99
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Thank you for the link. Off to go read.
I followed up on the original New England Journal of Medicine article referenced by SamClem's link in the other thread and made some comments here:

Ebola in Texas

I know SamClem has also brought up other studies/points -- I have not had time to track any of those down and read them. But I'm pretty sure that the CDC is aware of them and wouldn't recommend fever as a test if it had a 10-15% failure rate.
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Old 10-31-2014, 11:01 PM   #100
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But I'm pretty sure that the CDC is aware of them and wouldn't recommend fever as a test if it had a 10-15% failure rate.
According to the same LA Times article:
Quote:
Asked Friday how many people infected in the current outbreak should be expected to display fever, a CDC spokeswoman, Sharon Hoskins, said "the vast majority" would, but added that it was "impossible to give an exact percentage."
That doesn't inspire much confidence. What's the inverse of "vast majority?" "Significant minority?" Maybe about 10-15%? If the CDC knows a number, let's see it.

An acceptable screening test for a fatal infectious disease should have >very< few false negatives. A fair number of false positives might be acceptable (though it would be inconvenient and reduce the utility of the test).

And, for the record, Ms Hickox did have a slightly elevated temperature. But, I'm sure there's nothing to see here . . .
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