New York and New Jersey now requiring a mandatory 21 day isolation for anyone from West Africa, with or without Ebola Symptoms. Some poor Nurse from Doctors Without Borders who lives in Maine had the unfortunate consequence of flying into Newark, where she was met by a team in haz mat gear. Overkill much Chris Christie? She actually intended to isolate herself at home, but she is instead spending three weeks in a plastic bubble Sci Fi Style.
This will end in a lawsuit rather quickly.
(This post was last modified: 10-26-2014 07:32 PM by chiefsfan.)
(10-26-2014 07:31 PM)chiefsfan Wrote: New York and New Jersey now requiring a mandatory 21 day isolation for anyone from West Africa, with or without Ebola Symptoms. Some poor Nurse from Doctors Without Borders who lives in Maine had the unfortunate consequence of flying into Newark, where she was met by a team in haz mat gear. Overkill much Chris Christie? She actually intended to isolate herself at home, but she is instead spending three weeks in a plastic bubble Sci Fi Style.
This will end in a lawsuit rather quickly.
This is why politicians should leave these decisions to the people qualified to make them. The figureheads just care about being re-elected and rectifying the irrational fears of the masses, not trying to explain things through science.
If Bill Gates and some other billionaires want to spend their money helping the Ebola situation, how about they donate some private jets to fly doctors and nurses back from Africa to their homes? They would avoid the public transportation health issues, and we could quickly test them when they get back to the states to see if they have Ebola.
Isolate them at their houses for 21 days to get past the danger period, and we could avoid this whole mess/hysteria.
It kind of reminds me of the Communist scare of the 1950's. To the U.S.'s credit, we didn't isolate homosexuals when the AIDS epidemic burst onto the scene in the late 1970s/early 1980s.
(10-24-2014 08:57 AM)Redwingtom Wrote: You should be way more fearful of that cigarette you're smoking, that soda you're drinking and those french fries you're eating.
Yeah... Obama and the CDC and the AMA and every hospital in the country is stupid... Let's all listen to Tom
(10-24-2014 06:28 PM)I45owl Wrote:
(10-24-2014 05:03 PM)Hambone10 Wrote:
(10-24-2014 04:45 PM)Ole Blue Wrote: He didn't go out and slobber all over people. He came back in early October and just now developed symptoms.
Which is probably longer than the typical incubation period, which actually argues that the disease may be morphing.
He probably followed existing protocol, but that only argues that we may need to adjust the protocol
That's factually wrong - he developed symptoms within one week of returning.
http://www.cnn.com/2014/10/23/health/new...index.html Wrote:The doctor, identified as Craig Spencer, 33, came back from treating Ebola patients in Guinea October 17 and developed a fever, nausea, pain and fatigue Thursday. He is in isolation and being treated at New York's Bellevue Hospital, one of the eight hospitals statewide that Gov. Andrew Cuomo designated earlier this month as part of an Ebola preparedness plan.
You mean what I was responding to, right? Because all I was saying is that he probably followed whatever protocol was, and yet still may have infected people. I'd like to think that someone returning from an area like that wouldn't simply leave the area and jump on a plane, especially in that this was exactly what the Dallas patient did, lying to their TSA as they wouldn't have just let him go otherwise.
Just because he returned on the 17th doesn't mean that he was treating patients on the 16th. Based on the existing protocols for people CASUALLY in contact with people in the area (much less people directly involved in their treatment) I suspect they were quarantined for some period before getting on a plane and risking infecting others.
Sorry for the ambiguity. I meant the facts being discussed were wrong - "He came back in early October and just now developed symptoms"... he had only been back a week.
(10-26-2014 07:31 PM)chiefsfan Wrote: New York and New Jersey now requiring a mandatory 21 day isolation for anyone from West Africa, with or without Ebola Symptoms. Some poor Nurse from Doctors Without Borders who lives in Maine had the unfortunate consequence of flying into Newark, where she was met by a team in haz mat gear. Overkill much Chris Christie? She actually intended to isolate herself at home, but she is instead spending three weeks in a plastic bubble Sci Fi Style.
This will end in a lawsuit rather quickly.
Nurses and Doctors play a huge role in this situation - whether they are working here in America or in Africa (where it's more important, and their role in protecting Americans is probably larger). We have to look at whether it's possible for us to treat them badly enough for them to stop wanting to risk their lives flying across the world to save other people from suffering and the rest of the world from pandemic. I have to think that the answer is, yes, it is not very difficult to treat them that badly.
I doubt that people advocating mandatory quarantine would be the same people spitting on soldiers and calling them baby killers. But, pound for pound, these doctors and nurses are doing more to keep you safe than soldiers in Vietnam, Iraq, Afghanistan, and probably even WWII. (note the "pound for pound" comparison, not the aggregate comparison).
(10-26-2014 08:04 PM)Ole Blue Wrote: This is why politicians should leave these decisions to the people qualified to make them. The figureheads just care about being re-elected and rectifying the irrational fears of the masses, not trying to explain things through science.
I don't agree here. This is a public confidence issue and the CDC should have been prepared for it, but did not handle this in a way that reassures the public. The response of the Christie, Cuomo, et al is outrageous, IMHO, but it comes in the absence of clear leadership from the president. All of them have really failed to get clear and comprehensive guidelines of what should reasonably be expected of healthcare workers - whether they are returning from Africa or treating patients here in America. Mandatory campout in the parking lot is not a reasonable response, nor is "sure, go bowling, fly to Ohio, go on a cruise".
This really needs direction from the top down, and it is a public policy decision, not a medical one.
(10-24-2014 12:16 PM)Hambone10 Wrote: One side crying foul based on their extensive experience in infectious disease control (their 3rd grade class in hand washing) and others cognoscente of the fact that just because it HASN'T done 'x' before doesn't mean that it won't THIS time. That is rule #1 on infectious diseases and the doctor should have known better. One sneeze... one drop of sweat... one kiss CAN cost someone their life.
The reason Ebola is a problem, despite its incredibly low (by infectious disease standards) transmission rate is that it has a VERY high mortality rate... and the more we see it, the more 'different' it gets. As it moves from one country to another... from one set of natural and societal immunities to another... it, too will change.
Was the guy a fool? No. He was obviously aware of the risks and he took most reasonable precautions. However I'd note that the nurses who contracted the disease took some EXTREME precautions, as I am sure HE did, and ALL of them came down with it. To think that they couldn't similarly pass it is just silly.
Is it worth condemning the entire eastern seaboard? No. Is it worth following up on? Absolutely.
The problem that I see here is that yes, I can probably understand that the disease can and will mutate, and now that it the infection is at its most rapid spread in humans, now would be the time. But, what would that kind of mutation look like? From everything I have read or seen, no virus has ever (in modern medical history) changed mode of transmission - i.e. from bodily fluids to airborne (cough). If the current guidelines are to completely cover every bit of exposed skin, then what kind of mutation would allow the virus to penetrate barriers? No-one may be able to definitively say how the nurses in Dallas got exposed, but neither can you conclude that current guidelines that dictate complete coverage would be inadequate because they did not follow those guidelines from day one (they apparently did from day to, to the credit of Presbyterian, they went beyond the CDC guidelines of their own accord).
I will clearly state that I have no medical training or experience. But, it seems to me that whatever kind of mutation would make this more transmissible would at the same time make it less deadly. It seems to me that all of the decisions to let someone go bowling, fly, go on a cruise, etc. are medically sound, but they woefully disregard both the costs that others have then had to incur and the fears of the general public. Such fears are not likely to be calmed by doing things like that because they are by their nature emotional and irrational (I generally never use those words in close proximity around women, so if this is being read by any women, my apologies in advance).
(10-24-2014 12:16 PM)Hambone10 Wrote: I'd ask those who think anyone expressing concern about this is silly to spend 5 minutes in my office. I'm a hospital administrator with very limited patient contact. They are reviewing all of the 'precautions' to be taken with infectious diseases right outside my door. They not only wear double everything from head to toe and tell people to move slowly, but they pay people to stand there and watch you move, that will step in and remove you from the room should a gap or tear or cut or anything else occur... and I can assure you that until any room that patient passed through was completely sterilized, all open wounds would be rerouted from our emergency room.
This isn't paranoia, it is national and global protocol... and this doctor would have know that. You can poo poo concern all you want, and I agree that SOME of it can be overboard.... but I can assure you that should one single patient present at my hospital with an infectious disease, 60% of the staff will be TOLD not to report to work the next day and be directed to other locations.
What I find funny is that many of the same people saying this is hysteria are also against guns... which have FAR FAR FAR less natural propensity to kill people. Yes, far more people die from guns.... but far more people have them.
I don't envy any of those decisions. The Dallas Morning News indicated that Presbyterian lost about $8 million from shutting down their Emergency room. I'd rather you allocate that kind of money to a new EZF.
Exactly I-45. Presby didn't lose that money (much less what now must be a hit to their reputation) for political purposes.
As to the mutation, the method of transmission is actually not the most obvious way it would morph
More often it would simply be the virus adapting more to its host and living longer. In fact, the entire process of 'saving' patients actually encourages the disease to adapt. The person may eventually win the battle, but the disease doesn't often go quietly. The more natural progression would be that someone who wasn't symptomatic to be able to transmit the disease or that the disease would live longer than it was expected to. The concept of going from fluid to airborne is great for movies, but as you note, far less common. It is in part the swift and high mortality rate of the victims that keeps the disease from spreading. As we slow and reduce that, the diseases often spread more quickly (though not necessarily at a constant rate).
This is why groups like the CDC jump on things like this. Slow, measured responses actually make things far worse, not better.
(10-27-2014 05:38 PM)Hambone10 Wrote: Exactly I-45. Presby didn't lose that money (much less what now must be a hit to their reputation) for political purposes.
As to the mutation, the method of transmission is actually not the most obvious way it would morph
More often it would simply be the virus adapting more to its host and living longer. In fact, the entire process of 'saving' patients actually encourages the disease to adapt. The person may eventually win the battle, but the disease doesn't often go quietly. The more natural progression would be that someone who wasn't symptomatic to be able to transmit the disease or that the disease would live longer than it was expected to. The concept of going from fluid to airborne is great for movies, but as you note, far less common. It is in part the swift and high mortality rate of the victims that keeps the disease from spreading. As we slow and reduce that, the diseases often spread more quickly (though not necessarily at a constant rate).
This is why groups like the CDC jump on things like this. Slow, measured responses actually make things far worse, not better.
Even now, we're seeing quickly that the viral load is the most important thing when it comes to transmission. Early on, the disease is treatable, despite the lack of cure. It shouldn't be lost on anyone that the only Ebola death here came because of a hospital screw up. And he's also the only case to transmit the disease to someone else.
What I think we're seeing is that with prompt treatment, the survival chances go up significantly, and with that lowers the chance of the disease spreading to others.
The biggest issue in Liberia, Sierra Leone, and Guinea is that treatment is not often prompt. It took months for everyone there to realize what was happening, and it is taking even longer to convince the masses that the disease isn't made up because everyone is so afraid of the government. One of the guys who first discovered the disease made the comment the other day that at a critical point in Liberia in which the virus appeared control, a well liked person died of the disease, and over 20 people laid hands on the body as part of the funeral. That started everything all over again.
Customs and Practices along with the 3rd world country status of West Africa Nations is really allowing the disease to spread, compared to the US where we are responding at a much faster rate.
I'll point out the major obvious flaws with your info-graphic. First, it assumes there will be only 12 imported cases of Ebola over the course of a year. That's a huge assumption. Secondly, and probably most importantly, Ebola has the risk of spreading exponentially. 12 cases can quickly becomes 144 which quickly becomes 20,736 and so on. If it ever truly becomes airborne god help us all. Sharks, lightning, plane crashes, car wrecks, and bee stings do not have the ability to increase exponentially, that's the difference. Look at the various pandemics throughout history...disease is very scary.
(10-27-2014 05:38 PM)Hambone10 Wrote: Exactly I-45. Presby didn't lose that money (much less what now must be a hit to their reputation) for political purposes.
As to the mutation, the method of transmission is actually not the most obvious way it would morph
More often it would simply be the virus adapting more to its host and living longer. In fact, the entire process of 'saving' patients actually encourages the disease to adapt. The person may eventually win the battle, but the disease doesn't often go quietly. The more natural progression would be that someone who wasn't symptomatic to be able to transmit the disease or that the disease would live longer than it was expected to. The concept of going from fluid to airborne is great for movies, but as you note, far less common. It is in part the swift and high mortality rate of the victims that keeps the disease from spreading. As we slow and reduce that, the diseases often spread more quickly (though not necessarily at a constant rate).
This is why groups like the CDC jump on things like this. Slow, measured responses actually make things far worse, not better.
You have a viral load & viral shedding problem. High viral loads overwhelm the immune system, causing the high secretion viral shedding issue with associated organ failure & death that results in secondary infection of providers. Now if you hit it right after exposure with an RNAase anti-viral, and then follow with MB-003, with the right timing you might beat it. Problem is the time window is tight.
Thank you immunology & microbiology courses.
But you don't have this health infrastructure in West Africa to handle this.
(10-27-2014 05:38 PM)Hambone10 Wrote: Exactly I-45. Presby didn't lose that money (much less what now must be a hit to their reputation) for political purposes.
I intended to reply by saying that Presby has been running some promotional ads thanking people for standing by them and returning to the hospital. I forgot that part of my post, and the commercial came on again in the 3rd quarter of the Cowboys game...
Where I really expect Presby to hurt is people assuming that they'll get cooties going to the hospital there.
My physical was today at Methodist Richardson, which was designated as a Texas Ebola center. Of course, it's the professional building there. I asked the nurse if they were getting Ebola training (no) but she didn't seem pleased by the decision ... I think because the prospect of losing a couple weeks pay didn't seem good. I don't know what to make of it, but I've never seen the parking lot as empty as it was today... maybe just the time of day, though.
One thing she mentioned is that the staff may not have been able to piece together that Liberia is in Africa (geographical literacy is not a medical requirement, I guess, and they're probably no more immune to ignorance about such things than the general population). And, the computers are generally unreliable as a means of communication getting from admissions back to the staff.
(10-27-2014 05:38 PM)Hambone10 Wrote: As to the mutation, the method of transmission is actually not the most obvious way it would morph
More often it would simply be the virus adapting more to its host and living longer. In fact, the entire process of 'saving' patients actually encourages the disease to adapt. The person may eventually win the battle, but the disease doesn't often go quietly. The more natural progression would be that someone who wasn't symptomatic to be able to transmit the disease or that the disease would live longer than it was expected to. The concept of going from fluid to airborne is great for movies, but as you note, far less common. It is in part the swift and high mortality rate of the victims that keeps the disease from spreading. As we slow and reduce that, the diseases often spread more quickly (though not necessarily at a constant rate).
This is why groups like the CDC jump on things like this. Slow, measured responses actually make things far worse, not better.
That's a good point about survivors being the ones that help the disease mutate. I won't even touch what WMD said ... there's a reason that I stayed far, far away from the pre-meds.
(This post was last modified: 10-27-2014 09:36 PM by I45owl.)
(10-27-2014 07:14 PM)chiefsfan Wrote: What I think we're seeing is that with prompt treatment, the survival chances go up significantly, and with that lowers the chance of the disease spreading to others.
The biggest issue in Liberia, Sierra Leone, and Guinea is that treatment is not often prompt. It took months for everyone there to realize what was happening, and it is taking even longer to convince the masses that the disease isn't made up because everyone is so afraid of the government. One of the guys who first discovered the disease made the comment the other day that at a critical point in Liberia in which the virus appeared control, a well liked person died of the disease, and over 20 people laid hands on the body as part of the funeral. That started everything all over again.
Customs and Practices along with the 3rd world country status of West Africa Nations is really allowing the disease to spread, compared to the US where we are responding at a much faster rate.
I think you're begging trouble by starting a sentence with "the biggest issue in Liberia, Sierra Leone, and Guinea is..."
Is it the fact that patients are kept in rooms knee deep in vomit and diarrhea? Is it that the sick have to be treated at home by family members and are turned away from the hospital? Is it the complete lack of infrastructure to treat even a small level of infection? Or, as you say, that treatment is not prompt? It's just a ****** up situation and results in both unnecessary death and undeterred growth of the infection. It's a giant Ebola petri dish.
All of the above is why I think Obama did the right thing in sending troops to build up some infrastructure for treatment and isolation.
It's also why there is substantial harm that can be done by mistreating those in doctors without borders like lepers when they return. They should have clear, strict, and reasonable rules about what they can and can't do when they return. But, if you have capricious and reactionary rules, doctors and nurses will say "screw it - I could deal with third world conditions and dangerous disease in a third world country, but won't be treated like a convict when I return... have a happy pandemic, world!". I kind of doubt that someone willing to take on that task in Africa would change their decision on that basis, but I could definitely see someone deciding to transfer from one hospital to another or refusing to treat Ebola patients because of those negative consequences. If mandatory quarantine were a reasonable reaction, that would be one thing, but it's not, and I doubt that doctors and nurses would see it as such.
![[Image: ebik_custom-212aaf7466319b58697413b83d49...s4-c85.jpg]](http://media.npr.org/assets/img/2014/10/25/ebik_custom-212aaf7466319b58697413b83d49b392a120fa4b-s4-c85.jpg)
