Ebola in America

[Minoosh]

It really doesn't take a lot of knowledge to understand that ebola should be treated with far more caution than most diseases.

Bolding mine.

Why, exactly? Lethality? Communicability? Possibility of containment? Plenty of people with other dangerous diseases have infected fellow travelers on planes, buses, boats, in hospitals, etc. even as Ebola has hogged the headlines. The diseases may sound less scary - flu, TB - but are probably more contagious and potentially just as lethal as Ebola. Do these not warrant comparable caution?

 

[Shepherd]

People who know they have compromised immune systems and for whom the diseases you mentioned are probably much more likely to actually be lethal, I would suspect as individuals would probably be much more cautious than the average person with a healthy immune system.

Maybe we should be asking them, then, what precautions we should take since Ebola puts us all into the same boat together. ...and metaphorically speaking, of course, since they likely wouldn't allow us casual disease spreaders into their boat with them.

Wonder if they will emerge from - or at least call from - their isolated homes and bubbles to weigh in for us?

 

[cosmicaug]

You have said she was "exhibiting symptoms". Well, specifically, she had a body temperature of 99.5 degrees. Technically, that's a symptom.

Also, in reality, that's a symptom.

Is it? what would a normal temperature range be? Does this fall within the normal range of body temperatures?

Are you not doing what you accuse others by judging the correctness of an action based on results which may not be related to the correctness of said action? That is, you are judging the decision of saying that this nurse was fine based on the fact that some time later it was determined that she was infected with Ebola. In fact, you are doing more than that, you are indirectly judging what it means to be febrile based on the fact that she was determined to have developed an illness at a later time. By this reasoning, someone could have a temperature of 97F and you could call it a fever if they develop an illness at a later time.

 

[wollclark]

So this doctor gets back from working with ebola patients, starts feeling fatigued but decides to take public transport and go bowling in a highly populated, tourist heavy city anyway; he only decides to report the fact he's not feeling well when he finds he has a fever of 103.

And what do I hear from CNN? They keep repeating the lie that he was "asymptomatic" after just having stated that he was "feeling fatigued."

Then I heard that New York authorities aren't going to bother with sanitizing the elevator of his apartment building, nor the subway trains he took. If I'm remembering correctly, they also said they weren't going to bother with the taxi he took. There not even going to bother keeping in contact with the man who drove the taxi.

I hope these lazy, overly-confident actions (or inactions) taken by these officials don't end in more people getting sick. I hope they're right when they say the risk is "low" at this point in his illness that more can get sick, and they're not just saying that because it sounds nice and calming.

 

[Dan O.]

Bolding mine.

Why, exactly? Lethality? Communicability? Possibility of containment? Plenty of people with other dangerous diseases have infected fellow travelers on planes, buses, boats, in hospitals, etc. even as Ebola has hogged the headlines. The diseases may sound less scary - flu, TB - but are probably more contagious and potentially just as lethal as Ebola. Do these not warrant comparable caution?

One of the key issues is that Ebola is currently not spreading in the wild in the US. Many deaths may be prevented by taking the extra measures to keep it out.

 

[catsmate]

I don't see how the current restrictions would have changed his final destination. Yes, he would have flown through an airport with more rigorous screening. But, if he continued to lie he would have continued on until he landed in Dallas, where his fiance was waiting for him. He would not have stayed in any of those hubs while he was exhibiting no symptoms unless he told someone about his exposure. Since he wasn't clear about that with the doctor in Dallas I don't see him being clear about that during screening at immigration.

He still ends up in Dallas. He still goes to local hospital when he isn't feeling well. Local doctor makes a mistake in accessing patient info. He gets sent home.

The CDC isn't the problem here, it is our reliance on humans in treating disease. Not an easy problem to solve. Especially when this particular type of human tends not to embrace their own failings, but that is another topic.

Especially over-worked humans in understaffed and under-resourced facilities.

PANIC !!! PANIC !!!!!! Go go go ! Panic NOW !

Yeah that's what I expect.

 

[Belz...]

I hope these lazy, overly-confident actions (or inactions) taken by these officials don't end in more people getting sick. I hope they're right when they say the risk is "low" at this point in his illness that more can get sick, and they're not just saying that because it sounds nice and calming.

Do you, really ?

 

[Meadmaker]

So this doctor gets back from working with ebola patients, starts feeling fatigued but decides to take public transport and go bowling in a highly populated, tourist heavy city anyway; he only decides to report the fact he's not feeling well when he finds he has a fever of 103.

And what do I hear from CNN? They keep repeating the lie that he was "asymptomatic" after just having stated that he was "feeling fatigued."

Then I heard that New York authorities aren't going to bother with sanitizing the elevator of his apartment building, nor the subway trains he took. If I'm remembering correctly, they also said they weren't going to bother with the taxi he took. There not even going to bother keeping in contact with the man who drove the taxi.

I hope these lazy, overly-confident actions (or inactions) taken by these officials don't end in more people getting sick. I hope they're right when they say the risk is "low" at this point in his illness that more can get sick, and they're not just saying that because it sounds nice and calming.

The virus can live for up to four hours outside of a host.

What point is there in disinfecting places that he hasn't been in the last four hours?

It isn't "lazy" to avoid actions that have no benefit.

 

[Belz...]

It isn't "lazy" to avoid actions that have no benefit.

Ah, but they do have a benefit: the illusion of safety.

 

[Howie Felterbush]

It seems to me that we should have deluxe health resorts to give health care workers a place to relax for 3 weeks after they have been treating ebola patients. Plumb Island in New York would be an excellent site since it is already owned by the Feds and houses a premiere medical facility.

There's a very, very nice beach. Terns nest there.

 

[cosmicaug]

The virus can live for up to four hours outside of a host.

Are you sure it's even as long as that? Under what conditions? It's an enveloped virus, they tend to become nonviable almost as soon as they are exposed to the air and have a chance to dry out.

 

[wollclark]

http://www.dailymail.co.uk/news/art...on-tape-PUBLIC-trash-city-sidewalk-leave.html

They show police officers tossing their gloves, masks and the caution tape used to block off access to his apartment in a public trash can.

 

[Belz...]

That's it ! All the homeless people are going to become infected !

PANIC !!!

 

[Biscuit]

The the Duncan strain, for lack of a better description, infected 2 nurses who are both in isolation and the people they had contact with are currently being monitored. All others exposed to Duncan are past their 21 day infection period. All reports indicate the two nurses are doing well.

The NY doctor strain will require all contacts to be monitored for 21 days. He is in isolation and receiving treatment.

Seems like we are going to be OK. Caught off guard initially but no need to panic over 1 ebola death in America.

 

[Dr. Keith]

So this doctor gets back from working with ebola patients, starts feeling fatigued but decides to take public transport and go bowling in a highly populated, tourist heavy city anyway; he only decides to report the fact he's not feeling well when he finds he has a fever of 103.

And what do I hear from CNN? They keep repeating the lie that he was "asymptomatic" after just having stated that he was "feeling fatigued."

"Fatigue" is also a known symptom of one of the primary diseases of the international traveler: jet lag. Going out for a run and trying to live a normal life sounds like a reasonable treatment plan.

 

[Dr. Keith]

You're writing is typically top notch, but I think on this one you could use a bit of help. If you don't mind:

Seems like we are going to be OK all going to die!!! Caught off guard initially but no and totally blindsided, our only option now is that we need to panic over 1 ebola death in America !!!!!!!!!.

 

[Ziggurat]

Are you not doing what you accuse others by judging the correctness of an action based on results which may not be related to the correctness of said action? That is, you are judging the decision of saying that this nurse was fine based on the fact that some time later it was determined that she was infected with Ebola.

No, I'm not doing that. Even absent the final outcome, her symptoms plus known contact present a risk. Even if the risk had not been realized, precautions should have been taken. For example, the sheriff who visited the apartment Duncan stayed at and later developed stomach pain should have been isolated as soon as he experienced any symptoms (and I think he was), but in his case fortunately he did not have ebola. But the after-the-fact knowledge that he did not have ebola does not change the appropriateness of isolation until that determination could be made.

In fact, you are doing more than that, you are indirectly judging what it means to be febrile based on the fact that she was determined to have developed an illness at a later time.

No. She had an elevated temperature. She called the CDC because she had an elevated temperature. I'm not the only one who concluded that that this was a possible symptom. She did too, and so has the CDC head.

By this reasoning, someone could have a temperature of 97F and you could call it a fever if they develop an illness at a later time.

No. If you have a temperature of 97F, that is NOT a symptom of ebola, even if you have ebola.

 

[Ziggurat]

"Fatigue" is also a known symptom of one of the primary diseases of the international traveler: jet lag. Going out for a run and trying to live a normal life sounds like a reasonable treatment plan.

No, it's not a reasonable treatment plan for someone who was treating ebola patients in Africa. Even if the fatigue he experienced was merely from jet lag, even if he didn't have any symptoms at all, if he had ebola (and he knew he was at risk), then he could still develop symptoms while out and about, even if he had none when he decided to leave his home. Anyone in such a risk category should be trying to minimize their contact with other people for at least 21 days.

 

[Dr. Keith]

No, it's not a reasonable treatment plan for someone who was treating ebola patients in Africa. Even if the fatigue he experienced was merely from jet lag, even if he didn't have any symptoms at all, if he had ebola (and he knew he was at risk), then he could still develop symptoms while out and about, even if he had none when he decided to leave his home. Anyone in such a risk category should be trying to minimize their contact with other people for at least 21 days.

You are overlooking the fact that the disease is not very communicable in most situations, but even less so in the early stages.

Waiting until clear symptoms, not just feeling fatigue or a normal fluctuation in temperature but nausea and high temperature, appears to be a rational approach. Based on the science.

The only transmissions in the US were the result of those rational guidelines being ignored and inadequately trained and equipped personnel being pushed into the resultant mess.

ETA: If he gave blood while feeling fatigued or otherwise shared bodily fluids with people while out for a jog, then I might agree with you, but my experience with jogging is that such activities are rare.

 

[Meadmaker]

Are you sure it's even as long as that? Under what conditions? It's an enveloped virus, they tend to become nonviable almost as soon as they are exposed to the air and have a chance to dry out.

I read it on the internet, so it has to be true.

In this case, I'm pretty sure I read it on the CDC site, and they were discussing worst case scenarios, like in a blood drop not exposed to direct light. Don't quote me on that, though. If I get a chance and remember, I'll look it up.

At any rate, there's no reason for a team in haz-mat suits to spray down the elevator he used 24 hours earlier. It's not laziness or overconfidence that made them decide not to seek out elevators, taxis, or even bowling shoes.


ETA: From the CDC website -

How long does Ebola live outside the body?

Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dry surfaces, such as doorknobs and countertops, can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature

So-maybe I wouldn't want to wear his bowling shoes.