Ebola in America

A'isha said:
More people in America have been married to Kim Kardashian than have died of Ebola.
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Thoughts like this, the meteors and other quantitatively dismissive replies miss two crucial points

1) we've had one (1) instance of uncontrolled movement of ebola (oh, crap, it's ebola!) coming in contact with American medical systems. This one incident resulted in two infected healthcare workers. Bad ratio. The case was handled poorly from beginning to end, with 40 randoms quarantined, uncontrolled movement of an infected secondary contact, unnecessary exposure of law enforcement to uncleaned areas, et cetera.

2) more important than the above, all those mistakes have been caught and errors in hardware and procedures are being modified in response, quickly, now when we don't have multiple waves of primary contacts coming in.

I'm sorry Mr Duncan's family lost him, but his death served a greater purpose by smoke-testing the system for us. Obviously we needed it and inevitably there will be more mistakes in the future but now the entire nation's medical community has had a wake up call.
 
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Ziggurat said:
You're correct, I didn't click on the link. So what? I'm familiar with the story, because your link isn't the only source. As for me being wrong about the screening, your link doesn't contradict me. The test for a fever is a simple temperature measurement. Yes, they will also be asked questions, and I didn't specifically mention that aspect. But we know that's inadequate too. Duncan faced questions about Ebola exposure on his exit from Liberia, and that did nothing to stop him. I've heard conflicting reports about whether or not he knew he had been exposed, but either way, the questions aren't enough.
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Actually it's the same procedures that stopped the spread in Nigeria but whatever. :rolleyes:

Ziggurat said:
Note also that this change in policy is basically an admission that their previous position (no flight restrictions at all) was insufficient, and that their response is haphazard and PR-driven. If this is your attempt to prove competence on the part of the administration, it's not succeeding.
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No it isn't. It takes time to put these procedures in place, to train and equip staff. That's the reason for the delay. Instead of knee jerk hysteria they are doing things systematically and deliberately.

These aren't even flight restrictions, it's passenger screening, so they aren't going back on any previous statement at all.

CDC is sending additional staff to each of the five airports. After passport review:
Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
Trained CBP staff will observe them for signs of illness, ask them a series of health and exposure questions and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.
If the travelers have fever, symptoms or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.
Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.
Entry screening is part of a layered process that includes exit screening and standard public health practices such as patient isolation and contact tracing in countries with Ebola outbreaks. Successful containment of the recent Ebola outbreak in Nigeria demonstrates the effectiveness of this approach.
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http://www.cdc.gov/media/releases/2014/p1008-ebola-screening.html
 
theprestige said:
Your link doesn't describe the new protocols, but this one does:

http://www.nationaljournal.com/dome...restrictions-to-stall-ebola-outbreak-20141021
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I realized that and have edited that post and reposted the actual link I wanted. Thanks!

mgidm86 said:
What other measures are being taken besides temperature and a few questions? I see no mention of anything in the article you posted.

In response the above post, it does?
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See my post that includes the CDC link. It is a layered approach that was effective in stopping the spread in Nigeria.
 
Biscuit said:
Actually it's the same procedures that stopped the spread in Nigeria but whatever. :rolleyes:
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No, it's not.

The CDC is now claiming that they will perform such procedures (like contact tracing), but that's what you do after somebody is known to be infected. But contact tracing won't do anything to keep people with ebola from getting into the US in the first place.

No it isn't. It takes time to put these procedures in place, to train and equip staff. That's the reason for the delay. Instead of knee jerk hysteria they are doing things systematically and deliberately.
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No, you are simply wrong. The administration didn't claim that it needed time to implement these policies. It claimed that the (rather modest) flight restrictions were unnecessary.

And even in regards to their current policy of contact tracing, you are making assumptions about why these efforts have been delayed.

These aren't even flight restrictions
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Still wrong. These are flight restrictions (though very minor): passengers coming from certain countries are now only allowed to fly into five US airports.
 
Ziggurat said:
No, it's not.

The CDC is now claiming that they will perform such procedures (like contact tracing), but that's what you do after somebody is known to be infected. But contact tracing won't do anything to keep people with ebola from getting into the US in the first place.
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These are the same procedures that helped stop the spread in Nigeria, unless you are claiming the CDC is lying.



Ziggurat said:
No, you are simply wrong. The administration didn't claim that it needed time to implement these policies. It claimed that the (rather modest) flight restrictions were unnecessary.
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When did the administration claim that?

Ziggurat said:
And even in regards to their current policy of contact tracing, you are making assumptions about why these efforts have been delayed.
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As are you. You claim it's incompetence but have no evidence for any of your claims. Everything you have argued is based on assumptions.

I think assuming that ramping up, equipping, and training takes time is a perfectly reasonable assumption. Yours on the other hand appear to be based on an agenda.


Ziggurat said:
Still wrong. These are flight restrictions (though very minor): passengers coming from certain countries are now only allowed to fly into five US airports.
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Passenger screening. The flight restrictions are in the exiting countries and have been in place since august.

In the last two months since exit screening began in the three countries, of 36,000 people screened, 77 people were denied boarding a flight because of the health screening process.
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from my previous CDC link that I'll just assume you didn't bother to read before firing off again.
 
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ApolloGnomon said:
I'm sorry Mr Duncan's family lost him, but his death served a greater purpose by smoke-testing the system for us. Obviously we needed it and inevitably there will be more mistakes in the future but now the entire nation's medical community has had a wake up call.
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What concerns me the most about this incident is that the CDC needed a wake up call in the first place. It's not like this is a government agency that was established yesterday.

I mean, it seems like the CDC is making up its infectious disease response playbook as it goes along. The agency is behaving in a very reactionary manner, as if it's been caught by surprise by the idea of infectious disease outbreaks, and hasn't had time to fully think through the implications.

I think it's reasonable to ask why the CDC didn't start writing this playbook five months ago, when West Africa first experienced an unprecedented ebola outbreak, and the risk of flights to the US from that region first became apparent.

I think it's even more reasonable to ask why the CDC didn't already have an infectious disease response playbook. This is an agency that has been around since 1946. Surely that would have been enough time for any competent agency to figure out some best practices for controlling disease.

Restrict arriving flights from West Africa to certain cities and focus training and preparedness efforts on those cities? Why wasn't the CDC recommending this from Day One?
 
Biscuit said:
These are the same procedures that helped stop the spread in Nigeria, unless you are claiming the CDC is lying.
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"These" includes stuff that I wasn't even talking about.

When did the administration claim that?
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I don't have an exact date, but it's mentioned in your link.

As are you. You claim it's incompetence but have no evidence for any of your claims. Everything you have argued is based on assumptions.
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No. Incompetence is not an assumption when the CDC tells a passenger who had contact with an ebola patient and who exhibited symptoms that they could get on a plane. That is demonstrated incompetence.

I think assuming that ramping up, equipping, and training takes time is a perfectly reasonable assumption.
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I'm sure it does. I never said it didn't. But I only see evidence of such ramping up beginning recently. Why didn't that ramp-up process begin earlier? And if it did begin earlier, why didn't we hear about it earlier?

Yours on the other hand appear to be based on an agenda.
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Sure, Biscuit, sure.

Passenger screening. The flight restrictions are in the exiting countries and have been in place since august.
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You seem to be confusing passenger screening with flight restrictions. These are different things, even though there is a relationship between them. Flight restrictions are the rules saying that you cannot fly from one place to another. In particular, you now cannot fly from the ebola-affected countries to any US airport other than five specific ones where entry screening is being implemented. These flight restrictions have not been in place since August, they are brand-new.

And you know where you can find that information? From your link.
 
theprestige said:
What concerns me the most about this incident is that the CDC needed a wake up call in the first place. It's not like this is a government agency that was established yesterday.

I mean, it seems like the CDC is making up its infectious disease response playbook as it goes along. The agency is behaving in a very reactionary manner, as if it's been caught by surprise by the idea of infectious disease outbreaks, and hasn't had time to fully think through the implications.

I think it's reasonable to ask why the CDC didn't start writing this playbook five months ago, when West Africa first experienced an unprecedented ebola outbreak, and the risk of flights to the US from that region first became apparent.

I think it's even more reasonable to ask why the CDC didn't already have an infectious disease response playbook. This is an agency that has been around since 1946. Surely that would have been enough time for any competent agency to figure out some best practices for controlling disease.

Restrict arriving flights from West Africa to certain cities and focus training and preparedness efforts on those cities? Why wasn't the CDC recommending this from Day One?
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They may well have done, but there may well have been a political over-ride on it. The implication of imposing travel bans is potentially devastating to the fragile economies in those areas. Ebola kills quickly and kills a lot of people that become infected. Yet in the same period there were two orders of magnitude more deaths from other diseases in those countries from diseases such as HIV, which is twice as contagious (R0 = 4 for HIV, and 2 for Ebola).
 
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Throughout the Ebola outbreak, people have been catching diseases in hospitals by the thousands. Also throughout the outbreak, many other serious infectious diseases have claimed thousands of lives. People who travel on airplanes have been infecting other people and carrying diseases to other countries. The CDC has been doing all of its regular work in TB, flu, hepatitis, AIDS, measles, and so on. Ebola has an extremely frightening profile and I understand why it's particularly disturbing when it's transmitted within our borders, but the world is not made out of Tupperware that can be sealed compartment by compartment.

I haven't read the whole thread so maybe I missed the smoking gun that proves the Feds messed up big-time. I will take a closer look.
 
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theprestige said:
What concerns me the most about this incident is that the CDC needed a wake up call in the first place. It's not like this is a government agency that was established yesterday.

I mean, it seems like the CDC is making up its infectious disease response playbook as it goes along. The agency is behaving in a very reactionary manner, as if it's been caught by surprise by the idea of infectious disease outbreaks, and hasn't had time to fully think through the implications.

I think it's reasonable to ask why the CDC didn't start writing this playbook five months ago, when West Africa first experienced an unprecedented ebola outbreak, and the risk of flights to the US from that region first became apparent.

I think it's even more reasonable to ask why the CDC didn't already have an infectious disease response playbook. This is an agency that has been around since 1946. Surely that would have been enough time for any competent agency to figure out some best practices for controlling disease.

Restrict arriving flights from West Africa to certain cities and focus training and preparedness efforts on those cities? Why wasn't the CDC recommending this from Day One?
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My impression is that they had a playbook that was never really used, never really needed , and not updated often enough. With over 40 years of Ebola experience I think they really thought they had this under control, and frankly they did. Until about five months ago.

But, five months is a blink of an eye in a large organization with budgetary restraints. I'm not saying they didn't have any money, but they certainly weren't given millions of dollars each year to maintain an Ebola response team as decades of Ebola experience had shown it wasn't needed.

If every nurse in America spent 5 hours a month training for Ebola response it would have cost billions, if not trillions, of dollars over the last 10 years and still may not have been adequate to prevent the two illness that have resulted from not having everyone trained.

And, I like that the reaction has been thoughtful instead of reactionary. I don't want money wasted on BS that won't actually help. I don't feel like you "have to do something NOW" if you aren't' yet sure what needs to be done. I like that protocols are changing as the evidence comes in.

Yes, they should plan better for black swan events but, other than the military, what large organization does a good job of that? In other words, where would the money come from for every agency in the federal government to improve their black swan planning? More tax cuts, maybe?
 
Dr. Keith said:
My impression is that they had a playbook that was never really used, never really needed , and not updated often enough. With over 40 years of Ebola experience I think they really thought they had this under control, and frankly they did. Until about five months ago.

But, five months is a blink of an eye in a large organization with budgetary restraints. I'm not saying they didn't have any money, but they certainly weren't given millions of dollars each year to maintain an Ebola response team as decades of Ebola experience had shown it wasn't needed.

If every nurse in America spent 5 hours a month training for Ebola response it would have cost billions, if not trillions, of dollars over the last 10 years and still may not have been adequate to prevent the two illness that have resulted from not having everyone trained.

And, I like that the reaction has been thoughtful instead of reactionary. I don't want money wasted on BS that won't actually help. I don't feel like you "have to do something NOW" if you aren't' yet sure what needs to be done. I like that protocols are changing as the evidence comes in.

Yes, they should plan better for black swan events but, other than the military, what large organization does a good job of that? In other words, where would the money come from for every agency in the federal government to improve their black swan planning? More tax cuts, maybe?
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I disagree that this is a black swan event for the CDC. I also disagree that the CDC needs to maintain currency in an ebola-specific reaction plan. It's called the Center for Disease Control. Ebola is a disease. The CDC should have a plan in place to control it as part of their core mission. Their budget already runs to the hundreds of millions of dollars. Surely that should be enough to perform their basic duty of controlling disease in the general case.

It's absurd to imply that the CDC must maintain separate funding and training, a separate response team, for each individual strain of infectious disease. The same respiration, contact, and travel protocols that apply to ebola should be applicable to an entire category of infectious diseases. The CDC should have been equally prepared for ebola as for any other disease in that category, whether it was extant, dormant, or as-yet-unheard-of.

If the CDC can't even do that much on its current budget, maybe we need to take a look at where it's spending its money.
 
theprestige said:
I disagree that this is a black swan event for the CDC. I also disagree that the CDC needs to maintain currency in an ebola-specific reaction plan. It's called the Center for Disease Control. Ebola is a disease. The CDC should have a plan in place to control it as part of their core mission. Their budget already runs to the hundreds of millions of dollars. Surely that should be enough to perform their basic duty of controlling disease in the general case.
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First: Is Ebola not under control? I am unaware that there is a major outbreak of the disease, despite the fact that we have not shut down travel to the infected areas. To scream that they have failed to do their job at this point seems a bit much.

Second: It is clear that the protocols do need to be tailored to each disease. Is that at all surprising?

Third: It is also clear that they did have a plan and they are updating it as needed since it was not sufficient for this strain of ebola.

It's absurd to imply that the CDC must maintain separate funding and training, a separate response team, for each individual strain of infectious disease. The same respiration, contact, and travel protocols that apply to ebola should be applicable to an entire category of infectious diseases. The CDC should have been equally prepared for ebola as for any other disease in that category, whether it was extant, dormant, or as-yet-unheard-of.
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The CDC appears to have been fairly well prepared, it was a single hospital in Dallas that was not. In order for that hospital to have been prepared, every hospital in the country would have needed to be prepared. Who pays for that when the last 40 years have shown it was not needed?

If the CDC can't even do that much on its current budget, maybe we need to take a look at where it's spending its money.
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I think it has done pretty well at protecting us from ebola. But if you choose to look into their budget I bet you will find that it spends tons of money on research of diseases and their prevention. I bet you won't find that it spends a lot of money on hookers and blow, but I could be wrong. I look forward to your findings.
 
Dr. Keith said:
First: Is Ebola not under control? I am unaware that there is a major outbreak of the disease, despite the fact that we have not shut down travel to the infected areas. To scream that they have failed to do their job at this point seems a bit much.
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Not for the foaming at the mouth ODS infected. If we step back and look rationally at the what's happened in the last month I can't see how anyone can be very critical of the U.S. response to Ebola. Was it perfect, of course not.

But since it happened while Obama is president, well, I don't expect anything less from hyper-partisans.
 
THe CDC made mistakes, yes, but I have a feeling these mistakes would have been made under any adminsitration.
I think the partisanship of some of the posters here if pretty clear. Bash Obama at all costs.
 
Ziggurat said:
Where are you getting your information from?
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I read it in a news story the day after she was diagnosed. I found the news story on google news, but I don't know the actual source. And if you can't trust the internet, who can you trust?
 
Ziggurat said:
No, that is not the question. The question is whether or not appropriate actions were taken. Meadmaker claimed that results were all that mattered, and that actions taken are irrelevant. You are not even trying to defend his claim. You are yourself merely engaged in nitpicking.
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Is that what I claimed? I don't think I claimed that.

What I most certainly did do is react to your statement that mistakes were obvious and too big to ignore. (I'll go back and look up the exact words after I type, just in case it matters.) I'm questioning that claim.

Did the hospital in Dallas make a mistake when someone came in with flu-like symptoms and they sent him home, even if he answered "yes" when asked if he had been to West Africa? Absolutely, that was a mistake, but I don't think you can blame either the CDC or the President for that one.

What about after it became known that there was an ebola case in the hospital? The CDC responded pretty rapidly, and I haven't read anything saying they did so poorly. Yes, two workers were infected, but they had been treating before CDC showed up. No reason to believe they weren't infected during the initial contact and treatment. (i.e. I don't know whether or not they could have contracted the infection before then. Someone else might know. My claim at this point is that it is possible that they contracted the infection before the CDC had a chance to do anything, in which case CDC, and certainly not the President, could be blamed.)

Aaahhh, but what about the commercial flight that CDC cleared the worker for, despite the 99.5 degree fever. Surely that was ridiculous, wasn't it?

Well......from what I've read, ebola is a disease that is only contagious after symptoms appear. I'm not willing to say that the 100.4 threshold was a bad call. If someone one that flight gets sick, then it becomes clear that it was a bad call, but presumably that number was picked by someone based on the best available evidence at the time. If no one gets sick, then it's still the best available evidence.

Of course, when dealing with a hypothetical disease, people react differently than when dealing with a real disease. In a hypothetical disease, people might say that a risk factor of X.Y% is acceptable, but when dealing with a real person who has the disease, that might not seem quite good enough, so it can be the case that the guidelines which seemed great suddenly don't seem good faced with a real situation.

Regardless of all of those questions, when it comes to Presidential culpability, I'm not going to say that slip ups in procedure or questionable guidelines are his fault. Nobody died because of anything he did, and it just seems that the risk that there would be any significant numbers of deaths (from a Presidential perspective), so I'm really reluctant to say that Obama screwed up on this one.
 
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