October 30, 2014

"Ebola is a lot easier to catch than health officials have admitted..."

"... and can be contracted by contact with a doorknob contaminated by a sneeze from an infected person an hour or more before...."

That article, the top link at Drudge right now, makes the same point I focused on last week in a post titled "Ebola and the wet-dry distinction."


SDaly said...

When I tried to open althouse.blogspot.com at my office this morning, it was blocked by Websense because it fell into the "illegal or questionable" category.

RecChief said...

haven't we been sending people to Africa to help treat Ebola outbreaks for 30 years or more now? And the CDC and NIH didn't know how it's transmitted? Or...what exactly? Way to inspire confidence.

HT said...

That happened to me one time at work, too ScottD. At the time I was glad, because I needed to work.

Yes, droplet and contact precautions, as I said 6 days ago on this site - quoting an updated CDC card, which was updated on Oct 20. I wondered if they had always had Ebola listed as droplet too or if that was newly added on Oct 20.

Experimentation is exceedingly difficult and dangerous with this virus. But it would help expand our knowledge. For instance, were Craig Spencer's droplets as lethal as Thomas Eric Duncan's? From the little I have read, I would say no, that the virions increase exponentially the further along towards dying one is.

RecChief, yes, "we" have been sending people for many years. Where were we all then?

Unknown said...

I don't know, I was certain the people living with Duncan and were forced to quarantine for 7 days in an apartment that held the sheets and towels he used while infectious would catch Ebola. How could they not?

But they didn't. Yet two of the health care workers who treated him did get infected, even though they took precautions, not adequate precautions, (thanks CDC) but precautions nonetheless.

So my take on the infectiousness of Ebola is that we don't really know as much as we think we know.

For that reason, I think that a 21 day quarantine is a reasonable precaution for people who have been treating Ebola patients.

By the way, WHO guidelines are for a 42 day quarantine. Apparently 5% of Ebola victims will harbor the virus that long before becoming infectious.

The Drill SGT said...

I'll reuse last weeks comments:

The droplets travel only a few feet and soon fall to the ground

That statement implies that the risk drops when the droplets drop.

What isn't said is that, those drops remain on surfaces and can infect others for hours or days later.

I'm not a bio-scientist, but viral disease infection rates are not a step function, but a continuum of risk.

The moment you get infected, you have ebola RNA in your system, which IMHO reflects a chance of infecting somebody.

Over time, that viral load is expanding exponentially, but there is NOT magic point, the hour before you show a fever where you aren't infectious and an hour after you show a fever, you are.

PS: "If the plan is to convince me that the don't know WTF they are doing, the plan is working"....

furious_a said...

If only the (Ebola) Czar knew!"

Wince said...

With Ebola on my shoulder, feelin' kinda older, I tripped the merry-go-round

With this very unpleasing, sneezing and wheezing the protocols crashed to the ground...

The CDC said, "Take a right at the light, keep goin' straight until night, and then, boys, you're on your own"

They were blinded by the light...

rhhardin said...

They don't have doorknobs in Africa.

Bob Ellison said...

Ebola doesn't kill people. People kill people.

rhhardin said...

Francis Ponge :

Kings do not touch doors.

They know nothing of this pleasure: pushing before one gently or brusquely one of those large familiar panels, then turning back to replace it—holding a door in one’s arms.

…The pleasure of grabbing the midriff of one of these tall obstacles to a room by its porcelain node; that short clinch during which movement stops, the eye widens, and the whole body adjusts to its new surrounding.

With a friendly hand one still holds on to it, before closing it decisively and shutting oneself in—which the click of the tight but well-oiled spring pleasantly confirms.

Bob Boyd said...

"I went from doorknob to doorknob. They were filthy, no doubt, but there wasn’t time to find a rag to spit on. My immune system wasn’t all it should be” I was in the grip of the worst flu I had ever had” but I was on a mission. If for some reason I didn’t manage to get a pen from my mouth to Gary’s hands, I wanted to seed his office with germs, get as many of his people sick as I could, and hopefully one of them would infect the candidate.

So, much as it pains me to confirm a hateful stereotype of gay men ”we will put anything in our mouths” I started licking doorknobs . The front door, office doors, even a bathroom door. When that was done, I started in on the staplers, phones and computer keyboards. Then I stood in the kitchen and licked the rims of all the clean coffee cups drying in the rack." - Dan Savage

Todd said...

rhhardin said...
They don't have doorknobs in Africa.
10/30/14, 8:28 AM

That is racist!

steve uhr said...

If fear of ebola is interfering with one's daily life activities, gloves and perhaps a face mask may be the way to go. Esp. since there are hundreds/thousands of persons walking around today who have had incidental contact directly or indirectly with someone who has or had ebola and regardless of whether they should be, the fact is they are not all going to be quarantined (for six weeks?).

People should be more proactive in protecting their health based on their understanding of the risk.

pm317 said...

Hope nobody sneezed on Obama in his photo-op yesterday!

pm317 said...

I like how Obama and his cronies say, they are all rooted in science.. 'you hillbillies, just shut up and listen to us.'

Wince said...

I have a phobia of door knobs in small dark rooms that Johnny Carson backed into naked while carrying the Ebola virus.

Shanna said...

I don't know, I was certain the people living with Duncan and were forced to quarantine for 7 days in an apartment that held the sheets and towels he used while infectious would catch Ebola. How could they not?

I think they probably stayed as far away from his room as they could. People get more infectious the further along they are in the disease, as well. So health care workers and people who deal with dead bodies are at highest risk.

This droplet thing is not news, they've just been downplaying it in the public to prevent 'panic'.

Shanna said...

Ebola doesn't kill people. People kill people.

Newsflash, THAT is what real panic looks like folks.

Bob Ellison said...

Ebola has about a 50% kill rate with competent care. If we really have a pandemic, will the human species simply weed out those subject to die of it?

Boltforge said...

There are two things you need to consider with a virus. How infectious is it? And how contagious is it?

Infectious: If you do contact the virus what is the number of virions required to establish the infection. For Ebola, only 1 to 10 are needed. It is very very infectious.

Contagious: How easily does it move from person to person. Ebola is not as contagious because it kills quickly and is present in your external fluids when you are symptomatic or dead. Which gives it a window of about a week to two to move to new people.

Brando said...

But can't this all be fixed by simply asking travellers to fill out surveys and self-quarantine?

Oh wait, even suggesting self-quarantining is going too far. Let's just let everyone be the judge of what's best for them and everyone else.

steve uhr said...

How likely is it? I would think people treated in Africa are asked how they likely got it. And in most cases the person has a pretty good idea. So very few people say that they don't know how they got it, no direct contact with anyone, etc.. So that is why the CDC prob thinks the risk of such transfer is very low , esp here since we have much cleaner doorknobs.

We could also require all businesses to sanitize doorknobs, toiler seats, etc., twice a day. How could anyone possible object to that?

Deirdre Mundy said...

Imagine what happens if a toddler gets Ebola-- and mom and dad don't want to miss work to take the kid to the doctor, and (thinking at first it's just a normal virus) they dope the kid up on ibuprofin and send her to a daycare.

If Ebola gets into the toddler population, we're doomed, because they spread bodily fluids EVERYWHERE.

PB said...

More slow-walking of the truth.

Bob Ellison said...

Imagine what happens if Matt Lauer gets Ebola after an interview with that [expletive deleted] nurse in Maine.

B said...

I'm not scared of Ebola. But I do ride the bus to work and I'm acutely aware that I'm going to catch a dozen different infections this winter. Every time I grab that overhead handle I cry a little.

paminwi said...

A doctor has been quarantined in California (and he has no problem with it) and the "stupid" (sarcasm alert) department of health folks told him he had to stay home.

Comment at end of article by Eugene Volokh


madAsHell said...

Obama is just hearing about this on the television.

ganderson said...

More evidence that government today does all kinds of things it's not supposed to do, (regulating soda size, smoking, trans fat) and fails in its central missions. Even Hamilton would be appalled!

~ Gordon Pasha said...

Kaci Hickox is licensed in the state of Texas. You can easily find the File a Complaint link in the state's Department of Nursing website.

FleetUSA said...

Your link last week to the Sen Rand Paul comments sold me. And I'm not even a fan of his. He gave solid medical explanations.

William said...

I live in NYC. I'm not in a state of panic. Not even anxiety. I'm in a state of prudence. I hate these calm mongers who try to characterize wariness as panic in the streets.

Shanna said...

Every time I grab that overhead handle I cry a little.

Heh. I remember those days. Glad to commute by car now. Although usually I think it's better to be exposed to most types of germs, because it strengthens your immune system. The extent of my 'panic' involves spraying down the door handles with lysol a few weeks ago, but that was mostly because they needed it and it's cold and flu season.

I got my flu shot. Probably that would count as panicing to these people, rather than prudence since I can't remember getting the flu since I was a kid.

Peter said...

"Ebola has about a 50% kill rate with competent care. If we really have a pandemic, will the human species simply weed out those subject to die of it?"

Smallpox had about a one-in-three lethality rate, but it took vaccination to finally defeat it.

"Weeding out" never happened. An epidemic might be followed by decades with no cases, as practically everyone in a community had been exposed and developed natural immunity to it.

But after a few decades there would again be many who had never been exposed, and inevitably a traveler would trigger a new epidemic.

In general, pathogens tend to evolve into less lethal strains, as it does the pathogen no good to be trapped in a dead host.

But not always: sometimes evolving more rapid reproduction in the host will improve the transmission rate, and thus will aid the pathogen even if the host dies more rapidly.

Bob Ellison said...

Peter, thanks for your interesting comments.

If I were to build a spreadsheet around Ebola, I would probably use a few constants:

1) Survivability quotient
2) Total world population
3) Tendency to infect others, as a quotient

The first two are well understood. #3 is not.

You, Peter, well suggest that there are variables that we cannot predict, like evolution of the pathogen, and, I would say, evolution of the transmission of the pathogen (like on planes, trains, and assholes in Maine).

This spreadsheet is getting bigger and more 3D.

kcom said...

"They don't have doorknobs in Africa."

I had at least one door knob that I remember. My back door that I came and went through all the time. And I probably had six. I just don't remember the rest of the rooms in my house. Crazy, huh?

And no, commenting on the lack of doorknobs in Africa (which I'm sure on a per capita basis is true), is not racist.

Skeptical Voter said...

Ah but the White House says that the science is settled--and they know what they are doing--and Ebola is not easy to catch.

I would say that Ebola is NOT easy to catch if you're living in Kansas, and all Ebola sufferers stay in Africa. The dieease won't "fly across the Atlantic" on its own.

That said, Obama will charter a jet to help it get here.

kcom said...

Ebola has about a 50% kill rate with competent care."

Actually, of the cases we've had here (that presumably had competent care), the kill rate has been much lower.

# Kent Brantly - survived
# Nancy Writebol - survived
# Unnamed WHO doctor at Emory - survived
# Rick Sacra - survived
# Ashoka Mukpo - survived
# Nina Pham - survived
# Amber Vinson - survived

* Eric Duncan - died

? Craid Spencer - TBD

That's a survival rate of 87.5% currently with the possibility of going up to 88.9% if Dr. Spencer survives. And down to 77.8% if he doesn't.

Julie C said...

Kcom - I had a few doorknobs in Liberia, too. The bedroom doors all had them and so did the back door. I think the bathroom door did too (I'm also kinda fuzzy on that for some reason). My front door consisted of a screen door and a regular door but mostly the regular door was kept open.

Doorknob comments racist? No. Funny? Yes.

Shanna said...

I would say that Ebola is NOT easy to catch if you're living in Kansas, and all Ebola sufferers stay in Africa.

Exactly. People act like those odds can't change. We're completely able to handle a small outbreak, even a few small outbreaks (how many people might die them is another question). I fully believe that.

The problem will come if we hit that tipping point where it starts to overwhelm us. How many cases with how many R0=2's do we need for that to happen?

kcom said...

Julie C, where were you in Liberia?

Julie C said...

Kcom: Mano River, on the border with Sierra Leone.


kcom said...

I was in Voinjama.

Bob Ellison said...

kcom, good point on the numbers.

This disease may yet succumb to human ingenuity. AIDS is succumbing, thanks in no small way to George W. Bush.

"Competent care" is the weak variable in my estimate. Maybe soon we'll see >90% surviving Ebola with a little help.

Unknown said...

We’d all find it easier to believe the experts if the experts- the nurses and doctors- didn't keep getting infected, despite their knowledge, training, equipment, and procedures. Until they can stop that, I’ll have a hard time trusting their advice on how to keep the general public safe.

When people point out the disconnect between public health officials’ confidence and the actual track record of health workers’ infections, and calmly demand increased competence from the agencies responsible for handling epidemics, they are accused of ignorance and panicking.

Hey public health officials: We are not panicking. People are not emptying store shelves, rioting in the streets, or even holding protests. Quit falsely accusing us. Quit insulting us. Quit trying to change the subject.

Your track record belies your confidence, and until you address that with a tiny bit of humility, the public will be justified thinking you might not know what you're doing.

ken in tx said...

I was in the Air Force for 24 yrs. I got a mandated flu shot every year, among others. After I got out I didn't get one the first year out. I got the flu and was sick as a dog for two weeks. I've taken a flu shot every year since and no more 'sick as a dog' yet. Plus shingles shot as well.

n.n said...

A quarantine period is both a rational and practical requirement to manage risk.

tim in vermont said...

as it does the pathogen no good to be trapped in a dead host.

That used to be the wisdom, but what about a populations that handles its dead as part of the grieving process? That is how this virus has managed to break that rule so far.

tim in vermont said...

A quarantine period is both a rational and practical requirement to manage risk.

But the election is Tuesday! Shut up hicks and rubes and vote D!