Four hours after I landed at the airport, an official approached me with a forehead scanner. My cheeks were flushed, I was upset at being held with no explanation. The scanner recorded my temperature as 101.Why — before the blood test results — would the doctor feel her neck with his bare hands? What is the protocol? Either we're swinging from one extreme to another on how much to isolate people who've been in the proximity of ebola, or different officials and health-care workers have different ideas about the degree of isolation. Health-care workers have a personal self-interest in remaining free citizens, and they may lean — like Dr. Craig Spencer — toward feeling confident that as long as they don't have a fever they can go about the city — bowling, etc. — like anybody else. Others — those with political accountability/vulnerability — lean toward the crowd-pleasing Theater of Extreme Precaution.
The female officer looked smug. “You have a fever now,” she said.
I explained that an oral thermometer would be more accurate and that the forehead scanner was recording an elevated temperature because I was flushed and upset....
Eight police cars escorted me to the University Hospital in Newark. Sirens blared, lights flashed. Again, I wondered what I had done wrong....
The infectious disease and emergency department doctors took my temperature and other vitals and looked puzzled. “Your temperature is 98.6,” they said. “You don't have a fever but we were told you had a fever.”
After my temperature was recorded as 98.6 on the oral thermometer, the doctor decided to see what the forehead scanner records. It read 101. The doctor felts [sic] my neck and looked at the temperature again. “There’s no way you have a fever,” he said. “Your face is just flushed.”
October 26, 2014
The Doctors Without Borders nurse who didn't like the way the U.S. authorities treated her upon arrival at Newark Liberty International Airport.
Kaci Hickox tells the story from her perspective, and it's getting a lot of attention. I'd like to hear the story told from the perspective of the authorities who are said to have treated her with not just an abundance of caution but with disrespect and outright abuse. You should read the whole thing, but I'll quote the part that made me wonder what really happened:
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The nurse is "judgment proof" if she is wrong. If she is infected and causes many more infections she cannot be held to account. She will either be dead or, likely, have nowhere near enough assets to cover the damage she causes.
Who can best bear the burden and avoid the externalities that will be endured by society? The nurses and doctors, of course. It is about risk management not about feelings.
Her anger should be directed at her fellow health care professionals who ignore logic on not spreading diseases.
Q: How do we know that a 21-day isolation is sufficient? A: Primarily from our observation of how it affects Africans.
Q: How do we know that there has to be a fluid exchange in order to catch it, and that it is not airborne? A: Primarily from our observation of how it affect Africans.
Q: Primarily, what is the ethnicity of the folks for whom we have said recently: Well, we don't yet know HOW they got it? A: Non-African
Q: Are different diseases known to affect the different Races, differently? A: Well, yes, in some cases.
An abundance of caution, indeed.
Why — before the blood test results — would the doctor feel her neck with his bare hands? What is the protocol?
-----
Don't touch symptomatic Ebola patients with the bare skin, I would guess.
Seriously, until this is stabilized, so to speak, it's not productive to expect consistency and predictability and maybe even complete rationality. At least, I'm not. I feel that NY, NJ, and Ill are doing the right things finally, Miss Thing can just chill a while. It is believable to me, completely, that she was treated in a heavy-handed manner - unfortunately she was the first and didn't take it well and is not making herself look great. Her message is not really landing with the American people and maybe in time she will see that. Maybe in time the American people will see we are not justified in our fear.
Maybe maybe maybe.
Right now, it's too soon to tell.
"Seriously, until this is stabilized, so to speak, it's not productive to expect consistency and predictability and maybe even complete rationality."
We were assured that there was a well-known and completely effective protocol. We are entitled to "expect consistency and predictability" because we were told that's what was already there. We now know that was a lie, and we are entitled to be outraged. If we are not outraged, it is only because we were already so used to being lied to that we formed no expectations.
As for being "productive," I think it is productive to express outrage. If we do not, we are letting the authorities know that they can stumble and screw up endlessly and we will endure it all quietly because that's situation normal.
It is the killer combo of evil plus stupidity. The do-gooders can be organized and channeled through appropriate facilities.
And by the way, Professor, did you REALLY believe those stories about protocols?
http://www.usatoday.com/story/theoval/2014/10/26/obama-ebola-quarantine-samantha-power-anthony-fauci/17955781/
AA,
Well I disagree. The way I see it was that there is no way one person, two people, a division or agency *in this country* could or would know everything about how exactly to handle this. To me, expecting such is like expecting those people to be able to predict the future. We have to be able to live with a little bit of uncertainty here, and that includes being able to forgive elected officials and even agencies a little bit. At least, I will. For me, the standard, the question I want them to answer is NOT can you do the exact precise correct thing from the get-go but can you do the right thing after an adjustment becomes necessary? Yes, they should have been quarantining all along, but where was I, where were you in the earlier years when there were returning Ebola workers?
Yes, if it turns out that this is more serious than they thought (the camp I am in), then outrage is an appropriate reaction.
Also, we need to know the assumptions they were working with - like 1-2 returning workers per month or two.
Sorry, my answer is rather rambling.
On Meet the Press this morning C Todd interviewed Dr Fauci and part of the discussion was the new Ebola quarantine rules that IL, NY and NJ have implemented. Todd brought up that GA and VA have not yet added the extra rules. (These states have the five airports all travelers from West African must pass through)
Fauci was saying we cant treat the returning aid workers as pariahs as we need them helping over there. But the polling must be huge for restrictions as Todd kept pressing him that the issue is how the US public perceives this. Interesting to see if Gov Deal (who is locked in a close race in GA) institutes this protocol. It seems like a no lose proposition politically.
The political panel later brought up that "Wal-mart" Moms really fear the Ebola issue much more than ISIS. I can see this really pushing women voters towards the GOP. Explains the concern Todd expressed.
There is no reason why the nurse could not have been treated with common courtesy.
What they did do does not seem to follow what should have been done if acive Ebola was suspected.
So the way she was treated was both ineffective and rude.
Surely the blaring police sirens were completely unnecessary.
she also happens to work for the cdc
Theater. Got to LOOK like you know what you're doing. It's what bureaucrats do if they want to keep their job funding secure.
@sane_voter: Deal is incredibly corrupt. I hope he goes down in flames. (Not saying Carter would be better, but why reward Deal with more largesse in the form of another term?)
"Quarantine" used to mean 40 days -- it's baked into the word.
The returning workers need to take their oath -- "first, do no harm" -- seriously. The officials are looking out for us, while the doctors and nurses are more concerned about others abroad. Maybe longer sojourns to Africa should be sanctioned, encouraged, and enabled instead of the frequent flying. That's how the military rolls.
"Why —before the blood test results —would the doctor feel her neck with his bare hands?"
Perhaps because he's a competent doctor who understood she had presented no Ebola symptoms.
Chris Christie defended the quarantine of this nurse and ohers on Fox News Sunday this morning. I wonder what you thought of Wallace's questions, and how Christie answered them? Funny, while watching the interview, I kept thinking Althouse would enjoy this Q&A--parts of it she'd make fun of and parts she'd admire. It was *interesting* on both ends.
And of course that was even before Wallace got to the questions about Walker. Ha.
Hagar said: "There is no reason why the nurse could not have been treated with common courtesy."
We are talking about government authorities here. Having dealt with the US Border Patrol, Social Security, the DMV and the DNR in the past 6 months I can tell you that courtesy should not be expected.
Yeah, I''m with Chicklit here. We need greater macro-control of the situation, but that is not something that Americans have excelled at in recent times - mass coordinated action. In fact, I would say we kind of suck at it for various reasons. But to sort of shrug off returning workers as if eh, it's nothing, is sort of crazy. And for the life of me, I do not understand why returning medical personnel don't get this. Maybe it's a case of me having to be in their shoes. Do they think that they are completely responsible and can handle it? But then the number of workers grows (hopefully), and will everyone respond the same way?
For those who are deriding the workers as libs or whatever, I say that many of the original workers were missionaries. It's possible they were not liberals, ok?
Anyway, they did do a (voluntary) self-quarantine in Tenn or NC, can't remember.
I believe DWB does a good job in epidemic countries. I am less convinced of their expertise as they weigh in on the US' handling of things.
Apparently, in reality, there are no set rules or procedures for handling potential Ebola patients. Since the average Ebola case fatality rate is around 50%. Case fatality rates have ranged up to 90% in past outbreaks, we should have well thought out, scientifically based CONSISTENT procedures.
" How do we know that a 21-day isolation is sufficient? A: Primarily from our observation of how it affects Africans."
12.9% develop the disease after 21 days. The real limit is 42 days, just about the original origin of the word "Quarantine."
Diogenes, you are talking about a fatality rate in a country with a horrible medical system!
"There is no reason why the nurse could not have been treated with common courtesy."
Have you been through US Customs lately ?
The female officer looked smug. “You have a fever now,” she said.
Smug and wrong. Typical.
Eight police cars escorted me to the University Hospital in Newark.
The police try to use as many people as possible in any given situation to justify their bloated budgets.
Why ... would the doctor feel her neck with his bare hands?
What makes you think he (or she?) wasn't wearing gloves?
HT:
How many Ebola cases will it take for the U.S. Medical system to be compromised? How many nurses and doctors have to be infected before nurses and doctors decide the risks are too great? How many patients with otherwise not life threatening diseases will die?
The world you imagine will no longer be if Ebola spreads more than you contemplate is likely.
Prof A:
We were assured that there was a well-known and completely effective protocol. We are entitled to "expect consistency and predictability" because we were told that's what was already there. We now know that was a lie, and we are entitled to be outraged. If we are not outraged, it is only because we were already so used to being lied to that we formed no expectations.
So, the science isn't "settled"?
How rude! Those peons didn't realize she was a ministering angel/princess and must be treated as such.
Birkel, I don't really understand your last paragraph to me. But overall those are the same questions I am asking myself. As I tried to make clear, I am and have been for a quarantine or returning travelers. What I am more willing to concede is that we don't know everything, and living with some uncertainty is necessary whether we like it or not.
I am curious about the "Theater of Extreme Precaution" comment. What defines the crossing point from proper precaution and theatrical extreme precaution?
Speaking of princesses, I eagerly await Samantha Powers return to NYC from West Africa. Grab the popcorn.
HT, I quoted the World Health Organization numbers. WHO states the morbidity rate for Ebola averages 50%. By the way Smallpox averaged a 30% death rate.
Diogenes, what do you mean by morbidity rate?
Why — before the blood test results — would the doctor feel her neck with his bare hands? What is the protocol?
Mother Superior Sister Ellen Cecile did that to me in second grade when I was sent to her office claiming to be sick.
And when I say grabbed my neck she grabbed my neck. She was from the Bronx and had a well-earned reputation for brutality.
In reality, I was just "flush" because the class had just been ordered to write something 100 times because everyone acted up when the teacher was outside the room.
Everyone except me, I was a little angel. And I didn't want any part of that collective punishment.
After grabbing my neck a few times, Sister Ellen Cecile said I was fine sent me back.
But I did get out of having to write 100 times.
A true story.
Since she has been out of the country perhaps she was unaware of the uproar in NYC caused by the smug carelessness of one of her Dw/oB compadres just 3 days ago, who maxed out his exposure to his fellow citizens just hours before developing a fever from Ebola. No doubt medical staff was rude (it is in New Jersey after all), no doubt police and local gov't made a big show of their efforts to control a potentially lethal disease, but she COULD still develop Ebola. Since she is such a heroic and compassionate healthcare angel, she should just shut up and take her 21 day quarantine. She will risk her life for the victims in Africa, but won't tolerate inconvenience in New Jersey.
When the authorities go into a panic it's hard for the rest of us not to. Power blended with fear always creates some kind of excess. Since the modern state has created powers just about everywhere in its attempt to direct our lives, excess can be expected nearly everywhere when fear arrives. The state is not benign under normal conditions. Under stress it becomes very aggressive.
David, which authorities are panicking?
I'm no doctor, but it seems like we have a lot of medical professionals out there who believe (quite rightly) that Ebola is relatively difficult to catch; but can't quite seem to bring themselves to acknowledge that, if you are exposed to the virus in a particular manner, you are playing with fire. Dr. Spencer and Nurse Whiney both thought there was no way they could have come down with this disease. One of them was right. One of them was wrong.
Do these heroes not understand that there are tradeoffs in life ? So when you choose Door #1, it comes with certain required attachments and responsibilities.
Generally, direct and fairly prolonged face-to-face contact is required to spread it from one person to another. it also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Rarely, it has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. It's morality rate averages 30% versus 50% for Ebola. It is Smallpox. We did take extreme measures to eradicate Smallpox. The time to act is now.
She is a narcissistic, self-centered, smug twit. A do-gooder that think everyone should bow down to her. I saw lots of this type in the Peace Corps.
You can feel a neck with a gloved hand.
But Kaci Hickox was not "quarantined."
If she actually had been infectious, Ebola would have been spread all around her the way they manhandled her.
The point is that though Ebola has been around for 40-50 years, and this outbreak for - what, a year? or more? - this administration may have had "plans on the shelf," but had not done squat to organize a ready response with either knowledge ("protocols") or materials, such as the protective suits and medications. Not squat until they read about in the papers that there was an active case and probable a number of infected people in Dallas.
And then they just jumped 3 ft. in the air, spun like a top, and took off in all directions when they landed. It is still all smoke and mirrors and painted backdrops.
Compare this to Katrina, where the Bush administration and FEMA had a plan "on the shelf," and when they saw Katrina headed for the mainland, activated the plan a week before Katrina made landfall.
You may argue it still was not enough, but it was the largest disaster relief effort organized and carried out by the U.S. Government ever up to that time, and it worked.
Sam Hall knows someone intimately after only three paragraphs.
Impressive.
OK, I agree that she should have been treated with professionalism and courtesy. If some authorities behaved officiously and obtusely, that's sad and unsurprising.
Here's what I don't get about her, or Doctor Bowling, or Nurse "I thought it was OK to get on a plane after treating a patient who died of ebola, even though I wasn't feeling so hot, because the CDC said it was cool", or the TV doctor who went for takeout during her self-"quarantine":
If I had any contact with ebola patients, I would be demanding to be put into quarantine until it was damn-near certain I wasn't going to come down with it. I wouldn't want to take even a remote chance of getting sick around people and passing it on. I don't understand how any medical professional could see it differently.
she also happens to work for the cdc
According to LinkedIn she is an "Epidemic Intelligence Service Fellow" at CDC
Apparently not a Doctors Without Borders nurse. "Working with the media" is in the job description.
http://www.linkedin.com/pub/kaci-hickox/30/793/7b8
An extraordinary number of Bellevue Hospital staffers called in sick on Friday rather than treat the city’s first Ebola patient — and those who showed up were terrified to enter his isolation chamber, sources told The Post.
“The nurses on the floor are miserable with a ‘why me?’ attitude, scared to death and overworked because all their co-workers called out sick,” one source said.
“One nurse even went as far as to pretend she was having a stroke to get out of working there, but once they cleared her in the ER they sent her back up,” the source added.
Mother Superior did the same thing to me, sweetie.
The arrogance of physicians is leaking out into the entire Health Care industry. Sorry, Honey, but the immigration authorities don't care that you treated Ebola patients for no charge or that you lived with an African family for 3 weeks. They only care about whether you are harboring the virus and are or will be capable of spreading it around. You are being as DANGEROUS to the rest of us as your buddy in NYC who strolled the city. If you want to be a goody-goody that's fine. I don't want to get sick from your carelessness moment. I don't and I expect the Government to stop you. So far the Health Care professionals have been changing their story from day to day -- a certain indicator that they are holding back facts and/or lying to us. Zero credibility, folks.
When someone represents a mortal risk, you treat them differently. Some people respond with more charity, but most respond with more wariness and distrust.......I don't see why a quarantine should not be part of the debriefing for aid workers. They have assumed the risk for treating Ebola patients, but their neighbors have not. If the quarantine facilities are comfortable and well furnished, it would be a manageable hardship and probably not the greatest part of their sacrifice,
"Eight police cars escorted me to the University Hospital in Newark."
This part absolutely gob-smacks me and really encapsulates everything that is wrong with government today. The waste, the hubris, the meaninglessness, the too-much-too-late incompetence. In any sane country any official that ordered an eight car escort for a trip to the hospital would be laughed out of office.
RE protocols. It is the CDC's primary job to Have protocols, supplies, and trained personnel IN ADVANCE to deal with potentially catastrophic illnesses, Not to spend time and effort wondering why so many lesbians are obese.
Lemonade from lemons. I've never seen that show The Bachelor where a handsome young man chooses a partner from a field of contestants, but here's my pitch. Recruit a soulful young doctor with chiseled looks who's just back from treating Ebola patients in Africa. Let the pretty young women compete to win his heart. Here's the catch: neither the doctor nor the women know whether he has Ebola. They only know he has been exposed. Lots of suspense and surprises. Which girl will try to gain an advantage by slipping him the tongue and which girl will try to play it safe by remaining aloof. The show will be ratings grabber, and the audience will learn lots of useful things about the spread of Ebola.
The Cracker Emcee quoted...
Eight police cars escorted me to the University Hospital in Newark.
And we know this is true how?
The woman sounds to me like the type who would employ hyperbole.
I have little sympathy with the nurse. She was probably a bitch there and is a bitch here. I am willing to bet that her nasty mood is a precursor to the disease. See the status of the NYC doctor who thought he was fine. I commend all those who are over-cautious!
"The nurse is 'judgment prof' if she is wrong"
Wrong about what -- being treated like a criminal? If you read the article you will see that she gaive no opinion on whether or not quarantine is appropriate, just the process.
"The doctors and nurses are more concerned about others abroad"
There is only one planet and ebola doesn't recognize political borders. If as they predict there will be 10,000 cases a week in W Africa soon, that means alot more mutations, perhaps into an easily transmittable virus that will make the current strain look like the common cold. They are risking their lives for jerks like you.
And Liberia is a former USA colony which should give us some added responsibility.
Great that the proper protocol is determined by the polls and of course the politicians follow in lock step since they don't have the guts to lead. Maybe the next poll will say that we should shoot them all upon there return.
I would also point out that to date there is no evidence that anyone has been infected in this country through casual contact or from someone who was asymptomatic. But we should all panic and discourage health care workers to do their job where they are really needed; That will certainly help things.
"12.9% develop the disease after 21 days"
I have not heard that. Can you give me a cite?
Phil 3:14 said...
Sam Hall knows someone intimately after only three paragraphs.
Unfortunately, Hall speaks some truth in his stereotype. I've met such types. Haven't you?
meanwhile, Nina Pham exits the isolation ward, makes a rather bland expression of faith: "I believe in the power of prayer," and then gets attacked by Progessives all around the country as being an imbecilic science denier. Apparently, Science is a jealous god.
And you wonder why so many people think leftists/liberals/progressives are locked in a cult.
Michael K:
About that 12.9% - I could be wrong, but I thought it was more like 5% - i.e., 21 days is the 95% confidence limit that if you don't have it yet, you won't.
People go by 95% confidence a lot, in various fields, so it wouldn't surprise me if that's how 21 days became the magic number. Of course, in a large-scale outbreak, that other 5% could be a problem, so your point is taken and I don't mean to quibble over the numbers.
steve uhr railed: They are risking their lives for jerks like you.
And you sound like just the sort who wouldn't admit as much about troops overseas fighting political and ideological threats.
What your view on ISIS, asshole?
"so it wouldn't surprise me if that's how 21 days became the magic number"
I hope not. As far as I know, engineers don't design bridges to 95% confidence level. It's more like 140% or something. Imagine under certain realistic conditions a bridge is only likely to fall down 5% of the time.
I hope that 21 days has a cushion factor in there that makes sense.
If it were patients in Liberia who might have ebola they'd be quarantined too. If it was a patient who exhibited syptoms of ebola her and doctors like her would treat the patient the same way. Quarantine until they can prove they are not infected.
And when they do it, it's not a racist decision. Its nothing personal.
I am not usually someone who puts the community above the individual, but here, I think you need to. Best way to protect us is to be vigorous at the front end. Nigeria, with the largest city in Africa, is Ebola free. And that was because they were almost ruthless with the one case they had. They quickly tracked down every possible contact, and quarantined them. Not easy in a city of 21 million, but they did it. Imagine the world situation if the virus got loose in that city of 21 million people. It could have blazed through it, quickly infecting thousands, maybe tens or hundreds of thousands.
So, this woman flies into one of our largest cities, the one with the people packed closest together, after working around Ebola. Sure, not as bad as Lagos would have been, but it could be very bad if the virus got loose there. And then she appears to present the typical first symptom of infection. Right after a doctor came close to infecting the city.
I think that the reality is that the doctors and nurses who travel to Africa to work against the virus have to expect possible quarantine when they come back. Sure, what they are doing is noble. But that nobility won't prevent them being patient zero in the infection of thousands, if not millions.
Someonehastosay it wrote:
Q: How do we know that there has to be a fluid exchange in order to catch it, and that it is not airborne? A: Primarily from our observation of how it affect Africans.
droplet infection is not airborne.
Chicklet -- I supported the Iraqi war from day one. Same re ISIS. I would send in as much fire power as nec to destroy the bastards, including "boots on the ground" if needed. That's what the military is there for. Happy?
Delighted!
Nurses without circumference, the obesity problem.
steve uhr railed: They are risking their lives for jerks like you.
uh, kind of like the Bellevue staff calling in sick so they don't have to work around anyone with Ebola?
She's the first person ever to be mistreated by customs. Do I think people are over reacting? Yes. This is not an easily caught virus. It isn't until you are very, very sick with it that it can easily be transmitted and still most likely its healthcare workers (at least here in America) that are in danger. The people Thomas Duncan was in close contact with didn't even catch it.
This is all just so foolish and typical of Americans to freakout, kind of like with the war on woman garbage. Stuff we should be worried about we pretty much ignore.
off topic, but what does our feminist have to say about the Democrat Party candidate in SC saying this about Nikki Haley: "Escort whore out the door."?
I mean, the Democrat Party is all about treating women with respect right?
I have a cheap solution to all if this. Take all the doctors/nurses/other health care workers that are US citizens working in Africa and put them in a cheap hotel the US government purchased in some city in Nigeria or Sierra Leone or Liberia. Staff that hotel with CDC personnel who are so sure of what personal protective gear everyone should be wearing. Hold them all for 21 days there rather than shipping them back home, having 8 police cars escort them to a hospital and taking care of them in 1st world health care facilities.
Think of the cost savings! The medical personnel can all swap stories about what they did to help the world and how backward all of us idiots in the US are for our fears and if they are clear after 21 days they can come home. Also, if someone gets sick they are all in the same place and can do care for each other. No more exposure to medical personnel stateside and we will go from there!
Take all the doctors/nurses/other health care workers that are US citizens working in Africa and put them in a cheap hotel the US government purchased in some city in Nigeria or Sierra Leone or Liberia.
Why not make a luxury resort instead? Show some respect. The hitch would be a faithful quarantine period before returning.
"Dr. Klain, call your office STAT"
William said...
Lemonade from lemons...
Interesting pitch. The spolier is the Darwinian scythe operating against humanity which would reduce all to tears.
http://currents.plos.org/outbreaks/article/on-the-quarantine-period-for-ebola-virus/
Here is a reference showing that, based on mathematical modeling, the incubation period may be longer than 21 days.
There are huge gaps in our knowledge about Ebola. We do know, however, that no previous epidemic has made it past five generations from the index case. Some of this is likely due to better roads in the last decade. But there's also the possibility that this strain is more transmissible than previous strains. Unpublished data show the amount of virus in the bloodstream for those currently afflicted exceeds the average seen in previous outbreaks. I have not seen values for the current epidemic, but data published from outbreaks around 2002 showed that there were sometimes 10 to the 10th virus particles per cc of blood. That may be higher for current victims. The Material Safety Data Sheet for Ebola virus in pure culture shows that the LD50 (direct inoculation dose that kills 50% pf lab animals) is 10 virions. There really is no margin for error. Keep in mind also that sometimes the distinction between droplet and airborne is splitting hairs. Airborne can go theoretically into air ducts and from floor to floor, but droplet can get you from across the room, absolutely. Norovirus will get temporarily aerosolized and go way across the room if you are vomiting, and it will cling to the walls of restrooms after you flush, etc.
Kelly said...
This is all just so foolish and typical of Americans to freakout, kind of like with the war on woman garbage. Stuff we should be worried about we pretty much ignore.
What the conversation needs is for a couple HIV positive types to weigh in and tell Middle America to grow up because living with a virus isn't so bad.
Hopefully this happens before the election.
From what I see, every time the "authorities" issue their diktats about How Ebola Is Transmitted, you immediately get a new patient who doesn't fit their pronouncements. The original-issue warning was, don't butcher/eat bush meat, don't touch blood, vomit, corpse-fluids etc. because so many cases were transmitted during African funeral body preparation. That would seem to have excluded all the prepared medical personnel who went into treatment hot zones fully HazMatted and came out to a bleach spray before they were de-kitted--only it didn't save Brantley and 490 other dead staff with MSF, and whole lot of other dead African nurses and doctors. (And what about Nancy Writebol, who wasn't treating, or contacting patients? She was actually just training staff in disinfection procedures -- how did she get it? No one seems to be talking at all about her.) What about the community-organizer-turned-cameraman, who never admitted to any patient contact of any kind? So they keep revising their contagion explanations, but people keep catching the disease that don't fit their authoritative explanations. Until the "authorities" can explain how protected medical personnel and these other people acquire the disease no one, I repeat, NO ONE is going to take them seriously (nor should) when they get all wee-wee'd up about politicians apparently taking more care for the public than they have.
Why the fuck does the CDC exist? If they can't handle a situation like this why do they even have a budget? Everyone there should be fired and a competent system built so they can actually do the job they were created for.
There should be travel restrictions out of West Africa. Whenever we got back from deployment they would herd us through single points of entry. Sometimes to be monitored.
Maybe if we canned the CDC we could put the Army in charge. They wouldn't treat the little princess any better than the customs people did though.
William: They have assumed the risk for treating Ebola patients, but their neighbors have not.
But that's what's at the bottom of all this, isn't it? Nobody's quite shameless enough (yet) to come right out and say "but it's unfair that people in some countries are at high risk of catching this disease, we must make this an equal opportunity risk for everybody", but they skate pretty close by constantly insisting that it's wrong for Americans to impose essentially any serious infectious disease-control policies while the disease is still ravaging some West African countries.
Every day they have a new reason for why any such policy is bad: yesterday, because it would keep medical personnel from traveling to Africa to help (total straw man, nobody was calling for stopping medical flights); today, because quarantine is worse than the Spanish Inquisition and Hitler put together and will therefore frighten off volunteers and the blood of all West Africa will be on your hands you cowardly panicking American bastards.
Believe me, it's not that I doubt that gummint officials are capable of handling these things in the most ham-handed and abusive manner possible, but I do notice how the tone of the anti-quarantine propaganda went from smug to hysterical as soon as it became clear they weren't going to get their way everywhere. I'm looking forward to seeing what they cook up if the current tantrum doesn't get results.
Does the above sound crazy? Yes, but do these people sound to you like sober, rational adults simply soberly and rationally advancing their informed medical opinion on the subject of disease control? Nope, don't sound that way to me either.
Achilles - really?
How many Americans have gotten Ebola?
How many Americans have died from Ebola?
Let's not cut funding. Let's increase it, and increase it for NIH too.
RecChief said...
meanwhile, Nina Pham exits the isolation ward, makes a rather bland expression of faith: "I believe in the power of prayer," and then gets attacked by Progessives all around the country as being an imbecilic science denier.
Pham via CNN: "Throughout this ordeal, I have put my faith in God and my medical team."
Like: "Trust in god but tether your horse". IOW, don't trust in god.
Apparently, Science is a jealous god.
Or perhaps people like to make fun of people who say things that are stupid and hypocritical. Nobody who goes to a doctor really has any trust in god, despite their words. They might have hope, but not trust.
Would you rather be treated by a witch-doctor invoking god(s) - AKA placebo effect - by shaking a stick adorned with animal skulls (or by wearing funny clothes), or by someone with a bit of sense and knowledge?
And you wonder why so many people think leftists/liberals/progressives are locked in a cult.
I'm an atheist but the opposite of a socialist and don't appreciate it when people assume that an atheist is a leftist, very few of whom are atheists since only about 2-3% of the population are atheists.
Kelly: The people Thomas Duncan was in close contact with didn't even catch it.
This is all just so foolish and typical of Americans to freakout, kind of like with the war on woman garbage. Stuff we should be worried about we pretty much ignore.
So true, Kelly. It's amazing how freaked-out some people are about standard, simple quarantine protocols and travel restrictions that common sense dictates should be imposed in situations like this, at least until this outbreak runs its course at its source and we have a better handle on how it might be spread in new environments.
I guess you weren't paying attention and didn't notice that the anti-quarantine propagandists and sob-sisters were out in force well before anyone could know what would happen to the people in close contact with Duncan. Or are you saying that the fact that they didn't get infected means that they shouldn't have been quarantined?
The problem is not about whether or not to quarantine, but that they do not have any idea of how to carry out an effective quarantine program and have not made any preparations for it, if one should be needed.
Not just for Ebola, but for any other infectious disease as well.
I'm just spitballing here so bear with me. Here's another idea for a reality show based on Ebola: Ebola Survivor.. Two groups of newscasters are put on a desert island. They are told that one member of each time has asympmtomatic Ebola, but they're not told who. The fun comes from watching to see if they pick the right person.....,But here's the catch I would throw in. Dr. Nancy Snyderman tells the contestants that she has heard from the CDC and President Obama himself that eating the brains of an uninfected person is a sure cure for Ebola. All the newscasters would, of course, believe her. The two teams could compete to ambush and capture a member of the opposing team. Who wouldn't want to see Anderson Cooper eating Rachel Maddow's brains or vice versa. The show would combine all of the dramatic features of Survivor and Walking Dead......I recognize there are some technical problems, but many of them could be worked out in the editing room if the contestants used GoPro cameras.
I want to add to my comment above. Lagos, Nigeria has food delivery services so put the folks there and they can have food dropped off at the front door of the hotel so we don't even have to have food service workers. The doctors/nurses etc can clean up after themselves because they would have to do that if they self quarantined in their own apartments anyway.
So many ways to save money for us rubes back here in the good old US of A!
When life hands you melons, make melonade.
Let's not cut funding. Let's increase it, and increase it for NIH too.
The problem isn't funding levels (though these budgets have stagnated under Obama, after maybe doubling under GWB). The problem is that so much of their money is mismanaged and misspent. Instead of giving them more money, let's make sure that what they are getting is being spent wisely. That instead of spending money on lesbian obesity studies, gun control, etc, it is spent on their core mission - in the case of the CDC, that means protecting us against epidemics like that possible with Ebola.
The Dems do this a lot. They find a crisis, and don't let it go to waste. So, we have a potential epidemic, they get more money to combat it, and then give a lot of that money to their friends and cronies, or flush it down PC rat holes. Then, next time around, it inevitably turns out that not enough money was spent where it should have been, and the PC rat holes and crony projects are now in the agency baseline, so more money is needed and justified. This is, of course not unique to these agencies - rather it is just that this misspending that may be fatal this time, so we notice it.
"You have to come into direct contact with bodily fluids,” he Doctor Fauci, the director of NIH’s institute of allergies and infectious diseas reiterated on CBS
"and cannot contract Ebola from someone who is carrying it but does not yet have symptoms."
No shit. But what about those who do exhibit the symptoms?The doctor at the bowling alley was showing symptoms. Can you get ebola from someone in that situation? Of course you can. That's how people are getting it in Liberia.
So then the issue is to figure out if you have it and quarantine you before you start exhibiting symptoms, right? Since it takes 3 weeks before your symptoms show you could be walking around with it and not even know until you get a fever. And then the hospital is not going to know right away but as soon as they here you worked with Ebola patients they will immediately quarantine you until they are sure.
It should be a given that if you deal with ebola patients you are quarantined until you prove to the world or at the very least the hospital that you are not infectious.
I remember the times I went to the emergency room for something minor. Even after checking me I couldn't leave until they were done and cleared me to leave. Even though I ended up sitting there for hours. If I might have ebola, I'd imagine they'd keep me for a lot longer.
Maybe if we canned the CDC we could put the Army in charge. They wouldn't treat the little princess any better than the customs people did though.
Won't help. Though we are still technically fighting, the military is being treated as if we weren't by the politicians, esp the Obama Administration. Promotion, probably more than ever, is increasingly political, esp at flag rank, and not based on being good at the military's core mission of fighting wars. And that here means an awful lot of political correctness.
To use the TSA as a jobs program for minimum wage level hires, and then
have the TSA screening for Ebola, or any other disease, is ridiculous.
>>Four hours after I landed at the airport, an official approached me with a forehead scanner. My cheeks were flushed, I was upset at being held with no explanation. The scanner recorded my temperature as 101.
The female officer looked smug. “You have a fever now,” she said.
I explained that an oral thermometer would be more accurate and that the forehead scanner was recording an elevated temperature because I was flushed and upset....<<
I'm embarrassed for Kaci Hickox and the doctor who help her write her screed. A Temporal Scanning thermometer works by measuring the temperature near the temporal artery. While there's debate about the accuracy of such measurements I find it hard to believe that flushed cheeks would cause a 101 degree reading. The temporal artery is some distance away from anyone's cheeks.
Arriving travelers interact with federal officers (immigration and customs) long before encountering any TSA personnel.
The professor wrote: "We were assured that there was a well-known and completely effective protocol. We are entitled to 'expect consistency and predictability' because we were told that's what was already there."
I've flown in and out of EWR often. Neither of those sentences has any resemblance to what I've come to expect regarding anything that happens at EWR (or worse, JFK).
Also, over the last ten years or so, I've given up any expectation of being treated with courtesy or competence by police, TSA, or the clerks at my local city hall. It wasn't always this way.
Here's a newly updated article from CNN in which the quarantined nurse speaks her mind.
I gotta tell ya, between this lady's attitude & the cavalier attitude displayed by Dr. Spencer, I'm starting to think we should quarantine these professional do-gooders in an igloo outside of McMurdo Station in Antarctica.
Is it really that difficult for trained medical professionals to understand just how awful the worst case scenario can be here? What would have happened if Dr. Spencer, in his night on the town, had gotten hit by a taxicab while crossing the street? Everyone in the medical chain who treated him would have had a good chance of infection, because they would have seen this average white guy splayed out on a street and none of them would have thought "gee, I wonder if this guy has just come back from the Ebola zone?".
Biff wrote:
Also, over the last ten years or so, I've given up any expectation of being treated with courtesy or competence by police, TSA, or the clerks at my local city hall. It wasn't always this way.
You get shit-canned in retail with that attitude. And the pay is worse. You'd think the "public servants" would get a clue.
Steve Uhr:
You didn't understand the judgment proof comment. I'm not surprised.
And you can quit pretending that you're anything but a concern troll. Few are fooled now and it won't take more than a week before nobody is fooled.
chickelit:
If the people who work retail had a union (and bought-for-life politicians) that protected bad workers they'd not be shit-canned either.
Government workers need some invisible hand discipline, pronto.
http://cnsnews.com/news/article/brittany-m-hughes/cdc-you-can-give-can-t-get-ebola-bus
“The first is, if you’re a member of the traveling public and are healthy, should you be worried that you might have gotten it by sitting next to someone? And the answer is no.” “Second, if you are sick and you may have Ebola, should you get on a bus? And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you,” he said.
<
On Tuesday, a spokesperson for the CDC told CNSNews.com that it’s “not impossible” to contract Ebola from an infected person on a bus, particularly if the healthy person touches a contaminated object.
“It’s very unlikely,” CDC Spokesperson Kristen Nordlund explained. “But if, say, someone was sweating or had blood and touched a handrail and then you touched it right after, and put your hand in your mouth, it is possible. It’s not impossible.
And lots of uncertainty here:
http://www.latimes.com/nation/la-na-ebola-questions-20141007-story.html#page=2
,"We know for a fact that the virus occurs in sputum and no one has ever done a study [disproving that] coughing or sneezing is a viable means of transmitting," he said. Unqualified assurances that Ebola is not spread through the air, Bailey said, are "misleading."
Peters, whose CDC team studied cases from 27 households that emerged during a 1995 Ebola outbreak in Democratic Republic of Congo, said that while most could be attributed to contact with infected late-stage patients or their bodily fluids, "some" infections may have occurred via "aerosol transmission."
Ailing in Monrovia, Liberia
Relatives pray over a weak Siata Johnson, 23, outside the Ebola treatment center at a hospital on the outskirts of Monrovia, Liberia. (John Moore / Getty Images)
Skinner of the CDC, who cited the Peters-led study as the most extensive of Ebola's transmissibility, said that while the evidence "is really overwhelming" that people are most at risk when they touch either those who are sick or such a person's vomit, blood or diarrhea, "we can never say never" about spread through close-range coughing or sneezing.
"I'm not going to sit here and say that if a person who is highly viremic … were to sneeze or cough right in the face of somebody who wasn't protected, that we wouldn't have a transmission," Skinner said.
Speaking of being treated badly by airport officials, I had just got off the plane in Hong Kong from Taiwan and going through screening for my handbag and so on.. this woman in uniform was so rough in her language (not English) and attitude like we were not humans, I could not help but complain to a couple of her 'colleagues' sitting near there -- one of them told her (what I assumed to be) to take it easy.
There are several issues with the nurse in NJ situation: there are no clear expectations set for the returning health workers -- what they can expect in the airports and after. That is a govt fail.
She should tone her ego down -- not everybody is in a charitable mood to applaud her efforts when they are afraid that she could bring the epidemic here, and especially so, when the govt has failed in the basic efforts of setting expectations about how to deal with it here. It all comes down to how CDC and the Feds have operated in the wake of the disease here.
rhhardin said...
Nurses without circumference, the obesity problem.
lol
steve uhr: Great that the proper protocol is determined by the polls and of course the politicians follow in lock step since they don't have the guts to lead.
You're right, they don't. That's why quarantines and travel restrictions weren't imposed earlier.
Non-public health interests (economic and otherwise) and their attendant political corruption and cowardice can also lead to the decision not to quarantine and restrict travel. Throw in the current batshit ideological enthusiasms of our political class, and the odds that the baying mob is evincing more wisdom than the other "stakeholders" increase.
I realize now, after years and years of the media being filled with Democrats and biased news reports, why it continues to work when everyone knows they are biased.
Because people reflexively believe what they are told.
What reason do we have to take this woman at her word? Clearly she isn't happy at the protocols in place. So she writes a screed where everyone involved she disagrees with are bad guys. Duh.
And some of you believe this without question. How silly.
Here is what isn't silly. I've found a way you can make $5,000.00 a day risk free. All you have to do is send me a check for $10,000.00, you can make this back in two days!!! And I'll get you started on the road to riches.
"Ordeal."
""12.9% develop the disease after 21 days"
I have not heard that. Can you give me a cite?"
I'm looking for the source of the 12.9% figure.
http://www.ncbi.nlm.nih.gov/pubmed/24159443
That one says 4.1% over 21 days. It was Zaire in 2011.
I am avoiding the CDC sites.
This one is from a virology blog. .
Haas concludes that the 21 day quarantine value is derived from a ‘reasonable interpretation’ of outbreak data, but it might not be long enough. He estimates that there is a risk of between 0.2% and 12% of developing Ebola virus infection after 21 days.
Another site. PLOS
A 21 day period for quarantine may result in the release of individuals with a 0.2 – 12% risk of release prior to full opportunity for the incubation to proceed. It is suggested that a detailed cost-benefit assessment, including considering full transmission risks, needs to occur in order to determine the appropriate quarantine period for potentially exposed individuals.
Suit yourself. PLoS has an extensive analysis of incubation time.
What's with all the "Look how I helped!" in this screed. What is the purpose of that?
"Oh, honey, we don't need to check a sweetheart like you for Ebola. Go on home."
@helenhightops, take a look at this paper:
Says EVD2014 mutating hundreds of times faster than it did in previous outbreaks, and the first 2 strains in 2014 (GN and SL1) are gone, replaced by "newer" ones.
Until I read this, I'd been of the opinion the HCWs going to WAf were about as effective as eye droppers when fire hoses were needed ... and so what was the point? Good money after bad, etc.
But this article suggests a fairly apocalyptic global outcome if the virus continues to experiment on a steady stream of hosts. So ... hm.
As for returning HCWs being QT'd, there seems to be no other option.
First, there is not even one medical study which shows E-infected non-symptomatic persons cannot transmit the virus. Public health "experts" keep asserting this when there is nothing to back it up. Sure, there's a viral-load/contagion correlation but it's not enough to provide much comfort.
Second, this article suggests a much more contagious (or infectious) strain is quite likely to emerge in infected hosts (and HCWs would be no exception) as time marches on and this incredibly clever virus continues to go unchecked.
http://operonlabs.com/?q=node/18
Althouse wrote: Health-care workers have a personal self-interest in remaining free citizens, and they may lean — like Dr. Craig Spencer — toward feeling confident that as long as they don't have a fever they can go about the city — bowling, etc. — like anybody else.
Note to self: I get it now. It's the confidence they admire. The same attraction draws brides to Syria.
Hickox being pulled aside is reasonable; left sitting there for hours with no explanation while they were calling aound trying to find somone who could tell them what they were supposed to do next is not.
A couple of thoughts about the current ebola situation that I haven't seen covered elsewhere:
1) Ebola has been around for a while. Previous outbreaks have been limited to hundreds of cases. This outbreak has had over 10,000 cases, with roughly 5,000 fatalities, and the World Health Organization has suggested that there may be many more undocumented cases in this outbreak. I'm no expert, but after a quick skimming of the literature, it seems that there are more documented cases in this outbreak than in all previous known outbreaks combined. Something is different this time around, and I haven't heard anyone in authority even raise the issue, much less address it.
2) The dogma is that the virus cannot be transmitted by asymptomatic patients. Let's reduce that to practice: is symptomatic vs asymptomatic a visually obvious, binary thing? In other words, are you feeling fine one moment, and then, to any reasonable observer, obviously overcome with hemorrhagic fever the next? Or, is there some intermediate range, where you're not feeling quite on top of your game, within the normal range of everyday fatigue or minor illness, where even medical professionals can convince themselves that they are fine or that they can tough it out, like they do nearly all the other times when they are first feeling a little unwell but need to go to work? If so, and keeping in mind that for unknown reasons this outbreak is somehow different from all that preceded it, how long is that intermediate period, and is the virus transmissible during that period? If your job involves screening people coming off airplanes, how much do you trust what people tell you about how they are feeling?
Again, I'm not an ebola expert, but I have a little background in statistics and medical research, and here is what I'm thinking:
The population of Liberia, Sierra Leone, and Guinea is around 20 million. If there are around 10,000 cases of ebola in those countries, then around 0.05% of the population has/had ebola, and it appears that number will increase. For many reasons (public health knowledge, general quality of healthcare, geography, etc.), it is very, very unlikely that the US would experience anything near that rate, but if it did, you'd be looking at around 150,000 cases.
Again, I doubt very much that the US would have anywhere near that figure. Personally, my bet is that there will be a handful of US cases, perhaps as many as a dozen or so, before this is all over. That said, I would not be the slightest bit surprised if eventually there are multiple dozens, or even a hundred or more cases in the US before this outbreak is fully controlled.
It's a bit of an inverse lottery: the chances that any particular individual in the US will be infected are extraordinarily low, but the chances that there will be another infection in the country are higher than anyone should be comfortable with, especially since we don't fully understand this strain of ebola.
When military personnel from New Mexico are posted to the Middle East (and probably to anywhere, really) they must first be given a series of inoculations - not to protect them from the Middle East, but to protect the Middle East from them, since New Mexico is a known reservoir for bubonic plague, hanta virus, and tularemia.
There are a lot more lethal exotic diseases out there than ebola, and the Government does not seem to have much of a system in effect for protecting us from any of them.
A word of caution about the infection rate and deaths:
Just because there are 10K reported cases and 5k reported deaths does not make the survival rate 50-50. Many of the reported cases are active and will result in deaths in short order. The death rate is at least 50% in reported cases and likely much higher in unreported/untreated cases.
Birkel -- You may disagree with my views and my views may be wrong on many issues but I wish you would not question my sincerity. The problem when you are conservative on some issues and not others is that no one believes you. I'm used to it.
If we are going to quarantine people because it makes sense as a matter of public health, then we should do it right. First, we should track down everyone (or just medical workers?) who has arrived from W Africa in the recent past and quarantine them as well. And the quarantine period should, based on my new understanding, be 5-6 weeks, not 3. That the government doesn't do it right just shows that it is mostly politics as usual.
damikesc said...
"Her anger should be directed at her fellow health care professionals who ignore logic on not spreading diseases.'
Correct.
And keeping such diseases from spreading overrides ones right to go around potentially spreading the disease.
Sorry, but if you come from infected regions where the outbreaks are bad, expect to be quarantined.
HT said...
"Achilles - really?
How many Americans have gotten Ebola?
How many Americans have died from Ebola?
Let's not cut funding. Let's increase it, and increase it for NIH too."
YES! Throw good money after bad! The government screwed it up? We need another government program!
Another brilliant progressive observation!
It is pretty clear from the NIH example is that to get more funding all an agency needs to do is utterly fail in it's mission.
Hall speaks some truth in his stereotype. I've met such types. Haven't you?
Yes, but I would base such a judgment on personal experience.
Honestly, I'm disturbed by the hostility towards people who have volunteered to care for Ebola victims in Africa. What they do is heroic (like a soldier in the line of fire.). Does, that absolve them from proper infection prevention? No.
Still, they have done something honorable.
Concern troll shows concern when called a concern troll.
News at Never O'Clock.
What's with all the "Look how I helped!" in this screed. What is the purpose of that?
I suppose the purpose is to show that she is a decent and responsible person who tried to do a good thing and shouldn't be treated like a criminal for it.
Which seems fair enough. Quarantining her is fine, but she should have been told clearly what to expect, she should have been treated with reasonable courtesy and regard for her comfort, and with a minimum of upsetting and embarrassing theatrics. (Eight police cars with sirens blaring? Please.) Quarantine, for the safety of the rest of us, is a good idea, but she hasn't done anything wrong here, and quarantined people should not be treated in a way that leads them to think they're being punished.
How hard is it to provide a safe, comfortable place for her to stay during quarantine, give her a decent meal instead of a granola bar, and use some common courtesy and sense during the process? (Not very.)
How likely is it that some people, seeing that "quarantine" means "bad treatment" and thinking that the risk of their infecting others is negligible, will respond by evading quarantine? (Oops.)
One way to avoid this is to make sure not to abuse those who need to be quarantined. Well, the first person in this situation has just been publicly abused. (Oops.)
"Quarantine" does not have to mean "clusterfuck".
And now we find she actually works for the CDC. And she hews to the party line of the CDC.
Fernandinande, please go back and re-read my comment. Please highlight where I said anything about atheists in that comment.
Ferdinande said...
Or perhaps people like to make fun of people who say things that are stupid and hypocritical. Nobody who goes to a doctor really has any trust in god, despite their words. They might have hope, but not trust.
This is one area in which you and I differ. As an aside, I have room for my faith as well as an understanding of science, but that isn't what my comment was about anyway. When you say that nobody who goes to a doctor doesn't trust in God, I think you are substituting your rationalization. Fair enough, I wasn't asking you to go to mass. I am simply pointing out that any utterance of faith is met by swift condemnation by the science-y crowd. You'll notice she thanked both God and her medical team. The people I describe are in a religion, they just don't know it, they've adopted the first commandment though.
Would you rather be treated by a witch-doctor invoking god(s) - AKA placebo effect - by shaking a stick adorned with animal skulls (or by wearing funny clothes), or by someone with a bit of sense and knowledge?
This is quite the straw man. How you managed to get to this, from my comment, escapes me. Having read your other comments for some time, this kind of fallacious argument is rather beneath you.
Ferdinande said...
I'm an atheist but the opposite of a socialist and don't appreciate it when people assume that an atheist is a leftist, very few of whom are atheists since only about 2-3% of the population are atheists.
Sorry bud, it's you who made the assumption.
Honestly, I'm disturbed by the hostility towards people who have volunteered to care for Ebola victims in Africa. What they do is heroic (like a soldier in the line of fire.)
after one of my deployments, were were put on lock down. That is, no one was allowed to to leave a designated area. Not hard, since the area we were in was separated from the rest of the base. What followed was 7 days of briefings, and there was a high number of cadre, mostly just watching. I talked to one as we were leaving, and was told that they were watching to see if there were any behavioral problems such as excessive anger at the week's worth of boring crap etc etc. Now, we knew that we were going to be on lock down before, and maybe that is where your analogy breaks down. Civilians aren't used to restrictions on their freedom of movement. Even when it is perfectly good logic to self quarantine, most people wouldn't I would wager.
My guess is that the doctor was pretty confident there was no fever, so felt for a fever. Kind of dumb, but hey man, he's a doctor.
Althouse said:
"As for being "productive," I think it is productive to express outrage. If we do not, we are letting the authorities know that they can stumble and screw up endlessly and we will endure it all quietly because that's situation normal."
So was writing that enough of an expression of outrage to pass, to think, "I just kicked a little government ass?" Or should the expression of outrage be more because really I don't think the outrage expressed here does much to penetrate the thoughts of the White House and staff. Certainly most Congress men and women aren't bothering with our outrage even with the biennial elections just ten days away.
I think more is needed. That is why I'm proposing a General Strike for Safety and Sanity. Call it a self-isolation for health and safety if you want but pick a few days, that's more than two, weekends don't count, and stay home with the kids. Don't shop, buy gas, do errands, go to the movies, a coffee shop, or a bar. Don't get take-out (paging Dr. Snyderman) pick up a paper, or go to the dentist. As a matter of fact cancel all but the most essential health appointments. Because until we can do something as simple as that the powers that be know they have nothing to worry about. I'll start a Twitter hashtag to sort out the details if anyone here thinks this is a good idea.
By the way for the last few days I've asked about the family of Thomas Duncan, the Liberian who died in Texas, of ebola. Well they have been released from a twenty-one day quarantine but son of a gun there are no pictures of them that I can find. Agent Mulder call Scully.
"My guess is that the doctor was pretty confident there was no fever, so felt for a fever. Kind of dumb, but hey man, he's a doctor."
Yeah, he was pretty confident that she didn't have a fever because they took her temperature WITH A THERMOMETER.
As soon as Nina Pham said that I knew certain people would crawl out of the woodwork to hassle her about it. When did it become okay for people to be publicly dickish to people who mention a faith in God and medicine? (The two are not mutually exclusive.) And in any event, it's just tacky to talk like that to someone who just had a brush with death. Get off your high horse and demonstrate a bit of that tolerance that you're supposed to be famous for. What she said was personal and based on her own experience and no skin off your nose.
Ms Hickox is now suing the state of NJ to end her quarantine.
The legal eagles gathered here can pass their judgment on her chances, since the law ain't my bailiwick.
Lawyer Mom: thanks for that reference. Oh my.
I wonder who in the heck these guys are?
@helenhightops -- don't know, but looking at their sources, the data certainly looks good.
So now Cuomo is walking back strict QTs in NY because they are so "inhumane" (and Obama got super-duper mad at him).
But take a look at the QT camps (sorry, "community care centers") our military is employing in Liberia (linked below). Do they look very humane to you? You live in Liberia and your kid has an ear ache and slight fever ... so off he goes, whisked away to the roach motel called Hotel Ebolafornia.
It will sure be interesting to see what these public health grand poo-bahs will have to say about the "humaneness" of QTs on US soil if QTs become necessary on a large scale (e.g., large enough that suspected E+s don't get their own room ... rather, they get exposed to everyone else in QT with them).
It's primarily the forced QT-ing going on in WAfrica -- the "ignorant savages seek out vomit" meme is just flat-out racist -- that is fueling the violence against the HCWs. And it is completely understandable. No one wants to be carted off, or have their kid carted off, to a virtual death camp.
In the meantime, I sure don't hear wild nurse Hickcock or Frieden at the CDC or any other HCWs decrying the inhumane QTs that are being (or about to be) foisted on suspected Ebola patients in West Africa. (BTW, if memory serves, that "patient exit" you see in the diagram was added later ... it did not appear in the original graphic).
http://apps.washingtonpost.com/g/page/national/an-ebola-treatment-center/1333/
If there's any profession known for treating others with dignity, empathy, and understanding it's the medical profession, right? "Put on this paper gown, the Dr. will be in to see you in a few hours."
Question to Gov. Christy -- If as you say there is a public health emergency that necessitates that Ms. Hickox be involuntarily quarantined, why are you not placing in quarantine the XX people who came to NY from Liberia last week?
Answer: _____
I mean NJ
Do you have concerns Steve Uhr?
How many concerns do you have?
Would you like to express your concerns for Republicans to answer?
Or do you have concerns for Democrats too?
Troll, much?
I'm concernless. You?
Top NIH Ebola Specialist Says Quarantines Will Jeopardize Americans
Read more: NewsCorp 24: Top NIH Ebola Specialist Says Quarantines Will Jeopardize Americans http://newscorp24.blogspot.com/2014/10/top-nih-ebola-specialist-says.html#ixzz3HL0WN0us
Steve Uhr said...
Question to Gov. Christy -- If as you say there is a public health emergency that necessitates that Ms. Hickox be involuntarily quarantined, why are you not placing in quarantine the XX people who came to NY from Liberia last week?
Are you asking this question of Cuomo, Quinn, and Malloy? Or just Christie?
I'm asking Christi because so far he is the only one who locked someone up. But you are right since they all have adopted the same policy. I am just trying to make the point that they are more concerned about the midterms than anything else. Any policy that is not imposed retroactively is illogical and my prediction is that the court will release her from custody.
Steve Uhr is concerned about what Governor Christie is doing. Steve Uhr is not quite as concerned about Governor Malloy.
Steve Uhr thinks Governor Christie is overly concerned about the midterms. Steve Uhr takes no position about the concerns of Governor Malloy.
Steve Uhr is a *fill-in-the-blank* troll.
So we send 4000 US servicemen to help control the Ebola crisis in Africa; what happens when they get back? If the military does not initiate some kind of quarantine and they fly through one of the states with a quarantine...will the military consider them AWOL?
The population of Liberia, Sierra Leone, and Guinea is around 20 million. If there are around 10,000 cases of ebola in those countries, then around 0.05% of the population has/had ebola, and it appears that number will increase. For many reasons (public health knowledge, general quality of healthcare, geography, etc.), it is very, very unlikely that the US would experience anything near that rate, but if it did, you'd be looking at around 150,000 cases.
Maybe. But imagine the bulk of that happening in big cities, which is not impossible, given the population density. Imagine if that doctor had not been an Ebola doc, and didn't realize the significance of his symptoms. And then had ridden the subway another day or two, before collapsing and ending up in the hospital. Many thousands could have been exposed in the cars he rode in, and it would have been hard to track them all down. Some may not speak English well enough to respond to public health announcements, etc, and all of a sudden, you may have dozens of infected, who continue to ride the subway, until it is shut down...
Point there is that we all don't have equal risk. I am living up in NW MT. Population in the county is probably a couple of people per square mile. The area I live in has maybe 20 people in 10 houses, and we can see two of them from ours. I doubt that I have any contact with over 100 people a day, and the number I get close enough to to get infected from them on the average day is maybe in the single digits. And, yes, we are heading into winter. Contrast this to a single subway car in NYC.
I think potentially making things worse for the big cities like NYC, and esp NYC itself, above and beyond the danger of population density, is that they see themselves as the center of the universe. Which means that if an epidemic takes off there, there is a decent chance of panic, and from that, an explosion of people fleeing the city or cities, some of which might be infected. Could we quarantine NYC, if all the broadcast news centers were mostly located there and broadcast, 24/7, the unfairness of that? Would there be shoot-down orders for the billionaires escaping in their helicopters? Etc.
Birkel -- Didn't your mother tell you not to feed the trolls?
”Just because there are 10K reported cases and 5k reported deaths does not make the survival rate 50-50.”
From a Darwinian perspective, pathogens usually evolve toward less lethality, at least in the long run, as there’s no percentage in being trapped inside a dead host.
Unless increased lethality is a side effect for an adaptation that improves the probability of transmission, as might occur if a virus increases its rate of multiplication in the host. Which might at least increase lethality in the short run.
In any case, it seems apparent that this virus is not genetically stable. Which is not good news as it makes an effective vaccine unlikely. But I'd be surprised if there isn't a good deal of brainpower focusing on how it may evolve.
BTW - with my last, I am not predicting an Ebola epidemic outbreak here in the U.S., but rather am suggesting that if we have one, it is likely to come from the big cities, and esp. NYC. I doubt that it could get going that well in much of this country, due to the population density. Yes, the African exposures appear to be somewhat rural, but rural there is very different than rural here, at least these days. For one thing, we mostly don't live anymore in villages with extended kin groups living so close together.
The point about population density is that a rough approximation of the number of people you could infect is the number that are close enough to you to infect directly, or are where you had been, and pick it up from viruses you left behind multiplied by the number of days that you were infectious (heavily weighted with the later dates being weighted the heaviest). For me, that might be a dozen or two, since most of those I have contact with are the asme, day in and day out. Someone on a single subway ride in NYC could infect many times this in a single ride. And, here in MT, I could identify many of those I interacted with while contagious. Not so on the subway.
The critical relationship I see is between the number of people whom someone could infect and the speed of the knowledge of the infection. Which is why I expect that the curve of danger in this country would be closer to exponential than linear as you get closer to Manhattan and away from here in rural MT.
Re the two health workers who potentially may have spread ebola -- nurse 2 and the NY doctor. Were they instructed that they should self-quarantine, or just monitor themselves for possible symptoms but otherwise were free to go about their regular business. I.e., did they disobey clear instructions?
Capitalized "Steve Uhr" has concerns.
Lower case "steve uhr" shares some of those concerns.
Perhaps now is the time to be concerned about the two different accounts that the concern troll is using.
Bruce -- isn't it true that even a sick person is highly unlikely to infect many people, or even one person, on the subway unless and until the virus mutates substantially so that it is much easier to transmit. My understanding is that there is very little risk just sitting next to someone who is contagious; not that I would recommend doing so.
I understand the major prob in W. Africa is that the relatives of sick people for good reason don't trust the "hospitals" to make people well and hence those dying are doing so at home with the care of their unprotected relatives, and, second, the traditional burial practices, which includes the washing of the body, results in a lot of close contact. Neither is true here.
Birkel --
I may be the first non-anonymous troll in the history of the internet. As for the name, I'm not sure why sometimes there is caps and sometimes there is not, but if my goal was to have two identities I would probably do a better job.
Steve Uhr has an understanding of the transmission of Ebola. steve uhr recommends nobody be concerned about Ebola transmission.
That Ebola can be spread through sweat and every other bodily fluid is of no concern. That the virus can stay contagious even after the fluids in which it is contained are dried is of no concern. That Ebola victims are often coughing and hemorrhaging bodily fluids is not concerning. That Ebola victims run fevers that cause them to sweat Ebola containing fluid is not concerning.
You know, there's really nothing to fear. After all, Ebola was stamped out in Nigeria and America has better hospitals than Nigeria. The fact that Nigeria implemented isolation protocols that this Administration won't consider is of no concern.
Steve Uhr said...
Re the two health workers who potentially may have spread ebola -- nurse 2 and the NY doctor. Were they instructed that they should self-quarantine, or just monitor themselves for possible symptoms but otherwise were free to go about their regular business. I.e., did they disobey clear instructions?
That last sentence is actually a good question. However, the continually changing protocols don't inspire confidence. One problem I have with the doctor in NYC is that, regardless of his intentions which I think were good, there seems to be some basic precautions not taken. Why they weren't taken is now a football, but really, if you think about it, why wouldn't you at self quarantine? or at the first sign of possible symptoms, head back to your apartment, call the CDC, etc, instead of taking a drive around town? More basic than that, can anyone say what instructions he had? That is, was he given any instructions at all? The cavalier attitude by the people that are supposed to be up on this is the worrying part, not some mythical "ebola panic"
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