Ebola outbreak - general thread #8

[Woe.be.gone]

They already know that supportive care makes a big difference. That's not news.


"Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It isn't known if people who recover are immune for life or if they can become infected with a different species of Ebola. Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems."


http://www.cdc.gov/vhf/ebola/treatment/

This is the same for dengue fever. Yet, there is not much good info on the subject as it doesn't affect US and Europe for the most part.

 

[IMO]

I've gotta say, it would be unbelievable if all the epidemiologists have been wrong about ebola and it is easily treated with fluids, nutrition etc...Talk about not seeing the forest for the trees. How embarrassing.

Hmm, I'm afraid I don't agree on several counts. First, I think that one of the critical factors may be immediate intervention rather than, or in addition to, only fluids and nutrition, etc.. There may not have been adequate opportunity to study this in detail before. Second, as far as I know, the largest modern outbreak prior to this struck 500 people in Uganda. It's difficult under the conditions of having medical personnel come in to track every treatment and every stage at presentation in the field when an outbreak is already underway, as opposed to the tracking here which is obviously microscopic in its detail. Here, we have the first opportunity to do so in history, because the number of cases in developed countries, which was previously around zero, allows for this careful scrutiny. Third, it's just how science works. Until we have the opportunity to study something in controlled conditions and there are enough cases to do so, we can't possibly know certain things.

Yes, it is already known that these treatments improve survival of patients. What would be mind-blowing would be if the CFR was really 5-10% when properly treated, because obviously that is not the conventional wisdom. We just don't know yet, and it's interesting.

 

[SteveS]

No, there is fatigue and there is fatigue. I've also had dengue fever while in Thailand. Don't know about fatigue caused by Ebola, but Dengue fatigue is the 'I've fallen and I can't get up' type. So all fatigue isn't the same and one, I think, would recognize when their fatigue is different. Someone who jogs three miles, might not often experience fatigue? Don't know but he recognized he was fatigued but didn't think it meant anything? A little bit perplexing imo under the circumstances. Maybe denial is at play? Not sure.

I think there's a significant "reading into" the situation to try to create something ominous out of normal life. You describe some sort of debilitating fatigue, while Amber (if she even had any earlier issue, which was a matter of dispute) felt good enough the next day to get on a plane, go to a bridal shop after that, do all sorts of stuff, fly back to Dallas the following day...her ensuing activity level contradicts the idea that there was some sort of debilitating fatigue, and so does that of Spencer.

I also believe that both of them, being aware that they had some level of risk and that early care was vital, were super diligent in self-assessing. That is to say, I believe each would have rushed to the hospital pronto, at the first half an inkling they were sick. But they didn't, which tells me that the assertion by some that they were symptomatic days earlier lacks real merit.

 

[Woe.be.gone]

Anyway, didn't mean to veer off the topic of Ebola and its contagiousness. Just that the psychological issues related to illness shouldn't be underrated imo. It makes a world of difference when your fears are heard, believed and explained. No one should be put down for asking questions or for wanting explanations to make sense.

Closure is a big topic too - which is why I'm reliving my ordeal of the hazmat suits next door. Doesn't matter that I didn't catch it - just the fear I felt back then came rushing back because nobody cared about me or explained to me what was happening next door considering I couldn't avoid seeing the suited people going in and out. Imagination, when one isn't properly educated on a topic, can run wild. Especially when or if you're fragile to begin with or have already been dashed after expressing your concerns to 'authorities'.
Shoot, I need a shrink.

 

[Woe.be.gone]

I think there's a significant "reading into" the situation to try to create something ominous out of normal life. You describe some sort of debilitating fatigue, while Amber (if she even had any earlier issue, which was a matter of dispute) felt good enough the next day to get on a plane, go to a bridal shop after that, do all sorts of stuff, fly back to Dallas the following day...her ensuing activity level contradicts the idea that there was some sort of debilitating fatigue, and so does that of Spencer.

I also believe that both of them, being aware that they had some level of risk and that early care was vital, were super diligent in self-assessing. That is to say, I believe each would have rushed to the hospital pronto, at the first half an inkling they were sick. But they didn't, which tells me that the assertion by some that they were symptomatic days earlier lacks real merit.

Yes, but I thought they complained of being fatigued. My point was their slight fatigue might mean something if not normal for them. If you know you may have been exposed to something, why brush the fatigue off as being nothing?
If they had dengue fatigue, there'd be no discussion. You don't know you've even been exposed to the culprit.
Steve S., your comment was that fatigue is innocuous. My reply was, under the circumstances, should it have been?
All fatigue is not the same and is different for everyone or due to the underlying cause.

My feeling is that the general public, many who may be fearful until more is understood, want to trust that health care workers (who we appreciate and think are brave souls) would show diligence to their health and not ignore little changes after working closely with Ebola patients. I believe people are surprised to hear, two of them at least, acted a little bit reckless and were not more in tune when something seemed off.

 

[nrdsb4]

Doctor Spencer is entering the next phase of Ebola. Whatever that means.
"New York City health officials updated Ebola patient Dr. Craig Spencer's condition Saturday night, saying he is "awake and communicating" and "entering the next phase of his illness, as anticipated with the appearance of gastrointestinal symptoms.""
http://www.cbsnews.com/news/ebola-o...ctor-craig-spencer-fiancee-to-leave-hospital/

That's confusing. People have been stating as "fact" that he was vomiting and had diarrhea in his apartment at the same time as his first sign of fever. Those would certainly qualify as "gastrointestinal symptoms."

 

[SStarr33]

Hmm, I'm afraid I don't agree on several counts. First, I think that one of the critical factors may be immediate intervention rather than, or in addition to, only fluids and nutrition, etc.. There may not have been adequate opportunity to study this in detail before. Second, as far as I know, the largest modern outbreak prior to this struck 500 people in Uganda. It's difficult under the conditions of having medical personnel come in to track every treatment and every stage at presentation in the field when an outbreak is already underway, as opposed to the tracking here which is obviously microscopic in its detail. Here, we have the first opportunity to do so in history, because the number of cases in developed countries, which was previously around zero, allows for this careful scrutiny. Third, it's just how science works. Until we have the opportunity to study something in controlled conditions and there are enough cases to do so, we can't possibly know certain things.

Yes, it is already known that these treatments improve survival of patients. What would be mind-blowing would be if the CFR was really 5-10% when properly treated, because obviously that is not the conventional wisdom. We just don't know yet, and it's interesting.

Before Pham and Vinson were infected, I read stories about people who survived. It seemed pretty obvious to me that those who survived forced fluid and nutrition. It would't blow my mind at all that this is very survivable.

 

[Woe.be.gone]

That's confusing. People have been stating as "fact" that he was vomiting and had diarrhea in his apartment at first sign of fever. Those would certainly qualify as "gastrointestinal symptoms."

Yes, and it sounds to me one could be at the birthday party when the more grievous symptoms begin.
I'm trying to explain, not doing such a good job, there is an order to most diseases. With dengue, one minute totally fine, the next minute flattened. With Ebola, be aware of little changes, slight fever (to me 100.3 seems slight, no?) and then all hell breaks loose. Correct? How can one control where they are when and if vomiting begins? How long between the stages? Is it different for everyone? Any fever is a fever - there must be a reason for it as its nature's way to fight off infection.

 

[nrdsb4]

When we think about treatment in Africa, it "seems" like the virus is getting more virulent. However, it's important to note that the more people who show up sick, the more overwhelmed the HCW and the system itself gets. It's far easier to get a better result when you have fewer patients than when you have more. Whereas the survival rate may be x when you have more time and resources to devote to those patients, it could certainly be x minus whatever when you have so many that you cannot give them the medicines, the fluids, etc. that they need. At that point, it's not that the virus is more virulent, it's that you do not have the ability to give them the kind of care which results in survival.

 

[nrdsb4]

Yes, and it sounds to me one could be at the birthday party when the more grievous symptoms begin.
I'm trying to explain, not doing such a good job, there is an order to most diseases. With dengue, one minute totally fine, the next minute flattened. With Ebola, be aware of little changes, slight fever (to me 100.3 seems slight, no?) and then all hell breaks loose. Correct? How can one control where they are when and if vomiting begins? How long between the stages? Is it different for everyone? Any fever is a fever - there must be a reason for it as its nature's way to fight off infection.

Well, no, that is not what I was saying in my post. People here stated as "fact" that Dr. Spencer was experiencing nausea and vomiting at the same time he experienced first sign of fever (in his apartment when he called in a 100.3 fever). We are now hearing things which call that into question. If he is just now experiencing vomiting and/or diarrhea, then, no, he did not go from "fine" to "all hell breaks loose" in an instant.

 

[Woe.be.gone]

Before Pham and Vinson were infected, I read stories about people who survived. It seemed pretty obvious to me that those who survived forced fluid and nutrition. It would't blow my mind at all that this is very survivable.

That seems to be good news if all positive factors are in play. One has youth on their side, general good health, early awareness, don't live in a third world county therefore have access to good care, equipped with sanitation and methods of hydration and don't delay seeking treatment with the luck of not being misdiagnosed or dismissed. Not a large time frame for mistakes to be made and then be corrected.

 

[Woe.be.gone]

Well, no, that is not what I was saying in my post. People here stated as "fact" that Dr. Spencer was experiencing nausea and vomiting at the same time he experienced first sign of fever (in his apartment when he called in a 100.3 fever). We are now hearing things which call that into question. If he is just now experiencing vomiting and/or diarrhea, then, no, he did not go from "fine" to "all hell breaks loose" in an instant.

In that case, he must have been walking around with a fever already. What source reported the nausea, symptoms involving loss of fluids, began at his apartment? He returned to his apartment, slept, and then what clued him to call for help? Just elevated fever? Or, don't we know the facts?

 

[nrdsb4]

That seems to be good news if all positive factors are in play. One has youth on their side, general good health, early awareness, don't live in a third world county therefore have access to good care, equipped with sanitation and methods of hydration and don't delay seeking treatment with the luck of not being misdiagnosed or dismissed. Not a large time frame for mistakes to be made and then be corrected.

The early access to treatment seems to be very important. Nina Pham got help about as early as anyone could ever hope to. We don't know for sure that this is the reason she recovered so quickly, but it's certainly something to keep in mind and watch.

We also don't yet know if the plasma transfusion "made the difference" or not. Obviously we cannot do blind studies of that because it would be highly unethical.

As horrible as the introduction of this disease to our society has been, and though we would certainly do things differently if we could, we may well learn some very valuable information about this disease that we would not have otherwise.

 

[IMO]

Before Pham and Vinson were infected, I read stories about people who survived. It seemed pretty obvious to me that those who survived forced fluid and nutrition. It would't blow my mind at all that this is very survivable.

That's good, then you have nothing to worry about!

 

[IMO]

The early access to treatment seems to be very important. Nina Pham got help about as early as anyone could ever hope to. We don't know for sure that this is the reason she recovered so quickly, but it's certainly something to keep in mind and watch.

We also don't yet know if the plasma transfusion "made the difference" or not. Obviously we cannot do blind studies of that because it would be highly unethical.

As horrible as the introduction of this disease to our society has been, and though we would certainly do things differently if we could, we may well learn some very valuable information about this disease that we would not have otherwise.

Couldn't agree more. It would be a huge leap forward if even the fear of this disease could be lessened. People around the world might seek treatment sooner and make it much easier to contain in future outbreaks.

 

[nrdsb4]

In that case, he must have been walking around with a fever already. What source reported the nausea, symptoms involving loss of fluids, began at his apartment? He returned to his apartment, slept, and then what clued him to call for help? Just elevated fever? Or, don't we know the facts?

BBM
No, we cannot make that assumption.

There were some "sources" who claimed he was vomiting in his apartment, but they weren't identified. Some other news mainstream news sources stated that he had diarrhea. Nothing absolutely confirmed.

In Dallas, a near panic was created when one of our main news stations reported that a resident of Mr. Duncan's apartment complex and on the ebola watch list had vomited at a DART station platform and displayed fever and other ebola symptoms. After a string of several alarming notices, it was finally stated that not only was she not on any ebola watch list, she was NOT a resident of that apartment complex, and she had not vomited, but had willfully "SPIT" on the platform. It turned out she had called 911 to complain of a possible spider bite, but also had said she had "once visited" the Ivy apartments.

In other words, a total fail on the part of the news station.

So while many here don't believe a thing they hear from doctors, scientists, virologists, epidemiologists, the CDC, the government, etc., I think a good dose of skepticism should also be reserved for news outlets. Too many of them don't particularly show a real devotion to the truth vs. getting a story first. Fact checking, vetting the credibility of their sources, etc., doesn't seem to be high on the priority list of too many of them.

 

[Yoda]

New York Ebola patient Craig Spencer receives blood from survivor Nancy Writebol

nbcnews.to/1tpJLNw pic.twitter.com/I4NCEqFeTI

 

[Woe.be.gone]

My anxiety is up. On that note, I'm encouraged by the positive outcome in Dallas so far.
The good outcome for all the contacts does seem to suggest Ebola isn't as easy to catch as feared (they did send hazmat people into the good doctor's townhouse though which leads to confusion or, at least, more questions imo.)

Not to mention, signs all over my doctor's office warning about Ebola symptoms with baskets of masks out for the taking. Just in case, I guess. :thinking:

Time to :chillout:

 

[nrdsb4]

New York Ebola patient Craig Spencer receives blood from survivor Nancy Writebol

nbcnews.to/1tpJLNw pic.twitter.com/I4NCEqFeTI

Wow, interesting. Thanks for posting.

 

[SteveS]

Yes, but I thought they complained of being fatigued. My point was their slight fatigue might mean something if not normal for them. If you know you may have been exposed to something, why brush the fatigue off as being nothing?

<snipped>

I believe people are surprised to hear, two of them at least, acted a little bit reckless and were not more in tune when something seemed off.

See, that's where I part company with the storyline. I don't believe they "complained" of fatigue at all, or thought anything about it when it occurred. By their actions, in the moment it was normal.

Then, when they were diagnosed, there was a process where EVERYTHING got put under a microscope. What did you do, how did you feel, what symptoms did you show, tell us everything. So they mention every bump and bruise and note that "I felt tired" at such and such a point.

Tired enough to be alarmed? Well no, not at all. Debilitating? Nope. I felt good, took a planned trip, did normal stuff, felt fine all weekend. Or I ran the next day as usual, went bowling, did what I usually do, felt fine.

But once it gets into the account, it gets translated into a "symptom" by those who want to imagine such things lurking under every pre-fever rock.

That's how I read it, and I think their actions support that understanding.

And in no way do I think they were reckless at all. I think they were careful, observant, and went to the hospital at the first moment there was any hint of being sick, and imo people are working hard to create "pre-fever symptoms" for them that never really existed as symptoms whatsoever.