Ebola outbreak - general thread #8

[jjenny]

Yes, I do understand (I think) what you're trying to say.

As a non-doctor (nor nurse, nor any other medical professional), I have only a surface understanding of these concepts. It seems to me there must be a difference, medically, between someone who is a carrier and someone who has a virus and is on their way to becoming symptomatic but is not yet symptomatic.

MRSA carriers can still infect other people, right? So the same care must be taken with a MRSA carrier as with someone with an active MRSA infection.

And on the topic of being infectious, my understanding (again, as a non-medical professional) is that early on, before symptoms begin, there is such a low concentration of the virus in the person's system that infection is near-impossible. I'm not sure I accept that it's impossible, but I'll accept near-impossible. And as the quantity of virus increases, infection becomes more likely. (And especially at the end stages when the person is emitting huge concentrations of virus from every orifice.)

But to my knowledge, the docs/researchers don't know at exactly what stage of virus concentration contagion becomes "likely" vs. "not likely." And IMO, there wouldn't necessarily be a clear dividing line, but a continuum going from "near impossible" to "very likely." How certain are we -- how certain can we be -- that before symptoms manifest, the risk of contagion remains at the "near impossible" end of the spectrum?

That's exactly right. Virus builds up and person becomes more infectious. But I really don't think they can claim that before symptoms appear virus is impossible to catch. We know that Dr. Spencer's Ebola test came back positive on the first day he reported it.
So he already had enough virus in his blood to be detectable. Yet his fever wasn't even high enough.

 

[Sonya610]

Indeed, the small Monrovia hospitals became filled quickly. Ebola was first diagnosed in Liberia in March. By the end of August, Duncan knew what he would do.

That may have been the case back then but it sure isn't now. Since the Liberian Government announced that ALL deceased ebola patients in Monrovia would be cremated ebola treatment centers in the capital are now half empty.

MONROVIA, Liberia – Even as Liberians fall ill and die of Ebola, more than half the beds in treatment centers in the capital remain empty because of the government's order that the bodies of all suspected Ebola victims in Monrovia be cremated.

http://www.foxnews.com/world/2014/1...n-liberia-leave-more-than-half-hospital-beds/

 

[Elley Mae]

The only way of ensuring that the virus doesn't spread into a country is enforced quarantine for people coming from countries with an outbreak or - even more effective - a total travel ban.

http://www.cbsnews.com/news/ebola-outbreak-asia-casts-a-weary-eye-on-diseases-spread/

 

[SteveS]

The only way of ensuring that the virus doesn't spread into a country is enforced quarantine for people coming from countries with an outbreak or - even more effective - a total travel ban.

Simply shut the doors to all travel from Africa to the US? I'm not sure you can legally prevent a US citizen from entering/returning to the US, so there's that.

But there's a bigger issue. The harder you make it to get in the US from Africa, it will make it where no HCW's will go there.

Very interesting interview with Dr Fauci about quarantines, esp of HCW's returning to the US, and he made that point. In essence, you have someone who has bravely gone to fight this disease. Then they want to go home. Not sick. Yet we are saying they get jailed for weeks, and put in a less-than-decent setting, and can't go home until govt says so.

That is going to stifle a willingness of HCW's to go to Africa and help fight the disease on the front lines.

His point was this: the only way to win the fight against ebola is to have more brave HCW's, not less, to be willing to fight on the front lines against the deadly outbreak in Africa. And if we can't get it under control there, it will ultimately spread everywhere.

He admitted there are also issues here, more of of fear and panic than of safety, but issues that have an impact nonetheless. And the control of the disease is vital. But The Law of Unintended Consequences has to be considered too.

 

[faw720]

Snipped ..........

My personal view is that the urge to place blame was first manifest in the case of Mr Duncan and Marthalene's family in Liberia and it is continuing with the current urge to heap blame on Dr Spencer and insinuate he had overt symptoms and ignored them to go bowling.

I think he came back, felt a little jaded but probably thought this quite natural given a long flight and the stresses of what he had been doing. He was still well enough to go jogging and bowling - anyone who has had influenza will know that he therefore was not experiencing anything like the 'fatigue' one would expect from a serious viral illness. As soon as his temperature crept up, even though it had not reached the required threshold, he contacted the medical authorities.

I really think people should give Dr Spencer a break.

It's called 'blame the victim' & I think they all should be given a break. So far all ebola victims treated here in the US were infected because they were unselfishly trying to help others. It's a case of 'no good deed goes unpunished'. Just so sad.

 

[ATasteOfHoney]

I would personally like to hear a bit more about the "Law of Unintended Consequences".

Anyone care to share that regarding Ebola specifically? Details as it pertains to this disease?

 

[ATasteOfHoney]

That's exactly right. Virus builds up and person becomes more infectious. But I really don't think they can claim that before symptoms appear virus is impossible to catch. We know that Dr. Spencer's Ebola test came back positive on the first day he reported it.
So he already had enough virus in his blood to be detectable. Yet his fever wasn't even high enough.

'just as an aside and for what it's worth, not all viruses are at their most contagious points when the host is displaying the most profound symptoms.

 

[SteveS]

I would personally like to hear a bit more about the "Law of Unintended Consequences".

Anyone care to share that regarding Ebola specifically? Details as it pertains to this disease?

I just did.

If you don't follow the concept, it's the principle that you create rules to handle a problem, and in so doing you create an equal or greater problem instead by the way your "solution" impacts the landscape. As a result, sometimes your "solution" unexpectedly sends you backwards in the greater scheme of things, even though on its face it has solved a problem.

 

[ATasteOfHoney]

I just did.

If you don't follow the concept, it's the principle that you create rules to handle a problem, and in so doing you create an equal or greater problem instead by the way your "solution" impacts the landscape. As a result, sometimes your "solution" unexpectedly sends you backwards in the greater scheme of things, even though on its face it has solved a problem.

Thank you SS for your gracious response -- but where does the law of Unintended consequences come into play if NOT ENOUGH action has been put into effect. 'Just trying to apply critical thinking to this serious matter---looking at it from all sides, you know....

 

[SteveS]

Uhhh....are you sure about that? What about Cuba?

And no one is suggesting a travel BAN for U.S. Citizens, just a quarantine period. Big difference.

The point I addressed was the idea that you don't let ANYONE in the US who has recently been to Africa, even a US citizen, no matter what. I understand that a quarantine is also under discussion, but that wasn't the point I answered.

That has nothing to do with the ban on going TO Cuba (there is nothing preventing a US citizen from entering the US after being in Cuba) nor is it a ban on a US citizen going TO Africa. The idea has been proposed, in this forum and elsewhere, that we simply don't let anyone in the country who has been in Africa in the last 21 days, and I was responding to that idea.

 

[Sonya610]

The idea has been proposed, in this forum and elsewhere, that we simply don't let anyone in the country who has been in Africa in the last 21 days, and I was responding to that idea.

The idea was a QUARANTINE. Not letting U.S. Citizens return to the country for 21 days would be unrealistic to an extreme, where would they be quarantined? Being quarantined in the affected countries before travel would be useless, and I doubt any other countries would want to step up and say "Yeah, quarantine them here with us for three weeks before they travel to the U.S....just to be sure they won't infect the U.S. population".

Now TOURIST travel from the citizens of infected countries? That should absolutely be suspended ASAP. There is NO NEED for that whatsoever.

 

[winnnancy]

I am appreciating your perspective and opinions regarding ebola and find myself agreeing with your basic logic.
I want to add to the above that what bothers me is the way the system dropped the ball and seem to not be prepared to handle this within the communities.
I do not like feeling like we are a bunch of lab rats.
Also, what is the cost?
I am barely able to pay my bills, how could I ever cover the cost of this in my family?

I am a person who doesn't immunize. I made that choice after my own research and family experiences. My daughters who have children are being rejected & turned away by pediatricians for not immunizing now.
I want the facts and the truth. I want to be able to understand and trust the source of that information.
I do not follow the crowd when it comes to my life choices.
I take responsibility for those choices. It makes me really upset to know that our leaders are "failing" our country and my rights as a United States citizen are being taken away and diluted to a point where we are watching the literal invasion of a deadly virus let loose and possibly waiting to run rampant amongst us. I do not trust WHO, the CDC, the prez, or local government to protect me and my family and when it comes to life and death-that takes serious thought and consideration.

I am not a prepper or conspiracy nut, just a single mom who has struggled to raise 6 kids on less than 20,000 (last year I made 13.5) every year for 28 years. I never received child support, food stamps, medical assistance or even free food pantry community help. I tried a few times but the red tape and complicated and time consuming, drawn out effort made it easier for me to scrape up the money somewhere else. I mean gee, if my family was to get ebola-no one would come rushing to help us.

JMO

What really struck me is that there are only a finite number of facilities and beds able to handle the isolation and treatment of an ebola patient. Imagine that cases exceed that number and go on to exceed makeshift areas. Resources are finite. That basic supportive care may even be a stetch if there are outbreaks. Amber, Nina and others are fortunate in that they were very few in number and all resources essentially were available. Once hospital beds fill and emergency rooms are packed, where would these people be cared for and by whom? THis is why every precaution is being taken.

 

[IMO]

However Ebola is an equal opportunity killer and most strains of Influenza are NOT!

The vast majority of people that die from the "typical" yearly flu are elderly people or those with compromised immune systems and they almost always succumb to a secondary infection such as pneumonia. If a family member or co-worker gets the flu the whole lot of those close to them may get it BUT a 100% survival rate is expected.

Ebola is extremely deadly and ALSO comes with a big scary threat of government seizure, they take you physically into custody, they go through your home and all your stuff and destroy a lot of it, they can and will force your family/associates into mandatory quarantine, they confiscate your animals and you have NO say in the matter, etc....

They don't do any of the above when you have the flu. Honestly the thing that scares me about Ebola is NOT the actual disease or risk of dying from it but the ramifications of what will happen to you, your home, your loved ones etc.... IF you get it.

Totally agree that it appears more scary for all of those reasons. Quarantine especially is pretty nasty when it has to be implemented. Heck, people even get upset when their unimmunized kids have to stay home from school during an outbreak of a vaccine-preventable disease. It's no joke, that's for sure. And the history of quarantine is certainly not littered with feel-good stories.

 

[SteveS]

Thank you SS for your gracious response -- but where does the law of Unintended consequences come into play if NOT ENOUGH action has been put into effect.

You just made my point. Thank you.

What you label as "not enough" could instead have taken us in the wrong direction when considering the bigger picture. It provided some benefit in one way - - but if it was a massive detriment towards the solution to something far more important, then that's The Law of Unintended Consequences as its finest.

Ultimately the best way to keep it from ever coming to the US is to eradicate it at its source, where it's rare. Harming the efforts to do so would be a huge mistake. So on its face, the quarantine may be a plus, and we may want to do things even more invasive to those HCWs to feel more comfortable, but beneath the surface such "solutions" may be creating an even bigger problem.

I'm not arguing that "quarantine is bad" - but rather saying that it MAY be bad, and MAY be creating a bigger problem than it solves. It's a knee-jerk solution to something in the moment, and those are the very kinds of responses that cause The Law Of Unintended Consequences to come into play.

 

[ATasteOfHoney]

Why is there so much hostility on this thread? People here are allowed to express their concerns. It is a general open discussion?

There's no authority here....so let's all be respectful, please!?

 

[Elley Mae]

Simply shut the doors to all travel from Africa to the US? I'm not sure you can legally prevent a US citizen from entering/returning to the US, so there's that.

But there's a bigger issue. The harder you make it to get in the US from Africa, it will make it where no HCW's will go there.

Very interesting interview with Dr Fauci about quarantines, esp of HCW's returning to the US, and he made that point. In essence, you have someone who has bravely gone to fight this disease. Then they want to go home. Not sick. Yet we are saying they get jailed for weeks, and put in a less-than-decent setting, and can't go home until govt says so.

That is going to stifle a willingness of HCW's to go to Africa and help fight the disease on the front lines.

His point was this: the only way to win the fight against ebola is to have more brave HCW's, not less, to be willing to fight on the front lines against the deadly outbreak in Africa. And if we can't get it under control there, it will ultimately spread everywhere.

He admitted there are also issues here, more of of fear and panic than of safety, but issues that have an impact nonetheless. And the control of the disease is vital. But The Law of Unintended Consequences has to be considered too.

Africa? No just the infected countries, liberia, guinea, sierra leone.
bbm What makes them special that they don't get quarantined? Better yet have them quarantined there, after they are done working with the infected people have them wait it out there doing paper work or something that does not include going out in public.

 

[SStarr33]

http://currents.plos.org/outbreaks/...bola-virus-in-the-2014-sierra-leone-epidemic/

Conclusions: Estimates of R0 are sensitive to the unknown latent infectious period which can not be reliably estimated from genetic data alone. EBOV phylogenies show significant evidence for superspreading and extreme variance in the number of transmissions per infected individual during the early epidemic in Sierra Leone.

If you google the url, you can find some explanations of what it means in English. Currently, I can only find these explanations on blogs.

 

[faw720]

The idea was a QUARANTINE. Not letting U.S. Citizens return to the country for 21 days would be unrealistic to an extreme, where would they be quarantined? Being quarantined in the affected countries before travel would be useless, and I doubt any other countries would want to step up and say "Yeah, quarantine them here with us for three weeks before they travel to the U.S....just to be sure they won't infect the U.S. population".

Now TOURIST travel from the citizens of infected countries? That should absolutely be suspended ASAP. There is NO NEED for that whatsoever.

How about chartering a cruise ship to the mid Atlantic for quarantine? Provide the homeward bound healthcare workers with good food, drink & entertainment instead of throwing them in a tent or jail.:dunno:

 

[SteveS]

Africa? No just the infected countries, liberia, guinea, sierra leone.

I am well aware that "Africa" is not as precise as spelling out the countries by name that are dealing with a massive ebola outbreak. But I trusted that people understood what I meant, and would discuss the point I was making instead of focusing on some triviality.

 

[jjenny]

What really struck me is that there are only a finite number of facilities and beds able to handle the isolation and treatment of an ebola patient. Imagine that cases exceed that number and go on to exceed makeshift areas. Resources are finite. That basic supportive care may even be a stetch if there are outbreaks. Amber, Nina and others are fortunate in that they were very few in number and all resources essentially were available. Once hospital beds fill and emergency rooms are packed, where would these people be cared for and by whom? THis is why every precaution is being taken.

Exactly. Even if we have much better survival rate here than in Africa, if we were to get a lot of patients, we are in trouble.
Also, Ebola has a flu like stage at first.
It's hard to diagnose correctly.
Mr. Duncan died despite all kind of supportive treatments. Yes, maybe he wouldn't have died if diagnosed right away, but if Ebola were to spread, there would be a lot of people misdiagnosed because it looks just like the flu at first.