Ebola outbreak - general thread #8

[jjenny]

With respect, the CDC is not the only public health authority - they chose to diverge from some of the guidance on levels of PPE required - they have reviewed and updated their guidance. That does not suddenly mean that everything they say is worthless and the tabloids and conspiracy theorists must know better.

I am talking about the wealth of experience that the WHO has amassed since Ebola was first identified in the 1970s. the treatment protocols which they recommend and which are used in many countries are based upon the observation of all of those patients in the 20 plus outbreaks which have occurred over the past 40 years.

There are lots of documents and features on the WHO website tracing not just this outbreak but all aspects of the disease and its history.

I am not saying everything cdc says is worthless. I am saying they changed their guidelines. Protocols aren't written in stone.

 

[JudyBolton]

Well then please provide a link to show where people have picked up Ebola from someone who has just fever and no other symptoms - or even no fever at all. If this is what you are afraid might happen, what are you basing your fear on?

My thoughts are based on the evidence which we have available to us and the guidance and data gathered by the WHO over decades. I believe that makes them quite valid. Whay are your thoughts based on?

As I said, my thoughts are based on common sense. So if you *cannot* get the virus from someone who is running a fever - why does the CDC guidelines have incoming passengers checked for a fever? Why not just say, " If they aren't vomiting all over or having explosive diarrhea - exit right here to baggage claim"?

There is obviously some (unknown) period of time between running a fever and depositing bodily fluids all over the place. THAT is when you think we need to stop someone? How do we know when that might be? What if we are a few hours too late and they happen to be in the middle of a room full of children when they reach this tipping point? Is that risk worth it?

 

[BingoBongo]

bbm - Somehow, using the word "THINK" when discussing a virus with a 50-80% death rate does not give me any comfort. This is nothing more or less than old fashioned (yes - I said it) common sense. If the risk of contacting Ebola was very low AND if the potential outcome was something like the flu - then we could discuss whether the nurse, the dr., and others' "rights" to run around, ride bikes, go bowling, etc. outweighed the risk of innocent citizens being sick for a week or two. BUT we are not - we are talking about weighing their "rights" (for 21 or 41 or whatever number of days) with the potential DEATH of someone who is an innocent citizen. smh (MOO)

Thank you!!!

 

[CARIIS]

That IMO is the core issue, all of us here "attempt" to keep up. There have been so many "things" that noone can keep up - even thepeople who are suppossed to know what they are keeping up with !! Its such a mess. I truly believe that if from the beginning if media would have done this far more carefully we would not be where we are - which is we dont know where they are - casue they dont either!!!

ITs hard to follow the trial in order as time goes by casue what was "correct" for one person became someone else in the same place breaking a rule. Its like drivng down a highway and the speed limit keeps changing on the same parts of the higway.
One gets to a point where one does nsot know what speed to go to avoid a ticket. Semantics IMO, here are also a huge problem

Self monitor, be monitored, isolated, home isolated,public isolated, quarantine, a suggustion, voluntary, unvolantary,court order, request, be told, suggusted, recomended on and on - they all mean different things to different people in different contexts we need a dictionary for Ebola to be passed out!

I've already asked this, but I'll ask again in hopes someone will answer. Why did they quarantine Spencer's fiance if there is no chance of getting obola from him when he only had a mild fever?

 

[Lyra500]

I've already asked this, but I'll ask again in hopes someone will answer. Why did they quarantine Spencer's fiance if there is no chance of getting obola from him when he only had a mild fever?

Erring on the side of caution. Since they share an apartment if anyone was in close enough contact, it would be her. And, whilst not wanting to get personal, if they had intercourse that might well be a reason to monitor her more closely.

http://www.nhs.uk/Conditions/ebola-virus/Pages/how-it-spreads.aspx

Other ways people can catch Ebola are:

•touching the soiled clothing of an infected person, then touching their mouth
•having sex with an infected person without using a condom (the virus is present in semen for up to seven weeks after the infected person has recovered)
•handling unsterilised needles or medical equipment that were used in the care of the infected person

Ebola virus disease is not spread through ordinary social contact, such as shaking hands, travelling on public transport or sitting beside someone who is infected and does not have any symptoms - see below.

 

[JudyBolton]

Just saw this: WSJ/Marist/NBC poll: 82% of New Yorkers support quarantine for anyone who's had contact with Ebola patient.

 

[winnnancy]

As I said, my thoughts are based on common sense. So if you *cannot* get the virus from someone who is running a fever - why does the CDC guidelines have incoming passengers checked for a fever? Why not just say, " If they aren't vomiting all over or having explosive diarrhea - exit right here to baggage claim"?

There is obviously some (unknown) period of time between running a fever and depositing bodily fluids all over the place. THAT is when you think we need to stop someone? How do we know when that might be? What if we are a few hours too late and they happen to be in the middle of a room full of children when they reach this tipping point? Is that risk worth it?

Personnel interacted with other personnel exposed to ebola both in PPE and without PPE during off time. it is unknown WHEN those who became symptomatic were infected and certainly, there would have been caution exercised with any personnel who " may be infectious" Infact, I believe they stated the same. There is no singular moment at which a person may be contagious! why take the chance?

 

[Lyra500]

As I said, my thoughts are based on common sense. So if you *cannot* get the virus from someone who is running a fever - why does the CDC guidelines have incoming passengers checked for a fever? Why not just say, " If they aren't vomiting all over or having explosive diarrhea - exit right here to baggage claim"?

There is obviously some (unknown) period of time between running a fever and depositing bodily fluids all over the place. THAT is when you think we need to stop someone? How do we know when that might be? What if we are a few hours too late and they happen to be in the middle of a room full of children when they reach this tipping point? Is that risk worth it?

I have never suggested that people should not be isolated as soon as they run a fever - what is not logical is locking everyone away before then' just in case' they start to run a fever, or suggesting that someone who had not even developed a fever posed a huge Ebola risk to the public at large by going jogging or riding the subway.

If the person has a fever but no other symptoms, then the level of virus in their body is very low and unlikely to be passed on to someone else.

The protocols are designed to pick people up as soon as they get the early signs of a potential infection, at which point they are isolated and tested and then treated according to the test results.

 

[BingoBongo]

This video is from the Dean’s Symposium on Ebola: Crisis, Context and Response

I would imagine the featured speaker knows way more than any of us. Even he says...we don't know what we don't know.

Michael T. Osterholm, PhD, MPH, McKnight Presidential Endowed Chair in Public Health and Director, Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota

Worth watching!

https://www.youtube.com/watch?v=NAKBtPWGO10

 

[JudyBolton]

Personnel interacted with other personnel exposed to ebola both in PPE and without PPE during off time. it is unknown WHEN those who became symptomatic were infected and certainly, there would have been caution exercised with any personnel who " may be infectious" Infact, I believe they stated the same. There is no singular moment at which a person may be contagious! why take the chance?

Because I want to ride my bike ::::stomping foot::::

 

[BingoBongo]

I have never suggested that people should not be isolated as soon as the run a fever - what is not logical is locking everyone away before then' just in case' they start to run a fever.


The protocols are designed to pick people up as soon as they get the early signs of a potential infection, at which point they are isolated and tested and then treated according to the test results.

But they are not "locking everyone up just in case"

They are monitoring, quarantining and observing (in addition to asking for cooperation) those who have GOOD CAUSE to be monitored, quarantined and observed.

 

[Inthedetails]

Since some are saying people in the early stages are not contageous, why did they quarantine Spencer's fiance?

My guess would be because she was exposed to his bodily fluid. In the case of their likely intimate contact, it seems a reasonable response.

 

[BingoBongo]

Another excellent article.

http://www.vox.com/2014/10/9/6905347/too-afraid-to-ask-about-ebola-virus-outbreak-symptoms

 

[JudyBolton]

I have never suggested that people should not be isolated as soon as the run a fever - what is not logical is locking everyone away before then' just in case' they start to run a fever.


The protocols are designed to pick people up as soon as they get the early signs of a potential infection, at which point they are isolated and tested and then treated according to the test results.

You said, (and I quote) "Well then please provide a link to show where people have picked up Ebola from someone who has just fever and no other symptoms - or even no fever at all."

So if you were not suggesting that people should be isolated who were running a fever - why did you ask me to provide a link showing that you can pick up Ebola from someone with a fever? Not being argumentative but I don't think you are being consistent about the fever issue.

 

[SteveS]

Per what has been reported, he is a marathon runner.

A person who has run a marathon probably does not run anywhere near 10 miles a day. The marathon is the peak (by a considerable amount), not the norm, and running even half-marathons aren't normal unless training to build for another marathon.

 

[SteveS]

Why did they quarantine Spencer's fiance if there is no chance of getting ebola from him when he only had a mild fever?

Probably for the same reason they quarantined the visitor to Dallas who was nowhere near anyone with ebola, ever. Fear isn't rational.

 

[Lyra500]

But they are not "locking everyone up just in case"

They are monitoring, quarantining and observing (in addition to asking for cooperation) those who have GOOD CAUSE to be monitored, quarantined and observed.

There is a difference between monitoring and quarantining.

It is perfectly sensible to ask people to check their temperature twice a day, but when people in some states who have no symptoms and have not been in direct unprotected contact with Ebola patients are (in effect) put under house arrest despite being symptom free that seems illogical.

The Pentagon is doing likewise for all returning soldiers - they will all be under lock down for 21 days even though they are not coming into contact with patients or working in the treatment centres. the rationale just isn't based on experience or the facts of disease progression.

I have to ask, if people currently returning from West Africa having worked for MSF, Save the Children, WHO etc are such a huge Ebola risk, why have none of the returning medics and nurses who have arrived back in the US since the beginning of August developed Ebola or caused a problem - what do people think has changed?

 

[JudyBolton]

So if I quoted a woman who said, "The New York City Health Department finally sent Dr. _____to talk to ___. He stated "by that time she was convinced that the law was only persecuting her when she had done nothing wrong." Who would you think I was talking about? a certain nurse with the intials K.H.?

You would be wrong - those were the feelings of Mary Mallon(aka: Typhoid Mary) who infected 53 people with typhoid fever and refused to be quarantined or even examined by a doctor - she hid in the bathroom when they tried to interview her....

"there was no policy providing guidelines for handling the situation. Some difficulties surrounding her case stemmed from Mallon's vehement denial of her possible role, as she refused to acknowledge any connection between her working as a cook and the typhoid cases."

 

[Inthedetails]

Just saw this: WSJ/Marist/NBC poll: 82% of New Yorkers support quarantine for anyone who's had contact with Ebola patient.

So this 82% would put all health-care workers who work with ebola patients in a hospital in quarantine? Was that the question?

 

[CARIIS]

I think that is where media failed folks. They did not give it a "progressive" feel. They made it concrete and linear while it isn’t. No illness is. No one gets sick exactly like another person. Ever! . But they have gotten it to where it is in a box. X = y always then r = s.

There are however "ways"the human body responds to things that are not supposed to be inside! I am visual – if we think about both the virus and the antibodies as being mixed in water, and filling up a swimming pool, the more water, the more virus, more antibodies and higher fever. It takes time to fill up the pool , and it takes time for the pool to overlfow.

It is a process. They totally ,IMO, did a horrible job as "viral loading" is so important in virus stuff. Makes sense – more virus- higher concentrations. More concentrated, worse symptoms, higher fever. The test is not testing "for" Ebola.

The test is hunting for a detectable load, or quantity of the virus in the bloodstream and cells. Until the loading is high enough for both - to be detected in the test and trigger a fever it make sense that the person is not contagious simply because the concentration of the virus in the fluids isn’t even high enough for the body to register and start a fever nor for the test to detect.

But there will be thresholds, in which the two correlate as it relates to becoming contagious. The notion that someones viral load is going to be high enough to be transmitted while at the same time not regustering in the test or a fever beginning just is not the way it works. Same with any infection.

So, its like, IMO, going up a hill the higher up you are, and you fall (!) the harder your going to hit. But anything concentrated does influence what "it" does. And the concentration level does impact the whole thing.

Viral loads are solely used in HIV. It dictates treatment, it dictates which antivirals, it dictates the determination of weather of one anti viral is working or not. It determines how an individual feels , It determines what damage is done to organs .

Viral loading is in essence the entire thing.........................IMO!

As I said, my thoughts are based on common sense. So if you *cannot* get the virus from someone who is running a fever - why does the CDC guidelines have incoming passengers checked for a fever? Why not just say, " If they aren't vomiting all over or having explosive diarrhea - exit right here to baggage claim"?

There is obviously some (unknown) period of time between running a fever and depositing bodily fluids all over the place. THAT is when you think we need to stop someone? How do we know when that might be? What if we are a few hours too late and they happen to be in the middle of a room full of children when they reach this tipping point? Is that risk worth it?