Ebola outbreak - general thread #8

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ATasteOfHoney

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I know we all want to head for the hills and lock everyone up, just because ...

...but when we have enough evidence to know what happened, we keep seeing the same thing: a person caught the disease when they were in contact with someone who was close to death - which is when the virus is super-strong in the fluids, and those fluids are oozing out of every orifice and making new ones.

We saw it with Duncan, with Nina, with Amber ...all caught it at that stage. We also saw tons and tons who didn't catch it because they came across the infected person much earlier in the process, when the virus was relatively weak and the fluids were little to none.

I'm not willing to dismiss the evidence we keep seeing, just because it doesn't feed our fears and biases. Do I believe what I'm saying? My 91-yr-old dad and 88-yr-old mom had multiple appts at Presby Med Center a week ago, and I saw no reason to warn them away. They were blessed with easy-to-get prime parking spots, and no lines in the doc's offices, as a result.

I agree that there is a wide girth between hysteria and non-chalance when it comes to Ebola.
What I have trouble with is our leadership (ie CDC) being more reactionary rather than highly proactive & pre-cautionary. It is human nature for most of us not to live via an "aseptic technique" or a "self-quarantine" manner without defined instructions from our leadership. Caution goes way beyond a lay-persons common sense in dealing with this virus.

I wish I could fully trust the authorities/decision-makers but I haven't been impressed.
 

winnnancy

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JMO, but I would hope that any medical professional treating me would be compassionate & not easily scared. The medical profession is not a good match for anyone who scares easily, is uncaring, or faint of heart. Just like the teaching profession is not for someone who is scared of children or dislikes children. If someone makes a mistake in choosing their profession they need to make a career change.

Generally, there is nothing in the teaching profession that will place you in isolation from your family, anD KILL YOU Rapidly. Similarily, there has never been anything in the nursing profession that would do this before ebola.
Add to this that nurses ARE NOT provided appropriate PPE by money oriented institutions... ( those masks are EXPENSIVE after all)
Youre right its painful for me to think about people dying of this disease but I too have a life and young children to raise. Ebola and insufficient PPE is about death NOT simply fear and I sincerely doubt any teacher ever has to make that decision - its not about like and dislike- its about death .
 

SStarr33

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With the outbreak of ebola in the medical community it is my hope that those medical professional who have contracted ebola will be able to shed a lot of light to other medical professionals on facts of how how they became infected with the disease & exactly what treatment improved their condition. It seems to me if they all get together & share information in 'medical speak' a better understanding of the disease & it's treatment could be beneficial. They should be able to gain a greater understanding because of a professional to professional dialogue.

Not going to happen because they have no idea how they got infected. If they knew PPE had been breeched, they would go into immediate quarantine.
 

SteveS

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I found the article on phases of Ebola.
First three days are flu like symptoms and profound weakness.
Both Amber Vinson and Dr. Spencer appears to have experienced this weakness yet for whatever reason neither recognized it as first stage of Ebola.
So I am assuming Dr. Spencer is now entering the second stage.
I am amazed that we are being told that until fever the person is asymptomatic. Yet weakness is clearly a symptom and both of them had it for several days prior to onset of fever. So were they symptomatic or not?http://www.huffingtonpost.com/2014/08/02/ebola-symptoms-infection-virus_n_5639456.html

I think you are assuming wrongly.

The "flu-like symptoms" would be what Amber began to experience on that Tuesday morning after her flight when her fever shot up, and what Spencer began to experience on Thursday morning when his fever shot up.

"Flu-like symptoms" include a fever over 100 degrees, nausea, vomiting, diarrhea, and chills. Without any of those, I wouldn't call "fatigue" at the end of a day a symptom that a person has the flu. Sounds more like normal life to me.
 

SStarr33

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Absolutely. Caution is definitely warranted, especially among healthcare workers. This is a real-time drill for public health preparedness. What is so fascinating to me is that we may learn something truly mind-blowing about Ebola through this experience. And that *may* be that it's not as big of a killer as we had thought. It would be both a tragic and exhilarating finding, but it's possible that early detection and immediate treatment may substantially reduce the risk of mortality. I hope I am not eating my words in a month's time.

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.
 

faw720

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Generally, there is nothing in the teaching profession that will place you in isolation from your family, anD KILL YOU Rapidly. Similarily, there has never been anything in the nursing profession that would do this before ebola.
Add to this that nurses ARE NOT provided appropriate PPE by money oriented institutions... ( those masks are EXPENSIVE after all)
Youre right its painful for me to think about people dying of this disease but I too have a life and young children to raise. Ebola and insufficient PPE is about death NOT simply fear and I sincerely doubt any teacher ever has to make that decision - its not about like and dislike- its about death .

Well, every person is entitled to their own opinion.

Teachers have died in school shootings protecting their children, firefighters die fighting fires, police die protecting the public, & soldiers die every day protecting all of us. Death eventually comes to all of us.
 

chipmunk

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Haven't all three of the cases been recent? I wonder why. When did these brave volunteers begin serving in Africa? They're not all Americans, are they? No.

Good article and I should read it first before asking questions! The three doctors; one from Norway, one from France and one from the U.S.

I think I know why a MSF/Doctors Without Borders are beginning to have a couple more ebola cases among their workers.
They've been saying they're overburdened, understaffed, past their max.
They've been saying HELP!! :panic::eek:hdear: :eek:hdear: :help:
 

jjenny

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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.

Mr. Duncan got all of that and still died.
 

Herding Cats

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Hmm...wouldn't traveling on public transportation in crowded major cities such as NYC be a problem for returning staff members?

If colleagues & HCWs experience stress & anxiety, what about the public's stress and anxiety?

-------------------------
Forgive the inability to quote. I am on my phone and I still don't know how this works. Sigh. And SBM...

in reference to your comment about people having stress and anxiety on public transportation in such cities as New York, ie the subway or the taxis or the buses...I think most people in a place like New York City use the public transportation so often that they don't have a concern until something like this goes on.when I was back there doing the bookstore one of the lectures let out very late and then we went to dinner afterwards. I could have taken the subway back to my hotel, and my elderly mother, handicapped and using a cane, was going to travel from New York City into New Jersey via cab and bus.

After getting my mother a cab(a story unto itself, lol) I searched diligently for a cab to take me back to the hotel. I realized my predicament after no cab had stopped for 20 minutes, as I was standing outside the entrance to a subway station. I walked a block and a half away and was able to get a cab, with the help of some bystanders. those bystanders were interesting fellows. I was a little nervous when they approached me, as there were three of them and only one of me. It was also about 1 o'clock in the morning and raining slightly. Up until that time, I had not realized that cabs don't like to stop for people if they are by themselves but will stop for a group. I discovered that because the bystanders help me get a cab. in the conversation I had with these gentlemen, not only did I learn about the multiperson taxi law hahaha, but they also wondered why I wasn't taking the subway. My response was very general, and very noncommittal, something to the effect of oh I'm sure I would get lost, and that wouldn't be good. But the real reason is is because I was uncomfortable taking the subway at that time of night. As a matter of fact I am uncomfortable taking the subway at anytime of the day or night. A gentleman left and one said Oh you must be a tourist! We always take the subway at this hour and we never get lost.

Long story to say simply this: in New York City subways and buses and cabs are used all the time at all hours of the day or night. If you live there, you use the public transportation. You don't think about it, you just do it. I mean my mother who was 81 at the time, was leaving New York City in a taxi to catch a bus to get back to New Jersey. she had no qualms about it, and laughed when I said I'll put you up at my hotel it's too late for you to go around tonight. She said she would whop them with her cane, and she could still yell loud enough to raise the devil. she was very comfortable doing this. I even offered to go with her, and she told me just to go get some sleep at the hotel, and she'd call me in the morning.

again all of this is to say that the folks who live in an environment that relies on public transportation for the majority of their movement, will not have a concern or experience stress; further I suspect that dr. Craig never even thought it would be a problem. It's the normal way to get around so that's what he did.

Well you and I may think that he was irresponsible or used poor judgement and that may or may not be true, it's also very true that 6 people use the subway buses and trains to go see their doctor. They have no other way to get around.and it honestly may just not have occurred to him this was a problem.

just my thoughts for what it's worth.

Best,
Herding cats
 

IMO

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Risk perception has a high degree of personal decision-making and choices. For instance, I choose not to ride on the back of a motorcycle or handle rats in a lab without wearing gloves---that's me. I leave risk analysis to the actuarials.

What I worry about is a cavalier attitude and statistics leading to a conclusion on such a small sample size of Ebola infected people within this country. Yes, we have better sanitation methods than African countries so we will probably not have the lethal percentage of Ebola cases here in the USA but we do have a dense population in NYC with its own unique methods of transmitting potentially contagious diseases (ie subways, theaters, etc).

As you very we'll know, viruses vary greatly regarding their timeframe of contagiousness, shedding, hosts' immunity vs susceptibility, and so on. They are unique critters & tend to mutate.

And I'm certain you have the utmost of respect for their uniqueness and adaptability. My question to you is not about risk or exposure......my question to you is not about interpretation , politics, defusing panic for whatever reasons, etc, etc---
or risk analysis but rather on the qualities of the actual virus itself. ***Lets talk details of the virus itself***

I think it should be handled more aggressively than what I've seen occurring. A comprehensive pro-active, coordinated approach is key.

Remember, at the end of the day, doctors trained and properly suited came down with the virus.

Moo

Risk perception drives behavior, as you have pointed out, and is a key part of public health policy and decision-making. It is not just for actuaries.

Regardless, I do not think it is reasonable to state that I have a "cavalier attitude" because I have pointed out that the risk of dying from influenza is vastly greater than than the risk of dying from Ebola and provided data demonstrating this.

Further, I did not draw any conclusions whatsoever from the current case fatality rate in the US. I don't know why, to date, it is so low, and neither do you. It is a fascinating set of data, however. Personally I look forward to the identification of the reason(s) for this, particularly if it continues, and I suggested one possibility, which is that Ebola may not have as high a CFR when properly treated than was previously thought. Unlikely, but not impossible.

I used a comparison to cholera, which when left untreated has a CFR of 50-80%. When properly treated it is more like 5%. This was quite unfortunately apparent after the Haiti earthquake. The docs there knew what they needed to treat it, but they did not have access to rehydrating salts or IV fluids. Approximately 100,000 people die of cholera each year worldwide, even though we know how to treat it. Another possibility includes that every patient in the US had a "mild" strain of Ebola, which seems unlikely given the different exposures of each and the statistical unlikelihood that approximately 90% of the patients brought here just happened to have it. Unlikely, but not impossible.

You had also talked about mutations, etc. I have seen no evidence that this virus is mutating in either direction--to be more or less fatal or transmissible. As you say mutation rates for viruses tend to be high, but as you also know they tend to be neutral. If you have data to present that indicates otherwise, please let me know where I can find it.

Lastly you state that a comprehensive approach is needed, but you also said that you are not interested in talking about risk or exposure, which implies otherwise. As I see it, with Ebola exposure is everything.
 

jjenny

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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/
 

Ladylub

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JMO, but I would hope that any medical professional treating me would be compassionate & not easily scared. The medical profession is not a good match for anyone who scares easily, is uncaring, or faint of heart. Just like the teaching profession is not for someone who is scared of children or dislikes children. If someone makes a mistake in choosing their profession they need to make a career change.

JMO Ebola is not an easy scare. Its deadly disease. At the end of the day our HCW should be able to go home and not worry about bringing home deadly diseases b/c they feel they are not trained enough or whatever their reason is. To make sure you get the best care and compassion then those that are trained and feel fully capable should be the ones treating you. We will have to agree to disagree.
 

Brightbird

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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.

Wouldn't change the situation on the ground in West Africa though. It would just make it sadder. An article I linked earlier said that 77% of Liberians with Ebola aren't getting any form of treatment.
 

Woe.be.gone

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Emotion drives our risk perception, not facts. There is ample evidence that we do not perceive risk based on fact. I have put some articles below. IMO the reason there are 6 billion of us on earth has everything to do with science (antibiotics, sanitation, vaccines, food tech) and very little to do with individual instinct. I really cannot think of a time when a gut feeling has saved my life, though in fairness if the gut feeling worked then I would really have no way to know that it saved me. Science, OTOH, has saved my life at least twice.

The fact that our fear of Ebola (US deaths=1) supersedes our fear of influenza (US deaths/year= 20,000) highlights this, as does the burgeoning fear of vaccinations. The problem is that while our perception of risk is very often incorrect, at the same time this phenomenon cannot be ignored when trying to communicate public health information. We just haven't quite figured out how to do it yet. IMO, as ever.

http://blogs.nature.com/soapboxscience/2011/05/11/risk-perception

http://scienceblogs.com/thepumphand...rceive-risk-paul-slovics-landmark-analysis-2/

http://www.psychologytoday.com/blog...erception-are-we-doomed-because-we-get-risk-0

http://www.pbs.org/wgbh/nova/body/risk-perception.html

http://bigthink.com/risk-reason-and...sk-perception-and-politics-put-us-all-at-risk

I had a gut feeling that saved my life once. It is a long story but has to do with diagnosing cancer. The doctor said I was too young to get the test. A few weeks later I felt compelled and propelled from the chair I was sitting in (at home watching TV) to make another phone call. Julie, a nurse practitioner, saved my life the day of my appointment (the second time) by fighting for me to get permission for an offsite referral for a colonoscopy. Diagnosis, colon cancer. Turned out, just in the nick of time, as the surgery removed the tumor that hadn't yet spread out to the nodes. Trust your gut and believe in a higher power.
That said, the experience was traumatic overall (psychologically especially). If you can't trust your doctors, who can you turn too?

Then, while at Walter Reed (pulled back into the military system against my will), you'll never guess?
I'm laying there, after being partially gutted, when, all of a sudden, there are three people outside my room in the hallway wearing hazmat suits waiting to enter the room adjacent to mine - just a wall between us.

(I've been thinking about this experience ever since the ebola outbreak topic came to the US while feeling a bit re-traumatized).

The man next door was an old man (I couldn't see him but could tell by his voice and overheard him talking on the phone). While on the phone, he told someone he wasn't being released from the hospital, had been there awhile, because doctors had informed him he has some kind of highly contagious, rare virus. So, I'm in my room, waiting to find out my prognosis of whether or not tests show the cancer spread. Then, I was having to wonder about the situation next door as I watched the suited people going in and out. I worried if the same people would be tending to me when they finish next door. No one explained anything to me. It was horrible but I had no control over anything throughout my whole ordeal, other than, at that one point, I didn't take the word of a doctor. It is very hard for me to trust the system now.
 

Woe.be.gone

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I think you are assuming wrongly.

The "flu-like symptoms" would be what Amber began to experience on that Tuesday morning after her flight when her fever shot up, and what Spencer began to experience on Thursday morning when his fever shot up.

"Flu-like symptoms" include a fever over 100 degrees, nausea, vomiting, diarrhea, and chills. Without any of those, I wouldn't call "fatigue" at the end of a day a symptom that a person has the flu. Sounds more like normal life to me.

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.
 

Woe.be.gone

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I'm thinking I still have maybe three lives left? I hope anyway. Fatigue is my normal it seems.
 
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