Ebola in The USA

This is bogus. Can you give me one example where the medical experts have made statements about risk that have been proven wrong? (I can give you plenty of examples where they were proven right in this outbreak and in previous ones).

You and Finn keep making statements like this. I have yet to see a single example of what you are talking about.

I think my trust in medical experts is well founded (at least compared to the crazy stuff non-experts are saying). So put up or shut up.

Bogus? Nope he is very right!

Ebola to Republicans: “Thank you!”
http://bluntandcranky.wordpress.com/2014/10/15/ebola-to-republicans-thank-you/

Source info at the link.

Mr. Ebola Virus held a surprise press conference yesterday, as you all know by now. Speaking and secreting to a room full of reporters, many of them sketchily covered in makeshift protective gear, Ebola lauded the American “Republican” party for their assistance in spreading himself across multiple countries in a short period of time. But enough of me yakkin’, let’s hear what the Virus himself had to say:

“Thank you all for coming on such short notice, I appreciate it. I gotta say, I am getting too much credit for the death and mayhem I have wrought upon West Africa, and now America too. It’s unfair of you to not give props to those awesome Teapublicans in America. Their budget cuts in the past helped degrade the world’s ability to fight me, and even better for me, they are still refusing to spend money to fight me.

It’s helping me, no question about it. They throw money at terrorists and such, but leave me free to murder and terrorize at will. It’s not bragging to predict that I will kill thousands more people this year than those pathetic loons in ISIS and Al-Qaida put together, and I couldn’t do it without pig-ignorant, medieval morons like Boehner, Inhofe and Vitter shafting the CDC, NIH, WHO, and everybody else who needed resources to prepare for my assault on the human race.

That’s am I had to say, really. Please keep ignoring me, don’t listen to experts, panic all you want, I live for that. And vote Republican, they are my biggest supporters!”

Sounds like “mission accomplished” once again, doesn’t it?

You have not provided an answer to the question, and neither have the "experts."

Banning commercial flights from Ebola affected areas to the US will have no affect on transporting known Ebola patients who need to come to the US for treatment. The original healthcare workers who came to Atlanta for treatment were not booked coach seats on American Airlines.

Someone from the CDC or NIH may think a travel ban is not necessary, and they have alluded to how it might hurt the countries from which flights would be banned, but they have not provided a reason based on their area of expertise. We don't need them to provide reasons based on politics, economics, or what does or doesn't send a "good message."

The number of flights from these countries is not great enough to result in significant loss of profit or any loss of airline jobs. Any ill effects will be felt by the West African nations involved.

If there is a legitimate, explainable reason how such a ban would make the medical situation in these countries worse, I would like to hear it. I don't think that's too much to ask.

Now there is a second health worker in Dallas who has come down with the disease. Still no panic but understandably, anxiety levels are rising. If trained staff in haz-mat suits can catch it, the average person is going to start questioning explanations that it is very difficult to become infected.

No need for a a spiel on transmission, I appreciate that these people are in the belly of the beast in terms of contact with virus laden bodily fluids, but it doesn't take a panicked imagination to conjure up thoughts of an infected person, unidentified by the healthcare system, going about his or her business and leaving traces of their bodily fluids in public places.

As long as the only people catching the disease are health-care workers who come into direct contact with patients, I think the public will remain at Anxiety Level 1 or 2, but if and when someone outside of the healthcare system come down with it, it's going to get pretty tense.

Sometimes it's a good thing to take steps that do nothing more than make the public feel less anxious. Since you think panic (which has yet to materialize on even a moderate scale) is so dangerous, I would expect you to be in favor of taking steps to keep it from rising, even if they have no appreciable impact on controlling the outbreak. Whether you and the experts are correct that the average American has nothing to worry about, at some point circumstances can conspire to create a situation where the average American isn't going to listen to you, no matter how loudly you shout at them that they are a stupid herd of stampeded cattle. At that point a major component of the crisis becomes public attitude, and steps to manage that attitude will be required. A ban on flights from West Africa might be a big help.

A ban isn't worthy of consideration if it is going to actually make the health situation worse, but when people stop listening to "Don't worry because we're the experts and we're telling you not to," they're not going to be happy with a "We can't ban the flights because it will make things worse, but we can't tell you specifically how it will do so."

Worst case projections on how fast this bug could spread have consistently been many orders of magnitude wrong.

No they haven't. You are making this up.

Give me a single example of where the CDC, or any reputable (mainstream) medical expert has made a worst case project that was "orders of magnitude wrong".

I think you are full of crap.

The experts might be wrong but if they are right that the bug kills 70% of those it infects rather than the usual 90 then this bug is significantly different from past versions. Perhaps it infects easier. That would explain a lot about how the global medical community got caught with its shorts down.

Finn,

The medical experts have continued to say "There is no significant risk of an Ebola outbreak in the US".

The explanation for this is pretty clear to anyone who is listening to the medical experts. It has to do with the way that the disease is spread, the fact that it isn't infectious until there are symptoms, and the fact that in the US there is a functioning public health system.

This is a perfectly good reason that banning commercial fights is an unnecesssary (and extreme) measure.

The decision to ban flights is one that that should be made by medical experts with the resources and authority they need to make a scientifically sound decision. This is not a decision that should be based on public fear or political calculation. The medical experts are recommending that certain steps be taken to respond to Ebola, and we should follow these carefully.

I don't know why you think that public panic is a better way to make such a decision than the reasoned decision by medical experts.

Several other observations are note-worthy:

First, no Texas phlebotomists have become infected with the virus. Remember, these employees come into contact with each hospitalized patient during a blood draw. Why do you suppose this is? Excellent training?

Second, the infected Texas nurse gained her nursing education via a post BS/BA program, normally called an accelerated nursing program. It takes about 16 months to complete. The regular, BS/BA college program in nursing can take up to 5 years ( BS ) or longer (MS).

One reason the Texas nurse became infected is most likely her deficient educational background in aseptic technique , which a student normally learns in College, by taking a 1 year course in Microbiology, that consists of both lab and lecture.

As far as the CDC is concerned, I'd give them a D- grade. Nothing higher.

Nurse #2 took a commercial flight the night before reporting symptoms while her temp was 99.5. Everyone on the flight is being contacted.

http://www.npr.org/blogs/thetwo-way/2014/10/15/356334870/second-health-worker-tests-positive-for-ebola-at-dallas-hospital

Swell.

Lemme see: There was a single case of Ebola here in the United States...and from that one case, we now have two new cases...and have been told there is a strong probability that more will come. The two new cases are people who were protected (obviously not adequately) by gear designed to prevent infection from spreading, and they were trained medical people working at a hospital with quarantine facilities for this type of thing.

Yet people are still saying there is no chance of an epidemic occurring here?

I am not panicking...and I am certainly not saying there WILL BE an epidemic here.

But the people who are so certain there is little or no chance of a severe consequence of this Ebola scare really seem to be living in Wonderland.

Let us all hope that nothing serious comes of this...but let's not kid ourselves either. And it is worth noting that it would not take a lot more to begin a panic that could be as damaging as an actual outbreak of the virus.

There 'ya go, making sense again.

Presbyterian workers wore no protective gear for two days while treating Ebola patient
Health care workers treating Thomas Eric Duncan in a hospital isolation unit didn’t wear protective hazardous-material suits for two days until tests confirmed the Liberian man had Ebola — a delay that potentially exposed perhaps dozens of hospital workers to the virus, according to medical records.

The 3-day window of Sept. 28-30 is now being targeted by investigators for the Centers for Disease Control and Prevention as the key time during which health care workers may have been exposed to the deadly virus by Duncan, who died Oct. 8 from the disease.

Duncan was suspected of having Ebola when he was admitted to a hospital isolation unit Sept. 28, and he developed projectile vomiting and explosive diarrhea later that day, according to medical records his family turned over to The Associated Press.

But workers at Texas Health Presbyterian Hospital Dallas did not abandon their gowns and scrubs for hazmat suits until tests came back positive for Ebola about 2 p.m. on Sept. 30, according to details of the records released by AP.

The misstep – one in a series of potentially deadly mishandling of Duncan — raises the likelihood that other health care workers could have been infected. More than 70 workers were exposed to him before he died, but hospital officials have not indicated how many treated him in the initial few days.

<snip>
http://thescoopblog.dallasnews.com/2014/10/presbyterian-workers-wore-no-protective-gear-for-two-days-while-treating-ebola-patient.html/

Yes, Frank.

The medical experts are saying that there WILL NOT be an epidemic here. There is no reason not to believe them. They have been right in the past. They understand the disease very well.

Going against medical science as understood by the people who have the expertise and resources to understand the disease is not rational.

The experts have all said there would be cases of Ebola here in the US. As predicted there have been.

To have an epidemic, you need to have people infecting people infecting people in an uncontrolled way. The only people who have been infected in the US are medical personnel treating very sick patients.

Clearly this is a tragedy, but this isn't an epidemic.

The medical science is saying that there is no significant chance of an epidemic of ebola in the US. The people buying into fairy tales are the ones rejecting the science.

Max, it is in the interests of the "medical experts" to be as calming as absolutely possible. They will say what they have to say in order not to create chaos.

But to suppose that what they are saying closes the book on this...is naive beyond comprehension.

Keep in mind, some of these "medical experts" were the one assuring us that the hospital and staff had been thoroughly vetted to safely handle the patient...yet two of the staff have become infected.



I agree completely...and for anyone to say that an epidemic is imminent is absurd.

But to suggest that there is virtually no chance of a great deal happening...is every bit as absurd.




THINK ABOUT WHAT YOU JUST WROTE!!!!



Yes it is a tragedy and no it is not an epidemic. But that is not what is being discussed. We are discussing the people who are suggesting that an epidemic is virtually impossible...a position I consider absurd.




We had one patient...at a supposedly secure medical facility...being treated by trained medical people who knew the dangers...

...and that one patent died and now we have two patients.

C'mon, Max.

Thank you, Ragman.

In the meantime, I hope (and suspect YOU hope) the experts Max is relying on...ARE CORRECT.

Frank, there's a lot more going on here than experts. There's a cultural thing going on here: we take our sick and dying to doctors, hospitals and embalmers/crematoriums. Africans by and large nurse their own and even care for them themselves in a lot of hospitals and bush clinics. They wash and bury their own dead, also.

There is a learning curve to understand how to deal with it here and but we do have years and years worth of experience with Ebola, Marburg/Hemoralgic Fever to understand how it works in Africa. It spreads only through direct contact.

Flu is a whole lot scarier than Ebola as a threat to the US. Check out the Spanish Flu pandemic around WWI. More US soldiers died of Flu than combat, a lot of them here before they got off to Europe.

Well, it's pretty obvious that you are comfortable with government officials telling you "Just trust us, we know what we're doing," and I am not.

Still no answer from you or anyone else as to why a ban on commercial traffic between the US and the affected West African nations will be counterproductive to the healthcare efforts intended to combat the disease.

If there is one, it shouldn't be that difficult to articulate, and therefore I feel it's safe to assume that isn't.

Yes, it might cause minor damage to the economies of these nations, and yes, I'm sure, it smacks of colonial disregard to hyper-sensitive liberals, and yes, it may even look like the CDC has backed down a bit and done something primarily designed to assuage fears in the US, but otherwise we've not be provided any medical reason why it should not be done.

I see that you are maintaining your love affair with the term "panic." Can you provide us with some actual evidence of widespread panic as a reaction of the American people to Ebola? Anything to suggest that the panic is worse than the disease?

Ruth Marcus has a column in the Washington Post today which reflects her belated realization that as a member of the DC elite, "government-can-do-no-wrong" crowd she is obligated to add her sage voice to the cacaphony of progressive scolds telling the stampeding American cattle to just knock it off and worry about something that is really dangerous, like the flu, or the Republican's War on Women.

Her description of the desperate actions called for by the panicked herd include calling for the air travel ban which she tells her readers "could be counterproductive." Of course she doesn't explain how the ban could be counterproductive, but that's par for the course. She's read the memo, and she knows what she should write. She also blithely dismisses increased airport screening as a pointless effort that will make us feel better but not much safer. I guess she also got the memo telling her that this was endorsed by the CDC just to soothe the panicked mob and that it's OK to mock it as well. Of course if the Dallas hospital staff had stepped up it's screening too, Mr. Duncan might have received the intensive treatment he required, two days earlier than he did. This might have made the difference between his recovering and dying, but c'mon he's just one guy.

The Dallas events re Ebola are actually weirdly reassuring, and are strong evidence ...
...that we will NOT have an outbreak in the US.

First, prayers and good vibes to the nurses who are infected, and all hope is extended to them for a full recovery.

But here's why I'm beginning to understand what's happening:

All Americans have heard or understood about this virus for the last 20-30 years is that it is super contagious, incurable and practically un-treatable, wipes out entire villages so fast that it doesn't usually spread beyond the bush (the old "it's so deadly it's not a threat to us" meme), but ... (dah, dah, DAHHHH) if it ever gets going here, it would be a nightmare pandemic. We all saw the movie, right?

Fortunately for us, it was always a problem in Africa. Meh. Lemme know when it gets here and has infected a Kardashian. Then I'll give a ****.

Now - it has shown up at a Dallas hospital. A DALLAS HOSPITAL!!! I think Dallas is in the US!! In fact, I'm pretty sure it is. Uh oh. We're all gonna die!!! Death by hemorrhagic fever. What a way to go!!! Worst day ever! Did you see that freakin' movie?!!!

But then, the CDC and other "experts" - even the ones here at DU (the most trusted source of civilization ending events) - start telling us to chill. Don't panic. Its not that contagious, and we're not likely to have an outbreak in the US. WTF???? How does that jive with what we think we know about this bug? I mean, ****, we ALL saw the damn movie, right?!!!

So - the natural conclusion is to assume the government and health care experts are lying to us. We ARE all gonna die a horrible, bleeding from the eyes death, but they don't want a panic on their hands until they have the quarantine camps and the coffins and the corpse disposal ovens and all that **** ready for the carnage. Donald Southerland is in charge of it all! Damn. I wish I HADN'T seen that scary-ass movie!!!!!

But what's the evidence telling us?

So far - NONE of Duncan's pre-hospitalization contacts have been diagnosed. Not even the fiancee and other occupants of the apartment who had CLOSE contact. I know we're not past the possible incubation period - but we're well past the likely incubation period, and every hour that passes looks good for those people.

But then, two health care professionals are diagnosed. All within a week of Duncan's death. HOLY ****!!!!! Get me some plastic, duct tape, canned goods and ammo (in case someone tries to take my plastic, duct tape and canned goods), I'm running for the hills!!!!!!

But here's the thing. The apparent inconsistency of the pre-hospital contacts seeming to be clear, and the nurses contracting the disease, tells us a lot. This disease, like most viruses, has varying potential for transmission - depending upon when you have contact with someone who is infected. Well, duh. I should have thought of that before, but I was too busy putting out my hair.

In the early stages, the virus is hard to transmit. It is fragile outside the body, and you have to come into direct contact with the bodily fluids to contract it. In other words, you've got to go swimming in vomit and feces to get it. Thus - none of Duncan's pre-hospitalization contacts seem to have it. And remember, Duncan was sent home after he started having symptoms - and still it's not looking like his contacts at the apartment have been infected. The virus was certainly there, but not in high concentrations.

But in the later, final stages of the disease, apparently the infected patient's body is quite literally crawling with the Ebola virus. It is still fragile outside the body - but the sheer numbers, as well as the increased presence of contaminated bodily fluids, make transmission significantly more likely. Thus, we have nurses that are caring for Duncan become infected - because they were there to the bitter end with a patient who was spewing high concentrations of Ebola via explosive diarrhea and projectile vomiting.

Now - don't get me wrong. There were lots of problems with our state of preparedness - from the top down - and it should not have gone down like it has. We HAVE to get better at handling this. But it does seem to explain why the nurses were infected when the fiancee was not. It was the stage of the disease at the time of exposure.

In Africa, the sick are more likely than not cared for by friends and family until death, or at least until close to the end stage of the disease. Then the bodies are handled by friends and family through the burial process. Thus, we have untrained and unprotected exposures at the most contagious stage of infection. Those people are, figuratively at least, swimming in Ebola. Its no wonder there is an outbreak in West Africa that will get much worse before it gets better. And every country on the planet needs be pitching in there to turn it back. THAT would do more to protect all of us than all the plastic and duct tape at the all the Walmart stores in the world.

In the US, by contrast, most (most) of those who get sick end up at a hospital much sooner. They are likely to be isolated and undergoing treatment before the final stages of the disease are reached. Transmission from casual contact prior to hospitalization (like on an airplane, or from a doorknob) or even in the early stages of hospitalization (like in a waiting room or at a Doc-in-the-Box) is just not very likely. Possible, I suppose, but not likely. I don't think we have a single well documented case of such casual transmission. Not that I have seen, anyway.

Does it mean there can't be an outbreak in the US? No. We can all imagine nightmare scenarios (personally, mine is that when Duncan's vomit was power washed from the sidewalk into the sewer, it infected a couple of rats, and now there are millions of rats teeming with Ebola about to come streaming into the streets of Dallas any minute now - wouldn't THAT make a great movie??).

But I now think I understand why the experts say it's not likely to result in an outbreak in the US. It's not - and that's based on how it has played out in Dallas despite the mistakes and incompetence. The biggest risk in the US is to healthcare professionals, and they need to get up to speed quickly. And people need to get themselves in for treatment (that's a whole other topic, I know, I know).

Hopefully it stops at these two nurses. But it seems safe to say that the "Duncan as pt. zero" scenario is, for now, most likely contained in the healthcare arena. For the general public, that's weirdly reassuring.

My $0.02. Now, I'm going to go put on my flame resistant suit.