Ebola and media coverage

[Cassandra LeMay]

Is it immature that, given the context, my first thought was to make a viral 'load' joke?

I am not sure, but I think any laughter you may get out of that joke would not be very contagious.

[Drake Valentine]

I am not sure, but I think any laughter you may get out of that joke would not be very contagious.

Lols.

[Cycle]

Presidential candidate Chris Christie thinks people who come back from countries with Ebola should be locked up in a tent with no heating and no showers and a port-a-potty for three weeks.

Way to panic, governor.

[TaintedAndDelish]

Call it insensitive, but I would rather see a few folks inconvenienced, lonely and discouraged, than to see people get sick and die.

I haven't heard anyone talking about the possibility of legal action in the event that neglecting to properly isolate a person causes another to die from exposure to the virus. I have to wonder who could be held responsible in such a situation ( both the positive patient and medical staff? ) and what might the legal consequences be? ( ie. fine, prison time, civil suits, death penalty (lol), etc.. )

[Beguile's Mistress]

I was thinking about that when I heard they let the nurse in New Jersey return to Maine.  I don't know that I would want her to move back in if she lived next to me.  At least, I wouldn't want to see her there for the minimum three weeks of the incubation period.  If there is even a slim chance you could be infected but not show it you could be a walking time bomb.

[Cycle]

Did I neglect to mention that she tested negative for Ebola?

Yep.  She tested negative.

Oh, so did the gentleman up in Connecticut. 

Course, he really shouldn't complain since they let him stay where there is heat and a toilet.  The armed police officer won't let him out, of course.  So everyone is safe.  Assuming you ignore the fact that he is allowed out at night into the common area to use the washing machines.

Yeah.  Let's hear it for well thought out responses by politicians pandering to the base!

[TaintedAndDelish]

Unless I am mistaken, "tested negative" is not necessarily the same as "not infected."

A few things that can go wrong here:

1. The patient decides to "live it up" just in case he or she is infected. While out and about, they become symptomatic and infect someone on the way home.  For example, he or she passes out after binge drinking and wakes up the next day sick as a dog. They might then throw up or piss themselves as some folks do.

2. The patient is feeling sick but is in denial about it. As a result, they end up reporting themselves later than they should or making excuses for why their temperature is high.

3. The patient becomes symptomatic while in a very inopportune place - like aboard an plane or ship or in a very crowded place where they cannot easily leave.

4. The person in question gets into some sort of an accident and is cut badly causing blood leakage or splattering.

While these folks are "medical professionals" and should know better, they are also humans, and are subject to making mistakes and having bouts of poor judgement. ( Like the nurse from Dallas who boarded a plane, our friend from NY who decided to live it up while feeling a little crappy, and the other person who decided that it would be a good idea to board a cruise ship. )

I'm not necessarily saying that premature isolation is the right thing, but undermining the risks and consequences is not the way to go. When the stakes are "death", even low risk becomes intolerable. If the stakes were just a runny nose and a case of the shits, then a much higher level of risk would be tolerable.

[Cycle]

*shrugs*  I don't think our fear of the unknown should allow a governor to deprive the people who tried to help stamp out this disease of a shower, a real toilet and heat.  Here.  Christie for President 2016 posters:

I also think we should bear in mind that the total number of people infected by Thomas Eric Duncan outside the hospital is zero.  From all indications, the total number of people infected from the plane flight, the cruise, and that trip to the bowling alley is also zero.

As for the tests, well, it may not show that they won't possibly, ever develop Ebola later, but it does show they don't have it now.  So that should be considered when we decide how much we want to deprive these individuals.  Otherwise, why are we bothering to test them at all?  Just assume they're all infected for 21 days! 

Oh wait.  That's precisely what that governor was doing...

[Beguile's Mistress]

They get tested because they are coming from an area where they may have been exposed and may already have an active virus in their system.  There is a 21-day incubation period for a reason.  Some cases have presented with symptoms within the 21-day period from exposure, therefore, a person who is not symptomatic now could develop the virus sometime during that 3-week period.  Also, even though quarantine standards may be primitive at the moment, do we really say to the public we aren't going to quarantine anyone until we have upgraded our quarantine facilities?  Maybe we could find a building that has heat and lavatories.  Or we could empty a hospital and use that for quarantine putting other sick patients at risk while we spend hundreds of thousands of dollars to move and re-house them.

There is not good answer to the problem but when the need for quarantine is brushed off because someone may be inconvenienced the chances of that one sick person getting out and communicating the disease to others is much much greater.  Ebola is a deadly disease.  Most of the people contracting it die.  Pregnant women have a 100% chance of dying.  A few people who have been diagnosed early and have had intensive treatment have recovered.  I'd like to see people caring more about keeping the numbers down than worrying about their own comfort. 

I have nothing but praise and appreciation for the people who have volunteered to work in the highly infected areas and don't look for parades when they come home but when they do come back to some of the most highly and densely populated areas in our country we need to be cautious.  People who are concerned about the living standards of the quarantined people should do something about that and help those patients.

[TaintedAndDelish]

One thing that I think would complicate this is the number of infections. With only one or two people infected, its easy enough to give them their own little tent. If the number of infections grows to the point where individual private tents are no longer feasible and the risk of spreading the disease from one patient to another is a bit higher, then putting a negative person into a quarantine facility with lots of positive people could be a very bad thing.

[Florence]

Call it insensitive, but I would rather see a few folks inconvenienced, lonely and discouraged, than to see people get sick and die.

I haven't heard anyone talking about the possibility of legal action in the event that neglecting to properly isolate a person causes another to die from exposure to the virus. I have to wonder who could be held responsible in such a situation ( both the positive patient and medical staff? ) and what might the legal consequences be? ( ie. fine, prison time, civil suits, death penalty (lol), etc.. )

I'm on the fence about the idea of quarantine in general. I mean, I'm not a health expert, I don't know what the best way to handle an outbreak like this is.

However, it seems unacceptable to me to simply throw them in a tent with horrendous living conditions and basically being like "Good luck, hope you don't die."

I mean, that's a hell of a way to thank someone for heroically putting their lives on the line to save others.

I get that life isn't always fair, but shouldn't we at least TRY to treat these people with some respect and dignity?

[Cassandra LeMay]

While these folks are "medical professionals" and should know better, they are also humans, and are subject to making mistakes and having bouts of poor judgement. ( Like the nurse from Dallas who boarded a plane, our friend from NY who decided to live it up while feeling a little crappy, and the other person who decided that it would be a good idea to board a cruise ship. )

I see no reason to use quotation marks around 'medical professional' in this case, because they are professionals - just not all trained to the same level, for the same situations. Comparing the nurse from Dallas with someone who worked in West Africa with Doctors Without Borders (MSF) strikes me as unfair, as the former may know very little about Ebola, while the latter probably knows a whole lot more about this disease.

And where did you find that "...who decided to live it up while feeling a little crappy..."? From everything I read the doctor in New York stayed at home from the moment he detected he had a fever, informed the relevant authorities, and kept himself away from other people till he was transported to hospital.

Everyone working with MSF has strict orders to check their temperature twice a day for three weeks after returning home from working with Ebola patients, and they are paid a salary during that 21 day self-monitoring phase so they do not have to go back to work, lowering the risk of them infecting anyone if they should actually come down with Ebola. That is far different from the situation of the nurse in Dallas.

And even if the first symptoms show, chances might be slim to none that someone actually infects someone during the first few hours (perhaps even the first few days). Ebola can only be spread by contact with bodily fluids, and that only gets really nasty when diarrhea and vomitting set in - which doesn't happen immediately. During the first few days of infection virus RNA levels are so low in humans that they are almost undetectable. Even if someone starts showing the first symptoms it may be a while before their ... "viral load" is high enough to infect anyone. Even sharing a home with someone may not be enough to spread the disease, according to the CDC:

Several investigations have also demonstrated that persons residing in confined, shared spaces (e.g., homes), but who had no direct physical contact with these cases did not develop EVD

... Most of the people contracting it die.  Pregnant women have a 100% chance of dying.  A few people who have been diagnosed early and have had intensive treatment have recovered.  I'd like to see people caring more about keeping the numbers down than worrying about their own comfort.

BM, may I ask where you found that 100% mortality rate for pregnant women? I haven't heard that before so I would like to read up on it.

Also, intensive treatment is not always necessary for recovery - or maybe it is and we just define "intensive treatment" differently. One of the aspects of Ebola that kills a lot of people is organ failure from massive fluid loss. Just keeping a patient hydrated and providing them with the nutrients they might lose through diarrhea and vomitting can bring the mortality rate down from somewhere between 70% and 90% to about 50%.  That is still a lot, and it may take constant attention on the part of doctors or nurses, but but for a trained healthcare provider it's not rocket science and it can help a lot.

* * * * *

Edit: I'll add in a bit more, concerning the point I made above about the risks of contagion: The European Centre for Disease Prevention an Control gives the following examples for "low-risk exposure" in their guidelines for contact management:

> Casual or physical contact with a feverish but ambulant and self-caring EVD case (e.g. sharing a seating area or public transportation, including airplane transport; receptionist tasks; etc.)
> Close, face-to-face or physical contact with a case who is not coughing or vomiting.
> Household, classroom or office contact.

For those cases the only recommendation they make is self-monitoring twice a day for fever and other symptoms, with self-isolation and immediate notification of health authorities only if potential symptoms are detected. That very much seems to be the consensus between European health bodies, the CDC, and MSF as adequate for those who have only had casual contact with a patient.

[Caehlim]

This is a little bit of a sidetrack, but I'm posting this here because it might be of interest to people involved in the discussion.

http://www.abc.net.au/news/2014-10-28/nz-researchers-develop-device-for-quick-ebola-detection/5849270

A really cool new invention that's coming out of New Zealand looks like it'll be able to identify ebola quickly out in the field.

[Cassandra LeMay]

This is a little bit of a sidetrack, but I'm posting this here because it might be of interest to people involved in the discussion.

http://www.abc.net.au/news/2014-10-28/nz-researchers-develop-device-for-quick-ebola-detection/5849270

A really cool new invention that's coming out of New Zealand looks like it'll be able to identify ebola quickly out in the field.

I'll believe it when it has been proven under field conditions. Also

"Pretty much we can have a test result in an hour and a half - that's from a blood sample," Dr Stanton said.

is not that spectacular an improvement in detection time when you consider that a modern lab can deal with it in 3 to 5 hours, part of which is taken up by just careful handling of the samples (which will be necessary with this new device also, as we are talking about blood samples here, i.e. a high infection risk). Of course it would be great if there was a simple one-step diagnostic process that didn't require a full-blown lab, but even if this gizmo works, to prevent new outbreaks of Ebola what is needed is a solid healthcare infrastructure and public awareness, together with a lot of soul-searching on part of the WHO. It may be a step in the right direction, but it's not enough by a long shot.

[Florence]

is not that spectacular an improvement in detection time when you consider that a modern lab can deal with it in 3 to 5 hours, part of which is taken up by just careful handling of the samples (which will be necessary with this new device also, as we are talking about blood samples here, i.e. a high infection risk). Of course it would be great if there was a simple one-step diagnostic process that didn't require a full-blown lab, but even if this gizmo works, to prevent new outbreaks of Ebola what is needed is a solid healthcare infrastructure and public awareness, together with a lot of soul-searching on part of the WHO. It may be a step in the right direction, but it's not enough by a long shot.

So a portable device can get results quicker than a full laboratory and you don't consider that impressive?

I get doubting it until its proven in the field, but if it IS proven to work, I fail to see how that's NOT impressive and helpful.

[Cycle]

They get tested because they are coming from an area where they may have been exposed and may already have an active virus in their system.

I don't believe this is correct.  Hickox was tested because she had a fever.  Boyko was tested because he had a fever and diarrhea.  That is, in both cases, the test was applied after the individual developed a symptom, to see if the symptoms they had was caused by Ebola or any one of a number of other reasons:  e.g., the flu, a bad burrito, being interrogated for two hours, etc.  They were not tested simply because they flew in from Guinea, Liberia, or Sierra Leone.

Also, even though quarantine standards may be primitive at the moment, do we really say to the public we aren't going to quarantine anyone until we have upgraded our quarantine facilities?

No, what we do is get better facilities in place before we launch a State-wide blanket program to start quarantining people.  Cart, horse, which one goes first again, governor?  It isn't like New Jersey doesn't have a single portable heating unit or a shower somewhere in the State.  And it wouldn't have been all that hard to get one of those in place beforehand.

People who are concerned about the living standards of the quarantined people should do something about that and help those patients.

People are.  By spreading the word that fear should not override science.  And by threatening to sue these governors into oblivion.  And at least in Hickox's case, Christie caved.  As he should.  Because what he did was wrong.

[Oniya]

No, what we do is get better facilities in place before we launch a State-wide blanket program to start quarantining people.  Cart, horse, which one goes first again, governor?  It isn't like New Jersey doesn't have a single portable heating unit or a shower somewhere in the State.  And it wouldn't have been all that hard to get one of those in place beforehand.

For $115 at Target - not even one of those swanky outdoorsman shops - you can get a portable heated shower.  Depending on your power source, portable space heaters can be just as cheap or cheaper, and we're getting into the season when those are also available in everything from Walmart to Home Depot.  (I'd probably go with the electric type, since a quarantine area might have problems venting fumes.)  The point being that both these items are easily accessible, and could possibly have even been requisitioned at the time that the quarantine was imposed.

[Cassandra LeMay]

So a portable device can get results quicker than a full laboratory and you don't consider that impressive?

I get doubting it until its proven in the field, but if it IS proven to work, I fail to see how that's NOT impressive and helpful.

I don't know how much this device will really speed up the process, provided it works. If the "hour and a half" figure is the time a blood sample needs to be in the device, how much time is needed befpr and after that when it is employed in the field? How does that compare to a full lab test? It's pretty much impossible to say, given what little information we have. That's part of why I am somewhat sceptical about this being such a big improvement, provided it works as advertised. Plus, if you have a decent healt infrastructure with well-eqiped laboratories at hand it makes little difference. Once someone comes down with what might be Ebola they should be isolated while the lab test is run. If it takes one hour or eight hours for the results to arrive makes only one difference: Someone has to stare at the wall of an isolation ward for a few more hours. Is that really that much of an important difference?

Another reason why I am somewhat sceptical about tests like this (even if they work as advertised) is what I would like to call the "blinded by science" factor. What if this gizmo works? Would donors in the West invest millions and more millions to provide these diagnostic kits to every country in Africa? If they did, how long would it take for ... "diagnosis fatigue" (for lack of a better words on my part) to set in? The early stages of Ebola share a lot of symptoms with many more common diseases (e.g. malaria). How long would it take for people to just ignore these tests because they would too often come up negative? And could a test kit like this not become a cop out for Western nations who will spend their aid money on what they see as a "magic bullet" in the fight against Ebola, instead of spending their money on what is really needed - and will do a lot more than just help against Ebola - i.e. a good health infrastructure and health education in African countries? A test in a lab may take longer - and cost more - but a well-equipped lab can do a lot more than just help diagnose Ebola. In so far I see a good solid lab as the better alternative to what strikes me as a "one trick wonder pony".

[Retribution]

No, what we do is get better facilities in place before we launch a State-wide blanket program to start quarantining people.  Cart, horse, which one goes first again, governor?  It isn't like New Jersey doesn't have a single portable heating unit or a shower somewhere in the State.  And it wouldn't have been all that hard to get one of those in place beforehand.

Great plan! Lets make sure it is spread while we are establishing these facilities. That way we really need the facilities to combat epidemic. Both governors Christie and Cumo took similar action. A liberal democrat and a conservative republican. Opposing sides of the political spectrum. So what I see here is -responsible- action. I know it might put those in quarantine out. Tough luck.

There is a lot that is not known about the disease and taking basic, proven, steps is reasonable. I have no idea why the left leaning find this so distasteful. Sure, it puts some inconvenience out there for those affected, but to use the same argument that is tossed out when it comes to gun control "is not saving lives worth a little inconvenience?"

[Oniya]

I'm not sure how requisitioning a heater and shower would cause an excessive delay in quarantining someone.  Depending on traffic, the person sent to get it could be back and have it set up before the plane landed.

[Retribution]

I'm not sure how requisitioning a heater and shower would cause an excessive delay in quarantining someone.  Depending on traffic, the person sent to get it could be back and have it set up before the plane landed.

No argument on that Oniya, it is just that is not what I am hearing in this whole angle of argument. What I am hearing is we need to construct extensive facilities........yada, yada.

[Cassandra LeMay]

Great plan! Lets make sure it is spread while we are establishing these facilities. That way we really need the facilities to combat epidemic. Both governors Christie and Cumo took similar action. A liberal democrat and a conservative republican. Opposing sides of the political spectrum. So what I see here is -responsible- action. I know it might put those in quarantine out. Tough luck.

The current Ebola outbreak has been going on for months. Doctors and nurses from western countries (including the U.S.) have been working in West Africa for months to help fight this disease. Both are facts and could have been known to the authorities in New York and New Jersey for a while. If they had wanted to they could have put adequate facilities in place weeks ago, taking all the time they needed. Instead they acted only when that case in New York happened. What's happening now is not responsible action. It's shooting from the hip, pure actionism that serves more to spread fear than contain any virus. That people from different sides of the political spectrum fall into the same trap does not make their actions more justified, logical, or based on scientific facts.

[Beguile's Mistress]

Dr. Spencer, the infected Ebola patient in New York lied about his activities when he supposedly self-quarantined himself and now all the places he visited are being "scrubbed" to forestall the possibility he could have spread the disease.

[Retribution]

*pinches his brow* okay last comment here because I cannot get my mind around the whole mindset. Sure I agree action -should- have been taken months and months ago. It utterly baffles me that none was taken as I have said here multiple times. But since action was not taken in a timely fashion therefore no action should be taken? To say I find this silly would be an understatement of massive proportions. I have found it silly for months and months because as Beguile's just pointed out some people including this fellow lie.

Now, I am probably more likely to get struck by lightening than catch ebola. I acknowledge that openly, but being a bit facetious I see no reason why we should be starting the zombie apocalypse just because some people might be inconvenienced.

[Zakharra]

  Those coming back from those affected nations, especially if working with infected people, should be quarantined for awhile to make sure they are not infected if said contact has been within 21 days. Then they can be released into the general population. They should NOT be allowed to walk around free and potentially infected.  Yes it inconveniences them a lot, but considering the disease in question, it would be irresponsible to not quarantine them to make absolutely sure they are not carriers. They should understand that after seeing the disease in action.

Better safe than sorry. Take no chances and be sure there are no infected coming back.