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Author Topic: Ebola and media coverage  (Read 2941 times)

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Online Cassandra LeMay

Re: Ebola and media coverage
« Reply #100 on: October 31, 2014, 11:40:23 AM »
Is this "not based on science" because politicians made this decision and not doctors? Do only the decisions and ideas of doctors count as being "based on science? "  The decision on whether or not to quarantine has more to do with risk management than anything else. Those politicians who made this call were not comfortable with the same level of risk that the CDC was comfortable with and took a step to curb that risk to a more desirable level. It could very well be that the folks are the CDC have much bigger balls when it comes to dealing with diseases. That does not mean that the rest of the world must accept the same level of risk.
I can not look into the heads of governors Christie and Cuomo, but I suspect they made their decision at least in part for political positioning and to alley public fears. If not, why would they ignore the advice of the CDC, who have all the known facts about Ebola on their hands? But by advocating a quarantine they are actually helping to create fear, because people can easily start to think that the CDC is lying to them. After all, that train of thought might run, if the CDC were telling the truth and no quarantine was necessary politicians wouldn't advocate a quarantine. But as the politicians want a quarantine we can not trust the CDC.

But mistrust in the health authorities will help create fear, because it makes people doubt the facts of the matter. Something that is known "mutates" into something unknown in the imagination and fears of people. And the less people trust solid, scientific facts, the easier misinformation spreads. As fear and misinformation spread, how many African children will be banned from their schools for no good reason at all? How long before people start giving everyone arriving from Africa a wide berth, no matter where on the continent they come from? How long before the first doctors and nurses arriving back home after risking life and limb to care for the sick and dying receive death threats from some idiot who believes they are part of a secret plot to wipe out America via biological warfare? All this and more could well be consequences of fear and misinformation. Is that really a desirable outcome for something that may be completely unnecessary?

The best way to fight an epidemic of fear and misinformation is to keep calm and stick with the facts. Calling for a quarantine after just one single case has come to light is not keeping calm.

Offline Cycle

Re: Ebola and media coverage
« Reply #101 on: October 31, 2014, 12:37:14 PM »
Is this "not based on science" because politicians made this decision and not doctors?

No, the fact a politician makes a decision does not mean it is not based on science--a decision made not based on science is a decision made not based on science.  The fact that a politician made it simply means the bad decision can hurt far more people than if it was just an ordinary citizen making the bad decision.

Now, let's look at the science.

There have been numerous comments both here and in the news media about the mayor's decisions to mandate a quarantine not being based on science. While the decision to quarantine is very aggressive, it makes logical sense.

See, this is where the logic falls apart.  First, let's consider why one thinks quarantine is a valid response to control certain infections:  because medical science tells us this is the case right?  Quarantine were not invented by, say, a professional baseball player.  It was invented by medial science.  So, when someone advocates for a quarantine, they are following the advice of medical science.

So far so good.

Now, we also know you do not quarantine everyone for anything.  We know this is true because we don't quarantine people who have diabetes, for example.  Or gonorrhea.  Why?  Because medical science tells us that quarantines are not the right tool to address the transmission of such diseases.  So, when we decide not to advocate for the blanket quarantine of everyone with a stomach flu, we are following the advice of medical science once again.

Now let's turn to Ebola.  What does medical science say we should do about quarantining everyone who flies in from West Africa?  Hmm?  It says we don't need to do that.  It says we shouldn't do that.

And yet, we have people who because they are caught in the grip of fear--or are maneuvering for political advantage--advocating for the blanket quarantine of everyone who comes from West Africa.

Thus, we see that this particular application of the quarantine is no longer following the advice of medical science.  And this is why people like me say the reactions of certain politicians are not based on science.  Because it isn't.

« Last Edit: October 31, 2014, 01:21:58 PM by Cycle »

Offline TaintedAndDelishTopic starter

Re: Ebola and media coverage
« Reply #102 on: October 31, 2014, 02:18:44 PM »
I can not look into the heads of governors Christie and Cuomo, but I suspect they made their decision at least in part for political positioning and to alley public fears. If not, why would they ignore the advice of the CDC, who have all the known facts about Ebola on their hands?

I agree, there may be political positioning involved here. CNN reported that a poll that they did suggested that something like 80% of the people polled were in favor of quarantine. I don't have a link, but if assuming their poll is accurate, this would support the argument that the decision was politically motivated - at least in part.

Quote
But by advocating a quarantine they are actually helping to create fear, because people can easily start to think that the CDC is lying to them. After all, that train of thought might run, if the CDC were telling the truth and no quarantine was necessary politicians wouldn't advocate a quarantine. But as the politicians want a quarantine we can not trust the CDC.

OK, I see truth to both sides on this. Yes, the mandated quarantine undermined the CDC's authority, but at this point, I don't think the CDC's assurances that Ebola was not a significant threat were having the fear quelling effect that they had prior to the Dallas incident.


Quote
But mistrust in the health authorities will help create fear, because it makes people doubt the facts of the matter. Something that is known "mutates" into something unknown in the imagination and fears of people. And the less people trust solid, scientific facts, the easier misinformation spreads.

I don't think people are doubting scientific facts here. What is in being doubted is thoroughness of the CDC's recommendations. From the news about the allegedly insufficient protective garments that the folks in Dallas were recommended to use, it seems pretty clear that there is something lacking in their equation. Perhaps they are assuming the workers will follow their procedures flawlessly?


Quote
The best way to fight an epidemic of fear and misinformation is to keep calm and stick with the facts. Calling for a quarantine after just one single case has come to light is not keeping calm.

One single case?
I admit, my recollection of the exact time line is blurry, but I don't think is was in reaction to one single case.

Quote from: cycle
First, let's consider why one thinks quarantine is a valid response to control certain infections:  because medical science tells us this is the case right?  Quarantine were not invented by, say, a professional baseball player.  It was invented by medial science.  So, when someone advocates for a quarantine, they are following the advice of medical science.

No, it's an effective plan because it makes logical sense. You cut off the bad part before it infects the rest. It doesn't matter if this idea came from a doctor or some peasant who was trying to minimize the rot on his food.

Quote
Now, we also know you do not quarantine everyone for anything.  We know this is true because we don't quarantine people who have diabetes, for example.  Or gonorrhea.  Why?  Because medical science tells us that quarantines are not the right tool to address the transmission of such diseases.  So, when we decide not to advocate for the blanket quarantine of everyone with a stomach flu, we are following the advice of medical science once again.

Were talking about quarantining those few who are at risk of being infected with a contagious and deadly disease in order to minimize the risk. The fact that a person has been working directly with sick Ebola patients in an highly infected part of the world, puts them at some level of risk. The method for assessing that risk has been based on science. We learned from the CDC about the 21 day window and about what symptoms to look for.  What is in debate is what threshhold of risk is acceptable.

Quote
Now let's turn to Ebola.  What does medical science say we should do about quarantining everyone who flies in from West Africa?  Hmm?  It says we don't need to do that.  It says we shouldn't do that.

Quarantining people who have been caring for sick patients and quarantining everyone who flies in are two different things. I think you need a separate policy for each group since the factors that introduce risk are different. Fortunately for us, the folks in West Africa have reason to prevent sick people from leaving the country.

« Last Edit: October 31, 2014, 02:22:25 PM by TaintedAndDelish »

Offline Caehlim

Re: Ebola and media coverage
« Reply #103 on: October 31, 2014, 03:10:13 PM »
OK, I see truth to both sides on this. Yes, the mandated quarantine undermined the CDC's authority, but at this point, I don't think the CDC's assurances that Ebola was not a significant threat were having the fear quelling effect that they had prior to the Dallas incident.

More people have married Kim Kardashian in America than have died of Ebola. It's not a significant threat (the Ebola, I won't comment on the risks of marrying Kim Kardashian).

Quote
One single case?
I admit, my recollection of the exact time line is blurry, but I don't think is was in reaction to one single case.

This was in reaction to a single case. The Connecticut quarantine laws were signed on the 7th October. At this stage only Thomas Eric Duncan had been infected. Nina Pham was diagnosed on the 10th October, Amber Vinson on the 14th.

Quote
Quarantining people who have been caring for sick patients and quarantining everyone who flies in are two different things. I think you need a separate policy for each group since the factors that introduce risk are different. Fortunately for us, the folks in West Africa have reason to prevent sick people from leaving the country.

The only person so far who has infected others, Thomas Eric Duncan, was not identified originally because they either lied about coming into contact with a sick patient or were unaware of it (depending upon whose story you believe).

Offline Cycle

Re: Ebola and media coverage
« Reply #104 on: October 31, 2014, 03:56:32 PM »
No, it's an effective plan because it makes logical sense.

Wait, I thought we were discussing whether a decision was made based on science.  So we're done with that discussion?  It is agreed that this "just quarantine them all" plan--the effectiveness which I will address shortly--is not based on science?  Good.

Quote
You cut off the bad part before it infects the rest. It doesn't matter if this idea came from a doctor or some peasant who was trying to minimize the rot on his food.

There is a skipped step here.  Science tells us the "infects the rest" part requires contact with the bodily fluids of a symptomatic individual.  So if we want to do something to limit infection, let's also consider how infection takes place.

Take HIV.  It is very dangerous and can easily be lethal.  But do we quarantine everyone that has it?  No.  Because we know how it is transmitted, and we take steps to stop the transmission, based on the method of transmission:  e.g., do not have contact with bodily fluids of individuals with HIV. 

This is the step that those politicians are skipping:  consideration for how Ebola is transmitted. 

And this matters.  Look at Duncan's fiancee and all those passengers on the plane and cruise ship.  They didn't get infected?  Blind luck?  Or maybe they didn't come in contact with the bodily fluids of a symptomatic individual?


Offline Zakharra

Re: Ebola and media coverage
« Reply #105 on: October 31, 2014, 05:55:53 PM »

There is a skipped step here.  Science tells us the "infects the rest" part requires contact with the bodily fluids of a symptomatic individual.  So if we want to do something to limit infection, let's also consider how infection takes place.

Take HIV.  It is very dangerous and can easily be lethal.  But do we quarantine everyone that has it?  No.  Because we know how it is transmitted, and we take steps to stop the transmission, based on the method of transmission:  e.g., do not have contact with bodily fluids of individuals with HIV. 

This is the step that those politicians are skipping:  consideration for how Ebola is transmitted. 

And this matters.  Look at Duncan's fiancee and all those passengers on the plane and cruise ship.  They didn't get infected?  Blind luck?  Or maybe they didn't come in contact with the bodily fluids of a symptomatic individual?

 Do you think those people would have wanted to be around a possible carrier of Ebola if they had known who he was? I can bet the answer would be a very resounding 'No!' from almost all of them.

Offline Caehlim

Re: Ebola and media coverage
« Reply #106 on: October 31, 2014, 06:08:19 PM »
Do you think those people would have wanted to be around a possible carrier of Ebola if they had known who he was? I can bet the answer would be a very resounding 'No!' from almost all of them.

I don't see what that has to do with anything, people are terrible at assessing risks.

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Re: Ebola and media coverage
« Reply #107 on: October 31, 2014, 06:33:37 PM »
Of course, what we are seeing here are the opinions we hold about quarantine and adequate precautions regarding a deadly disease.  We've also seen to medical professionals, one fighting the disease and one fighting the government, who basically thumbed their noses at us.  After spending the day at my doctor's office and the hospital lab for some tests I got an earful from the people in the business who have a really low opinion of both the doctor and the nurse, the way the government is handling things and people who are brushing off the danger of an Ebola infection as something not worth mentioning.

Offline Cycle

Re: Ebola and media coverage
« Reply #108 on: October 31, 2014, 06:42:32 PM »
Do you think those people would have wanted to be around a possible carrier of Ebola if they had known who he was? I can bet the answer would be a very resounding 'No!' from almost all of them.

See, this is actually one of the reasons I am so critical of the politicians' behavior.

They feed the fear. 

A responsible leader should try to protect the welfare of the community, not use fear to advance their own personal status.  Quarantining someone simply because they worked in a region with Ebola is irrational.  But politicians do it because it sounds good.  And I am sad to see that it working for them.

If we apply reason to the situation, as well as medical science, we will see that what the governors are doing is irrational.  I've already tried the HIV example.  I've repeatedly pointed out how science says Ebola is transmitted--and pointed to situations that confirm medical science's analysis to be correct:  i.e., contact with bodily fluids is required, and casual contact by hundred of people on an airplane did not infect anyone with Ebola.  Now I will try this:  look up how the number of the Emory or Nebraska Medical Center treating doctors and nurses who have been quarantined.  Then look up the people who handle their medical waste disposal to see how many of them are sitting in a tent for 21 days.  Then look the number of techs who did blood tests for Ebola to see if any of them are under armed guard to stay in their apartment for three weeks.

Big fat goose egg, right?

See the problem?

We don't quarantine people who are in the U.S. treating individuals we know are infected with Ebola, but we do quarantine people who might have possibly shared common space with someone outside the U.S. who may have had Ebola, but we don't know for sure?

This is rational?  This is logical?  This is "good science"?  No.  No.  No.

But saying that you're instituting a quarantine plan to fight Ebola from entering the country sure gets people riled up and thinking you're a aggressive leader.

I hate to see folks fall for this kind of manipulation.  But there it is.  Sigh.


Offline TaintedAndDelishTopic starter

Re: Ebola and media coverage
« Reply #109 on: October 31, 2014, 11:29:31 PM »
Wait, I thought we were discussing whether a decision was made based on science.  So we're done with that discussion?  It is agreed that this "just quarantine them all" plan--the effectiveness which I will address shortly--is not based on science?  Good.

No, I was disagreeing with a portion of this statement which I had quoted. Quarantine makes sense not because of who invented it or who suggested it, but because it makes logical sense. From what I recall, the CDC's objection to closing the border or quarantining everyone who flew in from west Africa was that people would then circumvent this control measure which in turn would make it harder to track those who might be sick. Likewise, those who developed symptoms afterwards might be hesitant to get help and consequently admit that they circumvented the system.

As stated earlier, I don't think that medical professionals and the general public should be treated the same exact way. Those who are known to have had exposure with sick patients whether they are doctors or regular citizens are going to have a higher chance of having the disease than those who have had no contact at all. Likewise, those who had contact with sick individuals and were wearing protection and were medically trained will have a different probability of being infected than those who were in contact with sick people and had no protection and were not medically trained.

With regard to the requirements to transmit the disease, I agree that while a person is not symptomatic, they cannot transmit it. There is still the risk though, they they will become symptomatic while in public and then transmit the disease at that point. While this sort of worsening may not be possible during the course of one day, an uncontrollable circumstance could leave a potentially sick person out in public for more than one or two days. ( Based on the NY doctor's case, it looks as if this could happen within a few days, but I really don't know. )

Quote
Take HIV.  It is very dangerous and can easily be lethal.  But do we quarantine everyone that has it?  No.  Because we know how it is transmitted, and we take steps to stop the transmission, based on the method of transmission:  e.g., do not have contact with bodily fluids of individuals with HIV. 

There's a difference though in how Ebola and HIV are transmitted. HIV is not transmitted though urine, sweat, vomit, feces and tears It is primarily transmitted through blood, semen and vaginal fluids. It exists in saliva, but in a very weak concentration. ( I think you would need to drink something like a quart of saliva to be at risk of getting it. )  As I understand, medical professionals who work with HIV patients will wear plain latex gloves and maybe a cover over their mouth and nose. They do not need to don biohazard suits and get hosed down before taking them off. HIV can also go undetected for long periods of time and thus can be spread by seemingly well people. Unless I am mistaken, someone with Ebola will be done in a matter of days without treatment once the virus ramps up in their system.

While HIV has a higher basic reproduction number than Ebola (2-5 vs 1-2 ), I don't think you are as likely to get HIV from normal non-sexual contact with a patient as with someone who has Ebola -  given the types of fluids through which it spreads.

Some links that I thought were rather interesting:

http://www.businessinsider.com/what-makes-ebola-virus-so-deadly-2014-10
http://en.wikipedia.org/wiki/Basic_reproduction_number
http://www.everydayhealth.com/hiv-aids/protect-yourself-as-hiv-caregiver.aspx
http://www.webmd.com/news/20140806/ebola-virus-how-contagious?page=2

edit: spelling correction
« Last Edit: November 01, 2014, 02:49:17 AM by TaintedAndDelish »

Online Cassandra LeMay

Re: Ebola and media coverage
« Reply #110 on: November 01, 2014, 02:39:50 AM »
One single case?
I admit, my recollection of the exact time line is blurry, but I don't think is was in reaction to one single case.
I was referring to the quarantines in N.Y. and N.J. as they have garnered the most media attention lately and are the ones I am most aware of. Those - as far as I can tell - were a direct reaction to the case of Dr. Craig Spencer. They weren't put in place because of cases in some other states. They were only put in place when that one single case happened on their doorstep. One more reason for me to believe it was mostly politically motivated. If governors Christy and Cuomo were so concerned about Ebola, why not call for a quarantine earlier, when the first case in the US came to light? It had to happen to them before they sprang into action.

Edit, to address another point you raised:
OK, I see truth to both sides on this. Yes, the mandated quarantine undermined the CDC's authority, but at this point, I don't think the CDC's assurances that Ebola was not a significant threat were having the fear quelling effect that they had prior to the Dallas incident.
...

I don't think people are doubting scientific facts here. What is in being doubted is thoroughness of the CDC's recommendations. From the news about the allegedly insufficient protective garments that the folks in Dallas were recommended to use, it seems pretty clear that there is something lacking in their equation. Perhaps they are assuming the workers will follow their procedures flawlessly?
Handling the Dallas case could certainly have gone better, as far as communication by the CDC and local Health Services are concerned. For example, I bet hardly anyone is aware that the two nurses who became infected were caring for Mr. Duncan at the very last stages of his illness, when viral loads can be expected to be extremely high. No one who cared for him during the earlier stages caught Ebola from him. That is (in my opinion) a slightly different picture than what many people might believe happened, i.e. that everyone who cared for him was at risk at any moment. (Source: New England Journal of Medicine)

As for following procedures flawlessly, I can't imagine many people on the planet who would be more likely to follow protocol and procedures to the letter than the doctors and nurses who have treated the sick any dying in West Africa. They have seen first hand what can happen, what Ebola does. Perhaps the same can not be said for every single doctor or nurse in each and every hospital in the US, but the people who have been to West Africa should be trusted to have a very thorough knowledge of Ebola and what to do - or not do - if and when they detect the first signs that they may pose a risk to public health.
« Last Edit: November 01, 2014, 03:28:00 AM by Cassandra LeMay »

Offline Cycle

Re: Ebola and media coverage
« Reply #111 on: November 01, 2014, 10:01:30 AM »
HIV is not transmitted though urine, sweat, vomit, feces and tears It is primarily transmitted through blood, semen and vaginal fluids. It exists in saliva, but in a very weak concentration. ( I think you would need to drink something like a quart of saliva to be at risk of getting it. )  As I understand, medical professionals who work with HIV patients will wear plain latex gloves and maybe a cover over their mouth and nose. They do not need to don biohazard suits and get hosed down before taking them off. HIV can also go undetected for long periods of time and thus can be spread by seemingly well people. Unless I am mistaken, someone with Ebola will be done in a matter of days without treatment once the virus ramps up in their system.

Bingo.  See, this is an analysis how we respond to a disease based on its characteristics--specifically, how it is transmitted. 

And such an analysis should dictate how we respond to Ebola.  Now, given that medical science tells us Ebola cannot be transmitted until:

  (a) someone is symptomatic;
  (b) they expel bodily fluids; and
  (c) someone touches said bodily fluids

Following the same approach used with HIV means we should be considering the quarantine of people based on their level of infection, not solely because of who they treated or where they were or because they happen to have a fever.

Again, I point to how we are treating the medical staff in Emory.  And the Nebraska Medical Center.  They touched symptomatic Ebola patients' bodily fluids.  They were not all quarantined for 21 days thereafter.  And no one complained one wit. 

I also again point to the hundreds of people on the plane and the cruise ship who have not come down with Ebola even though they sat near or dined with someone who had or could have had Ebola.

Quarantine shouldn't be tossed around haphazardly.  It should be used when it will do some good, not just because a handful of people are panicking--or worse, pandering.  And when government does quarantine someone, than please, be smart enough to think of details like:  they need food, water, heat, sanitation and waste removal for the entire period of the quarantine!


Offline lilhobbit37

Re: Ebola and media coverage
« Reply #112 on: November 02, 2014, 09:31:23 AM »
Another thing to keep in mind when discussing what should be done about doctors and nurses who worked overseas:

Doctors without borders is aware of how dangerous this disease to the doctors and nurses who are working with patients dying of ebola.

So they assign someone who is a "Watcher" who makes sure they follow procedure to the letter to significantly reduce mistakes that may happen while treating a patient.

Things like making sure they remove all their gear in the correct order, make sure they do nothing out of protocol, etc.

This did not happen in the US in Texas, and perhaps had there been someone there to make sure everything went 100% to code, no one would have been infected.

But this greatly reduces the risk that a doctor overseas will get infected, as they have extra safety measures in place to ensure the safety of the brave men and women who are volunteering to go and help.

And as it has been pointed out, it is easier to catch the flu and the common cold, and more people in the US have died each year of that. Yet we don't quarantine these diseases.