First american ebola case diagnosed

[Smoker]

I work very close the the city of Dallas, and my work office is only about a twenty minute drive from the hospital Thomas Eric Duncan is being quarantined at. Most of the people in Dallas are not very worried about the outbreak of this virus. It can be easily contained as long as nobody comes in close contact with any of the body fluids of somebody else. As long as people can understand how this disease spreads, without attributing it to some kind of plague from the End of Days, then there is nothing to worry about.

 

[barbos]

So another american got infected, this time NBC reporter.
Maybe this thing is more serious (even for first world countries) than people think?

Two infections, zero deaths? That's a pretty low bar for 'serious'.

Point being, it may not be so hard to get infected. So washing your hands is not enough.
AIDS was too just two infections at some time.
And it is 4 infections - two doctors, guy in texas and this reporter.
And the only reason these two doctors did not die is experimental vacine which is in very short supply.

 

[bilby]

Two infections, zero deaths? That's a pretty low bar for 'serious'.

Point being, it may not be so hard to get infected. So washing your hands is not enough.
AIDS was too just two infections at some time.
And it is 4 infections - two doctors, guy in texas and this reporter.
And the only reason these two doctors did not die is experimental vacine which is in very short supply.

OK, four infections, zero deaths.

And washing hands is not enough for Ebola. But as that is not all that is being done, no big deal.

 

[Toni]

Why shouldn't we allow them in. Our system can cope with Ebola, it's not going to spread here like it does there.

The only acceptable policy issued by the CDC would be to quarantine passengers arriving from the affected nations for a period up to 3 weeks. However as you correctly stated, Ebola is certainly not a threat to the US population as it is in those affected nations.

And again, based on what I developed on regarding a far more infectious disease such as active TB, there is no CDC instructed measure to either quarantine or prevent individuals arriving from nations with a persistently high ratio of documented TB cases to enter the US. Again, identified and diagnosed as TB patients in the US remain isolated cases despite of the highly contagious/infectious aspect of active TB.

I am less sanguine about the threat to the U.S. population. We do not all have universal access to health care at all, much less good health care. As with TB, some people will be more vulnerable and have less good outcomes (and thereby increasing the risk of spreading the disease and of their own death) based upon wealth, access to health care, general health status, etc.

If we believe that we are safe from exposure, we're going to have people not asking the right questions, ignoring early warning signs, etc. We're also going to have people not telling the truth --deliberately or out of ignorance--about possible exposure.

I don't think we should panic at all but it is hubris to believe that there won't be more cases in the U.S.

 

[bilby]

The only acceptable policy issued by the CDC would be to quarantine passengers arriving from the affected nations for a period up to 3 weeks. However as you correctly stated, Ebola is certainly not a threat to the US population as it is in those affected nations.

And again, based on what I developed on regarding a far more infectious disease such as active TB, there is no CDC instructed measure to either quarantine or prevent individuals arriving from nations with a persistently high ratio of documented TB cases to enter the US. Again, identified and diagnosed as TB patients in the US remain isolated cases despite of the highly contagious/infectious aspect of active TB.

I am less sanguine about the threat to the U.S. population. We do not all have universal access to health care at all, much less good health care. As with TB, some people will be more vulnerable and have less good outcomes (and thereby increasing the risk of spreading the disease and of their own death) based upon wealth, access to health care, general health status, etc.

If we believe that we are safe from exposure, we're going to have people not asking the right questions, ignoring early warning signs, etc. We're also going to have people not telling the truth --deliberately or out of ignorance--about possible exposure.

I don't think we should panic at all but it is hubris to believe that there won't be more cases in the U.S.

Give me a call when Ebola has killed as many people in the US as influenza this year.

It's a non-issue. But it sells newspapers.

 

[barbos]

Influenza kills old and weak people mostly. I prefer to die old from Influenza than young from ebola.

 

[barbos]

Point being, it may not be so hard to get infected. So washing your hands is not enough.
AIDS was too just two infections at some time.
And it is 4 infections - two doctors, guy in texas and this reporter.
And the only reason these two doctors did not die is experimental vacine which is in very short supply.

OK, four infections, zero deaths.

And washing hands is not enough for Ebola. But as that is not all that is being done, no big deal.

Zero deaths and probably couple of millions of dollars on treatment.

 

[Jimmy Higgins]

So another american got infected, this time NBC reporter.
Maybe this thing is more serious (even for first world countries) than people think?

This outbreak has been the deadliest of any other ebola outbreak in the short known recorded history of the disease by a full magnitude. It managed to get into the cities instead of just sticking around in a remote village. So yes, this is a big deal Ebola outbreak wise. Which is why the local hospitals were overwhelmed.

Of course, we are well short of the Influenza pandemic which killed over 50 million people across the globe.

 

[Toni]

I am less sanguine about the threat to the U.S. population. We do not all have universal access to health care at all, much less good health care. As with TB, some people will be more vulnerable and have less good outcomes (and thereby increasing the risk of spreading the disease and of their own death) based upon wealth, access to health care, general health status, etc.

If we believe that we are safe from exposure, we're going to have people not asking the right questions, ignoring early warning signs, etc. We're also going to have people not telling the truth --deliberately or out of ignorance--about possible exposure.

I don't think we should panic at all but it is hubris to believe that there won't be more cases in the U.S.

Give me a call when Ebola has killed as many people in the US as influenza this year.

It's a non-issue. But it sells newspapers.

It's not a non-issue. I work in the health care industry and I assure you: if we do not accept that there is risk, it will become a huge issue.

Unlike influenza, there are no vaccines for Ebola.


Not much in the news in my regional newspapers about Ebola.

 

[Derec]

So the Hajj is on. 2 million or so Muslims are mingling around in Mecca as we speak. The countries suffering from the Ebola epidemic right now have significant Muslim populations and Sierra Leone has a large majority of Muslims. If somebody infected with Ebola travels there and gets sick during the Hajj (shedding the virus) it could become very, very bad because it could spread far and wide from a single event.

 

[Sabine Grant]

The only acceptable policy issued by the CDC would be to quarantine passengers arriving from the affected nations for a period up to 3 weeks. However as you correctly stated, Ebola is certainly not a threat to the US population as it is in those affected nations.

And again, based on what I developed on regarding a far more infectious disease such as active TB, there is no CDC instructed measure to either quarantine or prevent individuals arriving from nations with a persistently high ratio of documented TB cases to enter the US. Again, identified and diagnosed as TB patients in the US remain isolated cases despite of the highly contagious/infectious aspect of active TB.

I am less sanguine about the threat to the U.S. population. We do not all have universal access to health care at all, much less good health care. As with TB, some people will be more vulnerable and have less good outcomes (and thereby increasing the risk of spreading the disease and of their own death) based upon wealth, access to health care, general health status, etc.

If we believe that we are safe from exposure, we're going to have people not asking the right questions, ignoring early warning signs, etc. We're also going to have people not telling the truth --deliberately or out of ignorance--about possible exposure.

I don't think we should panic at all but it is hubris to believe that there won't be more cases in the U.S.

To clarify, my point was not that "we are safe from exposure" and the American population as a whole needs not be informed about precautionary measures, rather the undeniable fact that the CDC has demonstrated full effectiveness in containing a far more infectious disease such as active TB.

As to access to health care, an individual developing symptoms such as fever, diarrhea, vomiting, fatigue and bleeding would never be refused medical care in an ER. Further, the usual protocol when ER personnel identify a contagious illness under a CDC watch, they will not just discharge the diagnosed individual.

A couple of points which need to be brought up in terms of a much lower risk of an epidemic in the US :

1) Subject one has been identified and now fully removed from any contact with the public.

2) The CDC sent a task force to Dallas in order to track and monitor individuals who have come in contact with subject one. Out of that group of individuals susceptible to have been exposed, they will operate a triage of who runs a higher risk of actual exposure versus who does not. Measures of quarantine will depend on which individuals are most susceptible to have met the conditions of higher risk of exposure. Such measure has already been applied to subject one's close relatives (girl friend, son and nephew) who shared the same living quarters with subject 1 in Dallas.

Those CDC measures intend to contain risks of exposure and infection at a very local geographical level.

3) Since the "reservoir" of Ebola is not native of the Northern American continent, it is an advantage towards a very low risk of nationwide Ebola cases. If any surging of other Ebola cases, it would be caused by isolated importation from foreign nationals or individuals who visited the currently affected Western African nations ( Aside but Nigeria was able to contain and control effectively the emergence of 2 cases). Liberia, Sierra Leone and Guinea remaining the hot spots.

4) Considering that at this point, all medical personnel in the US should be aware due to the failure of the hospital in Dallas to flag subject 1 in view of his country of origin, Liberia, as he reported to their ER. Such failure has now made the national news. Aside from hospitals and private practices and clinics personnel being instructed via official guidelines to assess risks of Ebola carriers based on symptoms and their country of origin or having visited "hot spots", those nationally spread news are bound to reach every health care worker and professional susceptible to be examining patients.

5) What the general population ought to do : while in public spaces, to remember to maintain the same infection prevention they would maintain for any other contagion prevention. Generally, while in public spaces, most people are not going to be handling the bodily fluids and secretions of strangers. The risk of contamination for Ebola being at its highest when handling such bodily material or coming in contact with soiled/contaminated material. Basically, an infection risk based on public spaces is very low. Only certain locations may present a high risk such as gyms/fitness centers, etc...it would not surprise me if when it comes to specifically Ebola, sanitation measures will switch to the use of a bleach/chlorine solution to disinfect equipment. The towelettes we use at the YMCA to wipe a piece of equipment prior to using it (gym users are also supposed to wipe the equipment after use) are similar to Lysol based products. Effective sanitation would have to be based on chlorine based products.

6) Related to the above, let's review which factors heavily contributed to facilitating vectors of contamination in Guinea, Sierra Leone and Liberia :

a) Local culturally induced practices and rites.(public funerals come to mind)

b) Relatives caring for infected loved ones in their homes while not using any protective equipment. While not applying sanitation measures in the said homes.

c) Reduced health care force, Liberia being notorious for an extremely low ratio of doctors.

Is it reasonable to assume from the above that similar factors in the US are present which would facilitate the known vectors for infection?

 

[Toni]

Of course symptomatic patients would be treated at any ER. However, not everyone has easy access to an ER. Perhaps more importantly, by the time most people would go to an ER, they've been symptomatic and contagious for some period of time. There are plenty of people who avoid doctors in general and won't seek help until they are quite ill.

Again, I don't see any reason to panic but I think we are fools if we don't recognize that some people don't disclose, either through ignorance or fear and as we've seen, even medical personnel don't always ask the right questions.

 

[Rhea]

So the Hajj is on. 2 million or so Muslims are mingling around in Mecca as we speak. The countries suffering from the Ebola epidemic right now have significant Muslim populations and Sierra Leone has a large majority of Muslims. If somebody infected with Ebola travels there and gets sick during the Hajj (shedding the virus) it could become very, very bad because it could spread far and wide from a single event.

Holy shit - that could be a serious vector! They stand very crowded areas and I can't imagine the bathrooms are anything other than super crowded. I wonder whether there is any activity around detection and isolation of people from those countries? That would be pretty horrible.

edited to add:
http://www.pbs.org/newshour/rundown...ilgrims-ebola-stricken-countries-banned-hajj/

looks like they have thought about it and banned people from those countries. But people are notorious for trying to get around bans, and one of the rituals is drinking from a communal well.

So, this seems to me to be something to warrant intense concern. Remember how worried officials were about the disease arriving in Lagos because of its population.

 

[Derec]

Holy shit - that could be a serious vector! They stand very crowded areas and I can't imagine the bathrooms are anything other than super crowded. I wonder whether there is any activity around detection and isolation of people from those countries? That would be pretty horrible.

Apparently Saudis have banned travel from those countries but it only takes one to slip though the cracks.

 

[Rhea]

Holy shit - that could be a serious vector! They stand very crowded areas and I can't imagine the bathrooms are anything other than super crowded. I wonder whether there is any activity around detection and isolation of people from those countries? That would be pretty horrible.

Apparently Saudis have banned travel from those countries but it only takes one to slip though the cracks.

Yup. And people have always been willing to try to get around bans. "It doesn't apply to _me_!" The guy in Texas, for example, failed to disclose his contact with ebola patients, doing exactly this.

 

[Jimmy Higgins]

Apparently Saudis have banned travel from those countries but it only takes one to slip though the cracks.

Yup. And people have always been willing to try to get around bans. "It doesn't apply to _me_!" The guy in Texas, for example, failed to disclose his contact with ebola patients, doing exactly this.

I thought the guy in Texas helped carry a pregnant woman who was sick and they thought the illness was related to the pregnancy. And that there was no evidence that he knew she had Ebola.

 

[doubtingt]

looks like they have thought about it and banned people from those countries. But people are notorious for trying to get around bans, and one of the rituals is drinking from a communal well.

Add this to the infinite ways in which religion is harmful.

 

[Rhea]

Yup. And people have always been willing to try to get around bans. "It doesn't apply to _me_!" The guy in Texas, for example, failed to disclose his contact with ebola patients, doing exactly this.

I thought the guy in Texas helped carry a pregnant woman who was sick and they thought the illness was related to the pregnancy. And that there was no evidence that he knew she had Ebola.

I hadn't heard that. I may be wrong, then. The charges from the Liberian Gov't were the last I read.
On the other hand - carrying sick person in Liberia - should be mentioned?

 

[Sabine Grant]

I thought the guy in Texas helped carry a pregnant woman who was sick and they thought the illness was related to the pregnancy. And that there was no evidence that he knew she had Ebola.

I hadn't heard that. I may be wrong, then. The charges from the Liberian Gov't were the last I read.
On the other hand - carrying sick person in Liberia - should be mentioned?

Yes, it should. We are speaking here of direct physical contact with an individual. When you carry someone's body to assist them in any way, physical contact is unavoidable to include with their clothing which may or may not already be contaminated.

 

[Sabine Grant]

Of course symptomatic patients would be treated at any ER. However, not everyone has easy access to an ER. Perhaps more importantly, by the time most people would go to an ER, they've been symptomatic and contagious for some period of time. There are plenty of people who avoid doctors in general and won't seek help until they are quite ill.

Certainly, however for "plenty of people" who would be infected to occur, one would have to demonstrate that there is a serious potential for the SAME vectors of contamination (which I have listed) to be present in the US, vectors facilitating contamination.

Again, I don't see any reason to panic but I think we are fools if we don't recognize that some people don't disclose, either through ignorance or fear and as we've seen, even medical personnel don't always ask the right questions.

From one isolated instance in a specific location in a hospital in Texas of a health care worker not pressing the urgency of paying attention to the country of origin of this subject 1, are you under the impression that it implies that there will be further recurrences of a similar incident across the nation?
Personally, being aware of the hierarchical chain from the CDC top to each State Health dept. down to County HD and then each medical facility regarding upgraded precautions and detection measures for any contagious disease which usually prompt questionnaires in writing rather than just verbal communications in between patient and health care worker/professional, I am not as concerned as you are about medical personnel not asking questions.