Patterico's Pontifications

9/30/2014

First U.S. Case of Ebola in Dallas

Filed under: General — Patterico @ 8:53 pm

My inclination not to panic is counterbalanced by my inclination not to trust the U.S. Government when it tells me everything is OK.

You’ve already heard the reassurances from the government. But apparently the infected man was at an emergency room with symptoms and then left:

The man had some symptoms on Sept. 24. Early Friday morning, the patient went to the hospital emergency room on his own with nondescript, nonspecific symptoms. He was evaluated at the hospital and given antibiotics, then left, Goodman said. On Sunday, he was taken to the hospital by ambulance and admitted.

Goodman said they were looking into why he left Friday and were going to monitor those emergency room doctors closely. They are also looking into whether the man was asked if he had recently traveled to West Africa.

Who was in the emergency room with him? I’m guessing we have no idea. Who did he contact between the time he left the ER and the time he returned to the hospital? I’m guessing we have no idea.

Supposedly, it’s relatively difficult to transmit; it doesn’t fly through the air, but is typically transmitted through bodily fluids or direct contact. However, it’s not clear to me that touching a contaminated surface is not enough. And since a symptomatic guy was apparently walking around, the possibilities do seem scary.

My plan: don’t panic, but be skeptical of government statements.

76 Responses to “First U.S. Case of Ebola in Dallas”

  1. Ding.

    Patterico (9c670f)

  2. Yeah.

    nk (dbc370)

  3. Jus’ keep that boy away from the Cowboys, they on a roll!

    Colonel Haiku (2601c0)

  4. I’m personally more worried about the dreaded disease known as Obamaism. That’s where one’s common sense is rendered inoperative and the victim is prone to doing dumb things like favoring porous borders, pro-AGW crony capitalism and ambulance-chasing, politically-correct-crazed lawyers. It also paves the way for a corrupt IRS, DOJ and US military that loves gays and Nidal Hasan but not military chaplains who merely espouse Christian principles.

    Obamaism (which is a mutation of Clintonism or Goreism, or Bidenism, or Kerryism, etc) is a severe illness that can easily take on a life of its own and will ultimately render the victim — in this case, the US — into a shell of its former glory. Countries like Mexico, France, Venezuela and Greece have long been infected by variations of this major illness.

    Getting rid of Ebola is a cakewalk by comparison.

    Mark (c160ec)

  5. Don’t call it Ebola, call it workplace violence, like that totally random workplace beheading that had nothing to do with Islam last week. Then nobody will worry about it.

    daleyrocks (bf33e9)

  6. whether the man was asked if he had recently traveled to West Africa.

    He’s LIberian for crissakes ! This is the opening of the school year and 24,000 African students attend US colleges.

    Mike K (90dfdc)

  7. getting chicagoboyz 404 at link Mike K.

    elissa (57dbec)

  8. “You want to see the tape again?”
    Wow, Can you believe the president didn’t know what he was talking about and amazingly got something else wrong? again??? On Hardball, a cynical Chris Matthews discusses Ebola with Dr.Emanuel:

    CHRIS MATTHEWS: I’m just trying to follow the logic here. Everybody’s being told, don’t worry unless they have the infectious symptoms, you can see them, that you don’t have to worry about catching them. Yet, this guy picked up the disease apparently from somebody who did not have the infectious symptoms.

    DR. EZEKIEL EMANUEL: Again, don’t hypothesize because we just don’t know. We have no idea what he did or didn’t do and how he got it. I’m sure that’s going to be vital information to try to understand the transmission, but the idea that there’s going to be a widespread outbreak here, I think is just, again, it’s a bit of fear mongering. We have a single case. This is not a big, widespread —

    MATTHEWS: Yeah, yeah, but I’m just going back to the president’s statement, doctor, and that is that the president said it would be unlikely if we had a case in this country. Unlikely to even have one case. You want to see the tape again?

    EMANUEL: He said there wouldn’t be an Ebola outbreak.

    MATTHEWS: No, and in the second part of his sentence he said in the unlikely case someone brings it here. In the unlikely case someone brings it here. Well, they’ve done it. We’re living in the world of the unlikely already. That’s all I’m saying. I’m not fear mongering. I’m stating the facts and I wonder if everybody else is.

    http://www.realclearpolitics.com/video/2014/09/30/chris_matthews_vs_ezekiel_emanuel_on_ebola_obama_said_it_was_unlikely_it_has_happened_its_here.html

    elissa (57dbec)

  9. this is also weird

    really really really weird

    they shut the entire freeway down during rush hour

    w

    t

    f

    happyfeet (a785d5)

  10. as far as the ebola thing goes

    this is Dallas

    nobody who can afford a plane ticket uses public transportation in Dallas

    mostly we need to worry about Chicago NY Philly ebola I think

    Dallas ebola is just practice ebola

    happyfeet (a785d5)

  11. They keep telling us it is hard to get, then doctors who are wearing protective gear keep getting it. So maybe not that hard to get.

    Dr Dave (0c818d)

  12. “They keep telling us it is hard to get, then doctors who are wearing protective gear keep getting it. So maybe not that hard to get.”

    I am told, or read, that there is an order of magnitude difference between “protective gear” as it is understood and used in the Third World, and “protective gear” as it is understood and used in the United States. That in the Third World supplies are never adequate and so things like gloves are re-used, although that pretty much insures that some contagion will get through some of the time. Whether there is any truth to this is beyond my experience.

    I suspect that we are about to learn a harsh lesson about the core necessities of public sanitation, quarantine laws, and so forth. They have been severely eroded in recent decades because it isn’t PC to observe that immigrants from the Tropic of Filth don’t wash well enough often enough. The ’60’s hippie rejection of washing didn’t help; as Tom Wolfe observed in one of his books of essays doctors working in the big Hippie gathering areas saw the reappearance of diseases they had only read about in books.

    We have bed-bug out beaks in major U.S. cities. Some people are blaming this on immigrants, but I suspect it has more to do with the reflexive rejection of insecticides. I wonder how long the Lefty Intellectual demonization of DDT will survive a series of Malaria outbreaks. Also if the present fetishism over “wetlands” will survive a revival of mosquito borne disease.

    Fasten your seat belts, the ride get bumpy from here.

    C. S. P. Schofield (848299)

  13. So I suspect it won’t be hard to track down most of the people in the ER waiting room who might have been near the patient.
    Each patient would have left contact information when they signed in and they’ll likely know what family or friends came with them.

    I’m a bit concerned that they aren’t releasing specifics about what flight(s) the patient took from Liberia to Dallas, but it’s worth noting that both Nigeria and Senegal have managed to contain Ebola via aggressive contact tracing starting from a single infected individual.

    Bill (c091b7)

  14. we’re all gonna die…

    Jack Ryan isn’t in the White House, Alfred E Neuman is.

    redc1c4 (abd49e)

  15. Each patient would have left contact information when they signed in and they’ll likely know what family or friends came with them.

    Yeah, because an ER full of illegals ALWAYS

    hadoop (f7d5ba)

  16. This is all part of obama’s plan.

    Spread ebola through the US and the Military so Americans will take it seriously and find a cure. he doesn’t think appropriate attention is being paid to the problem when only poor black africans are suffering. It takes America to suffer for obama to be satisfied that things are right in this world. Otherwise it isn’t fair.

    Jim (145e10)

  17. D@mn!

    Doesn’t matter anyway. No sense in trying to convince others of things that are patently untrue.

    hadoop (f7d5ba)

  18. Yes, I agree that Dallas, a major city in a red state, is “practice” Ebola. this is an interesting way to turn Texas “blue”. Now for my next conspiracy.

    felipe (b5e0f4)

  19. My plan: don’t panic, but be skeptical of government statements.
    Be skeptical, those who are paying attention already know this, but too many aren’t.

    Mike K.’s link is working for me this morning.

    Yes, when was the last time you trusted the word of a government spokesman…I am not holding my breath.

    That said, if it is true that the infected person was without a fever and without symptoms while on the plane, from what we know with years of experience, people on the plane should not be in danger.

    And to reply to the idea that medical personnel using precautions still have gotten it, it has been said, including by people involved, that they did not get the disease from caring for people with Ebola while taking precautions, but from interacting with people with Ebola not identified in their “everyday” interactions.

    That said, I do think it is worrying that he was seen in an ER and then sent home. Not only does that mean there have been people exposed unknowingly, but unnecessarily, and that people who should be alert to the issue haven’t been.
    While a travel history is a routine thing in medicine, in reality it is not usually actively pursued unless a situation arises that doesn’t make sense with more common things.

    As I’ve said before, I expect the US to be able to contain Ebola to limited outbreaks, and that the death rate should not be as high in the US simply because of superior supportive care.

    But I was reading about Liberia yesterday. Normal life has been so disrupted that many are not able to work, which means not able to have money to buy food, even if food is available, and that they are “looking into the abyss” of societal anarchy.

    I think what is necessary is following Sierra Leone’s example (as I understand it), all of Monrovia and other affected areas probably need to “shelter in place” for a week, which requires local distribution of food and water for 1 million people, to have the best chance of getting a grip on the situation. I can only think that would require a major mobilization of resources akin to a WWII effort, or at least the effort of the Berlin airlift (I am too young to remember it, never looked into the details, anyone out there no more about this from experience?), with things like soda companies bottling water instead of their usual for transport.

    There is a significant Liberian population here in Philly, and I actually have an old friend who is a pastor there.

    MD in Philly (f9371b)

  20. I read the link at ChicagoBoyz, and I have seen that info before. A major issue of any study, especially in medicine, is asking how generalizable are the results and conclusions. Transmission by air in a lab between animals with aerosols that are generated in a controlled manner does not necessarily have any significance to what happens in nature with people.

    MD in Philly (f9371b)

  21. A brief internet search:

    After four to six days on average, symptoms of Ebola can begin. The period between the transmission of the virus and the start of symptoms is called the incubation period. For Ebola, the incubation period can be as short as 2 days or as long as 21 days.

    Even if a person exhibits no signs or symptoms of Ebola, he or she can still spread the virus during the incubation period. Once symptoms begin, the person can remain contagious for about three more weeks.

    The Ebola patient was sick for four (4) days walking around before he showed up at the hospital. You do the math….

    cedarhill (dd6b21)

  22. The assumption made by the CDC was that the victim was infected before he got on the airplane, at least as I heard it during the press conference. This was because passengers were routinely checked for fever before they they were allowed to board the plane. However, the timing is such that he could have been exposed on the airplane, despite the precautions, since trans oceanic flights are fairly long and symptoms could develop inflight.

    So hopefully they are contacting the passengers to verify that their assumption is correct.

    bobathome (5ccbd8)

  23. When I have a fever, I take three Advils and it usually drops to normal temperature in an hour. Taking somebody’s temperature screens for nothing. This Mau Mau stopped flights to Tel Aviv because of fear of Hamas rockets but allowed flights from Ebola countries. But that’s the history of this country. Tame the wilderness while importing the jungle.

    nk (dbc370)

  24. The progress notes from the ER visit should indicate which nurses cared for him and if any doctors or technicians came near him.

    Art Deco (ee8de5)

  25. And don’t forget the ambulance and emts and all the riders of the ambulance post-ebola patient’s transfer.

    elissa (68eca7)

  26. Behead Ebola NOW!

    Colonel Haiku (2601c0)

  27. #24, nk: And if you consider someone in Liberia who isn’t feeling well, but has a plane ticket the U. S., it would certainly be in their self interest to take some advil, or TheraFlu, if not to ensure that they get somewhere with some hope of proper care, then at least to keep their travel on schedule.

    It was encouraging that the Dallas health department was capable of identifying the virus in just four hours after they took a blood sample.

    I wonder what precautions the ERs are going to start taking at this point? It’s all very reassuring to think that all they have to do is ask a patient if they’ve been to Liberia or West Aftrica recently, but with just a few more cases here, that won’t be a very useful screen.

    bobathome (5ccbd8)

  28. Don’t stop thinkin’ about Ebola
    Don’t stop, it’ll soon be here
    It’ll be worser than pig flu
    yesterday’s news… yesterday’s news

    Colonel Haiku (2601c0)

  29. Even if a person exhibits no signs or symptoms of Ebola, he or she can still spread the virus during the incubation period. Once symptoms begin, the person can remain contagious for about three more weeks.

    cedarhill (dd6b21) — 10/1/2014 @ 6:06 am

    cedarhill, you would need to reference that claim more specifically than you “found it on the internet”.
    because from what I have read from the CDC and other medical experts, they say exactly the opposite, which is a large part of the rational for how they recommend handling Ebola outbreaks.

    It is true that many types of viral infection are transmissible before symptoms begin, especially things that are routinely spread via respiration, such as chickenpox, etc. The claim is that for Ebola to be infectious, it has to have already multiplied sufficiently to cause symptoms.

    I wonder what precautions the ERs are going to start taking at this point? It’s all very reassuring to think that all they have to do is ask a patient if they’ve been to Liberia or West Aftrica recently, but with just a few more cases here, that won’t be a very useful screen.
    bobathome (5ccbd8) — 10/1/2014 @ 7:09 am
    There are two caveats to that, one reassuring, another worrisome.
    First, the reassuring. Your point is why once an Ebola case is known there is an active effort to track down contacts before they have a chance to become ill, so that precautions can be taken. The most important part of controlling Ebola in Dallas is the work of the CDC surveillance team and others tracking down contacts right now.
    Second, the worrisome. Screening people by asking about recent travel is not a perfect screen. It would be entirely possible for someone to start to become ill and go to a doctor without telling they were recently in Africa, hoping to be reassured by the doctor telling them it is a flu or a cold or whatever. One could look at it as people being irrational, or as it people are being rational, given their presuppositions. If the predominating thought/feeling of a person is fear, assuming to get Ebola is to die, then it is “rational” to stake your hope on not getting it/having it, and if the doctor doesn’t finds it, then you don’t have it. I have had a few people over the years deliberately withhold information from me because they were told by another doc they had a diagnosis that they didn’t like, so they sort of used me to try to allay their fears, that if I didn’t agree with the first doctor, then the first doctor was wrong. This often means the person actively withholds bits of history and lab findings, etc., as if challenging “Columbo” (or Patterico in his day job) to figure out the case.

    MD in Philly (f9371b)

  30. > However, it’s not clear to me that touching a contaminated surface is not enough.

    As someone who regularly uses a subway system where it’s impossible to avoid touching a surface which someone else has accidentally contaminated, this is the concern that keeps me up at night.

    aphrael (001863)

  31. > all of Monrovia and other affected areas probably need to “shelter in place” for a week, which requires local distribution of food and water for 1 million people, to have the best chance of getting a grip on the situation. I can only think that would require a major mobilization of resources akin to a WWII effort

    I cannot imagine the Liberian government is capable of such a thing.

    So the question is: can the UN do it? Failing that, can *we*?

    aphrael (001863)

  32. agreed, aphrael, that the Liberian government does not have the ability to do such a thing, and they know it. I saw where the World Bank gave them money to fight Ebola, and they promptly gave it to the UN effort fighting Ebola.
    That’s why I was wondering if any readers remember or have studied the Berlin air lift, and how many Berliners did we need to provide for, and for how long. (Yes, yes, I could use Wikipedia, but crowdsourcing from PP is much more reliable).

    I think you would need to worry about touching a handrail that was touched by someone who had recently thrown up or had a bloody nose or diarrhea or such.
    Trying not to touch things (which my daughter already does) and having a bottle of waterless hand sanitizer in your pocket would be handy.
    Some areas are sort of used to this, remember seeing pictures of everybody in Japan wearing masks to avoid the flu?

    MD in Philly (f9371b)

  33. In the past before there was a chicken pox (varicella) vaccine, if a health care worker was exposed to chickenpox without evidence of immunity, that person was sent home and not allowed to return to work for 3 weeks, as one can be infectious with chicken pox immediately before the illness appears. The standard thinking has been this is not true for Ebola.

    I don’t know how effective ibuprofen or Tylenol is against a fever from Ebola, though it might be in the early stages.
    Drinking a cold beverage immediately before might still work, though if one was actively trying to get around the screening.

    MD in Philly (f9371b)

  34. I’ve read, don’t ask me where, that as few as fifty variola viruses from a six foot distance are enough to transmit the disease. Do they know how much inoculum is necessary for ebola? And I know the difference between “airborne virus” and carried by water droplets coughed or sneezed, BTW.

    nk (dbc370)

  35. > I think you would need to worry about touching a handrail that was touched by someone who had recently thrown up or had a bloody nose or diarrhea or such.
    Trying not to touch things (which my daughter already does) and having a bottle of waterless hand sanitizer in your pocket would be handy.

    As a general rule, I stand on the subway, because I’m a healthy middle-aged man, and so I want to save the benches for less healthy, older people. But that requires *holding the handrail*, which is what’s making me nervous now.

    aphrael (001863)

  36. Supposedly, it’s relatively difficult to transmit; it doesn’t fly through the air

    Unless, maybe you’re starting to become incapacitated, and you also have a coughing cold.

    In other words, this is probably rare, but not impossible. Most, if not all, such cases could probably be attributed to other methods of exposure, and they wouldn’t acknowledge such an method of transmission unless they have a dozen or more cases that can’t be explained any other way.

    Another thing they are wrong about is the idea that people don’t beat back the infection without getting diagnosed. Exposure through the air probably infects someone with fewer virus particles.

    I’m interested in the age of that person in Texas. He probably wasn’t under 35. Any disproportionate age distribution is a sign that people are beating back the infection and getting immunized as a result.

    Sammy Finkelman (ca4c0f)

  37. Which is why the amount of contaminant is important. Will washing your hands, or using a wipe, take away enough of it? How much do you need to get on your clothing?

    nk (dbc370)

  38. 12. Dr Dave (0c818d) — 9/30/2014 @ 11:16 pm

    They keep telling us it is hard to get, then doctors who are wearing protective gear keep getting it.

    They don’t wear it 100% of the time.

    So maybe not that hard to get

    No, it could still be hard to get, when you consider the total number of people infected. Small chances can add up.

    Even if it could only be gotten from a person who is visibly ill, that person would not have to be in front of them. It could be someone who prepared food. It could be using the same drinking glass or spoon as someone infected with ebola. It could be from washing clothes, especially soiled clothes. It could be from using the same bathroom or showerhead.

    Sammy Finkelman (ca4c0f)

  39. Well, it turns out he was treated and released 2 days before his ER visit with Ebola symptoms.

    Epidemiology gives us every chance of containing this but we’ve got a population to quarantine 21 days now. There will be deaths.

    gary gulrud (46ca75)

  40. nk (dbc370) — 10/1/2014 @ 8:29 am

    Will washing your hands, or using a wipe, take away enough of it? How much do you need to get on your clothing?

    I doubt they’ve even attempting to study this question, which is derelict. Because if they really investigated every case, they’d get answers that would work 95% to 98% of the time.

    Let’s say there’s one sick person and 14 people close to him. The people not infected, could have been exposed and beaten it back. So you don’t look at them, except that they may all have avoided extreme exposure like cleaning or washing the patient, or disposing of soiled bedding.

    But the people infected must have had some exposure (except that one could have gotten it from the other, although in such a case there is a time lag)

    But anyway you could pretty quickly come to an idea what kind of exposure is necessary (which is not the same thing as sufficient) for somene to come down with a diagnosed case of ebola. Right now in Liberia people are afraid of any kind of contact. They don’t even want people working in health care to come home to sleep.

    But I don’t think the answer is the same for every person – all you could do is say is that there’s a certain exposure level that won’t infect anyone (to the point of getting sick) except possibly babies between 6 months and 2 years, or well into their 80s.

    (Below 6 months, the mother’s antibodies circulate in the baby, and more antibodies come if the baby is breastfed, which of course is protective only if the mother got some exposure to the virus)

    Vitamin A levels, and other nutrients like folic acid, and simultaneous other infections and anything that increases cortisone levels (that would be negative) – matter probably much more than anybody thinks.

    There’s now a test (not commercial) for 3 proteins that are correlatated with how long it takes to recover from surgery and fighting an infection also has the element of the need for the body to synthesize proteins..

    Sammy Finkelman (ca4c0f)

  41. Can we now start worrying about our young men and women in the armed forces who have been shipped off to west Africa to fight the Battle of Ebola?

    ThOR (130453)

  42. Ebola is a small virus, 3000 base pairs, perhaps 4 genes. The issue of mutation re: going airborne like influenza is mostly just academic speculation, showing off. It is mutating rapidly but it doesn’t really need another attachment site to be airborne.

    What is of concern is its hang time in air when aerosolized. And whether and for what duration victims cough is not something I’ve seen.

    gary gulrud (46ca75)

  43. The size of inoculum for infection certainly is a reasonable question, and the answer could be alarming or reassuring.

    One must realize that prior to recently, not only has Ebola been a relatively uncommon disease in the scope of things, it is also terribly difficult to work with, requiring containment facilities that are few, so lots of relatively simple questions are not as well known as with some things.
    Even if one did the work to find the necessary inoculum for an animal model, that would not say a lot about humans.
    Offhand, I do not know how research was done that gives us such information about other illnesses, but you need some kind of “natural experiment”: that one can observe and collect data about (“just how much listeria was in that milk that people became sick with?”) or can do an ethical experiment with (“how man attenuated polio virus particles are necessary to produce an asymptomatic infection?”)

    *holding the handrail*, which is what’s making me nervous now.
    aphrael (001863) — 10/1/2014 @ 8:25 am
    Maybe get some disposable gloves, latex, nitrile or vinyl, at about any hardware store is where I get mine

    And if anyone gives you a look, say you have leprosy, and they will give you space…

    MD in Philly (f9371b)

  44. gary, you need to know if the virus is present in which secretions, saliva? lung fluids?, then the mechanism by which they can become airborne (fine aerosol from lungs, thick drops from nasal secretions), then the size of aerosols of that mechanism, all of that goes into the size of the aerosol and how long it can be airborne, then you need to know the necessary inoculum to be breathed in to cause illness. I have no idea about any of that.

    The practical answer by observation by all of the folks that have ever worked with Ebola patients is that one does not need to worry about someone who coughed in public, AFAIK.

    MD in Philly (f9371b)

  45. gary gulrud (46ca75) — 10/1/2014 @ 8:50 am

    Epidemiology gives us every chance of containing this but we’ve got a population to quarantine 21 days now.

    Twenty one days is probably way over the amoun of time really needed. On some things they do too much, and on others too little, and it depends on what’s convenient. When you have very few cases, you can go to extremes.

    There will be deaths.

    The history in Africa in countries that have encountered solitary cases, or very few, is actually very good. The New York Times has a front page story about Nigeria.

    http://www.nytimes.com/2014/10/01/health/ebola-outbreak-in-nigeria-appears-to-be-over.html?_r=0

    After the first patient — a dying Liberian-American — flew into Lagos on July 20, Ebola spread to 20 other people there and in a smaller city, Port Harcourt.

    They have all now died or recovered, and the cure rate — 60 percent — was unusually high for an African outbreak.

    Meanwhile, local health workers paid 18,500 face-to-face visits to repeatedly take the temperatures of nearly 900 people who had contact with them. The last confirmed case was detected on Aug. 31, and virtually all contacts have passed the 21-day incubation period without falling ill.

    Taking someone’s temperature is a very crude method of determining whether someone might be coming down with ebola, but they haven’t got anything else as fast and cheap.

    It was also contained in Uganda.

    It is out of control in Liberia because there are too many cases to follow the disease isolation and investigation protocols.

    Now what’s going to happen is that the United States is going to get exposed to repeated solitary cases, maybe what, every two weeks, or even more often..

    Sammy Finkelman (ca4c0f)

  46. C. S. P. Schofield (848299) — 9/30/2014 @ 11:32 pm

    I wonder how long the Lefty Intellectual demonization of DDT will survive a series of Malaria outbreaks.

    A long time. There are all sorts of legal obstacles to bringing back DDT, proposed (and used) alternatives that aren’t as good and are more toxic *, and it’s been so long since it has been used that people have forgotten about it.

    And there never was a problem, even with birds, with using DDT indoors and soraying it on walls.

    * to birds etc. too, probably, but it is not illegal DDT.

    Sammy Finkelman (ca4c0f)

  47. 45. The Reston variant was inarguably airborne.

    Getting good answers with a pathogen of this morbidity won’t be happening soon.

    gary gulrud (46ca75)

  48. #20, Doc: The Berlin airlift delivered a minimum of 1500 tons of food each day for about two million people. This provided about 2000 calories per day, plus meat, vegetables, milk for children, coffee and other things to make the diet enjoyable. They also had to deliver fuel since the Soviets had cut off power to the city. Once the thing was properly organized, the British and American air forces were delivering 5000 tons per day, mainly using C54 aircraft with payloads of about 10 tons. The big problems were the weather and the lack of a big airport. The issues for West Africa would be very different than for Berlin. Berlin was close to the bases supplying the aircraft, whereas West Africa is a long way from anywhere. And Berlin required a lot of fuel (coal) in the winter. West Africa is close to the equator, so heating is not an issue. My WAG is that the nearest likely major support bases would be in Spain or Morroco/Algeria, which are about 2000 nautical miles away. If a suitable airport could be identified in West Africa this would be very helpful, but the base would have to be very secure to ensure isolation of the personnel both from the disease and from civil unrest. The range of options for an airlift are enormous compared to Berlin. A C-130 can deliver about 15 tons and a C17 can deliver about 75 tons. The C-130 can deliver their load approximately 2000 nm. The C17 can be refueled in air so its range is unlimited, assuming the airbridge can be supported. The current inventory of C17s was set at 205 by HteWon in 2009, but the House authorized another 17 in 2012.

    My guess is that you could organize an airlift that would supply two million people using a fleet of under 50 C17s, so it is feasible. But it would be costly. The food costs would likely be the least significant of all the elements. But whether the major supply depot was in West Africa or in a more secure place would be an issue. If it was elsewhere, then another fleet of smaller aircraft, C-130s say, would be needed, and the numbers would be large. And, unlike HteWon, I would be concerned about the health and welfare of the troops delivering the goods, which would involve additional measures to ensure that the airlift didn’t provide another means of spreading the disease. And the first thing I’d do is get the 3000 out of West Africa if they were in any danger of becoming infected. I’d also be concerned that the supply base, and especially the distribution facilities and our 3000 hospital troops, might prove to be a tempting target for our muslim enemies.

    bobathome (5ccbd8)

  49. > all of Monrovia and other affected areas probably need to “shelter in place” for a week, which requires local distribution of food and water for 1 million people, to have the best chance of getting a grip on the situation. I can only think that would require a major mobilization of resources akin to a WWII effort

    Good God, man! We must save Pasadena!

    Colonel Haiku (2601c0)

  50. Arcadia!

    bobathome (5ccbd8)

  51. Q: What do you call today’s resignation of the head of the Secret Service?

    A: a good start

    Colonel Haiku (2601c0)

  52. thanks, bobathome

    So, providing food to prevent starvation (who needs fresh veggies?) for 1 million people should be within the realm of possibility. I would guess engineers would need to make or upgrade air strip facilities, and I think they would need to set up a “shoot to kill” security perimeter of a long distance away for all except authorized personnel at designated gates.
    All you folk with more knowledge about this than I, what do you say? I’m thinking that the time to do this is now, if it hasn’t already passed. Maybe 1 million will not die of Ebola, but after 50,000 have died, tens of thousands are sick, and the rest of the country is starving and killing for survival, it will be too late.
    It would be a telling point for November to point out that if under Obama the US military cannot respond to a humanitarian crisis as it did only a few years ago with the Indian ocean tsunami.

    MD in Philly (f9371b)

  53. Chrissie Matthews… if you feel a tingle up your leg, you just might have Ebola!

    http://hotair.com/archives/2014/10/01/chris-matthews-didnt-obama-tell-us-it-was-unlikely-ebola-would-come-to-america/

    Colonel Haiku (2601c0)

  54. http://www.thedailybeast.com/articles/2014/10/01/how-to-keep-ebola-from-spreading-to-other-u-s-cities.html

    The CDC Was Wrong About How to Stop Ebola ..

    …The CDC has a well-considered algorithm that places those returning from the three endemic West Africa countries—Sierra Leone, Guinea, and Liberia—into a measure of extra vigilance if and only if the person has had exposure to a known case of Ebola. Per the press conference, the Dallas case had no such exposure. He was not a health-care worker treating patients, nor was he from a family battling active disease. Of course, more facts may emerge that contradict today’s story—but today’s facts, if they hold up, mean that yesterday’s assumptions are no longer correct. Liberia may indeed be enough of a hotbed of Ebola that anyone arriving from the area will need to be considered for extra vigilance.

    It was obvious you couldn’t limit it to people exposure to a known case of Ebola because theer are alot of undiagnosed and untreated cases of ebola in Liberia right now.

    Although we lack carefully performed studies, Kent Brantly, the physician who developed the disease and was airlifted to Atlanta, seemed to have no gross exposure to the disease, though he worked on an Ebola ward. Ditto for Nancy Writebol the other American flown back in that dramatic first wave. According to reports, they were mighty careful at every step, but just not careful enough.

    In contrast, it is said that absolutely no one working for Médecins sans Frontières, or Doctors Without Borders, has come down with Ebola, though they have been and are working cheek by jowl with the same patients, presumably because they are perfectly and methodically garbed and attentive 100 percent of the time, not 99 percent…

    I read that they concluded it was most likely from one person who ate (?) in the cafeteria who was later diagnosed with ebola.

    Sammy Finkelman (d22d64)

  55. In contrast, it is said that absolutely no one working for Médecins sans Frontières, or Doctors Without Borders, has come down with Ebola, though they have been and are working cheek by jowl with the same patients, presumably because they are perfectly and methodically garbed and attentive 100 percent of the time, not 99 percent…

    As you said, Sammy, I have read that it is thought that all of the US people did not get it from faulty techniques, but from socializing with the natives, as missionaries often do.
    So, not falling prey to the Gell-Mann Amnesia syndrome, I do not trust the rest of the article quoted.

    From what (little) I know, the time has passed for a person from Liberia to have a high risk contact in order to come under increased suspicion, and if that was the CDC algorithm, it would have been appropriate a few months ago, but no longer. If the reports are at all close to true, it would seem that anyone coming from Liberia who gets sick should be quarantined for Ebola until proven otherwise.
    But if the algorithm really has been as the DB says, that explains why he was first sent home. I guess, Sammy, you could help us by looking up what the CDC says themselves.

    MD in Philly (f9371b)

  56. 58. he wa sin his mid-40s.

    Over 35, as I thought. (although much younger people died, but they must have a stronger exposure)

    He went with an ebola victim, who was dying, to a hospital and back.

    Her brother also died.

    He did fit the formula – except that the ebola victim(s) were never in any hospital.

    The formula assumed that any person in contact with an ebola victim would be known.

    In a pattern often seen here in Monrovia, the Liberian capital, the family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help on Sept. 15 after failing to get an ambulance, said her parents, Emmanuel and Amie Williams. She was convulsing and seven months pregnant, they said.

    Turned away from a hospital for lack of space in its Ebola treatment ward, the family said it took Ms. Williams back home in the evening, and that she died hours later, around 3 a.m.

    Mr. Duncan, who was a family friend and also a tenant in a house owned by the Williams family, rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Mr. Duncan then helped carry Ms. Williams, who was no longer able to walk, back to the family home that evening, neighbors said.

    “He was holding her by the legs, the pa was holding her arms and Sonny Boy was holding her back,” said Arren Seyou, 31, who witnessed the scene and occupies the room next to Mr. Duncan’s.

    Sammy Finkelman (d22d64)

  57. Well, Sammy-
    One moment it seems to be the mistake of the ER staff, then it seems to be the mistake of the CDC and it’s algorithm,
    now it’s totally unclear where the mistake was, but the story is obvious if true per the NYT, and told to the ER people,
    though as I said above, I can easily understand a person not giving the full story out of fear and a vain hope that they don’t have it.

    I have no idea who would take the initiative and who would pay for it, but I think a 1 week shelter in place with food and water delivered to local distribution points would be a good start at even trying to salvage the situation from total anarchy.

    MD in Philly (f9371b)

  58. Unless I missed something, it is not clear to me where the original story said that pt 0 was sick before leaving. The brother became ill, but he had been exposed before the incident where pt 0 reportedly was exposed.

    Did he come to the US in the event he became sick? That certainly seems possible, though if he was taking precautions like that to get here, I would have thought he would have “screamed bloody murder” when they tried to send him home.
    I mean, how much does it take to understand, “I carried a sick person who died of Ebola a week ago, and now I’m sick!!”

    MD in Philly (f9371b)

  59. Dr. Brantly:

    “Many have used the analogy of a fire burning out of control to describe this unprecedented Ebola outbreak,” Dr. Kent Brantly said, adding “Indeed it is a fire – it is a fire straight from the pit of hell. We cannot fool ourselves into thinking that the vast moat of the Atlantic Ocean will protect us from the flames of this fire. Instead, we must mobilize the resources… to keep entire nations from being reduced to ashes.”

    gary gulrud (46ca75)

  60. We should not have let you back into America, Dr. Brantly, we really should not have. I knew your agenda, that you wanted to make Ebola the world’s problem, the minute I heard about you.

    nk (dbc370)

  61. “I mean, how much does it take to understand, “I carried a sick person who died of Ebola a week ago, and now I’m sick!!””

    MD in Philly – He was probably not taking enough vitamin A.

    daleyrocks (bf33e9)

  62. no, I can’t fault Brantly, for his behavior, he didn’t engage in any subterfuge, as apparently Mr, Duncan had,

    narciso (ee1f88)

  63. nk (dbc370) — 10/1/2014 @ 7:31 pm

    ???

    Dr. Brantley has this notion about being his brother’s keeper, not because he is a liberal, but because that is what he thinks God asks of him, to not be selfishly isolated from others.

    People put too much fuss about a known Ebola patient coming to the US under the best of precautions, when the major concern should have been to be prepared for what was certain to happen sooner or later, with an Ebola person coming here.

    MD in Philly (f9371b)

  64. I think the CDC has totally messed this up and proved to be untrustworthy. Deal with stuff instead of focusing on PR, and in so doing, make the PR worse because you didn’t act responsibly in the first place.

    Maybe there is some neuro-computervirus that makes people want to hide the facts and pass the buck that has invaded every government computer then has jumped out of computer screens right through the eyes and into the brains.

    MD in Philly (f9371b)

  65. The story I saw about pt 0 said that his sister gave him the airplane ticket in late August and he resigned from his job with FedEx on Sept. 4th. So his trip was in the works long before he helped his pregnant neighbor into a taxi on Sept. 15th. Based on this, he doesn’t sound like typhoid Mary, rather, just a nice guy who got caught up in something beyond his or HteWon’s understanding. But unlike HteWon, pt 0 had a real job and he actually did something to help someone else.

    bobathome (5ccbd8)

  66. …has jumped out of computer screens right through the eyes and into the brains.

    what brains?

    redc1c4 (abd49e)

  67. Also, in thinking about a West African relief effort in comparison to the Berlin airlift, there is a real contrast between the nature of the food preparation that would be possible in the two different cases. There were flour mills and industrial bakeries in Berlin, and the Allies flew in three- or four hundred tons of wheat and other grains every day along with 3 tons of yeast. So the Berliners could make there own bread and apple streusel. These facilities would likely be unavailable in West Africa, particularly with a lock down. The simple solution would be MREs, but the question is whether the citizens would actually eat them. If they don’t, or if they just try to supplement their ration with black market food, then the quarantine fails.

    The complexity of the problem really makes the dispatch of the 3000 hospital troops questionable.

    bobathome (5ccbd8)

  68. thomas-eric-duncan-photos-pictures-of-ebola-patient-from-dallas-texas-united-states

    If many of the victims continue to be and remain of black or African descent, I imagine the paranoia already present throughout black (or particularly woe-is-me leftist) America about malevolent plots and devious racism aimed at them will ramp up several notches. The ethos of victimology of such people, who I’ve spoken with on more than a few occasions, is startling, odd and disturbing. It’s like dealing with the reasoning skills of a child or bratty teenager who occupies an adult’s body.

    Mark (c160ec)

  69. Liberia’s largest newspaper accused the U.S. of causing the Ebola epidemic. But that’s the real story of Sodom and Gomorrah, Mark. God allowed Abraham to bargain him down to where if Abraham could find ten good people, He would spare the cities. And we will not refuse to help millions of innocents because of some anti-American mental defectives.

    nk (dbc370)

  70. 74. Nitpick: I think it was one.

    gary gulrud (46ca75)

  71. 69. Yeah, hubris with dozens of lives is a crime.

    Dozens at this point is a best possible scenario.

    gary gulrud (46ca75)


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