Did the Government Have Time to Test the Patient in Newark Before Announcing He Did Not Have Ebola? – UPDATED
[UPDATE BY PATTERICO: Every so often, a blogger has a screw-up so epic, you just have to laugh. The original version of the post originally got Pacific and Eastern time backwards. You had one job in this post, Patterico, and it was getting the times right. One job! (It’s not as I don’t know Eastern time is later; the best I can say is that it’s a brain freeze.) This error distorted the timetable and changes the argument entirely. If I were Big Media, I would quietly remove the post or issue a tiny correction several days later. Instead, I will leave up the original post for comic effect, and add a postscript at the end indicating what the analysis should be using accurate times. Turns out, in the classic tradition of fake but accurate, that there is still a concern. — Patterico]
On Saturday I noted a possible Ebola scare in Newark. It was quickly said to be a false alarm, and I dutifully passed along that information as well. After all, we learned: “Federal health officials say Ebola has been ruled out as the cause of illness for a man who had traveled in West Africa and became sick on a flight from Brussels to the U.S.” And what possible reason could we have to doubt the word of federal health officials?
Wait just a second . . .
Let’s take a closer look at the L.A. Times story I linked to show it was a false alarm.
The ailing passenger, identified only as a 35-year-old man, began vomiting on a United Airlines flight that had flown from Brussels and landed at Newark Liberty International Airport around 12:15 p.m., a law enforcement official told the Los Angeles Times.
I assume that means 12:15 p.m. Newark time, which is 3:15 p.m. Pacific time. Then we see a number of updates to the story, each with a time stamp. I assume the time stamps are all Pacific time, including this one:
4:56 p.m.: This post has been updated to report that a man who fell ill aboard a flight to New Jersey does not have Ebola.
So the plane lands at 12:15 p.m. Eastern, and by 1:56 p.m. Eastern they are told he does not have Ebola. That’s less than 1 3/4 hours later.
Newsweek has a story about how quickly a test can be done:
But how do you actually test to see if someone has the virus?
Thomas Ksiazek, a professor at the University of Texas Medical Branch at Galveston who has done extensive research on Ebola, says that testing is done using a process called real-time RT-PCR, or reverse transcription polymerase chain reaction.
In this technique, doctors or medical personnel take samples of blood from a patient. They then add an enzyme to convert RNA found in the blood into DNA (RNA is a chemical messenger that helps turn DNA’s “instructions” into proteins). Next, a “primer” is added that targets a string of genetic code unique to the Ebola virus. The concoction is then run through a PCR machine, wherein that strand of Ebola genetic material is amplified, or copied, many times (if it’s there, that is. If it’s not, nothing happens and the test returns a negative.)
Finally, a chemical probe is added that binds to these snippets of DNA and alerts the scientists to the presence of the Ebola virus, Ksiazek tells Newsweek. The whole process can take as little as three to four hours.
Quick math review: three to four hours is more than 1 3/4 hours.
Dr. Bill Frist has explained that these tests must take place in a lab, and not just any lab:
Isolating the virus provides the most sensitive and specific diagnosis, but requires transport of biohazard material to a BSL-4 lab, of which there are few in the world. Alternatively there are reverse transcription polymerase chain reaction (RT-PCR) and quantitative PCR, which are both very sensitive and specific, but again require a lab.
If you look closely at the stories saying this was a false alarm, the basis for that statement appears to be that, yes, the passenger had been to Liberia, and yes, he had been vomiting — but his other symptoms were not consistent with Ebola. That’s probably right. But I had uncritically assumed — and I bet many of you did too — that he had actually been tested, and Ebola had been ruled out. But upon closer examination, there simply wasn’t time to do that.
Just another reminder to be skeptical of your government.
MORE REASONS TO TRUST! As I have reminded you more than once, Obama told us all on September 16: “We’re working with hospitals to make sure that they are prepared, and to ensure that our doctors, our nurses and our medical staff are trained, are ready, and are able to deal with a possible case safely.” And sure enough, if you look at the CDC Web site, you see this:
As part of a comprehensive and coordinated response to the 2014 Ebola outbreak in West Africa, the Centers for Disease Control and Prevention (CDC) is developing an introductory training course for licensed clinicians (e.g., nurses, physicians, and other healthcare providers) intending to work in an Ebola Treatment Unit (ETU) in Africa. This course will take place in the United States.
Wonderful! When did that happen?
The 3-day course will run each Monday thru Wednesday, beginning October 6, 2014, for the next 3 months (the course will be suspended during weeks containing Thanksgiving, Christmas, and New Year’s Day holidays; the course may also be suspended intermittently for 1-week periods to revise course content and delivery).
Oh. It’s starting . . . today.
Well, it’s only closing the barn door after the horse is gone if something already happened, and it appears that the situation in Dallas is well in hand, what with . . . wait, what’s this? From yesterday:
Update at 2 p.m.: Lauren Trimble, Jenkins chief of staff, said the man has been located and is now being monitored.
Original post: Dallas County law enforcement officers are looking for a man who reportedly rode in the Dallas Fire-Rescue ambulance that had carried a man stricken with Ebola to Texas Health Presbyterian hospital.
County Judge Clay Jenkins said Dallas police and county sheriff’s deputies are trying to find the man, who reports have suggested is homeless.
(Judge Clay Jenkins is the lefty judge who went to visit the Ebola patient without any protective gear and then proudly gave a press conference while wearing the same shirt.)
Luckily, the federal government says that homeless people have almost no personal contact with people, and tend to maintain the highest standards of cleanliness. I am reassured that they put the homeless guy in an ambulance with the Ebola patient and then promptly lost track of him. I think that’s a safety technique they’ll be teaching in that CDC class that starts today.
Was the homeless guy one of the 12? or the 18? or the 50? or the 80? or the 100? How about everyone he took money from for the past few days? Every business where he handed over money in exchange for fast food or beer?
All is foreseen, citizen. Do not trouble yourself with these questions.
UPDATE BY J.D.: Patterico indicates that the post is perfect except for the small fact that the times are all backwards, pretty much gutting the argument of the post. He will try to address this problem at lunchtime.
P.S. BY PATTERICO: Well, that was fun, wasn’t it? Now let’s analyze the situation with actual accurate times. The plane landed at 9:15 a.m. Pacific and the update to the LAT post was 4:56 Pacific. Put another way, the plane landed 12:15 p.m. Eastern and the post was updated at 7:56 Eastern. Either way you slice it, that’s under eight hours. In theory, then, that’s enough for a quick test — if a sample could be taken to a qualified lab and all other work could be put on hold. And assuming that the LAT was informed of the results and reported them immediately.
But there is still a problem. As DRJ points out in comments, the passengers were held for only 90 minutes before being released with a pat on the head and some “be careful” handouts. DRJ also raises even more questions about the nature of the tests available, where they could be done, and how quickly. Given the totality of what I know, I think the doctors just looked at the symptoms and reached their conclusion based on that.
Isn’t it wonderful to see DRJ?
Ding.
Patterico (9c670f) — 10/6/2014 @ 7:44 am12:15 PM Eastern is 9:15 AM Pacific. You got your directions reversed.
Observer (3a9775) — 10/6/2014 @ 7:54 amI do not have the time to look into details.
As with many tests, there is a “gold standard” and then other things which are useful in various settings, from my reading I know there are several molecular biology methods of identifying Ebola with I suppose various degrees of ease, availability, and differences in accuracy, sensitivity and specificity.
I suppose also that he was evaluated by a doctor and a very good explanation was found that was not Ebola, and there were enough things consistent with Ebola that he didn’t have to allow them to make a “clinical judgment” that it was “safe” and “reasonable” to treat the situation as if he didn’t have Ebola.
If no one else gets reliable info, maybe I will get back to it later tonight.
As I said in my posts on yesterday’s thread, I do believe the general public has little to fear especially at this time, but I think people should expect some more cases popping up in Dallas from contact with Mr. Duncan, then it will take another 3 weeks or more to see if any of those folks gave it to yet someone else. And I think we should expect more incidents in the US and elsewhere before it is all over,
but if Lagos, Nigeria, can contain an outbreak, I hope we can.
I linked to a CDC algorithm yesterday. In reality, the protocol for handling an patient in your ER is simply a combination of currently used types of isolation precautions. Anyone who is a thoughtful and competent nurse in a hospital setting that takes care of sick people on a med-surg floor should be able to do it,
but that can be assuming a lot in any given instance.
A sobering thought, how many college and grad students from West Africa have returned to classes in the US in the last month…
MD in Philly (f9371b) — 10/6/2014 @ 8:03 amWell, the BLS 4 lab would be the safe way to run the test. However, there are real-time machinesat most universities and many businesses, and NJ would have scores of the units.
Their department of Health could run the test and probably don’t have but a BLS-2 lab.
gary gulrud (46ca75) — 10/6/2014 @ 8:06 amI don’t think the testing is even the important question now. Even if they did test, they will tell us happy stories to calm us all down and when people start dying they will not report it. Lots of flu this year!
All of this is course backfiring. I went to a party this weekend and the Dems there were absolutely livid with him.
Frieden came back from Africa the end of August and talked to Obama. Obama renewed amnesty for Liberans the end of September. This outbreak was anticipated, and Obama had his usual grandiose expectations of how he would rescue the world from this scourge. He forgot to tell people how to clean up toxic sheets though or how to question people from a place called Liberia, but what the heck. He meant well.
Patricia (5fc097) — 10/6/2014 @ 8:18 am12:15 pm EDT is 9:15 am Pacific time.
carlitos (c24ed5) — 10/6/2014 @ 8:28 amebola doesn’t care what time zone it’s in all it wants is to make your eyeballs bleed
happyfeet (a785d5) — 10/6/2014 @ 8:32 amPat, I think the time difference is the key. The 12:15PM arrival is 9:15AM in LA, not 3:15PM. With a time stamp of almost 5PM in LA for the story, we’re looking at about 2PM East Coast and over 4 hours for the testing. Also, they may have been able to determine through other means what was going on. This almost sounds like a food poisoning which would have been easier to confirm.
Still, we need to watch out. I’m not at all confident the administration even knows what it is doing, let alone has this handled. But the medical professionals who are getting involved wouldn’t keep quiet if there were anything flakey going on. I do have confidence in them. It’s the old “Two can keep a secret if one of them is dead” thing: too many people involved to keep it under wraps.
Bill M (906260) — 10/6/2014 @ 8:34 amI’ve worked on the international side for virtually my whole career. There is something so counter-intuitive about time zones. 20 year veterans of global business can’t get the time right for a trans-Atlantic phone call. It’s just weird. Europe changes daylight time 2 weeks before and after us, just as a kind of childish taunt. A handful of nations and US and Mexican states don’t participate. It’s just not natural.
carlitos (c24ed5) — 10/6/2014 @ 8:34 am4. Of course, running a test requires primers, designed de novo by the expert or purchased as a kit(Ebola, not likely) wherever its done, so the likelihood a test was preformed is nil.
gary gulrud (46ca75) — 10/6/2014 @ 8:38 amprobably was tested for malaria antibodies and tested positive and was assumed to not have a dual infection.
Rorschach (61bf43) — 10/6/2014 @ 9:01 amBill M,
The issue for me is, supposing some medical authority has a concern contrary to Obama’s position; do we really have any expectation that the press will report it? Or are we going to find out AFTER the Zombie outbreak that some Chief Surgeon held a press conference and said that there measures for public safety that the Federal Government needed to be taking, and the Administration just wasn’t taking any of them?
C. S. P. Schofield (848299) — 10/6/2014 @ 9:04 amYes.
carlitos (c24ed5) — 10/6/2014 @ 9:08 amthe window for exposure in 48 hours,
narciso (ee1f88) — 10/6/2014 @ 9:10 am,
carlitos (c24ed5) — 10/6/2014 @ 9:14 amI got that from here,
http://www.miamiherald.com/news/local/community/miami-dade/article2522088.html
narciso (ee1f88) — 10/6/2014 @ 9:28 amobama’s goal is to spread ebola around the US so it becomes important to us. That way we will demand cures be found. He knows as long as it is an African problem we won’t care. That’s why he is shipping 3000 military personnel to Africa and that’s why he is allowing flights from “infected” countries to continue.
By the time anyone arriving in the US is diagnosed with ebola they could spread it to hundreds of others.
Don’t trust obama. Remember “if you like your insurance, you get to keep your insurance.” And, “I will have the most transparent administration in history.” Right!
Jim (145e10) — 10/6/2014 @ 9:46 amPatterico: If you look closely at the stories saying this was a false alarm, the basis for that statement appears to be that, yes, the passenger had been to Liberia, and yes, he had been vomiting — but his other symptoms were not consistent with Ebola. That’s probably right. But I had uncritically assumed — and I bet many of you did too — that he had actually been tested, and Ebola had been ruled out.
Well, from your update I did assume maybe they had eliminated it, and I read the whole thing anyway after it was all over, but the newspaper article I read on Sunday did not indicate that there had been any testing, and in fact ebola was not ruled out completely, but just regarded as highly unlikely, and therefore no cause for concern.
http://www.nytimes.com/2014/10/05/us/ebola.html (Page A20 Sunday)
http://www.nytimes.com/2014/10/05/nyregion/sick-airline-passenger-taken-to-newark-hospital-for-tests-amid-ebola-fears.html
Does it say anything there about a test for ebola?
No. They just diagnosed it as something else, and perhaps did a test for that
What the other disease is, is apparently being kept secret.
They never said he was confirmed as not having ebola. They said instead, in effect, that it was far-fetched to think he might have ebola, and not consistent with his symptoms, which fit another disease much better.
There never was any good reason for suspecting ebola in the first place, except he was sick in some way and had come from Liberia.
Sammy Finkelman (d22d64) — 10/6/2014 @ 9:58 amJim (145e10) — 10/6/2014 @ 9:46 am
By the time anyone arriving in the US is diagnosed with ebola they could spread it to hundreds of others.
I think the maximum number of cases one person might realistically infect is around 20. The issue is does an average case infect more or less than one other person.
If n > 1 the epidemic grows. If n <1 it subsides.
One case actually can be fairly easily contained, and even 20.
However, ALL THIS CANNOT BE SCALED UP indefinitely. Once you pass 100, or 300 cases, it starts to fall apart.
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:03 am11. Oh, the secret disease is malaria?
http://www.malaria.com/questions/vomiting-malaria
Is malaria treated on an outpatient basis?
Outpatient treatment of falciparum malaria is possible – British Medical Journal Aug 19, 2006; 333(7564): 397–398.
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:10 am8. Food poisoning sounds better.
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:11 amJim (145e10) — 10/6/2014 @ 9:46 am
The problem with your idea, while some may actually be thinking it, it will never turn out that way.
Overall, few people were talking about “AIDS in Africa” until we had potent multi-drug combinations to control the disease here in the US and widespread availability.
The more Ebola we have in the US, the more we will be spending astronomical amounts of money per case that could have gone much farther in Africa.
I bet if George W were in office, he and Bono would have already been on top of this like U2 fans at a free concert.
MD in Philly (f9371b) — 10/6/2014 @ 10:15 amSammy Finkelman (d22d64) — 10/6/2014 @ 9:58 am
A cursory reading suggest that is a very helpful comment.
MD in Philly (f9371b) — 10/6/2014 @ 10:18 amSammy, you add a lot to a discussion when you are focusing on getting information that clarifies something,
but then you make very unusual connections with it.
Not meant to be an insult, but a bit like “A Beautiful Mind”, smart, but sometimes make connections that don’t really follow, and then to stick to them.
narciso (ee1f88) — 10/6/2014 @ 9:28 am
I’m not sure what you mean by “window for exposure”, but without giving technical details, the article talks about a “screening test” that the local dept. of health had, and looking to a confirmatory test at CDC, likely something on the order of the PCR described above.
But I’m guessing off the top of my head at this point.
Looks like the Dade County people knew what they were doing.
I’m guessing no one else wants to look as unprepared as Dallas.
MD in Philly (f9371b) — 10/6/2014 @ 10:27 amAccording to this flow chart (posted by MD)
http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf
Testing for ebola was not even indicated. (although hospitalization and evaluation and reporting the case to the health department was)
Testing for ebola only happens once it is suspected.
and only then do they decide whether or not to administer an ebola test.
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:37 amThe Newark passengers probably fell into the category of:
Even low risk exposure would not call for an automatic test.
Low risk exposure is:
They would do a platelet test but not an ebola test.
Only this is High Risk exposure, which ALWAYS calls for an ebola test:
Now thess categories may not be 100% correct. Some of that “low risk ” exposure may not be quite that low risk.
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:38 amThis was probably:
False Alarm: YES
Ebola test: NO
Or maybe:
False Alarm: NO
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:39 amCleared : YES
Ebola test: NO
If this CNN report is correct that the passengers were only detained from 12:15 PM EST to 1:50 PM EST, then the post is not wrong.
DRJ (a83b8b) — 10/6/2014 @ 10:41 amFrom the reports, it sounds like this man didn’t have any signs of Ebola and was cleared by physicians based on their observations. For all we know, he may have had motion sickness from the plane trip. But I don’t think we can know he doesn’t have Ebola based on the results of an actual test.
DRJ (a83b8b) — 10/6/2014 @ 10:45 amTime Zones…..
askeptic (efcf22) — 10/6/2014 @ 10:46 amMath is hard!
Which really explains why news rooms always had that bank of clocks so the wretched scribes did not have to suffer catatonic episodes trying to do simple arithmetic.
Hi, DRJ.
MD in Philly (f9371b) — 10/6/2014 @ 10:46 amThere was almost certainly no ebola test.
He (and the child traveling with him) was just evaluated by physicians, and taking everything into consideration, they decided there is nothing to worry about as far as ebola is concerned.
The othwr passengers on the airplane, were also evaluated, although less intrusively.
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:48 amHi, MD. I learn a lot from your comments. Thank you.
DRJ (a83b8b) — 10/6/2014 @ 10:48 amSammy I do not KNOW malaria was the diagnosis, but it is certainly epidemic there as well so it is certainly a strong possibility.
Rorschach (61bf43) — 10/6/2014 @ 10:48 amHere is the Bloomberg Business Week September 29 – Octover 5 cover story on ebola:
http://www.businessweek.com/articles/2014-09-24/ebola-drug-zmapps-development-delayed-by-pentagon-agency
Sammy Finkelman (d22d64) — 10/6/2014 @ 10:50 amBill M said….“…With a time stamp of almost 5PM in LA for the story, we’re looking at about 2PM East Coast and over 4 hours for the testing…”
A 5PM West Coast time stamp is 8PM Eastern Time, giving them almost 8 hours since arrival (12:15PM) to make a determination.
askeptic (efcf22) — 10/6/2014 @ 10:50 amHi, DRJ.
askeptic (efcf22) — 10/6/2014 @ 10:51 amStick around longer this time, if you can.
I can envision a fast antibody test being rushed to market given this possibility which would change the testing time from hours to minutes. the technology exists to do this but until now there has not been much of a need for it. Perhaps MD would chime in, but I would expect that antibodies would start showing up before frank symptoms no?
Rorschach (61bf43) — 10/6/2014 @ 10:52 amI remember the last time we had a ‘time stamp’ controversy, and my suggestion at that time that all internet times should be GMT.
askeptic (efcf22) — 10/6/2014 @ 10:53 amActually, Rorschach, I agree that there may be ways that are better adaptable to a local rapid test but I don’t want to take the time look it up now, but detectable antibodies often do not present until the disease is established.
MD in Philly (f9371b) — 10/6/2014 @ 11:01 amHIV is a very different disease, but somebody with HIV infection can take up to 6 months to have detectable antibody levels, which is why direct viral particle measurement by PCR is the best way to get a “gold standard” test early in the infection.
What they might try to do, if they haven’t, is to make a test with a monoclonal antibody to some specific protein that Ebola makes that is found in the blood early on, or to a protein on the surface of the virus.
I do not know the time frame of appearance of antibodies for Ebola. I made the very narrow mention of HIV just to clarify how long it can take for antibodies to a viral infection, though usually it is much less than 6 months.
January 2010: http://en.ird.fr/the-media-centre/scientific-newssheets/337-possible-natural-immunity-to-ebola
That mortality rate is wrong anyway.
There could be a variant that is to ebola what cowpox is to smallpox.
Sammy Finkelman (d22d64) — 10/6/2014 @ 11:01 amInteresting, Sammy. But it is possible they have antibodies to a version that is not very serious in humans, like the Reston virus, and an antibody that is detectable in the blood is not necessarily protective of different strains (akin to the need for different flu vaccines every year, dependent on what strains are expected).
Why don’t you look up references on the various types of tests now used for Ebola and I’ll read them later, got to get back to work now.
MD in Philly (f9371b) — 10/6/2014 @ 11:06 amVia Patterico’s Bill Frist link in the post, there is a possible rapid test but it is still in the lab.
DRJ (a83b8b) — 10/6/2014 @ 11:06 amhttp://en.wikipedia.org/wiki/Reston_virus
It doesn’t seem to confer great immunity to ebola.
Sammy Finkelman (d22d64) — 10/6/2014 @ 11:07 amDRJ, I’m confident that the FDA will release it for general use in a decade or two.
askeptic (efcf22) — 10/6/2014 @ 11:07 amback to work, but what about the Supreme Court avoiding the SSM issue?
MD in Philly (f9371b) — 10/6/2014 @ 11:09 amIt’s a “political issue” (Heh), and since there’s no Circuit Conflict, it’s a question to be avoided.
askeptic (efcf22) — 10/6/2014 @ 11:11 amCan we all just lighten up a bit?
askeptic (efcf22) — 10/6/2014 @ 11:14 amActualy, ZMapp is precisely that, monoclonal antibodies to Ebola. So it is not only a potential treatment, but the basis for a potential rapid test as well.
Rorschach (61bf43) — 10/6/2014 @ 11:18 amThe Supreme Court often avoids touchy issues. It is almost a priciple. I think Justice louis Brandeis once announced it, in the 1930s. When it is not necessary to decide it is not necessary to decide. Somebody else maybe more familiar with this might track it down.
Sammy Finkelman (d22d64) — 10/6/2014 @ 11:18 amhttp://www.cdc.gov/vhf/ebola/diagnosis/index.html
Sammy Finkelman (d22d64) — 10/6/2014 @ 11:19 amMD,
Here is what the CDC says are available diagnostic tests. The earliest diagnostic tests that are currently available are effective “Within a few days after symptoms begin” and include:
Based on my reading, I think the labs, times and locations for Ebola testing in the US are:
DRJ (a83b8b) — 10/6/2014 @ 11:20 amHI DRJ, welcome back; it’s good to see you.
aphrael (001863) — 10/6/2014 @ 11:22 amHi aphrael. It’s always good to see you.
DRJ (a83b8b) — 10/6/2014 @ 11:23 amDRJ! Howzit going?
daleyrocks (bf33e9) — 10/6/2014 @ 11:32 amHi askeptic. Always nice to see you.
DRJ (a83b8b) — 10/6/2014 @ 11:33 amOk, daleyrocks. How are you?
DRJ (a83b8b) — 10/6/2014 @ 11:33 amIt’s nice to have a breath of Fresh Texas Air clean out the smog once in a while.
askeptic (efcf22) — 10/6/2014 @ 11:43 amDriving threw West Texas reminds me of my childhood, and visiting Signal Hill and Huntington Beach.
I love the smell of fresh crude in the morning.
THROUGH West Texas…..Oh Heavens.
askeptic (efcf22) — 10/6/2014 @ 11:44 amDRJ.
nk (dbc370) — 10/6/2014 @ 11:51 amnk.
DRJ (a83b8b) — 10/6/2014 @ 11:53 am🙂
nk (dbc370) — 10/6/2014 @ 11:55 amDRJ – I am trying to confuse the denizens of my Peoples’ Republic even more than their natural state of confusion. All is going according to plan, but it is tough to measure my impact since so much confusion abounds.
daleyrocks (bf33e9) — 10/6/2014 @ 12:11 pmThanks, DRJ
MD in Philly (f9371b) — 10/6/2014 @ 1:15 pmquick comments, based on similar technology used for HIV testing which I am much more familiar with
1. Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing
This is testing for a protein (or such) found in the blood from the virus, should be early in the disease, technically relatively simple. the first screening test for HIV is an ELISA
2. IgM ELISA
This would be a “quick” test for the specific type of antibody that is first made by the body and would be positive long before a generic “antibody test” (for IgG) would be
3. Polymerase chain reaction (PCR)
This is very specific for the virus one is testing for, is the test described initially above, is also quantifiable as to “how much virus” is swimming around. It was a major breakthrough in HIV treatment when this kind of test became available.
4. Virus isolation
Not sure if this is by growing it out in cell culture, or trying to purify it from blood and look under an electron microscope or what. whichever, it would take the most time and be the most dangerous to do not in a P4 lab.
Given the totality of what I know, I think the doctors just looked at the symptoms and reached their conclusion based on that.
And looking at the patient, not just his symptoms,
more or less, yes, I think so
Isn’t it wonderful to see DRJ?
MD in Philly (f9371b) — 10/6/2014 @ 1:42 pmagain yes, though more, not less
Wow DRJ is here… Patterico should put out a botched timeline and retraction more often..
Patterrico is no Mike Wallace, and that is a compliment.
steveg (794291) — 10/6/2014 @ 1:54 pmI think this speaks to the deep distrust Americans have for the Obama spin machine.
We expect politicians to BS us to a certain degree, but this is “The perfect storm” (which I’ll note preceded unprecedented storms)
Too many lies from Obama and the Democrats and as a prosecutor it probably almost gives a palpable pain to be lied to so frequently and so poorly.
I have to say that the quality of the lies has really tailed off after Jay Carney left…
How could anybody have any trust in this administration? Two headlines from today, the first from the AP:
http://www.theepochtimes.com/n3/1001915-obama-administration-considering-all-options-to-prevent-us-ebola-outbreak/
The second from Reuters:
http://news.yahoo.com/u-not-considering-travel-ban-amid-ebola-outbreak-171525384.html
According to the Obama administration, the Obama administration is considering all options to prevent an ebola outbreak. Except, according to the Obama administration, it won’t consider those options the Obama administration refuses to consider.
How schizo is that?
I don’t know. Jay Carney set a pretty low bar when it came to really bad lies. Is there a lower quality of lie than “the only people who aren’t laughing at the stupidity of this latest lie are in a permanent vegetative state?” That’s where Carney left things.
Steve57 (b50fab) — 10/6/2014 @ 2:15 pmThat’s why I keep my watch on Zulu (coordinated universal) time.
Malcolm Kirkpatrick (6ea6b1) — 10/6/2014 @ 3:34 pmThis Duncan fellow with Ebola knew he had the infection before coming to the US. Why didn’t he reveal that when he first went to the hospital when he was sick? Could have made it much easier for everyone.
The Emperor (771526) — 10/6/2014 @ 4:13 pmIt’s nice to see DRJ around again. Your class and kindnesses are much missed.
I’ve actually done all the procedures in #64 in grad school, postdoc, or in my own lab.
PCR is surprisingly fastest, so long as you don’t have an optimized ELISA kit.
Simon Jester (c8876d) — 10/6/2014 @ 4:23 pmYou are an idiot. Moron. Stupid. Please, don’t ever write anything, ever.
carlitos (c24ed5) — 10/6/2014 @ 4:40 pmSimon Jester (c8876d) — 10/6/2014 @ 4:23 pm
(Smacks forehead) I should have asked you.
MD in Philly (f9371b) — 10/6/2014 @ 4:47 pmAll things considered, the risk of biohazard, able to do in a less sophisticated lab by less well trained people, and what “kit” may be more easily made, what may have longest shelf life, what do you think makes sense to be the most available in the field?
The Emperor (771526) — 10/6/2014 @ 4:13 pm
For the third time… why aren’t you paying closer attention… or did you not believe my previous answer
(of course, I could be wrong)
People may have a reason for everything they do, it perhaps may always be “rational” in a manner of speaking
given all of the assumed presuppositions, etc.
sometimes people will go to a doctor afraid that have something, cancer probably being one of the most common, but they also hope that they don’t have it, so they figure if the doctor doesn’t find it, then they don’t have it.
So, it is possible he was hoping it was something else, and was all too willing to believe the doctor when the doctor said it was something else.
That would be my guess given my experience.
MD in Philly (f9371b) — 10/6/2014 @ 4:53 pmIs The Emperor the Chimperor?
carlitos (c24ed5) — 10/6/2014 @ 4:57 pmif obama tries to do the ebola on you there’s not a whole lot you can do except maybe make sure you drink lots of fluids
good luck you guys
happyfeet (a785d5) — 10/6/2014 @ 5:09 pmWhen did The Emperor ever pay close attention?
askeptic (efcf22) — 10/6/2014 @ 5:12 pmUsually, it would just go off on one of its P-A rants whether connected to the subject at hand or not.
I am so disappointed. If you can not trust your government who can you trust? I thank g-d everyday for Obama. He is not like Bush. He cares about me and my family. All of you racists can kiss my African American ass. My buttocks at one time was not black it was kinda cracker. Since I got the Barrack Hussein Obala it has gotten darker.
highpockets (f65e70) — 10/6/2014 @ 5:18 pmWelcome back, DRJ. I echo all of the sentiments expressed above.
felipe (40f0f0) — 10/6/2014 @ 5:33 pmIf Obama tries to do the ebola on you I suggest assuming the kneeling position.
http://www.globalsecurity.org/military/library/policy/army/fm/3-22-9/image1669.jpg
It’s a good steady position, and it lines you up perfectly for a pelvis shot. Nothing moves very far or fast with a shattered pelvis, so that’ll give you a chance to put lots of distance between you and ebola.
I second the recommendation about the fluids. Just make sure it’s this fluid.
http://www.theliquorbarn.com/everclear-grain-alcohol-190-proof-1-75l/
That’ll show ebola who’s boss. I survived the SARS epidemic while attached to COMLOGWESTPAC in Singapore by purifying myself religiously with the stuff. The CO had standing orders. “Purify it with alcohol.” And I’m a team player.
Steve57 (b50fab) — 10/6/2014 @ 5:42 pmI was not around when DRJ was here posting earlier, but it’s good to see her initials again and I hope we will see them regularly –epecially on Texas related topics where she da man!
elissa (657ad8) — 10/6/2014 @ 5:43 pmthanks for the tips I have a bottle of crown is all
i’m moving so I’m not very well-stocked on anything lately
i decided to drive my car after all so I’m not gonna have to get on an ebola jet
(apparently the people who move your stuffs and the car movers are two totally different people and it just got too complicated)
and they’re not very good about telling you when your stuffs is gonna get there
so i decided if I was gonna end up staying in a hotel for a couple weeks (worst case) i might as well see some america
i only have a couple weeks so i’m a focus on utah and then see how weather looks
i never been to utah my whole life except when i was little
i should ask dicentra if there’s anything special there I should for sure make time for
i wanna go see that arch where all the bungee people die cause they keep making their cords too long
and the lake
and I wanna see goblin valley before the stupid boy scouts totally ruin it
happyfeet (a785d5) — 10/6/2014 @ 5:51 pmAh, another extended trip— so, are you going to manage not to vote again, happyfeet? Are you even able to vote? Have you ever registered? Are you a citizen? And don’t start again with the “it doesn’t maaaaatter” crap. K?
elissa (657ad8) — 10/6/2014 @ 6:00 pmhah no is a lil trip this time
i’ll have to stay in touch with moving company and it’s possible the whole thing will be cut short and I’ll need to scurry to chicago to meet the movers
my next road trip will have to wait for awhile
my next thing is to hike the john muir trail so i have to save up all my vacation for that
i’m hoping to do that in like spring or late summer of 2016
I’ll register to vote in chicago though i promise
happyfeet (a785d5) — 10/6/2014 @ 6:08 pmso yeah technically I may not be able to vote in November this year, cause of red tape and stuff
happyfeet (a785d5) — 10/6/2014 @ 6:11 pmPatterico said: “Isn’t it wonderful to see DRJ?”
I agree.
That reminds me of the 1978 Saturday Night Live skit about the Voyager space probe. NASA had included spoken messages from humankind, earth sounds, and music by, among others, Bach, Beethoven, Mozart, Stravinsky and Chuck Berry. Playing a psychic in “Next Week in Review” Steve Martin announced that the Voyager messages had been received and next week’s Time Magazine would display the four-word return message — “the FIRST positive proof that other intelligent beings inhabit the universe.” The first four words from outer space were “Send more Chuck Berry”
“Send more DRJ.”
Bill Lever (f63e39) — 10/6/2014 @ 6:13 pmHi Simon Jester. Tell us more about these tests, if you have time.
DRJ (a83b8b) — 10/6/2014 @ 6:49 pmI’m from that generation, Bill Lever, so I appreciate both the compliment and the classic SNL reference.
DRJ (a83b8b) — 10/6/2014 @ 6:50 pmIt’s wonderful to have DRJ stop by.
Carlititos, not so much. You’re Ok, Jim.
gary gulrud (46ca75) — 10/6/2014 @ 7:20 pmI hesitate to add this because media reports are unreliable, especially when it comes to medical issues, and are often based on anonymous sources. However, this excerpt from an ABC report on the Newark case is interesting:
Flu-like symptoms aren’t that different from early ebola symptoms, are they? My guess is the only way they could determine the passenger was “not contagious” in under an hour — as apparently happened here — was by taking his temperature. I accept the odds are this passenger and his daughter don’t have ebola because there are other conditions that can cause these symptoms, including the flu. But it’s been reported Duncan had a low-grade fever when he first went to the ER, and that may be why the doctors mistook his illness for something like the flu. Why should we think the Newark doctors know how to diagnose ebola when the CDC says it’s difficult early in the disease?
That’s why I would like to know if the Newark decision was based on a lab test or a doctor’s judgment, because while there can be false negatives on ebola lab tests, there are also mistakes in judgment such as the one that may have occurred at Texas Presbyterian Hospital in Dallas on Duncan’s first visit.
DRJ (a83b8b) — 10/6/2014 @ 8:13 pmthe headline is misleading,
http://pjmedia.com/tatler/2014/10/06/greedy-corporation-stops-ebola-spread-in-liberia/
as are many things at this time,
narciso (ee1f88) — 10/6/2014 @ 8:18 pmI wonder if those who doubt Ogabe is allowing undiagnosed Ebola into the US would care to share their reasoning.
I doubt that “he doesn’t know any better”, or “he is relying on experts and is personally blameless” can be honestly claimed. The chances of contagion and death are non-zero in anyone’s estimation. Why are lives unimportant in view of what principle?
gary gulrud (46ca75) — 10/6/2014 @ 8:24 pmOstensibly, Duncan has succumbed, news of which is being interred.
gary gulrud (46ca75) — 10/6/2014 @ 8:32 pmi bought a ticket to the world
but now I’ve come back again
why do I find it hard to write the next line?
it’s cause you have ebola, silly
happyfeet (a785d5) — 10/6/2014 @ 8:51 pmConsidered opinion following careful attention:
http://www.zerohedge.com/news/2014-10-06/doctor-who-discovered-ebola-1976-fears-unimaginable-tragedy
gary gulrud (46ca75) — 10/7/2014 @ 2:27 amDRJ (a83b8b) — 10/6/2014 @ 8:13 pm
I’m thinking and hoping that the people in NJ had a very high level not only of awareness (which was obvious as to their HAZMAT response), but a high level of concern with a low threshold of calling it a possibility.
All of life is a consideration of odds. Getting in a car and driving home from the airport has a risk. It is reasonable that someone on a plane who vomits might have a constellation of symptoms and physical findings that make other diagnoses much more probable than Ebola.
Apparently they did take the precaution of making sure they had contact information of everyone on the plane before they left, and presumably plan active follow up of the sick person.
Assuming it is true that people are not contagious until they are symptomatic (and I think there is plenty of experience to make that claim), in the worst case scenario where the guy gets sicker and is diagnosed with Ebola a few days later, none of the people on the plane, even those who are “destined” to get Ebola, should have been able to infect others at that time, and as long as there is contact information any outbreak should be able to be contained.
gary gulrud (46ca75) — 10/7/2014 @ 2:27 am
That article is reasonable, as he agrees with me 😉
As I said before, the moment it came close to a major metropolitan area there should have been an “all hands on deck” response. Outbreaks had always been contained in large part because they were in isolated and sparsely populated areas, which made it possible to be successful with contact tracing and monitoring.
The Nigeria case, in another large and densely populated area, was controlled because there was one case that was identified immediately, but only after (I read somewhere) 19 additional cases and 7 additional deaths, and contacting up to 900 people.
The situation in Spain is a bit worrisome with a nurse contracting it apparently from taking care of a known patient, but that is an exception to the rule from observations from many outbreaks over 35+ years.
The idea that it could mutate into something that is air-borne is, IMO, on the order that an asteroid is going to hit earth and destroy all life. It could happen, but nothing one is going to plan life around.
MD in Philly (f9371b) — 10/7/2014 @ 5:24 amI have said before, there have been billions and billions more of HIV particles around the world for a long time and no one expects that mutation will happen. (Now, it is true that HIV is already harder to catch than Ebola, and a much more complicated virus than Ebola, so it is not meant as a precise comparison.)
MD, you probably know this already, but they traced the HIV virus to “1920’s Kinshasa.” Efficient Belgian railways and a thriving sex trade were to blame.
carlitos (c24ed5) — 10/7/2014 @ 6:54 amand teh monkeys
Colonel Haiku (2601c0) — 10/7/2014 @ 7:02 amMD,
A thoughtful response, as always. I agree the Newark incident was handled appropriately from the standpoint of protecting first responders and being able to trace a potential outbreak. It was especially handled very well from a PR standpoint: I assume the Port Authority of NY and NJ was trying to resolve this quickly in order to avoid fear and panic in a public airport. If so, I think they accomplished that goal, which they did in part by implying the patients were tested. But I’m still not convinced that testing happened (or, if it did, it happened a day or two later).
In addition, I guess I don’t like being “handled.” Specifically, I think the public can understand that doctors determined, based on their observations and taking the patients’ history, that these patients are not an infectious disease threat. But after the Dallas case, where doctors made the same determination at Duncan’s first ER visit, my guess is the authorities thought a similar statement might not put public fears at rest. So, with the good intention to reassure the public, they implied or allowed the impression that testing was done.
Does it matter? Probably not in the long run, but I think it does matter when government thinks it can gloss over the facts in an effort to avoid public panic. That enables them to say and do almost anything. If you google “hospital” + “ebola test”, you’ll see that many jurisdictions have quarantined suspected cases while they requested testing. I think all of the suspected cases have turned up negative, but there have been dozens of them. That’s how you reassure the public you are on top of things, but none of those cases involved commercial air transportation. Was the Newark response different because of the implications for the airline industry? I have a feeling it was.
DRJ (a83b8b) — 10/7/2014 @ 7:13 amRe: Espana
http://www.zerohedge.com/news/2014-10-07/spain-warns-something-went-wrong-suspected-ebola-cases-rise-madrid
Something, don’t know what exactly, is wrong with the heuristic. The rate of contagion, n = 2+, check. Incubation period, 48 hours, check. Period of onset, 3 to 21 days, check. Mode of exposure, contact with bodily fluids from symptomatic individual, check, I guess.
Think, peoples, think.
gary gulrud (46ca75) — 10/7/2014 @ 7:22 amgary gulrud (46ca75) — 10/7/2014 @ 7:22 am
1) Reading the link, there are many suggestions that the equipment and training of the staff was inadequate, and that this does not represent something new about the virus, but confirms what we’ve known and what needs to be done.
2) Where there is one newly diagnosed Ebola case, as with this nurse, as with Duncan, as with the man in Nigeria, it should be expected that there will be more before it is over. I heard a clip of the mayor of Dallas being enthusiastic that there have been “no fevers, zero” in all of those monitored to date. That is good news, but rather than suggest they are not going to have any more, he should learn from history and expect that there will be more, but that the number will be limited and there is no need for widespread alarm.
DRJ (a83b8b) — 10/7/2014 @ 7:13 am
I am firmly in the camp of Michael Crichton and Murray Gell-Mann, that the press is generally incompetent when it comes to anything technical. Crichton said he called some stories “Wet sidewalks cause rain” because they make the most basic mistakes in understanding logic as well as not understanding the technical facts.
So, I do not know how much to put any blame of health officials or the news people reporting.
But yes, I agree very much that a more realistic and sober response about the risks, while also emphasizing why there should be no wide-spread outbreak.
I think this is different from the Duncan 1st ER visit, where I don’t think the possibility of Ebola ever entered the treating docs’ mind. Had anyone known the history as reported elsewhere, that he had helped physically carry a woman dying of Ebola a week or so before, any evidence of fever even without any other symptoms would have been enough to put the fellow into isolation. In the NJ example, Ebola was front and center in their thinking, and they had to have adequate reason to say it wasn’t. Of course that doesn’t mean they couldn’t have been wrong, which is why they got contact info for everyone involved.
FWIW, as far as I know, nobody on the plane with the fellow flying into Lagos became ill, only those who were directly involved with his initial care, and perhaps some of their first contacts.
MD in Philly (f9371b) — 10/7/2014 @ 8:13 amOf course I respect your medical opinion, but others with equally impressive credentials aren’t so sanguine about Ebola.
http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-to-say-about-ebola.html?_r=1
Regardless, the CDC/Obama administration/LHMFM’s attempts to convince me that Ebola is extremely difficult to to catch have backfired in my case. And I think in most people’s case, and that’s for two reasons.
First, some in the media (the health reporter for the LAT was particularly vile in this respect) have practically equated the mode of transmission of Ebola to HIV. When they stress direct contact with bodily fluid they strongly imply that the contact must be intimate. And they strongly imply that certain bodily fluids are (like with HIV) more contagious than others. They stress, as do the “experts” the administration wants me to listen to, blood, vomitus, stool, and urine.
I’ve been to Africa, doc, and the people there are just not that stupid. They don’t casually touch such things. Also, unlike an STD which we learned in school you can’t catch from a doorknob or a toilet seat, clearly one can catch Ebola from a surface that someone infected with the virus has touched. I recall reading articles in which western reporters visited Ebola treatment centers in West Africa and were advised not to touch such surfaces as walls or counter tops because “the infection is everywhere.”
And the vagrant the Dallas authorities had been seeking in order to monitor for Ebola had merely ridden in the ambulance that took Duncan to the hospital. That homeless individual had never had any direct contact with the infected man himself, just surfaces the infected man had touched.
Clearly the virus is spread by far more casual contact (and even the CDC director had to admit no contact at all, just close proximity, before getting back in line) than this administration wants to let on.
Second, they keep trying to tell me that people aren’t contagious until they are symptomatic. Again, strongly implying they have to be shivering wrecks, vomiting uncontrollably and bleeding from every orifice. But based upon reports I’ve seen from West Africa people are contagious before they exhibit obvious symptoms. Perhaps the people themselves are aware that they’re feeling a little under the weather, but no one else would know unless the individual who senses they’re beginning to come down with something told other people. Outwardly, they appear fine.
So the CDC hardly reassures me with their “don’t worry, be happy” approach to Ebola. When they say that Duncan couldn’t have infected anyone while traveling because he wasn’t symptomatic and therefore not contagious, that’s a red flag to me. He hadn’t complained about any symptoms, but so what? That doesn’t mean he didn’t feel a bit ill and simply kept it to himself.
Just like he kept the fact he had been in physical contact with someone dying of Ebola when he filled out that screening form to board the plane to himself.
Same goes when they imply intimate contact with an infected person’s bodily fluids. If that were true, they wouldn’t have put out an APB and conducted a city-wide search for a homeless guy who had simply ridden in the same vehicle Duncan had ridden in.
Steve57 (b50fab) — 10/7/2014 @ 8:35 amI agree, but in this case it appears to me that the Obama administration is happy with the muddle the LHMFM is making of the situation.
Steve57 (b50fab) — 10/7/2014 @ 8:37 amI agree, as said before, that I think the CDC, etc., are being way to cavalier in their attitude and approach,
but, rather than speculate about the possibility of a mutation becoming transmissible by air,
I think we would be better served emphasizing what we do know, as you said,
like touching secretions on a door knob can transmit the disease, and that “being symptomatic” does not mean hypotensive with a fever to 105 and spontaneous bleeding, but can be the first time somebody throws up after not feeling well that morning, or saliva, tears, and ?sweat when first spiking a mild fever.
From what I have read about Brantley and others, these last two factors are likely to be the cause of their infections in a region which is now overwhelmed with the disease.
I read a case of some woman in Liberia who had cared for 4 sick relatives in her home and did not contract the disease, she did do her home version of precautions, wearing a rain slicker, rubber gloves, rubber boots, and a mask when tending to them. Had it been airborne, living in close proximity with no negative pressure rooms or positive pressure suits, I would think she would have been a prime candidate.
As I said before, in the last 30 years HIV has had orders of magnitude more opportunity to become more transmissible, and there is no evidence of that. (Again, as said before, very different in complexity, etc., and not necessarily a good comparison.
Just to repeat, I agree that the CDC is not displaying adequate concern, which may come back to haunt them (in fact, I think it will), but more concern about what we know is more important, IMO, than speculating about a mutation that changes the route of transmission to airborne.
MD in Philly (f9371b) — 10/7/2014 @ 9:02 amMD in Philly – I assume you’ve seen the story about how Firestone managed to get their plantation (and associated villages) ebola-free?
aphrael (001863) — 10/7/2014 @ 10:22 amaphrael,
I had not seen the story, but I looked it up (I see it credited to NPR, which I have refused to listen to since it lied about why JC Watts decided not to run for reelection in 2002/3). I actually don’t read many places other than here and PowerLine, because anything important will get covered and checked by crowdsourcing, I don’t have time to do anything more, so thanks for providing the info, and proving my point.
I am not sure why the version I read said they did something that the nonprofits did not do. What they did was manage the Ebola outbreak like what Doctors Without Borders routinely does, and what Samaritan’s Purse tried to do, but it was too little too late in a much larger area and population.
Isolate the known cases early, monitor the person’s contacts, minimize people going into and out of an area to those who are cleared and must travel. They were able to succeed as while they had a larger population by far than most previous outbreaks, it appears they were relatively isolated from other populations and there was already an organized societal infrastructure that was able to make a coordinated response.
At least that is how it appears to me.
The main problem, especially in Liberia, is that the disease got into a metropolitan area with poor infrastructure, organization, and hygiene with insufficient manpower and facilities to do what needed to be done.
Which is why I said before, (from what I understand not being there) that at this point, the only way to control this outbreak with current knowledge and tools, is essentially a massive “shelter in place” with a massive airlift of supplies, along with facilities to take sick people to when they are identified. A larger and far more massive effort than Sierra Leone did with their 3 days stay at home.
A company town run by responsible capitalists sometimes isn’t a bad place to live (emphasis on responsible).
MD in Philly (f9371b) — 10/7/2014 @ 10:52 amMD in Philly (f9371b) — 10/7/2014 @ 9:02 am
rather than speculate about the possibility of a mutation becoming transmissible by air,
I think we would be better served emphasizing what we do know, as you said,
like touching secretions on a door knob can transmit the disease…
It is probably transmitted in all the ways that staph is.
There have been some investigation of hospital infections, so all they have to do is collect all the illustrations.
And they should definitely not rule out in Spain, and other places, transmission through a third person who was never identified as having ebola, because they beat it back.
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