Patterico's Pontifications

10/23/2014

Ebola in NYC

Filed under: General — Patterico @ 10:39 pm



Doctor goes to Africa, treats some Ebola patients, comes back, rides the subway a little, does a little bowling, takes a taxi home, has Ebola.

Puts countless people at risk.

It’s nice that he helped fight the disease in Africa, truly. But why is it that these people who make such sacrifices, don’t bother to stay isolated for a few days when they travel back?

Hopefully nothing comes from him gallivanting around a crowded city with a contagious and deadly disease. I bet he’s not the only one who refuses to self-isolate. Luckily we have no general policy on this.

139 Responses to “Ebola in NYC”

  1. Ding.

    Patterico (9c670f)

  2. Also, made out with his GF. Such a giver…

    Gazzer (cb9ee2)

  3. They don’t need no steenkin’ protocols in NYC. Protocols are for the little people.

    daleyrocks (bf33e9)

  4. Doc has been explaining some of the problems that denial can bring in dealling with this sort of thing. So we can see that even Doctors are subject to the same phenomena. I’m sure Dr. Spencer knew intellectually that he had been taking some risks, but he obviously didn’t believed that it could happen to him.

    Watching de Blasio and Cuomo at the new conference I was struck by how confident these politicians are that they have this thing under control. They seem to enjoy the spotlight. I wouldn’t want to play liar’s poker with any of them. Compare their air of comfort and control with the behavior of the NYC authorities following 9/11. The latter knew that something really bad had happened. Not so today.

    One of the Dallas nurses has been declared virus free. So it may well be that the disease won’t prove to be as deadly here in the U. S. as in West Africa. I hope Nina Pham is getting better also. But it is also the case that in the 1996 outbreak of ebola in Gabon, they found that 11 of the 24 people who had been exposed to an ebola patient had developed anitbodies without experiencing any of the symptoms. It strikes me that we really don’t know very much about this disease despite all the interest and the assurances from the authorities that they are now in command. Could it be both less deadly and more contagious than we now believe?

    bobathome (5ccbd8)

  5. Perhaps he’ll now shed his God-complex.

    askeptic (efcf22)

  6. arrogance is pretty much a requirement for admission to med school…

    the whole “I’m a Doctor…” attitude gets patients killed or injured all the time.

    let’s hope this isn’t one of them, or things could go to hello in a hurry.

    redc1c4 (b340a6)

  7. Perhaps he’ll now shed his God-complex.

    if he doesn’t shed his internal organs first…

    redc1c4 (b340a6)

  8. What Bob said. Pols are currently breaking theirs arms to congratulate themselves on how well the protocol worked. Nothing could be further from the truth. Also, wishing Spencer all the best when I hope he dies in a bowel bleeding, organ exploding inferno of diarrhea. Not his consorts, just him, for his arrogance and disregard for his fellow man.

    Gazzer (cb9ee2)

  9. oh, and the story just keeps getting better by the minute…

    Obola doc went throught the awesome new CDC screening for high risk travelers

    it’s clown cars, all the way down. no window unlicked, and not a paint chip to be found.

    redc1c4 (b340a6)

  10. The AIDS crisis provides an excellent example of the unwillingness of probable virus carriers to curtail their contact with others. From the earliest days of the crisis, despite it being common knowledge that the mysterious “gay plague” was sexually transmitted, most gay men simply would not stop being promiscuous (they also wouldn’t stop donating blood). When Dr. Mervyn Silverman, San Francisco’s Public Health Director in the 1980s, finally ordered the closure of gay bathhouses, it was met with a substantial backlash. From the backlash we learned that gay men have rights, which apparently includes the right to be disease vectors.

    I wouldn’t count on a high degree of compliance with requests to self-isolate, even among medical professionals who should know better. Just ask Dr. Nancy Snyderman.

    ThOR (130453)

  11. ThOR #10 – if it was such “common knowledge”, how come you didn’t tell us about it back then, dear ?

    Have you communicated your special knowledge to the folk in sub-Saharan Africa – they don’t seem to realise that they are suffering a “gay plague” …

    Please try to realise that the disease of stupidity kills more people than HIV – and *you* seem determined to communicate that disease …

    Alastor (2e7f9f)

  12. and, because good news always comes in bunches, it now seems that Obola has spread into the country of Mali as well…

    redc1c4 (4db2c8)

  13. “Officials in Texas said on Thursday that nearly 100 health-care workers would be asked to sign pledges not to use public transportation, go to public places or patronize shops and restaurants for 21 days, the maximum incubation period for Ebola. Although this is not a mandate, the notices warn that violators “may be subject” to a state-ordered quarantine.”
    http://www.dispatch.com/content/stories/national_world/2014/10/18/exposure-leads-some-to-agree-to-quarantine.html

    Why would anybody think it necessary to ask a doctor who had been treating ebola patients overseas to avoid using public transportation, going to public places, etc.?

    I’m also sure if he was intimate with his girlfriend they practiced ebola safe sex.

    daleyrocks (bf33e9)

  14. “ThOR #10 – if it was such “common knowledge”, how come you didn’t tell us about it back then, dear ?”

    Alastor – I recall such being common knowledge. See the timeline below:

    http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/

    daleyrocks (bf33e9)

  15. On Wednesday, the CDC issued new monitoring guidelines for people arriving in the U.S. from ebola hot zones. The guidelines go into effect on Monday 10/27!

    http://www.cdc.gov/media/releases/2014/p1022-post-arrival-monitoring.html

    Excerpted from the current CDC web page on Ebola

    Returning Home

    Travelers in outbreak-affected countries are being screened at the airports to look for signs of Ebola and to find out if people have been exposed to Ebola, even if they are not sick. Those who have been exposed to Ebola or are sick with symptoms of Ebola will not be allowed to travel on commercial flights to the United States and potentially to other countries.

    Screening at the airport may look different in each country, but you should be prepared for screeners to check your temperature and look for signs and symptoms of illness. You will also be asked to answer questions about possible exposures to someone with Ebola.

    After the screening, authorities will decide if and when you can continue your trip.

    If you have symptoms of Ebola or have been exposed to Ebola —even if you are not sick— you will not be allowed to travel on commercial planes, buses, trains, or ships.

    http://wwwnc.cdc.gov/travel/page/humanitarian-workers-ebola

    daleyrocks (bf33e9)

  16. Cordone NYC
    We will all benefit

    mg (31009b)

  17. Doctors Without (Borders) Ethics should be sued. It’s clear that this rogue organization is making no attempt to stop the spread of this disease.

    someguy (37038b)

  18. It’s not only Doctors Without Borders. Brantly worked with Samaritan’s Purse. He was pretty explicit about wanting to make Ebola the world’s problem, not just Africa’s problem.

    nk (dbc370)

  19. And we’re not paying Doctors Without Borders to stop the spread of this disease. We’re paying NIH and CDC and the local health officers. It’s their f***ing job but they’re only interested in the politics of it just before the election.

    nk (dbc370)

  20. Doctors without Borders

    is now

    Outbreaks without Borders.

    kj (a4c7ab)

  21. A modest proposal. The AMA should have a policy requiring all doctors treating Ebola to self quarantine and if they break quarantine they lose their medical license.

    Marc (572692)

  22. my 2 cents

    Alastor, as daley links it was actually originally called “GRID”- “Gay Related Immune Disorder”. As it happened, it is thought (AFAIK) to have first come into the US through a gay male flight attendant, and the first cases were in that risk group.

    I know Doctors Without Borders is as left as it gets, but historically they have been the ones instrumental dealing with Ebola and containing it. I know this not only from the press, but having been in contact with missionaries in the middle of the 2007 Uganda outbreak. This is an unprecedented outbreak, overwhelming the usual workers, and I am sure there are people like this fellow who want to help out but do not have adequate respect for the disease.

    What do you mean, nk, that Brantley wanted to make Ebola the world’s problem? Are you suggesting he let himself get infected to make a point?

    MD in Philly (f9371b)

  23. No, I’m saying he said “Ebola is the world’s problem”. Then he made himself patient zero in the United States. In a way that made it look like it was ok to allow people infected with Ebola into the United States. And from that, I’m drawing the conclusion that he does not mind breaking a few eggs, i.e. spreading Ebola outside of Africa, to make his “the whole world should rise up against Ebola” omelet.

    nk (dbc370)

  24. Like the dentist in Florida who deliberately infected his patients with AIDS and, I suspect, others who knowing they had AIDS “donated” blood? No, I wouldn’t go so far as to accuse him of that. But I would put him in the class that opposed shutting down the bathhouses.

    nk (dbc370)

  25. But Brantly’s intentions and actions are important only if the CDC and local governments allow them to be important. It was their job to keep Ebola out of the United States and they’re failing at it.

    nk (dbc370)

  26. Puts countless people at risk.

    Thomas Duncan was symptomatic for five days before being shut up in the hospital and crossed paths with a population which broke into the three digits. Number of these he infected = 0, including four other people living in the same apartment and using the same toilet.

    Art Deco (ee8de5)

  27. Close contact with fellow Africans. And Amber Vinson is black. Let’s see if this is going to be the Mandans’ revenge for smallpox. A population never before exposed, and with no resistance, to Ebola.

    nk (dbc370)

  28. As he gently slid his fngers deep inside those bacteria infested holes, Doctor Craig Spencer was already starting to feel moisture. He thought to himself, “Bloody hell, Craig, this is f*cking disgusting.”

    “Here you are at a bowling alley when you could have spent this money on a prostitute.”

    Colonel Haiku (2601c0)

  29. Bleed, NYC, and drop dead.

    gary gulrud (46ca75)

  30. 27. Art Deco is Sammy on meds.

    gary gulrud (46ca75)

  31. While the experts argue about quarantines and travel bans shouldn’t we at least test these people during the 21+ day regularly before the virus begins to reveal itself? Surely there is a point at which the viral load is detectible before symptoms are severe enough for the virus to be impossible to ignore. Test them before departing Africa. Test them soon after arrival. Test them weekly, daily, every 72/48/24 hrs or whatever. Wouldn’t this be a much better idea than voluntary quarantine with thermometers and temp checks?

    crazy (cde091)

  32. well Nicole Lurie does exist, otoh, she still doesn’t have a clue,

    narciso (ee1f88)

  33. 27. Art Deco is Sammy on meds.

    But his point that no family members around Thomas Duncan — even though they were living in that hot-house apartment — apparently has been infected with Ebola is a good one. But that’s assuming such information is correct. And if it is, my own concerns about Ebola have been altered (or generally somewhat reduced).

    Moreover, Nigeria has managed to contain its outbreak of the virus, and that country, while it has oil wealth to take advantage of, can’t be anymore sophisticated than the US. Then again, with horrible clowns like Obama, et al, running things…

    Mark (c160ec)

  34. The CDC has already been caught hiding Ebola patients, too.

    nk (dbc370)

  35. he was just getting a resume tune up over in Africa … if he was really there to help people he would never have assumed he was safe when he got home … he was looking for credibility as a “good person” by working for Doctors without Borders … turns out he just self identified as a “Moron without Brorders” who endangered his girlfriend, close friends and possibly hundreds of NY’ers … whats the old joke “What do you call the guy who finished last in med school” ?

    JeffC (faa0ee)

  36. Gary Gulrud – given that two regular commenters at this site live in NYC, your comment in #30 is *incredibly* rude and disrespectful.

    Please retract it.

    aphrael (88ca09)

  37. The WHO yesterday released an update on their take of the crisis. They find that the number of “cases continue to increase exponentially in Guinea, Liberia, and Sierra Leone” (sorry Sammy and NPR,) but otherwise they recommend travel restrictions, etc., that are less intrusive than the CDC/HHS. Their findings mirror the administration’s concern over maintaining normal travel and trade relations in order to (maybe hopefully certainly presumably) keep the countries with “intense” outbreaks (those experiencing exponential growth) functioning as close to normal as possible. They have a more prosaic view of the crisis than the Obola administration as evidenced by this summary: “The key lessons learned to control the outbreak include the importance of leadership, community engagement, bringing in more partners, paying staff on time, and accountability.” Like Obola, they are also concerned about “uncontrolled migration” if more stringent travel control measures are taken.

    IMHO they’re just blowing smoke. Also, look for “intense” replace “exponential” in the coming days. Not sure why they think this is significant. Perhaps it is an acknowledgement that the public is so ignorant of simple mathematics that exponential has the same emotional connotation as logarithmic (really hard), whereas “intense” cannot be confused with diminishing or perhaps chilling out.

    If one assumes that it is impossible to control an international border, then the prospect of “uncontrolled migration” will always dictate your policies. And the policies will always involve a lot of wishful thinking. This is the thinking of utopians who have memory blocks when it comes to North Korea, the old Soviet Union, and even Cuba. Of course, regimes like those mentioned lock their inmates in, no fear of foreign invasion, but they do illustrate that border control, especially with land mines and machine guns (East Germany in the old USSR, and North Korea today) can be achieved.

    bobathome (5ccbd8)

  38. Rainbow visible through the clouds. Capital “J” Journalist and new national hero, MSNBC host Chris Hayes making plans to go bowling at The Gutter, presumably whenever it is cleared to reopen, to show New Yorkers he is not afraid of the ebola.

    I am in awe.

    daleyrocks (bf33e9)

  39. Aphrael – fixed it

    JD (d10a47)

  40. Point One- the moment Ebola hit a major metropolitan area, in this case Monrovia, it became a world-wide issue whether the world acknowledged it or not, whether Dr. Brantley was flown back or not.
    The world has a choice of basically three choices in dealing with it:
    1) Quarantine the countries involved. No flights out, no boats out, nobody allowed to cross the border on foot; enforced by shooting on sight. Maintain this until everyone is dead or the outbreak somehow comes under control after a massive loss of life.
    2) Play pat-a-cake with it and accept the reality of episodic Ebola outbreaks scattered around the world. The fellow who collapsed in a Nigerian airport was from Minnesota. He could have just as easily been flying into O’Hare for a connected flight to Minn./St. Paul.
    Repeat at unknown frequency around the world, sometimes in a city with resources to contain it, sometimes perhaps not.
    This is what we are now doing.
    3) Quarantine the countries with strict procedures (more than we have now), make a massive effort to control the disease, knowing that the sooner the disease is controlled the sooner the world can be at ease. This also would be the kindest to the people of the countries involved.

    As it is, there has been more BS and speculation being tossed around than taking action in regard to the things we know, and deal with speculation as a secondary concern.

    MD in Philly (f9371b)

  41. JD, thank you. :)

    aphrael (88ca09)

  42. Daley – aggressively beta males flexing is soooooo precious.

    JD (d10a47)

  43. 36. You are such a flatterer.

    gary gulrud (46ca75)

  44. Gary Gulrud – that’s enough of that crap.

    JD (d10a47)

  45. 45. Speaking of offensive, bye bye.

    gary gulrud (46ca75)

  46. Point Two- IMO, the concern over Brantley being flown back to the US is similar to concern over a nuclear submarine returning to a US home base.
    In both situations if there is a successful conspiracy plot or a multi-system failure of safeguards, there will be hell to pay; but the risk of this is so small as to be incalculable.

    Brantley was brought back in a plane with an isolation system that had been designed for such things and worse, e.g. smallpox, much more contagious and air-borne. He was taken to a facility designed to take care of people with such conditions. That these facilities exist reflects not only the possibility of such diseases reaching the US, but the fact that we have such germs already in the US in P4 labs. Brantley was essentially housed in a mobile P4 lab.

    MD in Philly (f9371b)

  47. I wouldn’t be afraid to go to the Gutter, daleyrocks. By the time I’m back in the city, even the worst case scenario (imagine he developed a blood blister and it exploded into a bowling ball finger hole and left virus there), the virus would have died of exposure.

    Now, I won’t be back in the city until Sunday night, and I haven’t been bowling in more then ten years, and I’m leaving the city again on Thursday and have lots to do in the interim, so the odds of me getting there are slim.

    I continue to maintain that the real *anxiety* should be over subway surfaces. The MTA doesn’t clean particularly often or well, and so they seem like a *possible* vector. And touching them is pretty much unavoidable.

    aphrael (88ca09)

  48. But why is it that these people who make such sacrifices, don’t bother to stay isolated for a few days when they travel back?

    The first question is: Why isn’t an ebola DNA test used? Can’t soembody bite the bullet and decide the test is reliable enough to use even without FDA approval?

    How long are we going to wait for official certification of things? If some really serious neew infectious disease strikes we won’t be able to afford this kind of thing. People have to us etheir brains.

    And you are right about “a few days” We don’t need a 21-day quarantine. Making it 21-days reduces the chances that any kind of isolation would happen at all.

    Sammy Finkelman (d22d64)

  49. “I wouldn’t be afraid to go to the Gutter, daleyrocks.”

    aphrael – Neither would I. I am mocking him for his public display of faux bravery. The City has closed it. Even if there were any risks, decon teams will have eliminated them before it reopens. He is truly a new national hero and example for all of us to follow.

    daleyrocks (bf33e9)

  50. Point Three- I am as untrusting of anything President Obama says, and that anyone who works under him says, as anyone. God alone knows the reaches of dishonesty and malicious (to us) intent.
    But I don’t think Dr. Brantley was involved in any plot wittingly or unwittingly.

    I did this once before, maybe nk you just disagree.
    “Walking a mile in Dr. Brantley’s shoes”-
    Brantley went to Liberia to help provide medical services in a country that has (I have read) 1 national doctor for every 1,000,000 people, which is the result of decades of civil war. When he went, with his family, Ebola was not an issue.
    Ebola became an issue. The Liberian government and Doctors Without Borders (DWB) asked Samaritan’s Purse to take over the anti-Ebola effort in Liberia so DWB could focus their resources on Sierra Leone and Guinea. Samaritan’s Purse has had an established presence in Liberia, they had a base to operate from. I am assuming this was better than DWB trying to turn over their efforts in the other countries to someone else.
    Brantley gets ill while his family is in the US temporarily for a family wedding. He is sick to the point where he “thinks he is going to die”. At this point he is trying to stay alive, barely, and has no influence on anything else.
    Dr. Brantley’s (ultimate) boss, Franklin Graham, thinks, “Oh my, one of my people, after risking his life to care for others, is now sick. What can I do to help him?”, and makes calls and finds out a number of things are available and pursues them.

    To me it seems perfectly expectable, especially since it could be done with essentially no risk to others, as I discussed above.

    MD in Philly (f9371b)

  51. “The first question is:”

    Sammy – The first question is why the protocols the CDC claims are in effect overseas, that people who have been exposed to ebola should not use planes or public transportation that I highlighted earlier in the thread, not in effect domestically?

    Is the CDC in fact suggesting you can catch ebola from sitting next to somebody on a plane or bus or subway, contrary to what President Obama has been assuring us?

    daleyrocks (bf33e9)

  52. He had gone for a 3 mile run earlier the same day, I think, of the later bowling alley event. I can imagine that he may have thought he couldn’t be coming down with Ebola that night after doing that earlier in the day.
    That on top of people just thinking it is not going to happen to them.

    People often don’t think something can happen to them until it becomes personal. Sexual behavior in the age of AIDS in the gay community did not change until after people had gone to enough funerals of friends.

    MD in Philly (f9371b)

  53. bobathome (5ccbd8) — 10/23/2014 @ 11:00 pm

    But it is also the case that in the 1996 outbreak of ebola in Gabon, they found that 11 of the 24 people who had been exposed to an ebola patient had developed anitbodies without experiencing any of the symptoms.

    Subclinical cases. And we are hearing nothing at all about subclinical cases, yet obviously they have to exist. So there’s something wrong right there with what is being said to the public. This could be easily checked. All you havr to do is check for ebola antibodies among people who were in a situation where the chances of getting exposed is high, but they never were diagnosed with ebola and you know enough about them to know that they would have been disagnosed with ebola had they had a real case.

    The question is: Are any subclinical cases infectious? It could be that it is possible, but rare (in 1 ebola case out of 20, or out of 150) You might have that then where there is a lot of ebola, but not anywhere else.

    But it is probably more likely that the doctor was infected by something that some not yet isolated or disagnosed patient had ejected.

    It strikes me that we really don’t know very much about this disease

    We should know a lot more. How is it we don’t know where the virus survives and what kills it? I think reason is this has only be studied so as to enable it to be safely studied. Anotehr reaosn is a reluctance to draw conclusions. We have ridiculous things going on. It last only a few days in water at room temperature/ There is no place else it should last longer. The idea of destroying the possessions of people who were in the presence of ebola seems unnecessary. At least anyway, in dallas, they didn’t kill the dog. But they also played with the dog!!

    despite all the interest and the assurances from the authorities that they are now in command.

    Well, some things actually can be known. I don’t pay attention to teh authorities. I pay attention to books written before all this, and anecdotal evidence.

    Sammy Finkelman (d22d64)

  54. bobathome @4

    Could it be both less deadly and more contagious than we now believe?

    Less deadly, definitely.

    I’ve been saying that for some time. Some people beat it back. And I said, therefore, that people in Liberia should be given 250,000 units of Vitamin A, plus other vitamins known to help in infections, like maybe folic acid, calcium, zinc whatever. It’s no more experimental than using so much chlorine.

    More infectious? That is always an idea, but if true, it would happen in very few ebola cases. When you have an epidemic, that could start to become a realistic possibility.

    I know there is something wrong with the 21-day incubation period. If that period of time is not just something pulled out of the air (a distinct possibility) and reflects experience in the Congo years ago, the extremely long incubation period could also be:

    A) Undetected cases, which could maybe be undetected either because

    1) they never became clinical

    or because

    2) the case never came to the attention of the doctors

    (Maybe because the people involved wanted to bury their dead or because it was somebody passing through or the exposure to one of the cases wasn’t known.

    Let’s say only 85% of possible contacts become known. There might be some cases where somebody had some sort of known 21-day old contyact with someone with ebola and unknown 10-day old exposure – the doctors or epidemiological investigators would attribute it to the 21-day exposure because that’s the easiest thing to say.

    B) Infection through things an ebola patient’s bodily fluids touched, maybe several days later.

    Sammy Finkelman (d22d64)

  55. They are actually treating ebola like it was more infectious than it is.

    It could be what they are overlooking is contamination by non-isolated patients (who are sick enough to be diagnosed, and would be isolated in the United States or Europe, but aren’t when the disease is new, or there are too many cases.)

    Another possibility is some route of contamination that didn’t come to mind.

    Sammy Finkelman (d22d64)

  56. MD in Philly (f9371b) — 10/24/2014 @ 10:16 am

    in a country that has (I have read) 1 national doctor for every 1,000,000 people, which is the result of decades of civil war.

    They used to have 3,000 doctors in the 1970s. People from other places in western Africa that were English speaking colonies, like Ivory Coast, used to go to medical school in Liberia.

    Wall Street Journal Oct 20: Many Liberian Doctors—Including President’s Son—Are Staying Away

    As President of Ebola-Ravaged Country Pleads for Foreign Helpers, Her Physician Son Sends Aid from U.S.

    he’s not only not going theer right now, he’s not sending anyone else:

    In 2007, Dr. Sirleaf founded Heartt Foundation—an acronym for Health Education and Relief Through Training—to recruit medical specialists and residents to spend a month practicing in Liberia and teach at its only medical school. Heartt sent 70 doctors in 2009 alone to Liberia to train students, including Dr. Moses.

    But Heartt’s last team of four doctors left Liberia in March, just as cases of Ebola were surging. JFK hospital, where Heartt physicians worked, appeared ill-prepared for the coming epidemic, Dr. Sirleaf said. The risk to doctors and trainees, who hadn’t confronted Ebola before, seemed unacceptably high, he said.

    He didn’t want to be responsible for sending anyone there.

    Sammy Finkelman (d22d64)

  57. Dr. Sirleaf runs the emergency room at a hospital in Albany, Ga. He heads an effort to ship protective gear to medical workers in Liberia, but hasn’t returned himself since a 10-day trip in August as the virus was spreading out of control.

    Sammy Finkelman (d22d64)

  58. #37: no, when an epidemiologist says “exponentially”, they literally mean that the number of cases is best modeled with an exponential function rather than a linear function. A disease is endemic when the underlying exponent (the “real” exponent, rather than the inferred exponent) is greater than or equal to 1.

    Jeff Hall (4e23a4)

  59. daleyrocks (bf33e9) — 10/24/2014 @ 10:17 am

    Sammy – The first question is why the protocols the CDC claims are in effect overseas, that people who have been exposed to ebola should not use planes or public transportation that I highlighted earlier in the thread, not in effect domestically?

    They used the same protocols. Remember, he was allowed to board a commercial plane in Liberia.

    If you have symptoms of Ebola or have been exposed to Ebola —even if you are not sick— you will not be allowed to travel on commercial planes, buses, trains, or ships.

    This does not apply to doctors, who are supposed to be skilled in preventing contamination. Just like the hospital in Dallas was supposed to be practicing infection control. And normal infection controls might have been enough.. But the dirty little secret is, hospitals aren’t so good at it.

    They would never apply the same defintion of being exposed to Ebola to doctors that they do to everybody else, because if they did, nobody would would go there to treat any ebola patients.

    Is the CDC in fact suggesting you can catch ebola from sitting next to somebody on a plane or bus or subway, contrary to what President Obama has been assuring us?

    I think they are, but the problem is, that is only supposed to be with somebody well past the first signs of serious ebola, (and the record seems to bear that out)

    So why this blanket prohibition, even on people who didn’t show a temperature a few hours before?

    They are being inconsistent, and possibly taking into account failuire to abide by the protools.

    Sammy Finkelman (d22d64)

  60. 28. nk (dbc370) — 10/24/2014 @ 6:14 am

    A population never before exposed, and with no resistance, to Ebola.

    That’s just about everyone in the world, except for people living in certain rural locations in Africa.

    They still don’t know the natural reservoir. Fruitt bats? There were no known human cases in 2010.

    Sammy Finkelman (d22d64)

  61. I think the American people are getting wise to the unpredictability of this ebola thing and the games the CDC, federal government, and city health departments are playing that are clearly not in the best interests of actual disease containment in this country. The virus story was settling down a bit, but thanks to the subway riding non self-quarantined Dr., the ebola story’s back with a vengeance in the nation’s biggest media market. There were a lot of squirming and tap dancing and butt covering high level democrat politicians sitting at the table at that press conference in New York this morning. You should go watch the press conference idiocy (it’s posted at Hot Air) if you have not already seen it.

    elissa (84541a)

  62. 37. bobathome (5ccbd8) — 10/24/2014 @ 9:25 am

    The WHO yesterday released an update on their take of the crisis. They find that the number of “cases continue to increase exponentially in Guinea, Liberia, and Sierra Leone” (sorry Sammy and NPR,)

    The WHO still doesn’t know what is talking about, now taht it’s exaggerating the extent rather than sleeping through it. Every day that goes by makes it clearer taht the epidemic has peaked in Liberia. All the precautions that people are taking in Liberia, do not count for nothing.

    To maintain that it is still increasing by two every two or three weeks while the number of reportyed cases goes down, means taht the percentage of reported cases is going way down, and there’s no signs of that – I would think the opposite might be true.

    Now it’s not just NPR – it’s Hot Air:

    http://hotair.com/archives/2014/10/24/report-ebola-cases-finally-starting-to-drop-in-liberia/

    Sammy Finkelman (d22d64)

  63. http://www.buzzfeed.com/jinamoore/ebola-cases-in-liberia-are-dropping

    Before, people used to wait outside ebola wards. Now 50% of them are empty. Are case sstill doubling and even more people avoiding ebola wards?

    Sammy Finkelman (d22d64)

  64. “They used the same protocols. Remember, he was allowed to board a commercial plane in Liberia.”

    Sammy – Reread that. Doesn’t it say he needs to arrange a charter flight and it specifically applies to health care workers who have been exposed to ebola even if they are not sick.

    daleyrocks (bf33e9)

  65. If one assumes that it is impossible to control an international border, then the prospect of “uncontrolled migration” will always dictate your policies.

    Well, you could control it more and more, and get people killed crossing the border, but it would
    be unrealistic to reduice it to zero. Not even North Korea tries that – they rather, let some people escape into China.

    You also have to consider what travel would be permitted. Theer is always some. If they cross the border by bus, there might not be such good checking of people as there is at the airport.

    Of course, regimes like those mentioned lock their inmates in, no fear of foreign invasion, but they do illustrate that border control, especially with land mines and machine guns (East Germany in the old USSR, and North Korea today) can be achieved.

    Cuba?

    What’s the latest news from Cuba? Page 1, New York Times of Friday, October 10, 2014: In Rickety Boats, Cuban Migrants Again Flee to U.S.

    Mr. Heredia is one of about 25,000 Cubans who arrived by land and sea in the United States without travel visas in the fiscal year that ended on Sept. 30, according to government figures. He, like many others, is also an unexpected throwback to a time that experts thought had long passed: the era when Cubans boarded homemade vessels built from old car parts and inner tubes, hoping for calm seas and favorable winds. As the number of Cubans attempting the voyage nearly doubled in the past two years, the number of vessels unfit for the dangerous 90-mile crossing also climbed.

    Not since the rafter crisis of 1994 has the United States received so many Cuban migrants. The increase highlights the consequences of a United States immigration policy that gives preferential treatment to Cubans and recent reforms on the island that loosened travel restrictions, and it puts a harsh spotlight on the growing frustration of a post-Fidel Castro Cuba.

    More Cubans took to the sea last year than in any year since 2008, when Raúl Castro officially took power and the nation hummed with anticipation. Some experts fear that the recent spike in migration could be a harbinger of a mass exodus, and they caution that the unseaworthy vessels have already left a trail of deaths….

    ….The United States Coast Guard spotted 3,722 Cubans in the past year, almost double the number who were intercepted in 2012. Under the migration accord signed after the 1994 crisis, those captured at sea are sent back to Cuba. Those who reach land get to stay, [or, as I descriobed it, instant amnesty] which the Cuban government has long argued draws many people into making the dangerous voyage.

    And why the deaths? For the past 10 years, sophisticated smuggling networks were responsible for the vast majority of Cuban migration. A crackdown by the American authorities and a lack of financing available to Cubans on the island have shifted the migration method back to what it was two decades ago, when images of desperate people aboard floating wooden planks gave Cuban migrants the “rafters” moniker.

    That’s what more border control gets you: Deaths.

    Sammy Finkelman (d22d64)

  66. Where does http://www.cdc.gov/media/releases/2014/p1022-post-arrival-monitoring.html say that anyone should take acharter flight?

    Besides which, those guidelines were issued after Dr. Craig Spencer arrived back.

    He landed at Kennedy Airport on Thirsday, October 17, and those guidelines were issued on Wednesday, October 22, 2014, the day he reported symptoms.

    Sammy Finkelman (d22d64)

  67. “This does not apply to doctors, who are supposed to be skilled in preventing contamination.”

    Sammy – Can you point to that language?

    They would never apply the same defintion of being exposed to Ebola to doctors that they do to everybody else, because if they did, nobody would would go there to treat any ebola patients.

    Except that doesn’t make sense, because doctors and other health care workers can incubate ebola from hot zones just as easily as anybody else and if they were actually treating patients their potential risk is higher. Why would you give them a free pass?

    daleyrocks (bf33e9)

  68. “Besides which, those guidelines were issued after Dr. Craig Spencer arrived back.”

    Sammy – The domestic guidelines go into effect 10/27 and were issued Wednesday, before Spencer was diagnosed. I believe the overseas guidelines were already in place, but let me know if you find something different.

    daleyrocks (bf33e9)

  69. I didn’t close the link, but this shouild work OK.

    Governor Andrew Cuomo was there:

    The session, more than three hours, turned out to be part pep rally and part training conference, as Gov. Andrew M. Cuomo and Mayor Bill de Blasio kicked off events with speeches that took pains to pay tribute to 1199 S.E.I.U., the powerful health care workers union that was one of the organizers.

    “What’s going to kill this disease is knowledge, is training, is preparation,” Mr. Cuomo said.
    The governor said he remembered anthrax in 2001, the advent of H.I.V. in the 1980s and even the discovery of Ebola in 1976, the year he turned 19, adding, in a Wikipedia-like note, that “it was named for a river in the Congo.”

    He vowed New York would be different from Dallas, where two nurses have contracted the virus after caring for Thomas Eric Duncan, the Liberian man who died on Oct. 8, because New York had more time to prepare.

    Sammy Finkelman (d22d64)

  70. Sammy– people can watch the press conference themselves. Did you? They wouldn’t have pulled together an emergency press conference this morning unless there was a perceived problem and unless the media and public demanded it. Right?

    elissa (84541a)

  71. here are the new CDC travel protocols, in one simple graphic.

    redc1c4 (4db2c8)

  72. Oh – these are the other guidelines:

    http://wwwnc.cdc.gov/travel/page/humanitarian-workers-ebola

    It’s advice.

    I think the charter flights are only if someone is being evacuated. Which could be for people not sick buit exposed, but I think this means something like being stuck with aneedle, or something splashing into theior face: known exposure.

    Ordinary travelers maybe will get turned away if they have any kind of closew contact – I don’t know what questions they are asking now. Medical people are assumed to know what they are doing and when they have been exposed. Obviously wrong, partly because the treatment centers are full of undiagnosed cases.

    Sammy Finkelman (d22d64)

  73. The CDC on how ebola is sopread:

    http://wwwnc.cdc.gov/travel/page/humanitarian-workers-ebola

    Ebola is spread through direct, unprotected contact with the blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of an infected symptomatic person, contact with the body of someone who has died from Ebola, and exposure to objects (such as needles) that have been contaminated with infected blood or other body fluids and tissues.

    This may be taking things too far. In addition to contact with the body, the virus has to get inside your body.

    But you can’t rule out airborne exposure entirely.

    Sammy Finkelman (d22d64)

  74. elissa (84541a) — 10/24/2014 @ 11:34 am

    people can watch the press conference themselves. Did you? They wouldn’t have pulled together an emergency press conference this morning unless there was a perceived problem and unless the media and public demanded it. Right?

    I didn’t watch it or know there was one The are front page headlines. I think the problem is some of their advice is contradictory. If A then B should be true. so you would think either don’t do A or do B.

    It really does matter whose ox is gored.

    Sammy Finkelman (d22d64)

  75. If Ebola cases are actually decreasing in Liberia, it makes no sense in light of everything we know, even in light of everything you speculate, Sammy.
    So I doubt very much it is the case.

    MD in Philly (f9371b)

  76. Be careful out there, Sammy.

    elissa (84541a)

  77. Here is some criticism:

    http://www.allnewspipeline.com/NY_Ebola_Press_Conference_Of_Lies.php

    Mr. Spencer was contagious as of the onset of the first symptoms he felt, according to every FAQ page out there, yet this NY Ebola press conference of lies, claims there is no risk.

    The FAQs are wrong.

    Showing symoptoms is a good “bright line” but there is every reasosn to believe someone can yransmit the disease only somnetiome later – they have to be shedding virus particles. If the syMptoms are only weakness and fever, that’s not getting outside the body.

    I UNDERSTAND THIS.

    I DON’T UNDERSTAND WHY EVERYBODY ELSE DOESN’T UNDERSTAND THIS.

    MAYBE THEY DO.

    The guidelines should not be taken literally. You have to think behind them. i.e. Why did they say this?

    Of course, the people issuing the guidelines can get themselves into trouble with oversimplifications and easy to follow rules like this.

    Sammy Finkelman (d22d64)

  78. 77. elissa (84541a) — 10/24/2014 @ 11:47 am

    Be careful out there, Sammy </i.

    No reason to worry. The doctor never came within half a dozen miles of me at least. Even if I was on the same subway car, it is nothing. It is doubt piled upon doubt piled upon doubt.

    It simply is not spreading this way.

    This is not the Andromeda Strain, or like most of the fictional books and movies about new epidemics.

    Sammy Finkelman (d22d64)

  79. High-fiving a sweaty hand at a bowling alley?

    hadoop (f7d5ba)

  80. There is no evidence that in the real world outside of a lab (or ICU on a ventilator) that Ebola is spread through the air, that a person can sneeze or cough into space and droplets with the virus remain suspended in air waiting to be breathed in by another person at a later point in time.
    This is why, in one way, “sitting next to a person” doesn’t put you at risk.
    What does put one at risk is if the sick person directly sneezes or coughs on you, sweats on you, bleeds on you. And one can’t be sure that will not happen until after the person is no longer sitting next to you.

    So, from the point of view of the public riding a bus, the risk is minimal at this point.
    from the point of view of one who might have it, there is no sense in potentially exposing others.

    At least that seems to me to be the common sense interpretation.

    MD in Philly (f9371b)

  81. “I think the charter flights are only if someone is being evacuated.”

    Sammy – I think the guidelines are self-explanatory.

    daleyrocks (bf33e9)

  82. 76. MD in Philly (f9371b) — 10/24/2014 @ 11:47 am

    If Ebola cases are actually decreasing in Liberia, it makes no sense in light of everything we know, even in light of everything you speculate, Sammy.

    It makes perfect sense, especially in light of my speculations. Ebola still can spread to someone unexpectedly, in an unknown way, but still there may be less than one new case per infected case. It may spread throuygh droplets, but the droiplet has to find a target, and theer may not be very many of them.

    So I doubt very much it is the case.

    I think it’s true, but it requires great effort on the part of everyone in Monrovia. The bleach is working.

    Meanwhile, it is posisley getting worse in Guinea. The doctor came from Guinea.

    Sammy Finkelman (d22d64)

  83. I do not think it is unreasonable for the public to expect that a medical doctor who has actually treated active ebola cases in one of the main theaters of the disease should be quite careful about his contact with the public for a reasonable period of time after he returns home. Whether you call it voluntary or forced quarantine I don’t care. But do it!

    elissa (84541a)

  84. “I think the problem is some of their advice is contradictory.”

    Sammy – O rly? Advice, guidelines, protocols, requirements? What makes you say that?

    daleyrocks (bf33e9)

  85. So has it ever been determined when and how Ashoka Mukpo contracted ebola? He is the NBC cameraman in the Nancy Snyderman group. That would be helpful to know, I think.

    elissa (84541a)

  86. Sammy, don’t be invested in your ideas and think.
    How has every Ebola outbreak in the past been contained?
    Isolating and quarantine of infected people and those exposed until the last person has died or recovered.
    All of the reports that I have read have said that the country has been reduced to family members taking sick individuals to clinics by cab, only to be sent home because there are no beds.
    No isolation, forced prolonged contact with people who are ill with poor sanitation, exposure of unknown members of the public.
    Everything is right for continued exponential spread, as long as there are still enough people to contract the disease.

    If there are fewer people showing up, maybe it is because the has ordered the cremation of all deceased, and the people don’t like that idea and would rather keep a sick family member at home so they can bury them after they die.
    That is more likely than actually having fewer cases.

    Unless there has been a direct miraculous intervention.

    MD in Philly (f9371b)

  87. from NYT:

    Dr. Spencer began to feel sluggish on Tuesday but did not develop a fever until Thursday morning, he told the authorities. At 11 a.m., he found that he had a 100.3-degree temperature and alerted the staff of Doctors Without Borders, according to the official.

    The staff called the city’s health department, which in turn called the Fire Department.

    Emergency medical workers, wearing full personal protective gear, rushed to Dr. Spencer’s apartment, on West 147th Street. He was transported to Bellevue and arrived shortly after 1 p.m.

    So he’s out jogging, bowling, riding public transportation, etc. until late in the evening on Wednesday and then being carried off to Bellvue by full suited hazmat teams about 12 hours later. Very reassuring.

    elissa (84541a)

  88. “How has every Ebola outbreak in the past been contained?”

    MD in Philly – Not much conversation about the ebola outbreak in the Congo. From the 10/22/2014 WHO situation report:

    ANNEX 2:
    EBOLA OUTBREAK IN DE
    MOCRATIC REPUBLIC OF
    THE CONGO
    As at 20 October 2014 there have been 66 cases (38 confirmed, 28 proba
    ble) of Ebola virus disease (EVD)
    reported in the Democratic Republic of the Congo, including eight among health

    care workers (HCWs). All
    suspected cases have now been laboratory confirmed or discarded. In total, 49 deaths have been reported,
    including eig
    ht among HCWs.
    Of 1121 total contacts, 1116 have now completed 21

    day follow

    up. Of five contacts currently being monitored,
    all were seen on 20 October, the last date for which data has been reported. This outbreak is unrelated to that
    affecting Guinea,
    Liberia, Nigeria, Senegal and Sierra Leone.

    daleyrocks (bf33e9)

  89. Imagined September Conversation

    Dr. Spencer: Honey, what would you like me to bring you back from Africa?

    Girlfriend: I can’t think of anything, darling, just surprise me, but bring yourself back safe.

    Imagined October Conversation

    Girlfriend: It’s so nice to have you finally back home safe, darling. What did you bring me.

    Dr. Spencer: Honey, it’s great to be back home. You may not have noticed your present, but I gave it to you last night, the gift of ebola.

    daleyrocks (bf33e9)

  90. “From the backlash we learned that gay men have rights, which apparently includes the right to be disease vectors.”

    – ThOR

    You realize that straight people have sex too, right? As in, they also seem to have “the right to be disease vectors”?

    Leviticus (f9a067)

  91. “You realize that straight people have sex too, right?”

    Leviticus – Pictures or it doesn’t happen!

    daleyrocks (bf33e9)

  92. Thor, your heteronormative narrative is leaving young Master Leviticus no safespace to express his intersections…

    Colonel Haiku (2601c0)

  93. In New Mexico, it’s illegal for an unshaven woman to have sex while walking down Main Street.

    Colonel Haiku (2601c0)

  94. he will not hesitate to confront your stupid racist/sexist/misogynist/homophobic/transphobic/ableist behavior.

    Colonel Haiku (2601c0)

  95. Leviticus, I mean no disrespect to you or to your opinions and worldview, but had you even been born yet when the AIDs epidemic was going full blast in America? There is a filtered and romanticized version of past events that comes through your comments sometimes which suggests you are not aware of what really happened. This AIDs comment to THOR is an example.

    elissa (84541a)

  96. “In New Mexico, it’s illegal for an unshaven woman to have sex while walking down Main Street.”

    Colonel – You are confusing me. I thought it was illegal for women to shave in New Mexico and that Main Street was the preferred location for sex.

    daleyrocks (bf33e9)

  97. Good allah. Noam Scheiber admits the NY Public officials’ ebola press conference was a pants on fire event. But you see it’s really a good idea for our betters to lie to us if it’s for our own good and so we won’t get too anxious. Because, you know, anxiety is a public health risk too.

    Among the many accurate pieces of information that Governor Andrew Cuomo, Mayor Bill de Blasio, and city Health Commissioner Mary Bassett disseminated to the public was the following whopper: That Dr. Spencer acted entirely appropriately and responsibly. Since returning home from Africa a little over a week ago, they told us, he’d stayed home from Columbia University Medical Center, where he is employed. He took his own temperature twice a day. He instigated his own hospitalization at the first sign of fever. As Cuomo put it, “He was familiar with the possibility and the circumstances, so he handled himself accordingly”—a sentiment the governor and his colleagues repeated over and over in response to questions from reporters.
    This is clearly not true. Despite the fact that Dr. Spencer presented a minuscule risk to anyone around him when he decided to ride the subway, go bowling, and frolic at the High Line Park on Wednesday, he obviously should not have been out and about. His decision to do those things forced the city to shut down and extensively clean the bowling alley in question and dispatch its “medical detectives” all over the city to figure out whom he may have come into contact with. Spencer’s wanderings probably also put a crimp in all the retail establishments along his Wednesday route. And they have generally required the city to manage the suddenly tormented psyches of millions of New Yorkers. It doesn’t seem like asking a guy to hang out in his apartment for a few weeks would have been too much to ask in order to avoid this mess. (On top of which, it’s become our policy in this country to quarantine anyone who had direct contact with an Ebola patient, as Dr. Spencer did repeatedly. Why should someone be exempt from this rule just because the contact happened outside the country?)

    So, as I say, we were some lies told last night.
    …..Having said all that, I kinda think Cuomo et al were right to lie last night. As I’ve noted, the big problem these officials faced in the aftermath of the Spencer news was massive public anxiety.

    http://www.newrepublic.com/article/119978/cuomo-de-blasio-lied-about-craig-spencers-ebola-thats-ok

    elissa (84541a)

  98. MD in Philly (f9371b) — 10/24/2014 @ 12:04 pm

    How has every Ebola outbreak in the past been contained?
    Isolating and quarantine of infected people and those exposed until the last person has died or recovered.

    I didn’t say it was contained. I said it had stopped getting exponentially worse and had plataeued.

    All of the reports that I have read have said that the country has been reduced to family members taking sick individuals to clinics by cab, only to be sent home because there are no beds.
    No isolation, forced prolonged contact with people who are ill with poor sanitation, exposure of unknown members of the public.

    Those reports are sort of a few weeks old. The clinics now are no longer full. People are using bleach all over. So they may have cut the transmission rate to less than one new case per old case/

    That is far from ending it.

    Everything is right for continued exponential spread, as long as there are still enough people to contract the disease.

    The new factor is clorox, and precautions people are taking.

    If there are fewer people showing up, maybe it is because the has ordered the cremation of all deceased, and the people don’t like that idea and would rather keep a sick family member at home so they can bury them after they die.

    Yes. But for it continue to be expanding the percentage of epople who show up would be getting even lower. And the numnber of burials would be going up. Or they would hiding the burials from the authorities.

    This was doubling evry three weeks or so/

    It can’t be doing that any more.

    Unless there has been a direct miraculous intervention.

    The things people are doing are having an effect. That could also be divine intervention. Not easy to happen.

    People wash in bleach before entering any grocery store.

    Sammy Finkelman (d22d64)

  99. 84. The doctor seems to haave put himself under half quarantine. Isolated himself from people he knew. Maybe was careful abouit any bodily fluids.

    Sammy Finkelman (d22d64)

  100. elissa – Doctors make the worst patients.

    daleyrocks (bf33e9)

  101. “84. The doctor seems to haave put himself under half quarantine.”

    Sammy – Maybe he only has half ebola.

    daleyrocks (bf33e9)

  102. daleyrocks (bf33e9) — 10/24/2014 @ 2:46 pm

    LOL!

    felipe (40f0f0)

  103. He didn’t “isolate himself” at all before he became obviously symptomatic. Going bowling is not isolating yourself.

    Going bowling after you’ve already been feeling “sluggish” for more than a day is certainly not “isolating yourself.” He had a subjective but known symptom, and nevertheless, he probably wore rented shoes and used a community bowling ball.

    As far as I can tell from press reports, the only ways in which he even arguably “isolated himself” before he became objectively symptomatic was that he didn’t return to seeing patients in his regular NYC ER. But given that he’d just returned from a heroic and taxing mission of mercy — let’s give Dr. Spencer full and due credit for that, folks — I suspect his refraining to see patients was more likely a function of him needing some time off from his job. None of his other conduct suggests that he was self-limiting his exposure in any other context.

    If I had to defend his conduct in court in a negligence lawsuit or a proceeding to revoke his license, I could argue, I suppose, that if he wasn’t objectively symptomatic yet, and neither the law nor hospital rules absolutely require him to self-isolate, and no-one had put him under a legal quarantine order (or its voluntary equivalent), then “reasonable care” didn’t require him to self-isolate. Let’s also absolve him of intentional misconduct, certainly. And let’s acknowledge that he’s not quite as unprofessional as that NBC News doc who broke a voluntary-but-official quarantine for no better purpose than to go get a burger.

    But he’s no paragon of sound medical judgment or prudence. He’s certainly no role-model, if the focus is on his post-return conduct.

    Beldar (fa637a)

  104. Maybe there are Patterico readers who can tell us if “The Gutter” in Brooklyn is the kind of place where young ER docs bring their own bowling balls and shoes. I can’t seem to find that anywhere on the net, but I got to feeling too discouraged so I quit looking.

    Beldar (fa637a)

  105. It must be admitted that the WHO data from Liberia is not very definitive. For the past two weeks Liberia has been reporting the number of confirmed cases as less than the number of confirmed deaths. In fact, the one statistic that has flat-lined is the number of confirmed cases, ranging from 931 on October 3rd, to 941 on Oct. 5th, and slowly creeping up to 965 on Oct. 18th. Meanwhile confirmed deaths have increased from 934 on Oct. 3rd to 1241 on Oct. 18th. WHO began flagging this data on the Oct. 3rd submission because that was the first time the cumulative number of confirmed deaths exceeded the corresponding number of cases. Since some people survive ebola, the reverse should be true, the number of cases should be greater than (or equal to) the number of deaths. I’m guessing that Liberia simply doesn’t have the resources to “confirm” ebola in patients with symptoms at this point because the number of deaths is getting so large. This may explain the deployment of the four U. S. ebola testing laboratories manned by Navy personnel.

    The number of deaths is not doubling every three weeks. However, the number of confirmed deaths increased by 303 in the 19 days between 9/14/14 and 10/3/12, from 631 to 934, and it increased by 307 in the 15 days between Oct. 3rd and Oct. 18th, to 1241. But this might just be a measure of the lab resources available to Liberia and not a real indication of the magnitude of the outbreak.

    I think you’re treading on very thin ice if you use the “probable” and “suspected” ebola data. Who knows what this really means?

    bobathome (5ccbd8)

  106. MD in Philly or other docs: Am I correct in focusing on the “sluggishness”? Isn’t is a known, but subjective, symptom? (Fever is also a known, but objective, symptom, right?)

    And if so, aren’t the press reports claiming that Dr. Spencer was “symptom-free” when bowling are blurring that distinction?

    Supposedly Dr. Spencer took his temp twice daily. Do we know when, during the day or evening before he self-reported to Doctors Without Borders, he had his last normal temp? If, for example, he was still had a normal temp some hours after visiting the bowling hour, that would be reassuring, I suppose. But did he have any slightly-high temperatures before he got to the 100.3-degrees F that prompted him to phone in? Was he, for example, at 99.3 but decided to go bowl a few frames anyway?

    The devil is in these details, I fear.

    Beldar (fa637a)

  107. *after visiting the bowling alley … I’m going to go check my temp now.

    Beldar (fa637a)

  108. From what I have read, what we have all read, about there not being enough facilities to even take in people with Ebola, it is hard to imagine they have a very good handle on the number of cases.
    Even if they counted every person they sent away, they have little idea as to how many never bothered to try.
    I doubt they are testing all of the corpses they find to look for evidence of Ebola, and even if they did, families hide bodies so they can bury them instead of cremate them.

    At least that is what the reports say.

    I haven’t seen a lot on the outbreak in the Congo; my impression is that it was a separate and more “traditional” isolated rural outbreak.

    MD in Philly (f9371b)

  109. “Sluggishness” obviously can mean all kinds of things, and whatever it meant, it seems from what I read, that he was able to run 3 miles during or nearly during this symptom. Maybe he runs 10 when he isn’t sluggish, IDK.

    If they have the resources, it would be worthwhile to take daily specimens of health care workers and even if they did not do testing in real time, to test samples of people who get sick and see if they can determine a correlation and time line between when people show symptoms and how severe the symptoms with appearance of virus in the blood.
    They could later test a wide selection of health care workers after weeks to months of exposure and look for evidence of people having had “asymptomatic” infections.
    With that kind of info we would have better guidance, I think.

    MD in Philly (f9371b)

  110. == And let’s acknowledge that he’s not quite as unprofessional as that NBC News doc who broke a voluntary-but-official quarantine for no better purpose than to go get a burger.==

    I don’t see a difference. And I still see no answer to my question of how they think Dr. Nancy Snyderman’s camera wielding NBC colleague Ashoka Mukpo got the virus. Mukpo had been around sick people while covering the crisis as a journalist, but unlike our new bowling friend, Mukpo had not been treating active ebola cases when he contracted it. Snyderman’s quarantine was ordered because she’d been around Mukpo. Dr. Spencer had also been “around” ebola patients–many of them. Upon returning home he should have quarantined himself for 21 days at least.

    elissa (84541a)

  111. I wonder what kind of precautions are regularly taken by DWB in the field. Every person taking care of Ebola patients is theoretically at risk of contracted the virus every day. I don’t think everyone goes from their decontamination post-shift to their own private cubicle where they have meals passed through the door until they come out to do their next shift.
    But they do socialize in a limited environment, where the risk of contracting Ebola is probably greater from the daily work than from one colleague who starts to get febrile.

    I think it should be comforting that there apparently have been no secondary cases in the community from Mr. Duncan, I would have expected some. It should also be somewhat comforting to know that of the 70 or so people at the hospital who were in some contact with Duncan only 2 have become symptomatically ill. I imagine epidemiologists are looking hard at what characteristics the 2 nurses shared and may have differed from others. Were they among the few around when Duncan was first intubated and workers were not yet wearing respirators?

    MD in Philly (f9371b)

  112. Assuming we know the truth about Nigeria, 1 seriously ill patient not identified originally as having Ebola lead to 900 people being contacted and monitored to some degree, 20 getting the disease, and 8 dying (do the 20 and 8 include the index patient?).
    To me that seems to be consistent with what we think we have known about the disease.
    It also shows outbreaks can be contained, but it is a tremendous effort in a densely populated area.

    I think it would be better all around to invest energy in “Fighting (Ebola) there, so we don’t have to fight it here”.

    MD in Philly (f9371b)

  113. OT- has anyone been following this rumor of a major computer network hack in the executive branch of government:
    http://www.powerlineblog.com/archives/2014/10/something-happening-here-an-update.php

    MD in Philly (f9371b)

  114. Expect the unexpected.

    Bowling will get you thru times of Ebola better than Ebola will get you thru times of no bowling.

    Colonel Haiku (2601c0)

  115. Perhaps people think I am fixating on Ashoka. I am. As far as I know, Ashoka Mukpo is the only American non-healthcare worker who has come down with ebola. It happened while he was reporting on the crisis in Liberia, and thankfully he has recovered back in the states after receiving a blood transfusion from Dr. Brantley.

    If they know how he got ebola (i.e., being touched by someone sick, or being splashed with infected fluid while taking a video, or accidentally doing something stupid) then just tell us. If they do not know how he, as a non-medical person contracted the virus, then it seems to me that we have every reason to at least question most of our assumptions about the ease or difficulty or paths to transmission of the virus.

    elissa (84541a)

  116. A recent update from a medical news source:
    In the wake of New York City’s first Ebola case, New York and New Jersey will quarantine all healthcare workers arriving at two key airports from Guinea, Sierre Leone, and Liberia for 21 days if they have treated patients with the deadly virus in those countries.
    The quarantine will extend to all travelers from the 3 countries who have had direct contact with an infected individual.
    New York Governor Andrew Cuomo and New Jersey Governor Chris Christie announced the decision to impose quarantines this afternoon. …

    Doctors Without Borders does not recommend a 21-day quarantine for international healthcare workers returning home from a stint of Ebola care in West Africa.
    Under the screening protocols announced by the 2 governors, the state health departments of New York and New Jersey will have the authority to hospitalize or quarantine travelers coming through John F. Kennedy International Airport or Newark Liberty International Airport, respectively.

    MD in Philly (f9371b)

  117. I am guessing that the DWB recommendations are old and based in past experience. I would not be surprised if they make changes themselves.

    MD in Philly (f9371b)

  118. With this disease it’s always “a day late and a dollar short”, it seems. But I’m glad to see the officials have finally taken this responsible and logical step.

    elissa (84541a)

  119. IMO, visiting Monrovia is a high risk activity whether one knowingly comes into contact with an Ebola patient or not. The previous healthcare workers that contracted it are NOT thought to have gotten it in the midst of their work with known Ebola patients.
    In light of other experience with Duncan, as I said above, I don’t think there needs to be any explanations other than what we know, with the realization that if you are in the middle of an epidemic in a city with poor sanitation, with people on death’s doorstep being ferried about in taxis, the risk of coming in contact with the virus is significant. He was familiar with Liberia. Did he go to some of his favorite local restaurants, mingle with people in the market?

    MD in Philly (f9371b)

  120. I think the DWB current recs that do not call for a quarantine are based on previous experience with their highly trained folk rarely if ever getting the disease.
    Now you have lots of folk who are not as well trained/experienced, and you have a setting where contact with Ebola is not limited to known patients that you are taking care of in protective gear, but in everyday life because of the disease burden in .

    Don’t touch doorknobs, don’t eat in places frequented by locals, or in places that employ locals.

    MD in Philly (f9371b)

  121. I don’t believe that there is a choice between fighting Ebola there and fighting it here. I don’t see those as mutually exclusive options in any way.

    Beldar (fa637a)

  122. I didn’t mean to suggest they were exclusive, Beldar, but my intent was to indicate that fighting it there would mean less of a need to fight it here, and in London, Paris, Frankfurt, Mexico City, etc.
    It’s not really a choice with terrorism, either, but the idea was that the more you occupy their resources there the less opportunity they have to take their time planning for something here.

    MD in Philly (f9371b)

  123. I hate to quote the Dog Trainer, but it’s handy and, in this instance, consistent with what I’ve read elsewhere. From an October 17 (and therefore pre-Dr. Spencer] article entitled “Aid group has set the gold standard on Ebola safety”:

    [T]he MSF [Médecins Sans Frontières a/k/a Doctors Without Borders] record isn’t flawless: Two foreign staff members have been infected, including a French nurse who was working at the front gate of the unit in Monrovia, one of the most contaminated areas of the site because of the large numbers of extremely ill patients who arrive there seeking admission, often vomiting or bleeding. The MSF reviewed its procedures afterward, and nurses at the gate began wearing thick plastic face shields when meeting patients.

    A Norwegian staff member was recently infected in Sierra Leone, a case being investigated. Commenting on that incident, director of operations Brice de le Vingne said there was always a risk involved in dealing with Ebola, despite the strict protocols.

    In addition, 19 local MSF staff members contracted Ebola, 12 of whom died. But the organization believes that “the vast majority” were infected in the community, not at the treatment center, a spokeswoman said. Medical workers often come under intense pressure from friends, family and community members to help sick people.

    This is not very reassuring, actually.

    Beldar (fa637a)

  124. Obama kissed a nurse

    so there you go

    happyfeet (0a4954)

  125. elissa (#111 — 10/24/2014 @ 4:18 pm): NBC’s Nancy Snyderman had agreed to obey a voluntary quarantine per an official request from New Jersey public health authorities. Dr. Spencer was under no such arrangement (although his diagnosis appears to have prompted a change on a going-forward basis). I think they were both unwise and unprofessional. But she lacks the fig leaf he has — which was that he wasn’t breaking any laws (or even voluntary assumptions of responsibility) when he went out into the public. He can still say, “In my medical judgment, I was engaging in a reasonable risk,” and based on the “official rules” binding him at the time, that’s at least plausible. She can’t say that: Once she accepted the voluntary quarantine, her own medical judgment became irrelevant in a way that his arguably still was.

    Beldar (fa637a)

  126. MD in Philly, we agree I think. And thank you for your comments!

    Beldar (fa637a)

  127. Beldar (fa637a) — 10/24/2014 @ 5:22 pm

    I mentioned this previously on another thread. MSF’s “usual Ebola contingent” was overrun in June. I think their recent infected workers reinforce the need for strict adherence to procedures with adequate training and supervision, and the problems in trying to absorb an influx of people unfamiliar with the situation.

    The local MSF contingent is over 2,400, I believe. That was dug out by someone (redc14?) a few days ago. 19 sounds like a big number, until you realize it is out of over 2,000 people who live daily in the midst of the epidemic.

    As I’ve also said before, MSF is about as left as one can get and I can’t say I’m an overall fan at all, but I think their experience with Ebola is accurate and reliable, taking into account new conditions (an overwhelming number of people infected, an unprecedented need for inexperienced health workers to help, and the hazards of previously unknown medical treatments- specifically the care of patients on a mechanical ventilator).

    You’re welcome, and thank you.

    MD in Philly (f9371b)

  128. A few virus updates:
    Another Doctors Without Borders staffer has been isolated and has developed a fever after arriving in Newark New Jersey today.

    http://www.nbcnews.com/storyline/ebola-virus-outbreak/worker-who-treated-ebola-patients-hospitalized-nj-has-fever-n233691

    Here’s the new updated CDC Ebola Factsheet. Hmmmm.

    http://www.thegatewaypundit.com/2014/10/cdc-yes-you-can-catch-ebola-from-being-sneezed-coughed-on-or-by-having-sex/

    elissa (84541a)

  129. Just for clarity, the info on the CDC factsheet is nothing new, just a clarification of the current/traditional understanding of Ebola.

    While we were hearing about Ebola:
    http://news.yahoo.com/mysterious-polio-disease-affecting-american-kids-130000338–politics.html

    MD in Philly (f9371b)

  130. I have to stop picking on the CDC. They have no real power to enforce their recommendations except in the absence of state law. If a state has enacted a law dealing with communicable diseases, the provisions of which do not conflict with the federal statute, there is nothing the CDC can do, even if the state or local unit of government refuses to act pursuant to it.

    nk (dbc370)

  131. Nightmare On Wall Street! What will they do if they find a floor trader at the NYSE has it?

    nk (dbc370)

  132. I said yeah… yeah… yeah Brown Sugah
    How come you bleed so bad

    Colonel Haiku (2601c0)

  133. Who would have thought that in order for the United States to finally do something more substantial in terms of travel restrictions from Ebola affected nations we would have to rely on the dynamic duo of… Andrew Cuomo and Chris Christie?
    …Cuomo was a bit long winded and technical in his announcement, as is his wont. Christie, as you would expect, was a bit more blunt. “You don’t have to hit us across the head more than once,” he said.

    …Christie went on to say, We are no longer relying on CDC standards. We will ensure that New York and New Jersey standards are met. The assembled press corps completely failed to summon up one person to say that it was about time. These new restrictions go well beyond what the Obama administration has been willing to commit to so far.
    … it was enough to show us what the system is supposed to look like when it’s working. Seeing Christie do this doesn’t come as all that much of a surprise, since – to put it kindly – he does not suffer the federal government gladly. But to see Cuomo override the CDC was something of a shock.

    http://hotair.com/archives/2014/10/25/christie-cuomo-enact-stricter-travel-restrictions-as-new-patient-showed-symptoms-in-nj-tests-negative/

    New York and New Jersey state health department staff will be present on the ground at John F. Kennedy International Airport in New York and Newark Liberty Airport in New Jersey. In addition to implementing the mandatory quarantine of health care workers and others who had direct contact with Ebola patients, health department officials in each state will determine whether others should travelers should be hospitalized or quarantined.

    The announcement marks a dramatic escalation in measures designed to prevent the spread of Ebola in the United States. Previously, only individuals with symptoms of Ebola would be quarantined upon entry to the U.S. under a federal rule from the Centers for Diseases Control and the Department of Homeland Security.

    http://time.com/3537755/ebola-new-york-new-jersey/

    elissa (75d957)

  134. Police in New York City
    Chased Ebola through the park
    In a case of mistaken identity
    They shot an allergy through the heart
    Lymph-breaker, vein-breaker
    Gonna rip your bowels apart

    nk (dbc370)

  135. Your serve, Haiku.

    nk (dbc370)

  136. Jumped on a plane and I flew to Liberia, oh yeah
    I flew back home and it was mass hysteria… oh yeah
    I started pukin’ and I bled from my face
    Run to the toilet it was just one big race
    I’ve got one ass and it hurts like hell
    If she don’t kill me Ebola will
    If she don’t kill me Ebola will

    Colonel Haiku (2601c0)

  137. Hysteria, politics, or prudence—add Gov. Quinn of IL (D) to the large metro governors who have ordered quarantine for returning ebola health care workers. Per WGN:

    Governor Quinn has ordered a 21-day home quarantine for all travelers returning to Illinois who had contact with Ebola patients in West Africa.

    elissa (fb33a1)


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