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Toy_Soldier
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24 Oct 2014, 5:55 am

Yes, but there are many places like that, which is the primary danger for spreading. If it gets into other parts of Africa, South America, Indian subcontinent, Parts of Asia... who knows what will happen and in new environs who knows how it will mutate.

The offical count is about 10,000 infected and 5,000 dead.

The real numbers of infected in West Africa are said to be 20,000-30,000 and the dead 10,000-15,000.



Janissy
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24 Oct 2014, 7:17 am

Raptor wrote:
/\ This is why they should never allow anyone known or suspected of being infected into the country, including American citizens.. Humanitarianism is all good but in cases like this the bigger picture has to be considered first.


The bigger picture is thinking globally. This needs to be stamped out where it is (though there will always be reservoirs) and that means humanitarian medical aid. It is critical that it not get loose in a large urban population with 3rd world healthcare elsewhere on the globe. In addition to the possibility of mutation, there is the possibility of it getting established in similar animal reservoirs elsewhere. That happened with West Nile Virus. Humanitarian aid is the only way we have any hope of preventing that.

A travel ban sounds like the perfect solution but it isn't possible to make it 100%. We live in a porous world and there is always a way for somebody to get from point A to point B even when that isn't allowed. A travel ban-which will be evaded by at least one infected person- counter-intuitively is more dangerous. A travel ban gives the illusion of protection which allows complacency by hospitals. Everything went wrong at Texas Presbyterian precisely because that hospital didn't think it was ever going to be be their problem and they were not ready. Dealing with this doesn't just merely require special rooms and equipment. It requires training for staff with continuous practice. It needs a battle plan and those battle plans are expensive which is why they are not routine for hospitals. I worry that a travel ban will allow complacency to come back. Hospital administrators aren't going to keep allocating the money required if they don't think they have to anymore.

I would like to see the humanitarian aid doctors self-quarantine for 21 days. We need to get some mechanisms in place to make self-quarantine more do-able. But I think this situation in NYC will unfold a lot better than in Dallas. The New York health department got a battle plan in place which included designated hospitals* (instead of letting it be down to random chance) and imitating the protocols of Emory and Nebraska rather than reading the CDC website and rummaging in the linen closet for available PPE. Bellevue learned from the mistakes of Texas Pres. And the staff there is a lot safer. It also helps that this guy got admitted the very second he got symptoms.

What's happening in NYC is an example of how to handle this right (I hope I don't have to eat those words). In theory, a travel ban would mean that no hospital or emergency workers in the U.S. would have to deal with this. But in practice I think we would just get Dallas all over again but in some other city where hospital administration thought, "whew, the crisis is over, we can put a stop on that order of respirators". It is a very good sign that nobody in Duncan's family, or the ambulance drivers, or the people in the emergency room with him have gotten sick. So far it seems that those most at risk are health care workers- not neighbors or fellow passengers. Hospital workers were endangered and infected by insufficient protections in Dallas and Madrid. But Bellevue is better prepared- a LOT better prepared.


*I hope other states follow the lead of the New York health department. It isn't feasible for every hospital in the U.S. to be qualified to handle this. Designating selected hospitals around the country is a better move. However, every doctor right down to the ones in little walk-in clinics needs to know what to look for so they can correctly triage. What needs to stop is the responses that aren't rooted in actual epidemiology- like the city in Maine that quarantined a woman who visited Dallas. That's just goofy.



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24 Oct 2014, 2:21 pm

The Mali case has some potential to be at least a mini-outbreak. The sick person was showing advanced signs (bleeding) on public transport.

With the NYC Doctor case, I do not understand why returning health care workers from the Ebola Hot Spot are not put in quarantine and lab tested upon return. We are just talking about a blood test right? Or sent to some point in route for the same before they arrive.



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24 Oct 2014, 3:41 pm

Toy_Soldier wrote:
The Mali case has some potential to be at least a mini-outbreak. The sick person was showing advanced signs (bleeding) on public transport.
:(

Quote:
With the NYC Doctor case, I do not understand why returning health care workers from the Ebola Hot Spot are not put in quarantine


This is being discussed right now by state and federal government. Until now it has been self-quarantine.

Quote:
and lab tested upon return. We are just talking about a blood test right? Or sent to some point in route for the same before they arrive.


Now things get a little more complicated. We are just talking about a blood test but it is one without clinical history of being used to screen for pre-symptomatic individuals. So there isn't data on how reliable that would be.* Hopefully the FDA is getting right on that. In terms of running the test itself, no hospitals do it (or have capability to do it). As of this Fall, State health departments run it with a turnaround time of 24 hours at the very fastest. Prior to this Fall, only the CDC ran it. Whoever can speed that up or make a way for it to be reliable for screening will deserve a raise.

As for being sent to a quarantine area- such a place has to be created. So far all quarantine has been in private homes (Duncan's relatives were housed for quarantine by a mystery benefactor). We don't have any mechanisms in place unless you're in the military. For returning military that was sent to Liberia, they can be quarantined in a set aside base easily enough. But what to do with returning doctors? That needs to be sorted out by the government and fast.

*edited to add: so unreliable as to be pointless. According to the CDC the virus is not at detectable levels prior to symptoms. I just visited that part of their website.



Last edited by Janissy on 24 Oct 2014, 5:29 pm, edited 1 time in total.

Janissy
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24 Oct 2014, 4:13 pm

Quarantine under discussion for returning health care workers:

http://www.washingtonpost.com/news/post ... -outbreak/

Quote:
A federal official said that the idea of quarantining medical workers who participated in the Ebola response in West Africa was being considered, but said no decision had been made.

While the idea of a quarantine is being considered, Josh Earnest, the White House press secretary, emphasized that officials are still determining whether it is medically justified.


Quote:
Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, said in an interview that while it made sense for returning medical workers to take voluntary steps to isolate themselves upon their return to the United States, concern over Ebola?s transmission in the West had begun to interfere with volunteers? ability to contain the outbreak at the source.

Quote:
Not only have many airlines curtailed flights to the three countries most affected by Ebola, Garrett noted, but nearly every major insurance carrier has now canceled medevac coverage for individuals choosing to travel there.


All the talk about a travel ban and it looks like the airlines are doing a mini one themselves by declining to fly there much. I think that's actually preferable since it keeps the hospitals in alert mode rather than getting complacent. Maybe chartering planes would work better? Standing back and letting the epidemic burn itself out is unlikely to work because it has gone way past the point of no return now that it's urban. If we don't help squash this, it will get even worse and worse. But if there are multiple obstacles in the path of volunteer doctors, it will not get squashed. It's a quandary.

There is some good news:

Quote:
The two nurses who contracted Ebola in Dallas were both declared virus-free this week.



:cheers: :sunny:



Janissy
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24 Oct 2014, 5:28 pm

Just visited the CDC website re: screening

We don't currently have the technology for pre-symptomatic blood test screening.

http://www.cdc.gov/vhf/ebola/hcp/interi ... ebola.html

Quote:
Ebola virus is detected in blood only after the onset of symptoms, usually fever. It may take up to 3 days after symptoms appear for the virus to reach detectable levels. Virus is generally detectable by real-time RT-PCR from 3-10 days after symptoms appear.


That makes a pre-symptomatic blood test screening of returning doctors a no-go. Quarantine is still a good idea.



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24 Oct 2014, 11:10 pm

Cover your mouth when you sneeze, grap a subway handhold, Ebola can live for hours there, and longer if it is colder.

In blood it can last for days. The bodies of the dead play host for no one knows how long.

HIV outside the human body just dies. Why can't Ebola be a good virus?

No exposed skin has been the medical advance, Ebola can infect through the skin.

The other side is no one living with the first case got it. He was sent home with symptoms.

It will be hard, no testable levels of virus until three days after symptoms appear, then Ebola takes over until in death, the body is teeming with it.

It is Flu season, the symptoms are the same, Flu kills 40,000 a year in the USA.

Here in New Orleans we have three travelers under self isolation. Altogether there are hundreds, perhaps thousands, who have been to west Africa recently. Some of those will come down with Flu. If they seek medical attention, doctors waiting rooms are full of weakened people.

In the first three days there seems to be no way to tell if it is Flu or Ebola.

Of the 40,000 that die many more get a hospital stay. Medical personal do not use hazmat gear to treat Flu.

The potential for many outbreaks is with us. This potential increases as more cases develop in Africa. It has to be treated at the source. The longer we wait, the worse this is going to be.

Another worry, 21 days is not absolute, and some reports say 8-12% of cases take longer to develop. The nurses it seems developed Ebola in a week. There is a range, we do not have hard facts yet.

It will not be confined to West Africa, as that is one of the places that people leave and go to Europe.

Medical personal we will notice, illegals in the slums will not be noticed. Spreading from slum to slum. it can get a foothold in Europe. Police, those picking up the dead will come in contact. New Orleans produces up to 400 bodies a year, just from murder. When it starts showing up in jails, we have a problem.

West Africa is small, four million in Liberia. If it makes it's way to Egypt, we have many more travelers. There are always options, cute girls being offered "Maid" jobs, Saudi funded Islamic Schools in Pakistan, USA funded Syrian Rebels, and other minor wars looking to hire.

If it is not stopped in West Africa, it will be worldwide, and forever.



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24 Oct 2014, 11:13 pm

Yeah, it looks like other entities are taking things into their own hands. The Governors of New York & New Jersey are requiring some sort of quarantine in their entry airports. Timely too. A health worker just came in to Newark tonite, was not showing symptoms but was required to go into quarantine. They developed a fever a few hours later...

The CDC and Administration seem a day late and a dollar short at every turn in this crisis. Whatever criteria they are using for decision making stinks frankly.



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25 Oct 2014, 7:30 pm

When it comes to national defense, we have never been prepared.

Even then, putting Joe Biden's lawyer in charge of everything Ebola was an advance to the rear.

I would point the finger at the WHO and the UN, as threats to the whole planet are supposed to be their mission.

In troubled times look to who rode to the sound of guns, and support them.

That would be Doctors Without Borders, and there is an operational Russian helicopter ship in France.

The Russians are hauling cargo for the UN in Afganistan, they could create landing zones, set up tent cities, and defend Doctors Without Borders from the local governments.

The UN has invaded countries over much less serious things.

No Visas, no Customs, no permission, just an armed Medical Invasion, forcing health care on the people.

I am reminded of Startrek, the only person with the power to relive the Captain from duty, by force if needed, is The Doctor.

The main problem with Democarcy, is the Demons only know how to get elected.

This is a Medical Problem, they are the front line troops, they are dying in the line of duty.

No one would put Joe Biden's lawyer in charge of World War III.

This battle has to be fought from the front.



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25 Oct 2014, 11:00 pm

A gobsmacking blend of ineptitude and panic seems to be the way America will deal with Ebola. If a genuine outbreak occurs (beyond the odd case here and there), I foresee medical staff walking off their jobs in large numbers. There will be quarantine centers, and military presence, and runs on the banks and supermarkets. The stock market will tank. We will quickly have all kinds of problems that are not directly related to the virus.



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28 Oct 2014, 7:55 pm

Question everything you know about EBOLA.
Be sure to question AUTHORITY.

http://jonrappoport.wordpress.com/2014/ ... sumptions/


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