outbreak! (ebola, sars, coronavirus, etc)

lol

Around the time that Spencer decided to go to West Africa, it seemed that the world was finally getting involved. In mid-September, the United States, joined by several other countries, pledged more than $175 million to the fight and 3,000 troops. Days after that announcement, the United Nations Security Council unanimously passed an “unprecedented resolution” calling for $1 billion (and an additional $570 million on behalf of WHO) from world leaders in order to send the people and supplies necessary to contain the epidemic.

Ten days later, when the dust had settled, MSF President Joanne Liu called their bluff. “Generous pledges of aid and unprecedented UN resolutions are very welcome. But they will mean little, unless they are translated into immediate action,” Liu said. “The reality on the ground today is this: The promised surge has not yet delivered.” As of Oct. 17, over a month after the plans were set, the UN has only collected 38 percent of its goal.

MSF, the first humanitarian organization to recognize the epidemic, has been waiting for help to come since March. According to a spokesperson, the organization employs 270 international and around 3,018 locally hired staff in the three affected countries: Liberia, Guinea, and Sierra Leone. Among those nations is a population of 22 million. Some heroic volunteers, like Spencer, have joined the fight—but not enough. “The sick are desperate, their families and caregivers are angry, and aid workers are exhausted,” Liu continued at the meeting. “Maintaining quality of care is an extreme challenge.”

http://www.thedailybeast.com/articles/2014/10/23/why-new-york-s-ebola-case-will-hurt-infected-patients-everywhere.html

http://www.theawl.com/2014/10/checking-in-with-the-ebola-day-traders

Paul Farmer article so good! God, I love him.

I work at one of the biggest hospitals in Boston and the prep going on here is really impressive and extensive but I guess now they're pre-screening every single patient both when they make their appointments and upon arrival which seems both excessive and smart. The IDX dept is right above ours and people keep making jokes about how they're always using our bathroom. ._. For someone with pretty extreme anxiety I'm surprised I'm not more (at all?) worried about this.

yeah same; i read a good thing at the times (on their well blog) about the specifics of transmission, which my medically-untrained mind had got kinda spooked out about, generally just thinking transmission-by-sweat & flu-symptom'ed-patients-on-major-city-transit were a terrifying combo. & it got into how viral loads in any of the more immediately encounterable fluids were just too small to be a concern. it is totally a fascinating & terrifying thing to think about but it's nice being back in a kind of raised eyebrow state wrt the hysteria.

Yeah, I guess one of the reasons I haven't been worried is that I do know a very small about about medical stuff including how transmissible certain things are and how Ebola in particular works. Also, I've never seen Outbreak which I'm guessing is a good thing right now. ;)

It upsets me how much the phrase "viral loads" crosses my mind these days

so did Ebola's CMJ set get rescheduled or what

was it at Brooklyn Bowl?

http://www.newrepublic.com/article/119969/new-york-city-ebola-case-why-did-dr-craig-spencer-go-bowling

irresponsible ignorant media bullshit, take 8472673

Christie, Cuomo inform the feds that they will be doing airport arrival quarantines

http://www.nytimes.com/2014/10/25/nyregion/new-york-ebola-case-craig-spencer.html

I hope the soundbites of Andy Cuomo now heard around the country are impressing you all with what a pompous dick he is.

"Quarantine means go home, stay home for 21 days.... that's quarantine. But I want to go out for pizza. Really, you can't. Well, I wanna go on one date. Well, really, you can't. That's why they call it quarantine," he said.

http://www.wnyc.org/story/cuomo-christie-announce-mandatory-quarantine-some-returning-travelers/

this is really stupid. there's no medical reason to quarantine people who don't have symptoms. and all this is going to do is 1) discourage people from volunteering and 2) encourage people to lie about their histories

they are both running for something, tho

there's no medical reason to quarantine people who don't have symptoms.

In the case of ebola, where contact with body fluids is required for transmission, the likelihood of transmission just by walking around in public would seem to be extremely low prior to noticeable symptoms. But, really, there has been so little experience with this disease prior to the latest outbreak, that categorical statements about it are a bit premature.

thanks aimless, please send an email to the physicians who make these recommendations and let them know

One problem I see is that someone can become symptomatic while out -- do you really trust yourself to recognize the moment you first have a 100.4 fever? Because that doesn't always feel like much. This isn't the flu but it's not HIV either, i.e. it can spread through ordinary personal contact via bodily fluids. So I don't think it's so crazy for a doctor who has been treating Ebola patients to have a 3-week quarantine. Why are you so against taking that relatively minor precaution?

Also I don't buy that this will "discourage people from volunteering" or "encourage people to lie" -- you really think a doctor willing to treat Ebola patients is going to change his mind because he might have to hang around his apartment for a few weeks after?

the hysteria is understandable but elected officials ideally should defer to the people who know what they're talking about. tho as morbs pointed out there are some political calculations obviously

One problem I see is that someone can become symptomatic while out -- do you really trust yourself to recognize the moment you first have a 100.4 fever? Because that doesn't always feel like much. This isn't the flu but it's not HIV either, i.e. it can spread through ordinary personal contact via bodily fluids. So I don't think it's so crazy for a doctor who has been treating Ebola patients to have a 3-week quarantine. Why are you so against taking that relatively minor precaution?

Also I don't buy that this will "discourage people from volunteering" or "encourage people to lie" -- you really think a doctor willing to treat Ebola patients is going to change his mind because he might have to hang around his apartment for a few weeks after?

― my jaw left (Hurting 2), Saturday, October 25, 2014 3:49 PM (40 seconds ago) Bookmark Flag Post Permalink

someone returning from an area where Ebola exists, even someone caring for ebola patients (who btw is a doctor and has presumably followed the safety protocols) isn't necessarily presumed to have ebola. there is a very well-accepted consensus, based on the best medical evidence available, that ebola can only be transmitted while a person is symptomatic (and having a low-grade fever represents the low end of that continuum; contagiousness increases as the person gets sicker), and even IF the person is symptomatic, it can only be transmitted through exchange of bodily fluids. not by being breathed on, or touching a subway rail, or by shaking hands. professionals who have returned from working with people with ebola are instructed to monitor their temperatures often and report to the authorities at the first sign of symptoms. the risk to someone without intimate contact with an asymtomatic person incubating ebola is essentially zero. not "small" but essentially negligible. and again, it is understandable that laypeople with a poor understanding of the disease are worried, but that doesn't mean policy shouldn't be evidence-based. it also underscores the need for effective public health messaging, which cuomo has now totally fucked up.

requiring that volunteers, who already are too few, spend 3 weeks after returning unable to work or live their lives, in the absence of evidence that this is even remotely necessary, could certainly dissuade them from going over and contributing to the effort where they're most desperately needed. additionally it's well-accepted in public health circles that mandatory disclosures of this sort (see also disclosing HIV status, etc) may have the paradoxical effect of causing people to lie about their histories, making epidemiological work even harder.

anyway hope that's coherent i'm on my phone

public distrust in medical authorities has already played a devastating enough role in the spread in africa. having the city health commissioner, the mayor, the CDC director, and the governor all present different messages based on their particular political priorities is a recipe for disaster, or at best, needless paranoia

really good & illuminating & more than coherent posts ^^^, ty k3vin

speaking of which: After Negative Ebola Test, Quarantined Nurse Criticizes Treatment at Newark Airport

Every unnecessary precaution made by officials validates public fear, which in turn creates more desire for more unnecessary precautions. It's a dangerous cycle, the avoidance of which is one of the most important jobs of leaders when dealing with public health events like this.

well said

i went to the doctor the other day for an ear infection and they asked me the standard pre-screening questions. have you been overseas? have you had any contact with anyone who was recently in west africa? etc. and i live in a midwestern town that's so far been unaffected.

kev k., thanks for the sarcasm. before your reply my life was missing something, but I didn't know what it was.

The experts you place such reliance upon can only work from the data they have. Based on their data of how the virus has behaved in the past they predict how it will behave in the future and recommend precautions that ought to be adequate. That is as far as science can take them.

The problem I was pointing out is not a problem with scientific method or with reasonable interpretations of the available data. The problem is more fundamental. It is how little data they are working from. It's hard to capture outriders when you lack data points. Factors that result in the transmission of the disease on average once in a thousand instances won't emerge from statistical noise when you only have a couple of thousand instances to examine. In a place like NY city, an asymptomatic infected person can easily have casual contact with enough people that a 1 in 1000 transmission might occur.

I suspect that if you spoke directly to the public health officials most intimately informed about ebola, they would be qualifying their statements about the behavior of the disease in ways that are not reflected in statements made to the general public, precisely for the reasons nick said and you approved:

"avoidance of [public fear] is one of the most important jobs of leaders when dealing with public health events like this."

http://mobile.nytimes.com/2014/10/27/nyregion/ebola-quarantine.html?referrer=

public administration at its finest

smfh

“We’ve taken this action and I have absolutely no second thoughts about it,”

What a thing to be proud of. Good luck usa.

Every unnecessary precaution made by officials validates public fear, which in turn creates more desire for more unnecessary precautions. It's a dangerous cycle, the avoidance of which is one of the most important jobs of leaders when dealing with public health events like this.

I'm sure this could happen if the official reaction went way overboard into hysteria, but to me, a mandatory 21 day quarantine for returning health care workers who have worked directly with Ebola patients probably strikes most people as reasonable, in the sense that erring on the side of caution strikes most people as reasonable, especially when people's lives are at stake.

It does strike most people as reasonable, but it doesn't strike experts in the field as reasonable. Letting most people take the lead on policymaking here is a bad scene.

P.S. I'm not trying to play internet genius here, ebola scares the crap out of me, and I still haven't gotten my flu shot because I'm lazy and it costs slightly above free and "it's just the flu, right?" I'd probably want to lock up everyone for a couple months just to be safe. But that's why people who know about how these things actually affect the circumstances of a potential pandemic should be making these decisions, not dumb dorks like yours truly.

erring on the side of caution strikes most people as reasonable, especially when people's lives are at stake.

you could use the same criteria to support a mandatory flu vaccination and save far more lives but I guarantee the public outcry would not be reasonable (xpost)

I would welcome compulsory flu vaxes, tbh. Give them at polling places when I'm casting my welcomed compulsory vote.

itt I am a fascist

I don't doubt that the experts know a lot more about Ebola transmission than the average person on the street, however, I think it feeds panic more having experts telling people not to worry about something and authorities appearing to be complacent in the face of constant terrifying media coverage. In this case, I think taking a more aggressive stance may actually help to calm some of the fears, even if many (not all) medical experts might think it's unwarranted.

Christie is going a little overboard, but anyone who's been to a buffet with him knows it's not the first time.

I think the experts lost some credibility with the public after telling people for a long time that Ebola could be easily contained by an advanced medical system like in the US, and then to see 2 nurses fall ill soon after the first case in Dallas. It seemed it wasn't quite the slam-dunk that had been portrayed.

Yeah that's really the problem. I think if the screw-ups at the Dallas hospital had never happened we wouldn't have gotten to this point. Especially since there was so much murk around how the nurses got it -- at first the word was that they had followed all the protocols, so people were like "holy shit, this is more contagious than we thought." Only later it came out that no, actually, they didn't, but there's a lack of public trust now.

I think the experts lost some credibility with the public after telling people for a long time that Ebola could be easily contained by an advanced medical system like in the US, and then to see 2 nurses fall ill soon after the first case in Dallas. It seemed it wasn't quite the slam-dunk that had been portrayed.

― o. nate, Monday, October 27, 2014 10:23 AM (3 hours ago) Bookmark Flag Post Permalink

there have been 2 cases in the US and zero deaths. compare that with what's happened in west africa

what strikes most people as reasonable is not necessarily the best policy. you know this. everyone in this thread knows this

Americans are stupid. The end.

well, christie certainly is.

how are people reacting to the nurse's outspokenness? i'm referring of course to the nurse who has been quarantined. she seems rather heroic to me, and i appreciate her reaction.

Kinda interested in what happens to her legal case actually -- "We detain u, people b scared" is not a principle I'd like to see expanded further

she says they wouldn't let her meet with her lawyer, which... i can't imagine this could hold up in court.

but this is american 2014 so...

Christie must just be like "fuck it, I'm gonna look good and we'll settle the lawsuit down the road"

Question for folks who understand this stuff better than I do: if ebola is relatively hard to contract for those being careful, how are these handfuls of people - who I presume have taken mostly recommended precautions against at least the most basic exchange of bodily fluids - catching ebola? What are they (both abroad and home) doing wrong? They understand the risk going in, so what is it that's they're not doing right?

From what I have read, it's not actually correct that it's "relatively hard to contract for those being careful." It's hard to contract from ordinary, passing contact, but it's somewhat contagious for people in close contact with the infected, thus requiring extraordinary precaution. I think I saw one article that described it as "highly contagious and at the same time not highly contagious" because of this.

people sick with ebola discharge copious amounts of vomit and diarrhea, which either gets on nurses or needs to be cleaned up. drawing blood, which is necessary for the diagnosis and determining whether the virus had cleared, also presents a risk. wearing all of that protective equipment, particularly in tropical areas where it is really hot, is fatiguing and even the most otherwise-diligent workers are prone to lapses; organizations on the front lines recommend wearing PPE for no more than a few hours at a time. the risks involved with disrobing have also been well-documented.

also keep in mind that over in west africa, particularly early in the outbreak, they lack the esources and staff to comply with the recommendations. they're left with the choice to work at greater risk or abandon their patients.

But what about in America? How did those nurses get it? If you wear gloves and masks, is that enough? If the blood/vomit/sputum gets on you, is that enough, or does it have to get in you?

There were conflicting stories at first, but I think the official line now is that the hospital really did not do a good job following protocols.

Again, not claiming expertise, but I think like with any virus, the larger a viral load you're exposed to the more likely you are to become infected, so it's not a matter of whether vomit or blood or sweat or whatever "has to get in you" so much as more exposure = more likely to come down with it.