outbreak! (ebola, sars, coronavirus, etc)

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.

So one infected guy on the train, low odds. A dozen guys on the train, better chance of catching it?

Is washing your hands enough to get it off you, or do you need to totally disinfect?

Like a dozen guys all with early Ebola symptoms in the same car as you at once?

Stop touching their essence, their precious bodily fluids, dammit!

http://i61.tinypic.com/24pdo5u.jpg

i think it's key that if you're around a patient in the worst stages of the disease—as health-care workers are going to be—they are emitting lots of fluids, and those fluids are likely to contain the ebola virus.

it probably seems like it's more contagious than it actually is since we don't read news stories about the 100s of medical professionals working in west africa who don't get ebola.

I wonder how the medical professional infection rate compares to people working with patients with other diseases.

Another thing though: even if infection rate is lower, death rate is much higher per infection (although so far our medical system seems to reduce the death rate quite a lot). So that's another reason people are scared.

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.

when it's 100°f/100% humidity you can only wear a ppe for ~30 minutes, so there's a lot of on/off

Can't they combine the suit with one of those little hat fans?

http://www.nybooks.com/blogs/nyrblog/2014/oct/27/hidden-truth-about-ebola/

Even as Ebola hysteria rages in the US, the epidemic here in Liberia, which is supposed to be its epicenter, seems to be subsiding. According to official counts, this impoverished West African country of 4 million people is currently home to fewer than four hundred Ebola patients. Not millions of patients; not tens of thousands of patients; not even thousands of patients. Fewer than four hundred patients. Even as the World Health Organization warns that any day now we could be seeing thousands of new cases, and Obama’s UN Ambassador Samantha Power claims the global response to the epidemic is “failing,” the number of new cases each week in Liberia is falling, not rising. In August, the streets of Monrovia were strewn with bodies and emergency Ebola clinics were turning away patients. Today, nearly half of the beds in those treatment units are empty. I’ve been here a week and have yet to see a single body in the street. Funeral directors say business is off by half.

Of course, the situation remains very serious. More than two thousand have succumbed to the disease here since the outbreak began—along with thousands more in neighboring Sierra Leone and Guinea, according to the CDC—and Liberia faces looming economic and political crises. This fragile country urgently needs help—both for the well being of its own people, and for the safety of the rest of this interconnected world. But the epidemic is far from the cataclysmic disaster currently on display on American TV screens. Why does this matter? By portraying Ebola as an out-of-control threat to humanity—the foolish calls for border controls, the needless and cruel quarantining of a healthy volunteer nurse, the canceling of contracts, trade and other exchanges—US politicians and the media are making the disease harder to fight. And that could make the epidemic far more dangerous than it currently is.....

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?

― Josh in Chicago, Monday, October 27, 2014 2:22 PM (5 hours ago)

infected bodily fluids have to get in you somehow, either by contact with mucous membranes or through a cut in the skin. the necessary inoculum size is probably small, though i haven't seen any research address this specifically, probably because it's still early in the information-gathering process in many respects.

and yeah, bears repeating that while the case-fatality rate is alarmingly high (~70% last i saw), that's also partly a function of the resources at the epidemic's epicenter. with world-class supportive care, the case-fatality rate should probably be half that

Iirc from half-watching news broadcasts, the gear the TX nurses were originally given didn't cover their necks--there were gowns/suits of some kind and some facial covering but nothing in between, and if THAT'S the level of protection their employer provided, you can imagine. Also they were often working alone and I think disrobing alone, which should never be allowed--someone else should always be there to watch/help and help you with on/off so you don't accidentally come into contact w fluids.

very good NYT editorial this morning

http://www.newyorker.com/wp-content/uploads/2014/10/daily-cartoon-141028-travelban-690-719.jpg

my god

https://twitter.com/hashtag/KaciHickox?src=hash

just look at these people fume

https://twitter.com/GenghisConsrv/status/527133230974394368

Bill Godfrey ‏@BillnShari 1m1 minute ago
#KaciHickox: Kaci's ATTORNEY feels she doesn't have Ebola and that her rights supersede the rest of U.S. citizens. So did other patients!

HABEAS CORPUS CAN SUCK MY DICK

Can't wait until this freak-out media scare is over so there's some kind of news on that I want to watch.

Between the NFL and ebola, there hasn't been a news segment of interest to me in weeks.

To the best of my knowledge, public health officials have almost unlimited power to impose and enforce quarantines. It is not a criminal matter, so habeas corpus is kind of irrelevant.

It's pointless to make a rational argument against the word vomit contained in those tweets. #OBOLA #TEAPARTY #DISESE

another cyberspace-teems-with-hateful-ignorant-jerks shocker

yeah, ugh. i need to take a shower. people are horrible.

To the best of my knowledge, public health officials have almost unlimited power to impose and enforce quarantines. It is not a criminal matter, so habeas corpus is kind of irrelevant.

― Scapa Flow & Eddie (Aimless), Tuesday, October 28, 2014 1:24 PM (2 hours ago) Bookmark Flag Post Permalink

1) where are these powers enumerated?
2) so far i'm not aware of any controversial public health-body sanctioned quarantine. the cuomo/christie ones have been ordered by elected officials and have been ordered despite the very clear objections of scientists.

courts have recently deferred to executive actions taken in the interest of "national security" or the like, which i'm sure is what these officials will claim. still their legal defense is anything but airtight imo

I saw Obama referred to as Obola on a anti-vax site today.