Ebola: It's In The US Now

[Nanci]

Ebola Survivor Nancy Writebol

Ebola nearly killed Nancy Writebol in July—and it also made her famous, which helped broadcast to the world that it needed to respond more aggressively to what had grown from a small outbreak into an out-of-control epidemic.

Writebol, a clinical nurse associate, became ill with the disease while working for the missionary group SIM in Monrovia. She and her husband David spoke with Science on 24 September about a topic that has yet to receive much attention: How do health care workers who are trained to protect themselves nevertheless become infected with the Ebola virus? The Writebols also discuss how the outbreak grew into an epidemic, as well as the treatment she received both in Liberia and then at Emory University Hospital in Atlanta. Questions and answers have been edited for clarity and brevity.

 

[Nanci]

Live Ebola Map

 

[Jace91]

The following was taken directly from the CDC Ebola webpage

As of September 28, 2014
(Updated October 2, 2014)

Countries with outbreaks

Totals for Guinea, Liberia & Sierra Leone
•Total Case Count: 7157
•Total Deaths: 3330
•Laboratory Confirmed Cases: 3953

Guinea

•Total Case Count: 1157
•Total Deaths: 710
•Laboratory Confirmed Cases: 950

Liberia

•Total Case Count: 3696
•Total Deaths: 1998
•Laboratory Confirmed Cases: 927

Sierra Leone

•Total Case Count: 2304
•Total Case Deaths: 622
•Laboratory Confirmed Cases: 2076

Countries with localized transmission

Nigeria

•Total Case Count: 20
•Total Case Deaths: 8
•Laboratory Confirmed Cases: 19

Countries with travel-associated cases

Totals for Senegal and U.S.
•Total Cases: 2
•Total Deaths: 0
•Laboratory Confirmed Cases: 2

Senegal

•Total Case Count: 1
•Total Case Deaths: 0
•Laboratory Confirmed Cases: 1

United States*

*In a traveler from Liberia

•Total Case Count: 1
•Total Case Deaths: 0
•Laboratory Confirmed Cases: 1

Western Countries aren't much better for containing serious outbreaks, I'm remembering the SARS outbreak. It wasn't anywhere near as lethal but ONE infected patient managed to spread it to TWO HUNDRED FIFTY ONE people.

 

[tsst]

... We can't think of their hospitals as like ours. They are very very much NOT. They are nowhere near the standards of our hospitals.
...

Wait. WHO says we are bad at healthcare ranking below countries like ...

Andorra
Singapore
Colombia
Chile
Dominica
Costa Rica

And in the same ballpark as countries like ...

Slovenia and Cuba


(just poking fun at WHO as I think we actually have the best healthcare on the planet, discounting cost)

 

[Rich Z]

The healthcare system might be OK during normal times, but will it be able to cope with flu season when now everyone with "flu-like" symptoms might have to be treated as being possibly Ebola? We've already seen what happens when one medical facility guessed wrong.

And how are people going to treat going to the doctor's office if they think there is a possibility that they may be ordered to remain in isolation for three weeks because of their sniffle and runny nose?

Just a couple more major metropolitan areas coming up with confirmed Ebola cases and it will likely start rapidly breaking down. I don't care how prepared the CDC says we are, this is going to be a brand new experience to a LOT of people.

Heck, I know if I lived nearby the Dallas area I'd be pretty much on my own self imposed isolation.

 

[Nanci]

This is the screening procedure at my place of employment.

Since early symptoms of Ebola are similar to those of many other viral illnesses (fever, abdominal pain, malaise and diarrhea), it is important for us to consider the diagnosis in patients who present with a fever-related illness and have a history of travel to West Africa within the prior month.

In clinical settings, ask all patients with fever about travel to West Africa (or contact with an individual who has traveled to West Africa) within the prior month.

Immediately move any patient with fever and a positive travel history to a room by him/herself with as limited contact to other patients and staff as is practicable. Caregivers should wear full personal protective equipment including gloves, gown, face mask and eye protection. Then check the patient for fever and other signs of infection such as headache, muscle pain, vomiting, diarrhea, abdominal pain or unexplained hemorrhage.

 

[vetusvates]

BOSS, COWORKERS OF US EBOLA PATIENT: HE KNEW HE HAD EBOLA, US TRIP WAS 'DESPERATE ATTEMPT TO SURVIVE'

http://www.breitbart.com/Big-Peace/2014/10/03/Boss-Coworkers-of-US-Ebola-Patient-He-Knew-He-Had-Ebola-US-Trip-Was-Desperate-Attempt-to-Survive

 

[tsst]

BOSS, COWORKERS OF US EBOLA PATIENT: HE KNEW HE HAD EBOLA, US TRIP WAS 'DESPERATE ATTEMPT TO SURVIVE'

http://www.breitbart.com/Big-Peace/2014/10/03/Boss-Coworkers-of-US-Ebola-Patient-He-Knew-He-Had-Ebola-US-Trip-Was-Desperate-Attempt-to-Survive

Wonder how many more will try the same thing?

 

[tsst]

couple more African travelers ... (not confirmed cases)

http://atlanta.cbslocal.com/2014/10/03/report-inmate-at-cobb-county-jail-being-tested-for-ebola/

http://www.nbcwashington.com/news/l...-at-Howard-University-Hospital-278025181.html

 

[Nanci]

NEW YORK - People who contract Ebola in West Africa can get through airport screenings and onto a plane with a lie and a lot of ibuprofen, according to healthcare experts who believe more must be done to identify infected travelers. At the very least, they said, travelers arriving from Ebola-stricken countries should be screened for fever, which is currently done on departure from Liberia, Guinea and Sierra Leone. But such safeguards are not foolproof.
"The fever-screening instruments run low and aren't that accurate," said infection control specialist Sean Kaufman, president of Behavioral-Based Improvement Solutions, a biosafety company based in Atlanta. "And people can take ibuprofen to reduce their fever enough to pass screening, and why wouldn't they? If it will get them on a plane so they can come to the United States and get effective treatment after they're exposed to Ebola, wouldn't you do that to save your life?" On Thursday, Liberia said the first Ebola patient to be diagnosed in the United States had lied on a questionnaire at Monrovia's airport about his exposure to an Ebola patient. Thomas Eric Duncan's arrival and hospitalization in Dallas have underscored how much U.S. authorities are relying on their counterparts in West African countries to screen passengers and contain the worst Ebola outbreak on record.
Virologist Heinz Feldmann of the National Institute of Allergy and Infectious Diseases has studied Ebola for years and helped develop an experimental Ebola vaccine. He told Science magazine in September that airport screeners in Monrovia, where he spent three weeks, "Don't really know how to use the devices." He said he saw screeners record temperatures of 32 degrees C (90 F), which is so low it "is impossible for a living person." Feldmann said in an email that according to his colleagues who have returned from Liberia in the last few days procedures for taking temperatures and doing clinical checks have improved.

 

[Rich Z]

In clinical settings, ask all patients with fever about travel to West Africa (or contact with an individual who has traveled to West Africa) within the prior month.

How about if they have those symptoms and were in Dallas recently?

 

[Rich Z]

Ebola Survivor Nancy Writebol

Ebola nearly killed Nancy Writebol in July—and it also made her famous, which helped broadcast to the world that it needed to respond more aggressively to what had grown from a small outbreak into an out-of-control epidemic.

Writebol, a clinical nurse associate, became ill with the disease while working for the missionary group SIM in Monrovia. She and her husband David spoke with Science on 24 September about a topic that has yet to receive much attention: How do health care workers who are trained to protect themselves nevertheless become infected with the Ebola virus? The Writebols also discuss how the outbreak grew into an epidemic, as well as the treatment she received both in Liberia and then at Emory University Hospital in Atlanta. Questions and answers have been edited for clarity and brevity.

I'm reading that article now. I find it interesting that she had both malaria and Ebola at the same time. And how is malaria transmitted? Might be just a coincidence, but the incubation time can be real similar for both of them. Which introduces the unnerving possibility that both Ebola and malaria were transmitted by a mosquito bite.

 

[Rich Z]

BOSS, COWORKERS OF US EBOLA PATIENT: HE KNEW HE HAD EBOLA, US TRIP WAS 'DESPERATE ATTEMPT TO SURVIVE'

http://www.breitbart.com/Big-Peace/2014/10/03/Boss-Coworkers-of-US-Ebola-Patient-He-Knew-He-Had-Ebola-US-Trip-Was-Desperate-Attempt-to-Survive

So, his thoughts were "to hell with everyone else who I may infect, I need to save myself......."?

Did he go directly to a hospital immediately after coming into the country?He didn't bother to quarantine himself, or INSIST at the hospital at the first visit that he had Ebola or at least strongly suspected it. No, he just goes back home to likely infect more people, including his own relatives. He probably didn't really know he was non-infectious while even on the plane over here, he just didn't give a crap about anyone else.

If he survives, he should arrested and put on a boat back to Africa that only goes half way and told to swim the rest of the way.

 

[Jace91]

So, his thoughts were "to hell with everyone else who I may infect, I need to save myself......."?

Did he go directly to a hospital immediately after coming into the country?He didn't bother to quarantine himself, or INSIST at the hospital at the first visit that he had Ebola or at least strongly suspected it. No, he just goes back home to likely infect more people, including his own relatives. He probably didn't really know he was non-infectious while even on the plane over here, he just didn't give a crap about anyone else.

If he survives, he should arrested and put on a boat back to Africa that only goes half way and told to swim the rest of the way.

Totally agree, they probably could slap him with Criminal Negligence.

 

[SarahP]

Here are my thoughts:

If you want to cause an epidemic, make sure you scare the crap out of everyone. Make sure they're so afraid to leave their houses that, should they need medical attention, they won't go because they might catch something sitting in the waiting room. While you're at it, tie up all the medical personnel with sudden cases of "ebola" that are allergies, colds or the current far-more-contagious strain of influenza.

*That's* how you cause an epidemic.

I feel sorry for this guy. Much sorrier than I do for anyone panicking about all the dirty people from Africa who are suddenly going to flood the US and kill us all.

 

[vetusvates]

Sarah, I respect and admire your opinion and generosity of sentiment.

I haven't used the words panic, dirty, suddenly, flood, or kill us all. I am not in a panic.

My pity is a rare and precious commodity. I have much for the people of Liberia, Guinea, and Sierra Leone.
This man has (actively, not passively) "made himself different" in a manner, and by means, that places him in a position to by no means deserve pity. Imho.
He has knowingly endangered the lives of what may very well be an uncountable number of people.
Transporting (possible) death from an already stricken country...to a larger population that was as yet untouched by what he knowingly brought here.
But, he will have to live with all this...if he lives.

There are vastly bigger and more far-reaching issues now.....than his ethically questionable decisions, and how we may feel about him.

 

[Rich Z]

Here are my thoughts:

If you want to cause an epidemic, make sure you scare the crap out of everyone. Make sure they're so afraid to leave their houses that, should they need medical attention, they won't go because they might catch something sitting in the waiting room. While you're at it, tie up all the medical personnel with sudden cases of "ebola" that are allergies, colds or the current far-more-contagious strain of influenza.

*That's* how you cause an epidemic.

I see. And the alternative to taking a realistic view of the potentials is to do what exactly? Doing the ostrich thing should be the rule of the day for everyone to follow? Sounds like a real good plan to me.

Personally I believe the best decisions are made when you have as many facts and extrapolated potentials on the desk in front of you as you can possibly get so your decision is INFORMED rather than simply keeping your head in the sand and hoping for the best. Is this scary to some people? Hell yes it is. Facts can be that way sometimes. So does that mean that people SHOULD be shielded from scary KNOWLEDGE? Well you can live that way if you want to, but that's not for me. Give me ALL the facts, please, and let me make the best decision possible for ME and my wife.

I feel sorry for this guy. Much sorrier than I do for anyone panicking about all the dirty people from Africa who are suddenly going to flood the US and kill us all.

I would have felt sorry for the guy had he at least announced while on the plane that he thought he had Ebola and precautions could have been taken then and there. Any chance of spreading the infection could have been securely contained. But did he do that? Nope. He chose to endanger a LOT of people instead. Everyone else's welfare became secondary to him in his effort to try to save his own skin. This guy was perfectly willing to go down in the history books as the person who single handedly caused an Ebola epidemic in the USA just to maybe save his own life. And he is to be felt sorry for? I'm sorry he caught Ebola. But every thing after that fact deserves nothing less than contempt and loathing.

 

[Nanci]

I was listening to talk radio yesterday, and the guest was the doctor who dressed up in the hazmat suit for his flight. He says we need to establish "fever centers" for people with undifferentiated fevers, so they can go there, and be diagnosed and treated, and hospitals will remain uncontaminated.

My question remains- how are all the doctors, who know all the routes of transmission, who ought to be taking it the most seriously- how are they contracting ebola?

 

[Rich Z]

I was listening to talk radio yesterday, and the guest was the doctor who dressed up in the hazmat suit for his flight. He says we need to establish "fever centers" for people with undifferentiated fevers, so they can go there, and be diagnosed and treated, and hospitals will remain uncontaminated.

My question remains- how are all the doctors, who know all the routes of transmission, who ought to be taking it the most seriously- how are they contracting ebola?

The fact that they don't know should be pretty worrisome.

Worst case scenario that I can think of would be an organism that can travel from one victim to another via airborne transmission, survive for days in that state, and be able to directly penetrate dry skin (not limited to mucous membranes) upon contact.

 

[diamondlil]

I've thought about that, but wonder if it's because they are staying in those areas where it's already taken hold, there's a reservoir at any time of the peple in the village, the markets where their food comes from, the drivers etc of potentially undiagnosed people, and without sounding judgemental the hygiene practices of the general population there and sanitation isn't to a high standard. A rat runs over the bag of rice that then becomes your dinner? That puddle you step in getting into your car has remains of someone's pee or vomit from the night before? The guy who hands you your sealed botle of water has his aunt laying sweating in the backroom of his shop? People there are fighting against the hygiene methods to reclaim the bodies of their loved ones who die, and actively trying not to go into the containment wards.