Ebola in the US

[9876543210]

SanteeFats,

Originally Posted by SanteeFats

Watching an American news broadcast (CBS) that says the camera man that got Ebola in Africa is considered cured. Plus, while better late than never, the US is now putting out training guidelines for healthcare workers. One nurse said she felt informed now she just needed to practice the protocol. Sooo I guess there is progress being made

Was watching the news last night and saw two things of interest. First, Texas' governor was announcing that only two hospitals will be allowed to work with Ebola patients in the state (Texas Presbyterian isn't one of them, thank heavens). Had to laugh. How's that going to work? Some infected person walks into another hospital and they turn him away? Sounds about right for Texas.

And second, both of the Texas nurses (who were transferred to hospitals out of state) seem to be doing well once they're out of the state!

I'm thinking I'm glad I don't live there as their health system seems to be in pretty bad shape.

[Norkles]

Originally Posted by DTravel

How about for economic, domestic and international legal reasons?

You mean keeping the air routes open for those reasons? I disagree. If Nigeria, Ghana have shut down their airports to flights from infected countries then why should we do the opposite. If I were at management at United and Delta my biggest concern would be the safety and health of the air crews. British and Air France have been smart enough to keep their employees safe.
If anyone wants to fly to the infected countries charter or better yet use military flights.

[deepsepia]

Originally Posted by CARLTON BROWN

Just to add a few words to this ongoing discussion about Nigera. The WHO does not have the resources to do much more than accept what they are told by officials in a country like this. And (I think it's fair to say that) should this kind of dubious information provide Western governments with the ability to takes some of the heat out of public concerns, they are going to make full use of it.

Nigeria had a single identified case from Liberia, and seems to have gotten on top of that case and the people he infected locally very efficiently. If they're wrong or concealing something, we'll know in quite short order.

Panic aside, its not hard to control small Ebola outbreaks, even in poor African countries (and although Nigeria is very corrupt, it also has a fair amount of wealth). Ebola outbreaks have even been controlled previously in the very worst governed places on the planet -- the Democratic Republic of the Congo.

In fact, since its discovery, there have been twenty or so Ebola outbreaks, all in Africa, nearly all in poor and poorly governed nations. (there have also occasionally been laboratory infections in Russia and the West, but no reservoir. There is a natural reservoir in the Philippines too, but no human infections)

They've all been brought under control in short order. Ebola isn't a hard disease for public health, in small numbers-- contact tracing and quarantine solves it.

The large scale epidemic in Guinea, Sierra Leone and Liberia is a horse of a different color-- but I don't have any worry about the ability of public health officials to control small outbreaks. Uganda, Zaire, DRC, Gabon, Sudan -- Ebola outbreaks really have been stopped in all these places previously

See: "Known Cases and Outbreaks of Ebola Virus Disease [CDC]"
http://www.cdc.gov/vhf/ebola/outbrea...hronology.html

[SanteeFats]

I see that a New York doctor who returned from treating people with ebola in Africa has been diagnosed with it. So what story will the government tell now about how it won't spread in the US? I guess they will eventually get it right but I wonder how many will get infected first?

[deepsepia]

Originally Posted by SanteeFats

I see that a New York doctor who returned from treating people with ebola in Africa has been diagnosed with it. So what story will the government tell now about how it won't spread in the US? I guess they will eventually get it right but I wonder how many will get infected first?

Why should it spread in the US?

Its clear that docs and nurses treating Ebola patients have to use tremendous care. That's do-able.

It also appears that with good medical care, most Ebola patients will survive. The reason that the disease appears so lethal is fluid loss-- this is fixable.

I know that people like the horror movie character of this disease-- but remember, roughly 1 million people die of diahreal diseases in Africa every year, and they're similarly treatable. Ebola is basically not unlike a nastier version of Typhoid or Cholera.

See the current New England Journal of Medicine for a much more balanced look
"Doing Today's Work Superbly Well — Treating Ebola with Current Tools"

Yet we also appreciated that most viral illnesses, and certainly most critical illnesses, have no specific therapy. And after spending much of the past 5 months treating patients with Ebola virus disease (EVD), we are convinced that it's possible to save many more patients. Our optimism is fueled by the observation that supportive care is also specific care for EVD — and in all likelihood reduces mortality. Unfortunately, many patients in West Africa continue to die for lack of the opportunity to receive such basic care.

EVD presents much as many other viral infections do, with nonspecific signs such as fever, asthenia, and body aches. After a few days, however, the predominant clinical syndrome is a severe gastrointestinal illness with vomiting and diarrhea. Volume depletion with a range of metabolic disorders ensues, and hypovolemic shock ultimately occurs.

{snip}

With the current focus on diagnosis of Ebola, we are routinely measuring Ebola viral loads in some of the world's most logistically challenged medical care environments using advanced polymerase-chain-reaction assays that are unavailable in most tertiary care centers. Yet we are not routinely deploying basic biochemical and hematologic diagnostic capabilities. We could do so. Simple interventions can prevent deaths attributable to hypovolemia and metabolic abnormalities. The high mortality from Ebola continues to reflect the natural history of the illness, not an inability to alter its course.
http://www.nejm.org/doi/full/10.1056/NEJMp1411310

Note that last line:
The high mortality from Ebola continues to reflect the natural history of the illness, not an inability to alter its course.

In other words "if you do nothing, the patient usually dies".

That's true of a lot of things.

My guess is that we'll see a bunch of folks treated in good medical settings in the US and Europe, and that most of them will survive.

Case in point, today

Originally Posted by Nurse Nina Pham Is Ebola Free, Headed Home

Dallas nurse Nina Pham, who was infected with the Ebola virus while treating Thomas Duncan, is now free of the deadly virus.

Pham will now be headed back to North Texas from Maryland where she had been receiving treatment at the National Institutes of Health facility in Bethesda
http://dfw.cbslocal.com/2014/10/24/d...from-hospital/

[SanteeFats]

Well Deep I think it will spread do to two things. Human error and ineffective techniques. I sure hope I am wrong but with human nature being what it is there will be lapses by some somewhere, IMO.

[deepsepia]

Originally Posted by SanteeFats

Well Deep I think it will spread do to two things. Human error and ineffective techniques. I sure hope I am wrong but with human nature being what it is there will be lapses by some somewhere, IMO.

There will be some people who get it, but why is that a big deal?

There will be some medical practitioners who get multi-drug resistant infections from their patients, including nasty stuff like TB.

We have bacteria that are resistant to ALL our antibiotics -- Ebola is really just another risk. Medical practitioners are always on the frontline for lots of stuff-- you can be sure that if SARS or MERS breaks out, there will be docs and nurses among the ill.

The thing that I'm getting at is that folks who are at no particular risk are behaving hysterically, while the people who actually are at risk are behaving as they should

NB: it now appears that the second nurse, Amber Vinson, has also cleared the virus.

The Brits got this one right, long ago . .

[danton]

Ebola is the latest in a string of "We are all doomed" health stories. Actual and existing threats to health are ignored in favour of the exotic and unusual.

HIV/AIDS: This was predicted to become a widespread and heterosexually transmitted disease. It was in Africa and decimated Zimbabwe, to give one example, because of a resistance to using condoms among men. In the west two high risk groups either died or followed advice. There was no 'Gay Plague' (disgusting British tabloid headline).

BSE/K-JD: Clearly a dreadful disease in its human manifestation, after a cluster theory was demolished quite early on, this disease ("!00,000-150,000 cases in five years") failed to develop in the wider society. Finally, predictions gave a incubation period before presenting as "forty years".

Chicken Flu: Risk of transmission from live animals reduced as one travelled west on the globe.

Ebola: Seeing the disgusting living conditions inflicted upon Africans by their Rolex wearing rulers, one can only marvel people live long enough to catch anything.

Meanwhile, ordinary diseases such as pneumonia, common influenza, TB, malaria and physical aliments induced by diet or starvation carry off millions daily. Starvation weakens most world wide before disease presents. This mundane side to human mortality does not however sell circulation for western media.

[Norkles]

Originally Posted by danton

Ebola: Seeing the disgusting living conditions inflicted upon Africans by their Rolex wearing rulers, one can only marvel people live long enough to catch anything.

Ebola made the jump from monkeys to people because the locals ate them. Couple that with poor hygiene and local customs (which has nothing to do with Rolex wearing rulers) and you have the perfect recipe for disaster. AIDS followed the same path.

[brk549]

The question wasn't whether you could control it,I suppose you can control anything but they had to be on top of it.The administration wasn't on top of anything.The head of the CDC first came out and said all you needed was a private room with a private restroom in the beginning and now they say you have to be completely covered and quarantined.How in the hell could they have missed it that bad.The way they they were going in the beginning we should have banned travel because they weren't protecting anyone.I'm glad the media jumped on it because probably half of us would have it by now if they hadn't.It wasn't the hospital that blew it,they were just as concerned as the CDC which wasn't much evidently.