Remember, You Can’t Get Ebola From Riding On A Bus . . . .
It seems the POTUS wants us all to remember that. He reminded us of that again just this past Saturday.
Well, then, pray tell: why – at that recent Pentagon Ebola scare, which apparently thankfully turned out to be a false alarm – did authorities hunt down the bus after it departed? And why did they temporarily detain and quarantine the tour bus and its passengers? I mean, that all happened the day before the POTUS gave us the reminder.
Sheesh. Do I even need to check Accuweather to see if my leg is wet because it’s raining? Nah, I didn’t think so.
Category: "Teh Stoopid", "The Floggings Will Continue Until Morale Improves", "Your Tax Dollars At Work", Barack Obama/Joe Biden, Government Incompetence
Well, you can’t catch Ebola from breathing the air someone else just exhaled, but you can catch it if they just threw up.
The problem here is that we all know this is potentially inaccurate. There is an alive time for the virus after it’s been exhaled and while airborne communication has so far been proven difficult the nasal discharge or oral discharge remains viable for a short period of time on external surfaces post discharge.
I am not certain I want to be sitting in a seat vacated moments earlier by an ebola infected and contagious individual and discovering I’ve made contact with some fluids they’ve left behind.
While it’s not time for the klaxons to be blaring a giant warning note, I do believe appropriate actions and restrictions have yet to be enacted by the procrastinator in chief.
VOV…As often heard in New York…”This is what I’m sayin’!”
As part of my day job, I represent my hospital at the regional emergency response meetings.
As you can surmise this has been a topic of interest lately.
While we all need to keep the threat in the appropriate perspective, the lack of preparedness across the board is pretty shocking, as are the responses so far to what I would characterize as near misses (i.e. a person who did not have ebola but showed up at a facility who exhibited similar early symptoms and had recent travel to a higher risk location). Screwing up the handling of a near miss (and there are many more out there than the press has reported) should set off the alarm bell just as would missing a live case.
The other item that I found deeply concerning is the number of medical providers (doctors and nurses) that have stated that they will not come to work if their facility gets an ebola patient. While I don’t know what that number was who privately voiced this to their hospital administration, it was significant enough for the hospital to raise the flag that it could become a significant issue effecting medical response in the region.
I would interpret that reaction as a conclusive evaluation by knowledgeable people that the hospital is not prepared to handle this disease.
What Valerie said.
The problem is that the folks inside usually know just how screwed up things truly are within that org.
All of the press conference bullshit and constant assurances that these and those hospitals are prepared for Ebola mean little to employees with little or no trust in their own facility’s readiness. It’s not very reassuring, either, when hospitals are suddenly discovering the need to educate staff on infectious disease controls. If I worked in a local hospital right now, I would be so gone before they even got to la in Ebola.
It was actually a system with multiple hospitals, but I would not disagree with your characterization.
The government’s response to this threat has been pretty atrocious. There are some common sense steps that should have been taken months ago to handle the isolated cases of the disease (or other highly contagious or infectious diseases) that enter the US/Canada. Not every hospital in the North America is equipped to tackle something of this sort, nor should they be. Just as there are only one or two hospitals in a given area that do brain surgery or organ donation/transplant, there should have been identified locations where patients exhibiting ebola symtoms/risks factors should have gone. Not, the “any hospital in America can handle taking care of this type of patient” stuff that came out of HHS and the administration.
On a personal note, while I have some empathy for health care providers who may be put at risk in caring for a potential patient, or being in the same facility; any licensed medical professional (doctor, nurse, clinician) who chooses to abandon their patients or potential patients needs to have their licence to practice permanently revoked.
Service before self comes as part of the profession. One of the reasons why doctors and nurses enjoy the status that they do (both professionally and economically) is that their predecessors in this country didn’t walk of the job when they were treating outbreaks of smallpox, typhus, Spanish Flu, malaria.
Unlike the military, or police and fire personnel, one doesn’t think of hospital staff as those expected to put their own lives on the line for others. And I mean that sincerely. Moreover, what profession asks its members to carry the potential harm home with them, to family? It is one thing for an Ebola-ready facility to accept Ebola patients but quite another for the 99.9% (?) of US community hospitals who aren’t Ebola ready to accept Ebola patients. I don’t blame any health professional or hospital employee who runs for the exits when their hospital’s first Ebola patient enters.
While I don’t blame them either if they make that decision, I personally believe they can drop their license at the door on the way out.
We shouldn’t expect every hospital to be able to treat this type of patient. But, I and you should expect that each and every emergency room in the country has a protocol in place to react and contain if someone happens to walk through the door exhibiting symptoms and risk factors associated with infection.
The CDC–the very org whose charge is is to lead this fight–failed miserably. Today–or was it yesterday?–the CDC conducted mass traing for healthcare workers. They are, by their own admission, running now to catch up to where they led us all to believe they were: ready for Ebola. so, my thinking is, if at that level there was (is!) unpreparedness, what in the world should anyone expect of their local hospital?
‘Screwing up the handling of a near miss (and there are many more out there than the press has reported)’ —
Okay, just HOW MANY are in the ‘out there’ zone?
My alarm bells went off with the first reports from western Africa, not with the mishandling of Duncan’s first arrival at the Texas hospital, or the story about the Spanish nurse contracting the disease.
My alarm bells were jangling with the reports that health care missionaries who went to west Africa voluntarily and contracted it were brought back here to be treated for it, and it was not because they were brought here, but because the entire thing was treated so lightly by the media.
Awareness afford preparedeness. So how many are in the ‘out there’ zone, Luddite? Don’t hint and then clam up.
I read that the average number of people coming into this country from the various West Africa hot zones is approximately 100 per day (not necessarily infected, you understand — just from those areas.)
I would say that somebody at the Pentagon followed the example of Dwight David Eisenhower during the Spanish Influenza epidemic, as re-told here a few days ago. That is, somebody decided to use his own good judgment in light of the many, large lacunae in our knowledge about how this virus spreads. To that person(s), my thanks.
CCO, VOV: I would not dismiss out-of-hand the possibility of airborne transmission of Ebola, for the following reasons:
1. Ebola Reston – the virus that caused the “Hot Zone” outbreak in the Reston “monkey house” but which apparently does not cause serious disease in humans – was documented to have spread via airborne transmission.
http://www.washingtontimes.com/news/2014/oct/16/airborne-ebola-outbreak-in-monkeys-raises-possibil/
2. Many knowledgeable medical researchers, including some who worked the “Hot Zone” outbreak, believe airborne transmission may be possible (albeit unlikely).
http://www.commdiginews.com/news-2/ebola-transmission-not-airborne-dont-count-on-it-28108/
3. The CDC defines a “low risk exposure” for Ebola as merely being within 1 meter of an Ebola patient without PPE for “an extended period of time” without physical contact. “Low risk exposure” means that there is indeed some risk of transmission.
http://www.cdc.gov/vhf/ebola/hcp/case-definition.html
4. Ebola transmission by airborne means has been documented between pigs and monkeys.
http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112
5. Coughs and sneezes produce relatively large droplet spray. These droplets are composed of mucous, saliva, or both. Ebola virus has been isolated in both saliva and mucous.
One of the primary issues here is terminology – airborne vs. aerosol droplets. Another is the biological differences between humans and pigs. Here’s a pretty decent write-up that covers some of this:
http://virologydownunder.blogspot.com/2014/08/ebola-virus-may-be-spread-by-droplets.html
And, the follow-up:
http://virologydownunder.blogspot.com.au/2014/08/ebola-pigs-primates-and-people.html
Both posts have references to papers if you feel you want to look at the source.
The short version is, airborne transmission has not been shown to be a risk for human transmission of Ebola. And to quote one of the final sections from the second link, which illustrates this pretty well:
Ebola is highly infectious, but not highly contagious. If 78 household members were exposed to particles in the air and none showed even any antibodies, that’s a pretty strong indicator that airborne transmission, if possible, is exceedingly rare.
(Yes, this strain is different, .. but not by that much.)
Thanks, LC and Hondo. “Ebola is highly infectious, but not highly contagious.” It’s interesting to learn the difference between the two terms; sort of like ‘accuracy’ and ‘precision’: accurate means you hit what you aim at; precision means you hit only in a small area, regardless of whether you hit your target.
I read recently that “highly infectious” means that relatively small numbers of viruses will make you sick while “not highly contagious” means it’s difficult for the virus to get to you.
And yeah, coughing as transmission had me wondering.
LC: not highly contageous? Debatable.
The reproduction number for the current West African outbreak is somewhere around 1.7. The reproduction number for the 1918 influenza pandemic is estimated to have been between 2 and 3.
Influenza is generally regarded as being very easily spread. You do the math.
Also, as noted above the CDC appears to believe that there is nonzero risk of airborne transmission of the virus. Otherwise, please explain why being within 1 meter of someone who has Ebola without PPE and without physical contact is considered a “low-risk exposure”.
I’d argue a reproductive number of 1.7, which has been calculated based on cases seen in places where customs involve high-risk actions like touching the recently deceased, is in fact supportive of the idea that it is not highly contagious. Or for a closer-to-home example, look at how Duncan’s family was living with him during the early stages of his sickness, and none have developed symptoms. It’d be nice to see if they developed any antibodies, as that would tell if they were even exposed, but as of yet we don’t have that information. The example I quoted above was similar, but with even more people. So what makes the typical flu different? I’m not a doctor, but I’d wager that since the flu primarily infects the nose and throat, the viral load of flu particles when one sneezes is much higher than Ebola, which doesn’t really any present capability for residing in the throat (or nose). Also, the flu can be pretty mild, and people tend to just think they have a cold, so while the reproduction number may be low, the threat is persistent. With Ebola, we know at-risk people due to contact tracing, and the moment symptoms present themselves, we are erring on the side of caution. Yes, that dynamic can change considerably if there’s a general, wide-spread outbreak here,… but right now there isn’t. And when it does, it’s useful to also recall that medical knowledge and practices are considerably more advanced now than they were during the 1918 flu. There is no doubt that Ebola is a monster – I’m not downplaying it’s utterly lethal risk. It is contagious, but it isn’t easily spread, thankfully. One possible caveat I’d be interested in knowing is the average number of people someone had contact with in 1918 vs. today. If we have roughly similar contact, comparing the R0 of Ebola and the 1918 epidemic is a bit unfair. And speaking of contact and airborne transmission, like I said, read the links – medically speaking, if you’re within a meter and they sneeze, and droplets infect you, that’s… Read more »
Your argument lacks merit.
1. Regarding Ebola not being “highly contagious”: influenza is generally the disease used as an example of a highly-contagious disease spread by airborne transmission. The worst influenza pandemic in history is estimated to have had a reproduction number between 2 and 3. That’s less than twice that of the current Ebola outbreak – and possibly barely larger than the current Ebola outbreak’s reproduction number. Thus, if Ebola isn’t “highly contagious”, then by your logic apparently influenza isn’t either.
2. I’d invite you to do a bit of reading as well. Droplets are not generally carried by ventilation systems to other rooms; aerosol particles may be. Spread through a ventilation system is believed to be precisely how Ebola Reston spread from room to room among the primates at the infamous “monkey house” of Hot Zone fame.
My point is that it’s premature at this point to believe that the airborne transmission of Ebola is “impossible” – as many have asserted, and as you have implied here. While airborne spread of Ebola not appear to be particularly common, “cannot occur” or “impossible” are far different assertions entirely.
As far as the Health Care workers contemplating not coming in if there is an Ebola outbreak, its a clear vote of no confidence in their place of employment.
Its really not far to compare a nurse or doctor who doesnt want to go into a facilty that has an ebola out break to Police and Firemen not reporting for duty.
Take those same Police and fireman, give them a squirt gun and tell them to break up a riot or put out a 4 alarm fire and you have a parralel.
The mention of military, police and fire personnel went to the mortal risk inherent in their jobs and nothing else. The point was that a nurse’s aide, a nurse, or a housekeeper for that matter, are not jobs that one takes knowing that they might not come home from one day.