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  #1  
Old 30 September 2014, 09:09 PM
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Default First Case of Ebola Diagnosed in the U.S., CDC Confirms

http://www.nbcnews.com/storyline/ebo...nfirms-n215231

Quote:
The Centers for Disease Control and Prevention has confirmed the first patient to accidentally carry Ebola to the United States has been diagnosed at a hospital in Dallas.
And the fears that everyone has been telling me are irrational for the last 15 years just came true...
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  #2  
Old 30 September 2014, 10:51 PM
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What fears were those? You were afraid that someone would be sick in Dallas?
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Old 30 September 2014, 11:22 PM
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Lol, not Dallas specifically but I've had the irrational fear that person or persons would bring the disease to this country. I know all the arguments against the worry but irrational fear is irrational and now it seems just a bit less nutty.
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Old 30 September 2014, 11:42 PM
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Well, judging by the comments on the news sites for Albuquerque people here think it can be spread by handshakes and are now trying to remember who they shook hands with yesterday.
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Old 30 September 2014, 11:44 PM
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I don't think it's irrational to think that someone here could get sick with ebola. It has a long enough incubation period that someone could be exposed and then fly to the US before getting sick. What is irrational at this point is the fear that it will spread and become an epidemic here. The conditions that allow it to spread that way where the epidemics are actually happening are not conditions that exist here.
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  #6  
Old 01 October 2014, 01:31 AM
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Unless a miracle happens something like a million West Africans will develop Ebola over the next few months. We just need to accept that Ebola infected travelers are going to arrive here with some frequency for the next several years. Hopefully in the future individuals who have traveled from West Africa, and then go to the hospital reporting flu-like symptoms, won't be released and allowed to walk around for a few days .
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Old 01 October 2014, 01:40 AM
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Quote:
Originally Posted by Dreams of Thinking Machines View Post
Unless a miracle happens something like a million West Africans will develop Ebola over the next few months.
What? No way. Cite?
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  #8  
Old 01 October 2014, 01:41 AM
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Originally Posted by boogers View Post
Well, judging by the comments on the news sites for Albuquerque people here think it can be spread by handshakes and are now trying to remember who they shook hands with yesterday.
There is an experiment performed in School on the spread of infections where you shake hands with a number of people in your class. Someone in your class has a product on their hands only visable under uv light. It is meant to show how infections are spread. Maybe this has confused some people in to thinking all dieases are spread that way.

Of course some infections like the common cold are spread like this. Or can be. But not all. I am old enough to remember the early days of HIV and how parnoid people where about that.

Education is the key. But whether people take on the message is another thing.

Still effective hand washing is a good thing to teach. Ordinary hold soap is ok.
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  #9  
Old 01 October 2014, 01:51 AM
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Quote:
Originally Posted by ganzfeld View Post
What? No way. Cite?
It's a worst-case scenario, not a foregone conclusion. The epidemic is speeding up, and spreading exponentially, as they do. Liberia has a huge problem with lack of hospital beds, and people getting into taxis to try to find a bed. The taxis have become a disease vector because they aren't disinfected at all, let alone after every fare.

Quote:
Both the Centers for Disease Control and Prevention and the World Health Organization agree that the epidemic is speeding up. But the CDC's worst-case scenario is a jaw-dropper: If interventions don't start working soon, as many as 1.4 million people could be infected by Jan. 20, the agency reported in its Morbidity and Mortality Weekly Report.
http://www.npr.org/blogs/goatsandsod...-organizations

The more realistic prediction I've seen is something like 20k infected, but that prediction was from a few weeks ago. I'd guess it will be more than 20k, but much less than a million.

Last edited by erwins; 01 October 2014 at 01:56 AM.
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Old 01 October 2014, 02:06 AM
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Thanks, erwins. "Interventions start working" isn't quite a miracle but that's still a lot worse than I had heard.
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  #11  
Old 01 October 2014, 05:14 AM
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The CDC's worst case scenario is simply the current progression of the virus. From their projection,
Quote:
If conditions continue without scale-up of interventions, cases will continue to double approximately every 20 days, and the number of cases in West Africa will rapidly reach extraordinary levels. However, the findings also indicate that the epidemic can be controlled.
"Can be controlled", which they take to mean that there are beds for 70% of active patients. A clinic that opened up with 120 beds filled-up immediately.
Not to mention that Liberia has 51 doctors for a population of 4.2 million (Had 51 doctors...).


Here is a Q&A with Jean-Pierre Veyrenche, a WHO employee responsible for treatment infrastructure:
Quote:
A:I am not optimistic about the immediate future. We're facing a lack of outside support, and a broken-down state trying to do what it can with what it has - which is not much. For me there's no doubt the number of cases will explode in the upcoming weeks and months.

The rainy season is on its way, and the mosquitos will be coming out. Then we'll see an explosion in the number of cases of malaria. This is not going to be easy: there's a risk of mixing up malaria and Ebola, since the symptoms are similar.

...
Q: You are in charge of the construction of Ebola clinics. Explain exactly what this entails.
A: My job is to set up 500 beds. I think I'll be done in a month. There are a lot of technical issues to consider - how a plot of land is laid out, how big and how accessible it is.

You need 5 000 square metres (5 400 square feet) for a 100-bed clinic - not easy to find in a big city like Monrovia, with marshy terrain. And the heavy rains are an enormous obstacle, as is the high water table which makes it impossible to dig latrines and is forcing us to build septic tanks out of concrete
The WHO has repeatedly waffled on the number of cases. First it was "up to 20,000 cases" an now it is "more than 20,000 cases." The WHO currently reports that the number of cases is north of 6200. The CDC believes that at the very least that's an underestimate by 40% (8400 cases) and quite possibly 250% (16000 cases). At any rate, I'm very doubtful of the ability for international workers to respond to this epidemic. There arn't nurses or physicians assistants for US doctors to train. In Liberia in particular, many of the roads would be difficult for military cargo trucks to navigate. We're sending 3,000 troops. Cuba is sending hundreds of doctors. But note that a 'scaled-up' response to something that's approximating an exponential curve means that over time more and more workers will need to be sent.

Ed: Also, ganzfield, you might try Jacques Pepin's book, the Origin of AIDS to get a background on why diseases are so difficult to control in Sub-Saharan Africa. It also sheds some light on why people in these countries are often suspicious of foreign doctors (it was the 70s, and who knew that you should sterilize vaccine needles...?)

Last edited by Dreams of Thinking Machines; 01 October 2014 at 05:28 AM.
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  #12  
Old 01 October 2014, 06:45 AM
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Thanks, DoTM.
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  #13  
Old 01 October 2014, 07:16 PM
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Here's an interview with the CDC head Thomas Frieden,
Quote:
Ezra Klein: The CDC recently released a report suggesting we could see as many as 1.4 million Ebola cases by January. What needs to happen to prevent that scenario?

Thomas Frieden: I don’t think we’ll see that number of cases. But I think it’s important to know that we could. Look at figure 10. It’s worth contemplating that figure for awhile. The president said at the UN that the slope of the curve is within our control. He totally got what we were showing.
As long as Nigeria and other neighboring countries continue to control their outbreaks, I think prospects are good that we will not reach 1 million cases by January (but this doesn't mean that total cases won't exceed 1 million by Spring). The real threat was Nigeria having an uncontrolled outbreak which would make it difficult to get food and other supplies into West Africa.
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  #14  
Old 01 October 2014, 08:27 PM
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Updates to the story are saying that he was initially told he had an unidentified virus, was given antibiotics and sent home where he spent time with his family including some children who then went to school. So many things wrong in that. They're still saying that the chance anyone else got it is tiny but that chain of events isn't really reassuring.
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  #15  
Old 01 October 2014, 08:34 PM
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You can tell the USA has top quality healthcare when a person reporting with flu-like symptoms is given antibiotics rather than Tamiflu.
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  #16  
Old 01 October 2014, 09:16 PM
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The children who went to school aren't an issue. People who have been exposed can't infect others unless they are actually sick. Meaning, not just in the incubation period, but actually experiencing symptoms. This is one of the reasons it is described as a disease that is actually fairly hard to catch. It's not like some epidemics where the person's contacts have to be traced all the way back through the incubation period (like, say, AIDS). Rather, ebolavirus is transmitted through direct contact with the bodily fluids of a person who has developed Ebola virus disease. It is possible the kids could get sick, but not that other kids at their school will.

I do wonder about the initial hospital visit. I'm curious if a travel history was asked for or given. It seems like a good question to ask just as part of a general screening. (Not whether they've been to Western Africa, but whether they've traveled recently). And if you've bee to the area with the epidemic, it seems like a good thing to volunteer.
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  #17  
Old 01 October 2014, 09:37 PM
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Here are a couple of blog entries from radio host Erick Erickson about some more detailed background information he seems to have received:

Quote:
The patient did not have symptoms when he arrived. But, and this is key and what did not come out at the press conference, the source tells me the patient actually did go to the hospital with symptoms on September 24, 2014. In fact, I assumed I was confused because the press conference said the 26th. I assumed I misheard the source. So I texted the source who called me back and, purported reading from the file, read that the patient arrived in Dallas, TX on the 20th of September, appeared in the emergency room with symptoms on September 24th. The patient was discharged with antibiotics and returned again days later with watery diarrhea and other symptoms, tested for both malaria and Ebola, and put in isolation on the 28th.
http://www.redstate.com/2014/09/30/t...ll-to-my-show/
Quote:
This then goes directly to what my source said yesterday. The Ebola patient in Dallas did show up at the ER for the first time on September 24th. He was sent home with antibiotics.

In other words, he had symptoms and was contagious for four days outside the hospital. They’re going to have to figure out who all he came into contact with. That’s not good.

The source tells me the guy had nausea on the 24th and was diagnosed as having a stomach bug.
http://www.redstate.com/2014/10/01/u...-was-the-24th/
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  #18  
Old 01 October 2014, 10:28 PM
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Quote:
Originally Posted by erwins View Post
I do wonder about the initial hospital visit. I'm curious if a travel history was asked for or given.
He did tell them, but it doesn't sound like the nurse made the connection.
Quote:
Thomas Eric Duncan explained to a nurse Friday that he was visiting the U.S. from Liberia, but that information was not widely shared, said Dr. Mark Lester, who works for the hospital's parent company.

Duncan's answer "was not fully communicated" throughout the hospital's medical team, Lester said.
She probably should have known to say something, but on the other hand, it shouldn't be the job of all ER personel to keep track of every current disease outbreak in the world. I'm kind of surprised there aren't any travel restrictions in place right now.
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  #19  
Old 01 October 2014, 10:40 PM
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What kind of travel restrictions should there be, do you reckon?

Air travelers from the area are already screened for a fever before boarding. Other restrictions are not likely to be helpful. http://www.washingtonpost.com/news/t...ged-countries/

ETA: I agree that it shouldn't be the job of ER personnel to know of all outbreaks everywhere. But to not know the significance of having recently traveled to Liberia and then having a fever is a level of ignorance that is orders of magnitude greater than that. The current Ebola epidemic is not something I would expect any ER medical personnel to be unaware of. It's relevant to their jobs, and requires a very specific response that you'd think hospitals would be addressing. Further, I would just expect people in that field to pay attention to such things.

Also, it's a huge pet peeve of mine for nurses or other personnel to ask questions or take down information and then for that information not to get to the doctor. Whether the doctor isn't reading the history or the other staff person isn't communicating it, it's ridiculous for that to happen, and it happens all the time.

Last edited by erwins; 01 October 2014 at 10:53 PM.
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  #20  
Old 01 October 2014, 11:36 PM
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I don't think they should really have Ebola on the brain right now. They have more important things to worry about that are millions of times more likely. This was literally a one in a billion case for the western world. As a matter of practice anyone who's been abroad should be watched carefully but the chances that their fever is tuberculosis or some other disease that is actually killing thousands of people even in the west is so much higher (even if they came from West Africa) that thinking about Ebola is a serious waste of time. A fever from abroad is something to pay close attention to but not because of Ebola.

(Also BTW Tamiflu doesn't do anything for tuberculosis. So I'm not so sure it should be handed out any more than antibiotics.)
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