And what steps should we take to prevent it’s spread?
This is an a really nasty virus, and extremely deadly. Incubation periods, as I understand it, can be weeks, with no signs of infection. The Powers that Be (I’m not trying to pin anything whatsoever on Obama here) assured us not long ago, when they brought to Americans infected with it back, that we are safe from it. But now there are patients in the U.S. I think Hawaii, Utah, and I know, Dallas. And the U.N. fears it could become airborne, the ramifications of which are hard to fathom.
So, what should be done. How cautious should we be? How quickly do we start to quarantine the homes of the infected? How quickly do we close schools? I’m not suggesting at all that we do these things now? But are they on the horizon?
Dallas resident here - whether they should be concerned or not, it’s the hot topic of conversation at the moment and some people are, as per human nature, totally flipping out.
There doesn’t seem to be any real chance that we’re going to see uncontrolled transmission of Ebola here in the US; other countries in the region like Nigeria have managed to stop new infections within their borders through basic sanitation and quarantine procedures. The real concern is that the disease will just sort of continue on a slow burn in West Africa and that occasionally you’ll get people like this who go to another country, infect a couple of others, and generally cause panic. We probably ought to be concerned about it in that sense, but not because it’s here, but rather because it’s not controlled elsewhere.
When someone says they have come from a country where there is currently an ebola outbreak the triage nurse should not ignore that information but make sure the medical team in the ER is informed so any necessary quarantine and contact tracing can start immediately.
Keep calm
Make sure medical personnel have all necessary isolation equipment from rubber gloves on up.
Sick people should go to doctors.
Yes, and people are NOT infectious during the incubation period. They become infectious when they become sick.
It was inevitable someone from an affected nation was going to go elsewhere then fall sick. That’s the nature of international travel in the modern world. That’s why hospitals have been briefed, airports are being monitored, and so on.
Such isolated outbreaks are containable - Nigeria has contained one successfully. Are you suggesting the US is less capable or has fewer resources to handle such a thing than Nigeria?
Who at the UN is saying that? Does that person have any medical training?
It is highly unlikely this could become airborne. Completely impossible? No - but you’re probably more likely to get hit by a meteorite than contract airborne ebola.
Make sure medical personnel are informed of what to look for, how to protect themselves, and how to pass on important information rapidly to those who need it.
Make sure public health systems have the resources - money, material, and personnel - to deal with any ill people who pop up.
Make sure anyone diagnosed with ebola in the US receives medical care regardless of insurance status, ability to pay, or citizenship.
Make sure those in mandatory quarantines do not lose jobs, residences, and can have food and necessary supplies delivered to where they live during quarantine so people have less incentive to try to avoid cooperation with health authorities.
Depends on where you are. In Alaska? In Dallas? In the apartment next to where the ill patient in Dallas was staying?
If you’re outside Dallas do what you should be doing to avoid things like colds and flus - mainly lots of hand washing. In Dallas - follow the public health directives. If you might be a contact they should be contacting you if they haven’t already. Otherwise, you probably shouldn’t worry unless more people fall ill.
Already started. The apartment where the ill man in Dallas was staying has been quarantined, along with several family members. Food and supplies are being supplied to them. They have attempted to clean/sanitize their home with bleach (that is the recommended treatment) but it’s unclear if this was done properly/thoroughly, and they’re concerned about the ill man’s belongings and used bed linens that are still in the residence. The public health folks are in communication with them and trying to sort out the logistics.
We haven’t had to quarantine people like this in the US since the last smallpox outbreak back in 1949. We’re a little rusty at it, but I’m sure someone is taking notes. Any subsequent quarantines will probably be much smoother for all concerned.
If the outbreak moves from an isolated case to something that is spreading in the community. Not necessary at present.
Yes, it could but most likely it won’t, at least not outside of those nations where things were allowed to get out of hand. As I said, Nigeria has already contained an isolated outbreak. It’s not impossible.
I think i recall you wanted to condemn the poor american volunteers to not come back to USA. They were cured. What is the connnection in mentioning these Americans to your one case in which is a Liberian who flew to see his family?
According to who?
as has the Senegal from some guinean case, who recovered.
Latest update is that a team in hazmat suits will be sent into the quarantined apartment in Dallas to make sure it is properly sanitized and contaminated items will be removed.
Anthony Banbury, the Secretary General’s Special Representative who is the head of United Nations Mission for Ebola Emergency Response (UNMEER) has mentioned that an airborne ebola is a “nightmare scenario, and unlikely, but it can’t be ruled out.”
No mention of a medical degree, but Banbury is the U.N.'s top man in charge for ebola response. His experience at the U.N. has focused on humanitarian relief efforts.
The occasional returning infected person is inevitable. We may even see occasional cases spread in the US with family members or health care workers. But that’s not really an outbreak. When you’d worry is when it is spreading in the wild.
Unless you are a family member of a traveller to Liberia or a healthcare worker in an isolation ward, it’s not time to worry. Ebola is primarily spread by people who are actively critically ill and by bodies. In theUS, we don’t encounter much of either.
That seems pretty different than “fearing” it could go airborne, which implies a strong possibility. He’s acknowledging that it could happen, which is true.
Keep in mind his job is also to drum up as much support for a response as possible, so he has motivation to keep the worst case scenario in people’s minds.
Certainly, nothing about the way the Duncan case has been handled inspires confidence in this country’s ability to contain Ebola should it appear any more widely.
[ul]
[li]No ability to screen incoming travelers. [/li][li]Sending him home from the hospital despite active symptoms and the knowledge that he’d come from Liberia. [/li][li]Letting several days pass after Duncan’s admission to the hospital without sanitizing his apartment (still hasn’t happened yet!). [/li][li]Letting various officials visit the apartment without protection before any cleanup. Query whether those officials are being monitored. [/li][li]Letting several days pass before hosing off his vomit from the surrounding property (let’s hope nobody’s dog wandered past there in the meantime). Query whether any hazmat disposal experts were consulted before it was decided to wash the vomit into, well, wherever they’re washing it into. [/li][li]Quarantining the family members in with Duncan’s used linens and personal effects. But at least authorities eventually brought them food.[/li][li]Query what’s happening to his hospital linen and waste, since there’s no protocol for its disposal, and regular hospital disposal companies won’t take it – at Emory, it piled up in bags for days until something (?) was done.[/li][/ul]
How many of your steps do you think happen in Lagos? And yet the Nigerians did not have an outbreak after the first contact round under a scenario similar. the same for Dakar, and yet the Senegalese also contained.
What are you going to do to screen the incoming travellers who have no symptoms? What is it you think is to be done?
Certainly, nothing about the way the Duncan case has been handled inspires confidence in this country’s ability to contain Ebola should it appear any more widely.
[ul]
[li]No ability to screen incoming travelers.[/li][/quote]
Duncan was screened no less than three times before leaving Liberia and showed absolutely no symptoms. Had he been screened upon arrive in the US he would have still been showing no symptoms. In this case, screening at arrival would have done squat.
Screening people for symptoms, or people visibly ill, is useful. Screening people without symptoms four times in less than 24 hours not no much.
[quote]
[li]Sending him home from the hospital despite active symptoms and the knowledge that he’d come from Liberia.[/li][/quote]
This is where the system broke down this time.
[quote]
[li]Letting several days pass after Duncan’s admission to the hospital without sanitizing his apartment (still hasn’t happened yet!). [/li][/quote]
Apparently the hazmat team DID go to the apartment and were turned away due to lack of permits, which means this is a bureaucratic snafu and is correctable.
[quote]
[li]Letting various officials visit the apartment without protection before any cleanup. Query whether those officials are being monitored. [/li][/quote]
Presumably they are being monitored at this point… do you have reason to believe they aren’t?
[quote]
[li]Letting several days pass before hosing off his vomit from the surrounding property (let’s hope nobody’s dog wandered past there in the meantime). Query whether any hazmat disposal experts were consulted before it was decided to wash the vomit into, well, wherever they’re washing it into. [/li][/quote]
Your source indicates the washing was performed with a bleach solution which does kill ebola and thus the washwater would be safe.
I’m curious about how well ebola survives outside the human body. Does drying kill it? Does UV? (Ordinary sunlight can kill TB, for example). You’re implying the vomit was some sort of long term hazard but it may not have been.
[quote]
[li]Quarantining the family members in with Duncan’s used linens and personal effects. But at least authorities eventually brought them food.[/li][/quote]
It’s not like anyone has been forced to roll in dirty linens - the family put the linens and possibly contaminated items into plastic bags, which should be adequate to contains and virus that might be on/in them. The family has also used bleach to disinfect their residence, although there are concerns that they make not have done as good a job as professional cleaners. Last I heard a crew is supposed to go in today to remove those bags of stuff and make sure the cleaning was done properly.
At Emory the waste was eventually sterilized in a large autoclave prior to being hauled away. Which really is overkill but hey, better that than sloppy handling, right? Most hospitals don’t have a sufficiently large autoclave but really, ebola waste shouldn’t require handling any more special than a lot of other diseases, it’s not from Krypton and our yellow sun doesn’t give it superpowers. The waste-hauling problem at Emory was, again, a matter of permits and that problem is largely from people getting hysterical and treating ebola as some sort of SF unkillable plague, which it isn’t.
Shifting the comparison from “Surely we’re as capable as Nigeria” to “Maybe Nigeria handled it just as badly” does not really challenge my lack of confidence.
Nor does our apparent agreement that airport screening is not going to contain the arrival of the disease over here.
I’d like to have your faith, but the very fact that those additional people were allowed into the contaminated site unprotected gives me no assurance that authorities are taking appropriate steps as to those people now.
I guess we’ll find out! I’d feel better if the answer weren’t “we don’t know,” or if some official had attempted some sort of organized response to the bodily fluids left behind.
And I’d make the same point here; if the official response is that people are basically on their own when it comes to handling contaminants, that just reinforces my lack of confidence; the next family may not be that careful. If the authorities can’t properly sanitize one apartment or move one family to an uncontaminated environment in less than a week, then any wider problem is just going to paralyze them.
And certainly, if we’re down to a distinction between picking up dirty linen vs. rolling in it, we’ve left best practices behind.
I’m not in a position to disagree, but that doesn’t change the fact that it’s piling up somewhere at the Texas hospital (the same hospital that sent him home with Ebola once). Hopefully this incident will spur the development of a disposal process, because I think we all agree that we’re going to keep getting some Ebola cases in this country.
I don’t recall that case, but I’m fairly certain it wasn’t preceded by months of media reports about the spread of Marburg in Africa, or high profile cases of American aid workers being infected with Marburg and flown home for treatment. If your point is that the diseases are similar and that the media is overstating the risk of Ebola, that’s probably true, but to ask why people are afraid now is to ignore all of the reported information that’s been circulating over the past year.
Moreover, to characterize a desire for competence in the official response to a public health issue as “fear” essentially just constitutes an attempt to change the subject.
What confidence do you need? The Nigerians with no resources contained with no second transmissions an identical case - and in fact much worse since it was identified very much later in time with less control and confidence on handleing.
So again, why are you more afraid than the Nigerians?
What does the USA have to do with flights to the Europe, specifically the Brussels? What “agreement” is in place for this?
And how is it you propose concretely to do a screening when no symptoms and no detectable signs are available in the blood?
How is it that it is faith to depend on the same procedures that worked in situations that are more difficult and have less resources than the USA?
I can not avoid asking how somehow bodily fluids become more scary in the USA and more contaminating than in the African countries neighbouring with less resources?
It is extraordinary to me to see this kind of ignorant and fear-promoting comment, but I think it helps for the context of people who have asked why the liberians have had such a poor response.
I think the common factors are the aversion to government and the distrust, and if it possible to see such responses from well educated americans, how can one fault people who have no formal education?
I find it very indicative that among the three countries it is the Guinea Conakry with its stronger administrative culture that is doing the best in the containment, even though it is poorer directly and in the aid flows than the other two.
I also find it indicative that the American media talks of the Africa or the West Africa outbreak, but they do not make specific identifications until very late. It is like if there was an outbreak of measles in the Germany and the media spoke of Europe being a danger.
The doctors didn’t even know it was Marburg at the time. She was tested for Ebola and Marburg at the time of treatment and initial tests were negative for both. Diagnosis was only confirmed several months after the patient recuperated.
The treating doctor did notify state authorities at the time of patient treatment in January 2008.
Isn’t the transmission of Ebola essentially the same as the transmission of HIV? Is there really a need for medical precautions more stringent than those used for AIDS medical waste? Isn’t the procedure with the guy’s sheets basically: put on some gloves, stick the sheets in a bag, send the the bag to burned at a medical waste facility? Why should any of the professionals freak about this?