In my defence, I usually make a concerted effort to avoid medical jargon when contributing to ‘medical’ threads. In the instance you cited, I quite consciously did the opposite! I deliberately used the medical terms knowing that Chief Pedant was an MD and, frankly, maybe naively, I assumed the thread would only attract medical types.
As a total aside, and I think of relevance to some of the up-thread insinuations about the care (or lack of it) received by African-American Ebola patients (in the US), this article may be germane. In particular, its authors note that the death rate for Ebola is more than 300 percent higher (349% to be exact) if the patient is over age 40 (regardless of severity of disease).
How old was that black man, Thomas Duncan, who died in Dallas? Forty-two.
And a 40-year-old lifelong resident of west Africa is not going to be the same as a 40 (plus)-year-old American.
Nancy Writebol and Dr. Sacra are both in their 50s. IDK how old the still-unnamed WHO physician, who was treated at Emory, is, only that this doctor is male.
No worries, I had to sort it out for myself, so added clarification.
That article also states that even with “volume repletion” (i.e. fluid balancing), antimicrobials, and laboratory work, the death rate was 43%. So there’s a number for Chief Pedant if he wants a more solid number than guesses by doctors working in the area.
Perhaps you have a cite for which I am unaware where any african country’s health system has proved quite capable in treating Ebola.
I am only lumping “african countries” together for the sake of convenience in naming all of the individual countries every time. I’m not aware that any of the african countries which have taken care of Ebola cases have had the remarkable success the US system has had.
So either the US cases are very lucky, or the healthcare system is more capable.
The Senegalese presently have a better record than your country in both the identification and the treatment.
Of course it is not a valid sample, but if we are to be ridiculous in making the generalisations from certain preconceptions…
No, I do not quite think that, but in any case if it is so, it displays very gross ignorance and even a level of unintelligent reflection.
It is like then insisting on saying the North American Police forces are very corrupt and incapable when dealing with the drug cartel violence, and also the North America is heavily hit by the outbreaks of mass school shootings. Oh and I did not say the Mexico or the United States, because it is all one continent and I did this for convenience…
Because it is sensible to say African, african, african as if all 47 countries are the same and the three countries representing a small corner of the West African region and a small portion of the population even of the West African region can not in any way be specified…
It appears you do not read things that do not confirm the preconceptions.
The answer of course is known…
To avoid misunderstanding, I was not saying the Nigerian case was a model of sound Ebola treatment, but I was saying it seemed from incomplete information that the question of capable treatment in a situation non-American that was more comparable to the unprejudiced question is the Nigerian case was to be found in what appeared to be better survival after the Nigerians realised it was the case of ebola virus disease and changed their treatment approach. I meant then that the Nigerian case might indicate - as I kept saying we needed the information to know more - that Nigerian hospitals performed better on after-first-generation transmissions in the area of the treatment - the containment was okay.
To this, I have found the first apparent analysis of the treatmment history over time and the transmission generations
The free PDF to download is easier to read.
Here is the proper data answer to treatment outcome possible. This presents an actual data on results, and that over time.
Yes this is a frequent feature of threads on Africa where something S. African that is strange to W. Africa is mixed in with something C. Africa that neither place practices, but it is all African…
As if the Mexican habits and the French Canadian habits are a basis to make comment on the Californians.
Since you appear to be ignoring things posted by Ramira, Senegal had one case where a person exposed and being monitored in Guinea evaded his monitors and traveled home to Senegal. He exposed his family and several people before going to the hospital, and not informing them he was exposed to Ebola. They treated him for malaria and sent him home. The next day he returned to the hospital. Then the hospital got an alert that someone evaded surveillance in Guinea, and promptly began treating him as an ebola case. He survived with treatment, and all exposed people were identified and monitored, with no follow on cases.
The US had one case where a person exposed in Liberia traveled to Dallas. He became symptomatic and went to the hospital, but did not inform them he had been exposed to ebola. They sent him home for several days, before he returned and was identified as being infected with ebola. Subsequently, two health care workers treating him contracted the disease. One of whom had traveled to Ohio, started becoming symptomatic, and still was allowed to fly back to Dallas before being isolated, creating more exposures. People exposed were identified and monitored, with no more follow on cases.
So, with similar conditions of a single patient zero import who did not inform the health care workers of his ebola exposure, Senegal had a better outcome of control than the US did.
The article just posted by Ramira discusses Nigeria. Once again, there was a single import case, this time the patient was symptomatic by the time he arrived in the country. He exposed numerous people before ebola was identified. Some of those people traveled and exposed other people, which included one health care worker who was symptomatic and had tested positive. She exposed numerous other people. Another person exposed by patient zero had traveled before becoming symptomatic, and infected a health care worker who died. Yet with all of that, Nigeria managed to track all of the exposures and ultimately has ended that outbreak. Similar results to the US.
Something happened in that paragraph where too many clauses were wrapped in an enigma.
I think your point was that Nigeria’s results were better once they realized they were dealing with ebola. Most of the deaths were early cases.
Yes, that is what I was trying to write. I was trying to say that is appears (I am not certain) that Nigeria’s results were better after realization.
The hypothesis is that in the higher income countries even in the african context in at least the urban centers like Lagos where there are the better skilled staff, if they know what they are dealing with right away the treatment results that can be achieved may be not very far from those in developed countries. The Nigerian case seems possible to support this.
Having clean water, medical supplies, and facilities for isolation is a huge step. Awareness that it might be ebola so to engage those isolation techniques is also important. With those two details, I would expect any decent medical center - in the US, Europe, or Africa - to have similar results.
Frankly, I don’t get what’s wrong with an actual quarantine for exposed people. This self-quarantine business has led to more exposures that had to be tracked. Like the lady that went on a cruise ship.
Sure, you aren’t contagious until you develop symptoms, but the problem is that once you develop symptoms, you expose people until you get into quarantine. Your family members, the ambulance personnel, the people on the bus or subway or airplane you travel on.
I would suggest it results in wasted effort and resources as the level of transmission is very low, and the effort to quarantine large numbers of persons who have a very low percentage chance of becoming sick is more than the rationale benefit. Only monitoring was done for the Senegal case, the Nigerian case and the Malian case right now. The monitoring is cheaper and less resource intensive - and less likely to meet a great resistance. I would expect that if the ‘potential exposure’ conversion to actual sickness was not very low (look at all of the similar cases, against the monitored potential exposure the number actually becoming ill was extremely low, only those in the very obviously close and direct contact - and not a majority of those even - became sick). the cruise ship ‘exposure’ was not a real problem, that was merely the irrationale panic taking over.
Ramira, I’m with Irishman on the quarantine issue, at least in West Africa. There’s less harm in exercising an abundance of caution provided the facilities to hold suspected or confirmed cases are available. Sadly the case of the American lady doctor held against her will in NY in a tent of course gives the quarantine strategy a bad rap as she did test negative yet they kept her anyway in a region of the world where proper monitoring would’ve sufficed.
Mali had actually kept over 100 people who came into contact with the 2 year old girl who died, and it was quite successful at it as they were expected to be declared Ebola free this weekend. She had traveled from Guinea on a bus with her grandmother. None of these quarantined individuals appear to have contracted the virus & none seem to have complained about being held unnecessarily.
Unfortunately reports in tonight’s news indicate that another patient crossed the border from Guinea and was being treated for kidney failure in Bamako, the capital, after being driven in a personal vehicle with 4 friends from a town near the border with Guinea. He died a couple days ago. A 25 year old male nurse who had been treating him died of Ebola shortly thereafter. At least 2 other individuals also succumbed to the virus. It should be noted that all these cases were confirmed to be Ebola cases posthumously so the authorities are now scrambling to contact trace. As I write this the hospital in Bamako that treated the male nurse that has been put under lock-down, unfortunately after many who were there for other ailments fled the facility. Let’s hope they can manage a Nigerian style recovery as they no longer rank at the top of the game with Senegal.
Say what? Is this yet another Chief Pedantesque generalization of life in West Africa? I know it may be difficult for some, who raised on images of Africa as seen through Band Aid lenses, to imagine but there are a number of people who lead lives comparable to if not superior to those of your typical American right here in Africa. Not all Africans live on $2 a day (that used to be a dollar before the Bush wars made the greenback tank) or spend the better part of their waking hours “swatting flies”. Seeing as Duncan could afford to fly to the US he probably had access to decent healthcare even if he may have been a “lifelong resident” in darkest Africa. Hell if things are so bad here why the heck have two American ambassadors (to Kenya) in a row chosen to retire from the US foreign service & take up permanent residency in Nairobi?
Here’s an essay that ironically appeared just yesterday, written by someone who was there is more ways than one.
No wonder people are hesitant to go to hospitals in that region, and that according to his father, he has a lot of survivor’s guilt and maybe PTSD. I can’t even imagine what that place full of sick and dying people must have smelled like.
You do understand that he describes an emergency facility of the Medecins sans frontières, yes? that is not a hospital. Of course for the three countries most of the public hospitals are quite terrible, never having been well rebuilt from the looting of the civil wars. This is a great reason why the outbreak has been so terrible in those countries. This is not the same case for a Côte d’Ivoire or a Ghana, although it is not to make a claim that the hospitals would be of a rich country level.
Bumping this thread: Dr. Sacra is headed back to Liberia later this month, for about a month, and the WHO physician came forward last month. His name is Dr. Ian Crozier and he’s in his mid 40s.
I felt this was the most appropriate thread for the following link, which includes a video shot before he became part of the story.
I’m guessing that in the future, he will not do freelance work for CBS or “60 Minutes”, and that’s not just because NBC, for whom he was working when he got sick, paid his huge medical bills.
:dubious:
Several days ago, I found two interviews on You Tube with Nina Pham, one of the nurses who got Ebola from caring for a patient in Texas, that were done last month by a local TV station. She had not yet been cleared to go back to work, and she was not allowed to talk about conditions at the hospital, presumably because she is suing. :eek: Can’t say I blame her, and honestly, if she does I hope it’s an open-and-shut case and she never has to work again. On a better note, she says her dog is fine, and one interview posted a tweet she did on her dog’s birthday.
Dr. Richard Sacra, the third missionary and second physician to be diagnosed and brought back here for successful treatment, is headed back to Liberia later this week. This guy lived there during the civil war (aka holocaust), so he’s definitely not afraid of anything.
Here’s another story about Dr. Sacra. It appears that the disease is fizzling out in Liberia, but is still raging in Guinea and Sierra Leone (and it’s quite possible that Liberians aren’t reporting when and if they’re sick).
He also won’t have to worry about being quarantined upon his return, because he’s already immune.
