Ebola in the U.S. of A.

[Genecks]

[...] When I first saw that someone [in the USA] was spotted with ebola, I thought to myself that the workers were seriously ignorant. Personally, I think the National Security Agency should step in, put things on lock down, and quarentine issues until this problem is solved. Am I right or wrong? Yeah, maybe some civil rights would be violated, but at least it won't be a plague.

 

It looks like the issue is getting worse from what I'm seeing on the news.

Edited October 20, 2014 by CaptainPanic
Sections between [ ] are edited by me to remove wording that was in violation of our rules, section 2.1 ("Be civil").

[ajb]

WHO is playing down the possibility of a large problem in the first world, mainly due to the good health care systems. (Compared to those in Africa anyway). The UK is doing some kind of screening of passengers from West Africa. Experts have said that this is just a gesture on part of the government to calm the public. Scary times, but I hope WHO is right and we don't have to worry too much.

[Strange]

 

Am I right or wrong?

 

Over-reacting, I would say. Clearly medical procedures need to be tightened up in the US. (The UK has recently had to treat a number of cases of similar diseases and so may be better prepared. And this may be one of the cases where a centralised health authority helps.)

 

But with only two cases in people who were caring for a patient, it seems a little premature (and also a little late) to be considering some sort of mass quarantine and curfew.

 

It was ridiculous that one of the nurses was advised it was OK to travel (and stupid of her to do it). I guess they won't be making that mistake again.

[ajb]

Over-reacting, I would say...

As far as I know, there has been very few cases of actually contracting ebola outside of West Africa. Those that have were in very close contact to those who were infected in Africa. With a little effort it should remain very localised. Or at least we all hope so.

[Phi for All]

Those that have were in very close contact to those who were infected in Africa.

 

... and did NOT follow a proper protocol for dealing with those infected. I'm still reeling from the incredibly ignorant approach taken in Texas. You have one major preventative method available, avoid contact with ANY fluids from a victim, but you let your nurses work without completely covering their skin?! Unbelievable for a modern hospital, but a big part of the reason I don't think healthcare should be using a for-profit business model. It fosters cheapness that can cost lives in the long run.

[CharonY]

Actually it is not only about procedure. It is also the ability to apply them. Full coverage helps little if you are inexperienced in disrobing and contaminate yourself at that point. In fact, partial body protection (depending on situation and condition of point patient) that is applied correctly, is better than full protection done wrong. Due to the rareness of the diseases chances are that average health care providers are not well trained in these protocols. Even those that are can make mistakes. The nurse in Spain most likely infected herself while accidentally touching her face (to her credit, she realized that).

Protocols do not replace situational awareness, but in situations like this (where you deal with a dying patient) lapses are not impossible.

 

That being said, the infection rate outside of West Africa are less than a concern. The situation of the swine flu pandemic in 2009 was far worse and with many more deaths.

Edited October 18, 2014 by CharonY

[MigL]

So just how infectious is it CharonY ?

Do you need exposure to blood, or is it possible from other fluids ?

Can it be contracted through skin tissue or does it need contact with mucous or moist membranes ?

Can it be contracted by being sneezed on ?

 

From everything I've read, it isn't nearly as contagious as a flu or the common cold.

( But the results are a lot more serious )

 

I've also read of a Canadian developed vaccine which is in testing right now, not for efficiency, but for side effects.

How close is a vaccine ? Or is it like HIV, where although no vaccine, quality of life can be provided with drugs so that its not a death sentence anymore ?

[CaptainPanic]

!

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Genecks,
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[Strange]

Do you need exposure to blood, or is it possible from other fluids ?

 

Any bodily fluids, think (even sweat contains the virus).

 

Can it be contracted through skin tissue or does it need contact with mucous or moist membranes ?

 

The Spanish nurse appears to have contract it by touching her face with a glove. But that may have been near her eyes, nose or mouth.

 

Can it be contracted by being sneezed on ?

 

I believe so.

 

From everything I've read, it isn't nearly as contagious as a flu or the common cold.

 

Because it is not airborne, so it needs direct contact with bodily fluids.

 

Can it be contracted through skin tissue or does it need contact with mucous or moist membranes ?

 

More here: http://www.bbc.com/news/health-29556006

 

People are infected when they have direct contact through broken skin, or the mouth and nose ...

[DimaMazin]

Ebola is useful for science.

[ajb]

Ebola is useful for science.

Useful in what way?

[CharonY]

A number of things are relevant to understand this. One has to differentiate between how infectious an agent is (typically assessed under controlled conditions) and how effective the transmission is. It may be a bit confusing that ebola does not require many particles to affect someone (at least under lab conditions), yet transmission is rather low. Even in the worst hit areas in Western Africa, on average less than two people get infected per patient. Obviously, this still will lead to spread, if not contained. Nigeria and Senegal were able to contain the current spread, and are now ebola free, for example.

 

It should also be noted that flu is not that contagious either (a bit more than ebola, but not by that much). However, as its symptoms are often very generic, people do often do not take proper precaution to limit spread and that is why it takes a while until the flu season burns out. So there is also a behavioral component to it.

Edit: I realize in my earlier post the comparison between flu and ebola could be understood as comparison of infectious mechanisms, rather I meant it in the context of behavioral differences, both in terms of containment, as well as public fears. Flu is more of a risk because it is much more prevalent, i.e. your chances of actually getting infected is much, much higher. Even with lower mortality the overall risk of complications and death are therefore much higher, unless you are in one of the hotspots.

 

Ebola is different in that regard, too, as in the strong viral shedding phase the symptoms are rather extreme. With regards to mechanisms, it has been established that aersols outside of lab situations as well as casual contact does not lead to infection. Even the likelihood of living with a patient is low, unless there is close contact throughout (sleeping in same bed, for instance) or direct contact with fluids. Skin contact carries low risk, mucosal much higher, which is mediated by the fact that aerosols and droplets carry low risk. I would be worried being coughed at the face, however.

 

Treatment seems to work somehow in the early phases, while I am not sure how individuals were treated, there are experimental antibodies (also produced by a Canadian group) and blood transfusion from survivors (which may contain antibodies). The rest tends to be symptomatic treatment. In contrast to HIV (which is more contagious as it can be transmittable while being asymptomatic) there is not means suppress viral activity. It is mostly down to clearing it before it spreads to organs. Recently, a health care worker was treated successfully in Germany, and the infected nurse in Spain is now also virus-free. It appears that the key is early treatment.

 

The vaccine you mentioned needs actually being tested for efficacy and estimates point toward 2016 at the earliest point for general use, I assume through an accelerated process. However, there is also another being developed since 2011/12 by a Swiss-Italian company (now bought by GlaxoSmithKline) also in phase I (scheduled to be finished by the end of the year).

 

I should add that phase I tests for safety and only in phase II and III the actual efficacy is assessed.

 

So just how infectious is it CharonY ?

Do you need exposure to blood, or is it possible from other fluids ?

Can it be contracted through skin tissue or does it need contact with mucous or moist membranes ?

Can it be contracted by being sneezed on ?

 

From everything I've read, it isn't nearly as contagious as a flu or the common cold.

( But the results are a lot more serious )

 

I've also read of a Canadian developed vaccine which is in testing right now, not for efficiency, but for side effects.

How close is a vaccine ? Or is it like HIV, where although no vaccine, quality of life can be provided with drugs so that its not a death sentence anymore ?

Edited October 20, 2014 by CharonY

[swansont]

A reminder from somewhere on twitter, regarding these recent events: more people have played Batman than have died of Ebola in the US.

 

People absolutely suck at risk assessment. I wonder how many people freaking out over Ebola don't buckle their seat belts or wear a life preserver when boating? (which presents a much greater risk of dying than Ebola)

[CharonY]

Unfortunately this is very typical. Risks of gory or spectacular events (plane crash, space shuttle explosion, mass shootings etc.) tend to get massively overestimated compared to "everyday" but much more fatal risk. It is especially problematic when these things gets prioritized in policy-making.

 

Actually, I could imagine that they are actually quite attractive for policy-makers, as they can roll out some silly (and most likely ineffectual) laws and regulations. Due to the rarity of events they can claim the almost certain drop after an event as a clear victory and nicely tie them into things that furthers their agendas.

 

And people will happily support that as fear trumps logic every time.

Edited October 20, 2014 by CharonY

[MigL]

Thanks for the info, CharonY.

[Ten oz]

I think the U.S. the political and media reaction is so overblown in part because there is an election soon ( early voting in a lot of places already underway). Fear is often a technique used to rally voters. The Right is using Ebola to criticize the President, attack the CDC (big govt failing), have yet another reason to secure the boarder, and etc. while the Left is using Ebola to criticize Congress for not allowing the nominated Surgeon General into office, cutting funding for forgiven aid, and fighting against various healthcare programs.

[DimaMazin]

Useful in what way?

Ebola helps to people to forget usual problems and senseless deals. Ebola successfully attacks places where science doesn't live. ​

[Fire Science Blog]

This is one problem that the Americans can't get wrong. If this spreads further than it all ready has were all in trouble.

[CharonY]

Time for an update: in the US a total of four reported cases and a single fatality. Situation is improving in Liberia, and slightly less severe than before in Sierra Leone and Guinea (though still increasing).

http://www.who.int/csr/disease/ebola/situation-reports/en/

[billvon]

This is one problem that the Americans can't get wrong. If this spreads further than it all ready has were all in trouble.

If Ebola gets a thousand times worse in the US, it will still cause fewer deaths than the flu does every year. That's not to say that we shouldn't be working on vaccines and cures - we should, both for our sake and the sake of the people of Africa. But the panic over it is very disproportionate to the risk.

[zapatos]

If Ebola gets a thousand times worse in the US, it will still cause fewer deaths than the flu does every year. That's not to say that we shouldn't be working on vaccines and cures - we should, both for our sake and the sake of the people of Africa. But the panic over it is very disproportionate to the risk.

While they may be panicking in Sierra Leone and Guinea, I don't see anyone in the US panicking. I very rarely even hear anyone mention it.

[Strange]

 

I don't see anyone in the US panicking.

 

Does wanting to impose house arrest on an asymptomatic nurse count?

[zapatos]

Does wanting to impose house arrest on an asymptomatic nurse count?

No. That is ignorance and political expediency.

[Strange]

No. That is ignorance and political expediency.

 

OK.

[billvon]

While they may be panicking in Sierra Leone and Guinea, I don't see anyone in the US panicking. I very rarely even hear anyone mention it.

We have, fortunately, gotten over the panic. But for a few weeks Ebola led every newscast, newspaper and news website. There were calls for quarantine and travel bans. People were isolated because they were ten miles from a suspected Ebola patient.

 

A good overview from CBS (who ironically was one of the culprits) -

 

========================

The threat of Ebola is generating a considerable amount of fear and misinformation across the country, not to mention a growing number of false alarms.

 

Fears about Ebola have reached a fever pitch in recent days. Hazmat crews boarded a plane in Boston. Traffic was halted near the Pentagon when a woman fell ill on a bus. And at Cleveland's airport -- several days after infected nurse Amber Vinson had passed through -- passenger Tamika Freeman was still worried.

 

"It was a huge scare," said Freeman. "You know, I'm pregnant. A lot of people touch each other."

 

Vinson was in Ohio to plan for her wedding. Now the bridal shop she visited is temporarily closed, the workers on voluntary quarantine.

 

Public health professor Andrew Noymer studies infectious diseases at University of California, Irvine. He says people do not need to be afraid of Ebola in the U.S.

 

"I would say the panic is harder to contain than the spread of the disease itself," he said. "People are focusing on that it's a scary disease from far away, and they see scary images of people caring for sick people with protective gear, and it looks frightening."

 

So frightening that even a schoolteacher's trip to Dallas was enough to cause a panic in Maine. She was placed on medical leave after attending a conference 10 miles from the hospital where Ebola patient Thomas Eric Duncan was treated. An overreaction, says parent Megan Starbird.

 

"You want to keep the kids safe," she said. "But I think it's a little ridiculous."

 

So far, the scares are all false alarms.

 

"It's obviously a scary disease if you have it," said Noymer. "But it's just not highly transmittable. I can't say that enough."

 

Asked if he would get on a plane with someone who had Ebola, Noymer said: "I would not be scared."

 

To this point, no one outside the Dallas hospital has tested positive.

 

"Everyone needs to take a step back," said Noymer. "Just take a look at the situation for a minute, take a breath. If we look at the family of Mr. Duncan, none have come down with the disease."

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