Ebola outbreak

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Re: Ebola outbreak

#361  Postby kiore » Oct 26, 2014 3:56 pm

GrahamH wrote:
kiore wrote:Me I am betting my safety and the safety of those around me on the science, which indicates that following contact with an infected case I will limit all direct contact for at least 21 days, and also to ease concern avoid public places for that period, during that period I will report my health status at least once daily and should I show any signs of illness will notify the appropriate authorities. If the science shows this insufficient I will modify this as required.
If the laws of the country I am in cause me to be detained, or deported I will deal with this as it comes.


That sounds ideal to me. Bravo.


This is nothing unusual, this is standard recommended behaviour post direct exposure, most medical NGOs and agencies do something like this. The Cairns Nurse who was lambasted by the politician Bob Katter in Queensland as being 'irresponsible' did exactly this, and turned out not to be infected.
For those with indirect exposure, for example just being in the region, the recommendation we are using is just 21 days monitoring (and tracking) and advice to minimize direct contact and report any illnesses immediately.
Why the MSF Dr in NY varied from this I am not sure, but still jogging and bowling hardly involve exchanges of body fluid, and can not really be viewed as high risk activities.unfortunately this turned out to be unwise under the circumstances and fed the already building panic.
The only unavoidable public spaces will be aircraft, and here at least there is pretty close monitoring and controlled environment.
I note the diplomat Sawyer who arrived unwell in Lagos after 2 flights, and was the index case for the outbreak in Nigeria, despite being actively unwell on the flight those he infected were the health staff on the ground, no one in the aircraft.
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Re: Ebola outbreak

#362  Postby GrahamH » Oct 26, 2014 4:26 pm

Weaver wrote:I have. I have posted the CDC protocols, and the science they are based upon.


Protocols aren't evidence, but if you have posed the science behind them I appologise for missing it. Can you provide a link to the relevant post?



Weaver wrote:You have replied with other articles posting only hypotheticals, with no actual examples of the thing you think so fearful - pre-symptomatic transmission.

There are NO CASES of this actually happening in actual known fact - yet you would have us institute quarantine based on a possibility not ever really demonstrated to exist beyond infinitesimal probability.


I haven't yet seen any evidence for the probability being infinitesimal.
I haven't yet seen any evidence on the probability of identifying such cases in the wild. I would be happy to see such evidence.



Weaver wrote:OK, so the virus exists in saliva - perhaps that is why aid workers returning from the region are told to not have intimate contact - or even shake hands - during the three-week monitoring period? How does following this protocol - which has STILL not actually caused a transmission case - present a risk which must be addressed via quarantine?

You demand replacement of working protocols based only on hypotheticals not demonstrated to actually exist.


I've searched for your posting of CDC protocols without success. Can you provide a link?

If the protocol is "to not have intimate contact - or even shake hands - during the three-week monitoring period" then all I'm suggesting in addition is taking particular care over all body fluids in that initial period, and for the protocol to actually be followed. Such control is most easily achieved by staying at home, but I've been advocating appropriate guidance, not compulsory quarantine in some government facility.

Maybe there is evidence that Spencer was especially careful about saliva, urine or touching people while he was out and about. I haven't seen mention of that. Maybe he wore surgical gloves while bowling. Evidence of that sort would be welcome.

I have seen reference to Spencer's supposed 'limited contact', which could be a reference to 'intimate contact', but it isn't clear.
Why do you think that?
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Re: Ebola outbreak

#363  Postby GrahamH » Oct 26, 2014 4:29 pm

kiore wrote:
GrahamH wrote:
kiore wrote:Me I am betting my safety and the safety of those around me on the science, which indicates that following contact with an infected case I will limit all direct contact for at least 21 days, and also to ease concern avoid public places for that period, during that period I will report my health status at least once daily and should I show any signs of illness will notify the appropriate authorities. If the science shows this insufficient I will modify this as required.
If the laws of the country I am in cause me to be detained, or deported I will deal with this as it comes.


That sounds ideal to me. Bravo.


This is nothing unusual, this is standard recommended behaviour post direct exposure, most medical NGOs and agencies do something like this. The Cairns Nurse who was lambasted by the politician Bob Katter in Queensland as being 'irresponsible' did exactly this, and turned out not to be infected.
For those with indirect exposure, for example just being in the region, the recommendation we are using is just 21 days monitoring (and tracking) and advice to minimize direct contact and report any illnesses immediately.
Why the MSF Dr in NY varied from this I am not sure, but still jogging and bowling hardly involve exchanges of body fluid, and can not really be viewed as high risk activities.unfortunately this turned out to be unwise under the circumstances and fed the already building panic.
The only unavoidable public spaces will be aircraft, and here at least there is pretty close monitoring and controlled environment.
I note the diplomat Sawyer who arrived unwell in Lagos after 2 flights, and was the index case for the outbreak in Nigeria, despite being actively unwell on the flight those he infected were the health staff on the ground, no one in the aircraft.


So you are saying Dallas and NY are exceptions and Kaci Hickox would have gone home and more or less self-quarantined for 21 days anyway, had she not been seized at the airport?
Why do you think that?
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Re: Ebola outbreak

#364  Postby kiore » Oct 26, 2014 4:48 pm

Graham, I do not work for MSF and not sure of their exact protocols, but yes should have been something like this. They trained the ICRC team in SL and the ICRC people told me this was the plan. This was what the ICRC Nurse in Cairns was doing. All medical NGOs and Agencies I have dealt with have a plan like this. 3 weeks home quarantine for direct contact, or 3 weeks followup for non-contact with advice. Now the 3 weeks can counted differently, ICRC doing 3 weeks following departure as are many others, others depending on the circumstances may count it differently as 3 weeks post contact, this would usually be for those not involved in treatment though. All those involved in treat or burials etc, the highest risk group have been counting from departure AFAIK.
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Re: Ebola outbreak

#365  Postby kiore » Oct 26, 2014 4:54 pm

Addit, OK google helped.
http://www.msf.org.uk/article/ebola-msf ... -countries
Seems they are not recommending home quarantine, if no signs of illness, the protocol a little vague in regard to high and low risk groups.
Recommending no return to work.
This has been posted following the NY case so possible adjusted accordingly.
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Re: Ebola outbreak

#366  Postby GrahamH » Oct 26, 2014 5:54 pm

The guidelines include the following instructions:

Check temperature two times per day
Finish regular course of malaria prophylaxis (malaria symptoms can mimic Ebola symptoms)
Be aware of relevant symptoms, such as fever
Stay within four hours of a hospital with isolation facilities
Immediately contact the MSF-USA office if any relevant symptoms develop
...

These are the steps MSF takes to ensure the health and well being of its staff and the community at large:

If returned staff members do not live within four hours of appropriate medical facilities, MSF will ensure they are accommodated appropriately during the 21-day incubation period.
In the unlikely event that a staff person develops Ebola-like symptoms within the 21-day period, he/she is advised to immediately contact MSF and to refrain from traveling on public transportation. Local health authorities are immediately notified.
As long as a returned staff member does not experience any symptoms, normal life can proceed. Family, friends, and neighbors can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.

However, returned staff members are discouraged from returning to work during the 21-day period. Field assignments are extremely challenging and people need to regain energy.

In addition, people who return to work too quickly could catch a simple bacterial or viral infection (common cold, bronchitis, flu etc.) that may have symptoms similar to Ebola. This can create needless stress and anxiety for the person involved and his/her colleagues. For this reason, MSF continues to provide salaries to returned staff for the 21-day period.
http://www.msf.org.uk/article/ebola-msf ... -countries


So, no mention screening for the virus or antibodies, a categorical assurance that no symptoms = no risk.
No mention of avoiding intimate contact.

Spencer followed this protocol to the letter. He was given assurance that no fever means no risk and "normal life can proceed".
According to these guidelines a returning health worker who has had direct contact with ebola patients is quite OK to have intimate contact, take no special precautions about body fluids and have any contact with as many people as they like for 21 days post contact. All they must do is monitor temperature twice a day watch out for specifically ebola-like symptoms.
Why do you think that?
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Re: Ebola outbreak

#367  Postby kiore » Oct 26, 2014 6:55 pm

I have to say the advice looks like the general advice for staff working in the affected areas, rather than specific advise for those with known contact. I would expect the organization to do a risk assessment and individual counseling for those departing home.
I do agree the home quarantine is generally unnecessary especially for those without high risk factors, but I would surprised if this was the extent of the advice given to returnees.
The home quarantine regime I said I would do would be only in the case of known exposure to positive case, not for if I had just visited the area or just training counseling and screening like I am currently doing.
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Re: Ebola outbreak

#368  Postby GrahamH » Oct 26, 2014 8:40 pm

kiore wrote:I have to say the advice looks like the general advice for staff working in the affected areas, rather than specific advise for those with known contact. I would expect the organization to do a risk assessment and individual counseling for those departing home.
I do agree the home quarantine is generally unnecessary especially for those without high risk factors, but I would surprised if this was the extent of the advice given to returnees.
The home quarantine regime I said I would do would be only in the case of known exposure to positive case, not for if I had just visited the area or just training counseling and screening like I am currently doing.


Maybe, although it references the Spencer case. If there is more specific advice it would be good to see it.

What do you count as high risk factors? I am assuming we are only discussing people who have had direct contact with patients in the most infectious stages of the disease, as I believe to be the case for Spencer and Vinson.
Why do you think that?
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Re: Ebola outbreak

#369  Postby kiore » Oct 26, 2014 10:03 pm

Yes high risk is dealing with the sick and the dead, not just being nearby.
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Re: Ebola outbreak

#370  Postby GrahamH » Oct 26, 2014 10:16 pm

kiore wrote:Yes high risk is dealing with the sick and the dead, not just being nearby.


I like your protocol much better that the MSF protocol, at least as it is presented on the web.
Why do you think that?
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Re: Ebola outbreak

#371  Postby Warren Dew » Oct 26, 2014 11:02 pm

kiore wrote:Me I am betting my safety and the safety of those around me on the science, which indicates that following contact with an infected case I will limit all direct contact for at least 21 days, and also to ease concern avoid public places for that period, during that period I will report my health status at least once daily and should I show any signs of illness will notify the appropriate authorities. If the science shows this insufficient I will modify this as required.

I'm not sure about johnbrandt, but I think most of us would have been happy about this. It's a pity Spencer didn't follow this, leading to the current quarantines.

Weaver wrote:There are NO CASES of this actually happening in actual known fact - yet you would have us institute quarantine based on a possibility not ever really demonstrated to exist beyond infinitesimal probability.

Essentially this says that someone has to die before we take precautions against it. I don't think that's a reasonable position.
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Re: Ebola outbreak

#372  Postby Weaver » Oct 26, 2014 11:22 pm

GrahamH wrote:
The guidelines include the following instructions:

Check temperature two times per day
Finish regular course of malaria prophylaxis (malaria symptoms can mimic Ebola symptoms)
Be aware of relevant symptoms, such as fever
Stay within four hours of a hospital with isolation facilities
Immediately contact the MSF-USA office if any relevant symptoms develop
...

These are the steps MSF takes to ensure the health and well being of its staff and the community at large:

If returned staff members do not live within four hours of appropriate medical facilities, MSF will ensure they are accommodated appropriately during the 21-day incubation period.
In the unlikely event that a staff person develops Ebola-like symptoms within the 21-day period, he/she is advised to immediately contact MSF and to refrain from traveling on public transportation. Local health authorities are immediately notified.
As long as a returned staff member does not experience any symptoms, normal life can proceed. Family, friends, and neighbors can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.

However, returned staff members are discouraged from returning to work during the 21-day period. Field assignments are extremely challenging and people need to regain energy.

In addition, people who return to work too quickly could catch a simple bacterial or viral infection (common cold, bronchitis, flu etc.) that may have symptoms similar to Ebola. This can create needless stress and anxiety for the person involved and his/her colleagues. For this reason, MSF continues to provide salaries to returned staff for the 21-day period.
http://www.msf.org.uk/article/ebola-msf ... -countries


So, no mention screening for the virus or antibodies, a categorical assurance that no symptoms = no risk.
No mention of avoiding intimate contact.

Spencer followed this protocol to the letter. He was given assurance that no fever means no risk and "normal life can proceed".
According to these guidelines a returning health worker who has had direct contact with ebola patients is quite OK to have intimate contact, take no special precautions about body fluids and have any contact with as many people as they like for 21 days post contact. All they must do is monitor temperature twice a day watch out for specifically ebola-like symptoms.

No, he did not resume "normal life" - he avoided close contact with anyone else, to include things like shaking hands and any sort of intimate contact. He took his temperature twice per day. That is not "normal life".

And he did not pass on Ebola to anyone else - indicating that the protocols were effective.

Again - why do you insist on changing functioning protocols based only on hypotheticals not on actual hard evidence?
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Re: Ebola outbreak

#373  Postby Weaver » Oct 26, 2014 11:26 pm

Warren Dew wrote:
kiore wrote:Me I am betting my safety and the safety of those around me on the science, which indicates that following contact with an infected case I will limit all direct contact for at least 21 days, and also to ease concern avoid public places for that period, during that period I will report my health status at least once daily and should I show any signs of illness will notify the appropriate authorities. If the science shows this insufficient I will modify this as required.

I'm not sure about johnbrandt, but I think most of us would have been happy about this. It's a pity Spencer didn't follow this, leading to the current quarantines.
The only thing Spencer did different is that he didn't avoid public places - but other than the misplaced fears of the overly fearful, there's nothing to suggest he increased risk to anyone. Certainly nobody has been shown to have been placed at actual risk from his actions, or to have contracted the disease.

Weaver wrote:There are NO CASES of this actually happening in actual known fact - yet you would have us institute quarantine based on a possibility not ever really demonstrated to exist beyond infinitesimal probability.

Essentially this says that someone has to die before we take precautions against it. I don't think that's a reasonable position.

No, not what I am saying. What is reasonable is not taking excessive precautions unless an actual risk is demonstrated. Nobody needs to die - simply becoming ill would be enough. But since nobody has EVER become ill from a sub-symptomatic infected person, such precautions are much more about ignorance and "do something even if it does nothing" than about actual valid efforts.
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Re: Ebola outbreak

#374  Postby Veida » Oct 27, 2014 12:05 am

In the news here, a reporter on location in Monrovia (capitol of Liberia) just reported that the number of new cases per week in the section of the city that was worst hit has now dropped from 60 - 80 per week to about 20 per week.

That pretty encouraging. The explanation was primarily that teams of locals have been going around in the area, explaining how the disease spreads and telling people how those that get sick should be handled until they can be brought to a hospital. There has also been quite an increase in the number of new beds for Ebola patients, which also helps to reduce spreading of the diseasse.
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Re: Ebola outbreak

#375  Postby DougC » Oct 27, 2014 2:02 am

B.B.C. - Prototype paper test can detect Ebola strains
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Do be do be do (Sinatra)
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Re: Ebola outbreak

#376  Postby Warren Dew » Oct 27, 2014 3:07 am

Weaver wrote:
Warren Dew wrote:
Weaver wrote:There are NO CASES of this actually happening in actual known fact - yet you would have us institute quarantine based on a possibility not ever really demonstrated to exist beyond infinitesimal probability.

Essentially this says that someone has to die before we take precautions against it. I don't think that's a reasonable position.

No, not what I am saying. What is reasonable is not taking excessive precautions unless an actual risk is demonstrated. Nobody needs to die - simply becoming ill would be enough.

Ah. So you don't insist on an actual death - you just insist that someone have a 50% chance of dying before taking precautions. That still seems unreasonable to me.
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Re: Ebola outbreak

#377  Postby Veida » Oct 27, 2014 3:30 am

Warren Dew wrote: That still seems unreasonable to me.


I disagree. What's unreasonable is to insist on measures that are not needed, for all we know.
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Re: Ebola outbreak

#378  Postby Weaver » Oct 27, 2014 4:56 am

Warren Dew wrote:
Weaver wrote:
Warren Dew wrote:
Weaver wrote:There are NO CASES of this actually happening in actual known fact - yet you would have us institute quarantine based on a possibility not ever really demonstrated to exist beyond infinitesimal probability.

Essentially this says that someone has to die before we take precautions against it. I don't think that's a reasonable position.

No, not what I am saying. What is reasonable is not taking excessive precautions unless an actual risk is demonstrated. Nobody needs to die - simply becoming ill would be enough.

Ah. So you don't insist on an actual death - you just insist that someone have a 50% chance of dying before taking precautions. That still seems unreasonable to me.

It seems unreasonable because you are setting up a strawman.

I do not say to take no precautions.

I say to stick with the established precautions, WHICH HAVE WORKED IN MULTIPLE INSTANCES WITH NO KNOWN ERRORS.

Otherwise, if we are to institute changes simply based on hypotheticals, and not risk anyone dying ever from any possible (though undemonstrated) possibility, then the only answer is to have everyone wear full Class 1 HAZMAT suits everywhere in the world until the disease is eradicated or we all die of suffocation.

Stop putting words in my mouth - you're fucking it all up, and not winning the argument.
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Re: Ebola outbreak

#379  Postby KeenIdiot » Oct 27, 2014 6:31 am

There is a chance, however remote, that ebola will mutate into a full on zombie virus. As a precaution we should shoot all corpses in the head.
Also, pull everyone's teeth, since no teeth, means no bites.
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Re: Ebola outbreak

#380  Postby Weaver » Oct 27, 2014 6:34 am

Why wait until they've become zombies? Under Warren's plan we should just start shooting all the aid workers before they get on a plane to fly home.

After all, it's a possibility, and shooting the nurses and doctors from MSF is just a precaution.
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