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The NY/NJ Ebola Cases


KingM
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Thankfully, the Dallas situation seems to be under control, but now it looks like there are two cases in the NY/NJ area, with a second returned aid worker sick and in isolation. I would have expected these two to be handled much better than the Dallas cases, primarily because of heightened awareness, lessons learned, etc.

 

But yesterday, there was the picture of the cops dumping their gloves and face masks into a streetside garbage can, and now there's this article showing the carelessness used when decontaminating the NY doctor's apartment. What are these people thinking?

 

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http://www.dailymail.co.uk/news/article-2807351/Hazmat-team-empties-Ebola-doctor-s-apartment-WITHOUT-gloves-face-masks-protective-gear.html

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If the experts are correct (and I believe they are, or there would be many more people in west Africa with Ebola) then the doctor either wasn't contagious at all or at the most was only very, very slightly contagious at that point.  I'm certainly not advocating not dong things "right."  But it seems to me that going way above and beyond what the experts say are reasonable precautions just serves to heighten fear.  Although I suppose some will have the opposite opinion -- that seeing this treated with the utmost safety in mind will calm fear.  I suppose it depends on whichever way one leans.

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The article said "it is standard procedure for police officers to wear gloves while putting up caution tape." I don't think the gloves or tape were contaminated or inside the apartment, so it was safe to throw them in public trash can.

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If the apartment is deemed contaminated enough to send in a team to remove all of the belongings inside, then wouldn't you expect the members of that team to be wearing personal protection? Either it's necessary and they are dangerously unprotected, or it's unnecessary, and the "decontamination" amounts to nothing more than kabuki theater. Either way, trust levels are not likely to increase as a result of this incident.

 

 

 

If the experts are correct (and I believe they are, or there would be many more people in west Africa with Ebola)

 

It is still growing exponentially in Africa, with cases doubling roughly every three weeks. Seems contagious enough to me.

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I don't think those pictures prove that the workers were not wearing any protective gear inside the apartment.  The workers could have taken off their protective gear and put it in the barrel before sealing the barrel and coming outside.

 

They might have, but that still means they stripped out of the gear inside, and then handled the barrels that had been in that apartment during the cleanup with their bare hands.

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We know people in Indiana that are going back to Liberia in November & our pastor has been several times & is constantly looking for ways to get back in. He's had malaria twice & still has other odd health problems from an accident tgat he had there that was left untreated. He's also picking up a missionary on the 31st coming frim Niger (into Chicago airport). This concerns me, but trying not to worry, as I know this is wrong.

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We know people in Indiana that are going back to Liberia in November & our pastor has been several times & is constantly looking for ways to get back in. He's had malaria twice & still has other odd health problems from an accident tgat he had there that was left untreated. He's also picking up a missionary on the 31st coming frim Niger (into Chicago airport). This concerns me, but trying not to worry, as I know this is wrong.

 

I think it's great that there are so many people willing to put their lives on the line for what they believe. I just hope that we start to put into place reasonable quarantine restrictions to make sure people are not infected before they come back into the general population.

 

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If the apartment is deemed contaminated enough to send in a team to remove all of the belongings inside, then wouldn't you expect the members of that team to be wearing personal protection? Either it's necessary and they are dangerously unprotected, or it's unnecessary, and the "decontamination" amounts to nothing more than kabuki theater. Either way, trust levels are not likely to increase as a result of this incident.

 

 

 

 

It is still growing exponentially in Africa, with cases doubling roughly every three weeks. Seems contagious enough to me.

 

As someone who considers herself a realist, the whole necessary/unprotected or unnecessary/overkill part is what drives me nuts. Whatever the science IS, it is.  But don't keep telling me so many of the decisions are "out of an abundance of caution" and then call me a nutjob fool for being abundantly cautious/alert.  :tongue_smilie:

 

I do believe we have the ability to drastically cut the R0 number in first world countries, and I'm fine with "abundance of caution" measures being taken to do so, but overconfidence and mixed messages can't help much in that area.

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I think it's great that there are so many people willing to put their lives on the line for what they believe. I just hope that we start to put into place reasonable quarantine restrictions to make sure people are not infected before they come back into the general population.

 

 

NY and NJ already have.  Three weeks.  Details yet to be determined as far as I heard.

 

I wonder if this was simply in response to the doctor there, or if it had to due with the ebola conference I heard someone in the white house was pushing for.

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I think it's great that there are so many people willing to put their lives on the line for what they believe. I just hope that we start to put into place reasonable quarantine restrictions to make sure people are not infected before they come back into the general population.

 

 

Yes, this. Quarantine needs to be federally enforced as well as on a state or local level.

I am generally a smaller gov't. is better person, but this is clearly a national issue and responsibility.

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The over response is actually a problem. The new restrictions NY/NJ have placed on invididuals returning from affected regions will likely reduce the number of people who volunteer to go help. If people do not volunteer to help the disease may get more out of control rather than become contained.

 

They actually need to treat volunteers better than the nurse who returned to the U.S. this weekend symptom free. It is not helpful to treat people who are really heroes in this fight, working to help to rest of the world, like criminals.

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The over response is actually a problem. The new restrictions NY/NJ have placed on invididuals returning from affected regions will likely reduce the number of people who volunteer to go help. If people do not volunteer to help the disease may get more out of control rather than become contained.

 

What will also hurt the response are additional outbreaks of the disease. The fact is, some people are going to come back from working in Africa with an undiagnosed infection. That is going to be some factor of the number of people going over. Every one of the infected people who are not in isolation, but who are wandering about in the general population, is a risk of spreading an infection to other people. The risk of this disease, and the staggering cost per additional patient, make it important to limit that additional spread.

 

 

 

 

They actually need to treat volunteers better than the nurse who returned to the U.S. this weekend symptom free. It is not helpful to treat people who are really heroes in this fight, working to help to rest of the world, like criminals.

 

Precautionary quarantine is not the same as treating someone like a criminal. It is one part of a long-proven way of slowing deadly outbreaks, together with contact tracing and isolation of the sick.

 

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Precautionary quarantine is not the same as treating someone like a criminal. It is one part of a long-proven way of slowing deadly outbreaks, together with contact tracing and isolation of the sick.

 

 

I believe what is being compared to being treated like a criminal is the way the nurse says she was interrogated as well as reports by her and her mother yesterday that she was being held in an unheated tent with only a portable toilet.  No shower, no books, no TV, etc.  They also reported that all she was given to wear was paper scrubs.  Her interrogation can't be undone, but hopefully they've moved her to suitable quarters and allowed her to wear comfortable and appropriate clothing.

 

This whole quarantine thing is nothing but a knee jerk reaction by politicians.  Governing based on fear and not fact.  Which is unfortunately typical for the U.S.

 

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I believe what is being compared to being treated like a criminal is the way the nurse says she was interrogated

 

 

I'm interrogated every single time I cross the border, sometimes quite rudely. That's what they do at border crossings, and while I don't care for it, I don't see that questioning someone who is emerging from a place with a spreading pandemic is a problem. And it can be effective when combined with other measures.

 

as well as reports by her and her mother yesterday that she was being held in an unheated tent with only a portable toilet.  No shower, no books, no TV, etc.  They also reported that all she was given to wear was paper scrubs.  Her interrogation can't be undone, but hopefully they've moved her to suitable quarters and allowed her to wear comfortable and appropriate clothing.

 

 

That's obviously a problem, and should be rectified ASAP. Quarantine should be both safe and comfortable.

 

 

This whole quarantine thing is nothing but a knee jerk reaction by politicians.  Governing based on fear and not fact.  Which is unfortunately typical for the U.S.

 

 

 

I strongly disagree. Quarantine is nothing new. The word itself comes from the Venetian practice or requiring entering ships to wait offshore for forty (quaranta) days during times of plague. It was a widespread practice with measles, small pox, and other deadly disease until quite recently, when widespread vaccination virtually eliminated these diseases.

 

It's not just good health policy, it's good economic policy. How many millions of dollars will it cost to deal with the aftermath of that single doctor who wandered the streets of Manhattan, versus the cost of providing him with a comfortable quarantine accommodation?

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It's quite clear you have no idea what this woman experienced. Perhaps do a little reading this am

 

There are two issues:

 

1. Did this woman have a bad experience?

2. Is the idea of quarantine itself a poor one?

 

You seem to be arguing that because #1 is true, then the idea of #2 is also true.

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http://www.huffingtonpost.com/2014/10/25/nurse-criticizes-ebola-quarantine_n_6047308.html

 

Some quotes from the nurse.

 

Is it a good idea to quarantine asymptomatic people?

 

She was interrogated rudely for hours, apparently, not just a minute or two.  And she is going to be kept in quarantine for 21 days even though she is showing no symptoms.

 

I'd be curious to know how many people working with ebola patients have come to the US and NOT come down with ebola.  I'm guessing it's a fairly high number.  We're not hearing about them.  So we have no idea if 100 percent of people coming back from working with ebola patients are then coming down with ebola (which seems to be what the media are trying to tell us), or if it's more like 1 percent.  Or .01 percent.  Does anyone even know?

 

This sort of full scale panic is only going to make disease spread worse in the long run.  People coming back from Africa are going to know to lie about what they've been up to, if they were around anyone who was sick.  So there'll be even less tracking of whether they get sick later or not.  So no one will know about it until they've had the chance to spread it around for a few days. And fewer people are going to volunteer to help out if they know it's going to result in a 21 day mandatory quarantine.

 

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I'm interrogated every single time I cross the border, sometimes quite rudely. That's what they do at border crossings, and while I don't care for it, I don't see that questioning someone who is emerging from a place with a spreading pandemic is a problem. And it can be effective when combined with other measures.

 

I wouldn't call anything I've ever experienced as being interrogated.  Brief questioning, yes.  But never anything approaching what this nurse says she was subjected to.

 

 

 

It's not just good health policy, it's good economic policy. How many millions of dollars will it cost to deal with the aftermath of that single doctor who wandered the streets of Manhattan, versus the cost of providing him with a comfortable quarantine accommodation?

 

According to what all the experts say, he was not contagious at the time.  The cost of any "aftermath" is an unnecessary product of fear.  Not fact.

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The conditions of the nurse's "quarantine" sound quite horrible.  There is no reason to subject someone who volunteered to help people in need to an unheated tent (is that correct?  that is unbelievable!), to rude questioning, to so much of what she experienced. I am so sorry she returned to the type of actions she described.  A quarantine doesn't mean she should be treated as a pariah or a criminal.  Someone who voluntarily goes to help out in a crisis like this is not a criminal, and if it were me greeting her - she'd get a lot of respect, care, and gratitude.

 

I want to know how they propose to carry out future quarantines.  Where will people be quarantined?  Not in tents, surely?? Not only must their immediate needs be met, some comfort given, but what about lost wages?  21 days of not working is a long time.  

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I don't think I have made any comment at all regarding my opinion of #2.

 

I am arguing that you are ignorant about #1 and you should remedy it.

 

In that case I'm sorry for misunderstanding, I think we might be arguing past each other. I don't agree with how this particular woman was treated, or many other things about our national response to the crisis, for that matter. I'm only arguing that a reasonable quarantine system would help combat the panic, not inspire it.

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I wish someone or something like say the Bill and Melissa Gates Foundation would provide a wonderful perk-like situation for quarantine (a Club Med -ish facility, or a lodge in the mountains or something, maybe several choices for different tastes people may have as to what is a wonderful perk) for health care workers returning from Ebola work. Something that would both provide a reasonably safe "quarantine" (I don't think they would need to be in total isolation like that nurse, and could have family with them if family wanted to be) that would cut down on needs for massive contact tracing if cases develop in densely populated areas, but which also would be really nice, something special as a winding-down, rest and relaxation time after grueling work in hard circumstances, so as perhaps to be an encouragement to others who might go help there--not a disincentive.

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I wish someone or something like say the Bill and Melissa Gates Foundation would provide a wonderful perk-like situation for quarantine (a Club Med -ish facility, or a lodge in the mountains or something, maybe several choices for different tastes people may have as to what is a wonderful perk) for health care workers returning from Ebola work. Something that would both provide a reasonably safe "quarantine" (I don't think they would need to be in total isolation like that nurse, and could have family with them if family wanted to be) that would cut down on needs for massive contact tracing if cases develop in densely populated areas, but which also would be really nice, something special as a winding-down, rest and relaxation time after grueling work in hard circumstances, so as perhaps to be an encouragement to others who might go help there--not a disincentive.

 

I dunno. A rudimentary scientific education world-wide would be nice, probably cheaper, and a lot more helpful than pretending all ideas are of equal merit and value. 

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So the nurse is being held in an UNHEATED TENT near the hospital.  She has no access to a shower and has not for days.  She has a portapotty only.

 

This is a national embarrassment.  

 

Yes, it is.

 

I am ashamed every time I read about it.  

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So the nurse is being held in an UNHEATED TENT near the hospital.  She has no access to a shower and has not for days.  She has a portapotty only.

 

This is a national embarrassment.  

 

:confused1: :blink: :svengo:  WTH?  It seems like we can't not go to crazy extremes.  First it's no restrictions at all (which led to Duncan), then taking temps at the airport (which is unlikely to catch anyone since they already had their temps taken getting on the planes back in Africa, and it's unlikely they just happened to become symptomatic on the flight), to this.  Where's the sane middle ground?  There is a reasonable place between letting people in all willy-nilly and just hoping that they act responsibly if they feel sick (which it's apparent won't work, as people are in too much denial - that NY guy took a 3-mile run on top of it the day he first felt crappy?  That is denial) and an unheated tent, paper gowns and a port-a-potty.  It's like they're looking to get shut down, and then we're back to no quarantine.  There is no reason for that level of isolation till someone is symptomatic.  Isolation at home or a centralized facility where you don't have half of NYC as potential contacts to trace?  Well, sure.  That's even a really good idea that I think should have been implemented at least a month ago.  But this draconian idea of quarantine, for this illness, is over-the-top nutso crazy-cakes.

 

The people coming back should be treated extra-well.  They have been on the front lines.  I think it would be great to be put up someplace really nice with free food, and think of it like a nice 3-week vacation, more like a reward for all the hard work they did.  That would still probably cost way less than the fall-out from even one case that slipped through (all the decontamination of public places and possible additional cases from that one). They could so easily make this win-win.

 

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I dunno. A rudimentary scientific education world-wide would be nice, probably cheaper, and a lot more helpful than pretending all ideas are of equal merit and value.

Yes, but then I couldn't have awesome conversations with people about why the recent local outbreak of Norovirus is not related to Ebola. At all. Nope, not even when a bunch of people at the same event caught it with a day of each other.

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:confused1: :blink: :svengo: WTH? It seems like we can't not go to crazy extremes. First it's no restrictions at all (which led to Duncan), then taking temps at the airport (which is unlikely to catch anyone since they already had their temps taken getting on the planes back in Africa, and it's unlikely they just happened to become symptomatic on the flight), to this. Where's the sane middle ground? There is a reasonable place between letting people in all willy-nilly and just hoping that they act responsibly if they feel sick (which it's apparent won't work, as people are in too much denial - that NY guy took a 3-mile run on top of it the day he first felt crappy? That is denial) and an unheated tent, paper gowns and a port-a-potty. It's like they're looking to get shut down, and then we're back to no quarantine. There is no reason for that level of isolation till someone is symptomatic. Isolation at home or a centralized facility where you don't have half of NYC as potential contacts to trace? Well, sure. That's even a really good idea that I think should have been implemented at least a month ago. But this draconian idea of quarantine, for this illness, is over-the-top nutso crazy-cakes.

 

 

Yes! It's like an insane pendulum swing. I guess if you look at our politics, it shouldn't be surprising that our politicians don't understand the concept of "middle ground," but I'm finding it hard to believe in this situation!

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It is a drastic step to require that healthy people completely isolate themselves from the world and make it a criminal misdemeanor for a healthy person to go to the grocery store or do anything else that breaks quarantine. I think states need to think through the legal implications of this a little more carefully if they are going to detain citizens, either in a hospital or in their homes, who are not sick and have tested negative for Ebola.  

 

I think it is reasonable to require monitoring for 21 days after arrival in the US.  If someone's temperature starts to rise, then I'm okay with their being required to stay home until a blood test is done.  That's as far as I'm willing to go with someone who is not showing any symptoms.

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It is a drastic step to require that healthy people completely isolate themselves from the world and make it criminal misdemeanor for a healthy person to go to the grocery store or do anything else that breaks quarantine. I think states need to think through the legal implications of this a little more carefully if they are going to detain citizens, either in a hospital or in their homes, who are not sick and have tested negative for Ebola.  

 

I think it is reasonable to require monitoring for 21 days after arrival in the US.  If someone's temperature starts to rise, then I'm okay with their being required to stay home until a blood test is done.  That's as far as I'm willing to go with someone who is not showing any symptoms.

Yes.

 

Hospital quarantine anyone who treated ebola in Africa for 21 days, while those who are treating it here go home every night.  Great logic!   :001_rolleyes:

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To not give them actual SHELTER or a toilet or shower seems...beyond insane.

 

You have to wonder who came up with this crazy plan.  I mean, I've been in favor of some kind of quarantine and travel restrictions (like I think having all passengers who originated from the affected countries come in through a limited number of airports was a good step), BUT but but but.... this thing they've come up with in NJ has not even a passing relation to the kind of quarantine I was thinking of.  Who thought this would be a good idea??? 

 

At least it sounds like NY state is more reasonable with their restrictions?  Aren't they just having people stay home? (With all the crazy going on with this nurse in NJ, I've barely heard about what the policy is in NY)   I think they should add free food delivery. :) 

 

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Yes! It's like an insane pendulum swing. I guess if you look at our politics, it shouldn't be surprising that our politicians don't understand the concept of "middle ground," but I'm finding it hard to believe in this situation!

 

Half the politicians don't understand science, or how the world actually works. How can they be expected to understand how to respond to emergencies? You can't fix stupid, but you can vote it out.

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Half the politicians don't understand science, or how the world actually works. How can they be expected to understand how to respond to emergencies? You can't fix stupid, but you can vote it out.

I'm not a bumper sticker person but I saw one the other day I would consider. It said "Re-elect no one!!" I agree!!

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Yes, but then I couldn't have awesome conversations with people about why the recent local outbreak of Norovirus is not related to Ebola. At all. Nope, not even when a bunch of people at the same event caught it with a day of each other.

 

And I could stop explaining that ,no, the Flu shot won't protect you against ebola this year. Or Enterovirus 68 either. Not even a little. 

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Half the politicians don't understand science, or how the world actually works. How can they be expected to understand how to respond to emergencies? You can't fix stupid, but you can vote it out.

Agree, though "Half" seems like a generous percentage for our current crop. And I'm definitely heading out to vote today!
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Half the politicians don't understand science, or how the world actually works. How can they be expected to understand how to respond to emergencies? You can't fix stupid, but you can vote it out.

 

Can we? I don't know, we don't seem to have been able to so far! It's funny to think that I was once a political science major who wanted nothing more than to work in politics...until I actually did for a little while. Then I couldn't get the h3ll away fast enough. 

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I dunno. A rudimentary scientific education world-wide would be nice, probably cheaper, and a lot more helpful than pretending all ideas are of equal merit and value. 

 

A worldwide rudimentary scientific education would be very nice, indeed! 

 

But to be able to do that, many different problems would need to be solved--poverty/malnutrition, safe access to the education (hard to do this where there is war, or essentially war even if undeclared), permission for everyone to get it, and even illnesses would need to be brought under control--including Ebola itself, which has caused school closure in the parts of West Africa where it is out of control, and which along with Civil War has produced a lack of school positions per student and many far more basic issues, like food and places to sleep and so on.

 

Providing some science curriculum materials might not be terribly expensive.  Providing the whole infrastructure to make such an education possible and meaningful is another matter. Though, hey, I am totally all for it since it would not only be a good thing itself, but better, it would require solving so many other problems to make it possible, including solving Ebola itself to allow for the world-wide education to take place in Liberia, Sierra Leone, etc.

 

Getting Ebola in control is a current solvable problem if people put resources into doing it. We need, as I understand it, thousands of health care workers to go to the affected areas of Africa. Every week that goes by, exponentially more HCW will be needed to deal with it (estimate I have heard is aprox. 250 HCW per 100 patients needed  to get on top of it -- in USA the ratio of HCW to patient is higher, but apparently it is thought that in Africa the 250/100 would be enough). 

 

How would you suggest motivating HCW to go to help with Ebola, or do you think that is not important?

 

How would you suggest making sure Ebola does not become someone's deliberate means of committing terrorism (like a suicide bomber, but instead of a bomb, a virus) if someone returning with it wanted on purpose to spread it as widely as possible via their own body somewhere like NYC--or even just an accidental problem that gets out of control, perhaps if the virus itself affects the judgement of the person who is sick with it in the very early stages (which I've been wondering about being a possible explanation for the behavior of some of the people who have had it)--and. at the same time, not having a quarantine that is draconian for the majority of HCW who would presumably be following reasonable rules to not infect others should they be infected?

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These pics are from the Daily Mail.

 

A british tabloid.  

 

Who knows if they are even of NYC or even related to this event.

 

OK, having clicked to the link there are very clearly SEVERAL sets of workers pictured- some in PPE and some not.

 

This is not newsworthy without clarification of which workers did what.

 

Yeah I was wondering about the reputation of the Daily Mail.  They often have some pretty crazy stories. 

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According to the Daily Caller, the nurse from Maine actually works for the CDC as an Epidemic Intelligence Service officer.

 

http://dailycaller.com/2014/10/27/released-ebola-nurse-kaci-hickox-works-for-cdc-her-lawyer-is-a-white-house-visitor/

 

(I know nothing about the reliability of the Daily Caller as a news source, but I do find it interesting if it is true that she is a CDC employee.)

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Here is an interesting article with some good news about the outbreak in Africa (I didn't want to start a new ebola thread just for this article, and so I am putting it in here because this is the thread that was active last):  In Liberia, Ebola Survivors Find They Have Superpowers.  It highlights not only the health care workers but also the survivors who then go on to help others (some of them begin to help even as they are still recovering themselves) - truly real life superheroes!  

 

Some interesting bits from the article:

* "World Health Organization figures showing that, for the first time in weeks, there are fewer new cases of Ebola in Liberia. At ELWA3, empty beds outnumber the patients, and only about 80 to 85 confirmed cases remain."

 

* "Ebola survivors are immune to the virus for as long as three months."  Interesting that immunity is not permanent.  In the comments, a commenter stated that people stop producing the antibodies after around 3 months.  I wonder what effect that has on the potential vaccines - I guess the vaccines would only be useful if administered at the start of an outbreak in the immediately-affected area.  

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