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Second Ebola Case in Dallas


emzhengjiu
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If the nurses had actually stuck with the CDC guidelines they might well have not got sick. 

 

I am not being argumentative - but, if the nurses had not stuck with the CDC guidelines, is that not a breach of CDC protocol by the nurses? Which the CDC chief says did not happen? Does this mean that CDC had no rules about covering all parts of the body in an appropriate manner? Makes me assume that the CDC does not have expertise in ebola.

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That is going to take quite a bit of detailing.  I seriously hope that somewhere in our gov and military there is a detailed massive quarantine plan that somebody is reviewing right now for just in case.  Off the cuff, I would think it could be set up on base to have sectors.  Those that have highest potential to develop the disease in one sector, those with minimal in another, those with the lowest risk  in another.   If need be separate the bases out to those with the highest potential, etc... Keep each sector separate with proper decon procedures between.  in each sector, people would have to isolate themselves from each other. Little mini isolation units inside larger ones.

 

It would be a nightmare. It would be a huge  deal and I am sure laws would need to be passed to protect those people financially and to protect their belongings.  I am not saying this would be an easy feat or easily snap your fingers and it is done type of operation.  It would require  a lot of thought, input from many sources, and way more patience than most have. And somebody with some serious attention to detail to oversee it. But we do have reports of HCW in Dallas sleeping in their car for lack of a better method because some of them didn't want to take the chance of taking it home to their families.

 

 I'm sure my state is like all the rest and are pulling their state Ebola response together.  Wards are being identified,set up, material requested, staff getting trained. The system is being put into place for all the non Ebola hospitals to identify and transport Ebola patients to these special wards.  I'm sure it is going to work well because the front line workers don't want to get sick and are taking more precautions than the CDC recommends.

 

 But there is only a limited number of beds and staff trained.   Not just any worker and not just any hospital can handle this. And the supplies and materials and staff are only for a handful of beds.  I believe my state is preparing 12 beds across the state. Which is a lot, until it is not.  My family would take up half of the beds.  

 

Where is the tipping point between "we can handle it and are prepared to take care of patients" and " we don't have enough beds and staff and materials"

 

What is the plan to keep us from that  tipping point? Is there another method outside of some type of quarantine?

 

Thank you for taking the time to break this down for me. I appreciate it.

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Nurses were told by their supervisors to wear tape around their necks, to cover exposed skin, which is not protocol anywhere, ever.  There is no possible way to remove tape without contaminating yourself. 

 

CDC had nothing to do with that. It was a hair-brained idea and I have no idea what the supervisors were thinking. 

 

If the nurses had actually stuck with the CDC guidelines they might well have not got sick. 

 

 

I am not being argumentative - but, if the nurses had not stuck with the CDC guidelines, is that not a breach of CDC protocol by the nurses? Which the CDC chief says did not happen? Does this mean that CDC had no rules about covering all parts of the body in an appropriate manner? Makes me assume that the CDC does not have expertise in ebola.

 

 

Given that the CDC's initial guidelines were that exposed skin was FINE, and guidelines changed multiple times, and that current protocol used is MORE strict than CDC guidelines, I think it's safe to say the CDC has no idea what it's doing in respect to PPE.   When people in Africa are getting it with Hazmat suits and chlorine decontamination showers, which is far more than the CDC has ever said was necessary, it's responsible to ignore what they are saying and look at the facts.  Previous studies done on how contagious this disease is do not reflect the realities of this strain.  That doesn't mean it's time to panic, but it does mean take everything the CDC says with a huge margin of error on the side of calming people down and trying not to disrupt our economy in any way, and trying to keep health care workers going to work.

 

 

ETA: what I mean is that the CDC's goal is not zero transmission.  The CDC's goal is for people to calm down and trust the healthcare system to work, even if a handful of people die in the mean time.

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I think the American public is being treated like children and that we aren't being told everything.  We're being told to trust the govt and all they do is screw up/lie over and over again.  They had the eyes of the entire world on them when Duncan was diagnosed.  You'd think they would have done everything they could to protect the nurses and prevent the spread of the virus.  We shouldn't be seeing all these exposures at this point.  This is the CDC- one of the best in the world when dealing with this stuff.  If the CDC didn't handle the care and isolation for 1 person, how can we trust them to keep the rest of the public safe?            

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Sadie, the Aus government have tried to negotiate with another country to treat Ebola workers. They can't airlift medical personnel home due to the 30 hour lead time. So far no other gov is willing to take Aus personnel if there is trouble. I imagine there'd be a pretty big outcry if someone was forced to go, infected and not able to get Australian level medical care.

 

I guess Aus would do what America is doing and provide logistical support or build a treatment centre there for Australian personnel. I am also not comfortable with the idea of forcing medical people to go. Providing a financial incentive and maybe covering income for the volunteers quarantine period might work though.

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I am not impressed with the new Ebola Czar. :ack2: I understand the administration wanted a communicator, but the person should have been an M.D., IMO. To me, without the medical credentials, he is just a spin doctor with the ability to greatly influence policy and the economy.

The WH considers this a political problem rather than a medical one. :(
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Im a nurse and I am on edge. We absolutely without a doubt can NOT handle an ebola epidemic. CAN NOT. just staffing and equipment needs are problems. Thinking for one minute that the hospital system can handle ebola is a scary from a resource material management view and human resource view.

 

We need to open up a couple of closed army bases and house everyone with the potential to even develop ebola.

 

Stopping this is the only effective way. Trying to treat and contain is only going to continue with blunders. Given how costly those blunders could be........ Quarantine is the only route.

 

I'm boggled forced quarantine isn't already in operation on a massive scale..

Yep, nor should hospital employees be asked to handle it.

 

Interesting thought...what will it do to the coming elections if by then people are too nervous to stand in groups to wait to vote?

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Nurses were told by their supervisors to wear tape around their necks, to cover exposed skin, which is not protocol anywhere, ever.  There is no possible way to remove tape without contaminating yourself. 

 

CDC had nothing to do with that. It was a hair-brained idea and I have no idea what the supervisors were thinking. 

 

If the nurses had actually stuck with the CDC guidelines they might well have not got sick. 

:iagree:   I do agree with this.  I linked somewhere up thread that had a quote that nurses were told masks/shields weren't necessary all the time either which is insane and different supervisors at the Texas hospitals were telling nurses different things.  I also read on CDC guidelines that ventilator use and dialysis were extremely high risk procedures in those with ebola - that it could aerosolize body fluids in quantities that *might* be problematic.  Both a ventilator and dialysis were used with Mr. Duncan.  I'm really wondering if extra precautions were taken with that. 

 

What is puzzling to me is that no HCW in Atlanta or Nebraska has gotten it.  What guideliness are they following because clearly, that should be the starting place. 

 

I also DO not think the Duncan family is sick.  You can google and find 50+ cases of "suspected ebola" that has turned out to be nothing in the past week in the media.  The media would be on that like nobody's business.

 

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Yep, nor should hospital employees be asked to handle it.

 

Interesting thought...what will it do to the coming elections if by then people are too nervous to stand in groups to wait to vote?

 

My guess?  Those who will show up to vote are more likely to be the ones most unhappy with the status quo.

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:iagree:   I do agree with this.  I linked somewhere up thread that had a quote that nurses were told masks/shields weren't necessary all the time either which is insane and different supervisors at the Texas hospitals were telling nurses different things.  I also read on CDC guidelines that ventilator use and dialysis were extremely high risk procedures in those with ebola - that it could aerosolize body fluids in quantities that *might* be problematic.  Both a ventilator and dialysis were used with Mr. Duncan.  I'm really wondering if extra precautions were taken with that. 

 

What is puzzling to me is that no HCW in Atlanta or Nebraska has gotten it.  What guideliness are they following because clearly, that should be the starting place. 

 

I also DO not think the Duncan family is sick.  You can google and find 50+ cases of "suspected ebola" that has turned out to be nothing in the past week in the media.  The media would be on that like nobody's business.

 

My understanding is that they are using hazmat suits, and decontaminating everything that comes out of the closed unit with chlorine, people, and lab samples included.

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um no.  I think he is just a really horrible human being who was accidentally given a platform.  

 

I had no idea people like that still existed who weren't internet trolls saying it for laughs. How can he have people willing to work for him?  :confused:

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Not hacked.  He's a nutjob.  He's not exactly a politician, though.  He was executive director of the SC Republican Party for 3 months at some point and then he resigned.  It appears he's "just" a lawyer currently.  And has some really crazy opinions.  Google him.  Most people think he's insane.

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Former director of the state GOP

 

If you are offended by the site I would not recommend reading his twitter

 

That is just one gem.  he isn't racist though.  he says.

 

Holy moly. I think what is amazing to me is how free people feel to express views like this. They aren't even trying to cover it up anymore.

 

That said, this guy is just a real life troll. He's always aiming hate at one group or another.

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I think the American public is being treated like children and that we aren't being told everything.  We're being told to trust the govt and all they do is screw up/lie over and over again.  They had the eyes of the entire world on them when Duncan was diagnosed.  You'd think they would have done everything they could to protect the nurses and prevent the spread of the virus.  We shouldn't be seeing all these exposures at this point.  This is the CDC- one of the best in the world when dealing with this stuff.  If the CDC didn't handle the care and isolation for 1 person, how can we trust them to keep the rest of the public safe?            

 

I feel like I'm beating a dead horse, but I'm going to repeat this again --

 

When Mr. Duncan showed up at Texas Presbyterian he was their problem, and the problem of the local and state authorities in Texas.  He was not the CDC's problem.  The CDC is a federal agency, not a state of Texas agency, and they had absolutely no authority to swoop in and do anything until their help was requested.  Now we can debate whether or not the CDC's protocols were adequate (although I think that's already been thoroughly covered).  But to believe that the CDC was directly responsible for Mr. Duncan's care or isolation is incorrect.

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I feel like I'm beating a dead horse, but I'm going to repeat this again --

 

When Mr. Duncan showed up at Texas Presbyterian he was their problem, and the problem of the local and state authorities in Texas.  He was not the CDC's problem.  The CDC is a federal agency, not a state of Texas agency, and they had absolutely no authority to swoop in and do anything until their help was requested.  Now we can debate whether or not the CDC's protocols were adequate (although I think that's already been thoroughly covered).  But to believe that the CDC was directly responsible for Mr. Duncan's care or isolation is incorrect.

 

Who cares how it started initially?

 

What matters is the ineptness that has been continuously shown throughout the past few weeks.   Every day they contradict what they said the day before, and in some cases just hours before.  These are the people that even libertarians trust to make the decisions to keep the public safe.

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Former director of the state GOP

 

If you are offended by the site I would not recommend reading his twitter

 

 

That is just one gem.  he isn't racist though.  he says.

 

 

 

His twitter profile describes him as

*ON DOUBLE SECRET PROBATION* / The Honey Badger of American Politics / Or: Kincannon, The Insult Comic Dog

 

Sounds like someone attempting to troll but isn't actually funny, just a jerk attention whore.

 

As much as I like teasing Republicans I don't blame them for this guy, it doesn't seem he is any position whatsoever with the Republican party. He's a nobody.

 

I am removing links to him from my posts, this seems like someone who googles themselves quite a lot.

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Given that the CDC's initial guidelines were that exposed skin was FINE, and guidelines changed multiple times, and that current protocol used is MORE strict than CDC guidelines, I think it's safe to say the CDC has no idea what it's doing in respect to PPE.   When people in Africa are getting it with Hazmat suits and chlorine decontamination showers, which is far more than the CDC has ever said was necessary, it's responsible to ignore what they are saying and look at the facts.  Previous studies done on how contagious this disease is do not reflect the realities of this strain.  That doesn't mean it's time to panic, but it does mean take everything the CDC says with a huge margin of error on the side of calming people down and trying not to disrupt our economy in any way, and trying to keep health care workers going to work.

 

 

ETA: what I mean is that the CDC's goal is not zero transmission.  The CDC's goal is for people to calm down and trust the healthcare system to work, even if a handful of people die in the mean time.

 

You are right! I agree that this is what the CDC is doing. But, considering that my taxpayer money is going into the CDC, I would like them to be more competent, more humble about their mistakes in handling this disease and more honest.

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Here is some encouraging news. Since I posted earlier my questions about the whereabouts of Mr. Duncan's family I am happy to see they are not sick and will be able to leave quarantine on Monday. I hope they are able to put their lives back together . . .

 

http://www.nbcdfw.com/news/local/Ebola-Victims-Family-Prepares-to-Leave-Quarantine-279633312.html

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Send the military, have them airlifted to Germany if required. We can get our act together to go out and play wars in Iraq, we can get our act together to go fight Ebola. IMO :)

 

And as that's straying into politics, I'd better leave it there!

 

I thought they had attempted to negotiate with eu countries and no one was willing to take them.

 

I don't know how seriously they negotiated though. I agree that the whole world should have done something a lot sooner.

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Here is some encouraging news. Since I posted earlier my questions about the whereabouts of Mr. Duncan's family I am happy to see they are not sick and will be able to leave quarantine on Monday. I hope they are able to put their lives back together . . .

 

http://www.nbcdfw.com/news/local/Ebola-Victims-Family-Prepares-to-Leave-Quarantine-279633312.html

 

I wish Duncan had survived. I feel terribly for this family that had to hear about him dying and will be reminded everytime ebola is mentioned for years to come and not even the triumphal success of beating it to balance out the pain.

 

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People who care about the facts. People who want to discuss the issue logically and rationally.

 

I do care about the facts, and I do want to discuss it logically and rationally.  The idea that the CDC has no responsibility is ludicrous.  To even have Mr Duncan get tested, the samples went to the CDC.  After he tested positive, there was someone from the CDC at the hospital advising them.  Guidelines were constantly changing.  The initial guidelines were completely ridiculous.  They've radically changed yet again in the past 48 hours.  I don't think the hospital managed this properly, but it is completely ridiculous to say the spread of infection had nothing to do with the CDC.  They've been heavily involved from the very beginning. 

 

You are right! I agree that this is what the CDC is doing. But, considering that my taxpayer money is going into the CDC, I would like them to be more competent, more humble about their mistakes in handling this disease and more honest.

 

Yes, me to.  I am incredibly disappointed in them. And I expect more too.  But at this point they've made more mistakes than FEMA in the days after Katrina, so it's going to be a long time before I take anyone from that agency at their word.

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I just found this video this video on Ebola CDC PPE training

 

http://www.cleveland.com/metro/index.ssf/2014/10/ebola_video_shows_how_medical.html#incart_story_package

 

It's like a 9 minute video, but I watched the whole thing.  This procedure as is does not seem at all full proof to me and I'm not a HCW.  It seems MUCH safer to decontaminate the outside of the suits before removing them as I've seen in other videos.  This is a disease that can involve copious bodily fluids which is when things are peak contagious.  And you can see why a nurse would be dealing with clean up and removal. 

 

Especially after watching this one of Sanjay Gupta showing how contamination can happen.  He's not wearing the exact same suit, but similar concept.  I just saw an interview today that said Nina Pham had the full hazmat suit the final days.  But really, contamination happens at take off.  It takes a very small amount of fluid on your skin somewhere, and then a cross touch to a hand and your face. 

 

 

 

Anyway, I don't understand why the recommendations are different than what they do at these other larger hospitals.   I've seen interviews out of Africa saying that most of the people who are getting really sick are the caretakers of the sick.  Early on, it was being spread by traditional funerals where people were touching and kissing their deceased loved ones. 

 
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WoolySocks- that video is outdated, the protocol changed again, but it pretty close to what you do for most airborne infections, with the exception being you have a respirator under your plastic face mask.

 

It is very common to get "chocolate sauce" all over your gloves and in spots on the front of your gown.  Typically with diseases that cause copious secretions like that you change gloves multiple times in the room so you can avoid spreading the contamination around the room when you take off the gown outside.  I don't know how they handle that with multiple gloves, as it can be difficult to take off one glove but not the ones underneath, and even if the ones underneath are taped to a Tyvek suit it is easy to accidentally rip the inner gloves. Nurses do get pretty good at taking gloves off by flipping them inside out, but with someone with copius secretions I'd say I've gotten visible contamination on my hands maybe one out of five times of doing clean up.  Since ebola reportedly has hundreds of millions of viruses in a small drop of body fluid, it's easy to see how a tiny, invisible droplet of fluid somewhere on your person could infect you.

 

I was taught to take the outer glove off first and the gown off second, by reaching criss cross over my shoulders with my hands, and grabbing the gown at the back of my shoulders where there is less likely to be contamination.  Then you rip the gown off and flip the gown inside out as you remove it, balling it up and hopefully the contamination is on the inside.  I don't know how that is possible in Tyvek Hazmat suits, as Tyvek does not tear easily.  I suspect it's very difficult to get out of a Hazmat suit without touching the outside of it, which is why it seems like spraying down the outside in Chlorine solution before removing it is a good idea.

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I feel like I'm beating a dead horse, but I'm going to repeat this again --

 

When Mr. Duncan showed up at Texas Presbyterian he was their problem, and the problem of the local and state authorities in Texas.  He was not the CDC's problem.  The CDC is a federal agency, not a state of Texas agency, and they had absolutely no authority to swoop in and do anything until their help was requested.  Now we can debate whether or not the CDC's protocols were adequate (although I think that's already been thoroughly covered).  But to believe that the CDC was directly responsible for Mr. Duncan's care or isolation is incorrect.

The President and the CDC have been involved and giving comments about Duncan from the start.  Now that it has gone poorly doesn't dismiss their responsibility.  This is no more a local problem than Hurricane Katrina was.   

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http://aattp.org/pro-life-tea-party-christian-todd-kincannon-execute-all-ebola-patients-screenshots/

 

Former director of the state GOP

 

If you are offended by the site I would not recommend reading his twitter

 

https://twitter.com/Todd__Kincannon/status/522721043564089344

 

That is just one gem.  he isn't racist though.  he says.

 

Pass me spray bottle of ebola, willya? I'll be right back. :driving:

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One of Mr. Duncan's caregivers who came in contact with bodily fluids left on a cruise ship last Sunday. Here is the story:

http://time.com/3515595/dallas-hospital-worker-ebola-texas-cruise/

Just to clarify, she was not a caregiver to him. She works in the hospital and handled some of his labs (I actually know some people on the cruise ship, which is sort of crazy).
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A bit of a side note: Am I the only one finding it more than a tad ironic that posters in an earlier thread were vigorously mocked for fearing things which have now come to pass? I wonder if any apology notes have been sent…

What has come to pass? Mass infections? Panic? Death in the streets? Perhaps you didn't see all of the earlier posts.

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A bit of a side note:  Am I the only one finding it more than a tad ironic that posters in an earlier thread were vigorously mocked for fearing things which have now come to pass?  I wonder if any apology notes have been sent…

:confused:   I haven't changed any of my opinions from earlier threads.  I still think that ebola is a serious disease that should be taken seriously.  I also still think that it has not run amok throughout the US or even Dallas.  I cannot predict the future.  I am not happy with how things have been handled.  But at this point with the information we have to date, one person has died, most of the people who came into contact with him before being hospitalized have not gotten ill despite all predictions, not even the guy who did the pressure washing.  Two nurses who were involved in his care while in the hospital have gotten ill but at this point are stable (unless I have that wrong?).  I truly hope that they get better (just as I had hoped that Mr. Duncan would).  I also hope that no one else will become ill.  But at this point I am still not afraid of ebola becoming a rampant epidemic in the United States.  Obviously data changes over time and bad decisions can make things worse but again, at this point, that is my opinion.  

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A bit of a side note:  Am I the only one finding it more than a tad ironic that posters in an earlier thread were vigorously mocked for fearing things which have now come to pass?  I wonder if any apology notes have been sent…

 

You are not wondering alone :) There were people on the thread that got shut down who were called alarmists and told that CDC was handling things competently and that the chances of anyone getting sick with ebola were slimmer than them dying in a car crash. 

 

Here we are a few days later: the govt has been caught flat footed, apparently the president is "seething" at all the incompetence according to news reports, there are more than 1000 people under observation for symptoms, 2 American cases of ebola, zero facilities if this becomes a massive outbreak and the whole country is spooked. Ironically, I have been seeing news reports of possible travel bans to parts of Africa.

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You are not wondering alone :) There were people on the thread that got shut down who were called alarmists and told that CDC was handling things competently and that the chances of anyone getting sick with ebola were slimmer than them dying in a car crash. 

 

How many people do you think have died in car crashes in the U.S. since Mr. Duncan arrived at the hospital?

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Well, those 2 poor nurses might have thought the same thing until they tested positive for ebola.

 

You have no way of knowing what they thought, but you do know that it's still more likely you will be killed in a car accident that from ebola. If that changes, I will apologize on my (digital) hands and knees. Until then, I'm not taking the bait.

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A bit of a side note:  Am I the only one finding it more than a tad ironic that posters in an earlier thread were vigorously mocked for fearing things which have now come to pass?  I wonder if any apology notes have been sent…

 

What has come to pass?  I don't believe anyone said there wouldn't be a small number of infections in the US.

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You have no way of knowing what they thought, but you do know that it's still more likely you will be killed in a car accident that from ebola. If that changes, I will apologize on my (digital) hands and knees. Until then, I'm not taking the bait.

I have no way of knowing what they thought - if you noticed, I used the word "might" - I was using an example of the 2 nurses to point out that what was a zero probability situation for all Americans became a nightmare reality for those 2 Americans. There are people in tears in a cruise ship scared that they are next and they may not agree with you that their chances of catching ebola are slimmer than them dying in a car crash either.

 

Let us hope that the CDC and the government and luck work in our favor that the chances of me dying in a car crash are greater than the chances of me dying of ebola really soon and that you don't have to apologize ever to anyone for anything digitally. And on that note, I am bowing off this thread - it was nice reading everyone's thoughts. Good night!

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Am I the only one finding it more than a tad ironic that posters in an earlier thread were vigorously mocked for fearing things which have now come to pass?  

 

What things?

 

You are not wondering alone :) There were people on the thread that got shut down who were called alarmists and told that CDC was handling things competently and that the chances of anyone getting sick with ebola were slimmer than them dying in a car crash. 

 

Here we are a few days later: the govt has been caught flat footed, apparently the president is "seething" at all the incompetence according to news reports, there are more than 1000 people under observation for symptoms, 2 American cases of ebola, zero facilities if this becomes a massive outbreak and the whole country is spooked. Ironically, I have been seeing news reports of possible travel bans to parts of Africa.

 

And your chances of contracting Ebola are still infinitely smaller than are your chances of dying in a car crash.   And really, always will be.  Glad we cleared that up!

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A bit of a side note: Am I the only one finding it more than a tad ironic that posters in an earlier thread were vigorously mocked for fearing things which have now come to pass? I wonder if any apology notes have been sent…

Yep. Don't expect apologies. Expect spin, spin, spin.

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What things?

 

 

And your chances of contracting Ebola are still infinitely smaller than are your chances of dying in a car crash. And really, always will be. Glad we cleared that up!

Ebola and car crashes are apples and oranges. "Glad we cleared that up!" as you would say.

Fascinating how divisive a deadly disease is.

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Well, I believe the statistics for dying in a car crash over one's lifetime is 1:100. Obviously, that depends on type of driving, where, how much, type of car, etc.

 

The chance of contracting Ebola if one took care of a particular patient at a particular Texas hospital is roughly 1:36.

 

Not that this is not apples to oranges, I was just thinking about the mathematics of the previous poster.

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