Second Ebola Case in Dallas

[KingM]

This is an interesting discussion, and I hope it doesn't get derailed. Talking about statistics, more people are being born in Liberia at the moment than are dying. More people have died of malaria in those three countries this year than from Ebola.

 

However, what is the trend line of malaria and childbirth in those countries? Are they growing exponentially? People are saying up to 10,000 new cases a week by December, with a third the population of Liberia potentially infected by February.

 

That's what scares people. The first case was only diagnosed in Liberia in March. People look at the trajectory and they look at the history of plagues through the generations. It is no longer ridiculous to posit a scenario by which this gets out of control worldwide. Should we panic? Absolutely not. But even if the odds are 1/1000 of a mass outbreak, that's something we should take very seriously. After all, I don't expect my house to burn down today, but I have still paid a significant sum of money for fire insurance, because in the unlikely case of a fire, I'm in serious trouble if I haven't.

[fruitofthewomb]

I am genuinely curious about the appt of this 'czar' who has good management skills but isn't a healthcare professional. I want to give him the benefit of the doubt but it doesn't make sense to me. Is he a spin doctor for the admin & CDC or is he truly the type of person needed to turn the tides?

 

My side note: I have followed all Ebola threads & I do not want this one locked. Who cares who said what last week? I humbly ask that we keep this thread on topic. Please! I was just thinking last night how nice it had been to be able to read peoples thoughts without all the drama & name calling & finger pointing.

[Carrie12345]

I'd just like to point out that many people who are "concerned about ebola" are perfectly aware of the available statistics. There's way more to the issue than fear of contracting the disease.  When I think about the ripple effects that 3 cases have caused (for individuals, businesses, and government), the idea of, oh, I don't know, a dozen cases is uncomfortable to me.  A hundred, a thousand... still not a statistically significant risk of catching and dying from ebola.  But what would the ripple effects look like?

[flyingiguana]

http://www.salon.com/2014/10/17/romance_novel_models_self_quarantine_after_sitting_near_ebola_patient_on_airplane/

 

"a pair of romance novel models and authors has decided to enter a three-week-long self-imposed quarantine after discovering that they flew on the same commercial jet as Ebola patient Amber Vinson."

 

As a bonus, they get their steamy pictures on news websites where people can think about buying their novels. If you're feeling kilt-deprived....

[*Lulu*]

I think those of us who are saying "this is not panic worthy" are not saying we are totally unconfined about Ebola.

 

I am just far more concerned about the enterovirus and influenza than Ebola.

 

In our larger family we have children under the age of 2 and adults over the age of 75. We also have several adults in the 60 year range that have undergone serious medical issues this year and are more vulnerable than usual.

[KingM]

I think those of us who are saying "this is not panic worthy" are not saying we are totally unconfined about Ebola.

 

I am just far more concerned about the enterovirus and influenza than Ebola.

 

The flu, especially, is a known commodity. Enterovirus is causing few deaths among the infected.

 

Ebola is an unknown quantity. It's spreading rapidly, and nobody knows where that ends. Even the WHO has talked about it being the biggest health crisis in decades, so it's not fearmongering to be concerned and growing more so with every passing day and each misstep from those who are supposed to be on top of this thing.

[Pawz4me]

I want to know more too.  I will go have a look.  Hopefully this is not a govt repeat like when Bush appointed some horse racing guy to oversee operations which led to the disaster after Hurricane Katrina.

 

Michael Brown was not a "czar" appointed just to oversee Katrina.  He was the director of FEMA.

 

(Not that it really matters, but just for clarification.)

[Katy]

I am genuinely curious about the appt of this 'czar' who has good management skills but isn't a healthcare professional. I want to give him the benefit of the doubt but it doesn't make sense to me. Is he a spin doctor for the admin & CDC or is he truly the type of person needed to turn the tides?

 

My side note: I have followed all Ebola threads & I do not want this one locked. Who cares who said what last week? I humbly ask that we keep this thread on topic. Please! I was just thinking last night how nice it had been to be able to read peoples thoughts without all the drama & name calling & finger pointing.

 

 

Yeah, I find this almost unbelievable. Even if the goal is someone who's good at spinning things, you'd think Obama would choose someone with a little bit of public health or medical administration experience.

 

I think those of us who are saying "this is not panic worthy" are not saying we are totally unconfined about Ebola.

 

I am just far more concerned about the enterovirus and influenza than Ebola.

 

In our larger family we have children under the age of 2 and adults over the age of 75. We also have several adults in the 60 year range that have undergone serious medical issues this year and are more vulnerable than usual.

 

I am very concerned about enterovirus.  I would be less concerned about influenza if I were you.  Those statistics are skewed because everyone who dies of anything related to pneumonia is statistically counted as flu, even if it's a completely ridiculous association such as a broken hip leading to hospital pneumonia.   Influenza would have nothing to do with it, but statistically those people died of flu.  I think every lung related complication except for cancer is counted towards influenza statistics.

[KingM]

OK this is not accurate.

 

I keep seeing this and hearing the "it could mutate" argument.

 

The fact is it has not mutated and we know a GREAT deal about it.  The fact is we know how to control outbreaks.  The fact is that missteps and bad communication and incompetence from TX local healthcare admins and authorities and etc CAN be overcome.

 

What is the part that is not accurate? This outbreak is unprecedented, period. More people are getting infected every two weeks than ever had Ebola in every previous incident combined. The chance of spread to surrounding nations grows as the number of total cases grows. Plus, we're going to be dealing with more incidents like what happened in Dallas, and every single one of those needs to be stopped successfully.

 

We need to get our act together or we'll see more foul ups like the one in Texas, and each one increases the risk of things getting out of hand. It's a small risk in any given case, maybe only 1 in a thousand, or less, but given enough time, we'd better be doing everything possible to bring down the odds.

[*Lulu*]

Yeah, I find this almost unbelievable. Even if the goal is someone who's good at spinning things, you'd think Obama would choose someone with a little bit of public health or medical administration experience.

 

 

I am very concerned about enterovirus. I would be less concerned about influenza if I were you. Those statistics are skewed because everyone who dies of anything related to pneumonia is statistically counted as flu, even if it's a completely ridiculous association such as a broken hip leading to hospital pneumonia. Influenza would have nothing to do with it, but statistically those people died of flu. I think every lung related complication except for cancer is counted towards influenza statistics.

Oh I agree about the flu. My mother comes in contact with a number of medically fragile or immunological compromised children each week so we are pretty vigilant in our family about illnesses in general.

[Amira]

Yes, US hospitals clearly need better protocols when someone shows up with Ebola-like symptoms and has very recently been in Liberia. Duncan's life might have been saved if he'd gotten decent treatment days earlier than he did. I hope that has already been addressed in every hospital across the US.

 

But even if they'd caught it right from the start, it sounds like health care workers would have gotten sick because the hospital's regulations didn't adequately protect its employees. I do think it's important to remember that only two people contracted the disease from Duncan and they were both treating him at later stages when there should be plenty of time to get adequate protections in place if the disease is diagnosed early enough. It sounds to me as if the disease is still acting as we would expect which is helpful.

 

There are a lot of things that have been mishandled about this breakout during its entire course. The biggest mistake isn't what the media is focusing on though, but it's the lack of international response to the outbreak months ago. In the early days not long after Ebola first started in west Africa WHO was saying that this outbreak had the potential to get bad because of its location in an area where people didn't know much about the disease and how to contain it. The world was a very different place during the first outbreak of Ebola over fifty years ago and much easier to contain in rural areas, even if getting to those areas was more difficult. A coordinated response to build adequate infrastructure months ago would probably have made a huge difference for everyone.

 

I sincerely hope that when things settle down in the US (and I personally think that will be relatively soon) that we can refocus our attention on what really matters. The affected countries in west Africa cannot beat this on their own. Wealthier countries must provide more support. This means that some people may go into risky situations, just like some health care workers in the US have been asked to treat Ebola patients in the US. But I truly believe this is stoppable in Africa with a concerted effort on the world's part. Because if we won't do that, then I think we actually have a reason to fear.

[StaceyinLA]

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

Here is my question; is this 21 days after their last exposure? Weren't they still in the house after he was hospitalized? How do they determine when the 21 days begins?

[Halftime Hope]

IIRC, they were in the apartment until Thursday the 2nd.  Epidemiologists would tell you that's when the clock should start.  Some epidemiologists believe that, based on data from previous outbreaks, it should be a 31 day quarantine as about 15% of infections manifest later.  That level of precaution would keep them in quarantine for an additional 2 weeks past when they will be released.  The thought of the family having to do that is heart-breaking, but that is the kind of reality our medical personnel need to come to grips with.

 

I sincerely hope that we don't have another snafu in the works.

 

 

 

[Matryoshka]

IIRC, they were in the apartment until Thursday the 2nd.  Epidemiologists would tell you that's when the clock should start.  Some epidemiologists believe that, based on data from previous outbreaks, it should be a 31 day quarantine as about 15% of infections manifest later.  That level of precaution would keep them in quarantine for an additional 2 weeks past when they will be released.  The thought of the family having to do that is heart-breaking, but that is the kind of reality our medical personnel need to come to grips with.

 

I sincerely hope that we don't have another snafu in the works.

 

I also wonder why the family is on so much stricter quarantine, when it appears they have less likelihood of actually having contracted the disease than the HCW that treated him, who are not only not quarantined, but apparently free to travel all over the country and possibly infect hundreds of others.

 

There is just absolutely no way an Ebola patient should have been treated at a local hospital in the first place - who very obviously had not just no clue, but like a negative clue.  Isolation, limiting access to just a few care workers, and having those care workers be dedicated to him as a sole patient seems just super-basic common sense.  But what would have made the most sense was just them saying 'our facility can't handle this level of care, and he needs to be transported to a specialized facility'.  When my dd was hospitalized with pneumonia when she was 8, the local hospital said after one day that she was too sick for them to handle, and she was transported the next day to a city hospital with more intensive care abilities.  If it's standard practice for something as relatively commonplace as a bad case of pneumonia, how did they not see they were over their heads with Ebola??!!  Wasn't one of the mantras of "the US can handle Ebola" that we had awesome specialized facilities that can handle it?  And that did indeed handle it fine for the aid workers airlifted in?  So why didn't we use them???   Even if the local hospital was too stupid to ask for help, the CDC should have stepped in and demanded it.  This is not a local issue.  This is a national, nay global, public health issue, and absolutely the exact kind of thing the CDC is supposed to take charge of from local authorities, not sit on its hands humming loudly.

[snowbeltmom]

OK this is not accurate.

 

I keep seeing this and hearing the "it could mutate" argument.

 

The fact is it has not mutated and we know a GREAT deal about it.  The fact is we know how to control outbreaks.  The fact is that missteps and bad communication and incompetence from TX local healthcare admins and authorities and etc CAN be overcome.

 

Do you have a source that states that Ebola is not mutating?  There are many articles that state this virus is mutating. Here is a snippet from an article published in National Geographic:

 

"The genetic study by Gire and his colleagues (five of whom were dead of Ebola by the time their study appeared) found 341 mutations as of late August, some of which are significant enough to change the bug's functional identity. The higher the case count in West Africa goes, the more chances for further mutations, and therefore the greater possibility that the virus might adapt somehow to become more transmissible-perhaps by becoming less pathogenic, sickening or killing its victims more slowly and thereby leaving them more time to infect others.

That's why, the Gire group wrote, we need to stop this thing everywhere as soon as possible. Future spillovers of Ebola are bound to occur, but those freshly emerged strains of the virus, direct from the reservoir host, won't contain any adaptive mutations that the West Africa strain is acquiring now."

 

http://news.nationalgeographic.com/news/2014/10/141015-ebola-virus-outbreak-pandemic-zoonotic-contagion/

 

[Pen]

 

 

I sincerely hope that we don't have another snafu in the works.

 

I hope not also. I also hope that the family will be checked to see if they have developed antibodies to ebola--as best that can be tested. If they do, then I hope they will be checked to see if they are shedding any virus, even though it is believed that people only shed virus when having symptoms.

 

 

I also wonder why the family is on so much stricter quarantine, when it appears they have less likelihood of actually having contracted the disease than the HCW that treated him, who are not only not quarantined, but apparently free to travel all over the country and possibly infect hundreds of others.

 

There is just absolutely no way an Ebola patient should have been treated at a local hospital in the first place - who very obviously had not just no clue, but like a negative clue.  Isolation, limiting access to just a few care workers, and having those care workers be dedicated to him as a sole patient seems just super-basic common sense.  But what would have made the most sense was just them saying 'our facility can't handle this level of care, and he needs to be transported to a specialized facility'.  When my dd was hospitalized with pneumonia when she was 8, the local hospital said after one day that she was too sick for them to handle, and she was transported the next day to a city hospital with more intensive care abilities.  If it's standard practice for something as relatively commonplace as a bad case of pneumonia, how did they not see they were over their heads with Ebola??!!  Wasn't one of the mantras of "the US can handle Ebola" that we had awesome specialized facilities that can handle it?  And that did indeed handle it fine for the aid workers airlifted in?  So why didn't we use them???   Even if the local hospital was too stupid to ask for help, the CDC should have stepped in and demanded it.  This is not a local issue.  This is a national, nay global, public health issue, and absolutely the exact kind of thing the CDC is supposed to take charge of from local authorities, not sit on its hands humming loudly.

 

 

Not as I recall.

 

As I recall the CDC had been, supposedly, aware that ebola was likely to arrive in USA and preparing hospitals  (regular, ordinary hospitals like the one in Dallas) to deal with it since March, 2014.

 

The mantra was that any USA hospital that could provide a private patient room and bathroom could handle it.

 

And also the mantra was that it is not a very contagious disease.

 

 One of the links I put on a closed thread also had given the information from the CDC that even though ebola is classed as a level 4 contagious disease with only 4 facilities in USA capable of handling it, nonetheless, they were expecting it to be (apparently successfully?) dealt with by regular hospitals with lower level PPE. Presumably even thought the thread is locked the link there would still be working.

 

A lot of what was being said prior to the Duncan case seems to have disappeared, but this blog below at least confirms that the CDC was aware and preparing for some time. 

 

http://blogs.cdc.gov/cdcdirector/2014/10/02/why-u-s-can-stop-ebola-in-its-tracks/

 

The comments to Frieden's blog run a gamut, but some of them are also interesting.

 

 

Yes, US hospitals clearly need better protocols when someone shows up with Ebola-like symptoms and has very recently been in Liberia. Duncan's life might have been saved if he'd gotten decent treatment days earlier than he did. I hope that has already been addressed in every hospital across the US.

 

But even if they'd caught it right from the start, it sounds like health care workers would have gotten sick because the hospital's regulations didn't adequately protect its employees. I do think it's important to remember that only two people contracted the disease from Duncan and they were both treating him at later stages when there should be plenty of time to get adequate protections in place if the disease is diagnosed early enough. It sounds to me as if the disease is still acting as we would expect which is helpful.

 

There are a lot of things that have been mishandled about this breakout during its entire course. The biggest mistake isn't what the media is focusing on though, but it's the lack of international response to the outbreak months ago. In the early days not long after Ebola first started in west Africa WHO was saying that this outbreak had the potential to get bad because of its location in an area where people didn't know much about the disease and how to contain it. The world was a very different place during the first outbreak of Ebola over fifty years ago and much easier to contain in rural areas, even if getting to those areas was more difficult. A coordinated response to build adequate infrastructure months ago would probably have made a huge difference for everyone.

 

I sincerely hope that when things settle down in the US (and I personally think that will be relatively soon) that we can refocus our attention on what really matters. The affected countries in west Africa cannot beat this on their own. Wealthier countries must provide more support. This means that some people may go into risky situations, just like some health care workers in the US have been asked to treat Ebola patients in the US. But I truly believe this is stoppable in Africa with a concerted effort on the world's part. Because if we won't do that, then I think we actually have a reason to fear.

 

 

I hope putting attention to stopping ebola in Africa does not need to wait for things to settle down in Dallas and elsewhere, because that may not happen.  

 

What you put in bold remains true. Even though there is more of an international response at this point than at the start of the outbreak, the level of response at this point  is what was needed months ago. It now needs a much bigger, exponentially bigger, response to get on top of the situation. Ebola has been expanding exponentially, medical workers in Africa trying to combat it have been dying exponentially (and also fleeing in some cases), and while the international response is no longer next to nothing, it is not yet sufficient and it's growth is still trailing behind the growth in numbers of new cases.

 

IMO working toward trying to help this, whether via financial contributions, or letters to the editor, or phone calls to elected officials,  whatever people are able to do, from those of us in countries capable of helping would be the most useful thing we could do to stop a pandemic from taking place.

[Pawz4me]

I also wonder why the family is on so much stricter quarantine, when it appears they have less likelihood of actually having contracted the disease than the HCW that treated him, who are not only not quarantined, but apparently free to travel all over the country and possibly infect hundreds of others.

 

There is just absolutely no way an Ebola patient should have been treated at a local hospital in the first place - who very obviously had not just no clue, but like a negative clue.  Isolation, limiting access to just a few care workers, and having those care workers be dedicated to him as a sole patient seems just super-basic common sense.  But what would have made the most sense was just them saying 'our facility can't handle this level of care, and he needs to be transported to a specialized facility'.  When my dd was hospitalized with pneumonia when she was 8, the local hospital said after one day that she was too sick for them to handle, and she was transported the next day to a city hospital with more intensive care abilities.  If it's standard practice for something as relatively commonplace as a bad case of pneumonia, how did they not see they were over their heads with Ebola??!!  Wasn't one of the mantras of "the US can handle Ebola" that we had awesome specialized facilities that can handle it?  And that did indeed handle it fine for the aid workers airlifted in?  So why didn't we use them???   Even if the local hospital was too stupid to ask for help, the CDC should have stepped in and demanded it.  This is not a local issue.  This is a national, nay global, public health issue, and absolutely the exact kind of thing the CDC is supposed to take charge of from local authorities, not sit on its hands humming loudly.

 

Until another person is diagnosed in another state, then it IS a local issue.  And this country has laws that prevent federal agencies from charging in and usurping local authorities.  If anyone thinks those laws aren't a good idea, then they should be working actively to have them repealed.  But I think it's fair to say that most of the time most people think those laws are very good things.

[songsparrow]

I thought this DKos diary contains a lot of interesting information that hasn't been shared here yet:  Are UK Ebola Protocols the Gold Standard?

 

The setup for isolating highly infectious patients in the UK is described as follows:  

 

"Effectively the patient is in a bed sized protective capsule. All items that need to be taken into or out of the tent are through an airlocked, separate tented trolley. The necessary face masks, sleeves and internal gloves are built into the tent as "half suits" so the medical staff can safely wear just scrubs and light gloves. The blue device round Breda Athan's neck in the photos is an air cooled vest to keep the staff cool when using the half suits, you can see the tube for the air supply in the first picture.  

 

The CDC appear to also use isolation tents but simple ones which require the staff to enter the tent to treat the patient. That of course requires that they wear full PPE and have to take this off properly, with all the risks we know that involves."  

 

The photos mentioned can be found at the Huffington Post UK article.  

 

The DKos diary also mentions screenings taking place at Heathrow Airport - although it sounds like there are complaints about the effectiveness of its implementation.

[Katy]

I also wonder why the family is on so much stricter quarantine, when it appears they have less likelihood of actually having contracted the disease than the HCW that treated him, who are not only not quarantined, but apparently free to travel all over the country and possibly infect hundreds of others.

 

There is just absolutely no way an Ebola patient should have been treated at a local hospital in the first place - who very obviously had not just no clue, but like a negative clue.  Isolation, limiting access to just a few care workers, and having those care workers be dedicated to him as a sole patient seems just super-basic common sense.  But what would have made the most sense was just them saying 'our facility can't handle this level of care, and he needs to be transported to a specialized facility'.  When my dd was hospitalized with pneumonia when she was 8, the local hospital said after one day that she was too sick for them to handle, and she was transported the next day to a city hospital with more intensive care abilities.  If it's standard practice for something as relatively commonplace as a bad case of pneumonia, how did they not see they were over their heads with Ebola??!!  Wasn't one of the mantras of "the US can handle Ebola" that we had awesome specialized facilities that can handle it?  And that did indeed handle it fine for the aid workers airlifted in?  So why didn't we use them???   Even if the local hospital was too stupid to ask for help, the CDC should have stepped in and demanded it.  This is not a local issue.  This is a national, nay global, public health issue, and absolutely the exact kind of thing the CDC is supposed to take charge of from local authorities, not sit on its hands humming loudly.

 

My understanding is that Presby IS one of the hospitals that your DD might have been transferred to if you lived in that area of Texas.  They went above and beyond in ICU care, including dialysis when his Kidneys shut down.  Later the CDC said that wasn't such a good idea, but if he hadn't been at that hospital he would have died sooner. In kidney failure a patient typically dies in three days to two weeks, depending on the nature of the illness.  I once had a patient who got sick of dialysis and refused treatment who was transferred to hospice and passed in three days, and he didn't have any other infections.

 

I think the patients should have been transferred to a bio containment facility immediately.  I don't understand why their caregivers didn't have the same level of safety as those of the missionaries brought here from Africa.

 

As for the concern that assuming federal responsibility is illegal, this is not the case in states of emergency, and in the case of a hemorrhagic fever, no governor would have objected to federal assumption of responsibility, it would be political suicide.

[Katy]

Something else that's been weighing on my mind- Mr Duncan was infected by someone who didn't present with typical symptoms.  No one knew she had ebola until he was diagnosed and my understanding is that at that point they went back and dug up her body and tested it. So he goes to the hospital with low grade fever, nausea, and diarrhea, but not projectile vomiting or high fever yet.  Granted, no one from that earlier exposure seems to have gotten ill, but it concerns me that the CDC was dismissing Amber Vinson's early malaise and low fever when it appears this is exactly the early presentation in Mr Duncan.

 

So that flight the other day, when a man that was projectile vomiting died on a plane, and it was ruled not ebola far too soon for even a rapid test to come back...  How do we know it wasn't?  Because he wasn't hemmoraging from the eyes?  Apparently the pregnant woman Mr Duncan was exposed to wasn't either.

 

I realize that even if the CDC is discussing this internally they're probably not going to announce it.  But I really hope someone is discussing it internally.

[ChristyB in TN]

That is awesome. Thank you. Just reposted it to my fb and twitter, thinking I will lose a few followers.

 

 

Injecting some humor and this fantastic headline from the New Yorker

 

 

http://www.newyorker.com/humor/borowitz-report/man-infected-ebola-misinformation-casual-contact-cable-news

[Pen]

Until another person is diagnosed in another state, then it IS a local issue.  And this country has laws that prevent federal agencies from charging in and usurping local authorities.  If anyone thinks those laws aren't a good idea, then they should be working actively to have them repealed.  But I think it's fair to say that most of the time most people think those laws are very good things.

 

No. It is a Federal Issue. The law for that is already in place.

 

It does not require 2 states.

 

Under the Commerce Clause of the US Constitution, the USA Federal Government has powers with regard to health and welfare. These powers have generally been delegated  from the Dept. of Health and Human Services to  the CDC.  

 

The CDC could probably have asserted authority with regard to Duncan on the grounds that he is/was a foreign national. Or on the grounds that his recent arrival fits into the mandate they have to stop the entry and spread of contagious diseases from foreign countries.

 

In addition, as specific to ebola:

 Executive Order 13295 of April 4, 2003  [provides as follows, bold and underline added:]

 

"Section 1. Based upon the recommendation of the Secretary of Health and Human Services (the “Secretaryâ€), in consultation with the Surgeon General, and for the purpose of specifying certain communicable diseases for regulations providing for the apprehension, detention, or conditional release of individuals to prevent the introduction, transmission, or spread of suspected communicable diseases, the following communicable diseases are hereby specified pursuant to section 361( B) of the Public Health Service Act:

 

(a) Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named)."

 

------------------------------

 

 

Prevention of the introduction, transmission and spread of Ebola into and within the USA has been placed under USA Federal jurisdiction since April 4, 2003.  As a specifically named illness in this order, it does not require cases in 2 states for the CDC to step in.

 

 

(edited to try to clarify what is a quote and what I wrote.)

[Pen]

PS It is legally an issue that the Federal authorities can act on.

 

I do not mean to deny that it is also a local issue, a personal and family issue for people who are affected, a community issue and so on.

 

In my post above my goal was to explain that legally there is a Federal Issue in response to those who think the CDC has no business in the Dallas cases.

[Pawz4me]

No. It is a Federal Issue. The law for that is already in place.

 

 

I'm in the midst of a killer sinus headache right now and don't have the concentration to do the technical legal research, so I've opted for the easy way out and limited my search to news articles that address the issue.

 

See this article from the WSJ.  One pertinent excerpt:

 

 

The quarantining powers of the federal government are more circumscribed. The CDC, part of the federal Department of Health and Human Services, has no power to tell states or the more than 3,500 local public-health agencies what to do, legal experts said. Within the states, the CDC’s primary role is as an adviser, health law experts said.

The U.S. Supreme Court has ruled repeatedly that the federal government can’t commandeer local officials to do the work of the federal government, nor bend states to its will. It can only create incentives.

“It’s called American federalism. We basically have a system that is bottom up, in terms of public health,†said Lawrence O. Gostin, a health-law professor at Georgetown University.

 

(bolded added)

 

That of course doesn't address the need for cases in two states.  But it does broadly address the (lack of) power of the CDC to enter into a state/local matter.  As does this USA Today article:

 

 

 

"One of the things we have to understand is the federal, state and local public health relationships," says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "Public health is inherently a state issue. The state really is in charge of public health at the state and local level. It's a constitutional issue. The CDC can't just walk in on these cases. They have to be invited in."

 

(bolded added)

 

The two men quoted appear to have solid credentials as experts in this area, and I accept their interpretation of the law.

[momacacia]

 

Injecting some humor and this fantastic headline from the New Yorker

 

 

http://www.newyorker.com/humor/borowitz-report/man-infected-ebola-misinformation-casual-contact-cable-news

 

 

 

That actually is quite cute, but what are people supposed to do with the misinformation coming from the CDC. :hat:

[Laurie4b]

I'd just like to point out that many people who are "concerned about ebola" are perfectly aware of the available statistics. There's way more to the issue than fear of contracting the disease. 

 

What I am concerned about is how fast the government can get on top of this.  I was dismayed by the chaotic response and the CDC, the hopsital, etc. playing catch up with a deadly disease and people's lives.

 

A "czar" is probably needed, but I do wonder about the ability of someone with no medical experience to be the czar. I agree that management is what is needed, but surely there will be decisions to make in which two different medical "voices" are in disagreement. How does someone with no medical background decide which one is most reasonable?

 

[Just Kate]

What I am concerned about is how fast the government can get on top of this. I was dismayed by the chaotic response and the CDC, the hopsital, etc. playing catch up with a deadly disease and people's lives.

 

A "czar" is probably needed, but I do wonder about the ability of someone with no medical experience to be the czar. I agree that management is what is needed, but surely there will be decisions to make in which two different medical "voices" are in disagreement. How does someone with no medical background decide which one is most reasonable?

 

Exactly! And I am having a hard time believing that they couldn't find someone with both management AND medical experience.

[Slartibartfast]

What I am concerned about is how fast the government can get on top of this.  I was dismayed by the chaotic response and the CDC, the hopsital, etc. playing catch up with a deadly disease and people's lives.

 

A "czar" is probably needed, but I do wonder about the ability of someone with no medical experience to be the czar. I agree that management is what is needed, but surely there will be decisions to make in which two different medical "voices" are in disagreement. How does someone with no medical background decide which one is most reasonable?

 

 

I think a skilled logistician would do as well as some of these people with medical experience who have been fumbling. 

[*Lulu*]

Exactly! And I am having a hard time believing that they couldn't find someone with both management AND medical experience.

I am sure they could have.

 

I personally think that someone bring excellent in management AND willing to listen to medical people who are excellent in their given areas is more important than actual medical experience at this point.

[BigMamaBird]

Something else that's been weighing on my mind- Mr Duncan was infected by someone who didn't present with typical symptoms.  No one knew she had ebola until he was diagnosed and my understanding is that at that point they went back and dug up her body and tested it. So he goes to the hospital with low grade fever, nausea, and diarrhea, but not projectile vomiting or high fever yet.  Granted, no one from that earlier exposure seems to have gotten ill, but it concerns me that the CDC was dismissing Amber Vinson's early malaise and low fever when it appears this is exactly the early presentation in Mr Duncan.

 

So that flight the other day, when a man that was projectile vomiting died on a plane, and it was ruled not ebola far too soon for even a rapid test to come back...  How do we know it wasn't?  Because he wasn't hemmoraging from the eyes?  Apparently the pregnant woman Mr Duncan was exposed to wasn't either.

 

I realize that even if the CDC is discussing this internally they're probably not going to announce it.  But I really hope someone is discussing it internally.

 

From what I've heard about how Ebola kills, when you're in the end stages, you're literally vomiting up your insides.  If the person who died was simply vomiting up food and gastric juices, they probably could tell right away it wasn't Ebola. But I'm not a doctor nor do I know very much about this, I'm just speculating.

[Mrs Mungo]

What I am concerned about is how fast the government can get on top of this.  I was dismayed by the chaotic response and the CDC, the hopsital, etc. playing catch up with a deadly disease and people's lives.

 

A "czar" is probably needed, but I do wonder about the ability of someone with no medical experience to be the czar. I agree that management is what is needed, but surely there will be decisions to make in which two different medical "voices" are in disagreement. How does someone with no medical background decide which one is most reasonable?

 

 

My dh manages a lot of people who have expertise that he lacks (which includes some number of medical personnel). I think this is pretty common out in the world. Hospital administrators typically have backgrounds in administration, not medicine. The Chairman of the Board of the Mayo Clinic has a business management background. Yes, he has medical doctors on his team, as will Ron Klain. I see this as similar in nature. I would *imagine* that if two medical people disagree, then the decision maker would ask for opinions from others *or* choose the more cautious/conservative path (the latter is more common among managers that I've witnessed in action). 

 

From CNN:

 

 

 

"I think what you can assume Mr. Klain's role will be is an important, high-level implementation role," said Earnest. "Ultimately, it will be his responsibility to make sure that all the government agencies who are responsible for aspects of this response, that their efforts are carefully integrated. He will also be playing a role in making sure the decisions get made."

 

 

 

 

"As far as I'm concerned, you can call him anything you want," Earnest told reporters. "We call him the Ebola Response Coordinator."

 

This is a management/administrative/corrdinator job that requires knowledge of how federal, state and local authorities and agencies work together. Klain has experience in those things.

[Pen]

 http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

[Matryoshka]

From what I've heard about how Ebola kills, when you're in the end stages, you're literally vomiting up your insides.  If the person who died was simply vomiting up food and gastric juices, they probably could tell right away it wasn't Ebola. But I'm not a doctor nor do I know very much about this, I'm just speculating.

 

Also, the person who died on the plane was from Nigeria, and last I heard they'd stamped it out there.  I would be incredibly bizarre and unlikely if the very last person to be infected in Nigeria happened to hop that plane with no symptoms and then die on arrival.

[Pen]

 http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

 

 

Quoting from the CDC's own website, bold added: 

 

"Federal isolation and quarantine are authorized for these communicable diseases:

• Cholera
• Diphtheria
• Infectious tuberculosis
• Plague
• Smallpox
• Yellow fever
• Viral hemorrhagic fevers
• Severe acute respiratory syndromes
• Flu that can cause a pandemic
• "

 

 

...

 

"Enforcement

If a quarantinable disease is suspected or identified, CDC may issue a federal isolation or quarantine order."

 

---------------

They may not choose to use the power (the page goes on to explain that the Federal government hasn't so chosen on a large scale since the 1918 influenza), and it might upset and worry a lot of us, if it felt like the CDC was too fast to step in and use the power when the state could handle it (and until the Dallas hospital messed up, it may have looked like the states and local authorities and local hospitals could handle it), however, they do have the legal authority and power, even if the quarantinable disease is merely suspected.

 

The bigger issue is not whether the CDC has that authority, but that Duncan was actually in "isolation"--but that the isolation was not sufficient to be effective.

 

But  that was not discovered until the nurses getting Ebola made it clear.

 

Prior to that we were hearing news like:

 

 

http://www.wfaa.com/story/news/health/2014/09/29/dallas-presbyterian-hospital-ebola-patient-isolation/16460629/

 

"Texas Health Presbyterian Hospital Dallas, ... said it's complying with all recommendations from the Centers for Disease Control and the Texas Department of Health to ensure the safety of other patients and medical staff."

 

 

And I personally believe that they did think that was true, including that the hospital did, the judge acting as a local homeland security person, and the CDC itself.

 

 

Because the idea of the Federal gov. stepping in where a case of _____ is merely suspected is one that worries me in terms of the potential for abuse, I am actually glad that the papers are reporting this as if they cannot do so, and hope that will lead to them being voluntarily called in by hospitals, local government and so on, rather than using this rarely used power.

 

 

 

 

[Pen]

Does anyone have any updates on how nurses Pham and Vinson are doing?

[Susan in TX]

This is unreal:

 

GALVESTON, Texas -

A helicopter met up with a cruise ship with a Dallas health care worker aboard who is being monitored for signs of Ebola in order to take a blood sample for testing prior to the ship's arrival Sunday in Galveston.

Carnival Cruise Lines released a statement Saturday which read, "Today we were advised by Texas health officials that they felt it was necessary for the health care worker currently on Carnival Magic to submit a blood sample for testing prior to the ship's arrival in Galveston tomorrow morning. As a result, a helicopter rendezvoused with the ship late this afternoon to facilitate the transfer of the sample."

http://www.click2houston.com/news/blood-sample-taken-from-hospital-worker-in-ebola-isolation-aboard-carnival-cruise-ship/29216240

 

Why go to such trouble to perform a test on someone who has no symptoms? If there is no reason to panic, then why are we panicking? If she really doesn't have symptoms and they are just doing this to reassure people, it isn't working. At least not for me. This sort of crazy over-reaction to Ebola worries me more than Ebola does.

 

On the other hand they chose not to test someone who had been in Africa who had symptoms because they didn't have contact with someone with Ebola. http://www.statesmanjournal.com/story/news/health/2014/10/16/suspected-ebola-patient-salem-tested/17385597/ 

Thomas Duncan didn't have known contact with someone who had Ebola. And if someone who did have Ebola showed up in an emergency room in Dallas with the same symptoms he had on his first visit, they would not meet the protocols for Ebola testing. http://www.dallasnews.com/news/metro/20141017-patient-with-ebola-victims-symptoms-can-still-be-sent-home.ece

 

What a mess.

 

Susan in TX

 

[BlsdMama]

I am genuinely curious about the appt of this 'czar' who has good management skills but isn't a healthcare professional. I want to give him the benefit of the doubt but it doesn't make sense to me. Is he a spin doctor for the admin & CDC or is he truly the type of person needed to turn the tides?

 

My side note: I have followed all Ebola threads & I do not want this one locked. Who cares who said what last week? I humbly ask that we keep this thread on topic. Please! I was just thinking last night how nice it had been to be able to read peoples thoughts without all the drama & name calling & finger pointing.

Indeed!

[fruitofthewomb]

 

 

My dh manages a lot of people who have expertise that he lacks (which includes some number of medical personnel). I think this is pretty common out in the world. Hospital administrators typically have backgrounds in administration, not medicine. The Chairman of the Board of the Mayo Clinic has a business management background. Yes, he has medical doctors on his team, as will Ron Klain. I see this as similar in nature. I would *imagine* that if two medical people disagree, then the decision maker would ask for opinions from others *or* choose the more cautious/conservative path (the latter is more common among managers that I've witnessed in action).

 

From CNN:

 

 

 

 

 

 

This is a management/administrative/corrdinator job that requires knowledge of how federal, state and local authorities and agencies work together. Klain has experience in those things.

Thank you for the info. I am completely ignorant when it comes to the health care field.

[idnib]

I don't think the czar has to be a medical person. If this spreads we're going to need someone who can manage medical information, virology, epidemiology, public health issues, distribution of items such as masks or medicines (FEMA?), etc., not to mention coordination with the State Department.

 

That's just off the top of my head; I'm sure there are more I'm missing.

 

It's a big job and in their own way, each of these areas is important.

[countrygal]

I'm still stuck on wondering if the original caretakers of Duncan had a decontamination room, where they are sprayed off with disinfectant before removing their PPE. I'm under the impression they had paper disposable gowns, etc. At what point do they go from 'dirty' to 'clean'. You can't take off your booties and step down in the same spot without walking though a disinfectant type bath, or it's contaminated. Am I the only one stuck on this? Why is it not protocol here to use plastic suits that can be disinfected?! That's what they are doing in Liberia, and this is American for goodness sake! Following CDC's protocol is worthless if the protocol isn't appropriate for the situation. Anyone who contracts this or has it needs to be sent to a special containment facility. Period. Then people wouldn't be freaking out watching all the management and all the workers run in circles trying to figure out what to do. I'm a registered nurse, I know PPE is very necessary, but at the same time, a joke. I've seen so many mishaps. Hospitals are filthy and germs are spread. Yes, they are greatly reduced by handwashing and proper PPE, but not 100%. People aren't 100% foolproof. To contain Ebola, the sick need to be separated into a different facility as soon as possible. Regular hospitals are not equipped or prepared for this. Thankfully the two nurses were sent to other facilities. I'm very saddened that they got sick. I believe it could have been prevented if Duncan was taken to an appropriate facility.

[Laurie4b]

Exactly! And I am having a hard time believing that they couldn't find someone with both management AND medical experience.

 

That's what I was thinking just from the nature of the issue.

 

I am sure they could have.

 

I personally think that someone bring excellent in management AND willing to listen to medical people who are excellent in their given areas is more important than actual medical experience at this point.

 

Could you explain more of your reasons why? I agree that excellence in management is an absolute must. I just wonder if medical understanding is not also an absolute must.

 

 

 

My dh manages a lot of people who have expertise that he lacks (which includes some number of medical personnel). I think this is pretty common out in the world. Hospital administrators typically have backgrounds in administration, not medicine. The Chairman of the Board of the Mayo Clinic has a business management background. Yes, he has medical doctors on his team, as will Ron Klain. I see this as similar in nature. I would *imagine* that if two medical people disagree, then the decision maker would ask for opinions from others *or* choose the more cautious/conservative path (the latter is more common among managers that I've witnessed in action). 

 

From CNN:

 

This is a management/administrative/corrdinator job that requires knowledge of how federal, state and local authorities and agencies work together. Klain has experience in those things.

 

I had thought about the hospital administrator angle, but then I thought that they were there for the money-making end of hospitals, and because this isn't about money making, I wondered. 

 

I totally see the need for someone who can oversee planning, communication, etc. The ,manager in me has been shocked all along at what things weren't planned for (waste disposal, for instance) or how poorly communication has been handled. I agree that someone who is just really good at management could improve things a lot.

 

But I guess my hesitation is, what about things like understanding of contagious disease spread?  We have some reasonable authorities who disagree about some aspects of managing ebola. I've read both sides and I've also seen things evolve. I have no idea who is right AND I don't have the background to evaluate it. If someone like me is the czar, wouldn't he be stuck picking his expert and hoping for the best?  Kind of like what many people are faced with when diagnosed with cancer: one doctor/hospital says x; another says y. Most people have to choose without totally understanding. In that case, their own life is on the line. Somebody will have to make final decisions about medical issues somewhere along the line here. The czar will have to take responsibility for wrong decisions, even if they are medical decisions. And it will be other people's lives at stake.  It just seems counter-intuitive to me.

 

Another question I have is: Is it better or worse to have someone who is political? For instance, it may be best to accept the reality that politics has played, is playing, will play into this and have someone who is savvy about it. On the other hand, maybe you need someone who  doesn't give a rip about politics and  will  tell politicians to go quarantine themselves. ;)

 

ETA: If faced with the choice of either an excellent manager without a medical background OR someone with the medical background without management skills, I'd choose the manager. I think it's just that I wish the czar had both.

[Mrs Mungo]

The problem (IMO) is that someone completely outside of the government/political system will not have any experience making inter-government agencies working together. People learn a lot of diplomacy, administrative skills and decision making skills when they deal with issues like that.

[Mrs Mungo]

But I guess my hesitation is, what about things like understanding of contagious disease spread? We have some reasonable authorities who disagree about some aspects of managing ebola. I've read both sides and I've also seen things evolve. I have no idea who is right AND I don't have the background to evaluate it. If someone like me is the czar, wouldn't he be stuck picking his expert and hoping for the best?

If you admit that medical professionals do not always agree, then wouldn't we be hoping for the best, regardless?

 

ETA: If faced with the choice of either an excellent manager without a medical background OR someone with the medical background without management skills, I'd choose the manager. I think it's just that I wish the czar had both.

The one other thing I thought about is how complacent medical professionals can get about this stuff. I have been on the end of fighting (as the parent of a patient) to get HCWs to take the required precautions in certain situations whether reminding them or having to insist. That experience doesn't make me believe that medical professionals necessarily take infection control more seriously than an outsider.

[momacacia]

To contain Ebola, the sick need to be separated into a different facility as soon as possible. Regular hospitals are not equipped or prepared for this. Thankfully the two nurses were sent to other facilities. I'm very saddened that they got sick. I believe it could have been prevented if Duncan was taken to an appropriate facility.

 

I strongly suspect this is what they figured out. Maybe they can only administer certain therapies at Emory and NIH, but I suspect the reality is that those are two of a few places that are actually equipped to handle Ebola and not spread to other patients or HCWs.

 

As to the czar, I'm not really sure it matters. If we're going to continue open travel from these countries, the issues will arise where the rubber meets the road in the local hospital ERs just like in Dallas. Maybe the Ebola Czar can do something over the next few weeks to drastically impact policy and provisions in every one of those local hospitals, but if it shows up again much comes down to how well prepared the lottery-winning hospital and admitting personnel are. And, maybe, hopefully, we've seen the last of it once all these quarantines are completed and the nurses are home well.

[Katy]

This is unreal:

 

GALVESTON, Texas -

A helicopter met up with a cruise ship with a Dallas health care worker aboard who is being monitored for signs of Ebola in order to take a blood sample for testing prior to the ship's arrival Sunday in Galveston.

Carnival Cruise Lines released a statement Saturday which read, "Today we were advised by Texas health officials that they felt it was necessary for the health care worker currently on Carnival Magic to submit a blood sample for testing prior to the ship's arrival in Galveston tomorrow morning. As a result, a helicopter rendezvoused with the ship late this afternoon to facilitate the transfer of the sample."

http://www.click2houston.com/news/blood-sample-taken-from-hospital-worker-in-ebola-isolation-aboard-carnival-cruise-ship/29216240

 

Why go to such trouble to perform a test on someone who has no symptoms? If there is no reason to panic, then why are we panicking? If she really doesn't have symptoms and they are just doing this to reassure people, it isn't working. At least not for me. This sort of crazy over-reaction to Ebola worries me more than Ebola does.

 

On the other hand they chose not to test someone who had been in Africa who had symptoms because they didn't have contact with someone with Ebola. http://www.statesmanjournal.com/story/news/health/2014/10/16/suspected-ebola-patient-salem-tested/17385597/ 

Thomas Duncan didn't have known contact with someone who had Ebola. And if someone who did have Ebola showed up in an emergency room in Dallas with the same symptoms he had on his first visit, they would not meet the protocols for Ebola testing. http://www.dallasnews.com/news/metro/20141017-patient-with-ebola-victims-symptoms-can-still-be-sent-home.ece

 

What a mess.

 

Susan in TX

 

My guess is that they want to make absolutely sure she doesn't have the virus before all those people are off the ship and it's impossible to trace all of their contacts on their flights home.  Tracing the contacts of thousands of people on a ship would become an astronomical amount of exposure very quickly, especially given that most people fly from all over the country/world to take a cruise.

 

I'm still stuck on wondering if the original caretakers of Duncan had a decontamination room, where they are sprayed off with disinfectant before removing their PPE. I'm under the impression they had paper disposable gowns, etc. At what point do they go from 'dirty' to 'clean'. You can't take off your booties and step down in the same spot without walking though a disinfectant type bath, or it's contaminated. Am I the only one stuck on this? Why is it not protocol here to use plastic suits that can be disinfected?! That's what they are doing in Liberia, and this is American for goodness sake! Following CDC's protocol is worthless if the protocol isn't appropriate for the situation. Anyone who contracts this or has it needs to be sent to a special containment facility. Period. Then people wouldn't be freaking out watching all the management and all the workers run in circles trying to figure out what to do. I'm a registered nurse, I know PPE is very necessary, but at the same time, a joke. I've seen so many mishaps. Hospitals are filthy and germs are spread. Yes, they are greatly reduced by handwashing and proper PPE, but not 100%. People aren't 100% foolproof. To contain Ebola, the sick need to be separated into a different facility as soon as possible. Regular hospitals are not equipped or prepared for this. Thankfully the two nurses were sent to other facilities. I'm very saddened that they got sick. I believe it could have been prevented if Duncan was taken to an appropriate facility.

 

They did not have a decontamination room, they were not sprayed with anything.  They initially literally wore less PPE than you do with a suspected TB patient. Later they wore plastic suits, but they still weren't sprayed with anything.  It's disturbing.

[Pawz4me]

 http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

 

I'm going to pull out a few things from your link which I believe firmly support my stance, and the opinions of the experts I quoted earlier.  For ease of reading, I'm going to snip things to minimize quoting clunkiness.  All these quotes come from the first page of your linked document or from the document linked in it entitled "Specific Laws and Regulations Governing the Control of Communicable Diseases."

 

 

 

Under section 361 of the Public Health Service Act (42 U.S. Code § 264), the U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states.

 

(snip)

 

Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases.

 

(snip)

 

States have police power functions to protect the health, safety, and welfare of persons within their borders. To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine.

These laws can vary from state to state and can be  specific or broad. In some states, local health authorities implement state law. In most states, breaking a quarantine order is a criminal misdemeanor.

 

(snip)

 

Who Is in Charge The federal government

• Acts to prevent the entry of communicable diseases into the United States. Quarantine and isolation may be used at U.S. ports of entry.
• Is authorized to take measures to prevent the spread of communicable diseases between states.
• May accept state and local assistance in enforcing federal quarantine.
• May assist state and local authorities in preventing the spread of communicable diseases.

State, local, and tribal authorities

• Enforce isolation and quarantine within their borders.

It is possible for federal, state, local, and tribal health authorities to have and use all at the same time separate but coexisting legal quarantine power in certain events. In the event of a conflict, federal law is supreme.

 

(snip)

 

The Secretary of the Department of Health and Human Services has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases in the United States. Under its delegated authority, the Division of Global Migration and Quarantine works to fulfill this responsibility through a variety of activities, including

• the operation of Quarantine Stations at ports of entry
• establishment of standards for medical examination of persons destined for the United States, and
• administration of interstate and foreign quarantine regulations, which govern the international and interstate movement of persons, animals, and cargo.

 

See how all the references to federal authority relate to ports of entry and interstate travel issues (in other words, two or more states must be involved)?  And that states have the power to "protect persons within their borders."  This is exactly what the legal experts are saying.  The federal government (CDC) can implement screening passengers at airports.  Those are ports of entry.  But it has no authority to come into Texas and take over.  They can step in if it becomes an interstate issue.  They may "assist" states (the use of the word "assist" implies that it is something that may be requested).  All the bolded statements in that link support that stance.

 

I worked as a legal assistant/paralegal for over thirteen years.  The attorneys I worked for were graduates of the top law schools on the east coast.  My direct supervisor was a Yale law school graduate.  I've seen him work on simple federal law interpretations for days.  And of course attorneys often disagree on interpretation.  But what I learned is that when laypeople try to interpret federal law they almost always get it wrong.  Local ordinances and some state laws are easy.  But there are just too many layers to federal law. Like all those links to the CFR--each one of those would need to be examined minutely to make a sound interpretation of the law relating to this issue.  While I think the things I've pulled out of your link firmly support my assertion that the federal government (CDC) has no legal standing to enter into what is at this point solely a local/state matter, what I believe most firmly is that the experts I quoted earlier likely know much more about the legal issues than either of us.  And until I see another public health or legal expert with a differing opinion, I stand by theirs.

[*Lulu*]

 

Could you explain more of your reasons why? I agree that excellence in management is an absolute must. I just wonder if medical understanding is not also an absolute must.

 

 

I would say someone who is intelligent enough to comprehend the medical information given him is a must.

 

Someone outside the medical community may not have as many opinions already formed or as much ego involved in having "the" answer.

 

Even within the medical community there is a lot of hyper-specialization. Having medical experience wouldn't mean a great deal IMO in terms of the person understanding the specifics of this issue. Having someone who is skilled in management, knowledgable of the buracracy that must be dealt with, and surrounded by advisors who are experts in the specific medical areas involved is what is most important in my mind.

[Valley Girl]

This is unreal:

 

GALVESTON, Texas -

A helicopter met up with a cruise ship with a Dallas health care worker aboard who is being monitored for signs of Ebola in order to take a blood sample for testing prior to the ship's arrival Sunday in Galveston.

Carnival Cruise Lines released a statement Saturday which read, "Today we were advised by Texas health officials that they felt it was necessary for the health care worker currently on Carnival Magic to submit a blood sample for testing prior to the ship's arrival in Galveston tomorrow morning. As a result, a helicopter rendezvoused with the ship late this afternoon to facilitate the transfer of the sample."

http://www.click2houston.com/news/blood-sample-taken-from-hospital-worker-in-ebola-isolation-aboard-carnival-cruise-ship/29216240

 

Why go to such trouble to perform a test on someone who has no symptoms? If there is no reason to panic, then why are we panicking? If she really doesn't have symptoms and they are just doing this to reassure people, it isn't working. At least not for me. This sort of crazy over-reaction to Ebola worries me more than Ebola does.

 

On the other hand they chose not to test someone who had been in Africa who had symptoms because they didn't have contact with someone with Ebola. http://www.statesmanjournal.com/story/news/health/2014/10/16/suspected-ebola-patient-salem-tested/17385597/ 

Thomas Duncan didn't have known contact with someone who had Ebola. And if someone who did have Ebola showed up in an emergency room in Dallas with the same symptoms he had on his first visit, they would not meet the protocols for Ebola testing. http://www.dallasnews.com/news/metro/20141017-patient-with-ebola-victims-symptoms-can-still-be-sent-home.ece

 

What a mess.

 

Susan in TX

 

According to reports today, the ship has docked and all the passengers have gone their separate ways. So it doesn't sound like they were waiting for tests results first.

 

 

[Perry]

According to reports today, the ship has docked and all the passengers have gone their separate ways. So it doesn't sound like they were waiting for tests results first.

 

 

 

She tested negative.

[Trish]

CDC is changing the guidelines for what is recommended for healthcare workers dealing with ebola patients. The problem as I see it is that these continue to be recommendations only, and if a local hospital is unwilling or unable to enforce these, it puts healthcare workers at risk. I would imagine healthcare workers would be required to work under whatever conditions their employer set forth for them, at risk of penalty.

 

That's why it would be nice if there were a way to make the CDC recommendations mandatory in order to protect the workers at the front lines of this. Otherwise we risk endangering or losing those people.