Second Ebola Case in Dallas

[Trilliums]

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

 

 

I don't think testing her equals being panicked.  Now that she has been tested negative it is now much less panic inducing and more reassuring.  I think this is more of the aggressive stance we should be taking to prevent it spreading.

[Valley Girl]

She tested negative.

 

Good to know! Thank you. I wasn't seeing that in the articles I read, which I found odd. I appreciate your filling in the gap.

 

[KingM]

I don't think testing her equals being panicked.  Now that she has been tested negative it is now much less panic inducing and more reassuring.  I think this is more of the aggressive stance we should be taking to prevent it spreading.

 

I know, this particular case seemed implausible, based on what we know about the disease. But aggressively tracking and testing any possible path of infection is how we'll catch those rare cases that slip through the cracks. The biggest danger is someone not knowing they're infected and spreading it two or three iterations before anyone catches it. By then, it's really hard to trace. That's how this outbreak got out of control in West Africa in the first place.

[VeteranMom]

I believe this ebola czar was picked in order that he will manage the political aspects of this virus for the Obama administration.  He's a political operative- nothing more.  It would have been very easy to find someone with medical and managerial expertise to manage this virus.  The fact that they picked someone who knows nothing about medicine indicates that they are only interested in spinning this in a positive way for the current administration.  People's lives are at risk and they gave the job to someone who knows nothing about disease and preventing the spread of disease.             

[The Governess]

Does anyone know the point at which the Ebola test is accurate? If they tested and released the lab worker on the cruise ship, who was not symptomatic, why couldn't they do the same for Duncan's family, or other people who have been in direct contact with the virus?

[Pawz4me]

I believe this ebola czar was picked in order that he will manage the political aspects of this virus for the Obama administration.  He's a political operative- nothing more.  It would have been very easy to find someone with medical and managerial expertise to manage this virus.  The fact that they picked someone who knows nothing about medicine indicates that they are only interested in spinning this in a positive way for the current administration.  People's lives are at risk and they gave the job to someone who knows nothing about disease and preventing the spread of disease.             

 

I too have questioned the appointment.  But I don't really agree with what you say.  Whoever was appointed needed to be able to navigate the "alphabet soup" of governmental agencies involved or that may become involved eventually, as well as walk a fine line with local and state agencies and authorities.  So while I don't think it's optimal to have someone with no medical knowledge (that we know of), I also don't think it would have been optimal to appoint someone who didn't have some political know how, either.

[Only me]

Does anyone know the point at which the Ebola test is accurate? If they tested and released the lab worker on the cruise ship, who was not symptomatic, why couldn't they do the same for Duncan's family, or other people who have been in direct contact with the virus?

That's a good point. I'm curious about that too.

[VeteranMom]

I too have questioned the appointment.  But I don't really agree with what you say.  Whoever was appointed needed to be able to navigate the "alphabet soup" of governmental agencies involved or that may become involved eventually, as well as walk a fine line with local and state agencies and authorities.  So while I don't think it's optimal to have someone with no medical knowledge (that we know of), I also don't think it would have been optimal to appoint someone who didn't have some political know how, either.

I don't see how a political operative= manager who can handle deadly virus.  Do you think Karl Rove would be a good choice in the position?  He has similar qualifications and served as deputy chief of staff.  I would have hoped that politics would have been left out of it when making this choice.  It seems as though that was the #1 priority in this pick, though.  The fact they didn't pick someone with medical knowledge should be alarming to the American people.  This is the guy who signed off on the Solyndra govt loan.  That deal cost the taxpayers $535 million.  He's a lawyer and lobbyist.  I'd love it if someone could show me ANYTHING in his resume that shows he knows anything about medicine.    

   http://www.usatoday.com/story/news/politics/2014/10/17/ron-klain-bio-resume-recount-stimulus-ebola-czar/17430563/

[Susan in TX]

I think the viral load in the blood would have to be detectable.  Nina Pham's viral load was not very high when she was dxed IIRC

 

But she was having symptoms. I don't think it is possible to detect Ebola in a blood test before the onset of symptoms. So it seems to me that going to all that trouble to test the person on the cruise ship was totally unnecessary.

 

Susan in TX

[Katy]

Does anyone know the point at which the Ebola test is accurate? If they tested and released the lab worker on the cruise ship, who was not symptomatic, why couldn't they do the same for Duncan's family, or other people who have been in direct contact with the virus?

 

Well it's been 21 days since the lab worker handled the blood samples, so if they were going to get the virus, the time has probably passed.  Generally you need symptoms to be contagious, and this person had no symptoms, but since this particular strain is different and no one knows exactly how yet, I think it was a good idea to test her as a precaution.  If she's had a hangover while on board and thought her malaise was hangover related but was actually ebola related, it would necessitate testing. I actually think this is one of the first proactive decisions the CDC has gotten right.  I'm glad things are moving in a positive direction.

[VeteranMom]

He does not need to handle medicine or anything medical.  He needs to handle govt agency communications.  

Political activists make decisions to benefit their party- not the American people.  His sign-off on Solyndra indicates that politics come first.  We need someone in that position who has a history of looking out for the American people and knows something about medicine.   

[Perry]

But she was having symptoms. I don't think it is possible to detect Ebola in a blood test before the onset of symptoms. So it seems to me that going to all that trouble to test the person on the cruise ship was totally unnecessary.

 

Susan in TX

 

If they hadn't tested her there would have been an uproar.  They can't win.

 

There are several different tests.  One detects virus.  The sicker someone is, the more virus they tend to have. 

 

Another test looks for antibodies to the virus, which tells if someone has been infected or not.  It is possible to have been infected and not ever have gotten sick.  In that case, your blood would have antibodies. 

 

My guess is that she had both tests, and all were negative, meaning she was never exposed. 

[Trish]

Does anyone know the point at which the Ebola test is accurate? If they tested and released the lab worker on the cruise ship, who was not symptomatic, why couldn't they do the same for Duncan's family, or other people who have been in direct contact with the virus?

 

They're talking about the 21 day quarantine for the family being over today because it's three weeks from when Duncan got hospitalized. (They meaning the news media) But didn't the family remain in the contaminated apartment for several days after that before being moved to a safe place?

 

Just wondering why that isn't considered part of the exposure timeline.

 

[VeritasMama]

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/

This is what I remember reading in the 1990's about Ebola, that the more cases occur the more mutations can occur, which is why it is so important to isolate outbreaks and stop them in their tracks.

 

I'm not panicked over Ebola, I'm just flabbergasted over the incompetent response, and honestly citizens complaining is what gets these bureaucrats to react. I think it's our civic duty to scrutinize all of our public agencies and speak up if we see incompetence. I'm not anti-government, I have family who work for the NIH, the DoD, and local governments as well. But they work for us, and we need to let them know when we think they are dropping the ball. It does cause them to make improvements.

 

Containment seems like the common sense way to handle this, and so of course I think we should be sending more aid to West Africa.

[Ummto4]

Looks like the Spanish nurse now recovers from Ebola. Hopefully Nina Pham and Amber Vinson recover soon.

http://www.bbc.com/news/world-europe-29683616

 

 

 

[Trish]

Judge Clay Jenkins just announced that the Duncan Ebola Finacee (Troh?) will "remain quarantined" for several more days before being moved to a rental home. So hopefully that fills the gap in the timeline from when they were last exposed in that apartment.

[KingM]

After a few alarming days, it seems like the news has been better. I'm feeling more confident that this particular outbreak (in Dallas) has been nipped in the bud. There will undoubtedly be more across the world so long as the main outbreak in Africa rages on, but hopefully, we've learned some valuable lessons from how this one has played out.

[VeritasMama]

He does not need to handle medicine or anything medical. He needs to handle govt agency communications.

But the outcry from the public has been due to what were inadequate medical protocols. It seems someone with at least some knowledge of infectious disease outbreaks would help calm the public's unease.

[Pen]

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."

 

 

 

 

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 (1) 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 (2) 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, (3) I stand by theirs.

 

(1)

LOL. So am I. Though I am at this time just a home school mom.

 

(2) Of course.

 

Indeed, we just did something like that... you are focussed on the Interstate Commerce issue, and I am focussed on the Executive Order which specifically names Ebola.  :)  If it went to court we could each argue our side. 

 

There is also very common in legal situations a goal of getting ones own views on a matter out to the press, setting things up in the press so as to help possible future legal maneuverings, such that actions taken would be seen to be desired by the general public, or so that action taken would be likely to have a Constitutionality challenge pass muster in whatever direction the parties who are speaking to the press would prefer to see that.

 

This actually worries me, that this situation may be being used to set up future situations where the Executive Order will be more quickly used, perhaps in an abuse of power way, and harkening back to this situation where it was not used, and resulted in two innocent nurses getting sick... etc.

 

 

 

(3) By all means!  

 

You take the people quoted in WSJ and USA Today as your experts. Every case/side needs its expert witnesses. 

 

 

It is interesting that CDC head Frieden himself, in a Time mag. dated Oct 27, was quoted as saying he now thinks they should have stepped in sooner, "We could have...been more hands-on with the hospital from day one."   He does not say he could not have done so--interestingly since it would be a very good defense if true.  I'll take Dr. Frieden, head of CDC, as my expert.  However, I only saw this as a bold blurb, so maybe if you find the full quote it will be food for more argument.  :)    

 

 

 

And there seems to be no bar to a Pentagon team being set up.

 

 

 

(4) At this point though, the interstate commerce clause burden appears to be reached in any case.

[ChocolateReignRemix]

Hands on /= control.

[Mrs Mungo]

Comparing this level of ONE hospital mismanaging the situation with Katrina seems a bit absurd. Nearly 2,000 people died in Katrina. *So far* zero people have died through contracting the disease in the US, and only two contracted the disease out of the possible hundreds of people working in the hospital, the surrounding areas and all of the people those people may have had contact with.

 

Only one of the three AIDS "czars" appointed by Bush was a medical professional. The bird flu "czar" appointed by Bush was a lawyer, just like Klain.

 

Pretending that this appointment is unique and irresponsible is just plain wrong. It is *extremely typical.* Any other claim is an attempt to deflect from the issue and create political controversy where there is none.

 

Multiple threads have already been shut down. Can people please stay on topic and away from the inflammatory political rhetoric?

[Pen]

 

 

 

 

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.

 

 

 

 

I was thinking about this over night and today. I really need to let it go and focus on other things, but it has been hard to get out of my mind. So I am going to post and then try to move on to what I need to really be doing in my own life.

 

I am not inclined to write off understanding law as something too difficult for laypeople to understand.  I do have an Ivy League law degree. But I am writing as a home school mom, a member of the public and this forum, not as a lawyer at work and giving a legal opinion on something.  Still, whether as a lawyer or as a citizen, I think that understanding the laws that affect us is important. We are presumed to know the law by the law itself ("ignorance of the law is no defense"), and while I realize that it is generally impossible for even a lawyer to know all the myriad and overwhelming volume of law that exists in this country, still, I don't think it should be approached as something that the layperson cannot work on grasping.   

 

So, as I have thought on it more, it is not just that erroneously dismissing me as a layperson who could not be expected to be able to understand the law was factually wrong and rather condescending too, but I think it is wrong to write that laypeople in general cannot come to an understanding of the law. I think they can. And I think that doing so is important. As Benjamin Franklin may have said, we have a republic--if we can keep it.  

 

 

The initial very clear legal standing for the CDC to get involved would come from the 2003 Executive Order that specifically named Ebola as a Federally quarantinable virus, to me that is clear, though to you, it is not.

 

Notwithstanding that disagreement, however, by the 19th when you posted your assertion, bolded above, the situation had already gone interstate via exposed health care workers traveling out of state. So, why, at that point did you still think it was solely a state and local matter? Belize, Mexico, and Ohio were all "involved" in some way. Schools in Ohio were being or had already been closed for cleaning. And possibly it was directly affecting interstate commerce as people were expressing not wanting to travel to affected areas.  I am sincerely wondering what your thinking here that takes it to still have been local/state only as of the 19th is.  Do you still believe this now as of the 20th?

 

As to the people quoted or referred to in the newspapers you quoted, I hear you.   I can understand your desire to defer to the experts cited in the papers--especially when they agree with your own views-- though I do hope you or others reading this take the contrast of that and Frieden's own statements into account.  I've not seen any interview where he seems to get a direct question about the legal powers of the CDC, but it appears that he knows the CDC has the power to step in, simply assumes that in what he says, does not try to excuse the CDC as it is under fire by alleging that their hands were tied by lack of legal authority to do more. 

 

My guess is you are not so much going to see other public health or legal experts giving opinions in newspapers, but just the actual action by the Federal government as it takes more and more control. The CDC will do that, I expect, as will others. I think that we are in fact already seeing that as, for example, with the new Pentagon task force on this.

 

I know you said you did not have time to do your own legal research yet, but when you do have time to do it, I hope that you will look up the effects and powers of a standing Executive Order that has not been superseded or revoked by the President of the US, modified by US Congress, or declared unconstitutional by the Supreme Court.

 

 If you look that up (or anyone else reading this does so) and find a credible legal authority that a Federal Law, or more specifically a US President's Executive Order, would not be given precedence in the absence of being declared unconstitutional by the Supreme Court, please do let me know. That would interest me greatly, as it would certainly conflict with my own Ivy League law school learning, and I am always interested in learning more or new information or different information in such an area.  The EO specifically referring to Ebola is pretty clear in giving Federal jurisdiction. The general law by which an EO has the same legal weight as a law passed by US Congress is pretty clear. 

 

If you (or others reading this) examine all those CFR links minutely (as you say must be done) and come up with something that supports your contention that the Federal government (CDC) has no business  (I'm not using the word "standing" because that generally refers to a party being in position to bring suit, which is not what I am concerned with here) in Ebola cases, as a supersession to the 2003 EO, or anything else that modifies or revokes it so that it would not be the current law, please do let me know.

 

 

 

 I think it is important for residents and citizens (parents, our children as part of home school) to understand the laws of our country if we live in USA, or where ever we do live, especially in a legal area that is not minor, but has life and death aspects in many ways, as well as potential for abuse.  I think this is still an important area to understand the law about also because even though the cases from Dallas are, I hope, not going to increase in number, nor any more deaths occur, I would expect that it is very likely that someone else or several others with Ebola will enter the country before it is brought under control in Africa.  So, frankly, I am in favor of grappling with what the law in this area is, and teaching legal understanding, and how to find out about the law to your children too. IMO it is as important as, probably more important than many other curriculum subjects.  Math is complex too, though not everyone has to be a mathematician for math to be important for them, and to work on understanding it, and learning even how to learn it.

 

[Mrs Mungo]

I am not the one that you are arguing with, but just because the federal government has legal ability to step in, doesn't mean that they are required to do so or that it is always warranted or wise to do so every time it is legally allowed.

 

There were three hospitals involved with caring for ebola patients. Two of them seemingly managed not to transmit the virus to any HCWs, one assumes by using CDC guidelines and/or going above and beyond the guidelines?

 

One hospital failed in that with their initial patient. One assumes that they have adjusted their protocol with advice and guidance from the CDC. The public most definitely doesn't know all of the information being communicated back and forth.

 

So, aside from the "is it allowed at this stage" question, do you really think it should have been necessary and/or would it have been wise for the federal government to step in and take over from local authorities, given the very small transmission rate? Or do you think it was better for them to help the hospital adjust protocol as needed?

[Pawz4me]

 

 

 

I was thinking about this over night and today. I really need to let it go and focus on other things, but it has been hard to get out of my mind. So I am going to post and then try to move on to what I need to really be doing in my own life.

 

I am not inclined to write off understanding law as something too difficult for laypeople to understand.  I do have an Ivy League law degree. But I am writing as a home school mom, a member of the public and this forum, not as a lawyer at work and giving a legal opinion on something.  Still, whether as a lawyer or as a citizen, I think that understanding the laws that affect us is important. We are presumed to know the law by the law itself ("ignorance of the law is no defense"), and while I realize that it is generally impossible for even a lawyer to know all the myriad and overwhelming volume of law that exists in this country, still, I don't think it should be approached as something that the layperson cannot work on grasping.   

 

So, as I have thought on it more, it is not just that erroneously dismissing me as a layperson who could not be expected to be able to understand the law was factually wrong and rather condescending too, but I think it is wrong to write that laypeople in general cannot come to an understanding of the law. I think they can. And I think that doing so is important. As Benjamin Franklin may have said, we have a republic--if we can keep it.  

 

 

The initial very clear legal standing for the CDC to get involved would come from the 2003 Executive Order that specifically named Ebola as a Federally quarantinable virus, to me that is clear, though to you, it is not.

 

Notwithstanding that disagreement, however, by the 19th when you posted your assertion, bolded above, the situation had already gone interstate via exposed health care workers traveling out of state. So, why, at that point did you still think it was solely a state and local matter? Belize, Mexico, and Ohio were all "involved" in some way. Schools in Ohio were being or had already been closed for cleaning. And possibly it was directly affecting interstate commerce as people were expressing not wanting to travel to affected areas.  I am sincerely wondering what your thinking here that takes it to still have been local/state only as of the 19th is.  Do you still believe this now as of the 20th?

 

As to the people quoted or referred to in the newspapers you quoted, I hear you.   I can understand your desire to defer to the experts cited in the papers--especially when they agree with your own views-- though I do hope you or others reading this take the contrast of that and Frieden's own statements into account.  I've not seen any interview where he seems to get a direct question about the legal powers of the CDC, but it appears that he knows the CDC has the power to step in, simply assumes that in what he says, does not try to excuse the CDC as it is under fire by alleging that their hands were tied by lack of legal authority to do more. 

 

My guess is you are not so much going to see other public health or legal experts giving opinions in newspapers, but just the actual action by the Federal government as it takes more and more control. The CDC will do that, I expect, as will others. I think that we are in fact already seeing that as, for example, with the new Pentagon task force on this.

 

I know you said you did not have time to do your own legal research yet, but when you do have time to do it, I hope that you will look up the effects and powers of a standing Executive Order that has not been superseded or revoked by the President of the US, modified by US Congress, or declared unconstitutional by the Supreme Court.

 

 If you look that up (or anyone else reading this does so) and find a credible legal authority that a Federal Law, or more specifically a US President's Executive Order, would not be given precedence in the absence of being declared unconstitutional by the Supreme Court, please do let me know. That would interest me greatly, as it would certainly conflict with my own Ivy League law school learning, and I am always interested in learning more or new information or different information in such an area.  The EO specifically referring to Ebola is pretty clear in giving Federal jurisdiction. The general law by which an EO has the same legal weight as a law passed by US Congress is pretty clear. 

 

If you (or others reading this) examine all those CFR links minutely (as you say must be done) and come up with something that supports your contention that the Federal government (CDC) has no business  (I'm not using the word "standing" because that generally refers to a party being in position to bring suit, which is not what I am concerned with here) in Ebola cases, as a supersession to the 2003 EO, or anything else that modifies or revokes it so that it would not be the current law, please do let me know.

 

 

 

 I think it is important for residents and citizens (parents, our children as part of home school) to understand the laws of our country if we live in USA, or where ever we do live, especially in a legal area that is not minor, but has life and death aspects in many ways, as well as potential for abuse.  I think this is still an important area to understand the law about also because even though the cases from Dallas are, I hope, not going to increase in number, nor any more deaths occur, I would expect that it is very likely that someone else or several others with Ebola will enter the country before it is brought under control in Africa.  So, frankly, I am in favor of grappling with what the law in this area is, and teaching legal understanding, and how to find out about the law to your children too. IMO it is as important as, probably more important than many other curriculum subjects.  Math is complex too, though not everyone has to be a mathematician for math to be important for them, and to work on understanding it, and learning even how to learn it.

 

 

 

Respectfully, Pen, I think maybe you do need to drop it.

 

I'm sorry I offended you.  I assure you I meant no disrespect to you or to anyone.  Perhaps this is a good example of the failings of internet communication.  I was simply stating my experience -- That federal law is hard to interpret by laypeople.  And I stand by that.

 

As far as why I think (thought) this was a state/local issue -- Because my understanding was that we were discussing the original incident in Dallas.  You know, the one that caused all the problem?  'Cause it seems to me that's where everyone thinks the CDC should have stepped in.

 

In a way I'm glad you brought this up again.  I wasn't going to mention it, but I heard Mr. Gostin being interviewed on NPR this afternoon.  I don't know what the name of the program was, but it was on around 4:00 or 4:30. The interviewer introduced Gostin as the CDC's legal adviser.  And he reiterated quite clearly that the CDC lacks the authority to intervene in state/local matters other than in an advisory capacity.  If they said when the interview took place I missed it, so I'm not sure if it was before Ms. Vinson's trip to Ohio or not.

 

When I posted the article he was quoted in, I assumed Gostin was just a law professor who had some expertise in public health.  Now that I know he's actively involved in advising the CDC . . . yeah, I'm going to continue to assume that his interpretation of the law is correct.  So you see, it's not just a matter of it not being clear to me.  It's a matter of (in your opinion) it not being clear to the CDC's own legal adviser.  Perhaps you should take it up with him?

[melmichigan]

Emory released another doctor  today.  I was glad to hear that he is recovering from ebola.

[MBM]

Have the Canadian and US vaccines been discussed yet? The Canadian vaccine had just begun human trials according to the first article.

 

http://online.wsj.com/articles/canada-to-ship-experimental-ebola-vaccine-to-world-health-organization-1413664138

http://online.wsj.com/articles/ebola-vaccine-push-ramps-up-1413762856

 

 

[flyingiguana]

http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-to-say-about-ebola.html?_r=1

 

I can't tell if anyone posted this yet: Osterholm talks about worst case scenarios.  (Michael T. Osterholm is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.)

 

I was under the impression that Osterholm was often a voice of reason, so this would be enough to get me nervous.

[Ummto4]

Emory released another doctor  today.  I was glad to hear that he is recovering from ebola.

 

The NBC cameraman was just also released from Nebraska. And Nina Pham's status was also upgraded from 'fair' to 'good'.

[Pen]

I am not the one that you are arguing with, but just because the federal government has legal ability to step in, doesn't mean that they are required to do so or that it is always warranted or wise to do so every time it is legally allowed.

 

There were three hospitals involved with caring for ebola patients. Two of them seemingly managed not to transmit the virus to any HCWs, one assumes by using CDC guidelines and/or going above and beyond the guidelines?

 

One hospital failed in that with their initial patient. One assumes that they have adjusted their protocol with advice and guidance from the CDC. The public most definitely doesn't know all of the information being communicated back and forth.

 

So, aside from the "is it allowed at this stage" question, do you really think it should have been necessary and/or would it have been wise for the federal government to step in and take over from local authorities, given the very small transmission rate? Or do you think it was better for them to help the hospital adjust protocol as needed?

 

 

No. I was speaking to what the jurisdiction and authority of the Federal Government is. I agree that they are not required to step in.

 

I am not a "states' rightser" as I think perhaps people I was arguing with on here may be. But I do have deep concerns about human rights and was deeply concerned about much Homeland Security legislation that came into being in the wake of 9/11, with what seemed to be many possibilities for extreme abuse built in.  The specter of the right to quarantine on a mere "suspicion" turning into a scenario where people could be rounded up and put in concentration camp type situation was one, is one such potential abuse scenario, that concerns me.

 

I was relieved to see the CDC acting with some restraint in terms of their Quarantine powers, personally.

 

However, I was/am more deeply concerned about, and where I would personally fault the CDC was, that they appeared to downplay possible arrival in this country of an Ebola case, and seeming to downplay the seriousness of it such that hospitals and health care workers seemed to be unprepared.  I am speaking of regular mainline hospitals such as most of us have in our communities, not the 4 special units in Montana, Nebraska, Maryland (NIH), and at Emory.  2 of the successful hospitals (you mention) were amongst the special ones. Had they been unable to care for Ebola cases adequately we would be in deep deep trouble.  All but Montana now seem to have had a case come to them and so far seem to be managing. 

 

I am hopeful that the if the possible case in New York turns out to be Ebola that Bellevue will be able to handle it.  Bellevue is sort of between the Dallas hospital and the 4 special ones. It is, as I understand it, a designated center in its area supposedly able to handle Ebola, but not one of those top 4 centers in the USA for contagious diseases, which have special wards and have been in special training.

 

oops.  We lost electric power and this has gone on battery back up.  I'll post what I've got and come back at some point when we get electric back.

[Pen]

I am not the one that you are arguing with, but just because the federal government has legal ability to step in, doesn't mean that they are required to do so or that it is always warranted or wise to do so every time it is legally allowed.

 

There were three hospitals involved with caring for ebola patients. Two of them seemingly managed not to transmit the virus to any HCWs, one assumes by using CDC guidelines and/or going above and beyond the guidelines?

 

One hospital failed in that with their initial patient. One assumes that they have adjusted their protocol with advice and guidance from the CDC. The public most definitely doesn't know all of the information being communicated back and forth.

 

So, aside from the "is it allowed at this stage" question, do you really think it should have been necessary and/or would it have been wise for the federal government to step in and take over from local authorities, given the very small transmission rate? Or do you think it was better for them to help the hospital adjust protocol as needed?

 

 

Continuing--

 

So, I was trying to explain that I am glad there was some restraint in terms of not having a "Quarantine" turn into something as drastic as that might be.

 

At the same time, I am concerned that even in the USA, as in Liberia back some months ago, there may be too little being done to be fully ready and able to address the situation, and I do think the CDC should have done more earlier.  (As also, I think the world should have been doing something more and earlier to help in West Africa, and still should be doing far, far, far more now.)

 

As to the Federal Government with regard to stepping in and taking over, I think there are some ideas being confused and conflated, mixed together, that are part of the misunderstanding about the legal situation, and which I will come to in a moment.

 

I do think the CDC should have stepped in and been more hands on sooner, for example, should have looked at the PPE both as to what exactly was being used and how exactly it was being used, on an ASAP basis. Maybe they would have thought it was all right even if top CDC experts on Ebola had personally observed this, because maybe it was not really clear to them that it was insufficient until with perfect hindsight it became clear it was not. But maybe if they had seen it for themselves they would have realized that what was being used, and/or how it was being used was not sufficient with foresight rather than hindsight.

 

As for your words "take over"--I am not sure what you have in mind. I think part of what may have been confused by those who do not see the Federal Government as having jurisdiction to act right away in the case of Ebola, was reading things written by the "experts" (Osterholm, for example) about what the CDC does and confusing the idea that the CDC is not in the business of doing direct patient care, but rather advises and guides what is done, with the idea that the CDC cannot act at a local level if there are Ebola cases in one state only (which may be also a confusion with "standing" rules, where a party can sue in Federal Court in some specific situations, one of which is if parties to the case are domiciliaries of 2 different states). These are different concepts.

 

By analogy this would be like saying the Justice Dept is not in the business of running hotels, and then from that coming to the conclusion that it cannot take action where a hotel chain in only one state refuses access to, say, African-Americans, believing that only if the hotel chain operates hotels in two different states would the Federal Gov. have any jurisdiction in the matter.  Some of what seemed to be mentioned as being "expert" opinions supporting the idea that the Federal Gov cannot act unless there are Ebola cases in two states, actually, when I read it, appeared to be an "expert" explaining, not that at all, but rather that the CDC does not do direct patient care, basically.

 

So, if what you mean by "take over" would be that they would start taking direct care of the patients, and do I think they should have done that, taken over the care of Duncan?

No, that is not what they do do, just as the Justice Dept would not take over and run the hotel, but  could enforce laws pertaining to non-discrimination even if a hotel chain was only in a single state.  Similarly, the Fed. Gov., CDC could have gotten more involved, more "hands-on," right away when they learned that Duncan had Ebola in overseeing that his isolation would be more effective in terms of not getting the nurses sick, or at least it could have tried to do so.  If they had gotten involved right away, and if things like taping around necks, stacks of soiled linens, etc. etc. had been observed as right away as possible--if the CDC had recognized it as insufficient, they might have improved what was being done a lot sooner. They also may well have had the power to rapidly get in better PPE for the health care workers if the hospital did not have the right things. Or, upon finding that the hospital was not prepared, perhaps he should have been sent to one of the  hospitals that had already shown itself able to take care of Ebola.

 

The CDC certainly should have been prepared (far better prepared) helping the frontline primary care hospitals to get ready, prepared to get them what would be needed to safely care for Ebola patients, since mathematically speaking, with 150 travelers from the affected countries arriving daily in USA, and with a 21 day period for most cases to show up, it was really just a matter of time before it came. And the preparation for that is very much within the CDC's mandate. 

 

As to the transmission rate, I do not consider it small. If 2 cases develop out every one case on average, without the top level hospitals like Emory being in charge, it has the potential to become a rapidly exponential problem here like it did in Liberia. It may sound small when it is a very few cases, but it can easily become way out of control. 1 becomes 2, 2 becomes 4, 4 becomes 8, and so on...which at the start sounds low, but it you do the math, you'll see that it gets huge very fast.

 

So far we seem to have been tremendously lucky. The one case that got here unexpectedly, Duncan, has so far not resulted in any deaths, even with all the errors and mistakes.  But as more and more come, again simply as a matter of mathematics, the chances that we will continue to be so lucky diminish. 

 

If we are prepared, indeed what may be thought of by most as "over-prepared" which is to say prepared for a lot more cases, and for it to perhaps mutate to being more easy to catch before symptoms show, and more transmissible by air also, then we may have a chance of stopping it, though then probably people will put down the preparation efforts as having been unnecessary since it did not turn pandemic. I would rather have people criticizing what would appear to be over-preparation for a situation that gets halted, rather than see Ebola turn into a terrible pandemic.

 

So far, in terms of number of deaths, we have been more fortunate than Nigeria was, but our handling of the situation so far, does not appear to have been as well done as they managed in Nigeria despite much less resources in Nigeria compared to the USA. And that is deeply troubling.

 

While the CDC may now be increasing preparedness, we are probably still behind the 8-ball as it were, in terms of our preparedness compared to the exponential rise in numbers of cases in West Africa, and thus the increasing likelihood that more cases are likely to arrive in USA, possibly a lot more. 

 

I have heard that there may be some vaccines tested on humans in a few months, and perhaps 250,000 doses ready by next January--but if the virus continues to affect people at the rate it is now, there will be millions sick with it by then. If it takes multiple health workers to care for every sick person, how do those vaccine doses cope with that, even if they turn out to work perfectly, which they may or may not.

 

... and the millions infected figure is based on the virus as it is now, continuing as it is now, not on it mutating to something worse.

[unsinkable]

http://www.nytimes.com/2014/10/24/nyregion/craig-spencer-is-tested-for-ebola-virus-at-bellevue-hospital-in-new-york-city.html?_r=0

 

Doctor in NYC tested positive.

[Ausmumof3]

This seems odd. It seems odd that he developed the disease exactly 10 days after arriving when presumably he'd been working with infected patients for some time. And also doctors without borders rang the health department that sounds fair enough but why ring the fire department. Maybe there's something I'm missing but I don't understand why the fire department would get involved in a healthcare crises.

[Joker]

This seems odd. It seems odd that he developed the disease exactly 10 days after arriving when presumably he'd been working with infected patients for some time. And also doctors without borders rang the health department that sounds fair enough but why ring the fire department. Maybe there's something I'm missing but I don't understand why the fire department would get involved in a healthcare crises.

 

I think they just wanted to handle this one correctly from the get go. There has been a lot of talk about how other cases, and probable cases, were handled. This is someone who was very forthcoming and knew he could have it so they took all the precautions they could. Hopefully it means it will be contained.

[Ausmumof3]

I guess the fire department would have been needed for quarantining the department and organising hazardous material clean up.

 

Another question I have is with relation to cleaning up whether it makes more sense to simply seal off the apartment and clean up later when there is more chance that virus has "died" (don't know the correct term).

[Ausmumof3]

I also see that a 2 yo girl in Mali has it. I think the thing that seems saddest about all this is that those who offer compassionate care to others seem to be the most likely to be affected. The healthcare workers, those who cared for orphaned family members etc.

[melmichigan]

This seems odd. It seems odd that he developed the disease exactly 10 days after arriving when presumably he'd been working with infected patients for some time. And also doctors without borders rang the health department that sounds fair enough but why ring the fire department. Maybe there's something I'm missing but I don't understand why the fire department would get involved in a healthcare crises.

In my area all EMS response is routed through the fire department.  

[Joker]

In my area all EMS response is routed through the fire department.  

 

Yes. We actually have a fire department a mile away, so they always come first. I didn't think of it but it's probably not that they notified the fire department but if they called 911 that is who is often first on the scene.

[StaceyinLA]

I think they just wanted to handle this one correctly from the get go. There has been a lot of talk about how other cases, and probable cases, were handled. This is someone who was very forthcoming and knew he could have it so they took all the precautions they could. Hopefully it means it will be contained.

If the stories I've seen are true, I'm a bit disappointed that he would've been in so many crowded places before a reasonable time had passed. You'd think after seeing the horrors of the disease, one would lay low until at least 21 days had passed since last possible exposure.

[Joker]

If the stories I've seen are true, I'm a bit disappointed that he would've been in so many crowded places before a reasonable time had passed. You'd think after seeing the horrors of the disease, one would lay low until at least 21 days had passed since last possible exposure.

 

I agree and feel I would stay away from as many people as possible, but it does seem TPTB know what they are talking about in regards to when it is contagious. I'm not really worried about him spreading it around before he had symptoms and it appears, so far, that as soon as he did show symptoms he called for help.

[busymama7]

I also see that a 2 yo girl in Mali has it. I think the thing that seems saddest about all this is that those who offer compassionate care to others seem to be the most likely to be affected. The healthcare workers, those who cared for orphaned family members etc.

It is sad :( but I just can't figure out why the health care workers are not put into quarantine before coming home? They are the most likely to contract it so why not use caution and keep thrum isolated for 3-4 weeks. I know it would suck but spreading the disease in the US would suck more.

[Reflections]

I guess the fire department would have been needed for quarantining the department and organising hazardous material clean up.

 

Another question I have is with relation to cleaning up whether it makes more sense to simply seal off the apartment and clean up later when there is more chance that virus has "died" (don't know the correct term).

 

I think that the problem here is that they don't know exactly how long the virus lives on different materials.  Hard surfaces vs carpets.  Warm environments vs cold ones. Blood vs sweat vs vomit. There haven't been enough studies.  Although, I read somewhere they were studying it where they could with the ebola victims that are being treated here.

[TeacherZee]

If the stories I've seen are true, I'm a bit disappointed that he would've been in so many crowded places before a reasonable time had passed. You'd think after seeing the horrors of the disease, one would lay low until at least 21 days had passed since last possible exposure.

 

Again, individuals are not contagious until they are showing symptoms. The doctor took his temperature twice a day and when his temperature was elevated he contacted the proper authorities.

[Twolittleboys]

If the stories I've seen are true, I'm a bit disappointed that he would've been in so many crowded places before a reasonable time had passed. You'd think after seeing the horrors of the disease, one would lay low until at least 21 days had passed since last possible exposure.

 

I know my opinion won't be popular and I do understand people's concern but I honestly don't think that is a reasonable expectation. Based on what we know people are not contagious until they show symptoms (and based on the experience in Dallas ebola really doesn't seem to be very contagious until the patient is VERY sick) so going out and about while free of symptoms really doesn't endanger anyone. I do think it is too much to expect people to basically put their life on hold for three weeks if there is practically no chance of infecting anyone (personally I believe the chance in such a case really is zero).

 

Honestly, if we all lived our lives in a way to completely and absolutely ensure that we don't endanger anyone we wouldn't get much done. I am not the best driver - does that mean I should never drive anywhere because there is a chance I will cause an accident (actually, even for excellent drivers that risk exists)? If you have taken your kids to school and later it turns out that a child at that school has gotten chicken pox - would you (assuming you are not immune to chicken pox) then quarantine yourself?

 

I do believe in taking precautions and doing our best to ensure we do not expose others to unnecessary risk but I think for ebola taking your temperature regularly and contacting a hospital at the FIRST sign of a temperature (or other signs of sickness) is sufficient. At this point I am starting to become concerned about the way people who are unlucky enough to get ebola (mostly because they went out there and helped others) are being treatedk/talked about. There seems to be quite a bit of blame assigned (maybe not for getting sick but for living a normal life which is highly unlikely to endanger anyone). In my opinion this is not a positive development.

[Pawz4me]

This seems odd. It seems odd that he developed the disease exactly 10 days after arriving when presumably he'd been working with infected patients for some time. And also doctors without borders rang the health department that sounds fair enough but why ring the fire department. Maybe there's something I'm missing but I don't understand why the fire department would get involved in a healthcare crises.

 

Here in my city and county it's standard procedure to dispatch the fire department as well as an ambulance on all health-related calls.  The FD can often reach the scene faster, many firemen are also emergency medical technicians, and they can help with traffic control if needed.

 

 

I also see that a 2 yo girl in Mali has it. I think the thing that seems saddest about all this is that those who offer compassionate care to others seem to be the most likely to be affected. The healthcare workers, those who cared for orphaned family members etc.

 

The spread to Mali is very worrisome. :(

[KingM]

 

 

Here in my city and county it's standard procedure to dispatch the fire department as well as an ambulance on all health-related calls.  The FD can often reach the scene faster, many firemen are also emergency medical technicians, and they can help with traffic control if needed.

 

 

Also, calls for fires are way down over the past few decades, thanks to better building codes, furnaces, etc., so this is a way to utilize FD resources while still having them on hand for when there's an actual conflagration.

 

 

 

The spread to Mali is very worrisome. :(

 

 

 

They seemed to catch it quickly, and I'm encouraged that both Senegal and Nigeria have managed to snuff out small outbreaks. That shows it can be done, even in an impoverished nation in West Africa.

[Valley Girl]

I know my opinion won't be popular and I do understand people's concern but I honestly don't think that is a reasonable expectation. Based on what we know people are not contagious until they show symptoms (and based on the experience in Dallas ebola really doesn't seem to be very contagious until the patient is VERY sick) so going out and about while free of symptoms really doesn't endanger anyone. I do think it is too much to expect people to basically put their life on hold for three weeks if there is practically no chance of infecting anyone (personally I believe the chance in such a case really is zero).

 

Honestly, if we all lived our lives in a way to completely and absolutely ensure that we don't endanger anyone we wouldn't get much done. I am not the best driver - does that mean I should never drive anywhere because there is a chance I will cause an accident (actually, even for excellent drivers that risk exists)? If you have taken your kids to school and later it turns out that a child at that school has gotten chicken pox - would you (assuming you are not immune to chicken pox) then quarantine yourself?

 

I do believe in taking precautions and doing our best to ensure we do not expose others to unnecessary risk but I think for ebola taking your temperature regularly and contacting a hospital at the FIRST sign of a temperature (or other signs of sickness) is sufficient. At this point I am starting to become concerned about the way people who are unlucky enough to get ebola (mostly because they went out there and helped others) are being treatedk/talked about. There seems to be quite a bit of blame assigned (maybe not for getting sick but for living a normal life which is highly unlikely to endanger anyone). In my opinion this is not a positive development.

I get what you're saying and, in one sense, I agree.

 

But where I get stuck and, quite honestly, frustrated with this doctor and the nurse who flew is that they are clearly at greater risk than the average person of contracting the disease at this point. Even if they call as soon as they are symptomatic, officials are still having to trace their contacts prior to becoming symptomatic. And because they are out and about doing things that many people would consider nonessential under the circumstances, taking public transportation, those contacts can be numerous. Look at how many people had to be contacted after the nurse's flight... how much expense their airline went to in cleaning the plane and ripping out carpet... etc. They haved created a huge amount of unnecessary worry and expense for their fellow citizens. So there's that side of it, too. Yeah, having to sit home stinks. But balance that with the financial and emotional cost to others, and I think that's where some of the anger and "blame" originates.

 

It's a tough situation.

[TeacherZee]

Mali is really unstable govt wise tho.  UGH

 

Yeah. A friends son is going there as a UN peace keeper in January. It is very very worrying. Nigeria has a stable government and a GOOD health system (even if it isn't accessible to all) that is very much NOT the case in Mali. Although I agree it is encouraging that they seem to have caught the case early.

[flyingiguana]

I know my opinion won't be popular and I do understand people's concern but I honestly don't think that is a reasonable expectation. Based on what we know people are not contagious until they show symptoms (and based on the experience in Dallas ebola really doesn't seem to be very contagious until the patient is VERY sick) so going out and about while free of symptoms really doesn't endanger anyone. I do think it is too much to expect people to basically put their life on hold for three weeks if there is practically no chance of infecting anyone (personally I believe the chance in such a case really is zero).

 

 

I think, though, that we have less information than we need at this point to be making some of these decisions.  Given that, it makes sense to err on the side of caution until we know more.  So the people treating the Dallas ebola patient really probably should have cancelled their travel plans.  (And someone should have been working to help them with that, either in moving their vacation days or making sure they didn't lose money)

 

On the other hand, the fact that one did travel when sick is going to give us more info on how dangerous that actually is.  Just as the fact that there was very sloppy quarantining and clean up going on after the case was diagnosed is going to give us info on how sloppy things can be.  Not ideal for the people involved, but it is providing more information.

 

It is interesting that the latest case in NY seems to have self-quarantined himself during the awkward period when he knew he was sick but couldn't yet tell if it was ebola.  If many of the people coming back to the US are health care workers who know the drill, my guess is that this will mean it won't spread as much.

 

The real way to protect the US, though, is to do as much as possible to stop the spread at the source.  I think the US and the CDC have gotten way too complacent from watching lots of ebola outbreaks just go away before.  There was always the chance that there would be a strain that would spread more easily.  Now we have it.  If the countries involved don't have the resources to stop the spread, we're all better off in the rest of the world if others step in to help.  If that means that we get the occasional ebola case coming to the US (or Spain or whatever) then that's the price we'll pay to help keep the epidemic under control and protecting the rest of us. 

 

Telling health care workers that if they go into an ebola country they can't come back is hardly going to make more people go.  And if the health care resources in those countries are overwhelmed, where is that going to end? 

 

So my take on it is that the nurses etc in Dallas probably could have delayed their vacation plans.  That's not much of an imposition.  But the dr flying back from Africa pretty much HAD to fly when he had recently been exposed to ebola patients.  Was he supposed to go into quarantine in Africa where there are ebola patients?  And then NOT assist those patients if he was there?  If I'd been in his position, I don't see how I could have sat by and not treated patients just so I could fly back to the US where I knew I probably had a small chance of a) contracting the disease and b ) passing it on to anyone else if I did and c) if I made it back to the US IF I then came down with it I'd have a better chance of surviving it AND a better chance of seeing the people I infected survive it as well.

 

So no, I don't think his flying home was irresponsible.

 

(Not that that had much to do with what I quoted at the top here...)

 

 

[flyingiguana]

Although -- I probably would have tried to avoid riding in the subway if I were that dr.  Given that I'd just come back.  I'm not sure how feasible that would be though, as his subway ride may have just involved getting home from the airport.  And a taxi ride might have been fairly pricey.

[VeritasMama]

Although -- I probably would have tried to avoid riding in the subway if I were that dr. Given that I'd just come back. I'm not sure how feasible that would be though, as his subway ride may have just involved getting home from the airport. And a taxi ride might have been fairly pricey.

He took a subway ride an then an Uber ride to go to and from Brooklyn for the sole purpose of going bowling at a trendy bowling alley.

 

God bless him for his service in Africa, I hope he recovers, but this doctor is a jackass.