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e_moon60

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Ebola: Facts v. Opinions [Oct. 27th, 2014|01:46 pm]
e_moon60
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From a Washington Post article about states imposing restrictions, including involuntary quarantine in primative conditions on persons returning from working with Ebola patients in Africa:

“It seems a quarantine would be unnecessary,” said John Ard, an anesthesiologist affiliated with Bellevue and NYU Langone Medical Center. “We should stick with the science and avoid hysterical overreaction.”

But Tom Sullivan, who was working on a construction project a block from Bellevue, said quarantines make sense for returning health workers. “You’re working with diseased people. That’s common sense. It doesn’t take a rocket scientist.”

One person appeals to facts, which do not support the need to isolate a healthy person in a tent within a tent without any facilities for bathing or any normal contact with people or even a TV set.

The other person appeals to "common sense"--to an opinion, not facts.

The facts about Ebola--as repeated multiple times by people who've actually worked with, and studied, the disease, as shown in the way Ebola has not infected hundreds of people in this country who had close contact with someone who developed it--should trump opinion.

Buyt the Washington Post gives Tom Sullivan Construction Worker equal space and does not correctly identify his opinion as an opinion.   In his opinion, "it's common sense" tht if you work with "diseased people" you should be quarantined.  Doctors and nurses and home health aids work with "diseased people" all the time, including those who are more infective than someone with Ebola.   Should all of them be quarantined?   And his statement "It doesn't take a rocket scientist" does not equal "It doesn't take someone who knows about this disease" to show that "common sense" in this case is commonly believed nonsense.

Facts tell you about a topic, such as Ebola, or rockets, or anesthesiology or construction workers.

Opinions tell you about the person holding them.  What Mr. Sullivan's opinion tells me is that he's ignorant of the facts about Ebola (or thinks common sense trumps the knowledge of those who study the disease.)   It doesn't tell me anything about Ebola.

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Comments:
[User Picture]From: martianmooncrab
2014-10-27 06:54 pm (UTC)
there should be some kind of middle ground, where either they do blood work before they leave Africa or when they get back, I dont think treating them poorly after they return is good.
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[User Picture]From: e_moon60
2014-10-27 07:28 pm (UTC)
Blood work will not show the Ebola virus in the blood until about the same time the temperature goes up. The amount of virus in the blood has to be high enough to be detected. That's why observation for 21 days is the standard.

Temperature twice a day, blood test when it first goes up, and again in 12 hours if the first is negative (because some people spike a low fever just before the viral load is big enough to turn the test positive and others don't until it's that high.)

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[User Picture]From: e_moon60
2014-10-27 07:33 pm (UTC)
Keep in mind: people who have been exposed and may become sick with Ebola are not infective until they have a fever.

A middle ground might be to require the person to register with a health care professional, wherever they are, and record their temperature twice a day, reporting it to that health care professional once a day. It would be advisable not to share bodily fluids just in case (but probably still OK).

For noncompliant persons who do not report in, then track them down and make them wear an ankle bracelet locator.
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[User Picture]From: robby
2014-10-27 07:35 pm (UTC)
You couch your argument as if all the people that arrive are sophisticated, high-minded medical professionals. People that would self-report symptoms of Ebola

About 150 people per day are flying in to the US from Ebola hotspots. A
5-year old boy just arrived Saturday from Guinea and by Sunday he was hospitalized with a 103F temperature. Thomas Duncan lied about contact with sick people in Liberia when he arrived at the Dallas ER.

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[User Picture]From: e_moon60
2014-10-27 08:31 pm (UTC)
No. You are interpreting what I said through your own strongly colored filter. I said nothing about "all the people that arrive." I said nothing about screening for Ebola, which is a different topic I have covered before.

This post was about facts v. opinions.

The claim that Mr. Duncan lied about contact with sick people in Liberia has been made by a hospital that lied about Mr. Duncan in the first place--multiple stories came out in the first week (about faulty software, about the doctor not seeing the notation about Africa on his entry form, then that the doctor did see it, then that the symptoms were wrong for Ebola, then they clammed up for awhile, making up new stories.) When outsiders first looked at the ER record, it was clear that Mr. Duncan had told them he had come from West Africa, from Liberia. It was instantly surmised that Mr. Duncan lied by people who weren't involved in the case at all--commenters on some online sites saying "He probably lied" without any evidence one way or the other. But the fact is that Mr. Duncan went to the hospital when he first felt sick; he told them he'd come from Liberia and reported his symptoms--which were not recognized by the medical staff in the ER. He did not fail to "self-report symptoms of Ebola"--he did exactly that. That should have been enough to spark a test for Ebola and isolation until they got the answer--but it wasn't.

Let's review the facts. Ebola becomes infective when (or sometime after) the individual spikes a fever. Someone without a fever is not infective. The early symptoms, even after the fever comes up, look like several other diseases common in Africa--malaria, typhoid, anything else that gives you a fever, headache, and stomachache. So it's misdiagnosed fairly often without a blood test. The medical people have to test for it to be sure, early on. Air travel does allow someone to cross half the globe between no-fever and having a fever: thus, fever on arrival from an area where Ebola has been present (for example, nursing staff in the US who have cared for an Ebola patient in the US and have flown overseas) should result in a blood test for Ebola. Not quarantine.

In the US, it is reasonable to ask medical staff to stay in the community--not work in the hospital--for 21 days after last caring for an Ebola patient, IF they are on paid leave or receive some support during that period. It is reasonable to ask them to self-monitor and report in daily all temperatures and symptoms. It is NOT reasonable to insist they stay in quarantine. For nurses serving in Africa, whose schedules have already been set, tickets purchased, etc., it is not reasonable to ask them to stay in Africa for another 21 days. Not all nurses are infected, and all of them have families and jobs to come back to. Self-monitoring and known location are more important. Ideally they will stay in one community for the 21 days, reporting to a known health professional. Those who are not health care professionals need to be monitored, but not confined if they are free of symptoms. It should be enough to get their address; if they fail to report in, then it's time to go find them, take temperature, etc.

It's wrong to assume that every fever coming out of West Africa is Ebola (and wrong to assume it isn't--that why the test.) But automatic quarantine of all arrivals is the wrong answer to the possibility that someone might have Ebola. If they're not running a fever, they're not an immediate danger. If they start running a fever, THEN is the time to run the test for Ebola. Anyone not actually touching him or his body fluids IS NOT AT RISK. That is a fact. It is a fact that everyone should know, and be told, as many times as it takes to stick.

With appropriate care, an Ebola patient will not infect anyone else. Even in Africa, clinics with enough staff have cared for hundreds of Ebola cases without infecting staff. The US death rate of Ebola is now down below 12%, well below that in Africa, due to the greater resources here and to some extent to the better health status of the US patients (other than Mr. Duncan...and Mr. Duncan might well have survived if the ER and hospital staff at that hospital had been competent.



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[User Picture]From: robby
2014-10-27 08:48 pm (UTC)

RE:Let's Review The Facts

It is the emergency room nurse, Sidia Rose, not the hospital, that is claiming that Duncan lied to her in the ER.


Here's how easy it is to transmit Ebola. Perspiration on a bus seat:

Department of Health and Human Services Assistant Secretary Dr. Nicole Lurie said in sworn testimony that Ebola can spread through perspiration left on a bus seat.

Massie asked Lurie whether or not Ebola can survive on inert surfaces for at least 15 minutes. Lurie replied that “it can survive.” Massie then asked whether Ebola could be transmitted on a bus. Lurie said that someone would have to be exposed to infected bodily fluids. Massie asked if that includes perspiration.

“It does include perspiration,” Lurie replied.
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[User Picture]From: e_moon60
2014-10-28 02:53 am (UTC)

Re: Let's Review The Facts

An employee of the hospital. A nurse who may have been told by hospital administration what to say (some of them clearly were.) Look--that hospital told multiple stories in the first few days, and they've told conflicting stories since. They could tell me their windows were made of glass and I'd want a chemical analysis, that's how much I believe what any hospital employee says. The record--as seen and reported on by someone outside the hospital, reports that Mr. Duncan said he had been in Liberia. He was sick with typical symptoms of early Ebola. Whatever else he said, there is no excuse for their not recognizing that he might have it. He was not running a fever when he left Liberia, or when his temperature was taken at intermediate airports before he reached Dallas. At least, multiple persons other than him said his temperature was taken three times in Liberia and at transfer to a US bound aircraft, and upon landing. Thus he was not infective then. He did not hide his illness; he sought medical treatment...and ran into a wall of prejudice and greed. Black guy with funny accent and no insurance, get him out of here.

Transmission: http://www.cdc.gov/vhf/ebola/transmission/qas.html

"Direct contact means that body fluids (blood, saliva, mucus, vomit, urine, or feces) from an infected person (alive or dead) have touched someone’s eyes, nose, or mouth or an open cut, wound, or abrasion."

The World Health Organization says transmission by sweat has not been reported. Blood, vomit, and feces are the common modes of transmission.

In other words, sitting where someone with Ebola sat and sweated on a seat will not involve direct contact unless an open wound (including abrasions--any breach of the skin) contacts the sweat.) Usually people sitting on bus or subway seats are wearing clothes. Clothes are an additional barrier. This probably why no sweat-only transmission has been reported even though it is theoretically possible in late-stage disease.

All of which has nothing to do with whether or not Christie was right to imprison that nurse in that tent and say initially that she'd have to stay there 21 days. She wasn't sick. Therefore she wasn't infective *even if* she was incubating it. Even if she had been sick, sticking her in that tent would have been wrong. That's not how to care for sick people--with Ebola or with any other disease.

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[User Picture]From: robby
2014-10-28 03:09 am (UTC)

Re: Let's Review The Facts

We probably shouldn't belabor these details. I was just giving you another set of "facts" that contradict your "facts". We'll see how this plays out, and I do hope for the best.
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From: 6_penny
2014-10-28 03:23 pm (UTC)

Re: Let's Review The Facts

And if she had come down with pneumonia because she was in an unheated tent ... the Ebola hysteria would have hit the stratosphere. I'm glad she has finally gotten home.
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[User Picture]From: e_moon60
2014-10-27 07:36 pm (UTC)

Courage

http://www.latimes.com/world/africa/la-fg-liberia-ebola-survivors-20141027-story.html#page=1

Compare reactions of too many Americans.

IF Americans and Europeans had helped more last January--more money and more personnel--we might not have seen this outbreak grow.
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From: sheff_dogs
2014-10-28 10:54 pm (UTC)
I am wary of an expert in one field commenting on how to handle a problem in an unrelated field. This is in large part due to personal experience, but I have seen that backed up many times. My father was an eminent mathematician, there is a piece of group theory named after him, he was much lauded and asked his opinion on matters totatlly unrelated to mathematics would expound with authority. In his case I do not think his opinions ever caused any damage, but the assumption that his brilliance in one area gave his opinion in other area more validity than that of any other layman was erroneous. I certainly knew more about the biological sciences than him, but my knowledge was not as valid in his terms as his opinion. Now I know that says a lot about the family dynamic that may not be applicable generally, never the less I still believe that valuing the opinions of someone just because they are eminent in one field is a foolish behaviour.
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