CNN: 2 Ebola patients returning to U.S.

[visionary]

http://bigstory.ap.org/article/80060d5318a5480f8bd8bef6a2c0bb00/life-goes-nurse-standoff-over-ebola

Judge rejects Ebola quarantine for nurse

 

A Maine judge has given nurse Kaci Hickox the OK to go wherever she pleases, handing state officials a defeat in their bid to isolate her.

 

The nurse who treated Ebola patients in Sierra Leone called it "a good day" and said her "thoughts, prayers and gratitude" remain with those who are still battling Ebola in West Africa.

 

The state sought to impose restrictions until Hickox's 21-day incubation period for Ebola ends on Nov. 10.

 

The judge is requiring only daily monitoring and said she's not a threat to the public. In his ruling, the judge wrote that "people are acting out of fear and that this fear is not entirely rational."

 

Maine Gov. Paul LePage said it's "unfortunate" that restrictions were eased, but he said the state will follow the law.

[ABQCOWBOY]

Worms are out of the can now.

[PeterMP]

Maine Gov. Paul LePage said venturing away from her house jeopardizes Hickox's safety.

"The reason there's a police car there when she does that is to protect her, more than anybody. 'Cause the last thing I want is for her to get hurt," he said. "But at the same token, her behavior is really riling a lot of people up, and I can only do what I can do. And we're trying to protect her, but she's not acting as smart as she probably should."

http://www.cnn.com/2014/10/31/health/us-ebola/index.html?hpt=hp_t2

Right and your behavior as governor didn't have any thing to do with the current situation.

[twa]

the judge offered her some words of wisdom as well....respect peoples fear

[Special K]

the judge offered her some words of wisdom as well....respect peoples fear

She has respected peoples' fear:  she left her home to go for a bike ride with her boyfriend.  A bike ride that was not even into an area of public gathering.  She hasn't been roaming around at the mall or jumping onto airplanes and vomiting on people.  The problem is that peoples' fear is largely irrational and you cannot let your life be dictated by others' irrationality.    

 

The direct active monitoring she is now complying with is the CDC-recommended level of monitoring for her risk category.  This is what should have been done in the first place, but politicians overreacted and went into full-moron mode when demanding a strict quarantine.  This whole situation didn't need to happen this way, this didn't need to be a story.  Political overreaction made this a story.  I'm glad to see the judge make his ruling based on evidence, sensibility and recommended protocol. 

[visionary]

http://www.nytimes.com/2014/11/01/us/better-staffing-seen-as-crucial-to-ebola-treatment-in-africa.html?partner=rss&emc=rss&smid=tw-nytimesworld&_r=0

Better Staffing Seen as Crucial to Ebola Treatment in Africa

 

Dr. Rick Sacra, a missionary who contracted Ebola in Liberia this August, was first treated there. Each nurse on the ward cared for 15 or 20 patients, and none could work for more than an hour at a time because the protective gear was so suffocatingly hot. They never drew his blood for lab tests. There was no lab.

 

“A nurse makes rounds maybe once every eight hours,” Dr. Sacra said. A doctor came by once a day. “The staff is so few.”

 

After he was evacuated to Nebraska Medical Center, a nurse stayed in his room all the time, and dozens of people were involved in his care. He had daily blood tests to monitor his electrolytes, blood count, liver and kidneys, and doctors used the results to adjust what went into his intravenous lines.

 

The stark difference in the care available in West Africa and the United States is reflected in the outcomes, as well. In West Africa, 70 percent of people with Ebola are dying, while seven of the first eight Ebola patients treated in the United States have walked out of the hospital in good health. Only one died: Thomas Eric Duncan, a Liberian, whose treatment was delayed when a Dallas hospital initially misdiagnosed his illness.

 

The survival gap can and should be narrowed, experts say, and they agreed that the single most important missing element is enough trained health workers to provide the kind of meticulous intensive care that saved Dr. Sacra and the others treated here. West Africa is starved of doctors, nurses, hospitals and equipment, so more outside help is urgently needed, they said.

 

“There is no reason we can’t turn this around,” said Dr. Paul Farmer, a Harvard professor and co-founder of the aid group Partners in Health, which is setting up treatment centers in Liberia and Sierra Leone for 500 patients each. “You need the four S’s,” he said. “Staff, stuff, space, systems.”

[twa]

you don't think a traveler from the infected area and with close contact with ebola that presents a high fever should be detained and checked?

I think things were confrontational from the start....on both sides

[Special K]

you don't think a traveler from the infected area and with close contact with ebola that presents a high fever should be detained and checked?

I think things were confrontational from the start....on both sides

She was checked.  She tested negative for Ebola.  Twice.

 

I think the monitoring guidelines developed and disseminated by the CDC to health officials, hospitals and state authorities should be followed instead of politicians who have no experience in infectious disease control and surveillance making up their own policies.

 

I would have been pissed too had I been treated like that.

[sacase]

All I got to say is if she ends up getting it....whew.....not going to be pretty. I hope from everyone's sake that she doesn't have it/get it but she burned a lot of bridges over this. 

[Special K]

All I got to say is if she ends up getting it....whew.....not going to be pretty. I hope from everyone's sake that she doesn't have it/get it but she burned a lot of bridges over this. 

I agree, I truly hope this disease doesn't manifest.  I suspect she's going to be fine, but will obviously breathe easier when she's asymptomatic on Nov. 10.

 

However, I have a big problem with how she has been essentially villainized by the media.

[PeterMP]

All I got to say is if she ends up getting it....whew.....not going to be pretty. I hope from everyone's sake that she doesn't have it/get it but she burned a lot of bridges over this. 

 

Why does it matter if she gets sick or not?

 

Her point has nothing to do with the chances of her having the disease.

 

She isn't arguing that she doesn't have to be quarantined because she can't/won't get sick.

[Bonez3]

Her apparent nonchalance attitude doesn't seem to take into account what is going into even treating one patient right now. It's one thing that in Africa there is 1 nurse for every 20 patients. Here, we are establishing triage centers for EVD patients.

I think she should respect the current status of this countries preparedness. I totally understand how self monitoring is appropriate under ideal circumstances. But when we are still formulating protocol on a case by case basis, I think cooperation might not be a bad idea.

Oh yea, all this while an infected nurse flies to Cleveland to bridal plan. An infected doctor goes bowling, via the subway. An our first triage in community center misdiagnosed than had 2 co-infections on 1 patient.

When Spencer got admitted in NY authorities essentially sent out an SOS for Zmapp.

Hospitals are just now on boarding staff on appropriate PPE, which has changed in less than a month. And that equipment process is COMPLEX. And a process almost never undertaken by any staff member for any case EVER.

I get that self monitoring is safe, in a vacuum. I also get that it obviously can fail. Couple that with untrained healthcare system. Well, stunting the potential for disease here probably prudent for the next couple months or so.

And, guys and girls, correct me if I'm wrong but about 200 volunteers in 10 months. Please put to rest that notion it will prevent people trying to help. I agre it may, if anyone was helping in first place.

New England Jiurnal editorial disparaging quarantine did say it would be 100% effective, but overkill. Well, right now, 100% is what we need, and it's not overkill.

Keep in mind, these were health care workers. What about general population, children, uninformed, careless. Flight bans is my bigger priority. I doubt the general population would be as diligent monitoring, and we already know they would lie.

I wouldn't say anyone 'Villanized' Hickox. IMO, she is not respecting the bigger picture by breaking what government has asked and is acting selfishly. However, by all accounts Spencer and Duncan lied, that is beyond dangerous and is evidence for what we can expect in human flaw.

[twa]

her point glosses over the point it becomes infectious(which is not as clearly delineated as some suggest)

 

the notion they should freely move about with just temp monitoring is rather risky.

 

the continued suggestion politicians just pulled quarantine rules out of thin air is ignoring much as well.

 

add

 

Canada to stop issuing visas from infected countries

[PCS]

 

Maine Gov. Paul LePage said venturing away from her house jeopardizes Hickox's safety.

"The reason there's a police car there when she does that is to protect her, more than anybody. 'Cause the last thing I want is for her to get hurt," he said. "But at the same token, her behavior is really riling a lot of people up, and I can only do what I can do. And we're trying to protect her, but she's not acting as smart as she probably should."

http://www.cnn.com/2014/10/31/health/us-ebola/index.html?hpt=hp_t2

Right and your behavior as governor didn't have any thing to do with the current situation.

 

Apparently he had more to say about her later yesterday. 

 

http://bigstory.ap.org/article/80060d5318a5480f8bd8bef6a2c0bb00/life-goes-nurse-standoff-over-ebola

 

 

 

Later in the day, the governor lashed out at Hickox, saying: "She has violated every promise she has made so far, so I can't trust her. I don't trust her. And I don't trust that we know enough about this disease to be so callous."

 

Way to hold it together Governor. 

 

 

Oh and. 

 

 

 

After the ruling, a state police cruiser that had been posted outside Hickox's home left, and she and her boyfriend stepped outside to thank the judge.

 

 

 

 

 

 

 

 

 

[Bonez3]

If she indeed 'promised' certain behaviors than the Governor should be upset.

I mean, what's the worse that can happen? Well, she does have indolent disease, has trauma event on bike, now has to expose extensive first responders and trauma teams to direct blood at even low viral loads which likely increases transmission. And start another round of exposure monitoring for health care providers.

We're not talking about Influenza, HIV or the amount of People who had sex with Kim Kardeshian.

Why us it so hard to recognize the potential of this disease and follow conservative recs for time being.

Whatever... Go base jumping today.

[Duckus]

I sort of love that this is happening with LePage. Man is straight up insane. 

 

http://www.politico.com/magazine/story/2014/01/paul-lepage-maine-governor-crazy-101923.html#.VFUAq4vF_sc

[Special K]

Her apparent nonchalance attitude doesn't seem to take into account what is going into even treating one patient right now. It's one thing that in Africa there is 1 nurse for every 20 patients. Here, we are establishing triage centers for EVD patients.

Hospitals are just now on boarding staff on appropriate PPE, which has changed in less than a month. And that equipment process is COMPLEX. And a process almost never undertaken by any staff member for any case EVER.

I get that self monitoring is safe, in a vacuum. I also get that it obviously can fail. Couple that with untrained healthcare system. Well, stunting the potential for disease here probably prudent for the next couple months or so.

New England Jiurnal editorial disparaging quarantine did say it would be 100% effective, but overkill. Well, right now, 100% is what we need, and it's not overkill.

I wouldn't say anyone 'Villanized' Hickox. IMO, she is not respecting the bigger picture by breaking what government has asked and is acting selfishly. However, by all accounts Spencer and Duncan lied, that is beyond dangerous and is evidence for what we can expect in human flaw.

Say what?  She's been slammed in the media.  She's been slammed by her own state's governor.  She's been called "irresponsible," "selfish," and a plethora of other names not only by the media, but by people in this very thread.

 

As for following the "government's rules," she WAS following the CDC-recommended guidelines for monitoring and surveillance based on her risk category.  She said, and correctly so IMO, that the state's rules were overkill and unnecessary.  Fortunately a judge agreed with her and found no evidence backing up the supposed "necessity" of the stricter enforcement.

 

To your point regarding the effectiveness of various monitoring, surveillance and quarantining tactics, sure, there are many, many things that would be "100% effective" on the monitoring spectrum.  However, the real question is whether or not they are reasonable measures based on scientific evidence, or measures based on fear.

 

Since August, hundreds of people have successfully participated in the self-monitoring process (e.g. all the medical professionals and ancillary staff involved in the treatment of the multiple American Ebola victims who've been brought back to the US for treatment or Ebola victims who became infected while providing treatment for Thomas Duncan).  Currently, hundreds of additional individuals the public isn't even aware of are involved in one of the 3 CDC-recommended levels of monitoring that state and local health officials have decided upon based on the CDC's risk assessment guidelines.  For example, as of yesterday there are 47 individuals in California who are under one of the 3 CDC-recommended monitoring protocols.  This monitoring has been enacted and enforced by health officials in each individual's local health jurisdiction with further oversight provided by California Department of Public Health.  Their names have not been, and will not be, released to the media due to HIPAA laws.  However, that's just an example of the number of people being monitored in California, where we have yet to even experience an active case of Ebola.  Many of these cases fall into the same risk category as Hickox, they just are not publicized by CNN and argued about on online discussion forums...  Anyway, that's just an example from California.

 

The bottom line is that the CDC protocol for risk assessment and monitoring has worked for probably  500+ individuals by now.  However, this success has been ignored by the press and overshadowed by the sensationalized stories about a doctor bowling in NYC and a nurse biking in Maine because those are the stories the public wants to hear about.

[Bonez3]

Sure... Less than a hundred active surveillance cases ongoing and there should be a comfort level. I'm sure none of them are flying or mountain climbing or bowling. Gosh forbid we didn't let them return to some form of normalcy.

It's all good, it's allowing for propagation potential on mainland US.

We're saying a hundred or so individuals. I just hope they're all upstanding, non-cavalier type. As per my numbers, active volunteer infection rate is 1-100. Soooooo anyway.

Anyhow, I'll stand by the statement it's hardly the volunteers in worried about. Its the gen pop on open airways. But, it seems inevitable that that next couple cases are 'just a matter of when'. Hopefully the won't be returning to normalcy in endangering nature.

[Special K]

Sure... Less than a hundred active surveillance cases ongoing and there should be a comfort level. I'm sure none of them are flying or mountain climbing or bowling. Gosh forbid we didn't let them return to some form of normalcy.

It's all good, it's allowing for propagation potential on mainland US.

We're saying a hundred or so individuals. I just hope they're all upstanding, non-cavalier type. As per my numbers, active volunteer infection rate is 1-100. Soooooo anyway.

Anyhow, I'll stand by the statement it's hardly the volunteers in worried about. Its the gen pop on open airways. But, it seems inevitable that that next couple cases are 'just a matter of when'. Hopefully the won't be returning to normalcy in endangering nature.

Less than 100 currently, in California.  I am not privy to the numbers nationwide.  Over the last 3+ months I'm sure the number is much higher. 

 

I don't know how much you know about the details of the CDC's monitoring protocol and risk assessment guidelines, but these guidelines don't give those being monitored carte blanche on doing whatever the heck they want.  It is unfortunate these guidelines were released right after Dr. Spencer returned to the US, became symptomatic and tested positive for Ebola.  I agree with you that Dr. Spencer's actions, particularly his lying to health authorities was extremely irresponsible and unethical as a physician.  Although though the public exposure risk was extremely minimal, I think he should be legally punished for lying to authorities.  Hopefully appropriate implementation of CDC guidelines will occur as we move forward.  They hardly "allow for propagation potential on mainland US." 

[Bonez3]

I get it K, monitoring is reasonable... If reasonable people are trusted with it. There's too much at risk to simply say Spencer's actions were irresponsible. Regardless of transmission risk, and I know it's likely low.

My ultimate stance is to allow self monitoring. Right now, given the reported low figure of those that would require 'quarantine', the need to become more EVD ready and the underwhelming volunteering anyway I support stricter measures.

But, please know, I'm full support of travel ban. Our worst case was that of an individual that lied to Liberian government and than was misdiagnosed here. That's the real pandora a box IMO.

And if we're only 'hopeful' that CDC guidelines will be followed, than yes, propagation potential does exist.

[Special K]

I'm always curious about people who support a complete travel ban.  It just seems like as soon as the word "Ebola" enters the picture, people quickly jump to these extreme solutions that really have no evidence to support their necessity; knee-jerk solutions that serve more to make people feel better than to actually reduce risk.  What is wrong with the current plan of routing passengers through the 5 east coast airports for enhanced screening?

[Bonez3]

98% already go through those airports anyway, no? What's the difference?

But anyway, because they'll either lie (Duncan), be uninformed (there are some strange beliefs by many native Africans regarding illness) or the simply missed diagnosed (slipped through the crack).

Why is a travel ban a bad idea right now, especially entering flu season in Western Hemisphere in another month or two.

[Special K]

As has been mentioned numerous times by multiple people and even in the New England Journal of Medicine that you referenced, a travel ban serves only to complicate efforts to fight Ebola at the source.

 

Ebola is spreading exponentially in West Africa and if we don't throw all our resources behind stemming the outbreak, it's only a matter of time before cases start popping up in Kenya or South Africa, countries that are significantly more connected with international travel and trade.  At that point we're in major trouble and all the travel bans in the world are going to be hard pressed to stop a pandemic.

 

The WHO states that tens of thousands of additional volunteers are needed to effectively stop this outbreak at its source.  You claim there are only a couple hundred American volunteers at this point.  However, you are failing to account for the active recruiting that is currently being conducted on a wide scale by a ton of NGOs in collaboration with USAID and the CDC.  The more complicated we make it for health care workers to come and go, and the more we decide to automatically treat them as infected patients upon their return (even though years of scientific research and field experience has shown asymptomatic individuals are not contagious) the less likely it is NGOs and other organizations are going to be successful in their recruitment.  You may not believe it, but travel bans and rigid quarantine rules that are not based on any scientific evidence whatsoever act as a disincentive to those who might otherwise volunteer.  Heck, after seeing how Kaci Hickox has been trashed in the media, who'd want to subject themselves to that?  

 

Maybe if I saw some legitimate evidence that proved an all out travel ban of flights, or of people with certain passports or VISAs would decrease risk to Americans, I'd support that idea.  However, at this point I can only view it as a short-sighted and ill-advised idea with the only purpose being that it would make the general public feel more secure while in actuality only making the situation worse.

[PeterMP]

The idea that the fact that we don't have enough people in Africa fighting Ebola makes it reasonable to put restrictions on the people that do go seems like an odd argument.

 

We need more to go so let's make it harder to go?

 

That's like saying, we need more jobs, but let's make it harder for companies to hire new people or make it harder for companies to grow.

 

Who is buying that argument?

 

The other thing there is man power required to defeat it where it is, which is one thing, and then there is man power from keeping it spreading too much.

 

It has been cleared from Nigeria and Senegal after some initial infections.  That's good and western health care professionals have been involved in those processes.

 

Forcing fewer Americans there for fewer times makes it more likely it will spread to these neighboring countries again.

 

(Mali has had its first case in Oct. and right now people are working hard to contain it.  It easier to contain an initial out break, like that in Mali, then clear out of Liberia completely.  Smallish numbers can make a big difference in clearing new infections in new areas, which is something we absolutely want to do.  Right now, every hand on the ground in Mali in terms of tracking down people that are connected to the existing cases is huge and treating those that have it.  A few well trained and dedicated people on the ground in Mali can make a huge difference in Mali over the next few weeks.)

 

A travel ban is a bad idea because it will force people that want to come here illegally making them harder to track and less likely to report if they show symptoms.

 

It will also retard support to the general area- not just the Ebola area and not just with respect to Ebola, which will make it less likely it will even be contained and more likely it will end up in other countries, which means longer term more likely to become an issue in the US.

 

Even though Duncan was out of walking around for days with an Ebola induced fever and was vomitting and Pham flew on an air plane and Spencer did all of the things he did, we still have ZERO people that have gotten Ebola that weren't carrying for a late term Ebola patient.

 

And the same case is true for Spain.

[Bonez3]

This 'scientific evidence' is not necessarily abundant in either end. And the NEJM I quoted described a large quarantine maneuver at the first outbreak.

Listen, I asked for the number of volunteers because I couldn't find it readily available. I believe Peter stated a total of about 200. I won't listen to the idea that it may discouraged another 'handful' of volunteers.

What is scientifically documented is the overwhelming lack if early recognition and the ongoing understaffed region.

I did read the various organizations are TRYING to mobilize HELP. Well, I'll say it again, it's a world health emergency and we need paid workers.

In the interim, until more stability established here, hold the line. Let me know when the volunteer line is around the corner, I doubt it it will happen. This isn't 9/11 and the patriotic surge is gonna flush out masses of people.

And flight bans and quarantines are scuentifically accepted to reduce spread of communicable disease. Please don't suggest it won't reduce potential risk here, some of the language used makes it sound like we'll have more cases by January if we did that.