As U.S. Ebola Fears Widen, Reports of Possible Cases Grow

[Purveyor]

DALLAS — In Washington, a patient who had traveled to Nigeria and who was suspected of having Ebola was placed in isolation at Howard University Hospital on Thursday. In New Haven, two Yale University graduate students plan to sequester themselves when they return this weekend from Liberia, where they have helped the government develop a system to track the Ebola epidemic.

And at Newark Liberty International Airport on Saturday, a sick man who had just arrived from Brussels was rushed to a hospital amid concerns that he was showing Ebola-like symptoms, a fear later dismissed by the Centers for Disease Control and Prevention.

With fears about Ebola widening across the United States, federal health officials said Saturday that they were receiving an escalating number of reports of possible Ebola infection, particularly after a Liberian man tested positive for the deadly disease in Dallas last week, the first Ebola case diagnosed in this country. Since the disease began spreading rapidly across West Africa this summer, the C.D.C. said, it has assessed more than 100 possible cases, but only the Dallas case has been confirmed.


But increased attention about the virus has jangled nerves around the country, particularly among West African immigrant communities and recent travelers to that region, and placed health care workers on a kind of high alert. “We expect that we will see more rumors, or concerns, or possibilities of cases,” Dr. Thomas R. Frieden, director of the federal C.D.C., said Saturday. “Until there is a positive laboratory test, that is what they are — rumors and concerns.”

In a sign of the seriousness of the virus, the Dallas hospital where the Liberian man, Thomas E. Duncan, has been recovering changed the status of his condition on Saturday from serious to critical.

In the more than 100 inquiries the C.D.C. has received about possible Ebola, about 15 people were actually tested for the virus, officials at the disease centers said. In addition to doing their own testing on suspected cases, federal officials have helped more than a dozen laboratories around the United States do Ebola testing.

more...

http://www.nytimes.com/2014/10/05/us/ebola.html?_r=0

[Purveyor]

1. Locally at this time, this enterovirus 68 is of greater concern. eom

[defacto7]

2. I would agree with that. n/t

[In_The_Wind]

17. Yup

[onyourleft]

41. I certainly...

...agree.

[Warpy]

3. Right now paranoia is at a fever pitch. Ebola will be seen everywhere

and anyone who has visited Africa in the last year and who has gut rumbles will be detained and tested.

I think a lot of people are looking at Mr. Duncan's case and taking note of all the ways Texas in general and Dallas in particular dropped a lot of very important balls, one of which was Gov. Goodhair's ignorant and short sighted refusal to expand Medicaid. That made the hospital look at the bottom line over the very real possibility of turning a horrific disease loose in the city. Then there was the lack of a coordinated plan to disinfect every place Mr. Duncan was, including the ambulance, along with proper protective gear for the EMTs.

All of this is a direct result of Republicans considering anything but their own salaries and the military to be useless frills and anachronisms. They're learning the hard way that strong public health departments are neither.

[LawDeeDah]

4. I also hear that no one is turned away from ER for lack of $/insurance. What to believe....

[Warpy]

5. Treat 'em and street 'em

They gave him antibiotics that weren't going to do a damned thing and turned him loose.

The point is that they didn't admit him like they should have.

[cwydro]

6. Antibiotics for a viral flu -

Gah!

But hey, we got the world's best health care, doncha know?

[pnwmom]

7. Better that than sending any more Ebola patients home with antibiotics. nt

[cwydro]

10. Ditto. nt

[Warren DeMontague]

9. I'd rather have people be paranoid, than hospitals sending people like Mr. Duncan home from the ER.

I think when you're dealing with a virus that is 70-90% lethal, and a government which apparently under no circumstances will do anything beyond have temperature checks and a form in the departing airport as screening for people from ground zero of this deadly epidemic to fly into our country, a little paranoia is not necessarily a bad thing.

[Warpy]

11. Oh, I sincerely hope a lot of people are paying very close attention to this one

The multiple ways Texas in general and Dallas in particular have dropped so many balls over Mr. Duncan's case should be studied very closely.

I sincerely hope paranoia over this convinces people to vote against any oaf who calls himself a fiscal conservative.

[Warren DeMontague]

12. You certainly don't get a "first world health care system"

at 3rd world prices.

[kestrel91316]

33. The most significant ball they are currently dropping is that

contact who is a "panhandler", who they naively trusted to report in daily for 21 days, who now has gone missing.

Awesome! Homeless dude gets Ebola and there is NO WAY to reliably trace HIS contacts.

They should have slapped him in a comfy, guarded hotel room the minute they got their hands on him. Now he's potentially the cause of a nightmare scenario.

[jambo101]

8. Panic and hysteria

Seems for some reason the rightwing media is blowing this ebola issue totally out of proportion. with a mere 4 people in the USA with the condition all of whom have been quarantined in hospitals and as yet no one has contracted the virus in the USA or died from it its all a media generated tempest in a teapot. considering all the ways many thousands of Americans will die today why the need to foment such hysteria over such a non issue like ebola?.
If people really want something to be worried about=
http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals

[Warren DeMontague]

13. The infection rates are growing exponentially, and it is 70-90% lethal.

Is it "Ohmygodtheworldisgonnaend"? No. Is it something we absolutely should take seriously? Yes.

And it's not a "right wing/left wing" issue.

[jambo101]

14. We are taking it seriously.

As for right or left? certainly seems IMO the right wing media is the one generating much unnecessary gloom and doom hysteria.
If you listened to Rush on Friday his whole show was about it and before that Dennis Millers show was all about it. Some reading on the issue.
http://politicalconundrum.lefora.com/topic/19415950/No-Seriously-How-Contagious-Is-Ebola-NPR

[Warren DeMontague]

15. And Alan Grayson has been saying for months we need to stop letting travelers in from those 3

countries.

As for "we are taking it seriously". Right, give me a break. After months of bland assurances that "we're ready for it if it comes here", it came here, and guess what? We weren't ready for it.

"if you listened to Rush this Friday". Yeah, that's exactly what I do with my Fridays, I listen to that bloated sack of wheezy, pompous shit.

[jambo101]

16. Totally agree with your assessment of Rush.

However if you want to be fully informed on both sides of a story you have to listen to both sides.
Its been a while since those two volunteers returned with ebola, its also been a while since the guy came over with ebola, to date no one in America has contracted the disease or died from it, i'd say we are taking it seriously enough that it isnt a danger..
Have a look at the conditions this disease is flourishing in.
Couple with the general populations lack of education on the issue and you have a recipe for disaster although its only about 4000 deaths so far.
https://www.google.ca/search?q=Slums+of+monrovia&safe=active&biw=768&bih=484&source=lnms&tbm=isch&sa=X&ei=ah4xVLjVFsOpyATPsYCwCg&ved=0CAcQ_AUoAg#safe=active&tbm=isch&q=Slums+of+Monrovia

[Warren DeMontague]

18. I am pretty well informed on this topic, without having to abuse my brain listening to that turd.

I am not sitting here going "holy fuck we're doomed". We're not doomed. I do believe that our health care system can handle small outbreaks, as they did in Nigeria; although it's worth noting that Patrick Sawyer flying into Lagos managed to infect some 20 odd other people before they brought that under control, and even the Nigerians would admit to some nail-biting moments, because as they saw in Port Harcourt, the more secondary cases and vectors you have to control, the harder it becomes.

Sure, maybe 20 secondary and tertiary cases is not a bad ratio for a single importation- great, unless you or one your family members, your spouse, your kids, happen to be one of those cases.

Its been a while since those two volunteers returned with ebola, its also been a while since the guy came over with ebola, to date no one in America has contracted the disease or died from it, i'd say we are taking it seriously enough that it isnt a danger..

...Um, really? You can't possibly believe the conclusion you come to in that sentence, if you parse out the underlying facts. The "volunteers returned with ebola" under strict medical supervision, in the only plane on Earth designed to handle a level 4 pathogen, I might add. And they spent every second under treatment here in strict isolation, also in a negative pressure enviroment (which you don't happen to find "in every hospital", by the way) ... I mean, if someone else had gotten sick from either of those people, over here, despite all that precaution, I'd say we all were roundly and truly fucked.

But again, you have to understand that a sick person getting on a plane in Monrovia, coming over to Dallas, being sent home from the ER, puking all over the common grounds of the apt. complex and an ambulance only THEN to be put in isolation at a hospital-- is a far different situation than the volunteers being brought back under medical supervision. To wit, a sick person traveling with this thing is not the same ball of wax as a medical evacuation- not even close.

And "the guy came over with ebola" on Sept. 20. He was reportedly exposed on Sept. 16 (and knowingly got on a plane 4 days later, apparently) and got sick on Sept. 24, which is 4 days after that. He went to the hospital on the 25th and was sent home, was home for 2 or 3 more days potentially exposing people, only to be put into isolation on the 28th. So presumably most of the people he could have exposed were between 9/24 and 9/28. Sept 28 was, what, 6 days ago? Duncan didn't show symptoms for 8 days. It is 21 days before medical authorities will declare someone not infected, after exposure. Understand? You can't SAY "no one in America has contracted the disease from it" when the first week of the 3 week period it normally takes to develop the disease, isn't even over from presumably the last exposure.

As for "isn't a danger", that sort of ties into your "only about 4000 deaths". Okay, "only" 4000. A few weeks ago, it was only 2000. A few weeks before, it was only 1000. Which means in a few more weeks we will likely be looking at 8000, then 16000, then 32000, etc. That's what "exponential" means. And as the numbers of cases there grow, the more likely it is that we will be having people- one, two, then five, then ten, etc. coming over here or going elsewhere with the disease. The more people who have it, the more who can spread it. To say it "isn't" a danger now is ludicrous, because the situation is clearly changing day by day, and not only that but getting progressively worse. The odds of additional passengers with ebola getting on airplanes get higher and higher as the thing grows. How can anyone say it "isn't" anything, when you're dealing with that kind of flux? It wasn't terribly likely that we'd get a case in the US in July, some statisticians had the probability at 20% by the end of Sept, and they were right. Do you suppose that probability is going to get lower if, God Forbid, by early next year there are really a million cases in L/SL/G?

And the more people who come over with it, the more opportunity there is for chaos, for additional cases. It IS something we should be concerned about, which is not the same thing as saying it's likely there will be a widespread outbreak of it here. I'd rather have no cases, than a small number or a bunch of little clusters. Those little clusters will wreak havoc, close schools, shut down buildings, etc. too. And probably fuck up some hospitals that are NOT as well prepared as they all are claiming to be.

Lastly, I'll say this- which is what I've said from the get-go on this deal. It is incumbent, OBVIOUSLY, on us and the rest of the world, to assist West Africa in shutting this down over there, and when this is all over, NOT leaving them with these dilapidated health care systems (or lack thereof) ... we have a moral responsibility as well, as we can see, as one which has no small amount of our own self-interest involved.

But that said, it is absurd and even a bit offensive to chastise people for worrying about this or suggesting they shouldn't. It's a dreadful disease, and it kills quickly and brutally. Of course people are going to worry about it.

[Lars39]

19. Thank you for that excellent overview!

[nc4bo]

20. You expressed my feeling so much better and far more intelligently

Than I could ever have done.

Thank-you!

[jambo101]

21. Thats a long one..

I find it hard to believe that one man in a short time was exchanging bodily fluids with up to 20 or more people.
The volunteers returning under strict quarantine would show how serious the US is taking this issue
The guy who got on the plane and came over to the US Has yet to infect any one,by the end of this week we'll see if your concerns of contamination are justified or just hysteria.
Sure more people are going to come down with the virus but thats over there and not over here.
My point being to date there is no outbreak of ebola in the USA,lets wait till at least a couple of people get it before getting all hysterical about it.

What would you do at this point? close all the airports, cease any form of public transportation,lock down America all because they are having a problem over in west Africa.
At the moment there are many healthcare workers combating the problem over there and i'm sure financial aid is being sent over by the boat load.
If you are this concerned over this overblown virus that as yet hasnt killed any one in the USA you must be apoplectic over the thousands of US citizens dying every day from cancer,emphysema, car accidents,shootings and a myriad other things people are actually dying of .

[LisaL]

23. It was very clearly explained that if Duncan infected people,

they might not be showing symptoms yet. Incubation period up to 21 days.
It hasn't been anywhere near that.
Most commonly people start showing symptoms at 8-10 days.
It hasn't even been 10 days.

[jambo101]

37. Well then in 21 days from Sept 28 we'll have more to say on the issue

I'll either admit i was wrong as ebola runs rampant across America or if no cases are transmitted in the USA you can admit you've been caught up in the media hype and hysteria.

[Warren DeMontague]

40. Let's see- straw man, false dichotomy, red herring

... any more logic fails you want to try?

[magical thyme]

25. there are 9 people on the CDC's short list. That includes the ambulance EMTs who picked him up

and the family living with him in close quarters while he sweated into every bed and ended up puking all over.

While I'm not for shutting down travel, we need tighter restrictions and tighter monitoring.

It's not enough to check temperatures leaving Ebola countries. They should check while disembarking as well, and at every point in their travel, as well as checking for other signs and symptoms.

The CDC criteria needs to be reviewed. Duncan did not meet the 3 criteria because his intake form showed his temperature as 100.1 -- significantly lower than the 101.5F -- their criteria states.
The temperature threshold should be lowered to 100, and instead of fever + 1 other symptom, it should be any 2 of the symptoms listed.

[JimDandy]

30. I agree the fever threshhold definitely should be lowered.

Mr Duncan and most other individuals with cases of Ebola here in the US will probably be taking Ibuprofen for the headaches and pains that are one of the first symptoms of this disease.

We grow up having pain/headache medication like that on hand at all times at home and will be reaching for it at the earliest sign of observable symptoms of the disease, when it can and obviously does mask as some less important malady (But antibiotics Presby Hospital? Really?)

Medication like that reduces the 101.5 fevers airports and hospitals are counting on to reveal the disease in their facilities and isolate such cases from the rest of the public.

If the 101.5 temp is the revelatory norm for Ebola in a country where people don't have Ibuprofen on hand at home, then we should not be comfortable using that as the norm in the US, if we want to catch this disease at an early stage here.

Losing a day or two to identify Ebola cases, due to not having the magic 101.5 fever, may put us behind countries like Liberia as far as the advantage of time. Liberia is losing the Ebola battle due to not having the facilities/equipment/supplies/personnel to handle it. The U.S. does not have those problems, but if the loss of 1-2 days to identify cases in the US is equal to that loss of facilities etc, then we may get no better results (without Zmapp or some other drug) than Liberia is getting.

Mr Duncan's case may prove this if he does not survive.

[magical thyme]

31. the course of the disease remains the same, so while 3-4 days of nontreatment

(he had symptoms for a day or two before going to the ER) put him into a more weakened state than if he'd been admitted immediately, we still able to provide support that they can't provide in Liberia. They would not be able to provide ventilator support, which will help him to rest and oxygenate his organs to help them clear clots. I don't know that they are able to provide full parentarel support. If his kidneys fail, we can provide dialysis. And so on.

[JimDandy]

32. If Mr Duncan dies, we will need

one case of someone admitted in the 100 degree fever stage to see if non-weakened state vs weakened state is the difference in survival, all else being the same (organ-failure-by-organ-failure treatment/ventilation etc at same stages as Mr. Duncan received)

My thinking for pushing for the lowered fever threshhold is that we can't sustain an "organ-failure-by-organ-failure treatment" with the number of cases that will occur unless we catch cases early enough to keep the total case numbers low. We won't have the resources to do that even here in the US.

I would add to your two suggested CDC guideline changes that the 2-21 days for symptoms to appear be broken down between observable symptoms and those that can only be detected by blood tests. It would help infected individuals and others to know that the 2 days average applies to white cell detection in a blood test versus the 6-10 days out average when the 101.5 fever will present (depending on variables).

[magical thyme]

36. the course of the disease is the same, regardless

The reason I think we need a lower threshold is to get patients into isolation immediately and reduce the risk of transmission to others.

All else remains the same. Whether they are admitted at 100F temp or 101.5F temp, they will end up in the same state sooner or later as far as potential for organ failure. It has to do with the pathogen and how it attacks the innate immune system, triggering a cascading sequence that starts DIC, which leads to random, chaotic clotting, which damages the organs.

All the US patients to date, except for Duncan, have received experimental treatments that appear to have effectively stopped the pathogen in its tracks, which stopped the progression.

Ebola isn't confirmed by testing for white cells. They most likely test for the presence of Ebola antigen.

The 2 to 21 days is for observable symptoms to appear. There isn't a particular time sequence for testing for Ebola antigen, but by the time symptoms are observable, there apparently is sufficient antigen present to test positive. Very early on, there won't be sufficient antigen present generate a positive and there is no point in generating a series of false negatives. By the time you're symptomatic, there is enough to generate positive results.

[distantearlywarning]

28. IMO, Warren's post was reasonable and rational

Not even close to "hysteria".

[Warren DeMontague]

38. Of course the concerns are justified. I hope he didn't infect anyone else- he may well have not.

But it would be idiotic not to be "concerned" about it.

And I'll say this, although again, my post was rational, not "hysterical"-- the reason this outbreak IS so bad, is because people didn't take it seriously enough, early on. Had the authorities- both local and international- gotten more "hysterical" back in April, we wouldn't have this problem at all.

[LisaL]

22. Add to that, official numbers coming out of Africa likely are vastly lower than

the actual numbers. A lot of people don't go to the hospital and they are not even counted among the cases.

[Barack_America]

27. That's pretty much in line with my opinion on Grayson.

Though I hadn't realized he was such a champion of human rights.

[Warren DeMontague]

39. "human rights" = not restricting travel from an area with a deadly outbreak?

Does this mean that the other countries in Africa that have already closed their borders, like South Africa, are guilty of egregious human rights violations?

[magical thyme]

26. Rush Limbaugh versus left wing sources? How about simply reading the medical information? nt

[suffragette]

29. Rush and Dennis Miller? Those are not sources most of DU would consider credible.

[kestrel91316]

35. You listen to Rushbo. That tells me all I need to know about you.

[jambo101]

43. I got the time

Tell me what listening to Rush tells you about me..

[magical thyme]

24. there have been 5 people quarantined, 4 of them diagnosed prior to entry and treated at facilities

designed specifically for biohazard level 4 facilities by staff that have trained for a dozen years for these types of cases, and treated with experimental drugs in short (or zero) supply plus plasma transfusions from survivors. There is a 4th, unnamed patient that was brought in a week or two ago, believed to be the WHO doctor that contracted it. There haven't been any announcements concerning his or her condition.

This is the 1st who arrived asymptomatic, diagnosed and being treated at an ordinary hospital by staff who have never seen the disease before, as oppsed to diagnosed by staff immersed in it and treated at hospitals and by staff prepared and trained for it.

World of difference. The clusterfuck that has ensued kind of proves that point.

[kestrel91316]

34. Tell West Africa or the families of the dead that it's a "non-issue"

and then get back to us.

People who don't comprehend epidemiology need to refrain from pontificating about it.

[Wella]

42. Is it true that bleach kills Ebola?

There's so much misinformation out there, it's hard to tell.

[jambo101]

44. We arent talking about unfortunate victims in west Africa.

The topic is about fears about Ebola in the USA.