US advises against Ebola isolation

[JDGRUEN]

I believe the U.S. military is handling it in the right way, contrary to some of the politicians and government folks in the U.S.

From what I saw on the network news last night, U.S. soldiers returning from Ebola areas of West Africa are being sent to 21-day quarantine locations (the news mentioned one group being sent to/housed in Italy) before being returned home to the general population in the U.S.

That's the sensible, public health-protecting kind of approach that certainly ought to be employed with returning front-line medical personnel who are likely to have had far greater and more direct exposure to Ebola than the U.S. troops performing construction and logistical support duties.

Yes Tallguy... isn't it amazing how logic has died more frequently than the Ebola patients ... When the naive - governed by a political agenda make national policy decisions we are in for chaos and tragedy ...

[TallGuyJohninBKK]

There was a pretty sorry, sad episode on this subject that involved the White House Press Secretary being pressed by reporters the other day to explain why the U.S. military is/was following the 21-day quarantine approach, but the Administration was opposing that policy elsewhere, including for returning medical aid workers.

And as best as I recall, the WH Press secretary's comments included that they didn't want the quarantine issue to serve as a potential deterrent to getting medical workers to go to West Africa (although if I was one of them, I absolutely WOULD NOT WANT return to the general population until I was sure I wasn't carrying the disease. Do actual doctors and nurses think otherwise, that they're somehow immune to coming down with the disease? (I think not, certainly by now). And then, my favorite, the Press Secretary commenting that soldiers are required to follow orders and do as they're told, whereas doctors, nurses and civilians aren't!!! Makes perfect sense to me!!! (while entirely missing the underlying point of the military having a REASON for enforcing the quarantine, and not just doing it for the fun of things).

[thailiketoo]

I believe the U.S. military is handling it in the right way, contrary to some of the politicians and government folks in the U.S.

From what I saw on the network news last night, U.S. soldiers returning from Ebola areas of West Africa are being sent to 21-day quarantine locations (the news mentioned one group being sent to/housed in Italy) before being returned home to the general population in the U.S.

That's the sensible, public health-protecting kind of approach that certainly ought to be employed with returning front-line medical personnel who are likely to have had far greater and more direct exposure to Ebola than the U.S. troops performing construction and logistical support duties.

Yes Tallguy... isn't it amazing how logic has died more frequently than the Ebola patients ... When the naive - governed by a political agenda make national policy decisions we are in for chaos and tragedy ...

I think Obama will get the message loud and clear when the American people tell him in the mid term elections just how they feel.

[attrayant]

I was [a medical worker in West Africa], I absolutely WOULD NOT WANT return to the general population until I was sure I wasn't carrying the disease.

Even if you're not contagious?

[thailiketoo]

I was [a medical worker in West Africa], I absolutely WOULD NOT WANT return to the general population until I was sure I wasn't carrying the disease.

Even if you're not contagious?

If you were the Commander in Chief would you have one rule for quarantining your soldiers and another for your citizens?

[attrayant]

Do you always answer a question with a question?

[thailiketoo]

Do you always answer a question with a question?

Yes, I'm Irish. But in this situation I was the one asking the question first as you were asking the question of another poster so I was kind of butting in, impolite but not answering a question with another.

[attrayant]

Fine. I'll bite.

Article 1 Section 8 of the US constitution permits the congress to "make rules for the government and regulation of the land and naval forces". I know that not all posters here are American, but among those that are, it's common knowledge that most countries with a well-developed armed forces govern them under a different set of laws than do apply to its citizens. If you're a member of the armed forces and you commit a crime on a military base, you can expect different treatment compared to your civilian counterparts. Depending on the severity of your crime, you might even be court-martialed. I hope you won't be expecting a jury of your peers to be present (a jury trial is a constitutional right for non-military citizens).

If you were the Commander in Chief would you have one rule for quarantining your soldiers and another for your citizens?

The US Congress established the Uniform Code of Military Justice in the 1950s. It may surprise you to learn that Obama was not the Commander in Chief at the time. So what, precisely, would you have Obama do about this? Strike down the UCMJ with an executive order?

And just as an FYI, there are twenty-five posts on the previous page of this thread, and the name "Obama" appears twenty-eight times. TV posters, some of your slips are showing.

Edited November 2, 2014 by attrayant

[thailiketoo]

Fine. I'll bite.

Article 1 Section 8 of the US constitution permits the congress to "make rules for the government and regulation of the land and naval forces". I know that not all posters here are American, but among those that are, it's common knowledge that most countries with a well-developed armed forces govern them under a different set of laws than do apply to its citizens. If you're a member of the armed forces and you commit a crime on a military base, you can expect different treatment compared to your civilian counterparts. Depending on the severity of your crime, you might even be court-martialed. I hope you won't be expecting a jury of your peers to be present (a jury trial is a constitutional right for non-military citizens).

If you were the Commander in Chief would you have one rule for quarantining your soldiers and another for your citizens?

The US Congress established the Uniform Code of Military Justice in the 1950s. It may surprise you to learn that Obama was not the Commander in Chief at the time. So what, precisely, would you have Obama do about this? Strike down the UCMJ with an executive order?

And just as an FYI, there are twenty-five posts on the previous page of this thread, and the name "Obama" appears twenty-eight times. TV posters, some of your slips are showing.

Article II Section 2 of the U.S. Constitution, the Commander in Chief clause, states that "[t]he President shall be Commander in Chief of the Army and Navy of the United States.

Obama is the Commander and Chief of the US armed forces. The buck stops there.

[Ulysses G.]

And just as an FYI, there are twenty-five posts on the previous page of this thread, and the name "Obama" appears twenty-eight times.

I get it that you are trying to provide cover for Obama, but we are talking about quarantines here and the point is to protect American citizens. The UCMJ - which DOES have jury trials - has nothing to do with whether a quarantine will work, or not. He should have the same policies for medical workers as the military.

Edited November 2, 2014 by Ulysses G.

[attrayant]

And just as an FYI, there are twenty-five posts on the previous page of this thread, and the name "Obama" appears twenty-eight times.

I get it that you are trying to provide cover for Obama, but we are talking about quarantines here and the point is to protect American citizens.

Not covering anybody. The question was raised as to why there are two sets of rules. I gave the factually correct answer. Nothing more.

The UCMJ - which DOES have jury trials - has nothing to do with whether a quarantine will work, or not.

Wow you're taking issue with a whole lot of things I didn't say. Can you quote where I said the UCMC does not have any jury trials? And I said nothing about effectiveness of quarantines WRT the UCMJ either.

He should have the same policies for medical workers as the military.

Well he doesn't, and that's his prerogative. The current Ebola US citizen death toll (zero) might have something to do with that. Edited November 2, 2014 by attrayant

[Ulysses G.]

Can you quote where I said the UCMC does not have any jury trials?

You certainly seemed to be implying it strongly.

Depending on the severity of your crime, you might even be court-martialed. I hope you won't be expecting a jury of your peers to be present (a jury trial is a constitutional right for non-military citizens).

[attrayant]

It's those pesky words "depending on" and "might", where I indicate that it's possible you might not get a jury trial.

[Ulysses G.]

It is a long time since I was in the military, but I'm pretty sure that one is guaranteed a jury, unless they choose to opt out and let a judge decide the case. You can do the same thing in civilian courts.

[JDGRUEN]

When it comes to Ebola - a person cannot know if they have Ebola festering in their tissues until at least the minimum average time of incubation of the disease... (and that is just the average minimum - because a few percent take up to 42 days to present symptoms)...

Never the less - a quarantine is a process to allow any and all who may have been exposed to Ebola in this case to develop and show symptoms... which with Ebola when Symptoms show one is contagious at the same time... Without quarantine - isolation of potentially Ebola exposed people and the waiting out of at least 21 days -- there is no way what so ever to know if they are possible Ebola patients or not.

Quarantine is not for people who are showing Ebola symptoms and are in fact sick with Ebola - although putting one in a hospital in isolation for Ebola treatment is a kind of quarantine ... IT IS NOT WHAT QUARANTINE IS ABOUT.

Quarantine for possible Ebola is just that - those who have been exposed or even possibly exposed to active Ebola patients must be quarantined for at least 21 days to make sure that they will not suddenly appear with symptoms which is tantamount to having the disease and are capable of passing it on to another...

Only those who wish to further a political agenda cannot understand these basic facts ... it is not about NOT SHOWING SYMPTOMS ... it is about the possibility of showing symptoms at any given moment - which means you are infected with Ebola and are capable of passing it on...

IT THAT SO DAMNED HARD TO UNDERSTAND ?

[F430murci]

When it comes to Ebola - a person cannot know if they have Ebola festering in their tissues until at least the minimum average time of incubation of the disease... (and that is just the average minimum - because a few percent take up to 42 days to present symptoms)...

Never the less - a quarantine is a process to allow any and all who may have been exposed to Ebola in this case to develop and show symptoms... which with Ebola when Symptoms show one is contagious at the same time... Without quarantine - isolation of potentially Ebola exposed people and the waiting out of at least 21 days -- there is no way what so ever to know if they are possible Ebola patients or not.

Quarantine is not for people who are showing Ebola symptoms and are in fact sick with Ebola - although putting one in a hospital in isolation for Ebola treatment is a kind of quarantine ... IT IS NOT WHAT QUARANTINE IS ABOUT.

Quarantine for possible Ebola is just that - those who have been exposed or even possibly exposed to active Ebola patients must be quarantined for at least 21 days to make sure that they will not suddenly appear with symptoms which is tantamount to having the disease and are capable of passing it on to another...

Only those who wish to further a political agenda cannot understand these basic facts ... it is not about NOT SHOWING SYMPTOMS ... it is about the possibility of showing symptoms at any given moment - which means you are infected with Ebola and are capable of passing it on...

IT THAT SO DAMNED HARD TO UNDERSTAND ?

Are the terms obsessed, paranoid and delusional so hard to understand. So far, your projected outbreak in the US has fallen flat on its face and things are just fine.

Vibrio vulnificus impacts and kills more people swimming in the Florida ocean every year than Enola in the US. Ebola is child's play compared to what happens to one impacted by vibrio vulnificus. Should we stay out of the Ocean?

One could literally go crazy fretting over all the bad things out there that could screw us up. Neither the CDC nor Obama want an outbreak. They are way more knowledgeable and armed with more facts than your amateur Net research can yield. Things seem to be under control.

Relax and enjoy the day. Life is short.

[F430murci]

Ebola, like many other health issues, appears to be a developing country concern and not a concern for countries such as the US or countries with good health care symptoms.

For instance, 80 million cases and 700,000 deaths from Shigellosis annually and Amebiasis infects over 50 million people and killls 50,000 annually. Yet, Amebiasis killed like a 150 in the US in approximately 20 years.

[MJP]

Ebola, like many other health issues, appears to be a developing country concern and not a concern for countries such as the US or countries with good health care symptoms.

For instance, 80 million cases and 700,000 deaths from Shigellosis annually and Amebiasis infects over 50 million people and killls 50,000 annually. Yet, Amebiasis killed like a 150 in the US in approximately 20 years.

MRSA?

[F430murci]

Ebola, like many other health issues, appears to be a developing country concern and not a concern for countries such as the US or countries with good health care symptoms.

For instance, 80 million cases and 700,000 deaths from Shigellosis annually and Amebiasis infects over 50 million people and killls 50,000 annually. Yet, Amebiasis killed like a 150 in the US in approximately 20 years.

MRSA?

Very aware of both hospital acquired and community acquired MRSA. Got it once from a gym and have seen many medical cases. I acknowledged in an earlier thread that MRSA scares me more than Ebola. MRSA and superbugs are a developed country problem stemming from over use of antibiotics. Certain bacteria are everywhere and always present, but can act in an opportunistic manner.

[TallGuyJohninBKK]

I've never made any predictions of what ebola would mean for the U.S., or its likelihood of spreading there, or compared it to any other diseases.

However, given that it's a very deadly disease for those who come down with it and very easily spread with close exposure -- and that for the time being, there's no validated vaccine or real cure -- simple CAUTION and PRUDENCE would seem to suggest taking measures to PREVENT its emergence in the U.S.

If you can protect an entire country in a significant way by imposing a 21 day quarantine/waiting period on a pretty comparatively small group of people (those returning from work in West Africa) and imposing the same restriction on West Africans or those exposed there seeking to travel to the U.S., it would seem folly not to do so.

The problem with the point Attrayant raised above is that by the time someone KNOWS or has reason to know they've come down with Ebola, they're probably already contagious at that point, and potentially exposing everyone they come into close contact with, including their families, paramedics and ambulance workers, subway riders, others. At least in a quarantine/waiting period setting, hopefully, that kind of potential exposure spread is minimized.

Edited November 2, 2014 by TallGuyJohninBKK

[TallGuyJohninBKK]

Meanwhile, just wondering, has anyone else pondered about this question/issue?

The death rate for Ebola in West Africa is pretty high, generally averaging about 70% from what I've read. And certainly, the available medical facilities there are minimal in quality at best.

But in the U.S., look at what's happened thus far (and I hope I'm getting these details correct):

The one West African guy who returned to the U.S. and got pretty sick before going to the hospital DIED.

But, the two original Americans working in West Africa who were diagnosed with the disease and later sent to the U.S. for treatment both survived. And the two Dallas nurses who contracted the disease in Dallas now have both survived and emerged clear of the disease. And from what I've heard, the NY doctor who contracted it seemed to be faring pretty well. WHY?

Is it because some/all??? of those folks treated in the U.S. received some of the experimental treatments? Is it because they had medical intervention at an earlier point in the disease than the one guy who died in the U.S.? And/or a combination of those things along with simply a better quality of supportive care in the U.S. compared to what's happening in West Africa???

[TallGuyJohninBKK]

Amber Vinson, 29, the second of two Texas nurses infected with Ebola virus while caring for the late Thomas Eric Duncan, has been released from Emory University Hospital and declared free of the virus. Her release comes only 13 days after her October 15 diagnosis and transport from Dallas to Atlanta.

Vinson’s release comes on the heels last Friday’s release of Nina Pham, 26, her Texas Health Presbyterian Hospital nursing colleague who was treated at the National Institutes of Health Clinical Center. Like Vinson, Pham was released 13 days after diagnosis.

Bruce Ribner, MD, MPH, Emory’s director of the Serious Communicable Disease Unit, cited two potential reasons for the rapid recovery of the two nurses.

First, because they were wearing personal protective equipment when caring for Mr. Duncan, they likely received a lower number of infectious Ebola virus particles when compared with conditions under which people are infected in West Africa.

Second, Pham and Vinson are two of the youngest people to have been infected with Ebola virus in the developed world, and already began in a much better state of health.

Though then they get into a discussion of the use of the experimental drugs AND the blood plasma from the two originally recovered victims who were returned to the U.S.

Nurse Vinson expressed her gratitude to Dr. Kent Brantly and Mrs. Nancy Writebol for their blood plasma donations to her and other Ebola patients. It is believed that the antibodies that both recovered patients developed to the virus can transfer a passive type of immunity to other patients.

Emory officials did not indicate whether any other experimental treatment was given to Nurse Vinson. But I asked Dr. Ribner how his team goes about selecting the drugs that might be used, such as the Tekmira interfering RNA drug, TKM-Ebola (given to Dr. Rick Sacra at Nebraska), or the Chimerix broad-spectrum antiviral, brincidofovir (given to NBC video journalist, Ashoka Mukpo), now that the ZMapp triple-antibody cocktail used for Brantly and Writebol has been exhausted.

http://www.forbes.com/sites/davidkroll/2014/10/28/academic-medicine-produces-another-ebola-cure-nurse-amber-vinson-leaves-emory/

But, obviously, it’s too early to know if any of these experimental treatments contributed to the recovery of the patients.

“In terms of evaluating efficacy, clearly, we can’t do that in these one-off episodes. We do get a little bit of a feel for safety data because, again, many of these agents have not been used in humans before. So we do get a feel for what kinds of side effects these might have,” said Dr. Ribner.

“But, really, from the extremely small numbers of patients that we have, we have no ability to determine efficacy. We are in collaboration with the National Institutes of Health and with other treating centers around the world in an attempt to try and develop the kinds of protocols which will answer those questions,” said Dr. Ribner.

[TallGuyJohninBKK]

USA Today also posted an article on exactly the question I posed above... why are most Ebola patients in the US surviving thus far...

http://www.usatoday.com/story/news/nation/2014/10/28/care-american-ebola-patients/18061203/

As she was released, Vinson thanked Ebola survivors Kent Brantly and Nancy Writebol for donating blood to help her. Vinson ended up receiving blood only from Brantly, who also donated blood to several other surviving patients. Doctors have been experimenting with blood transfusions in the hope that a survivor's blood will contain antibodies to help other patients fight the virus.

Vinson's fellow nurse, 26-year-old Nina Pham, who also contracted Ebola while treating Duncan, was released from the National Institutes of Health last week. Pham also received blood from Brantly.

American Ebola survivors now include Brantly, a doctor who worked for the aid group Samaritan's Purse; Writebol, who worked as a missionary for SIM USA; physician Richard Sacra, who also worked for SIM USA; cameraman Ashoka Mukpo; an anonymous patient.

In some ways, it's easy to see why Westerners have done so well.

All of the survivors have gotten state-of-the-art care at hospitals with specialized biocontainment units designed to handle the most dangerous infectious diseases.

In West Africa, many patients never make it to the hospital. Hospitals have beds for only one in five Ebola patients in Liberia, according to the WHO. Doctors at Ebola treatment centers in Africa often lack personal protective equipment such as gloves and gowns, or even running water and soap.

At least 450 health care workers have been infected with Ebola in West Africa and 244 have died. Overall, more than 10,000 people have been infected and nearly 5,000 have died, according to the WHO.

Studies of African patients have shown that ones who are in better condition at the time of infection — with better nutrition and overall health — are more likely to survive Ebola. Younger people and those who receive blood transfusions also fare better, said Peter Hotez, dean of the National School of Tropical Medicine in at Baylor College of Medicine in Houston.

Edited November 2, 2014 by TallGuyJohninBKK

[TallGuyJohninBKK]

So thus far, it seems like:

--Brantly and Writebol got the ZMapp triple-antibody cocktail.

--Sacra got the Tekmira interfering RNA drug TKM-Ebola and donated plasma from Brantly

--Mukpo got the Chimerix broad-spectrum antiviral brincidofovir and donated plasma from Brantly

--the NY doctor Spencer received a blood transfusion from Writebol.

--And Pham and Vinson at least got blood plasma from Brantly (not clear if they received other treatments).

Emory treated four of the survivors — Vinson, Brantly, Writebol and the unidentified patient. The Nebraska Medical Center in Omaha treated Sacra and Mukpo.

Both nurses were hospitalized only two weeks. Other Ebola survivors had a much longer course of illness. An anonymous patient treated at Emory, for example, was hospitalized for six weeks.

From the USA Today report:

Pham, Sacra and Mukpo all received donated plasma — the liquid part of the blood that contains antibodies — from Brantly, who himself got a transfusion from a survivor before leaving Africa.

Physician Craig Spencer, who contracted Ebola while working for Doctors Without Borders and is hospitalized in New York, received a blood transfusion from Writebol.

Although Duncan didn't receive a blood donation — the Dallas hospital has said his blood type didn't match — he did receive an experimental drug called brincidofovir a few days before he died. Mukpo received the same drug.

Sacra received an experimental drug called TKM-Ebola.

Brantly and Writebol got an experimental drug called ZMapp.

[F430murci]

Tallguy:

Just speculating here, but it seems treatment is very effective when early detection. Duncan had it for a few days and perhaps long enough to get into organs making recovery more difficult. Brantly and Witenol, however, were really sick at one point based on reports before they arrived state side. I am sure the doctors here are on a steep learning curve and perhaps learned a lot after losing Duncan. Perhaps quality of care between institutions played a role with Duncan.

Blood transfusion may be more important than the experimental drugs. Didn't Brantley and Whitebol get transfusions from survivors before arriving stateside and before making a turn for the better?

Edited November 2, 2014 by F430murci

[TallGuyJohninBKK]

from Brantly, who himself got a transfusion from a survivor before leaving Africa.

In Duncan's case, the disease probably had progressed further than with the other subsequent victims (excluding Brantly and Writebol).

Although Duncan didn't receive a blood donation — the Dallas hospital has said his blood type didn't match — he did receive an experimental drug called brincidofovir a few days before he died.

The survival rate in the U.S. thus far is pretty darned good, considering...

But, transfusions/plasma from recovered patients seems to be playing a prominent role in that.

And given that there's only a limited number of those folks available at this point and they only have so much blood/plasma to give, it would seem to make another compelling argument for keeping the U.S. caseload of victims as small as possible!

Edited November 2, 2014 by TallGuyJohninBKK

[TallGuyJohninBKK]

All of which makes me start wondering/thinking:

If someone was diagnosed with Ebola here in Thailand, would the Thai doctors have access to either a) any of the experimental drugs mentioned above, or b] blood plasma from any of the recovered victims???

My guess is... NOT! At least, not for the time being/now.

[zydeco]

All of which makes me start wondering/thinking:

If someone was diagnosed with Ebola here in Thailand, would the Thai doctors have access to either a) any of the experimental drugs mentioned above, or b] blood plasma from any of the recovered victims???

My guess is... NOT! At least, not for the time being/now.

Yep, probably no chance in Thailand. So, if you're an American, hop in a plane bound for the closest American hospital. Hawaii sounds nice. And plop yourself down in the hospital emergency ward. I'm sure all the anti-quarantine people will have no objection to this plan of action whatsoever.

[TallGuyJohninBKK]

I was thinking about that prospect. And supposedly, my Thai medical insurance does cover medical evacuation when needed.

But I suspect, Thailand being the backwater that it is, if it was even possible to gain approval for such an evacuation with all its attendant risks and complications, I or anyone else here who's just a regular Joe U.S. Citizen (as opposed to a VIP of some sort or a medical worker) probably be goners or beyond recovery by the time any such thing could be arranged.

Maybe I'm wrong about that prospect. But I tend to doubt it, again, at least in the present state of things regarding Ebola and Thailand's place in the world.

And just to be clear -- it's one thing to have a medically controlled evacuation where hopefully all the required precautions and protections are taken. It's an entirely different thing for Ebola exposed people to start getting on commercial flights unprotected and flying from country to country.

Edited November 2, 2014 by TallGuyJohninBKK

[JDGRUEN]

Americans who have survived Ebola have done so mainly by being diagnosed early, being mostly younger adults - otherwise healthy and strong, plus having the best of treatment and drugs, serum available, and all surrounding care, IV fluids of all nature to keep tissues alive.

It is great that they are alive, however at a great cost. For the two American Nurses - THEY SHOULD NEVER HAD TO HAVE BEEN EXPOSED IN THE FIRST PLACE. It was never necessary Mr. Duncan, all other Liberians, people of Sierra Leone and Guinea should have been barred entry into the United States months ago...

And if all the effort and extreme cost was thrown into building a first class hospital or hospital ship in the region the Ebola Aid workers could have been treated there... We spend millions and millions here - exposing people as Dr. Spencer did to treat Ebola Aid workers BUT if America and other countries joined in and built and staffed a real Western style treatment center in the region or as hospital ship - No Ebola would be in America - it would still be in the region and American Aid workers would be treated just as well as in America.

But NO - politics of open borders, no hindrance of immigration - no talk of this having a negative medical connection can be made all because of political correctness and nothing else.

None of it should have ever happened in the USA - period - it was not necessary and could have been prevented.

Americans have a right to be protected by their government - Americans should never be or have been EVEN exposed to Ebola...

But we have what we have and what we have is a total failure for leadership.

Thomas Sowell is a black American who should be President because he is actually intelligent - not just hyped as being intelligent and has an abundance of common sense.