Ebola case in Dallas.

kaitie said:

Do we know it's going to discourage workers? Or is this just speculation? As in, has someone surveyed the people who are actually planning to go and said, "If you had to do a quarantine, would it change your mind about going?"

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Dr. John Carlson, a pediatric immunologist at Tulane University, is one of them.
He has spent four weeks working with Ebola patients at a hospital in Freetown, Sierra Leone, and is scheduled to return to New Orleans on Saturday. Health care workers already sacrifice a lot by volunteering their time to help those who most need it; tacking on more time or not being able to venture out in public or go to work might seem like a punishment, discouraging people like him from doing it again.
"If I lose three weeks on my return and don't get to do the work I'm supposed to do," Carlson said, referring to his job at Tulane, "means this wouldn't be workable for me."

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Xelebes said:

IT all depends on what they mean by quarantine. Does it mean staying in your house and having a monitor to check on your condition? The cost is less because the quarantine can be quite comfortable.

Does it mean staying in a tent outside of a hospital wearing paper clothes? Then no, there is no sense.

Voluntary quarantine is what is recommended by the medical community.

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...I turned to Dr. Elke Muhlberger, an Ebola expert long intimate with the virus — through more than 20 years of Ebola research that included two pregnancies....
Dr. Muhlberger is an associate professor of micriobiology at Boston University and director of the Biomolecule Production Core at the National Emerging Infectious Diseases Laboratories (widely referred to as the NEIDL, pronounced “needle”) at Boston University....

Could you please lay out a brief primer on the biology of how Ebola is transmitted?

We know from previous outbreaks, and also from the current outbreak, that Ebola is transmitted by having very close contact to infected patients. So we know that it is transmitted by bodily fluids, which include blood, first of all — because the amount of virus in the blood is very, very high, especially at late stages of infection — but it’s also spread by vomit, by sputum, by feces, by urine and by other bodily fluids.
The reason for that is that at late stages of infection, the Ebola virus affects almost all our organs — it causes a systemic infection. One main organ targeted by Ebola virus is the liver, and that could be one of the reasons that we see these very high concentrations of viral particles in the blood. But I would like to emphasize that that occurs late in infection.
Early infection is the other way around. The primary targets — the first cells that come in contact with Ebola virus and get infected — are cells that are part of our immune system. And these cells most likely spread the virus throughout our body. But there are not so many cells infected at the very beginning of the infection, which might be the reason why Ebola virus patients do not spread virus at the very beginning of infection. And that’s why it’s safe to have contact with these patients, because the viral titers in their blood are so low that we cannot even detect them with methods like PCR, which is one of the methods we use to diagnose Ebola virus.

Is a virus only contagious when it reaches a certain level of “titer” or load?

That’s very difficult to answer because we know that for some viral infections most likely one viral particle is enough to infect somebody. So then the answer would be no. But we also know that some viruses are not really good spreaders, so you do need a certain amount of viruses to transmit this virus to another person.

Is that true for Ebola?

For Ebola virus, it seems to be true, because from experience, we know that this virus is not transmitted early in infection. If the viral titers are very low, if you’re not able to detect free viruses in the blood, then it seems Ebola virus is not transmitted to other people. Which is very good because, theoretically, that makes it really easy to control Ebola virus infection. And the reason why we have such a disaster right now, with almost 10,000 infected in West Africa and more than 4,000 already dead, is not so much the transmissibility of Ebola but rather the lack of infrastructure in these countries....


...Ebola virus does not begin an infection by infecting our upper respiratory tract. The route of infection starts with little lesions in our skin, and then the virus gets in our skin, and then in our blood system, and then in these immune cells I mentioned before, which are the primary target cells. It’s also able to get into our eyes and mucosal membranes, but it does not infect the cells which we need to get infected to have an infection be airborne. Late in the infection, when the Ebola virus patients have very high viral loads, they are really really ill, way too ill to get on a train and sit there.

So you’re saying that when they’re so ill that it could be in the respiratory system, they’re super-ill, not able to go anywhere?

Exactly. The cells in the lung can be infected by Ebola virus but really late in the infection. That’s very important. As far as we know, the infection starts with the immune cells — for those who know a little more about the immune system, it’s dendritic cells and macrophages. Then it goes to lymph nodes. Then very quickly to the liver, and there it goes crazy. The liver is very crucial in Ebola virus infections because it is so heavily affected. Ebola virus also spreads to the spleen, to other organs, and then later in infection it tends to infect the cells that coat the blood vessels, and of course we have these cells in the lung as well....

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...It’s very unfortunate, what happened in Dallas — that’s already the worst-case scenario for the U.S. It already happened to us. First, the patient came into the country without being identified as infected. That could happen again, just because of travel activity. Also, if the outbreak in West Africa is not controlled, more and more people will become infected. This makes it likely that infected patients will get into other countries. So that was the first thing that happened, which most likely is not easy to avoid.

Second — and this is something that could have been avoided — is that the infected person was not quarantined immediately, though we knew he had already gotten sick. He had contact with other persons who were not protected during his illness.


Finally, the nurses, who contracted the virus from the patient and eventually became ill, were not immediately quarantined and could have infected more people. And that is the worst-case scenario we can think of with Ebola virus....

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kaitie said:

I find putting someone in a tent with no bathroom ridiculous. I'm not suggesting that at all. Quarantines can be done in a way that's reasonable and even comfortable for the person in question.

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Chris Christie, an antagonistic noisemaker who happens to be in charge of governing the state of New Jersey, was in Rhode Island on Tuesday, campaigning for the Republican candidate for governor there. Reporters asked him what he thought about potentially getting sued by Kaci Hickox, a nurse Christie forced into mandatory quarantine this week under his Ebola policy.

"Whatever, get in line," he said. "I've been sued lots of times before. Get in line." The reporters then went on to ask the governor what he thought of the conditions that Hickox was reportedly kept under—which included being forced to wear paper scrubs in an unheated tent—at which Christie looked characteristically indignant, responding, "She had access to the internet and we brought her takeout food."

"She had a tent inside. There's been all kinds of malarkey about this. She was inside the hospital in a climate-controlled area with access to her cell phone, access to the internet, and takeout food from the best restaurants in Newark."

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The governors have gotten a lot of heat from the White House and CDC for trying to impose quarantines on returning health care workers. Why is this so controversial?

The public health people are getting it wrong and framing it disingenuously.


There's certainly a case to be made that quarantine is excessive, that active monitoring would be good enough. But it seems to me to be a pretty open debate on whether quarantine is excessive or appropriate, and it depends on how cautious you want to be. Saying that the science proves incontrovertibly that quarantine is wrong — it's bad communication and it's bad science.

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veinglory said:

Saying it is just about how cautious you would be overlooks how excessive measures affect compliance and how non-compliance affects disease spread.

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Would-be volunteers are worried about losing three additional weeks of work when they return to the United States, about still-evolving isolation rules and about being holed up in an unfamiliar place, aid organizations say.

They also worry about mistreatment generated by the public fear of Ebola, the organizations say.

“We have seen a big deterrence,” said Margaret Aguirre, head of global initiatives for International Medical Corps, which has about 20 Americans working in the outbreak countries. “People are worried. They don’t want to sign up.”

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At International Medical Corps, 18 to 20 of the 110 volunteers who had pledged to go to Africa are now rethinking their plans, said Rabih Torbay, the organization’s senior vice president for international operations.

The organization asks for six weeks of volunteers’ time — two for training and four for deployment. Quarantines raise the prospect of three more weeks away from their regular jobs at hospitals, practices and universities, and from their families.

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Judge Charles C. LaVerdiere said Friday that Hickox must continue daily monitoring and coordinate travel with state officials so monitoring can continue. But the judge said there's no need for further restrictions because she's not infectious.

In his ruling, the judge thanked Hickox for her service in Africa and wrote that "people are acting out of fear and that this fear is not entirely rational."

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dfwtinman said:

Nosense. Beyond being safe, we have to feel safe.
It's not like what takes place over there can impact us here. Er...wait.

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raburrell said:

Aid Groups Beginning to see Fallout from Quarantine Uncertainties

Sad and scary.

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