Dallas Ebola (not a Cowboys post)

[BHB2008]

Especially if the survival rate on these existing cases is better than over there in Africa, you'll see as many who can possibly get over here, buying plane tickets to drop themselves off in an EMTALA governed ED near you.

Wow. I don't think you realize how out of touch you sound.

First, Nigeria and Senegal have eradicated the virus in their borders with far fewer resources than we can marshal.

Second, if you think there is a real danger of Liberian patients dropping $3,000USD for a last minute flight to the US, you're just insane. Given the *deplorable* conditions in these countries, anyone with the resources who could escape to US would do so even now. Even without Ebola. It's just not a realistic problem. The US doesn't give out visas like candy, and again, there is the prohibitive price. As someone above noted, it took 7 months for one case to reach us.

You still haven't addressed the legitimate arguments of the experts in this field (which isn't your field, by the way). They sincerely believe that a travel ban would make things worse. So I throw back to you--do you want more Ebola? Naturally I don't think you do. It's alarming that you think anyone who disagrees on this, regardless of their education or expertise, must be blinded by ulterior motives and not care about an epidemic. You're stating that the individuals who have devoted their lives to public health and epidemiology actually want a global pandemic. Do you realize how ridiculous this sounds?

Also, I Don't think practicing doctor should be the gold standard for these types of decisions. There *are* other fields and other experts whose knowledge of public health policy far exceeds a simple MD. What does an MD know about nexus of economics, epidemiology, international law and public health? If anything, she didn't learn it in microbiology.

The Ebola here seems to be burning out. Time will tell.

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[Pons Asinorum]

Wow. I don't think you realize how out of touch you sound.

First, Nigeria and Senegal have eradicated the virus in their borders with far fewer resources than we can marshal.

Second, if you think there is a real danger of Liberian patients dropping $3,000USD for a last minute flight to the US, you're just insane. Given the *deplorable* conditions in these countries, anyone with the resources who could escape to US would do so even now. Even without Ebola. It's just not a realistic problem. The US doesn't give out visas like candy, and again, there is the prohibitive price. As someone above noted, it took 7 months for one case to reach us.

You still haven't addressed the legitimate arguments of the experts in this field (which isn't your field, by the way). They sincerely believe that a travel ban would make things worse. So I throw back to you--do you want more Ebola? Naturally I don't think you do. It's alarming that you think anyone who disagrees on this, regardless of their education or expertise, must be blinded by ulterior motives and not care about an epidemic. You're stating that the individuals who have devoted their lives to public health and epidemiology actually want a global pandemic. Do you realize how ridiculous this sounds?

Also, I Don't think practicing doctor should be the gold standard for these types of decisions. There *are* other fields and other experts whose knowledge of public health policy far exceeds a simple MD. What does an MD know about nexus of economics, epidemiology, international law and public health? If anything, she didn't learn it in microbiology.

The Ebola here seems to be burning out. Time will tell.

And you seem out of touch to the desires expressed elsewhere in this thread. No one is questioning what the public health experts are saying; what I'm saying is that my incentives and desires seem to be much different than theirs. I get when they say that they want to reduce the total burden of this disease. What I want is for another one of these jaggnuts like index case in Dallas from showing up in the ED in which I work unannounced because the only thing keeping him away is scraping up a little coin. If people want to go over there, knock yourself out. Save lives. I applaud the conviction. My feeling however is that until you've passed some kind of firm quarantine-in-place, you just are not traveling into the United States. If there is some secret to how keeping the possibly-infected as far away as possible isn't a good idea, I'm still waiting to hear it, because I haven't yet. Not from the spokesholes, not from the WHO, especially not from our President. Why can we not fight this disease over there? I expect my nation's government to value my life more than the life of a foreign national on their home country's soil. Kind of the whole point of the existence of a national government. I don't get the sense that that is happening, and I'm uncomfortable with the only reason that I can settle upon for that not happening.


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[jl lin]

First of all, the experts in this field are in agreement that it would do more harm than good, so the onus is on you to show studies proving the contrary. Second, it's quite possible that a simple idea--travel ban to keep Ebola out--would come with unintended consequences that could make it more likely that Ebola would actually get in. Consider the danger that Ebola would pose were it to gain a foothold in India, or another more developed nation. The best way to keep it from spreading is to contain it where it is. The experts in the field believe a travel ban would stymie this goal, and considering what a complex question it is, with administrative, legal, logistical, and medical factors, it would be prudent to consider that they know more than you and might, just might, be making a reasonable point rather than sacrificing world health for mere political correctness.

Now that is truly funny. Um, no it certainly is not. Expert or not, substantiate the claim and don't just keep drumming the same old non-scientific guesswork. Your attitude and statement is something that is/and has been used by despots and tyrants.

We don't have to believe unsubstantiated nonsense just b/c someone who is an "expert" or a bonafide expert says so. Especially when they hold the claim for reasons that are far outside of scientific substance. If they want to say it's their opinion, why that's fine and dandy. Is has no substance with scientific or any otherwise substantial rationale. If you want credibility for your OPINION, you had better be able to back it up, expert or not.

Every single time I have seen a expert in either law or medicine or anything else, I have ALWAYS asked for rational support, evidence, and a logical basis for the particular expert's opinion or position. This is only reasonable. Only an autocrat or a person who drinks the KoolAid of an autocrat or someone who is an arrogant egomaniac would be offended by others that ask for support for their positions--even as the other person pays to actually seek their advice. Articulate it and back it up, or just keep walking--and so will I--that is to the next expert. The days of people being OK to be talked down to b/c they must genuflect to someone with MD or PhD behind their names is ending in many areas, thank God. To expert others to follow along with zip for substantial rationale is medieval. Remember those days? Yes, those in power loved it when people couldn't read.

Listen, if a person is truly expert in their field, they should not be afraid to expound upon and support any questions that are genuine.

Oh BTW, you mention Nigeria and Sierra Leone. Yes, well didn't they put in travel restrictions and controls?????? Oh, but it's OK that Nigeria and Sierra Leone and others have placed travel bans--and it has helped to seriously cut down on the spread of the disease.

They "believe" it would fetter the goal? Well, exactly how so? Getting back into our country after once having left is, again, NEVER an absolute. The same mechanisms that help them to return now could still be employed. There is nothing to stop humanitarian, medical, or military aid. ABSOLUTELY NOTHING other than what already is risky business without a travel ban. Arrangements are arrangements. Anyone that was going to help before Ebola in American would be no less stymied to go and return. Why should or would they be?

It is the same if they left a month ago, and it would be so if there were a non-essential ban into America of people from the hot zones with visas.
Let's see; why would medical, humanitarian and military help not be ESSENTIAL people anyway?????

So, this would mean that they in fact are NOT held to the restriction, and I'd go further than that. I'd say that our country would have an absolute responsibility to ensure they get the best medical help at home, if they need it, and their return arrangements would necessitate being expedited and not stymied.

Now, should they also be isolated for the relevant time period upon return? And that is the kind of thing that would make people think twice before going to help--other than the inherent risks of exposure to the disease and the ever-present reality that once you leave your homeland, regardless of any promises, there is never a guarantee to get back in when you want; b/c GUESS WHAT? The USA isn't sovereign OVER ALL LANDS and all untoward situations.

So, if anything, people that have been working in the hot zones and needing to be isolated for the 21 to whatever (I have read of changes in the time-frame of late.) might be in jeopardy with their employer. That's the kind of thing that stops people from helping outside of this country. I mean most people aren't independently wealthy and cannot afford to take a month or more off to be a part of humanitarian or medical aid in other countries. It would be great if they could; but it's not reality for many doctors and nurses and medics and other healthcare personnel. So add to that the possible need for 21-42 day quarantine. Come on. That would be the real story as to why more feet on the ground from America is a problem. Beyond that and in most cases, however, if proper arrangements and priority was given to these folks, they'd get back home. Should they then be quarantined--and if so, how many folks could afford to be away from their jobs for that long???


All the other nonsense about not getting home is constant subterfuge, and it just utterly illogical rhetoric. In the reality of action, it's just lunacy.


I'll be glad to support the so called "expert" opinion when they supply some substantial support. Until then, many of us Americans will continue to call it what it is: lunacy

 

[Birdstrike]

Wow. I don't think you realize how out of touch you sound.

First, Nigeria and Senegal have eradicated the virus in their borders with far fewer resources than we can marshal.

Second, if you think there is a real danger of Liberian patients dropping $3,000USD for a last minute flight to the US, you're just insane. Given the *deplorable* conditions in these countries, anyone with the resources who could escape to US would do so even now. Even without Ebola. It's just not a realistic problem. The US doesn't give out visas like candy, and again, there is the prohibitive price. As someone above noted, it took 7 months for one case to reach us.

You still haven't addressed the legitimate arguments of the experts in this field (which isn't your field, by the way). They sincerely believe that a travel ban would make things worse. So I throw back to you--do you want more Ebola? Naturally I don't think you do. It's alarming that you think anyone who disagrees on this, regardless of their education or expertise, must be blinded by ulterior motives and not care about an epidemic. You're stating that the individuals who have devoted their lives to public health and epidemiology actually want a global pandemic. Do you realize how ridiculous this sounds?

Also, I Don't think practicing doctor should be the gold standard for these types of decisions. There *are* other fields and other experts whose knowledge of public health policy far exceeds a simple MD. What does an MD know about nexus of economics, epidemiology, international law and public health? If anything, she didn't learn it in microbiology.

The Ebola here seems to be burning out. Time will tell.

I think this is med-student trolling at this point. It's been fun though. Peace.

 

[Pons Asinorum]

I think this is med-student trolling at this point. It's been fun though. Peace.

Pre-med. He's applying now. Knows how to critically appraise a CDC press release already though.


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[Boatswain2PA]

Is there ANY evidence that travel restrictions actually work to do anything other than slow the spread by a few weeks? From just a cursory search, the answer is NO. So, is it really political correctness driving the recommendations for no travel ban? Or is it that some people have considered the available evidence?

Considering that physicians should be somewhat used to considering evidence for or against doing something, it is kind of embarrassing to see how quickly that concept is shed in these discussions as if the concept of making decisions based on evidence is only applicable to medical treatments.

While there is no level 1 evidence (kinda hard to do prospective RCTs), the public health/epidemiology folks know very well that open borders and travel spread diseases.

We can look back almost a hundred years ago and track where the Spanish Influenza popped up....areas where tourists traveled to (south coast of Spain), or anywhere where troops came and went.

Travel spreads disease to non-infected populations, whether it is influenza, ebola, tuberculosis, or typhus, etc.

We put barriers between us and our (potentially) infected patients. The greater the likelihood of transmission, OR the greater the severity of infection, the more barriers we put between us.

Gloves, gowns, masks, boots, hats, isolation rooms, isolation wings, separate hospitals, voluntary quarantine, court/govt ordered quarantine....a national quarantine (ie quarantining another nation) is just another layer, and one we should have taken.

Boatswain, MPH (and a bunch of other useless abbreviations)

 

[BHB2008]

Pre-med. He's applying now. Knows how to critically appraise a CDC press release already though.


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Top 5 law grad. No spring chicken. Know enough to know that any MD is not greater than entire body of academic and public health officials.

Appealing to educational authority in this conversation rather than engaging with the argument is a capitulation.

 

[BHB2008]

You're so all over the place, it's difficult to respond. Bordering on Godwining this thread with your "tyrants and despots" line. It's not unsubstantiated nonsense, since it's all theoretical at this point. There is no way to "control" a developing real life situation. Deferring to those with experience and expertise is prudent. At least acknowledging that they may have a point rather than dismissing them as operating in bad faith. Anyway. That's all, bye.

Now that is truly funny. Um, no it certainly is not. Expert or not, substantiate the claim and don't just keep drumming the same old non-scientific guesswork. Your attitude and statement is something that is/and has been used by despots and tyrants.

We don't have to believe unsubstantiated nonsense just b/c someone who is an "expert" or a bonafide expert says so. Especially when they hold the claim for reasons that are far outside of scientific substance. If they want to say it's their opinion, why that's fine and dandy. Is has no substance with scientific or any otherwise substantial rationale. If you want credibility for your OPINION, you had better be able to back it up, expert or not.

Every single time I have seen a expert in either law or medicine or anything else, I have ALWAYS asked for rational support, evidence, and a logical basis for the particular expert's opinion or position. This is only reasonable. Only an autocrat or a person who drinks the KoolAid of an autocrat or someone who is an arrogant egomaniac would be offended by others that ask for support for their positions--even as the other person pays to actually seek their advice. Articulate it and back it up, or just keep walking--and so will I--that is to the next expert. The days of people being OK to be talked down to b/c they must genuflect to someone with MD or PhD behind their names is ending in many areas, thank God. To expert others to follow along with zip for substantial rationale is medieval. Remember those days? Yes, those in power loved it when people couldn't read.

Listen, if a person is truly expert in their field, they should not be afraid to expound upon and support any questions that are genuine.

Oh BTW, you mention Nigeria and Sierra Leone. Yes, well didn't they put in travel restrictions and controls?????? Oh, but it's OK that Nigeria and Sierra Leone and others have placed travel bans--and it has helped to seriously cut down on the spread of the disease.

They "believe" it would fetter the goal? Well, exactly how so? Getting back into our country after once having left is, again, NEVER an absolute. The same mechanisms that help them to return now could still be employed. There is nothing to stop humanitarian, medical, or military aid. ABSOLUTELY NOTHING other than what already is risky business without a travel ban. Arrangements are arrangements. Anyone that was going to help before Ebola in American would be no less stymied to go and return. Why should or would they be?

It is the same if they left a month ago, and it would be so if there were a non-essential ban into America of people from the hot zones with visas.
Let's see; why would medical, humanitarian and military help not be ESSENTIAL people anyway?????

So, this would mean that they in fact are NOT held to the restriction, and I'd go further than that. I'd say that our country would have an absolute responsibility to ensure they get the best medical help at home, if they need it, and their return arrangements would necessitate being expedited and not stymied.

Now, should they also be isolated for the relevant time period upon return? And that is the kind of thing that would make people think twice before going to help--other than the inherent risks of exposure to the disease and the ever-present reality that once you leave your homeland, regardless of any promises, there is never a guarantee to get back in when you want; b/c GUESS WHAT? The USA isn't sovereign OVER ALL LANDS and all untoward situations.

So, if anything, people that have been working in the hot zones and needing to be isolated for the 21 to whatever (I have read of changes in the time-frame of late.) might be in jeopardy with their employer. That's the kind of thing that stops people from helping outside of this country. I mean most people aren't independently wealthy and cannot afford to take a month or more off to be a part of humanitarian or medical aid in other countries. It would be great if they could; but it's not reality for many doctors and nurses and medics and other healthcare personnel. So add to that the possible need for 21-42 day quarantine. Come on. That would be the real story as to why more feet on the ground from America is a problem. Beyond that and in most cases, however, if proper arrangements and priority was given to these folks, they'd get back home. Should they then be quarantined--and if so, how many folks could afford to be away from their jobs for that long???


All the other nonsense about not getting home is constant subterfuge, and it just utterly illogical rhetoric. In the reality of action, it's just lunacy.


I'll be glad to support the so called "expert" opinion when they supply some substantial support. Until then, many of us Americans will continue to call it what it is: lunacy

 

[BHB2008]

And you seem out of touch to the desires expressed elsewhere in this thread. No one is questioning what the public health experts are saying; what I'm saying is that my incentives and desires seem to be much different than theirs. I get when they say that they want to reduce the total burden of this disease. What I want is for another one of these jaggnuts like index case in Dallas from showing up in the ED in which I work unannounced because the only thing keeping him away is scraping up a little coin. If people want to go over there, knock yourself out. Save lives. I applaud the conviction. My feeling however is that until you've passed some kind of firm quarantine-in-place, you just are not traveling into the United States. If there is some secret to how keeping the possibly-infected as far away as possible isn't a good idea, I'm still waiting to hear it, because I haven't yet. Not from the spokesholes, not from the WHO, especially not from our President. Why can we not fight this disease over there? I expect my nation's government to value my life more than the life of a foreign national on their home country's soil. Kind of the whole point of the existence of a national government. I don't get the sense that that is happening, and I'm uncomfortable with the only reason that I can settle upon for that not happening.


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That makes sense. Quarantine shouldn't be too controversial. I expect if there are more cases, this will happen.

 

[Pons Asinorum]

Top 5 law grad. No spring chicken. Know enough to know that any MD is not greater than entire body of academic and public health officials.

Appealing to educational authority in this conversation rather than engaging with the argument is a capitulation.

I capitulate nothing. I find your arguments, which entail regurgitating the comments made by politically appointed bureaucrats, lacking. You haven't stated a single individual thought other than to essentially cut and paste from a Vox piece. I'm not trying to change your mind, but you, nor the originators of your ideas, are changing mine. It's their job to change mine, if what they're saying is truly the best thing. Unfortunately, the vast majority of voters whom elect their bosses agree with me, and now the expert way of doing this has landed two nurses in horrible spot. Soooo....we'll see what happens.

 

[jl lin]

You're so all over the place, it's difficult to respond. Bordering on Godwining this thread with your "tyrants and despots" line. It's not unsubstantiated nonsense, since it's all theoretical at this point. There is no way to "control" a developing real life situation. Deferring to those with experience and expertise is prudent. At least acknowledging that they may have a point rather than dismissing them as operating in bad faith. Anyway. That's all, bye.

No, you just can't follow along, or you choose not to do so. I can't help it if you have a problem with following. Demanding that we listen to experts merely b/c they are expert is no different that making an argument based on appeal to authority.

Now, if you aren't embracing the group-think of despots, please show the sound theory. I mean, it's not even a hypothesis by true definition at this point. Your time would be better served standing and facing the reality--or at least putting forth some research from your beloved experts.

No one should defer to anything without sound substantiation. Where in point of fact and substance is their point? Show it. Develop it with substance. Let it logically speak.

But at this point, I have to implore you to move past your grasp on a hobbling and wobbling and still unsupported perspective from the "experts."
Dear God. And this is science?

 

[Boatswain2PA]

Top 5 law grad. No spring chicken. Know enough to know that any MD is not greater than entire body of academic and public health officials.

Appealing to educational authority in this conversation rather than engaging with the argument is a capitulation.

Your problem is your definition of "experts". In this case, you are relying on the "expert" testimony of our President (a lawyer), our CDC director (a political hack, but at least a physician), other top level government hacks, and the physicians they let appear on TV. And coming soon, another expert who, as Biden's COS gave away a half BILLION of our tax money toward the Obama donors who ran Solyndra....he's gonna be our new Czar.

There are many true experts who are not ideologues and they disagree....but you won't find them on TV.

 

[Boatswain2PA]

Remember, if he is a lawyer, the argument means more to him than the facts/science. They speak a different language.

 

[rajhanda]

Duh.. Logic 101: The best way to keep Ebola out is to let Ebola in!

 

[jl lin]

Duh.. Logic 101: The best way to keep Ebola out is to let Ebola in!

LOL

Yes. I am still waiting for the argument from the "experts" (who often must side politically) that begins with, "Although it may seem counterintuitive, ...blah, blah, blah. . .

 

[BHB2008]

The President, the CDC, WHO all have resources beyond our wildest imaginations in the form of doctors, scientists, data, etc. These orgs are not just a few hacks but many many people, again, with education, expertise, and resources that are bar none.

The following post rounds up some articles demonstrating why a travel restriction is not an evidence based intervention:

Should CDC Director Dr. Tom Frieden step down?

The last link in particular is interesting, as it suggests travel restrictions did not aid efforts to stop spread of H1N1.

I've only seen hysteria based arguments on this thread! And lots of big talk about microbiology and science but no one else actually supplying any.

Anyone have any actual science justifying the travel ban or just the oversimplified argument that not letting it in will keep it from getting in?

 

[Birdstrike]

There are many examples in history, where a single person or a small minority of dissenters was right, while being ridiculed by the so-called experts and the majority. Remember when the world was flat, bleeding with leeches healed the sick and slavery was legal?

 

[Birdstrike]

the chicken littles on this thread

Kind of insulting response.

how out of touch you sound.

Also, kind of disparaging.

Top 5 law grad. No spring chicken. Know enough to know that any MD is not greater than entire body of academic and public health officials.
.

And as a "top 5 law grad" (whatever that means) and still someone who's not a doctor, or a resident, or a medical student in his clinicals, or a medical student at all, you are qualified to know that "any MD" on this board is wrong about medical matters? Medical doctors, some of whom have been practicing physicians for a decade or more, who themselves are experts in Emergency Medicine which includes treating and diagnosis life-threatening infections, some of whom are expert sub-specialists, and some of whom are academic physicians teaching pre-meds, medical students and residents? As a "top 5 law grad" you know enough about Medicine, viruses and infectious disease to know we are wrong about medical matters, not matters of Law?

Hmm...

Are you a malpractice plaintiff's attorney?

Lol

You're so all over the place

Kind of demeaning, again.

I've only seen hysteria based arguments on this thread!

A "top 5 law grad" pre-med, calling a bunch of expert Emergency Physicians, hysterical? Lovely.

If you're a practicing lawyer, and have a different and unique perspective on things, related to law, particularly medical-legal matters, that would be cool. I'm sure people would love to hear it. There's other lawyers on this board who are good posters. Though it might be win many friends at an MSNBC round-table, to come to this forum and call a group of professionals "chicken little," "out of touch," "all over the place," and "hysterical" is not cool. Not fun. Not collegial. And it certainly wont give anyone the warm-and-fuzzies. Just sayin'.

 

[Pons Asinorum]

Should CDC Director Dr. Tom Frieden step down?

The last link in particular is interesting, as it suggests travel restrictions did not aid efforts to stop spread of H1N1.

Do you think that transmission patterns for Ebola and H1N1 will be the same? You seem to think they will be since you deferentially refer to this piece. Do they have comparable Rnaught values? Do they have similar natural reservoirs? Do they have the same routes for infection? Do you have any idea how silly it is to compare influenza and EVD? Or do you just post links to other people's thoughts whom we have already laid out reasons for having some questions regarding motives/incentives? Expecting me to defer to the "expert" opinions would be fine if they would have acted in an expert-like fashion at any point during this debacle.

 

[Birdstrike]

I wonder why the "experts" who decided restricting travel to keep Ebola out of the country might be funneling all potential Ebola patients through only 5 airports? Hmm....Certainly not to restrict travel and keep Ebola patients out of the country. No, no. Because that would be impossible, so say those same experts. Hmm...

"The US Department of Homeland Security (DHS) will begin limiting the airports where travelers from Ebola-stricken countries in West Africa may enter the US. Starting tomorrow these passengers will be forced to fly through 5 airports: JFK International in New York, Newark Liberty International in Newark, NJ, Washington Dulles International in Dulles, VA, Hartsfield-Jackson International in Atlanta, GA, and Chicago O’Hare International in Chicago, Ill."

http://www.hcplive.com/articles/West-Africans-Funneled-to-5-US-Airports

 

[GeneralVeers]

I don't think some people on here understand how international travel works. I travel internationally at least every 2 months (Argentina last month), and I was in Africa in May. It would be quite simple to refuse entry to anyone carrying a passport from one of the effected countries. Furthermore, the U.S. can simply deny a visa to you. Yes you can get a fake passport, but if you don't have a visa, you will not get into the country period.

I think my opponents on this thread miss the point. I want our government to do everything it can to prevent more Ebola from coming here. A travel/Visa ban would eliminate 99.9% of the people who could potentially carry it. Is it possible that an Ebola-carrying person from Liberia could get a fake passport and lie to get in the country? Certainly. We will never be able to 100% close the border to these people, but I'd settle if our government started at 99.9%.

 

[powermd]

Anyone have any actual science justifying the travel ban or just the oversimplified argument that not letting it in will keep it from getting in?

Sometimes it makes sense to take rational action in the absence an established evidence base. Restricting travel from Ebola epidemic nations is merely a form of quarantine. This may temporarily inconvenience some, but in all likelihood will save lives elsewhere.

 

[GeneralVeers]

Sometimes it makes sense to take rational action in the absence an established evidence base. Restricting travel from Ebola epidemic nations is merely a form of quarantine. This may temporarily inconvenience some, but in all likelihood will save lives elsewhere.

Correct. As I stated, by refusing Mr. Duncan entry into the U.S., we most certainly would have prevented two nurses from getting infected. Simply denying him access would have done it. He flew United from Brussels to the U.S. United Airlines is required to check passports at the check-in counter. If there was a travel ban in place, he would have been denied boarding to the the United Airlines flight in Brussels, and never made it to the U.S.

 

[Cheese Whiz]

Changing the topic from travel here for a moment. One of the EDs I work at has adopted a plan for comfort care only approach should we get any coding or near coding patients believed to have ebola. EMS has been instructed to not bring them to the ED as care is considered futile. No IVs. No intubations. PO fluids and pain meds. Anyone else working with similar plans?

 

[jl lin]

Sometimes it makes sense to take rational action in the absence an established evidence base. Restricting travel from Ebola epidemic nations is merely a form of quarantine. This may temporarily inconvenience some, but in all likelihood will save lives elsewhere.

I am not seeing corresponding data, that could be used in a fair and reasonable argument, as an established evidence-base. What has been posted can't meet the necessary criteria.

And why is it OK for Nigeria or Sierra Leone to establish travel bans, but it's not OK for the US. How many reported cases in the USA meets the political threshold?

 

[Birdstrike]

Lancet Study: Screening Necessary to Prevent Ebola Flying Out

Hmm? Thought that wasn't going to happen...

"A new study underscores the potential danger of airplane passengers infected with Ebola leaving West Africa: If there were no exit screening in place, researchers estimate that three people with the disease might fly out of the region each month."

http://bigstory.ap.org/article/aaac...no-checks-more-ebola-cases-might-leave-africa

 

[BHB2008]

Screening has been happening,and I haven't heard anyone disagree with it. Arguments against blanket travel ban include 1) increases difficulty of tracing travelers, 2) difficulty of extracting infected HCW which would in turn 3) disincentivize international aid and 4) decreasing supply lines as cargo and personnel use same flights in an area that isn't well serviced.

I was in the ED at a local hospital the other day and everyone was being asked about travel by multiple persons. (Registration, triage, and doctor).

 

[BHB2008]

I wonder why the "experts" who decided restricting travel to keep Ebola out of the country might be funneling all potential Ebola patients through only 5 airports? Hmm....Certainly not to restrict travel and keep Ebola patients out of the country. No, no. Because that would be impossible, so say those same experts. Hmm...

"The US Department of Homeland Security (DHS) will begin limiting the airports where travelers from Ebola-stricken countries in West Africa may enter the US. Starting tomorrow these passengers will be forced to fly through 5 airports: JFK International in New York, Newark Liberty International in Newark, NJ, Washington Dulles International in Dulles, VA, Hartsfield-Jackson International in Atlanta, GA, and Chicago O’Hare International in Chicago, Ill."

http://www.hcplive.com/articles/West-Africans-Funneled-to-5-US-Airports

In order to route them through customs that will screen them for infection. Just about allocation of resources, and no doubt about it, they will quarantine anyone who doesn't pass screening. There's a real disconnect here between what you are arguing against and how you portray it. As far as I know, the CDC has been screening passengers and would quarantine because they do not want ebola to get in, but they also believe a travel ban is too broad of a measure that could do more harm than good.

 

[BHB2008]

Do you think that transmission patterns for Ebola and H1N1 will be the same? You seem to think they will be since you deferentially refer to this piece. Do they have comparable Rnaught values? Do they have similar natural reservoirs? Do they have the same routes for infection? Do you have any idea how silly it is to compare influenza and EVD? Or do you just post links to other people's thoughts whom we have already laid out reasons for having some questions regarding motives/incentives? Expecting me to defer to the "expert" opinions would be fine if they would have acted in an expert-like fashion at any point during this debacle.

It's called having a conversation. The transmission pattern will differ, naturally, but one can use this data as a base point for discussing the efficacy of a travel ban. Or contrarily by demonstrating that it is completely different. You seem to think it is silly to compare the two, but it's not as preposterous as you make it out to be. In any event, H1N1 can be transmitted by more casual contact than Ebola, so a comparison would be conservative in that regard.

Why so touchy? Your post didn't answer anything but just a slew of questions shutting down dialogue....again, you may feel like you're an in agreement with others on this thread, but your view is outside the mainstream of scientific consensus on the issue so your dismissiveness is curious.

 

[BHB2008]

Bird strike, the "all over the place" was meant for hi Lin, not you or anyone else. (You can read that post, and I think you'll agree. I don't believe isn't an EM physician FWIW.).

Didn't mean to be disparaging. My apologies.

 

[WilcoWorld]

My gut reaction is to support a travel ban, but I worry about unintended consequences. Thomas Duncan made it through at least three slices of swiss cheese. A fourth slice - a travel ban - would probably have made the difference, but we don't know. Additionally, it is at least conceivable that a travel ban could worsen things (decreased aid --> increases spread --> other countries affected --> undermines travel ban).

On the other hand, if everybody waits for an RCT to make every decision, than they can't even be sure the floor will be there to stand on when they get out of bed in the morning, because it's never been studied! So I understand those who feel that action must be taken. Personally, I support a 21 day quarantine for all travelers from affected countries. Have a separate area within the quarantine for anyone with symptoms. I bet that all you'd have to do to be meeting Emory/Nebraska level outcomes would be to equip a small building with IV fluids (maybe TPN), PPE, and waste control capabilities.

But a travel ban? I just don't think I know enough to say either way, so I'm trusting the experts on this one. I hope to err, Birdstrike, that they're right on this one.

 

[jl lin]

Bird strike, the "all over the place" was meant for hi Lin, not you or anyone else. (You can read that post, and I think you'll agree. I don't believe isn't an EM physician FWIW.).

Didn't mean to be disparaging. My apologies.

Are you sure?
I said, "Your attitude and statement is something that is/and has been used by despots and tyrants....Demanding that we listen to experts merely b/c they are expert is no different than making an argument based on appeal to authority. " That's where I went with your weak position. So, it was germane, but if you insist on not seeing the connection, well, it was at worst, only mildly tangential. What made it relevant and connected was that I stated outright that claiming we should just believe appointees to government agencies b/c they are considered experts, when they have not presented reliable information to support their "theory," yet only continue to restate their beliefs as absolutes that we must accept, well, that is autocratic. And it goes against sound reasoning, especially when considering historical approaches and basic science regarding how to deal with highly infectious and highly fatal organisms. The idea is to limit spread. This has been so in medical practice for ages. In fact, it is still so; hence the need to place these folks in strict isolation and give HC providers proper education and PPE. It's why we don't want people that are sick flying all over the place. Not one person here has ever said that we should abandon the hot zones. Everyone agrees that they need more help and support over there. That has nothing to do with denying visas to people from that area, who just want to visit their girl friend or Auntie May in America.

Neither did anyone say denying visas and placing a ban would stop all possibility of carriers coming in to this country. As the ED physician above basically said, 100% reduction of risk may certainly be impossible; but he and I both would gladly take 99%.

At some point, another person or persons are going to come here, and they will not show anything that can be viewed as Ebola or any illness (no symptomology yet) or something that could look like an allergy. They will invariably be missed by the non-medically trained TSAs. For heaven's sake, the disease was missed by trained nursing and medical professionals in Dallas. What makes anyone think TSAs will do a better job of not missing something so easy to miss? LOL So, then these poor souls traveling from hot zones will move around and infect others here. We will not be able to trace all the people with whom these travelers interacted. And the reason is b/c they will have no idea with which strangers they interacted. At some point, our properly appointed, Ebola-prepared hospitals will reach critical mass. Then what?

So, these scientists and political cronies, whom you feel are the last word on infectious disease safety for something as deadly as Ebola--an illness that is really not at all a nice way to die-- well, they had better understand that the public safety of Americans cannot simply hang on their mere, unsubstantiated say so. People are reasonably troubled by their inaction and circular words. It's hubris for them or anyone else to think their position of "Because we are the experts and we say so" is good enough--especially when their actions are counterintuitive without the support of sound, data-based reasoning.

Every presented argument they have given thus far has been, in a word, lame. Each of their statements of "rationale" do not hold water and are easily pulled apart. And when they are, what do they do? They repeat, verbatim, the same lines/excuses, oops, I mean, "reasoning," or they have their allies say, "Hey. They are the experts; so really since they are, that should be good enough." It's not. It's that simple.

 

[Birdstrike]

The "experts" are all in agreement? I think not. Here's a signed letter from 16 members of Congress, all of whom are also doctors, nurses or other health professionals who do support a tighter travel ban:

http://roe.house.gov/uploadedfiles/docs_letter_ebola.pdf

http://www.politico.com/tag/health-care

 

[Birdstrike]

t's hubris for them or anyone else to think their position of "Because we are the experts and we say so" is good enough--especially when their actions are counterintuitive without the support of sound, data-based reasoning..

You don't have to have born before World War I to have been around long enough to remember the laundry list of catastrophic and wrong decisions made and advice given by so called "experts" over the years, in and out of the field of Medicine. I mean puh-leez people, let's think for ourselves a little but here. Also, why are the same people demanding "evidence" and "absolute proof" a certain policy will "work 100%" the same people that keep falling back on, "Oh...Well, I'm just going to trust the 'experts'"?

 

[powermd]

Help me out here. If the standard for working with Ebola in a nice, controlled lab setting is one of these:

http://en.wikipedia.org/wiki/Positive_pressure_personnel_suit

How come it's okay to tend a festering, "projectile vomiting", diarrhea squirting Ebola bomb of a patient with anything less?

I love how the CDC is soooo adamant that Ebola is NOT airborne while casually ignoring the likely reality that in the local environment around a symptomatic patient there are floating secretions that could easily infect anyone not wearing a positive pressure suit with a filtered air supply.

 

[Birdstrike]

Help me out here. If the standard for working with Ebola in a nice, controlled lab setting is one of these:

http://en.wikipedia.org/wiki/Positive_pressure_personnel_suit

How come it's okay to tend a festering, "projectile vomiting", diarrhea squirting Ebola bomb of a patient with anything less?

I love how the CDC is soooo adamant that Ebola is NOT airborne while casually ignoring the likely reality that in the local environment around a symptomatic patient there are floating secretions that could easily infect anyone not wearing a positive pressure suit with a filtered air supply.

The crux behind their policy right now seems very much to be, "Let's not create panic," first, and everything else, later. Remember, there's an important election coming up in a few days (midterm congress). You're likely to see more aggressive policies after that's done.

 

[BHB2008]

So apparently 94% of travelers from West Africa already arrived to the U.S. via those airports, which have been screening passengers since week before last. The move is a good one, to round up the 6% and allocate resources efficiently. And fewer than 150 people a day from the affected area arrive here, a number which is dropping due to voluntary (market-induced or otherwise) reduction of flight service.

I'd be curious to know how many of these passengers have some affiliation with international health efforts (probably few).

 

[GeneralVeers]

So apparently 94% of travelers from West Africa already arrived to the U.S. via those airports, which have been screening passengers since week before last. The move is a good one, to round up the 6% and allocate resources efficiently. And fewer than 150 people a day from the affected area arrive here, a number which is dropping due to voluntary (market-induced or otherwise) reduction of flight service.

I'd be curious to know how many of these passengers have some affiliation with international health efforts (probably few).

How about just not letting those "150 people" enter the country? People may not know they were exposed to Ebola, or they might outright lie. Unless they happen to have a fever at the time of screening, it is unlikely it would accomplish anything. I'm certain Mr. Duncan would have breezed through this screening....

 

[BoBeanEater]

http://www.washingtonpost.com/news/...d-from-west-africa-being-evaluated-for-ebola/

 

[sum dude]

http://www.orlandosentinel.com/opinion/os-ed-ebola-quarantine-102214-20141021-story.html

 

[WilcoWorld]

http://www.orlandosentinel.com/opinion/os-ed-ebola-quarantine-102214-20141021-story.html

How interesting that when I follow a link to an article advocating a quarantine to protect against Ebola I am actually sent to an article on gun violence. More Americans have probably died from gun violence in the time it took me to read this article than have died from Ebola over the course of this whole outbreak.

I fully expect a firestorm of posts accusing me of being a bleeding heart liberal as a response to this post. So it goes.

 

[BHB2008]

Latest patient is an EM fellow. On the bright side, patients treated in the U.S. have much improved odds of beating this. No one has died except the one patient who was sent home with antibiotics. I wish Dr. Spencer a full recovery.

 

[Birdstrike]

Latest patient is an EM fellow. On the bright side, patients treated in the U.S. have much improved odds of beating this. No one has died except the one patient who was sent home with antibiotics. I wish Dr. Spencer a full recovery.

Can't confirm this, but rumor has it they rocked a 5/5 press Ganey Score from him before he succumbed due to the rapid multiple and unneeded CT scans and prompt antibiotic script.

 

[Birdstrike]

How interesting that when I follow a link to an article advocating a quarantine to protect against Ebola I am actually sent to an article on gun violence. More Americans have probably died from gun violence in the time it took me to read this article than have died from Ebola over the course of this whole outbreak.

I fully expect a firestorm of posts accusing me of being a bleeding heart liberal as a response to this post. So be it.

Oh geez....

 

[Birdstrike]

Nurse: Duncan Lied About Ebola Exposure

“And I asked ‘Have you been in contact with anyone who's been sick?’ ”

“No. He said no,” Rose said...

http://thehill.com/policy/healthcare/221905-er-nurse-duncan-lied-about-exposure-to-ebola

 

[EMIM2011]

http://www.newsweek.com/ebola-west-africa-ebola-epidemic-thomas-eric-duncan-dallas-texas-284142
"The agreement reached with the hospital sets up a charity in Duncan’s name, eliminates his hospital bills and pays an undisclosed sum to his next of kin. While the amount was not mentioned, Weisbrod told Newsweek that “my opinion is the amount of money that was paid is as much, or more, than the family would have received if the case had been tried to conclusion.”

What do y'all think - how much did they get?

 

[MSmentor018]

http://www.newsweek.com/ebola-west-africa-ebola-epidemic-thomas-eric-duncan-dallas-texas-284142
"The agreement reached with the hospital sets up a charity in Duncan’s name, eliminates his hospital bills and pays an undisclosed sum to his next of kin. While the amount was not mentioned, Weisbrod told Newsweek that “my opinion is the amount of money that was paid is as much, or more, than the family would have received if the case had been tried to conclusion.”

What do y'all think - how much did they get?

more than if he would have stayed in liberia
I am sure more than the family will ever make here
a family member that you don't see frequently, lies and gets into the US and delivers us a gift that could decimate millions that has never been seen on US soil, and we still provided him with the best chance of survival compared to staying in liberia, and his family is smiling all the way to the bank. talk about rolling at 7
bet this s$%t doesn't happen over there
{slow golf clap} thanks

 

[BHB2008]

Uh, sending him home with antibiotics for 3 days doe snot equal the best chance of survival. That's probably the basis for the suit.

 

[ERDude]

Uh, sending him home with antibiotics for 3 days doe snot equal the best chance of survival. That's probably the basis for the suit.

Failing to diagnose a disease which had never before been diagnosed in the US (Ebola) in a patient presenting to the ED with flu-like symptoms and not even being forthcoming about his medical history (direct exposure) is not even in the same ballpark as a breach from standard of care.

 

[BHB2008]

Is it certain he failed to disclose the disease? It's been reported that he told the nurse, who noted it in the system, Did that change? Hard to know truth of matter, but the hospital has a good idea of their potential liability, so you shouldn't really shed any tears for them. The above poster talking about "decimating millions" (which Ebola hasn't even approached over the course of 40+ years of its known existence) is ridiculous.