First Ebola Case Coming to America- TIME magazine article

[pink/\floyd]

http://time.com/3067816/emory-university-ebola-patient-isolation-unit/

What do you guys think?

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[RussianFrolic]

I'm not sure I understand why they are bringing a person with Ebola into the country. This is highly risky considering no vaccine or treatment is available. As far as I'm concerned, this seems unnecessary considering the potential danger if this disease somehow gets out and spreads in the US. I would like to hear from others as to why people might think this is a good idea or the benefits from this action.

 

[2Pints]

“There is the potential that the actual movement of the patient could do more harm than the benefit from more advanced supportive care outside of the country.” - so I'm left with the question is this a dangerous publicity stunt? The article mentions the staff is highly trained in specific protocols and procedures but didn't indicate if the staff had ever dealt similar diseases.

 

[pink/\floyd]

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[2Pints]

*no cure approved for use on humans. http://www.nature.com/nature/journal/v508/n7496/full/nature13027.html
I might give this antiviral a chance if I'd been infected with Ebola. Although the study says administration within 48 hours of infection. Still wouldn't risk other people's lives by coming back to the States.

 

[ndafife]

Probably shouldnt be bringing it here, but it isnt an airborne disease and it kills so fast that the chance of a a wide-spread epidemic is pretty low... So its probably better than brining a new strain of the flu or something

 

[Tots]

Interesting. Ebola is not flu though so I wouldn't be concerned about this. I am only speculating but they are probably going through with this because it gives them an opportunity to test their experimental treatment, test their isolation procedures and get a better idea on how deadly this disease would be in a 1st world country with advanced medical support. Ie its probably as much in the CDCs interest as it is the patients.

 

[Lamel]

I don't think ebola would be as dangerous in a 1st world country; it is hard to spread in general, and limits itself with its own severity, but the better hygiene and sanitation in the USA will also help. Still dangerous of course; really scary disease (anyone read Hot Zone?)

 

[LizzyM]

As I understand it, the people being returned to the US are Peace Corps Volunteers. No one would join the Peace Corps if there was a "no return" clause in the contract! The treatment of this disease is supportive therapy. There is some possibility that blood transfusions from a person who has recovered from Ebola (about 40-45% of victims do recover) could also be used to provide antibodies to help fight the infection. The plane in which the American victims will be traveling is outfitted to prevent transmission to the health care workers caring for them. Here everything is disposable and sent to an incinerator; in Africa life is much different.

 

[2Pints]

As I understand it, the people being returned to the US are Peace Corps Volunteers. No one would join the Peace Corps if there was a "no return" clause in the contract! The treatment of this disease is supportive therapy. There is some possibility that blood transfusions from a person who has recovered from Ebola (about 40-45% of victims do recover) could also be used to provide antibodies to help fight the infection. The plane in which the American victims will be traveling is outfitted to prevent transmission to the health care workers caring for them. Here everything is disposable and sent to an incinerator; in Africa life is much different.

Really good points. Guess I'm more focused on cases of human error instead of our technology. Despite our technology, we are still struggling with hospital acquired infections in the US and then there's the recent CDC incident with anthrax and H5N7. This situation is complicated but I'm not suggesting by any means we don't care for our volunteers.

 

[Tots]

As I understand it, the people being returned to the US are Peace Corps Volunteers. No one would join the Peace Corps if there was a "no return" clause in the contract! The treatment of this disease is supportive therapy. There is some possibility that blood transfusions from a person who has recovered from Ebola (about 40-45% of victims do recover) could also be used to provide antibodies to help fight the infection. The plane in which the American victims will be traveling is outfitted to prevent transmission to the health care workers caring for them. Here everything is disposable and sent to an incinerator; in Africa life is much different.

I guess the names of those coming back have not been released but this article: http://www.washingtonpost.com/natio...132634-18ce-11e4-9e3b-7f2f110c6265_story.html seems to imply that the returning patients are the two non-peace corps AIDS workers who have signs of infection. It seems 2 peace corps volunteers were exposed to the virus but have not yet shown symptoms. Curious because I imagine it would be a whole different ballgame to bring back two people basically on the brink of death vs. two people in isolation, possibly infected.

 

[Goro]

American infectious disease doctors aren't stupid; check out this story of an imported Marburg fever virus case in an American tourist.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm

http://time.com/3067816/emory-university-ebola-patient-isolation-unit/

What do you guys think?

 

[Salt Salt]

“Emory University Hospital has a specially built isolation unit set up in collaboration with the CDC [the Centers for Disease Control and Prevention] to treat patients who are exposed to certain serious infectious diseases,” the hospital said in the statement. “It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation. It is one of only four such facilities in the country.”

It sounds like the chances of the virus being spread at all from these two patients is virtually zero. And who knows? Maybe studying the illness in person with all the resources of Emory/CDC might turn up something useful.

 

[2Pints]

American infectious disease doctors aren't stupid; check out this story of an imported Marburg fever virus case in an American tourist.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm

ID docs aren't stupid but there a lot of hands involved in patient care including lab techs and environmental staff that could unknowingly expose themselves or others due to a lack of understanding.
I'm curious why the CDC took a year after this woman's discharge and 6 months after confirmation of anti-MARV IgG to conduct an investigation.

 

[ridethecliche]

Additionally, it's going to get here sooner or later. Emory is one of the centers that's outfit to do well to treat and contain this kind of pathogen, hence the CDC affiliation. Being able to have patients on home turf means that you can manage them better and give them the best chance of survival, which is more than reasonable given that they're americans.

It's a good way to see how other facilities might need to be improved if this is going to be a global thing ever.

It's a great clickbait headline, but that's all it is.

 

[Pacna]

From what I've read, the facility receiving the patient is new and would be the first [whatever unit] in the US to receive such a case. I think it has more to do with publicity.

 

[Ms. Chanandler Bong]

I think it's publicity on the part of the CDC. And regardless of the level of isolation, panic is about to ensue among patients and their families at Emory. From a public relations standpoint, it's going to be a nightmare. I'm sure it already is.

 

[DokterMom]

With the increases in globalization, it seems like Ebola is a virus we should learn a lot more about, and these particular circumstances offer a logical opportunity to do that. I'd expect transmission risk to be extremely low, especially since we know what virus it is we are dealing with and are correspondingly cautious to prevent transmission.

 

[knv2u]

I don't like it one bit. And while I am aware that there are safety precautions in place including isolation chambers, if one of them should fail, I would not risk contaminating others. It's great that people want to volunteer to go on mission trips, but when it potentially poses public health concerns, I think the safety of the general public outweighs any individual right to re-enter the United States. I would leave them in Africa, but would have sent all of the technical equipment including gasoline generators to try to improve the quality of care as much as possible.

 

[knv2u]

I don't think ebola would be as dangerous in a 1st world country; it is hard to spread in general, and limits itself with its own severity, but the better hygiene and sanitation in the USA will also help. Still dangerous of course; really scary disease (anyone read Hot Zone?)

I suppose it depends on your definition of "hard to spread." It is not airborne, but it is highly infectious. Transmission occurs through direct contact with bodily fluids. If a patient were to vomit on you, bleed on you, etc., there is a decent chance that you would contract the disease. Even small traces of blood on a surface could potentially transmit the disease. The African countries even have a ban keeping families from touching dead bodies in any capacity. If mere touch is enough, I wouldn't be so quick to downplay it. I think the media and the CDC are downplaying this in hopes of preventing public outcry, even though the risk would be minimal if the patients are properly isolated.

 

[M12B]

Not sure yet how I feel. Definitely gives you a lot to think about. I think it is an incredible opportunity to study not only the virus but our procedures and protocols as well. But, you can't ignore the fact that it is ultimately risky, despite the technology and facilities at Emory. I'm curious about what more SDNers have to say...

 

[pink/\floyd]

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[ForensicOdontology]

Absolutely ridiculous. I can't wrap my mind around why one would subject millions of otherwise uninvolved people to the possibility of infection. To me, it simply boils down to: Why would you?

 

[AMEHigh]

I'm surprised that so many educated people here have these views.

I think it would be a dangerous slippery slope to deny American citizens the right to be able to come back to their country to receive health care and be with their families. We live in a global society and I don't think that should change.

Doctors without Borders has successfully been treating patients with Ebola for years with zero doctors or other staff dying from Ebola. The incubation period and how it's transmitted make it difficult to spread in controlled conditions.

 

[AMEHigh]

Agreed. I applaud people going to West Africa to help these victims, however they need to sign some sort of no-return clause in case of a possible infection. There is no cure and the best thing to do at this time is to contain the spread of this virus.

Are you joking?

So now we all have to sign "no-return clauses" when we travel to areas with higher rates of HIV, TB, etc?

 

[ForensicOdontology]

I think this highlights some pretty serious ethical questions, but I can't help but consider the obligation we have to the public, to ensure their safety. This is obviously a very emotionally loaded question, with many more implications than we can possibly realize at face value, but my rationale won't let me conclude that it's ok to risk so many more lives.

Having said that, I can understand the humanist view that we cannot keep people from their families, and turn our backs on our fellow Americans in times of need. So, are there alternatives to bringing them back? Bring families to them, setting up locations to house patients where the infection took place, or quarantining a specific facility strictly for such cases (stateside), in remote locations, that are properly secure?

I cannot see letting emotion over take common sense, especially in this situation. I understand there was a quarantined plane, and the patient will be also, but I feel that their proximity to the "outside world" is too close for comfort.

Thoughts?

 

[xffan624]

We treat way more contagious diseases in hospitals daily. The US can afford to bring home its citizens and bring them the best possible care. I'm sure Emory was chosen specifically due to their extremely close proximity to the CDC and the likelihood that they would be prepared to deal with an even more contagious and potentially deadly affliction than Ebola that is kept in the CDC stores--smallpox. Laboratory exposure is a real risk as we recently saw at that location. Emory would likely be the responding hospital if an accidental infection occurred at the CDC.

This concern is fearmongering by the mainstream media. EVD is not easily transmitted when proper precautions are followed. More concern for actual transmission in the US is the recently publicized case of transmission via international flight in Nigeria. The man had helped care for an EVD patient (his sister) and was still allowed to travel. He became too sick to continue at Nigeria, but one wonders what kind of symptoms he must have been showing at his origin airport that were completely ignored.

Edited to add: This is not the first Ebola strain in the states. Ebola Reston was in monkeys that came to the US in Reston, VA, but it proved not transmissible to humans.

 

[infinitessimal]

The chances of accidental infection from these two highly-controlled patients are low. I'd be more worried about all the people flying back and forth, from Africa to Europe and America... The incubation period is 21 days and people could be sick for a while before anyone realizes it. WHO and CDC have already said that preliminary containment efforts were insufficient.

On another note, some of the American doctors who died in Africa said they took all precautions and don't know how they got sick. I really don't have much expertise in infections diseases, but the fact that highly trained professionals are slipping is dubious and also worrisome.

 

[theseeker4]

This is pretty interesting, how many people on here don't understand the mode of transmission of this illness. Bringing infected individuals here, who are known to be infected allowing all necessary precautions to be undertaken, will NOT put "millions at risk." A much, much, MUCH greater risk is present by allowing people to travel randomly to pretty much any location in the world, for pretty much any length of time, and return here without being subjected to a substantial quarantine period. If you really think these Americans who have Ebola shouldn't be brought back here for care, you might want to start lobbying to close down international travel, since that is a MUCH bigger risk to public health.....

 

[xffan624]

The chances of accidental infection from these two highly-controlled patients are low. I'd be more worried about all the people flying back and forth, from Africa to Europe and America... The incubation period is 21 days and people could be sick for a while before anyone realizes it. WHO and CDC have already said that preliminary containment efforts were insufficient.

And still the risk is not incredibly high, EVD is only transmissible during the symptomatic period. This certainly puts caregivers at risk who will have greater exposure to bodily fluids when they appear to have the "flu", but it doesn't pose a significant risk to the general public.

 

[ForensicOdontology]

I have to say I'd be concerned for my safety if my doctor had the type of relaxed, optimistic attitudes about deadly infections as some here have.

Dr. Phil: "Ohhh relax, it only touched the floor for a second, what harm could it do?"

 

[theseeker4]

I have to say I'd be concerned for my safety if my doctor had the type of relaxed, optimistic attitudes about deadly infections as some here have.

Dr. Phil: "Ohhh relax, it only touched the floor for a second, what harm could it do?"

Who here is advocating a nonchalant attitude toward deadly diseases? We are talking about a transfer of infected individuals while providing every precaution and safety measure, for a disease that is NOT that easily transmissible.....

ETA: look up "Burnett's Law" here on SDN.....

 

[kyamh]

The point of developing technology and techniques to cure diseases is to use these tools to help people, not to have them sit unused.

 

[ForensicOdontology]

Who here is advocating a nonchalant attitude toward deadly diseases? We are talking about a transfer of infected individuals while providing every precaution and safety measure, for a disease that is NOT that easily transmissible.....

ETA: look up "Burnett's Law" here on SDN.....

Hahaha.. "Burnett's Law," too funny. I've never come across it, but I hear you.

Idk, I just tend to err on the side of caution when it comes to these kinds of things. The way I see it, it's been proven before that "all precautionary measures possible" didn't stop the transmission, so what's to say we know exactly what's going on yet?

 

[pink/\floyd]

Are you joking?

So now we all have to sign "no-return clauses" when we travel to areas with higher rates of HIV, TB, etc?

I'll buy TB, but HIV really?

 

[NontradCA]

This is pretty interesting, how many people on here don't understand the mode of transmission of this illness. Bringing infected individuals here, who are known to be infected allowing all necessary precautions to be undertaken, will NOT put "millions at risk." A much, much, MUCH greater risk is present by allowing people to travel randomly to pretty much any location in the world, for pretty much any length of time, and return here without being subjected to a substantial quarantine period. If you really think these Americans who have Ebola shouldn't be brought back here for care, you might want to start lobbying to close down international travel, since that is a MUCH bigger risk to public health.....

You're in pre-Allo.

 

[NickNaylor]

This is pretty interesting, how many people on here don't understand the mode of transmission of this illness. Bringing infected individuals here, who are known to be infected allowing all necessary precautions to be undertaken, will NOT put "millions at risk." A much, much, MUCH greater risk is present by allowing people to travel randomly to pretty much any location in the world, for pretty much any length of time, and return here without being subjected to a substantial quarantine period. If you really think these Americans who have Ebola shouldn't be brought back here for care, you might want to start lobbying to close down international travel, since that is a MUCH bigger risk to public health.....

The overwhelming majority of people living in rural African areas (where most of these cases are occurring) likely don't have the means to buy plane tickets and go on international flights. Yes, I know about the Liberian-American guy who managed to get on a flight to Nigeria, but the fact that only a single case out of ~1500 has had this problem proves the point.

 

[AMEHigh]

I'll buy TB, but HIV really?

My point was to illustrate how absurd it would be for people to sign an agreement saying they wouldn't return to the US after travelling abroad to areas with infectious disease prevalence higher than in the US, which is what you suggested. Hence, I really hope it was a (poor) joke.

Like someone said above, more contagious diseases are treated here on a daily basis.

 

[pink/\floyd]

My point was to illustrate how absurd it would be for people to sign an agreement saying they wouldn't return to the US after travelling abroad to areas with infectious disease prevalence higher than in the US, which is what you suggested. Hence, I really hope it was a (poor) joke.

Like someone said above, more contagious diseases are treated here on a daily basis.

Comparing Ebola to HIV is a very "poor" assessment.
But, to each his own. I am not interested in quarreling with you. Express your opinion and keep it moving.

 

[theseeker4]

The overwhelming majority of people living in rural African areas (where most of these cases are occurring) likely don't have the means to buy plane tickets and go on international flights. Yes, I know about the Liberian-American guy who managed to get on a flight to Nigeria, but the fact that only a single case out of ~1500 has had this problem proves the point.

Oh I know, my point wasn't that it is incredibly dangerous to have open international travel, the point was that the risk of these patients coming here causing an epidemic of Ebola in the US is much less.

 

[NickNaylor]

I suppose I'll add my own opinion. I must admit that I'm not a fan. The points about precautions being taken, the entity being dealt with being known, "difficulty" of infectivity, etc. are well taken. However, knowingly bringing patients infected with a disease that has a greater than 50% case fatality rate to an exposure-naive population doesn't seem like a good idea to me. Precautions were taken in the endemic areas and yet the infection has spread. The disease was a known quantity and yet infection has spread. There is no effective treatment or cure - what's the logic behind bringing them to the US short of the feels? This may be callous, but I'm not convinced that going through this trouble after voluntarily sending yourself into the middle of this situation is appropriate. I commend the staff willing to go work there, but in my view that doesn't in and of itself warrant what is being done.

In all likelihood, nothing will happen. But that being said, in the event something DOES happen everyone will rightfully be climbing up the asses of the people who signed off on this decision.

It's important to reiterate that there is no effective treatment for this disease. The same things that will likely be done to these people are the same things that likely could've been done in the field with the addition of a small but no less real risk of starting a pandemic. Short of the argument that "we've gotta do something!" I just don't see what the goal here is.

 

[heymeg]

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[NickNaylor]

Your point that the disease was known and precautions were taken has to be put into context of poor countries in West Africa. There are a ton of factors contributing to the disease's spread in Africa that are not the case here in the U.S.
"Precautions" in poor areas of African countries are entirely different than they are in the U.S. There aren't new gloves, gowns, or even needles available for every patient. The isolation units aren't as sophisticated as the ones at Emory. The public health infrastructure isn't as modern, nor are the local hospitals and clinics. Overall, the standard precautions in the US have a much higher likelihood of containing a disease than an overwhelmed, resource-poor hospital in rural Africa.
The populations being affected by Ebola in Africa have cultural practices that put them at much higher risk of coming into direct contact with body fluids - e.g. handling infected dead bodies for funeral rituals, mistrust of Western medicine that makes people less likely to seek healthcare and isolation and more likely to stay at home and receive care from traditional healers or family members. Many people might not have access to care, and even those who do may not be willing to seek it.
None of this stuff applies in the U.S., not to mention that if any of the caregivers for these two patients showed symptoms of Ebola, they'd be put in isolation immediately. The risk of creating an epidemic in the US minimal compared to the value of these two patients receiving excellent supportive care and researchers having a chance to learn more about the disease.

This says nothing about the Western physicians who are quite educated and know what needs to be done still becoming infected. I understand the roles that traditional cultural practices have played in launching the initial epidemic. That really doesn't have anything to do with healthcare workers themselves getting infected.

 

[Gauss44]

I haven't had a chance to look into the Ebola situation. I do think that societies tend to forget history and sometimes tend to get cocky when there hasn't been a RECENT tragedy. I both suspect and hope that the same degree of CAUTION is being used right now, as would be used if we RECENTLY had a serious event LIKE tuberculosis prior to effective antibiotics, Black Death, or the flu of 1918. (SARS and H1N1 did NOT rise to that level in the USA IMO.)

 

[heymeg]

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[AMEHigh]

Precautions were taken in the endemic areas and yet the infection has spread. The disease was a known quantity and yet infection has spread.

I'm not going to pretend to know all the answers or the complete situation, but it's very complex as to why it has spread. Yes precautions have been attempted, but due to differences in public health and cultural norms it has been ineffective. I've lived in W and S Africa (although not in the countries directly affected) and it was an interesting experience to understand the communities a little more indepth.

Doctors and health care workers have been attacked and forced out due to widespread belief that Westerners are bringing the disease in and/or doing more harm than good. It's a cultural norm that when people die you should have close contact with them. People who are sick have left their homes and gone to other communities for fear of people in their own community condemning them. Family members are helping their loved ones escape from hospitals to take care of them in their homes.

The WHO General Director addressed this just this week with 3 country presidents.

Those are just a few reasons as to why it's complex and the precautions taken in other countries aren't directly applicable about how an infection could spread US.

 

[NickNaylor]

I'm not going to pretend to know all the answers or the complete situation, but it's very complex as to why it has spread. Yes precautions have been attempted, but due to differences in public health and cultural norms it has been ineffective. I've lived in W and S Africa (although not in the countries directly affected) and it was an interesting experience to understand the communities a little more indepth.

Doctors and health care workers have been attacked and forced out due to widespread belief that Westerners are bringing the disease in and/or doing more harm than good. It's a cultural norm that when people die you should have close contact with them. People who are sick have left their homes and gone to other communities for fear of people in their own community condemning them. Family members are helping their loved ones escape from hospitals to take care of them in their homes.

The WHO General Director addressed this just this week with 3 country presidents.

Those are just a few reasons as to why it's complex and the precautions taken in other countries aren't directly applicable about how an infection could spread US.

As mentioned above, this provides some explanation as to why the endemic developed but says nothing about the fact that healthcare workers who have been taking these precautions with a virus that is "nearly impossible to spread" have contracted the infection. I'm aware of these things. They aren't related to my point.

 

[NickNaylor]

My first point regarding precautions has absolutely nothing to do with the knowledge of the physicians, rather the availability of resources. The most educated physician in the world wouldn't be able to effectively prevent transmission without the necessary tools to do so. We have those tools readily available in the US, and most of them are unavailable or limited in the areas where Ebola is endemic.

Precautions HAVE been taken. Just take a look at some of the media from the region. Since the infection is spread via contact, all you need is full body coverings. These resources are available, as are disinfectants.

You don't need a level 4 biolevel lab to institute contact precautions.

 

[heymeg]

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[NickNaylor]

It's "nearly impossible to spread" under highly controlled conditions with ideal precautions, which don't exist in Africa. As I mentioned in my earlier posts, the problem is not the ability of the physicians but the resources and supplies they have access to. The best physicians in the world would be hard-pressed to avoid getting Ebola without enough gloves, gowns, goggles, disinfectant, and high quality isolation chambers to go around. We have those resources very readily available in the U.S. You have to admit that they are at least somewhat limited in the areas where Ebola is endemic. The pictures you're seeing on the news are better than nothing, but they are nowhere close to the precautions that will be in use at Emory. The precautions at Emory are far superior to those in Africa, and therefore will significantly reduce the likelihood of Ebola spreading in the US.

"Significantly reduce the likelihood" > 0