The smart thing would be for aid agencies that send workers to these hot spots to pay for their employees to stay in a nice quite "resort" somewhere for a month on their return for them to relax and as a thankyou for their efforts. And to deflect growing negative public opinion about the risks returning aid workers pose. Needless to say the "resort" could have daily health checks and minimal contact between people but could otherwise be quite pleasant.
That strategy certainly worked for the Venetians. Merchant ships had to chill off shore for 40 days before unloading their cargo to make sure no one harbored deadly diseases. Hence the quarter in quarantine.
"People infected with Ebola cannot spread the disease until they begin to display symptoms, and it cannot be spread through the air. As people become sicker, the viral load in the body builds, and they become more and more contagious."
This is sort of misleading in this context, unfortunately. The WHO considers (sustained presence) within 1 meter of EBV carrier to be ~physical exposure. The young doctor appears to have been on a NYC subway within 12 hours of having a fever of 103. Creating a potential group of exposures that may be un-traceable.
Maybe someone can correct me if I'm wrong. But this would be highly unfortunate if these reports are correct. Presumably the uber driver is also in this group now, but records should be able to provide some data on that one much easier.
Many signs point to the viral load not being highly infectious at the beginning. Duncan was sent back to his home by the hospital and lived with his fiance who was taking care of him for two days before being readmitted. She wore no PPE yet appears to be uninfected. If sitting next to someone infected on a bus or subway is enough to pass it on, there would be a million cases in West Africa by now, not 10K. It appears to be primarily caregivers at the later stages of the disease, and the custom of kissing corpses that appear to be spreading the disease because the viral load is extreme at that stage. This doesn't mean that the potential contacts of this person should not be traced or that it was good idea for him to go bowling, but the sky isn't falling just yet.
Ebola can spread only after a person begins to show symptoms. And that takes ~21 days. Or putting it straight, for it to spread from one person to another it would take 21 days of period in between getting infected and spreading it to others.
Though the growth of number of patients with Ebola is definitely exponential. Please note it takes 21 days for the each multiplication to happen. It started in March and has been been spreading since, 10K is pretty large for a 7 month period.
>>but the sky isn't falling just yet.
In things like this you won't know when the sky will start falling apart. And generally when that happens its already too late, and you would be staring at a pretty big damage.
No body knows how many people have been infected, or will be infected in the next multiplication.
Which is why WHO suspects ~1.4 million could get infected by January. By then it would be too late.
The doctor should have known better than to go to a bowling alley soon after he returned. Whether or not he was contagious now they have to perform contact tracing and disinfect the place.
Not to mention riding the subway. Good luck doing contact tracing with that. I'm not saying he was contagious. I hope he wasn't.
Was the bowling alley public subway trip really a must-do thing, for someone who had just directly worked with ebola patients? Could this kind of thinking not be part of the training for this kind of work, I wonder?
It took the MTA over three weeks to remove a used condom hanging from the pole of an F train. I'm guessing whatever trains he took haven't been scoured beyond the bare minimum.
I think discipline is the bigger issue than awareness. Even someone who absolutely knows better can end up thinking that the bad thing can't happen to them.
In my experience with experts I'd say especially someone who "knows better" can end up thinking that the bad thing can't happen to them right up until they, in a fit of being human, have an oops and it does.
Yeah. I hate this 'holier than thou' attitude that some folks on this thread are displaying. We are all human, and we all do stupid things based on our psychology. The best we can do is create systems to help guard against our own mistakes.
"The best we can do is create systems to help guard against our own mistakes."
Like enforced isolation of some kind? The thing that people have been asking for since the beginning, but is a bad idea for some reason that nobody can explain?
Please read up on Ebola. It is only contagious when the patient is experiencing symptoms, not earlier. He got fever Thursday morning.
So he knew better, just hackers have no idea. "Since returning, he had been taking his temperature twice a day". Or maybe they just cannot read. So no, they don't have to disinfect the bowling area. But people are hysterical, so they did.
Even the NY Times got it right this time: "People infected with Ebola cannot spread the disease until they begin to display symptoms, and it cannot be spread through the air."
Prior to this outbreak, this Ziare strain of Ebolavirus, now formally known as "Ebola virus", has never infected more than 318 people at a time, and not a whole lot more than a thousand total: https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks#List_o...
I guarantee that at least one of the things the usual suspects like the CDC "know" about its transmission is wrong. Consequentially wrong? Well, we'll see.
As for this case, he was not feeling well (also described as "sluggish") for a couple of days before his self-monitored temperature spiked. Which is prompting the usual suspects to say that that wasn't a "symptom" ... which is open to question.
What's at risk with your guarantee? An internet handle?
Meanwhile, the transmissions in Dallas have all been in keeping with the things the usual suspects were saying (health care workers did become infected there, but they are known to be at higher risk, PPE is known not to be 100% safe, the hospital did not have great PPE procedures in place).
My "universal" login handle (aside from the occasional rigid company) that I've been using since 1978 (sic); my user page's email also leads straight to my true name, home address, etc.
As for Dallas, the plural of anecdote is not data. We just don't know yet; for example, in 1st World conditions where IV saline etc. are standard, the death rate may be well below the 70% currently estimated in West Africa. Although your points about the Dallas Ebola Magnet Hospital of Excellence's, are correct: while following the then current CDC "protocols" (scare quotes since the CDC and others invested so much into their sanctity vs. health care workers following them), were inadequate, e.g. no neck coverage.
Heck, look at the standard Bellevue Hospital PPE picture that's been floating around for many days, e.g. http://www.nydailynews.com/life-style/health/bellevue-hospit... Based on what we suspect the person on the right would stand a serious chance of getting Ebola, and that's no longer the protocol.
I absolutely believe that medical workers in the US that have potential exposure should be very careful about what they are doing (both people traveling back from West Africa and people involved in treatment at US hospitals). The various institutions involved should be helping with this (the hospitals, city, state, federal agencies).
That doesn't mean chickens need to start running at axes the second a known case is identified and isolated.
well, he went to a bowling alley eight days after getting back to NY. What is more egregious is that the NYTimes is reporting he was feeling sluggish on Tuesday, why didn't he self-quarantine or contact someone earlier than today?
I haven't been to JFK from Africa, but I've been there from London, Amsterdam, and Berlin, flights which are (if anything) shorter... and I was sluggish for a whole week after getting back, just going to throw that out there.
Also, when he says he called DWB on Thursday his temperature was 103. Did it go from 99 to 103 overnight? Or was he running a low grade temperature for several days.
Accounts of how he was found are a bit odd. In some articles the fire department was sent to retrieve him. According to another article, a tenant in his building claims police broke down the door to get into his apartment.
>>now they have to perform contact tracing and disinfect the place.
I wonder how feasible this is. Its not just the bowling alley, using public rest rooms, subway, or utensils at a restaurant. Its almost impossible to find every thing he came in contact with and disinfect it. Plus in case of stuff like utensils, whats to guarantee that they were not mixed with each other and used by other people already.
If some one has been infected due to this by now. It will become impossible to get a realistic perspective of how far this thing would have spread.
In short you are dealing with a exponential growth scenario.Which is why these sort of things are so dangerous.
Everything I've read suggests that this doctor is conscientious, selfless and kind. I don't believe he would have exposed others to Ebola if he had any inclination that he was infected. He measured his temperature twice a day as was required and didn't feel sick until today.
It could be the case that he was infected 2-3 weeks ago, but since the average time of symptoms showing up is 8-10 days because he was symptom-free before leaving for nyc, he might have thought he was fine.
"A 21 day period for quarantine may result in the release of individuals with a 0.2 – 12% risk of release prior to full opportunity for the incubation to proceed."
Totally agree. It sounds like he was all over the place, and using mass transportation. If anyone needs to seek refuge out on Long Island just let me know!! :D
Before judging this man for going bowling etc., we should bear in mind that he caught Ebola working for Doctors without Borders in Guinea. I would guess that without workers like him, the risk to Americans and others outside Africa, would be much higher, since the disease would be spreading much faster within Africa. Hopefully he recovers and we can improve travel policies if necessary.
To borrow an idea from math, "doing good" isn't a commutative, infections and diseases are. Have some respect for others and slow your roll before going out during the 21 day post exposure window.
It's a bit like saying, "Hey I've saved lives over here so I have earned the right to be irresponsible over here". Because you know, karma balances out. No, the world doesn't work like that. And you aren't doing any good propagating this idea either because it encourages this privileged way of thinking.
As much as this guy isn't being vilified (and say what you want about the government spinning its story of ebola being hard to transmit), lets think clearly and rationally. He knew the risks that he could possibly be infected and decided to endanger others when he could have easily stayed home or gone anywhere to a more isolated environment (upstate NY is calling). It is well known symptoms generally show up by the 10th day. Today is his day 10.
It's very interesting that the government has locked down this guys apartment, yet if you need contact with bodily fluids to contract the disease why quarantine the apartment and surroundings? Could it be that droplets are a transmission method as many people are starting to suspect. Sneezing and coughing may spread these droplets to the floors and walls? And if that is the case, what about other objects that come in contact with saliva and other fluids like utensils, door handles, glasses...
> He knew the risks that he could possibly be infected
> and decided to endanger others when he could have
> easily stayed home
That may be over stating things. Given that he is a doctor, and he is confident in his process with keeping clean, he might actually have a really hard time believing that he was infected. People have faith in their own abilities, that lets them do things which might put them at grave risk.
In the military service you will hear it as "trust in your training." Basically you believe you won't be the guy that gets shot or steps on a land mine or what ever because you trained really hard and you know you are implementing that training flawlessly.
It is entirely possible this person was so confident in their training, and their own competence in putting that training into action, that they believed it was impossible for them to be infected. They do the self monitoring because that is what you are supposed to do, but it never comes up positive because you did what you were supposed to do. This gets worse the more times you do something and the outcome is exactly as you expect it to be.
So I can believe this guy didn't believe he was at risk. Just like I have foolishly believed this small change I am checking in can't break anything[1]. One hopes he was asymptomatic when he went out. Unlike the guy in Texas who was showing symptoms and went home, or the nurse who had a fever and got on a plane anyway.
Sure you could put anyone coming back from West Africa in an airstream trailer [2] for 21 days but that is impractical if you want to support the process of fighting it in West Africa.
[1] I know, hugely different scale, but illustrative of my fight against my own assumptions in the pursuit of better process.
"Given that he is a doctor, and he is confident in his process with keeping clean, he might actually have a really hard time believing that he was infected."
Unless you are in proper (BSL-4) lab, the sad reality is there will always be risk. I hope that MSF doctors and volunteers are well protected. But it worries me that they would even contemplate believing that they have zero risk of exposure. That's simply not scientific or a professionally responsible. Although, to be fair, the CDC was guilty of making this same assumption up until about two weeks ago.
It makes more sense for them to spend 21 days self monitoring (in a secluded environmnet) locally in country. There is no need for a complete travel ban, but a staged ingress/egress process would make sense. And certainly we don't need to be issuing sight-seeing or tourist visas etc. Critical business travel could also be easily arranged for with a built in waiting period (most visas take 2-6 weeks anyway to issue).
You can fight the deleterious effects on support of quarantining by making the quarantining fun/enjoyable/pleasant. Choose a remote resort location, rent it out for the duration of the crisis, send everyone there to sit out their quarantine in comfort.
I wouldn't mind a 21 day quarantine on a beach or camping
I don't know much (well, anything really) about disease transmission, but should these health workers not quarantine themselves away from the immediate vicinity of the infection, but before taking a cross-Atlantic/Pacific flight where they could infect a number of other people in close proximity?
I would have through the health agencies they volunteer with would enforce these kind of quarantines to prevent international transmission of disease.
On one hand I can't help admire these people risking their lives to help people on the other side of the world. On the other hand some of them seem content to play Russian roulette with their neighbors and family back home, which makes no sense to me. Is it as the OP suggested that doctors make for bad patients?
I thought it was well known that ebola can be spread through any bodily fluids and that this includes droplets from coughing and sneezing. What they don't yet know is whether ebola is 'airborne' - i.e. dried droplets that can float in air as is the case with measles for example.
If you asked 10 average people what they think "airborne" means in this context, I doubt they'd say there is a difference between wet and dry transmission. I'd say for the purposes of argument, if a guy coughs violently on you because he's sick there is risk you could get Ebola. If a guy vomits in the subway car, apparently there is a risk of Ebola transmission. I've been on the subway cars and in taxi cabs it happens more than you think. Do you think they bleach all of those things adequately? No way, the financial incentives don't align to properly do it.
The government is using semantics and spin to their advantage by saying it isn't airborne via dried viral transmission. The WHO agrees[1] that it also isn't airborne, but also admits surfaces can transmit the virus.
Most officials omit this detailed explanation since they have no adequate explanation of how to decontaminate the urban environment en masse if an outbreak does occur.
In the end we all have to assess our own risk profiles. Will I stand or sit next to somebody coughing? I doubt it. Or will I take mass transit if I can easily walk to where I need to be by leaving a bit earlier? Nope.
> I thought it was well known that ebola can be spread through any bodily fluids and that this includes droplets from coughing and sneezing. What they don't yet know is whether ebola is 'airborne' - i.e. dried droplets that can float in air as is the case with measles for example.
I would suggest to everyone: Don't comment on questions like this one (how Ebola spreads) unless you know for certain what you are saying and can back it up. We have complete saturation of rumors and bad information; adding to it won't improve the situation.
I don't mean to criticize the commenter above; they just happened to have the top-most comment of this kind.
EDIT: What a strong signal of over-reaction when a post that says you should know what you are talking about, on HN, is modded down. (I don't care how it's modded, it's just depressing to see this response here.)
EDIT: The same applies to my other post, which asks serious, legitimate questions in a non-offensive way. How sad.
Ebola and Marburg viruses are the sole members of the genus Filovirus in the family Filoviridae. There has been considerable media attention and fear generated by outbreaks of filoviruses because they can cause a severe viral hemorrhagic fever (VHF) syndrome that has a rapid onset and high mortality. Although they are not naturally transmitted by aerosol, they are highly infectious as respirable particles under laboratory conditions. For these and other reasons, filoviruses are classified as category A biological weapons. However, there is very little data from animal studies with aerosolized filoviruses. Animal models of filovirus exposure are not well characterized, and there are discrepancies between these models and what has been observed in human outbreaks. Building on published results from aerosol studies, as well as a review of the history, epidemiology, and disease course of naturally occurring outbreaks, we offer an aerobiologist's perspective on the threat posed by aerosolized filoviruses."
or
Our study has shown that Lake Victoria marburgvirus (MARV) and Zaire ebolavirus (ZEBOV) can survive for long periods in different liquid media and can also be recovered from plastic and glass surfaces at low temperatures for over 3 weeks. The decay rates of ZEBOV and Reston ebolavirus (REBOV) plus MARV within a dynamic aerosol were calculated. ZEBOV and MARV had similar decay rates, whilst REBOV showed significantly better survival within an aerosol."
What you posted is from good sources and is interesting, but I'm not sure it's conclusive or helps. They are two studies/reports of possibly many and I don't know their credibility or if they represent consensus or fringe, good science or bad. Also, they require expertise to interpret and draw conclusions from.
We're not qualified to perform our own analysis; what we need are conclusive analyses from experts about the scientific consensus and range of possibilities.
I have to believe the US Government already knows that ebola is capable of this, they've been studying it for decades. If it can spread by aerosol, they're lying to prevent substantially more panic.
Downvoters should start by refuting the linked article - it's a pretty important article. The authors are guaranteed to know a lot more about ebola than anyone here.
Why not seal off the apartment? There's pretty much no downside, so I don't think it really says much (especially assuming ~2 people regularly use it...).
Agreed. He might have been silly for being out in public right after having come back from Africa, but I'm sure he did more good over there in preventing the spread of the disease (which helps us), than he might have done when coming home. Lets hope future doctors learn from this.
"Many signs point to the viral load not being highly infectious at the beginning. Duncan was sent back to his home by the hospital and lived with his fiance who was taking care of him for two days before being readmitted. She wore no PPE yet appears to be uninfected. If sitting next to someone infected on a bus or subway is enough to pass it on, there would be a million cases in West Africa by now, not 10K. It appears to be primarily caregivers at the later stages of the disease, and the custom of kissing corpses that appear to be spreading the disease because the viral load is extreme at that stage. This doesn't mean that the potential contacts of this person should not be traced or that it was good idea for him to go bowling, but the sky isn't falling just yet."
wfjackson
https://news.ycombinator.com/item?id=8501792
Based on the timeline, he had to have contracted Ebola pretty much the day he left.
That seems pretty unusual, isn't it? How long was he there, a couple months?
"Symptoms usually occur within eight to 10 days of infection and Dr. Spencer had been home nine days when he reported feeling ill." That's not including travel time local and international.
At the same time, I wouldn't be surprised if people tend to let their guard down in the days and hours before they leave the country.
Instead of quarantining by default, I think it would be interesting to offer a free, relaxing vacation in a low population density region to people who are returning from helping in Africa. i.e. you cannot leave West Africa and return to a major city directly. Instead you fly back to your home country by way of a desirable destination and hang out there for a few weeks.
It would be really cheap for the rest of us to provide
"the basics", e.g. a flatscreen TV (get the cableco or DirectTV and/or Dish to donate service), Internet connection (ditto on trying to get it for free from a provider) and if needed a computer, and then it won't be that onerous. Historically to my knowledge we typically haven't gone the prison route outside of special cases like Typhoid Mary.
I think this is something like selection bias: had he contracted ebola earlier he wouldn't have returned to the US, or maybe would have been shipped back for treatment, which would be a very different headline.
"Background:
21 days has been regarded as the appropriate quarantine period for holding individuals potentially exposed to Ebola Virus (EV) to reduce risk of contagion. There does not appear to be a systematic discussion of the basis for this period.
Methods:
The prior estimates for incubation time to EV were examined, along with data on the first 9 months of the current outbreak. These provided estimates of the distribution of incubation times.
Results:
A 21 day period for quarantine may result in the release of individuals with a 0.2 – 12% risk of release prior to full opportunity for the incubation to proceed. It is suggested that a detailed cost-benefit assessment, including considering full transmission risks, needs to occur in order to determine the appropriate quarantine period for potentially exposed individuals."
How about "Doctor Returning From Guinea..." to more accurately reflect the geographic relationship instead of creating a bomb of a headline as if some random, yet-unknown vector resulted in Ebola in New York.
Where they just returned from makes the news highly generic, unsurprising, and it drops off the main page rapidly instead of being an attention grabber. Even the article that is linked to says "Doctor..." which at least leads me to believe that the just returned from treating someone. This is not incredibly surprising news, but if someone who just happened to be in New York with no obvious connection to the Ebola outbreak in West Africa caught Ebola, that would be pretty obviously significant since there might be someone who was unidentified and contagious in New York recently, suggesting that an outbreak could flare up in New York. News that misleads wastes time and makes money, but not my money.
Of course it's being spread from a region with an ev outbreak. That's how it works. The news is that it has now officially spread to the US and there is potential of more cases popping up soon since he wasn't quarintined.
Do location-based services work in the NYC subway? I suppose you could also infer locations and transfers based on train schedules and tower handoff times upon emerging from stations. I mean, if there is a 21-day gestation period between infection time and the ability to retransmit the disease, it seems like it would be worthwhile/possible to look into.
Apologies for the cliche 'use technology to solve all the problems' HN comment.
It would be interesting to allow people in New York to compare their phone location data with his to determine the likelihood that they had contact with this person.
It should be standard practice to give someone returning from West Africa that had contact with ebola a GPS tracking device the records their exact location for 21 days following the last know exposure.
This notion that anyone exposed to ebola is basically responsible for keeping tabs on their own well being voluntarily leaves way too much room for human error.
But you should be able to infer location from the gaps. If someone was at station A, then disappears and 2 minutes later is recorded at station be, it should be possible to know they took the train between those two stations.
Yup. There's ample data from metrocards and security cameras to follow his route. The more difficult challenge would be finding everyone he had come in contact with on those trains since data granularity of which cars he took would likely be unspecific.
This response is poor risk management. I'm not sure the risk is significant: What is the chance that someone else will get infected? Higher than the many other risks we face every day?
What is higher risk?: 1) Going to the Ebola zone in W. Africa (EDIT: And taking the proper precautions to protect yourself), 2) Walking as a pedestrian on NY streets, or 3) Sharing a subway car with someone who has been in the Ebola zone?
There are around 3 cases of Ebola in the United States. I expect most of the resultant suffering will be because the public reaction is causing us to divert resources from where they could do more good (including West Africa).
I'm not afraid of Ebola as much as the "experts" who keep intentionally misleading us about Ebola. I don't know why they do it, and that scares me. But it's very obvious that it's intentional.
I also heard on NPR that sweat contained a lot of the virus (don't have a reference handy).
Real experts don't shoot their mouth off with false assurances about a disease we don't know much about. The "hard to catch Ebola" mantra was going on long after that was discredited[1]. These aren't experts, they have some kind of agenda, and I'm not sure what it is. For some, it's probably just being on TV. For others, it's to feel smug about how the ignorant masses under them are panicking irrationally. As for the rest, probably political.
Again, I'm not panicking about Ebola. We'll have a few isolated cases in the West. It will remain in Africa in all of the hot zone countries until we have a vaccine. And hopefully that happens before it spreads to Nigeria, India, Brazil, or other areas where it might be hard to control.
I am not panicking. I am just mad at the irresponsibility of these "experts" we keep hearing from.
[1] No references here, but I think everyone remembers that the first story was that, unless you were engaging in some unsanitary funeral practices deep in an African village, it was impossible to catch. After doctors began to catch it, the story changed to be that they don't have enough resources to protect themselves. Then several Western doctors got infected while in hospitals in Western countries (Spain and the US at least), and the story changed into something about how the protocols will protect us, but were just not followed properly these few times (despite not knowing the specific protocol violations that lead to infection).
