First Ebola Diagnosis in US

[Anvilbrother 0]

It was a sarcastic comment that went right over your head.

Postes r made from an iPad or iPhone. Spelling and gramhair mistakes guaranteed move along,

[wolfriverjoe 1,523]

Anvilbrother

It was a sarcastic comment that went right over your head.

I got the sarcasm. I'm trying to have an actual discussion here.

So do you disagree with what I said, or are you just throwing out one liners because you have no valid argument?

"There are NO situations which do not call for a French Maid outfit." Lucky McSwervy

"~ya don't GET old by being weak & stupid!" - Airtwardo

[Anvilbrother 0]

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So do you disagree with what I said, or are you just throwing out one liners because you have no valid argument?

Absolutely no one here can say if anyone had the right answer about this or not.

Do we know if it ended they way it did because what we did worked? Do we know if what we did was right because we just got lucky? Do we know if what we did worked just because of the simple fact not too many people came over from Africa with it and overloaded our ability to track, control, and treat it? What would have been the outcome if 1000 people came over with it? What would happen if the states designated hospitals got overrun? How many over run hospitals could we have closed down before it started to shut down the normal emergency room operations?

You cant claim your way is the only way to work ebola in the end when we were faced with a handful of cases. Thats why I sarcastically stated next time we will do it your way, and when were faced with 1000 refugees, and 100 arrogant nurses refusing to take one for the team and isolate themselves we will see how your plan works.

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[wolfriverjoe 1,523]

A thousand people coming over here from West Africa with Ebola?

That would be a huge percentage of current cases.
I can't see that happening. Not in the real world.

Keep in mind that this outbreak has been going on since March. One doctor was brought back infected (and treated). One journalist was brought back infected (and treated). Two people brought it back with them (Duncan & Spencer). One died.

That's FOUR cases that have arrived here. Total. I don't see how you reach "thousands" from that.

The fact that there were zero cases transmitted through casual contact wasn't luck. It was the fact that Ebola doesn't transmit that easily.

And Kaci Hickox wasn't "arrogant" when she refused to "take one for the team."

She was realistic about the actual risks and refused to get railroaded into unnecessary quarantine because the politicians were panicking and posturing.

And a judge agreed with her.

I find it really hilarious that the CDC told Vinson she could travel on the airplane, yet everyone panicked when she came down with it.
So CDC backpedaled, not for any actual scientific reasons, but due to pressure from the panicking public, and ordered those who had come into contact with contagious people off of public transportation.

And keep in mind, that using the standard protocols, both Nigeria and Senegal stopped it. Both have now been considered "Ebola Free" for two or three weeks.

"There are NO situations which do not call for a French Maid outfit." Lucky McSwervy

"~ya don't GET old by being weak & stupid!" - Airtwardo

[Anvilbrother 0]

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Keep in mind that this outbreak has been going on since March. One doctor was brought back infected (and treated). One journalist was brought back infected (and treated). Two people brought it back with them (Duncan & Spencer). One died.

That's FOUR cases that have arrived here. Total. I don't see how you reach "thousands" from that.

I cant type it any slower for you, so I will have to say it another way so you might understand. You cant sit back after its over and armchair quarterback this situation and say what you would have done is the way we need to always handle it. Im fucking aware of what happened and how many cases there were in the US. The 1000 cases I mentioned was a question about how your plan would stand up to it were to happen again. Hense the reason I sarcastically stated .....Next time we will just do it your way.... 73....

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[kallend 2,027]

wolfriverjoe

***Woosh!

This outbreak has been going on since March.

The index case died Dec 6, 2013.

...

The only sure way to survive a canopy collision is not to have one.

[wmw999 2,447]

I have a relative who's an infection control nurse, married to a retired CDC doctor. I asked them about it, and the comment was that yes, it was a clusterfuck. However, given our experience in that world, it was guaranteed to be a clusterfuck, simply because we didn't know, or have the practice.

The good thing is that the healthcare system appears to be learning. Not so sure about the politicians.

Only in retrospect do people always make the right decisions. That's how we spend the time in the incidents forum, too

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[wolfriverjoe 1,523]

Anvilbrother

I cant type it any slower for you, so I will have to say it another way so you might understand. You cant sit back after its over and armchair quarterback this situation and say what you would have done is the way we need to always handle it. Im fucking aware of what happened and how many cases there were in the US. The 1000 cases I mentioned was a question about how your plan would stand up to it were to happen again. Hense the reason I sarcastically stated .....Next time we will just do it your way.... 73....

I don't see any realistic way that we could reach "thousands" of cases here in the US. At all.
It doesn't spread that easily.
Standard BBP protocols work.

All of the ideas of quarantining people who weren't contagious is stupid. That's not my way, that's just basic science. It's what doctors & healthcare experts have been saying all along. It was the politicians and the public (aided quite handily by the media, as Jerry pointed out) who freaked out and started calling for some stupid overreactive measures.
I have to wonder how Christie will answer any questions about this if he runs for Pres. Obama called for calm and reason. Christie threw a nurse who had been helping the sick overseas into a pretty spartan jail, even though she had no symptoms and tested negative.

To repeat, the disease has been stopped in Nigeria. Which is truly a 3rd world country. The government is corrupt, the infrastructure is poor, the healthcare system is pretty primitive. And they didn't get "thousands" of cases.

The only reason that the epidemic has gone on as long as it has in Liberia and Sierra Leone is because their infrastructure is totally trashed, the government is useless and the people don't have a basic understanding of how viruses work & spread.
That is changing, however. Apparently most places where people may gather now have "Ebola Buckets", buckets containing a bleach solution for disinfecting things (heard that on NPR).

"There are NO situations which do not call for a French Maid outfit." Lucky McSwervy

"~ya don't GET old by being weak & stupid!" - Airtwardo

[jakee 1,489]

kelpdiver

"It comes in as one person here and there, "

You didn't use the word if, but it certainly belongs there.

So what's going to happen? How are you going to get 50 people with Ebola turning up at once? Plague ship in New Jersey?

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***
So why assume that 'next time' (if there is one) will be different?

because assuming the happy path is reckless. That Dallas hospital didn't do well with the light case. The CDC check having to restate their realities. Governors did lots of stupid shit. All sorts of stuff to improve even with this easy one.

Right. Everyone fucked up. It was chaos. Ebola flying around everywhere. Anyone could have caught it! And... they didn't. So with those lessons learned, why is it going to be a mass outbreak next time?

Do you want to have an ideagasm?

[jakee 1,489]

Anvilbrother

Thats why I sarcastically stated next time we will do it your way, and when were faced with 1000 refugees, and 100 arrogant nurses refusing to take one for the team and isolate themselves we will see how your plan works.

Oh yeah? And what are you going to do when a Somalian comes to your house and makes you eat Ebola? How's your plan going to work out for you then, smart guy?

Because both of those things are totally going to happen.

Do you want to have an ideagasm?

[kelpdiver 2]

jakee

So what's going to happen? How are you going to get 50 people with Ebola turning up at once? Plague ship in New Jersey?

This last year saw more cases in Africa then in its prior combined history. Larger outbreaks = larger potential for cases here, esp if the belief is that its 60-70% lethal there and < 20% here. And if we want to be dramatic in the hollywood style, mutations can change the equation considerably.

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Right. Everyone fucked up. It was chaos. Ebola flying around everywhere. Anyone could have caught it! And... they didn't. So with those lessons learned, why is it going to be a mass outbreak next time?

Were lessons learned? Or will they be quickly forgotten?

To repeat, to assume a happy path is stupid, Jake. The threat is more likely to be one of these asian flu variants, but the legwork is similar.

[jakee 1,489]

kelpdiver

This last year saw more cases in Africa then in its prior combined history. Larger outbreaks = larger potential for cases here, esp if the belief is that its 60-70% lethal there and < 20% here.

We know why outbreaks get started in west Africa and we know why it's harder for them to contain it. That's no reason to assume there's any likelihood of a mass outbreak in the first world.

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And if we want to be dramatic in the hollywood style, mutations can change the equation considerably.

Even less reason to worry about Ebola then. Sure it could mutate into some kind of raging super virus of doom, but so could anything else. Ebola gets lost in the noise if you think about every virus that could potentially become nasty.

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To repeat, to assume a happy path is stupid, Jake.

And to assume the apocalypse is daft. The way it's played out every time so far shows that Ebola is not a major threat in the first world. It's not very hard to contain. Why you're so determined that there's a case around the corner that's going to rip up the rule book and bring about doomsday I have no idea - but it's not a situation that's based on reality.

Do you want to have an ideagasm?

[davjohns 1]

Over 5,000 people have died of ebola this year.

In 2012, the WHO estimates over 627,000 people died of malaria.

Context would suggest there was something to this hysteria other than the number of deaths.

Just an observation.

David

I know it just wouldnt be right to kill all the stupid people that we meet..

But do you think it would be appropriate to just remove all of the warning labels and let nature take its course.

[jakee 1,489]

Fully agreed. I made the point a bunch if pages back that, harsh as it sounds, Ebola isn't even a major health crisis in Africa.

Tetanus is a far bigger killer year after year but it's not a sexy enough disease for anyone to give a shit. If your criteria for worrying about diseases is whether Michael Crichton could write a book about it then OMG Ebola!!! If it's about what is actually killing large numbers of people then it's fairly low down a pretty long list.

Do you want to have an ideagasm?

[kallend 2,027]

davjohns

Over 5,000 people have died of ebola this year.

In 2012, the WHO estimates over 627,000 people died of malaria.

Context would suggest there was something to this hysteria other than the number of deaths.

Just an observation.

David

Opportunity to take cheap shots at Obama before the elections. Notice how the politicians have shut up now that the election is over.

...

The only sure way to survive a canopy collision is not to have one.

[Anvilbrother 0]

Why are you even talking about Tetanus? There was NEVER a question about what kills more people. Its the fact that Ebola can be spread.

http://www.sciencedaily.com/releases/2014/09/140911130048.htm

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Researchers Gerardo Chowell-Puente, ASU School of Human Evolution and Social Change Associate Professor, and Hiroshi Nishiura of the University of Tokyo found that transmission rates for each single case of Ebola consistently showed at least one new case of the disease being transmitted. Country-specific analysis of transmission rates in Liberia and Sierra Leone showed on average between one and two new cases for every existing case.

"Our analysis of the reproduction numbers of Ebola cases shows continuous growth from June to August 2014 that signalled a major epidemic," Nishiura said. "Uncontrolled cross-border transmission could fuel a major epidemic to take off in new geographical areas as was seen in Liberia."

I guess your smarter than all these people, so lets go with your plan next time also...........

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[jakee 1,489]

Anvilbrother

Why are you even talking about Tetanus?

Why are you talking about Ebola?

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Its the fact that Ebola can be spread.

Yeah? So? There are plenty of contagious diseases that kill far more people every year.

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I guess your smarter than all these people,

What exactly do you think they wrote that contradicts anything I'm saying?

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so lets go with your plan next time also...........

Yep, that'd be great. I'm so glad you're seeing the light.

Do you want to have an ideagasm?

[wolfriverjoe 1,523]

davjohns

Over 5,000 people have died of ebola this year.

In 2012, the WHO estimates over 627,000 people died of malaria.

Context would suggest there was something to this hysteria other than the number of deaths.

Just an observation.

David

Sure. It's a hemorrhagic fever. Pretty ugly way to die.

There's no vaccine for it. No way (other than not exposing yourself to body fluids of an infected and symptomatic person) to prevent it.

It's got a high fatality rate. Over in Africa it's well over 50% fatal. Here in the US, with first world healthcare and a few experimental treatments, the death rate is lower. But it's still very dangerous.

It's rare. So it's an "unknown" to most people. Tetanus, malaria, and all the other diseases that are far more serious threats have been around a while. Plus they don't have anywhere near as high of a fatality rate, so they aren't as scary for both reasons.

People have seen "Outbreak", where the star disease is similar to Ebola. They've read the "Hot Zone", which was the story of the Reston variant.

They know how the flu and/or rhino virus (common cold) is transmitted and assume that Ebola is similar.

There are a bazillion websites that are posting scary stories and nobody seems to understand the concept of "critical thinking" or factchecking.

Throw in the political crap (a month or so before elections) and you have the perfect conditions for "Chicken Little" syndrome.

"There are NO situations which do not call for a French Maid outfit." Lucky McSwervy

"~ya don't GET old by being weak & stupid!" - Airtwardo

[kelpdiver 2]

wolfriverjoe

It's rare. So it's an "unknown" to most people. Tetanus, malaria, and all the other diseases that are far more serious threats have been around a while. Plus they don't have anywhere near as high of a fatality rate, so they aren't as scary for both reasons.

How can tentanus rate as a serious threat in America? It's a shot every 10 years. And even for the anti vaccination wackos, you can get the shot after the bite or stepping on nail and still be protected.

[kelpdiver 2]

jakee

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To repeat, to assume a happy path is stupid, Jake.

And to assume the apocalypse is daft.

Which is a false dichotomy. Planning for a variety of scenarios is hardly presuming the worst case. You would advocate a reactive approach rather than a proactive. Your funeral.

I spend most of my hours at work engineering for reliable infrastructure at scale The old school happy path is to try to prevent failures from happening. That's your happy path.

Modern thought acknowledges that failures will occur and the focus is on recovery process. That prepares you for a much great range of severities.

MTTR > MTBF.

[jakee 1,489]

***

You have been talking about what will happen when we see a mass outbreak in the first world rather than if we see a mass outbreak in the first world. That's the presumption. Especially since I've asked several times how it's going to happen and you've only been able to come up with 'maybe it'll mutate'. In which case the plans you've made for Ebola as it is transmitted now might be useless anyway.

Current Ebola plans are good enough even when a bunch of people screw up. Now people are expecting it they're less likely to screw up. So why assume next time's going to be worse?

Do you want to have an ideagasm?

[billvon 2,991]

>To repeat, to assume a happy path is stupid, Jake.

And no one is. No one is suggesting "just don't do anything and everything will be fine." Between those two strawman positions - don't do anything, and panic! panic! panic! - there's a more reasonable course of action. Indeed, so far it has proven to work.

[kelpdiver 2]

billvon

>To repeat, to assume a happy path is stupid, Jake.

And no one is. No one is suggesting "just don't do anything and everything will be fine." Between those two strawman positions - don't do anything, and panic! panic! panic! - there's a more reasonable course of action. Indeed, so far it has proven to work.

Jake has made quite a few postings indicating a belief that what we saw was as bad as it can be, including the one just before your's. In an effort to counteract a strawman argument of PANIC PANIC, he's doing precisely the same on the other end of the spectrum.

[wolfriverjoe 1,523]

kelpdiver

***>To repeat, to assume a happy path is stupid, Jake.

And no one is. No one is suggesting "just don't do anything and everything will be fine." Between those two strawman positions - don't do anything, and panic! panic! panic! - there's a more reasonable course of action. Indeed, so far it has proven to work.

Jake has made quite a few postings indicating a belief that what we saw was as bad as it can be, including the one just before your's. In an effort to counteract a strawman argument of PANIC PANIC, he's doing precisely the same on the other end of the spectrum.

I'm not seeing Jakee doing that.

I'm certainly not.

What we saw was what we are likely to see. A few people coming back who have been infected, but are not yet symptomatic (and therefore aren't contagious yet).

The idea of "thousands" of cases is pretty unrealistic. At current infection levels, that would require about 1/3 the population of Liberia to come over here to bring that many cases (assuming a random sample).
Most Liberians are too poor to be able to afford it. The rich ones are educated enough to know how to (mostly) avoid getting infected.

The CDC has recommendations based on the level of risk the person has of being infected.

Duncan made it pretty clear that self assessment of that risk isn't going to be perfect, and direct monitoring of people coming from West Africa is the current standard for just about everyone coming in from the affected areas.

But quarantining people who show no real symptoms is stupid. But then, so many people are pretty much idiots. Like the students at the school where Kaci Hickox's boyfriend used to attend.
You'd think that nursing students would understand how diseases are transmitted and the level of risk both of them presented (very low).
You'd think that a school that teaches nurses would make an effort to keep their students from threatening and intimidating someone who isn't a health risk.

http://www.pressherald.com/2014/11/07/kaci-hickox-boyfriend-leaving-maine-after-ebola-quarantine/

But they didn't. They wanted to balance "overall concerns of the community."

Keep in mind the story of Chicken Little. He was so concerned about the sky falling and telling the king about it that he completely ignored the very real threat that the individual who claimed to be the king wasn't. And paid the price.

"There are NO situations which do not call for a French Maid outfit." Lucky McSwervy

"~ya don't GET old by being weak & stupid!" - Airtwardo

[champu 1]

kelpdiver

MTTR > MTBF

I'd hope not or else your system wouldn't be very useful...



...I know you meant "more important than" not "greater than" but I couldn't help but imagine a person running around a bunch of racks of equipment with a fire extinguisher as more and more components burst into flames faster than they could be put out.