Monday, October 27, 2014

More Restrictions, Same Level Of Intelligence - updated



MINNESOTA:
Medical Personnel potentially exposed to Ebola while treating patients in west Africa will be confined to their homes for 21 days when they return to Minnesota, state health officials announced Monday, as authorities across the nation continued grapple with appropriate safeguards against the deadly virus.
Gov. Mark Dayton, joined by experts including the Health Department’s chief attorney and a leading University of Minnesota bioethicist, said such restrictions might be burdensome, but they would give the state the best chance to keep Ebola from spreading if someone brings the virus into the state.
“My number one priority is to do whatever will best protect all Minnesotans from exposure to this disease,” Dayton said.
Restrictions would vary for other travelers returning from Liberia, Guinea and Sierra Leone — the three nations at the center of the Ebola outbreak — depending on their perceived risk levels, state officials explained. Those who simply traveled to those countries to visit relatives would be asked to submit to daily health monitoring when they return to the state. Health care providers who cared for Ebola patients but had no known exposure to the virus would not need home confinement. Health care providers with potential exposures, such as being stuck with a needle while caring for an Ebola patient, would be confined at home.                                            Minnesota has the added concern of a robust population of 30,000 residents from Liberia who might travel back to the country or host relatives from there. All travelers returning from the West African nations would be subject to travel restrictions. Those potentially exposed to Ebola during their travels would be banned from public transportation, while all travelers under monitoring would be asked to refrain from trips using public transportation lasting longer than three hours.
 Because apparently not being exposed, and travelling around for LESS than 3 hours is totally cool; like say, getting meatball sandwiches, or going bowling.
But hey, they're being "asked to refrain".
Maybe they could try that out for all other threats to the community, like robbers and such.
Jackasses!

FLORIDA:
(AP) Florida Gov. Rick Scott is ordering twice daily monitoring for anyone returning from places the U.S. Centers for Disease Control and Prevention designates as affected by Ebola.
Scott signed the order Saturday, giving the Florida Health Department authority to monitor individuals for 21 days. Scott said in a press release that his administration had asked the CDC to identify risk levels of returning individuals from specific parts of Guinea, Liberia and Sierra Leone, requesting information specifically about the risk level for four people who had already returned. His office said that the CDC had identified the four individuals who faced some risk but had not provided the levels of risk.
"Therefore, we are moving quickly to require the four individuals who have returned to Florida already - and anyone in the future who will return to Florida from an Ebola area - to take part in twice daily 21-day health evaluations with DOH personnel," he said.

Thus both states get to perform CYA, make it feel like they're "doing something", but without either actually pissing off Washington D.C. minions, or actually protecting the public.
Genius. These guys could trade Magic Beans for cows.

These beans are GUARANTEED to protect you from Ebola!
 
UPDATE:
Georgia says "Me six!":
Georgia Governor Nathan Deal is ramping up monitoring for all travelers coming to Georgia from Ebola-affected countries.
“We are taking every necessary precaution to ensure that Georgia stands prepared to manage the risks associated with Ebola,” Deal said.
Atlanta's Hartsfield-Jackson International Airport is one of five airports in the U.S. that is a designated point of entry for travelers from Guinea, Liberia and Sierra Leone.
"I have developed, in coordination with my Ebola Response Team, a policy to more aggressively monitor travelers from affected countries, symptomatic or not, and quarantine if need be. We are taking these proactive steps to protect the health of the people of our state, and this new policy is an altogether effective and appropriate response at this time," Deal said.
Previous policy for West African travelers required checking for symptoms and isolating any symptomatic passengers. In accordance with Deal's plan, travelers who show no symptoms will be placed in one of three categories for further monitoring.
  • Category 1, high risk – Travelers with known direct exposure to an Ebola patient. Travelers in this category will be subject to quarantine at a designated facility.
  • Category 2, low risk – Travelers from affected area with no known exposure to an Ebola patient. Travelers in this category will sign a monitoring agreement with the Georgia Department of Public Health. This agreement requires travelers to conduct temperature and symptom self-checks twice per day and report results to Public Health once per day (electronic, email or phone contact acceptable). Travelers who fail to report during the 21-day incubation period will be contacted by Public Health and issued a mandatory quarantine order if necessary.
  • Category 3 – Medical personnel actively involved in treating Ebola patients returning to the United States. Individuals in this category will be issued a 21-day active monitoring order and will be visually monitored (video communications or home visit) by Public Health twice per day. Public Health will assess for the development of symptoms and adjust restrictions as necessary. Noncompliance will result in quarantine at a state-designated facility.

14 comments:

Anonymous said...

I have quarantined one of my clients since she returned from west africa on 9/29.
Pretty pointless though as the client has been working since that return date.She is a UPS pilot.
I think the quarantine duration is incorrect, do you think five weeks is enough ?

Anonymous said...

Question

Ebola is supposedly not contagious and not detectable until it is contagious and detectable by blood test. Has anyone performed a study of when Ebola is detectable, and when it starts becoming contagious?

If we are monitoring med workers returning twice a day? Can they take blood samples, other (mucous, stool, sweat, urine?) samples along with their temperature?

If the subject is not infected, the samples are useless. BUT if they are infected, it would be a way to prove how Ebola actually progresses. When is it detectable in the blood? In other fluids? Is it before or after they develop a fever? As a lay person have not seen any good information, other than a lot of contradictory information/ hearsay/ Bull Shit in the MSM.

Thought?

Grouch, MD said...

95% of Ebola patients exposed to the virus develop symptoms within 21 days. The 99% cutoff is 41 days. But to be frank, there is a huge spike between 4-10 days, this 21 or 41 days represent a very long, small tail on the graph. Pick your comfort level appropriately.

Grouch, MD said...

Anonymous, the following is a very good summary of what is known about Ebola transmission from past outbreaks. They do mention the detection limit, but no one has directly evaluated the contagion threshold, as that is considered unethical.
http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html?mobile=nocontent

ASM826 said...

I made a post and linked back to your blog. It might bump your readership. I think you have been nailing it with your recent posts.

http://borepatch.blogspot.com/2014/10/ebola-question.html

Anonymous said...

Dr. Grouch,

Thank you.

Miles said...

It is being reported that Belleview Hospital has had to transfer their ICU patients to another hospital because that staff is needed to support the care of the Ebola patient.

http://online.wsj.com/articles/bellevue-home-to-ebola-unit-moves-patients-to-nyu-1414442697

Able said...

Dr. Grouch & Aesop

Forgive me if I'm wrong but the study I read stated that 95% of infected became 'febrile' within 21 days not otherwise generally symptomatic. If the other studies indicating that an unknown percentage (3-13%) never become febrile then just what is the point of monitoring patients temperature as an indicator of infection? And what exactly is the point in reassuring people that if they are asymptomatic at 21 days then all is well, when it very well may not be?

Personally I am still of the mind that a total quarantine of 'all' from the regions with infected is required (since we already have an example of someone blatantly denying close contact when explicitly questioned, and medical personnel pretending they were untouchable, and knowing exactly what they did when they did so), and that a sixty day quarantine is warranted since that is the only point it is guaranteed 'all' infected will have shown symptoms, or not, unless and until a sufficiently accurate test is available to discount those persons.

We don't have the luxury of allowing that 5% or even 1% in, since all it could potentially take is one unknown, untracked and unmonitored person to start a pandemic.

I also still have issue with the (still constantly harped on) blanket assertion that it is purely through direct contact (including droplet) when the evidence existing for aerosol/nebulised transmission in primates is well documented with the only provisor being 'it would be unethical to experiment on humans' to identify/rule out this mode of transmission when, I would again suggest, sufficient examples already exist which raise this as entirely possible, at the least.

It seems we should be admitting 'we don't know' rather than stating 'this won't happen' when we haven't any evidence it can't, and plenty that it may. This really smacks, even now, way too much of an exercise in managing possible panic/PR rather than anything whatsoever to do with containing an infectious disease (a la Reston).

Also I'd be grateful if you could point out any evidence regarding how long viral particles remain active on surfaces (wet and/or dry) (since E. Reston was proven to remain active >5 days) that you are aware of. Since in so many, of the few historical cases, remain with unidentified routes of transmission, I'd hate to think we are ignoring what may turn out to be a major issue.

Aesop said...

The same thing happened at THP-Dallas.

Even one Ebola patient severely compromises that hospital's ability to care for all patients.

That creates huge problems: when a patient comes through the ER, or leaves surgery, and the ICU is closed because of Doctor Ebolawalker, that patient requires an expensive and dangerous inter-facility transport.

This risks patients dying because there's no place at that hospital for them, and now they have to be moved across town when they're at their most fragile, and also creating a non-zero risk from discontinuity of care when you change doctors, nurses, charting systems, follow-up, etc.

And all of that can be laid on back of the dickhead that's is sitting in their ICU, blocking all the other beds single-handedly.

Now imagine NYC gets a second patient, and they lose another hospital's ICU.

In any major city, the number of available critical care beds is rarely abundant, and at times there are not only none, but a backlog of patients needing care there they can't get.

ICU patients are the sickest of the sick.

And now we lose entire wards, because they're being used for do-gooder dilettantes.

F*** that.
Move him out to one of the BL4 iso wards, set up a separate Ebola facility locally, or ship him back to the Ebola treatment center he left in W. Africa.

Keeping him at Bellevue is risking many more lives than just his own.

He made the choice to go there, let him bear the brunt of the risks as well.

Anonymous said...

Folks may want to look at this: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2010.04778.x/pdf

Ebola virion survival on surfaces is a potential problem according to the article for up to 50 days under the longest conditions they could come up with.

Bill K.

Anonymous said...

Thank you all for concise, truthful, accurate and honest reportage. The question was put "when" vis' a vis' folks may desire to 'self isolate' to prevent exposure... here in my little part of Gethef**kouttahere, the neighbors and I are of one accord. Ebama...er, Obola.... oh you know what I mean, gets anywhere within a hunnert miles o'here, and we're closed. Don't even point in this direction, or the disease you'll die from will be lead poisoning. Those pansies in .gov maybe lack the stones for hard decisions, we seem to have already reached consensus... s f

mike18xx said...

Meanwhile, out in the ass end of nowhere (NewsWatch Sierra Leone):

"These individuals blatantly defy the local laws by escaping with their sick relatives and friends to nearby villages in search of traditional cure..."

Robin Datta said...

Ebola passed from swine to primates via air or (perhaps worse!) floor sweepings. No need to worry about transmission through the air, but wear powered respirators when taking care of ebola patients.

Don't panic! Everyone dies sooner or later ...

Aesop said...

Able:
Nothing is perfect, esp. with a disease we really know so little about. So at some point it comes down to playing the best odds. And where people are concerned, with safety being the primary concern.

With 150 people/day coming here, I could live with a quarantine no stricter than the classic 40 days isolation (which is where we got the word 'quarantine'). That's 99 and some fraction%, which is as good as you'll ever get short of a permanent ban forever (which would be frankly crazy, IMO).

But TPTB doing a whole lot more "We don't know" and a lot less "This will work absolutely" would go a long way towards staying ahead of the panic curve while still taking prudent steps.

People don't panic when you tell them the truth, even when that is "we don't know, but here's what we think is playing it safe". They panic when you BS them, and they catch you.

Which has been the CDC/.gov/media M.O. on this since before Ebola first got to the US.