Did Duncan know he had been exposed to Ebola…
…by the time he left Liberia, and did he lie about it in a form he signed on leaving the country? That’s the meme that’s been spreading, and it’s now widely believed.
I don’t buy it. I’m writing a piece on the subject that I might submit to PJ or some other publication if all goes well. But till then, I’d just like you to read this article and mull it over.
The gist of it is that the ill woman’s family was in denial of her Ebola status, and so was the village. So, why believe that Duncan was the only one of them who knew the truth? The people in the town are now angry at the dead woman’s family for supposedly lying to them and allowing their exposure to Ebola, which they apparently only realized days later was the disease Marthalene Williams must have died from, after several of her relatives had grown sick and died. By that time, Duncan was already in the US, and starting to become ill himself.
It’s a very plausible story, knowing human nature and the propensity for denial. You could say Duncan and the others should have known, but that’s different from saying he did know and lied about it. I’m not at all certain that Williams’ parents and family were lying, either; they could easily have rationalized that her symptoms were complications of pregnancy and/or malaria, especially if they were people who lacked medical sophistication.
[ADDENDUM 10/9: Several people have asked me questions about the fact that the LA Times article linked in this post mentions that the family took the pregnant woman, Marthalene Williams, to an ebola clinic that evening, along other medical facilities. I responded to that in a comment, but I thought it important enough to add as an addendum here as well.
I have read perhaps 25 or more articles describing what happened in Liberia with Duncan and the woman who died, and the articles differ somewhat on the facts, and there’s very little sourcing. However, although some of the articles cite the family (and Duncan) as having taken her to an ebola clinic, the vast majority of the articles cite “hospitals” and do not mention ebola clinics.
I referred to that LA Times article not because every word in it is gospel or completely clear (for example, it’s not clear why or how she went to an ebola clinic, since she’d actually been told at another clinic that same evening that she had malaria). I referred to it for the story of how the village reacted and what it knew, which seems consistent with the timeline and the behavior of Duncan as well.
For example (from the same article) [emphasis mine]:
A chain of confusion and denial links the Dallas apartment complex to which he moved to a dark green house about 30 yards from Duncan’s door in Liberia, where the desperate family of a dying pregnant woman treated her illness as malaria…
Duncan had ridden in a taxi with Marthalene, who was seven months pregnant and desperately ill, as they crisscrossed the Liberian capital, Monrovia, going from a clinic to two hospitals, trying to get her admitted. With them were her father, Emmanuel, and brother Sonny Boy.
From the clinic, where she was given an intravenous drip but deteriorated sharply, they were sent to an Ebola treatment unit and then another, at a time when there were no Ebola beds available in the city…
It’s unclear whether the Williamses knowingly misled people, as angry neighbors charge, or whether they were simply convinced that Marthalene didn’t have the virus, like so many other desperate families in Liberia.
And if it was unclear what the Williams family knew or didn’t know about what she actually had, it’s even MORE unclear what Duncan knew or didn’t know, since he (a) wasn’t a family member, and (b) was riding in a cab to help carry her, not in charge of any decisions and probably not even privy to the medical decisions or even the discussions between the family and the medical staff. It sounds to me as though the family went from medical facility to medical facility trying to get her a bed somewhere, because they knew she was critically ill, and so they went everywhere, and there was no room in any hospital of any type.
There there’s this:
What happened in Paynesville is common in parts of West Africa where Ebola has been spreading. When a loved one becomes ill, family members assume, or hope, that it’s something else. They buy malaria, typhoid and headache medicine from a drugstore, or from a nurse, as Marthalene did. They wash and care for the sick person, moving them and touching them and their clothing, and the infection circle widens a little further.
So, what did the family know? We don’t know. But it’s safe to assume that, whatever they family knew (and I doubt they knew all that much, although they might have suspected something), Duncan knew considerably less. The community also knew less:
According to neighbors, people in the community didn’t realize until Wednesday that Marthalene Williams had died of Ebola. That was the day that two other people died ”” her brother Sonny Boy and her close neighbor Sarah Smith ”” and news emerged of Duncan’s illness in Texas.
The neighbors—who knew she had taken ill and died, and participated in funeral rites for the her without knowing how she died—did not know she died of Ebola till others had taken sick, and Duncan was already sick by that point.
So people who read an article here and there about it, and who are confidently saying “he lied; he knew” are just not basing that on a preponderance of evidence. I see the bulk of the evidence as going against the notion that he knew—and that evidence includes (as I have said several times) the fact that if he knew, it makes no sense that he failed to inform the Dallas hospital of his exposure.
I think this man pretty much sums up the mindset that Duncan probably had. This man more or less played the same role, and had the same relationship to the Williams family, and has no apparent reason to lie:
Like Duncan, Robert Garway rents a room from the Williams family, his house one pace away from theirs. When he and his wife, Sarah Smith, heard that the landlord’s daughter was sick, he thought they should pitch in, as Duncan did. They helped move Marthalene and touched her. It was difficult to say no to the landlord.
“We thought it was a fever or some other thing. There were plenty of people who touched her, and I was among them,” Garway said, speaking on his cellphone from an Ebola unit where he is undergoing treatment.
Also this:
As a crowd gathered and the shouting grew louder, accusations flew. Some claimed that she had vomited on Duncan. Some said that she had bled from the mouth. Others said the family lied and said she’d been injured in a car accident. Few of the accusations were consistent, other than the general outrage that the family told neighbors she had died of “low blood,” or low blood pressure, and pregnancy complications.
But the Blessing Home Clinic, which examined Marthalene on Sept. 15, had diagnosed malaria, according to staffers. When she started convulsing, they told the family to take her to a hospital.
That’s all from the same article. And yet some people think that, because at one point she apparently was at an ebola clinic, the family and friends knew (including Duncan) that she had ebola? I think, on the contrary, the confusion and lack of knowledge are apparent.
In Africa, by the way, death from pregnancy-related complications or from malaria are common—probably a good deal more common than Ebola. For example, in Liberia, “According to the 2009 Health Facility Survey (prior to the ebola epidemic there), malaria accounts for 34.6% of outpatient visits and 33% of in-patient deaths.” That’s a lot of very serious cases of malaria. And the maternal mortality rate in Liberia is 770 per 100,000 live births. Compare that to the US, 18.5 per 100,000 live births. So you can see why it was very plausible that she had died of either malaria or pregnancy (and convulsions, her main symptom, are the main symptom of a pregnancy-related illness called eclampsia, which is sometimes fatal).
Putting it all together, it is far more likely he didn’t know she had ebola than that he knew. It only became clear to people after he and the others had become ill themselves.]
If Duncan’s IQ was high enough, he would have realized it too in time if he thought about it. Especially if he was internet savvy.
But that doesn’t quite explain his job quitting thing.
Ymarsakar:
You are underestimating the force of denial and looking on the bright side.
I already linked to an article (don’t have time to find it at the moment) saying that Duncan quit his job on September 4. He helped Ms. Williams on September 15.
No connection whatsoever. The timeline is key.
Also, he appears to have gotten his visa to leave Liberia some time before September 15, as well. I’m still looking for where I read that. But since he left Liberia on the morning of Sept. 19, one would think it logical that he made his plans to leave before the 15th.
“It’s unclear whether the Williamses knowingly misled people, as angry neighbors charge, or whether they were simply convinced that Marthalene didn’t have the virus, like so many other desperate families in Liberia.” Oh. I see. Unclear.Wow.
Look at the 1st photo in Neo’s link, and tell me why we should seriously contemplate anything these people “think” about illnesses. It is amazing that Duncan could live like this and scarf up the price of an airline ticket.
Sitting in jury, I’d have to give T.E.D. the benefit of the doubt.
As a poster I can see it easily going both ways.
The cynic in me argues that the poor, deceased woman was carrying his child.
The saint in me argues that the gal was merely the daughter of his landlord/ employer/ significant clan member and Duncan was being charitable.
(The narrative coming out of Liberia is seldom confirmed and seems to drift and spin with each day. A fair number of those interviewed and cited, in retrospect, seem to have been guessing.)
In our own media, the record is replete with garbled tales and agitprop. Some of the biggest stories take years to parse.
&&&&
I have to admit, that if I were in Duncan’s shoes I’d want to get out… But I would’ve sought treatment in Europe… ASAP.
Every minute of delay is wholly against the interest of survival.
Yet, Duncan spent an ocean of time getting into the ER and even then was remarkably placid about being thrown back onto the street.
Such behavior is consistent with a man who still thinks he has got something other than ebola.
I strongly suspect that he didn’t even comprehend that he had a viral infection — making all antibiotics useless.
It also points to additional error in the ER. They didn’t comprehend that he had a viral infection.
&&&
There is one term of art that I see quite a bit of: Incubation Period.
No virus in existence ever had an incubation period…
The term comes out of the chicken coop. Fertilized eggs have incubation periods. Bacteria and viruses don’t reproduce that way at all.
Bacteria reproduce by fission. That tempo swings up and down based upon temperature, food supply, proximity to toxins, etc.
Viruses reproduce by hijacking host cells. They begin reproducing additional copies of themselves almost instantaneously. Being so small, dozens to hundreds of copies are created until the victim cell runs out of proteins — and the cell wall ruptures for lack of repair/ internal attack.
For all practical purposes, the incubation period for any virus is nil.
It was medical presumption — in the 19th Century — that adopted the concept of ‘incubation period’ directly from the chicken coop in an attempt to explain the lack of early on-set symptoms.
The understanding that both bacteria and viruses reproduce exponentially from itsy bitsy infection was lacking.
&&&
Thus, all the happy talk about victims not being able to transmit ebola — or any other infectious agent — because of an “incubation period” is pure fantasy. It also indicates that the speaker hasn’t got a CLUE as to how exponential reproduction operates.
The scientific truth is that anyone infected becomes able to pass it on to another in extremely short order.
The only thing restraining this effect is that when concentrations are very, very, low random chance causes the infectious virus to fly astray without crossing our natural defenses. These swing up and down based upon just how intimate we are with a carrier.
Even when a virus infect a new victim, most of the ejecta that transferred that virus went astray. Because of our natural defenses, it may well be that it takes 100,000 viral bodies to statistically get even one copy into our system.
That sounds good… until one comprehends that in the later stages a carrier is emitting staggering numbers at every turn. Even one-in-a-million is stiff odds when billions are to hand.
All of which is a long way to say that the particular weakness of any given ebola virus is practically irrelevant. It’s the one-in-ten-million ebola virus that got into your system that has a shot at killing you.
It’ll get rolling, fast. Your immune system won’t even kick in — at all — until a number of generations have burst forth. It’s at this point your T-cells start mapping onto this new threat — and begins a counter attack. Eventually, this process becomes so intense that a victim’s temperature becomes elevated.
It’s important to note that the elevated temperature is a DELAYED immune response. It’s an indication that the immune system has mobilized for total war.
Any victim has plenty of ebola in them BEFORE the body elevates its temperature.
And, the victim is certainly contagious BEFORE their body temperature takes off. We’re talking about levels of intensity here. There simply is no time when one can state that it’s impossible to pass on the infection. The risk merely starts out really, really, low and exponentiates away until victim death.
&&&
The above dynamic informs us that we can drastically reduce the transmission of the virus by merely wearing a face mask. While nothing is perfect, it’s most likely that ebola is getting into its next victim via the lungs.
Anyone who smokes is at dire risk of ebola passing through damaged lung tissues. Anyone with any gum issues is at risk; most adults have troubles there. Any cuts or abrasions have to be treated, ASAP, lest ebola leak in.
China famously follows this protocol whenever it has an epidemic. It largely works. Even cheapo face masks have a drastic impact on airborne transmissions.
&&&
Which brings us back to west Africa. The First World ought to parachute in massive quantities of face masks, gloves and cleaning agents. The full body haz-mat gear is a total bust in that climate.
The rate of ebola transmission could well collapse if everybody is running around in face masks.
This is something that could be done in short order.
Face masks for everybody would be almost as effective as having given the entire population immunity.
This should be buttressed by regular washdowns / showers with anti-viral soaps.
Frustrating the rate of transmission should be the first stage in shutting down this epidemic — before it flips all the way into a pandemic.
Curiously, even in Dallas, no-one is wearing face masks — when they cost peanuts — and are ready to hand.
Think about THAT!
blert:
There is no evidence of any kind that Duncan was the father of Williams’ child.
No one has asserted it in the town where they lived. Plus, many people helped when Williams became ill, not just Duncan:
All the evidence is that he was a Good Samaritan who thought he was helping the family of a young pregnant woman who was ill. There aren’t even any rumors otherwise from people in his neighborhood.
blert- the Dallas situation is a travesty, a circus of incompetence.
As to your dislike of “incubation period”, it is still handy: from the time of inoculation to the onset of clinical illness. Helps define the duration of quarantine (or anxiety).
You are underestimating the force of denial and looking on the bright side.
I’m looking on the side that doesn’t have any answer. Because as usual, they can’t explain something so they ignore it.
Don Carlos:
Yes, unclear.
By the way, have you read this?
Yamasakar:
What are you referring to when you write, ” they can’t explain something so they ignore it”? What is the “something”? Who is the “they”?
I tend to agree with Neo. If Duncan had thought he had Ebola when he left for the U.S. and was coming here for medical care, then he would have made it very clear to the hospital in Dallas the first night he went there that he’d been exposed to the virus.
That photo (in the linked article) of the house Duncan lived in in Liberia makes this ring true:
And I bet many of the Liberians living in the U.S. are doing the same thing — trying very hard to get relatives over here.
Why is important that he “lived in a room with a plain wooden door”? What is the point of telling readers about the door to his room? Heck, my house has two plain wooden exterior doors. I can not judge this fellow and his motivations; I can judge the motivations of team obama that refuses to ban flights/passengers from ebolalandia.
Ann:
It would certainly make sense to want to leave that country and come here, whether a person had had any specific exposure to Ebola or not.
I don’t personally consider denial to be the same thing as not knowing. A fine line maybe, but I think he knew, even if he didn’t want to believe it it informed his actions.
Don’t know if any of it is true: “All of the public transportation hubs have special thermal cameras to pick sick people out of the crowd” in China, etc., but too good to check.
http://pjmedia.com/richardfernandez/2014/10/03/my-hull-is-so-big-and-the-leak-is-so-small/?show-at-comment=942978#comment-942978
‘Tarnsman’:
How will it get here? Very easily I am afraid. Years ago a friend of mine, a businessman living in Southern California and with factories in China, were engaged in conversation during one of our sons’ Scout meetings. Mind you this was same time period as the SARS outbreak. During the course of our conversation my friend talked about his recent trip to China and how while on the trip he started to feel ill with flu like symptoms. I stood in dumbfounded silence as my friend continued his story. Seems in China they are very conscious of the fact that outbreaks of infectious diseases in a country of 1.3 billion people must contained, period. All of the public transportation hubs have special thermal cameras to pick sick people out of the crowd. If you are picked up by one of these cameras you will be quickly apprehended by the health officials and off you will go to quarantine. No arguing, no pleading, no appeal and it doesn’t matter if you are a foreigner or not, off you go. So my friend once he realized that he was coming down with something suddenly had one imperative: get out of China and get home. Never mind who knows what he was ill from, just that he needed to get home. Feeling like crap, he made good his escape with the help of Tylenol and his knowledge of the Chinese health surveillance cameras. He traveled first by train from one of his factories to Shanghai where he boarded a plane for Tokyo where he caught his plane to the States and home. When he got home he was bed-ridden for three days until the fever broke and he felt good enough to get out of bed. At one point his wife wanted to take him to the hospital, but he would have none of that. My friend was quite proud of himself when he finished his story. Me? I wanted to smack him across the face. I did scold him about the fact that not knowing what he was ill from that he was placing the health of all those he came in contact with at risk, including his own family. My friend seem genuinely surprised by my reaction as if he had never once consider that what he did was even remotely wrong. Another one of my friend’s has a saying that sums up the attitude of too many of our fellow human beings: ‘It is all about me” So that is how it will get here. Because someone somewhere will come down with the disease and want to get home and screw everyone else.
You could look at this as another case of “fool or knave” (seems to be our favorite game here). And like my previous statements on the subject, the answer is the same: it doesn’t matter which.
What was going through this man’s mind is of much less importance to me than the results.
Containing a fearsome outbreak like this may boil down to a gruesome calculus. If it gets really bad, the goodwill of your fellow man will evaporate.
Let’s hope it doesn’t come to that.
Wait a minute–the LA Times article says that Marthalene was “desperately ill” and going to EBOLA centers all over Monrovia for treatment:
“From the clinic, where she was given an intravenous drip but deteriorated sharply, they were sent to an Ebola treatment unit and then another, at a time when there were no Ebola beds available in the city.”
This isn’t even a case of ‘should have known’, Duncan and everyone else in the Taxi KNEW that Marthalene likely had (or definitely had) Ebola.
Wes Dorman:
I’ve responded to that issue in a different comment on another thread. But I’ll reproduce the gist of that comment here.
I have read perhaps 25 or more articles describing what happened in Liberia with Duncan and the woman who died, and the articles differ somewhat on the facts, and there’s very little sourcing. However, although some of the articles cite the family (and Duncan) as having taken her to an ebola clinic, the vast majority of the articles cite “hospitals” and do not mention ebola clinics.
I referred to that LA Times article not because every word in it is gospel or completely clear (for example, it’s not clear why or how she went to an ebola clinic, since she’d actually been told at another clinic that same evening that she had malaria). I referred to it for the story of how the village reacted and what it knew, which seems consistent with the timeline and the behavior of Duncan as well.
For example (from the same article) [emphasis mine]:
And if it was unclear what the Williams family knew or didn’t know about what she actually had, it’s even MORE unclear what Duncan knew or didn’t know, since he (a) wasn’t a family member, and (b) was riding in a cab to help carry her, not in charge of any decisions and probably not even privy to the medical decisions or even the discussions between the family and the medical staff. It sounds to me as though the family went from medical facility to medical facility trying to get her a bed somewhere, because they knew she was critically ill, and so they went everywhere, and there was no room in any hospital of any type.
There there’s this:
So, what did the family know? We don’t know. But it’s safe to assume that, whatever they family knew (and I doubt they knew all that much, although they might have suspected something), Duncan knew considerably less. The community also knew less:
The neighbors—who knew she had taken ill and died, and participated in funeral rites for the her without knowing how she died—did not know she died of Ebola till others had taken sick, and Duncan was already sick by that point.
So people who read an article here and there about it, and who are confidently saying “he lied; he knew” are just not basing that on a preponderance of evidence. I see the bulk of the evidence as going against the notion that he knew—and that evidence includes (as I have said several times) the fact that if he knew, it makes no sense that he failed to inform the Dallas hospital of his exposure.
I think this man pretty much sums up the mindset that Duncan probably had. This man more or less played the same role, and had the same relationship to the Williams family, and has no apparent reason to lie:
Also this:
That’s all from the same article. And yet some people think that, because at one point she apparently was at an ebola clinic, the family and friends knew (including Duncan) that she had ebola? I think, on the contrary, the confusion and lack of knowledge are apparent.
In Africa, by the way, death from pregnancy-related complications or from malaria are common—probably a good deal more common than Ebola. For example, in Liberia, “According to the 2009 Health Facility Survey (prior to the ebola epidemic there), malaria accounts for 34.6% of outpatient visits and 33% of in-patient deaths.” That’s a lot of very serious cases of malaria. And the maternal mortality rate in Liberia is 770 per 100,000 live births. Compare that to the US, 18.5 per 100,000 live births. So you can see why it was very plausible that she had died of either malaria or pregnancy (and convulsions, her main symptom, are the main symptom of a pregnancy-related illness called eclampsia, which is sometimes fatal).
Putting it all together, it is far more likely he didn’t know she had ebola than that he knew. It only became clear to people after he and the others had become ill themselves.
I’m not sure where the LA Times got its information, but even if they were simply driving around to ‘hospitals’, the fact that every single one was full would seem to give them a hint that something unusual is going on. “Hey, this is the [second][third] hospital we’ve gone to, what’s up with there being no beds available?” I know I would ask that if I took someone (child, neighbor, whomever) to multiple hospitals and they said they were all full.
I also presume that there would be some reporting on this in print and radio of the affected countries, especially since is started in West Africa in late 2013 and by September 14th there were already 4507 cases and 2296 deaths:
http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_home&
While I know information and reporting aren’t remotely the same as in the U.S., where 1-3 cases in the entire, much larger country result in the vast majority of the populace knowing about a possible problem, I find it hard to believe that nobody in the car had heard anything about the virus, even if they didn’t know it was specifically Ebola.
Wes Dorman:
I assume they knew that ebola was spreading in the area. But the rate of reported ebola infection in Liberia is about 1 in 1000 (I don’t have time right now to give you the link, but it appears somewhere on this blog in a different thread). Not so high they’d immediately think of it, when they had much stronger reason (as I wrote in my earlier comment here) to believe that Marthalene had malaria or some pregnancy complication, and no particular reason to believe that she had ebola or to even suspect it. I doubt they were familiar with all the symptoms of the disease, and it’s not at all clear that even health care workers told them she had it (in fact, it’s not alleged that they were told she had it). And the fact that there were a lot of ebola cases overburdening hospitals in Liberia that are probably usually, even under normal circumstances, fairly crowded, would not have told them that she had ebola.