Again with the low-grade fever
I’ve written that it seems that ebola can start with a low-grade fever for a while, and that the criteria for diagnosis should note that fact and not exclude people with other symptoms and risk factors because their fevers haven’t quite reached the 101.5 level yet.
Here’s even more evidence for that:
The CDC carried out further blood tests on Sunday that confirmed the [Dallas] healthcare worker’s preliminary positive result. Health officials said she had “mild” Ebola symptoms, including a “low-grade fever”.
Seems pretty clear at this point.
In other US-ebola-related news, the Dallas healthcare worker’s dog will be spared, unlike the Spanish one.
I’ve had a number of medical test and procedures done in the last two months. Just within the last three weeks they have added questions at the front desk.
Do you now or have you recently had a fever or a cough?
Have you traveled outside the country anywhere within the last thirty days?
If you answer yes to the first question they require you, at minimum, to wear a mask. Not sure what a positive answer to the second question would involve.
Keep in mind that we don’t necessarily know the full range of expression of Ebola fever. She might only ever have a “mild” case. Lassa fever is caused by a completely unrelated virus in West Africa whose symptoms are very similar to Ebola. In fact, when a virus outbreak was first announced back at the beginning of the year and they didn’t know what it was yet I guessed that it would be Lassa since that virus is indigenous to that area and there’s never been an Ebola outbreak in West Africa. But it turns out it was Ebola.
Anyway, when Lassa fever was first “discovered” back in the ’60s it had reported death rates as high as some Ebola outbreaks. Fever, bleeding from orifices, quick death, the whole bit. It was bad news. But over the years, as they’ve done further research, they have discovered that there are apparently many more cases of Lassa fever every year than they realized at first. That’s because many of them are too mild to be recognized and are never officially diagnosed. The same could be true with Ebola and not all cases will necessarily present the same way.
From the CDC site:
The number of Lassa virus infections per year in west Africa is estimated at 100,000 to 300,000, with approximately 5,000 deaths. … In some areas of Sierra Leone and Liberia, it is known that 10%-16% of people admitted to hospitals every year have Lassa fever, which indicates the serious impact of the disease on the population of this region.
If those numbers are accurate (they are estimates) that’s a death rate of well under 5%.
This is from the Lassa fever Wikipedia page:
In 80% of cases, the disease is asymptomatic, but in the remaining 20%, it takes a complicated course.
Again, when it was first discovered in nurses caring for a sick patient in Nigeria (where Lassa, the village, is), they thought death rates were well above 50%. Very similar to Ebola. It got passed onto others and there were a lot deaths but there was a bigger picture no one knew about at the time as far as how prevalent and how deadly it is.
It’s possible the reason the nurse trainee caring for her relatives in Liberia and saving their lives with her trash bag hazmat suit never got sick is because she’s immune. Or had an asymptomatic case. We just don’t know everything yet.
Since we are finishing up the West Nile Virus season and moving into the regular flu season, I suspect that the fever/cough question will be a common question. I like that masks were given out. I just ordered some masks, mostly because leaf mulching season is upon us and I’m tired of coughing up the brown dust for days. But, a few will be stashed in the car, just in case.
My neighbor remembers taking her kids to the doctor during flu season. She stayed in the car with the kids and the nurse or doctor came out to see them. Kept the sick kids out of the waiting room.
A few years ago, they were having drive through flu shot clinics. I bet there will be more of those this year.
Somewhat off topic, but I’ve thought since the Duncan story broke that one of the major problems re the response to ebola is the lack of preparedness at U.S. hospitals. This seems borne out by a survey of U.S.nurses that indicates 85% of them lack training in ebola:
Shocking, really.
And about the Dallas hospital, in particular — one of the first things that crossed my mind was whether there had ever been a discussion in staff meetings about the potential for ebola to arrive there because of the large Liberian community in the area. That just seems a no-brainer to me, but it probably never happened, otherwise how could the ER staff there have been so clueless?
Somewhat off-topic but the TX judge has ordered the infected nurse’s Spaniel into a secret quarantine. If nothing else, we will learn more about canines and ebola.
Ann,
The Dallas/Fort Worth Metro area is 6.5 Million people, Dallas the city alone is about 1.25 Million a community of 10,000 is almost invisible under those numbers.
Saying that a major ER who see hundreds of thousands of patients a year should have been more vigilant is not realistic. BTW the Nigerian community is 10x the size of the Liberian one.
Ebola: Five ways the CDC got it wrong:
1. The CDC is telling possible Ebola patients to “call a doctor.”
2. The CDC director says any hospital can care for Ebola patients.
3. The CDC didn’t encourage the “buddy system” for doctors and nurses.
4. CDC didn’t encourage doctors to develop Ebola treatment guidelines.
5. The CDC put too much trust in protective gear.
The full piece has recommendations for getting it right, and is worth a read.