Ebola response team
An ebola response team is being organized:
In response to a request by the Department of Health and Human Services, a 30-person team will be ready to “response quickly, effectively, and safely” should more Ebola cases arise inside the U.S., according to a Pentagon press release.
“Secretary [Chuck] Hagel today ordered his Northern Command Commander, Gen. Chuck Jacoby, to prepare and train a 30-person expeditionary medical support team that could, if required, provide short-notice assistance to civilian medical professionals in the United States,” Pentagon spokesman Rear Adm. John Kirby said in statement.
The team of 20 critical care nurses, five doctors trained in infectious disease and five trainers in infectious disease protocols will be sent to Fort Sam Houston in Texas for up to seven days of training provided by the U.S. Army Medical Research Institute of Infectious Diseases.
My questions:
(1) Why on earth did it take this long? We’ve known about the extent of this ebola epidemic and the strong possibilities it could come here for many, many months.
(2) Why the Pentagon? Why not the CDC?
My preliminary answers:
(1) A combination of hubris (“it can’t come here; we’re so smart we’ve prevented that”) and a complete inability to think ahead and prepare for contingencies. Some people would add “actually, the government wants it to come here,” but I don’t agree. That doesn’t further their cause at all, especially the open border cause. Of course, there’s another possible cause it could further: a state of emergency and granting of more powers to the government. I just don’t see this particular crisis being used in that way; too much potential for it to spiral out of control.
(2) The CDC has not covered itself with glory in this matter
That it took this long to prepare this sort of response is an embarrassment and an outrage.
[ADDENDUM: Gee, they finally figured this out, too.
And in some good news, the hospital workers who saw Duncan during his first ER visit are now off the hook for ebola isolation, and his family members are close to being let out of quarantine as well. That they all may be safe underlines the fact that ebola becomes exponentially more contagious as it progresses. That it was two nurses who contracted it from Duncan despite wearing protective—even if somewhat inadequate—gear, while none of the family appears to have caught it despite wearing no gear at all, makes it even more evident how incredibly virulent ebola becomes later on. Duncan himself seems to have contracted ebola from rather mild (skin to skin rather than mucous membrane to body fluid) contact with a patient who was in late stages of ebola, despite her seeming lack of typical symptoms such as vomiting or diarrhea.]
[ADDENDUM II: Louise Troh, Thomas Duncan’s fiancee, is coming out of quarantine, and though she craves privacy and a chance to grieve right now (this coming week would have been her wedding day) she plans to tell her story in the future. She’s been through an extraordinarily horrific experience, although fortunately she seems to have been spared contracting ebola:
As her boyfriend Thomas Eric Duncan lay dying of Ebola in a Dallas hospital bed, Louise Troh battled loneliness and fear that she too had contracted the disease while confined to a stranger’s home under armed guard…
After three long weeks, she will be able to have a clean bill of health, leave the house and be done with twice-daily temperature readings by government health care workers. She likened the period to being a prisoner.
“I want to breathe, I want to really grieve, I want privacy with my family,” Troh told The Associated Press on Friday, lamenting that she was missing Duncan’s memorial service at his mother’s church in North Carolina because of the quarantine. Troh says she and Duncan planned to get married later in the week…
Jenkins and Troh’s pastor George Mason delivered the news of Duncan’s death to her during the confinement period…
Mason said he is coordinating efforts with the city, county and philanthropic community to help Troh and the family recover. Because of the Ebola infection risk, crews stripped Troh’s apartment down to the carpeting, saving only a few personal documents, photographs and a Bible.
“They were left with nothing. They are completely devastated by this, so there’s need to have their lives rebuilt,” Mason said.
Troh plans to partially recover financially with a book written about her life, from growing up in Liberia, meeting Duncan in a refugee camp in Ivory Coast, Duncan’s years-long quest to come to America to be reunited with his girlfriend and their 19-year-old son, and his death in an isolation ward.
“It will be a love story,” she said.
Troh also issued a statement Sunday asking for privacy as she comes through the ordeal while thanking everyone who came to their side.
Troh’s daughter, a nurse’s aide who cared for Duncan before he was hospitalized, and who called 911 for help, is also getting out of quarantine—in her case, self-imposed. Although she was only being monitored by the CDC for fever, and was allowed to leave her home, she decided to err on the side of caution and not go out in public for the duration of the 21 days. She says that now, “”I’m telling you, just to step outside will be so great. To hug my mom and grieve for Eric [the name Duncan used with friends and family], not over the phone like we’ve been doing but in the flesh.”
I wish them well.]
[ADDENDUM III: I think that this statement by Louise Troh shows the caliber of person she is, and the fact that Duncan was her fiance reflects well on him, too:
Our hearts also go out to the two brave women who have been infected by this terrible disease as they were trying to help [Duncan].
We are also aware of how much this has affected many other people of my city, Dallas, and my country, the United States of America, even as it has in the country of my birth, Liberia.
We also know that many people who work in Presbyterian Hospital are hurting because of this tragedy. We pray that God will bring healing to all in our community soon.]
I just don’t see this particular crisis being used in that way; too much potential for it to spiral out of control.
And the chances of them blaming Republicans for this is what, low after it is out of control?
Yamsakar:
Of course they would try to blame Republicans. But I don’t see that working, either, not in this case. They are in charge, and have been from the start. The argument that they didn’t have enough money because of Republicans is very weak. They have money for what they want to have money for. Their response was chaotic and conceptually flawed, and amounted to false reassurance.
This seems to have occurred after the meeting where Obama got “mad”.
I would speculate that if the military had said they could assist in the US, it was denied. So, after the meeting, Defense pulled HHS aside and said that they could order a team together within a short period of time. They probably already have all of the protocols and supplies ready.
Note that training would be “up to” seven days, which is far more than the four hours the troops going over to Africa received.
They have many soldiers going over to West Africa, so they need to be prepared to any outbreaks there as well as when they come back. I just hope that the soldiers are assigned to barracks for 30 days after they come back and not allowed out into the general population.
They are in charge, and have been from the start. The argument that they didn’t have enough money because of Republicans is very weak.
That doesn’t stop their true believers from thinking Bush Hitler II is why Iraq is de composing and combusting now.
Religious dogma technically aren’t “arguments”. They are take it or leave it axiomatic statements of metaphysical truth or belief.
Put in another frame, arguments aren’t going to stop ISIL and weak arguments aren’t going to stop the Left either.
Ymarsakar:
Their true believers will believe whatever they are told to believe. In fact, they’ll probably believe it even without being told.
I’m not talking about the true believers. The true believers are a lost cause. But they are still a small percentage (maybe 25%?–don’t know the exact figure).
Government by and for the bureaucracies of the government explains the current situation. Leftists worship at the altar of the beltway. Reagan understood, “I am from the government and I am here to help you.” should make the hair on your neck rise and make your hands reach for the rifle.
“…ebola becomes exponentially more contagious as it progresses. That it was two nurses who contracted it from Duncan despite wearing protective—even if somewhat inadequate—gear, while none of the family appears to have caught it despite wearing no gear at all”
Point one seems to be well established.
1. Point two about the family is much weaker. 2. Based on the information available, it would be dangerous to let down our guard during the late prodromal and early symptomatic phase. Until we know how much exposure Duncan’s family actually had with him and when the contact occurred we can’t draw any firm conclusions. When the daughter was caring for him, she apparently was suspicious and took extreme caution to limit her exposure and may have had no direct physical contact with Duncan or his contaminated bedding at all.
illuminati:
I certainly do not mean to suggest for a moment that we should lay down our guard, or consider that ebola is not contagious earlier than thought—merely that I’m glad no one in the family appears to have been infected, and that it is consistent with the fact that ebola becomes more contagious in a patient as time goes on.
I wonder if it would be useful to have those coming out of isolation have blood drawn for the ebola test.
Do they have any antibodies to the virus which would suggest that their mild exposure was beneficial in combating the disease and do they have future immunity? Could they give blood plasma to help others? Or would the presence of antibodies suggest that they need to stay longer in isolation – say the 42 days that WHO mentioned as the possible time frame for expression of the disease?
What is the impact on future blood donations? When I came back from Africa, I tried to donate blood but could not since I had taken anti-malaria meds.
Liz:
That’s a great idea, in my opinion.
I doubt the CDC would even think of such a thing, but I’d like to be pleasantly surprised.
It would be the start of a research project since one could determine the level of exposure across a timeline of the illness. Heck, I would be drawing blood on a daily basis from those taking care of the patients.
There are reports stating that a British startup has developed a quick test for Ebola (90 minutes) and a microbiologist from Tulane is also developing a test.
http://www.fiercediagnostics.com/story/british-startup-finishes-quick-and-easy-ebola-test/2014-10-13
http://www.klfy.com/story/26786230/development-of-test-for-faster-detection-of-ebola
There were a few other countries or companies mentioned in the search that are working on similar tests.
If these tests work, I would hope that they would become part of the protocol for monitoring health care workers and first responders.
Liz raises the interesting question. Is it possible to receive a dose of Ebola which is small enough to elicit an immune response but not to cause clinical disease or perhaps virions which have been degraded in the environment but which are still antigenic?
We know this happens with rabies. Scientists have tested trappers in territory in which there is endemic rabies and have found that many of them have developed anti-bodies to rabies but remain healthy. I have never read an explanation for this so this is my guess. Since rabies like Ebola is rapidly inactivated in the environment, the trappers may have developed immunity by exposure to virions which have become attenuated in the environment but which are still highly antigenic. Theoretically that could same thing could happen with Ebola.
I ask this out of an abundance of ignorance regarding virology? Has there been any commentary reassuring, or otherwise, regarding the transmission of this virus by careless food handlers? Is it presumed to be just too unlikely? I’m thinking about sweat, cuts, or sores, not vomiting or diarrhea. Or, is it the case that by the time the patient is that infectious, he is too debilitated to be working?
Exasperated:
I think you’ve answered your own question. I would guess it’s certainly not impossible to transmit it that way, but the possibility is very small for a host of reasons: too debilitated to be working, and not a large viral load anyway in sweat. Cuts would probably be the main mechanism, if it were to happen. The CDC says no to food transmission (but then again, how much do we trust them?) My guess is that they are correct, though.
Am I the only one of the opinion that a CDC emergency team of 30 people has the potential to be pathetically inadequate? What if say 5 cases pop up in widely spaced areas of the country? 10 cases? 100?
Another thing, what does Northern Command Commander, Gen. Chuck Jacoby, [directed] to prepare and train a 30-person expeditionary medical support team know about infectious disease? His wikipedia entry makes no mention of any medical training.
Geoffrey – getting a team together to go to a specific area is a start but I agree it is not adequate for an extended outbreak. Perhaps they will split up into smaller teams or go to evaluate, train and move on to the next place.
I read the article to mean that Jacoby was directed to select the team, via recommendations or volunteers, and they go to San Antonio (Ft Sam Houston) for “training”. The ones selected are already very experienced in infectious disease, so the training would be more of getting updates, meeting everyone, get their routines down, etc. In other words, becoming a well-coordinated team.
GB,
Am I the only one who is cocked and locked? 😉 If you are not prepped and armed, with a back woods retreat, and extended kin to rely upon; you are helpless before the storm. Get thee to flyover country. We are not the ignorant neanderthals clinging to our guns depicted by the msm. We are the actual folks who know how to survive.
Glad the family is OK and hope they are right about the 21 day thing. Ms Troh sounds like a very nice lady.
I do feel bad for and uncomfortable about our military having this mission thrust upon them. We should be drafting the bleeding heart liberal doctors that propagandized for Obamacare to go to Africa instead. Protective gear optional.
parker: if I don’t make it out west before the SHTF, I’d love to stop by for a visit on the way!
One of my kids spent 5yrs in Grinnell.
Thanks Neo, I am guessing that you are correct about the viral load. However, one of the theories is that ebola jumped species via fruit bats. What was never made clear was whether it was because the food preparers were exposed, and became infectious to others, due to the handling of the fruit bat carcasses, or whether the transmission was via the ingestion of the virus in the meat. The former seems more probable, and the latter seems less likely because presumably the virus would be destroyed in cooking. I don’t, of course, expect fruit bats, or bats of any kind, to become popular cuisine here, I was just pondering how the various ways of transmission were ruled out.
Exasperated:
Fruit bats would have to be imported—they don’t live in the western hemisphere.
And at this point I’d say “let’s keep it that way.”
They don’t sound very tasty to me.
< The Dallas hospital that sent home Thomas Eric Duncan the first time he showed up at the emergency room has a machine that could have detected Ebola in less than an hour — but doctors were barred from using it because of federal regulations.
Texas Health Presbyterian Hospital has treated three Ebola patients — Duncan, who died last week, and two of its own nurses who contracted the disease from Duncan. In each case, the hospital had to wait up to two days for confirmation that that patients were infected with the virus.
The Associated Press has also reported the medical records reveal nurses didn’t wear full protective gear while treating Duncan for two days while they awaited the results of his Ebola test.
neo-neocon
Fruit bats would have to be imported–they don’t live in the western hemisphere.
what do you mean we dont?
Artibeus
Neotropical fruit bats
The genus consists of 21 species, which are native to Central and South America, as well as parts of the Caribbean.
and dont forget the vampire bat, which can feast directly on blood..
New World leaf-nosed bats (Phyllostomidae)
are found throughout Central and South America, from Mexico to northern Argentina. They are ecologically the most varied and diverse family within the order Chiroptera. Most species are insectivorous, but the phyllostomid bats include within their number true predatory species as well as frugivores (subfamily Stenodermatinae and Carolliinae). For example, the false vampire (Vampyrum spectrum), the largest bat in the Americas, eats vertebrate prey including small dove-sized birds. Members of this family have evolved to use food groups such as fruit, nectar, pollen, insects, frogs, other bats, and small vertebrates, and, in the case of the vampire bats, even blood.
🙂
Artfldgr:
That device appears to have not gone though the complete testing process yet for ebola; I’d like to see evidence of its accuracy. But in any event, it has no relevance to Duncan’s first ER visit, when it would have mattered, for one simple reason: for the doctors at Dallas Presbyterian to have used it on Duncan, they would have had to have suspected he had ebola. They appear to not have even considered the possibility on that first ER trip. They did not test him in the conventional manner for ebola until his second trip to the ER when his symptoms were extremely obvious, and it took two more days to get the definitive diagnosis through blood test. But even before receiving that diagnosis they had him isolated, and staff was wearing some protective gear (although inadequate gear). They seem to have strongly suspected it on that second visit even before the diagnosis, and not suspected it at all on the first visit.
What was never made clear was whether it was because the food preparers were exposed, and became infectious to others, due to the handling of the fruit bat carcasses, or whether the transmission was via the ingestion of the virus in the meat.
In the book Spillover he talks about how one village outbreak started from eating an infected chimpanzee. It sounds like they were sick from butchering and eating it, since 18 people got sick, but I’m not 100%. (this was Mayibout 2). But that chimp was scavenged and dead already when they found it. I’m not sure how that translates to bats, who don’t actually get sick from the disease, like we do (and chimps, gorillas, monkeys, etc).
Artfldgr:
This is what I mean:
My understanding is that’s the group that carries ebola. Not all fruit bat species carry it, either; the ones that do carry it don’t live in this hemisphere.
Whoa, sorry; I didn’t intend to send the thread off on a tangent. The question is not about bat cuisine or the range of bat species but about how the virus jumped species. Did some of the earliest victims ingest the virus and become infected and then go on to become infectious to other humans? Or, can we put it down to food preparers becoming infected due to handling the bat carcasses and then passing it on to other humans via their body fluids? So the essence of my initial question is can a person become infected solely by inadvertently ingesting the virus? I am guessing, no but I wondered why it was never addressed by the authorities.
I wondered because there are some viruses that are food borne and can be passed by infected food handlers who are careless about hygiene.
Bats might transmit it to humans by humans exploring their caves where their droppings are.
Exasperated:
I think they just don’t know—except through eating infected meat itself. There’s a lot we don’t know about ebola.
This still doesn’t answer my question but it is interesting. It is from the BBC via an article by Jim Hoft on Gateway Pundit:
“The origin has been traced to a two-year-old child from the village of Gueckedou in south-eastern Guinea, an area where batmeat is frequently hunted and eaten.
The infant, dubbed Child Zero, died on 6 December 2013. The child’s family stated they had hunted two species of bat which carry the Ebola virus.
…………………..In some remote areas it is a necessary source of food — in others it has become a delicacy.
In Africa’s Congo Basin, people eat an estimated five million tonnes of bushmeat per year, according to the Centre of International Forestry Research.
Doctors Without Borders has more on the bat-eating family.
The epidemic seems to have originated in a village near Guéckédou in Guinea, from where the disease then spread out. It is a place where people do a significant amount of bat hunting. Just as many other families living in that area, the first family in the village to be infected with the disease admitted to having hunted two species of bat. These were Hypsignatus monstrosus and Epomops franqueti, which both carry the Ebola virus.
Bat colonies migrate across vast distances and we think that they first pass the virus amongst themselves, thereby passing it from the east to the west of Africa. The Ebola virus is then introduced into the population if they come into contact with infected animals.
The black market demand for monkey meat could see Ebola spread in the UK and Europe.
Scientists report that Ebola may be present in more animals than previously thought. So far, it has been detected in chimpanzees, gorillas, fruit bats, monkeys, antelopes, porcupines, rodents, dogs, pigs and humans.”