Ebola in the US: some trends
Been wondering about the condition of Dr. Craig Spencer, being treated at Bellevue? There hasn’t been all that much in the news about him, but here’s a relatively laconic article saying he has been upgraded from serious but stable to stable condition.
It also says that he “is receiving therapies that have been effective in treating Ebola patients at Emory University Hospital in Atlanta and at the Nebraska Medical Center.” In other words, (my translation), he’s getting some antiviral drugs and/or transfusions from survivors of ebola.
Fortunately, we haven’t had very many ebola patients in the US so far. But I can’t help but notice a couple of things about the group of patients we have had.
The first is that all of them except Thomas Eric Duncan seem to have contracted ebola while caring for other ebola patients. And if “carrying to a cab to go to the hospital” is defined as “caring for” (although I don’t think it actually does), that would include Duncan as well.
Note that I wrote “seem to have contracted ebola while caring for other ebola patients.” That’s because Dr. Rick Sacra, who contracted ebola in Liberia, was not caring for known ebola patients at all: he was treating pregnant women. So we must conclude that both Dr. Sacra and the staff at the hospital where he worked in Liberia, although they are medical professionals in a country currently experiencing an epidemic of the disease, have encountered patients who are ill enough to transmit ebola to others and yet whose symptoms are either not serious enough, or are atypical enough, that their ebola status has gone unrecognized by the medical people treating them.
Dr. Sacra’s case is a sort of mirror image of Thomas Eric Duncan’s case, because Duncan also helped a pregnant woman who was not known or recognized to have ebola at the time (look to all my previous posts on the matter if you disagree with me about that), but who turned out to have been highly contagious. This fact sequence points out something that health professionals here have mostly been mum about: although ebola is an extremely serious and often-lethal disease, it is not always recognizable as such, even by highly-trained (including Western) doctors and nurses.
There are many reasons for this (one is that what we think of as “typical” symptoms are not present in a significant number of cases), but for our purposes right now it’s enough to state that it is a troubling fact.
Another pattern that leaps out is that so far the death rate in the US has been much lower than in other places. This also includes all the US citizens who got their initial treatment in Africa and were only flown here after they had become quite ill. The good results might just be a coincidence, because the number of patients treated here has been very, very small. But if we assume there’s something to it, it could be some combination of early treatment (for about half the patients here, anyway), the high quality of our medical care in general (effective rehydration, etc.), and the aforementioned “therapies” which seem to include antiviral and other special drugs and survivor transfusions.
The only ebola death in the US so far has been Thomas Eric Duncan. He missed having the advantage of an early diagnosis because his case went unrecognized by the Dallas hospital ER he first visited. He also had the misfortune of not matching the blood type of the available survivor donors, so he got no transfusion. It’s also possible there was something different about his physiology; perhaps other illnesses had weakened his immune system, or there could even have been genetic factors that made him more susceptible to the illness.
It may be that we risk becoming a little too cocky, though, about our ability to treat ebola. Our success so far appears to depend in part on the tiny number of cases. It wouldn’t take much to completely overwhelm our ability to give patients the sort of care these first victims have gotten, and then things could change dramatically. What’s more, the fact that almost all the cases here have been among health care professionals caring for already-diagnosed ebola patients is in a strange way a tremendous advantage, because it has enabled us to monitor them from the start and to treat them almost the moment they display symptoms—symptoms that in a person not known to have had prior contact with ebola would cause no alarm. That, in turn, has two advantages: early treatment almost certainly makes it more likely that they will survive, and early isolation makes it less likely that they will spread the virus into the general public (or to other health care professionals, who will be wearing protection almost from the start while treating them).
A nightmare scenario would be if ebola were to get out into a population that was unaware they had been exposed to it, and who therefore could easily interpret early symptoms as commonplace flu and therefore would be far more likely to infect others in the public before being diagnosed. That’s the way ebola could get out of control in this country. And that is why so many people (including me) are in favor of quarantining returning health care workers, and placing a moratorium on the issuing of visas to citizens of the ebola-affected countries of West Africa, except in compelling circumstances. This is not because we are unaware of the fact that ebola is alleged to be contagious only in symptomatic individuals. It is because we realize that symptoms are not always heeded right away, the contagion is a continuum rather than an “off/on” phenomenon, and that there is a small percentage of African ebola cases where there has been no previous known contact with a symptomatic ebola victim.
Being extra-careful makes sense, because the stakes—and the risks if things get out of control—are tremendously high.
Neo makes an excellent point re Dr. Sacra. I always thought he was treating Ebola patients.
A very important distinction!
Barry’s current policy on ebola smacks of true belief and political enthusiasm.
The same could be said of Napoleon and Hitler — when they went east into Russia. In both cases the weather risk was well known. Yet they plunged in… and actually felt pretty good during all of the early going.
By the time either tyrant figured out that Plan R was off the rails, they couldn’t pull out. Optimist had totally done them in.
By the time Barry figures out that ebola is a serious threat, it will be too late. It’s in the nature of the beast. There’s nothing linear about it.
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One thing dominates the story arc of compulsive gamblers: they had unusual and excessive ‘success’ early in.
Such unwarranted successes so colored the mind and emotions that all of the wrong lessons became hard wired into long term memory.
The same perverse dynamic is under way with Barry. Success in small numbers is leading him and his sycophants to project long and large.
Whereas our entire system of health care breaks down the second this epidemic scales past ones and twos.
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I’m reading, here and there, that hospital administrators are waking up to the need for totally separate ebola oriented facilities. Ebola victims MUST NOT BE TREATED REGULAR WAY.
The only workable solution is for specialists to come to candidates — all kitted out. Ebola candidates have to STOP MOVING AROUND, even being moved around. All such travel expands the problem — eventually beyond our ability to regain containment.
With each passing day, we’re being informed how shocked the experts are: ebola is a sturdier critter than we’ve been led to believe.
It’s only now conceded what I asserted more than a month ago: that ebola can be transmitted by sneezes and coughs… even a blown nose.
It’s also coming out that THIS ebola is not quite the same as known strains. It’s morphing right under our noses!
The larger its population gets, the more variability one can expect.
As for the longer term: west Africa is now known to have a natural reservoir of ebola in its fauna. Quarantine of travellers from there is going to become routine and normal. This policy shift will be compulsory: no nation can hazard ebola cutting loose.
As neo has related, ebola looks too trivial until it’s too late.
And we are still miles from a vaccine. If it were easy to craft, virologists would’ve done so long ago.
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It’s taboo to say it, but the most endangered community is the ummah. Ebola has hit Muslim west African populations with disparate impact.
All MSM video reporters dance around the obvious.
Since west Africa is so connected with Muslim populations to its north and east, there is the frightful prospect that ebola can break out.
Boko haram’s civil insurrection amplifies such a risk.
The kicker is that there’s little the infidels can do.
We may have a ring-side seat to a slow motion epic horror.
Friendly Reminder: The economy was better in 2006 (GOP Control) than in 2014 (Democrat Control):
http://commoncts.blogspot.com/2014/11/friendly-reminder-economy-was-better-in.html
I was impressed by a throwaway line in a discussion about treating one of our Ebola patients, and that was that treating just the one patient necessitated the efforts of more than 30 people (when you considered three shifts per day); and those were presumably just those caregivers who had some kind of direct or semi-direct contact with the patient and their “bodily fluids.”
When you added in all the second and third tier people that were probably spending a majority of their time performing some sort of function to support the 30 or so front line people, we could conceivably be getting close to seventy five or even a hundred people.
Add to that number the people tasked with tracking down and keeping tabs on those who might have been exposed to those Ebola patients and now we’re conceivably in the several hundreds. Then, add in those manufacturing and delivering the specialized quarantine equipment and pharmaceuticals for those Ebola patients.
All this manpower and these resources–the recent, late, unlamented Department of State proposal estimated that the cost to treat the foreign Ebola patients they proposed bringing here to the U.S. was going to be somewhere between $300,000 and $500,000 each (the Texas hospital stated that the bill for the late Mr. Duncan’s treatment was $500,000).
What happens, then, if we get not just one or two but, say, five, or ten, or even twenty such patients coming into the U.S. in quick succession or as the result of being infected by existing foreign or domestic cases?
How would our hospitals and our supposedly “world-class” health care system hold up that load?
Blert,
One of the points both you and neo allude to is the potential for the disease to overwhelm health care resources suddenly. This accounts, I think, for the ban by both Canada and Australia, where low numbers of health service facilities could render them vulnerable to breakdown with even a few cases.
Hitler and Napoleon hadn’t experienced that 40 below zero Russian winter and weren’t prepared for it. Our medical professionals haven’t really experienced an epidemic even though the flu kills an estimated 20,000 people a year on average. They only expect to have to deal with a few Ebola cases. They aren’t prepared for a real Ebola epidemic.
“… Being extra-careful makes sense, because the stakes–and the risks if things get out of control–are tremendously high.”
= = = = = = = =
“Sense” is what this current Administration is avoiding — desperately — with all its collective might.
Oklahoma has decided to develop an Ebola specific facility using a decommissioned hospital building in the OKC Med Center area. I think it is the old children’s hospital that just hadn’t been repurposed yet.
They’ll update the building with isolation units, limited lab space, and there will be no other clinical space in the building. Since this was done in cooperation with the State Health Department, the OK Hospital Association, the OU Med Center and hospitals in OKC and Tulsa, I suspect that the volunteer staffing will pull from multiple facilities when needed. And the other hospitals in the state will not have to worry about losing patients over fear of contamination.
http://newsok.com/state-officials-developing-specialized-unit-for-any-future-ebola-cases-in-oklahoma/article/5362400
It’s a neat idea and one that could be replicated in other metro areas.
This will get out of hand. Dear leader and his jv string are incapable of addressing the consequences of 200, let alone 2,000, cases of ebola. The medical systems in the infected metro areas would collapse and panic would be wide spread. Could it be such a scenario would be a feature and not a bug? Its good to be in flyover country hundreds of miles from a large city.
That’s way too much common sense for today’s power that be to absorb.
“Being extra-careful makes sense, because the stakes–and the risks if things get out of control–are tremendously high.”
Amen, Neo, Amen. Let’s those who are crying about the health care workers “civil liberties” call it fear-mongering; but, it is real that we don’t know everything and it is better to be extra-careful and not jump to any conclusions without evidence.
Giving up your personal freedom for less than a month isn’t a terrible “penalty” to pay for making sure this doesn’t spread. Quite frankly, I would NOT feel safe being around MY loved ones if I wasn’t 100% certain that I was no danger to then.
And, yes, if this were to get out among the general population; God help us then!
Oh, Chareles ,, you are wishing and hoping team messiah does not wish you be infected. This may be their ultimate crisis to waste. Imagine the worst and you within 10E10 of what hard rain they want to down on you and yours.
Liz Says:
“Oklahoma has decided to develop an Ebola specific facility using a decommissioned hospital building in the OKC Med Center area.”
Good idea. Every state should have a facility dedicated to treat highly infectious patients during an epidemic.
If the new vaccines are effective, Ebola epidemic will probably soon fade away. However, it should be a wakeup call. The bugs are mutating rapidly and it is only a matter of time before another deadly epidemic which is more transmissible than Ebola will come and those special treatment facilities will be vital. Obama is doing his best to break down our defenses against exotic diseases with the open borders including diseases designed as bioweapons by the jihadis who are flooding into our country uninpeded.
Wolla Dalbos’s point about the costs is relevant in another way. Every dollar we spend taking care of the patients and tracing their contacts is a dollar that can’t be spent on research and sending supplies to Africa. Kaci may have worked there, but with more primadonnas like her, the workers won’t have to supplies they need to deal with ebola in Africa.
Pregnancy causes the immune system to be suppressed. It may be that pregnant women are more susceptible to ebola.
More confidence-building activities at the CDC: New CDC confusion over Ebola as it deletes warning that virus can spread through coughs and sneezes from its website
Ann:
They don’t want to scare the peons.
Yeah, exactly, Neo.
What amazes me about these bozos is that they don’t seem to consider that anyone will notice stuff like this. Have they not heard of the Internet and the ability to do screen-grabs or archiving?
Years ago, I read The Hot Zone, and I seem to remember that the longer the chain from the original infected person, the less fatal the disease was. Those who were infected near the primary site of infection were most likely to die.
This is in line with the idea that Ebola mutates readily.
LindaF
More happy talk from our most gabby.
Spanish flu went around the Earth before losing any potency.
Small pox, the infamous virus, went everywhere and lasted for centuries, without losing any potency.
Silly happy talk is the worst thing that one can engage in.
It certainly doesn’t help.
BTW, in our age of jet travel, what does distance mean?
Nothing at all.
Flu season this year is going to be epic.
Maquis: Flu season this year is going to be epic.
Thread winner.
Good article, good points. From a retired nurse’s perspective: on contagion, close contact means 3-4 feet, that’s pretty close.
Hospital admin is responsible for costs. Nurses, according to admin, are expensive, spend too much in equipment and do not generate income. Thus, the minimal protections in Dallas.
Just like heart surgery is only done in certain facilities, so should infectious disease treatment be done. OK is a great idea. The whole floor or building should be for infectious disease.
Staff must be trained. Lots of people from every level do not wash their hands well.
This from Michael Osterholm, an infectious disease specialist is worth the time. http://hub.jhu.edu/2014/10/14/ebola-experts-johns-hopkins
Lastly, medical workers coming home should be in a mandatory confinement for 21 days. Period. Never trust a nurse with a MPH.
It’s easy to get cocky about “containing” Ebola in America when so many (expensive) medical resources are thrown at a very few. If Ebola goes mainstream under the current atmosphere of optimistic denialism, it could get ugly FAST. And if not Ebola, surely there’s another viral infection just waiting to be turned into a pandemic by arrogant modern medical scientism.
Now how many hospital beds are available in America on a day-to-day basis?
You’ve hit on precisely my argument for quarantining those coming here from the infected countries. Right now, the best diagnostic tool in the early stages is having been in those countries or in contact with someone who was.
If Ebola breaks out into our general population, that will no longer be true. Every elevated temperature will become a potential case and that means millions of potentials as we enter the flu season. We don’t come remotely close to having enough resources to even quarantine such people, much less isolate them and began early treatment.
Keep in mind that this crisis, as terrible as it is, has an upside. An effective vaccine would provide a first-line defense, first in Africa, then in healthcare workers, and finally in the general population around the world.
But for that we need time, time we can only get by keeping Ebola from establishing itself outside the African countries where there are wild animal carriers of the disease.
That’s why we need not only quarantine, but one that starts when people attempt to leave an infected country. Once they’ve traveled though several countries, their country of origin may be lost.
Re the ability of our health system to withstand a real attack of Ebola, I wonder if now that the virus has been introduced to America (thanks, Mr. President) is it here forever, to rear its head periodically? Is it in the dirt, in insects or animals who manage to eat infected tissue?
Well done, Neo.
AnneG:
Agreed that infectious disease control (of ebola in particular, but it wouldn’t be limited to that) should be done in specialized facilities.
However, if visas from affected West African countries continue to be freely given, the reality is that another West African visitor can walk into any emergency room at any time with symptoms such as vomiting, diarrhea, and fever not knowing he/she has ebola. That could expose emergency room staff. Some people have suggested mobile units to respond to such calls. Screening would have to be careful, though, and of course setting up such units all around the country would be very costly.
All because we refuse to suspend the issuance of non-essential visas from these countries for the duration of the epidemic. It wouldn’t solve the problem, of course, but it would greatly reduce the risk of a walk-in patient who didn’t know that he/she had been exposed, like Thomas Eric Duncan.
Blert,
I wasn’t referring to Physical Distance, rather the number of infections between the original vector and the patient – I should have said, generations of the virus.
Don’t worry, if the flu and enterovirus and obola all come out at once, Leftists and Democrats will expend all the rare vaccines and medicines on themselves and their children.
You and yours… well they can burn. So sayeth the Left.
Never trust a nurse with a MPH.
Just because it needed to be repeated.
Michael W. Perry Says:
November 3rd, 2014 at 8:51 am
The President, in his arrogance, spews out the zany notion that because America has such a high standard of health care that ebola can’t progress through our population — unlike west Africa.
Whereas, in fact, wherever ebola breaks loose, the human dynamic will be the same. No-one can stop it from propagating far and wide. That’s why it’s long been acknowledged as a pandemic scale disease, very much like Spanish flu.
BTW, the ONLY thing that slowed down Spanish flue was the use of quarantine.
It’s in the nature of these viruses that they propagate before it’s flamingly obvious that one is infected.
No better example: look at the staggering percentage of health workers that have become infected — even when going in they knew they were dealing with ebola — and had hazmat gear.
Yet they STILL contracted ebola — with dire, lethal, results — time and time again.
It’s now so bad in west Africa that medical staff are either dead or fleeing or have some immunity.
Even in the US, the minute it was known that ebola was brought into a hospital, staffers suddenly called in sick!
This ugly reality is suppressed by the MSM. It doesn’t fit the narrative.
It’s to be expected. The same wariness occurred during Spanish flu and the Black Death. After all, doctors and nurses were dropping like flies in winter.
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Also: while ebola monopolizes staggering amounts of medical talent — others are suffering and dying. It’s not as if there’s a ton of slack in the system. Every doctor I’ve known in recent times is working pretty much flat out. We’re not graduating more than one third of the talent needed within our own borders. America imports most of its doctors/ or trains them in off shore medical colleges. That’s remarkable — and is a sin.
There is a study published in the NEJM on a case of a healthcare worker who was evacuated to Germany and successfully treated. This shows just what might have to be done to treat some patients. If this person had not received top notch care he would not have survived.
Treating one or a few like this is possible but not if there are many such.
I agree that the tipping point for healthcare collapse with a community outbreak of Ebola is a lot lower than most would expect. If half of your local ICU is filled with Ebola patients, you have maxed out what the staff can handle at an “American” level of care, maybe even at a third full. This assumes all your critical care nurses are available, trained and willing to work in an Ebola environment, which is probably optimistic. Forget about ZMapp, all of that is gone until the next batch of gendered tobacco plants are ready. At this point we have blood from Ebola survivors (four of which are known to have the same blood type) and brincidofivir, which may or may not work.
I wouldn’t worry about more lethal variants arising, there’s not a lot of headroom above a 70% lethality rate. The only things worse are rabies, pneumonic plague and weapons-grade anthrax, The path forward for zoonotic viruses in a human population is in exchanging lethality for transmissibility. RNA viruses are sloppy transcribers and mutations are common, but not all mutations are beneficial. The point of the virus is propagation, the maximization of propagation means a virus that is easier to catch but doesn’t kill the host as often. Still, an Ebola strain that is twice as transmissible but half as lethal would put it on par with smallpox on the lethality scale…and infect a lot more people.
I don’t believe the hospital in Dallas intentionally shorted their staff of protective equipment. I think the CDC guidelines at the time were inadequate (they did not require PAPRs, for example) and the idea was that this could be treated like super-C. difficile. The difference is that C. difficile doesn’t try to kill the hospital staff. This is a BSL-4 disease and in retrospect the patient should have been transported to a biocontainment facility immediately. No community hospital staff is ready for a BSL-4 disease the way the biocontainment people are, that’s what they do and what they practice. It’s the difference between a pro football team that practices and 11 great athletes with a pile of equipment and a printed playbook.
That nurse in Maine is a self-righteous idiot. Good for you that you went to Africa to help, now please get off your bike, stay in your house for a couple weeks and try to not reproduce the devastation here, mmkay? Plus, an outbreak here makes her cocktail party story of selfless heroism that much less valuable.
Had a doctor’s appointment yesterday. Was given an oral Ebola cross-examination upon checking in. Do you have a fever? Do you have diarrhea? Have you traveled outside the US to countries with Ebola? Etc., etc., etc. (I gave the office staff a chuckle when I responded to that last question with ‘I haven’t travelled outside of Queens!’)
I see these questions as being useless Kabuki theater, just as useless as President Obola’s policies toward this disease.
I was surprised that Duncan’s family members did not come down with Ebola. This means that we don’t know anything about this virus.