Thinking about disease
September 29, 2014 12:25 PM   Subscribe

Ebola and the Construction of Fear by Karen Sternheimer (Everyday Sociology)
"Sociologist Barry Glassner, author of The Culture of Fear: Why Americans are Afraid of the Wrong Things, explains how misguided panics are not just benign opportunities to prevent something horrible, but can divert attention and public funds away from more likely threats. He notes:
Panic-driven public spending generates over the long term a pathology akin to one found in drug addicts. The money and attention we fritter away on our compulsions, the less we have available for our real needs, which consequently grow larger (p. xvii).
"Fear of a 'new' threat (Ebola has been documented since 1976; it was even the subject of the 1995 film Outbreak, in which the virus becomes airborne) can heighten attention and news coverage. It can also distract us from more immediate threats to our health.

"What virus is likely to kill at least 3,000 Americans this year? The flu."
Why Ebola won't become a pandemicThe Economist

No, Ebola is not coming to the U.S. (5 min 15 sec) – NPR's On the Media – Host Bob Garfield interviewing Dr Daniel Bausch.

News You Can Use: Trusted Resources on Ebola, by Sheila Snow-Croft, Public Health Coordinator, National Network of Libraries of Medicine, Southeastern/Atlantic Region. Snippet: "Good information can be your best defense."

Previously: Non-ebola care, Ebola reaches Nigeria's largest city
posted by joseph conrad is fully awesome (74 comments total) 15 users marked this as a favorite
The lead article is weirdly flawed. For instance:

"Fear of a 'new' threat (Ebola has been documented since 1976; it was even the subject of the 1995 film Outbreak, in which the virus becomes airborne) can heighten attention and news coverage. It can also distract us from more immediate threats to our health.

I'm not sure why "new" is in scare quotes there. While it's true that the disease was first documented in 1976, this current outbreak is far and away the largest Ebola outbreak in history, on a scale and in numbers never seen before. The virus may not be literally unknown but the public health problem is certainly a new thing.

What virus is likely to kill at least 3,000 Americans this year?

This, and the entire article, comes across as the standard libertarian/conservative rant against foreign aid in general. The virus could hit 20,000 West Africans in the next 6 weeks. The region, as the article note, is entirely unequipped to deal with something on this scale; is saving African lives not worth anything?

Even if one cares only for American lives and interests, Ebola-affected nations are so badly ravaged that they face collapse. Even cold hard realists who care not for humanitarian concerns would agree that having a quarter of an entire continent destabilized isn't good for American interests.

And what resources are being diverted to the ebola fight were going to go into combating the flu? Did the US military scrap a planned national flu shot drive to deal with this crisis? Were the infectious disease labs at the CDC going to be used to inoculate school children if it weren't for that pesky ebola?
posted by Sangermaine at 12:47 PM on September 29, 2014 [17 favorites]

Related, Vox by Ezra Klein (just spotted via Twitter): How America's top public health expert sees the Ebola crisis.
posted by joseph conrad is fully awesome at 12:58 PM on September 29, 2014 [3 favorites]

(I don't think it's supposed to be anti-foreign aid *at all*, fwiw - it's supposed to be anti-panic about Ebola in the U.S. I was worried about this interpretation but went ahead and posted this FPP because I'm also pro-information, anti-panic, and I wanted this as a counter-balance to previous discussions.)
posted by joseph conrad is fully awesome at 1:00 PM on September 29, 2014 [2 favorites]

anti-panic about Ebola in the U.S.

Yeah, but what panic in the US? There are news stories, some people express concern, some Congressional said some dumb-ass thing. But what exactly is being done because of this?

The danger seems to not be wasting medical and other resources in America on pointless fears, but in cutting off all resources to the ebola-infected regions that need them.
posted by Sangermaine at 1:10 PM on September 29, 2014 [3 favorites]

I had a nasty summer cold last week, dripping nose, sneezing, etc.. and though about families in Liberia.

What would I do if I was a father in Liberia who suddenly caught Ebola. Would I want to leave my family to try to save them, would I want their help to try to be one of the 50% who survive with supportive care.

What if I had already infected them, etc.. etc.. etc..

As a Human, we should be doing whatever we can to support Liberia and keep it from falling apart, even if it wouldn't affect American in the slightest.

Isn't this why we have a UN? A WHO?
posted by bottlebrushtree at 1:14 PM on September 29, 2014 [5 favorites]

Yeah, but what panic in the US?

Are you kidding? Try watching Fox News. According to those droids, our southern border is leaking millions of ebola-infested muslim-mexicans as we speak, coming to suicide-bomb ebola all over YOUR TOWN!!! Just like Benghazi11!!!
posted by Thorzdad at 1:53 PM on September 29, 2014 [3 favorites]

"Panic-driven public spending generates over the long term a pathology akin to one found in drug addicts. The money and attention we fritter away on our compulsions, the less we have available for our real needs, which consequently grow larger (p. xvii)."

I'm currently in a Political Communications course that speaks to pretty closely to this, but on a more generalized scale. Many a policymaker and politician are hungry for power and fame, and to make their mark on American politics in whatever way/shape/form they can. Through instilling a sense of panic and urgency (in this case, Ebola as "a new threat"), those seeking political power enable themselves to step in and "save the day," as well as establish a sense of dependency from the general public.
posted by ourt at 2:08 PM on September 29, 2014 [2 favorites]

Ebola is making a mess of the health care systems in Liberia, Sierra Leone and Guinea. Those countries did not have robust health care systems before this outbreak. There's well-justified fear - who knows when a team of costumed people may come and remove your family member, who is only a little bit sick, and you may never see the family member again. People there have limited access to education and news, so there are all sorts of rumors. Meanwhile, people are sick and dying. US troops are in Liberia building a clinic and teaching nurses. I'll bet their families aren't sleeping well. Hemorrhagic fevers are deeply unpleasant and Ebola has a 50% mortality rate. Even in the US, there are plenty of misconceptions. A plane carrying a health care worker with Ebola refueled in Maine and the news stations went batshit.

I'm really afraid of car accidents, anything happening to my family, another Republican presidency appointing Supreme Court justices, plenty of things. I'm compelled by the stories of Ebola, especially the heroes who treat people, especially Fatu Kekula. Ebola is terrifying, and even though it's happening somewhere far away, empathy makes it terrifying over here.
posted by theora55 at 2:16 PM on September 29, 2014 [2 favorites]

"What virus is likely to kill at least 3,000 Americans this year? The flu."

"Influenza occurs globally with an annual attack rate estimated at 5%–10% in adults and 20%–30% in children. Illnesses can result in hospitalization and death mainly among high-risk groups (the very young, elderly or chronically ill). Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 250 000 to 500 000 deaths. "

That's a pretty low mortality rate which is why people are not afraid. You are about 10 times more likely to die in a car accident than die from the flu. To make the flu the equivalent of ebola it would have to kill 1.5 to 2.5 million people a year.
posted by srboisvert at 2:24 PM on September 29, 2014 [2 favorites]

Are you kidding? Try watching Fox News. According to those droids, our southern border is leaking millions of ebola-infested muslim-mexicans as we speak, coming to suicide-bomb ebola all over YOUR TOWN!!! Just like Benghazi11!

Business as usual for Fox, as long as we remain ground beneath the heel of our Kenyan Muslim Communist dictator.
posted by Sangermaine at 2:26 PM on September 29, 2014 [2 favorites]

Anthropologists: the missing experts in the Ebola outbreak response.

Notes from case zero: Anthropology in the time of Ebola.
posted by Rumple at 2:51 PM on September 29, 2014 [2 favorites]

"Panic-driven public spending generates over the long term a pathology akin to one found in drug addicts. The money and attention we fritter away on our compulsions, the less we have available for our real needs, which consequently grow larger"

Quite right.

Perhaps if we didn't all need the new iPhone, we could spare a few moments to think a bit about where our soil and fertilizer is going to come from in the future.

(Who knows, maybe we could even kick in a few bucks to help find a solution! We could think different, even!)
posted by markkraft at 6:31 PM on September 29, 2014

No, Ebola is not coming to the U.S.

Hahaha, an Ebola case has now been diagnosed in the United States. Hah hah. Hah.... ok its not funny.
posted by Justinian at 1:55 PM on September 30, 2014 [8 favorites]

an Ebola case has now been diagnosed in the United States

Expanding on that -

CDC Confirms Patient In Dallas Has The Ebola Virus
Officials with the Centers for Disease Control have confirmed that a person in Dallas definitely has the Ebola virus. Tuesday’s official determination makes the Dallas patient the first diagnosed Ebola case in the United States...Health officials said given the information that the unnamed patient had been in the West Africa area where the Ebola virus exists and the type of symptoms they were exhibiting, testing was being performed.
CDC press briefing scheduled for later today.
posted by cjelli at 2:21 PM on September 30, 2014 [4 favorites]

He was displaying symptoms and thus contagious for at least 4 days while wandering around in public. So that's good.
posted by Justinian at 3:17 PM on September 30, 2014 [3 favorites]

So much for "Here's why Ebola will never happen in the US".

Let's just keep sticking our heads in the sand about the ability of Ebola to mutate, too. Nah there won't be an airborne human-communicable version. The window-of-mortality won't lengthen thus increasing chances of infection…

Remember, just keep telling yourselves "It can't happen here."

posted by mistersquid at 3:44 PM on September 30, 2014 [6 favorites]

according to cjelli's link, the patient first sought treatment at the ER on Thursday but was sent home. Wow. Somebody done fucked up.
posted by lullaby at 8:55 PM on September 30, 2014 [5 favorites]

Remember, just keep telling yourselves "It can't happen here."

I dunno, I think that the extent of the US public health system is still pretty well-suited to handle the occasional incursion of a viral epidemic. It "can't" happen here, at least not on the horrific scale we're facing in West Africa, because we really do have enough doctors, emergency rooms, labs, biohazard clothing and gear, and educated professionals. Public health isn't any more magic than ebola is magic. It's a virus; we have systems that work well against viral epidemics. Maybe they won't always stop them at patient zero, but neither is it really likely that we'll see people dying right and left and not enough people to pick up the bodies. That's not smugness; that's having solved a problem. We could solve the problem in West Africa, too, but that would take money that until about this week hardly anyone was prepared to spend.

Somebody done fucked up.

Or more properly, the patient apparently lied by omission, volunteering nothing about coming from West Africa. Privacy concerns have allowed no information about whether the patient is a native of Liberia or a citizen of the US, so we don't know if they would have looked like someone (ahem, black, with heavily accented English, etc.) the hospital staff ought to have made more inquiries of.

It remains to be seen whether this patient's lie will cost them their own life, let alone anyone else's. It's sad, even angering, but part of the problem in mustering public health responses is getting cooperation from the public, who sometimes exercise short-term self-interest and manage to escape data collection or crucial early treatment. In terms of vaccination rates for childhood diseases, for example, we know that is a real issue, even here in the US.
posted by dhartung at 2:13 AM on October 1, 2014 [3 favorites]

So much for "Here's why Ebola will never happen in the US".

As if someone was really saying, "no one will contract Ebola in Africa and then fly to the US ever."
posted by smackfu at 7:45 AM on October 1, 2014

the patient apparently lied by omission, volunteering nothing about coming from West Africa

If (as reports suggest) no one in the hospital asked that patient with those symptoms about his travel history then that is absolutely a screw up on the hospital staff's part and not solely on him for not independently volunteering that information.
posted by lullaby at 7:46 AM on October 1, 2014 [1 favorite]

I hope the Dallas patient survives, and I hope the infection didn't/ doesn't spread. And I really hope the hospital doesn't divulge the name, race, nationality, etc., of the fellow. People actually deserve privacy on health issues. The patient had no knowledge of Ebola contact, and we don't know if the patient hid information or if the patient history was incompletely gathered. or both. Given that patients treated in the US have fared well, that most people don't want to infect their families, and that the patient was ill, and possibly not thinking as clearly as one would like, I'm not ready to point a finger. And health care professionals in the US are not likely to think Ebola. I'm curious about where the patient sought care; before I had a primary care doc, I had to go to Urgent Care, and they were wildly inconsistent. I didn't get proper care til a saw a primary care doctor, and that took a couple months (of living with bronchitis and pleurisy, really not enjoyable at all). We have a sort of robust care system, with massive holes in it.

The hysteria that would result from an outbreak in the US would be different than in Liberia, but would be scary. Gun sales would go up, hoarding, etc. I hope people would help each other, too. It would probably vary by location, and I would feel kind of uneasy that I'm in Colorado and not home in Maine, where we have common sense and civility in large doses. No offense, Colorado, but I don't see it here, Maine is really special.
posted by theora55 at 1:51 PM on October 1, 2014

Well, his identity is out of the bag, according to the AP divulged by his sister. The CDC is also concerned that the hospital apparently failed to do any follow-up, given that he did divulge his having come from Liberia:

At a news conference Wednesday, hospital officials said a triage nurse performed the recommended screening — asking about his symptoms and his travel history — but her report wasn't communicated to the rest of his health care team.... [A hospital official said] the patient "volunteered that he had been to Africa in response to the nurse operating the checklist and asking that question."

So, yes, that is a pretty big good grief. (What I said above came off more emphatic than I remembered ("Or..."), but I was trying to present an alternative scenario close to behaviors seen in the affected areas of Africa, and I didn't see how that step could have been skipped; and it wasn't, really, just the paperwork mislaid, apparently.)

'm curious about where the patient sought care; before I had a primary care doc, I had to go to Urgent Care, and they were wildly inconsistent.

It was Texas Health Presbyterian Hospital of Dallas, and it was the ER. The hospital treated former President George W. Bush last year, so it's no backwoods clinic.

In any case, this does again highlight the public health angle. The basic foundation for the current epidemic is the woeful state of the health systems in three countries that have experienced civil war and other calamities. Let's assume there will be more screening failures stateside, but these will likely be clusters confined to small groups like an initial patient's relatives. Our system may not be perfect, but once it starts throwing resources at a problem the robustness will be more apparent.
posted by dhartung at 2:16 PM on October 1, 2014

I read this today, and thought I'd share it here:

Ebola thrives on poverty and disparity: Places were the people at the bottom of the ladder have no access to clean water to drink and wash with, no access to decent healthcare, no public health providers to track and contain outbreaks. West Africa is nearly ideal for Ebola. Increasingly, so is Central Texas and the rest of the United States.

To protect yourself, your household, your community from communicable diseases like Ebola requires decency for the poorest, the most marginalized in your community–the people who pick your produce, make your food, clean your streets and workplace, working the myriad of minimum-wage service jobs that make most of our lives possible.

Decency for the poorest is what makes a developed country a developed country: a place where one does not die from easily prevented diseases (among other things). Decency isn’t our long suit.

posted by duffell at 6:17 PM on October 1, 2014 [7 favorites]

So here in Dallas the news is being dominated about the patient at Presby hospital.

It was Texas Health Presbyterian Hospital of Dallas, and it was the ER. The hospital treated former President George W. Bush last year, so it's no backwoods clinic.

This is correct. Presby is a very esteemed and nationally recognized hospital. It's about 1000 bed hospital (not including all the ASCs and physician-owned hospitals on its campus) that is included in the discussion with Baylor University Medical Center as to what is a go-to hospital of excellence in DFW and North Texas for certain specialties. This is the opposite of a backwoods clinic.

It's also the hospital that is closest to the middle of the wealthy area of Dallas (called Park Cities and Preston Hollow) and isn't really a high volume emergency center like Parkland Hospital, which is the safety-net county facility. While I can see this guy not getting properly diagnosed at Parkland (Parkland has a long history of screwing up patient care), it is a bit surprising to see such a mistake at Presby. Apparently the hospital had just instituted some ebola protocol the week before, so it should have been fresh on the clinician's mind.

What's remarkable to me is that the hospital is acting like business as usual there. Patients are keeping their appointments; babies are being born, etc. There are lots of other options for hospitals (about 5 different hospital sin a 10 mile radius) and I'm surprised more people aren't staying clear of the whole place. Granted, I understand the containment and why it shouldn't be an issue; I just can't believe the general public isn't freaking out. Certainly the local news is doing its best to cause panic. They are breathlessly reporting about how some kids were exposed to Patient 0 and then went to public schools so now the public schools are under watch. Some reporting has claimed that this guy was vomiting all over the parking lot at the apartment lot he was in as if that made the whole complex exposed. And they are claiming the city government is tense and monitoring 6 then 21 then 80 people, as if the whole city is about to get quarantined.

The upside here, I guess, is that in 21 days this all ends. As I understand it, if no one else shows a sign or symptom in 21 days, then we know it wasn't spread. It's just going to be a lot of hand-wringing here until that clock expires.
posted by dios at 8:35 AM on October 2, 2014

What scares me is that the state fair is going on in the DFW area. I hope the officials didn't miss anyone who should be isolated and that those instructed to do so stay home.
posted by MuChao at 10:01 AM on October 2, 2014

Reuters: Scores possibly exposed to U.S. Ebola patient; four isolated.

The fact that, in spite of all the chest beating "we are ready for everything" noise, that this patient was turned away even after stating he came from Liberia and was also given antibiotics which are completely useless for any virus, leads me to wonder if the local authorities are prepared for anything other than to recieve a large cheque.
I presume an investigation as to incompetance is ongoing.
posted by adamvasco at 10:19 AM on October 2, 2014

No doubt poverty contributes to the conditions under which diseases such as Ebola thrive.

But again, wealth and excellent medical conditions are no panacea. They merely mitigate risk (though that is a pretty big merely).

Reiterating the poverty of countries stricken with Ebola as a means of distinguishing them from the United States, for example, can be a way of diminishing the threat of Ebola in the US in no place but the mind (i.e. wishful thinking, #firstWorldSmugness).

According to the NYTimes, patient zero (Duncan) contracted Ebola from shuttling an Ebola sufferer to and from the hospital.

The family of Marthalene Williams, an Ebola victim, said Thomas E. Duncan helped take her to and from a hospital in Monrovia last month.
I don't have specifics on how close Duncan's contact with Williams was, but I am willing to wager no closer than what many North Americans experience on a day-to-day basis with each other.
posted by mistersquid at 10:19 AM on October 2, 2014

Seems like a bit of a slow-motion fuckup in DFW at the moment:

Nuran said that she is confident that Duncan did not closely interact with anyone outside when he became infectious following his arrival in Dallas from Liberia on 20 September, though a man who lives on the complex said on Wednesday that he had seen him stagger outside and vomit on the ground as the ambulance arrived.

Earlier in the day, angrily brandishing an Ebola fact sheet, David Mbusa strode out of the complex and told reporters that he was completely unaware that a fellow resident had the virus until this morning.

Mbusa said he is a night shift worker from South Sudan and has lived in the Dallas area for about 15 years.

He said that he woke up this morning to find a one-page general information sheet about the virus on his door and was confused by the police presence in the complex and asked a small boy what was happening.

“I don’t know anything about Ebola,” he said. “This thing is happening in west Africa.” After reporters updated him, he said that he was “upset completely, I’m not sure what’s going on … Me and everybody who lives here should be screened, that hasn’t happened … whoever lives here should stay inside.”

Nuran said that she had arranged for flyers to be posted on every apartment door on Wednesday evening but the variety of different languages spoken by residents made communication difficult and it took time to translate the information.

posted by Nevin at 2:16 PM on October 2, 2014

My pet theory is that the nurse who took Duncan's history didn't know that Liberia was in West Africa and that's why it was not properly transmitted to the docs.

I still don't understand his actions, though. If I had been carrying around ebola victims a few weeks ago and had these symptoms I'd refuse to leave the hospital, screaming "FOR THE LOVE OF GOD I THINK I HAVE EBOLA. HELP ME. OH GOD PLEASE HELP ME."
posted by Justinian at 2:53 PM on October 2, 2014 [1 favorite]

The guys cleaning up the Ebola contaminated vomit and stuff outside the quarantine apartment are clearly up to date on the best practices for such things. Hose that shit right down boys!
posted by Justinian at 5:31 PM on October 2, 2014 [1 favorite]

A freelance photojournalist working for NBC News has contracted ebola in Liberia and will travel to the US for treatment. NBC's medical editor, Dr. Nancy Snyderman, will also return and stay in a voluntary quarantine for 21 days.
posted by Small Dollar at 6:38 PM on October 2, 2014

It's pretty clear they are overstating the difficulty in catching Ebola to try to prevent panic. Listening to some officials you basically have to roll around in a big pile of Ebola with open cuts to catch it. One assumes a cameraman wasn't doing that.
posted by Justinian at 8:07 PM on October 2, 2014 [2 favorites]

They were literally visiting Ebola wards in a country where Ebola is uncontrolled and isn't uncommon. There was definitely opportunity for exposure to infectious bodily fluids.
posted by Small Dollar at 8:21 PM on October 2, 2014

The thing that bothered me about the "can't happen here" argument is that it seemed to ignore the realities of U.S. health care.

First of all he assumption that people showing the symptoms of an ebola infection will go to the hospital. How many people are aware of what the symptoms of an ebola infection are? The guy in Texas was in Liberia so he had some idea and that's why he went to the hospital. A person who might've caught it from him, on the other hand, might not know what the symptoms are and might not go to the hospital because they might not know that it's ebola.

Also, people showing the early symptoms might not go to the hospital because they might not be able to afford hospital care and thus won't go.

In this case we see that the issue happened with the hospital screwing up. This is another reason why "it can't happen here" is a weird attitude. It assumes that the quality of health care is high. I've had multiple friends have broken bones who, when they went to the hospital, were told that nothing is broken. Later on, after going to other doctors, they found out that they had broken bones.

Also, let's say I'm sick with ebola and I don't know it, or maybe I do, and I'm showing advanced symptoms like vomiting everywhere. Let's say I take myself to the hospital instead of calling 9-11. The waiting rooms of hospitals tend to be crowded. And so all those people will face potential exposure. Thus all the medical staff in close contact will face potential exposure.

And if I don't take myself to the hospital but call for an ambulance? What if the paramedics screw up a quarantine procedure and get exposed?

There's no logical reason to say "it can't happen here" because it can. So far we've been relatively lucky. I don't think the guy in Texas infected anybody but we don't know yet and we won't know for 3 more weeks. And if somebody did get infected after being exposed to some of his fluids (like from the vomit) then we might have an outbreak on our hands.
posted by I-baLL at 8:41 PM on October 2, 2014 [2 favorites]

Holy crap, it's worse than I thought!

The sweat-stained sheets of Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, still on her bed, a woman quarantined in a Dallas apartment said Thursday that she desperately wants her family's nightmare to end.

Yeah, yeah, I know it's CNN but still, this blows my mind.

I assumed people were quarantined at some quarantine facility.

No, they're in their apartment!

And what keeps them there?

"While Duncan is in isolation at Texas Health Presbyterian Hospital, his partner and three others have been stuck in a Dallas apartment since his diagnosis this week. Louise told CNN that authorities had her sign paperwork stating "if we step outside, they are going to take us ... to court (because) we'll have committed a crime.""

So there's a legal threat to keep them in the apartment. But what's really keeping her in the apartment is, if I understand her mentality, the fact that if she's infected she won't want to infect anybody else. But that's it. Just her and her family's good will and a legal threat is the only thing preventing her from sneaking out.

Is something missing? Am I misreading the article? Did CNN leave something out? Can somebody explain quarantine procedure to me?
posted by I-baLL at 8:48 PM on October 2, 2014 [1 favorite]

And "At the apartment, 'there is a law enforcement person there in case individuals leave.'"
posted by Small Dollar at 8:55 PM on October 2, 2014

On the bright side, they've yet to show symptoms so hopefully they're okay.
posted by I-baLL at 8:58 PM on October 2, 2014

That's better than the alternative, of course, but it has only been a week since he began exhibiting symptoms. The incubation period is up to 3 weeks so you wouldn't really expect anyone he infected to have shown symptoms yet. It's possible they would since the incubation period can be just a few days but it's not as likely as still being asymptomatic even if infected.

If everyone is still asymptomatic in a week we can start feeling better about it.
posted by Justinian at 10:25 PM on October 2, 2014

There's some difficulty in thinking about what we mean by "it" when we say "It can't happen here".

Previously for me "It can't happen here" was invalidated with patient zero.

But that doesn't seem right. I think by "it" we more likely mean "contract Ebola in the US", rather than manifesting symptoms once inside the US.

In any case, I think it's important to provide care for those infected and to take humane and rational steps to limit people's exposure to those who are infected.

That's the best way to ensure the US's patient zero (or patient zero prime) doesn't infect anyone else.

I'm wondering, now, how long it will be before there are confirmed cases of EBV infection happening outside Africa.

This whole thing is horrible, let alone the ongoing nightmare in Liberia, and other West African nations.

And don't tell me no stupid shit about how the flu kills many more millions of people than EBV in an attempt to suggest our collective reaction is overblown because, goddamnit, I vaccinate against the flu and would against EBV if I could.
posted by mistersquid at 11:20 PM on October 2, 2014

I'm wondering, now, how long it will be before there are confirmed cases of EBV infection happening outside Africa.

If I were a gambling man I'd say its 50/50 that happens in one week. Maybe 60/40. Because I think its even odds or slightly better that at least one person contracted Ebola from Duncan. The R0 for Ebola is around 2.
posted by Justinian at 11:57 PM on October 2, 2014

Sanitizing crew turned away at Ebola patient's residence in Dallas.

They didn't have the proper permits for transporting hazardous waste on Texas highways so authorities turned away the only people willing to clean the contaminated apartment (in which 4 people are still living.)
posted by Justinian at 1:57 AM on October 3, 2014 [1 favorite]

“They were noncompliant with the request to stay home,” Jenkins said. “I don’t want to go too far beyond that.”
posted by I-baLL 11 hours ago

Yeah, noncompliant is an innocuous way to put it.

Per the DMN, the family with whom Duncan was staying sent their kid to school on Wednesday despite the quarantine and being told not to do so.

That's a complete asshole move. I get being frustrated about being quarantined. I can see demanding to be in a better place. But don't send your exposed child to a public school around a bunch of other kids. What the hell were these people thinking? Not only does it present a risk of exposure of a bunch of kids, but it causes even further public concern and fear.

This is the kind of stupid ass grossly-irresponsible move that undermines the government's professed confidence about being contain this. Yes, you can contain it if people act responsibly. But when you have people who act with reckless disregard with this, you can't contain it.
posted by dios at 8:30 AM on October 3, 2014 [4 favorites]

dios: Yeah, in a way that was my whole point. Really the only reason why ebola won't be as prevalent here than it is in Africa is because we have a better sewage system. That seems to be the big difference.
posted by I-baLL at 9:39 AM on October 3, 2014

Wow, just found out something interesting on reddit:

Basically the CDC says that ebola is not airborne...but it is spread through coughing and sneezing which we, the regular public, do consider to be "airborne". So ebola is spread through coughs and sneezes....this could get a lot worse.

Especially since the article that the reddit thread is about is:

Student who had contact with Ebola patient attended Dallas school despite request

and also:

DALLAS -- Five members of the Dallas County Sheriff's Department who were briefly inside the apartment where a man with Ebola stayed have been temporarily put on leave.‎

Worst part of that article?

"Dyer was one of the deputies on scene Wednesday night, but he did not go inside. He said the family of the Ebola victim told the deputies that went inside that they were running out of food.

"What kind of planning is that for the feds?" Dyer said. "You quarantine them, but you're not going to make sure they have food?"

Dyer said one of the supervisors got sandwiches and drinks for the family from a police prostitution diversion initiative that was going on nearby. His understanding is that food has since been delivered to the family.
posted by I-baLL at 11:41 AM on October 3, 2014 [1 favorite]

but it is spread through coughing and sneezing which we, the regular public, do consider to be "airborne"

I believe this is because they draw a (very dubious) distinction between something which is airborne and something which is spread through aerosolization. Ebola is what they would consider the latter. But that distinction is on very shaky ground in my opinion and experience. In some ways it is a distinction without much of a difference.
posted by Justinian at 11:46 AM on October 3, 2014 [1 favorite]

Christ almighty, I am speechless. You are honestly telling me that this family has been living in the UNCLEANED apartment, complete with soiled towels and sheets, for DAYS now?!??!! And they're forbidden to leave and nobody even brought them food?! Jesus holy christ, if they didn't have ebola before, they probably do now. I hope somebody survives to sue the ever-loving shit out of whoever fucked this one up so badly.

Someone should make this little case study in US preparedness into a new FPP, this is unbelievably awful. Just a huge slap in the face to everyone who believed this stuff could never happen here - they forced a kid to literally incubate in a virus chamber and then he took off to go to a school! His "non-compliance" does not even begin to cover the extent of this insanity. Where in the quarantine handbook does it say "make sure to quarantine people in the most contaminated area you could possibly find in the entire fucking country"?

God I feel absolutely awful for the poor family. It's one thing to enforce a quarantine, but not in a victim's apartment that you've thoughtfully decorated with virus-ridden textiles!!! Not to even mention the other people living in the apartment complex - I'm sure that unmasked, un-Tyveked dude doing the highly aeresolized pressure-washing in the parking lot will appreciate his tiny hazard pay bonus (if they were even so kind).... just wow.

I'm not afraid of ebola and I'm not someone who would panic over this stuff at all - I actually went through a yearlong phase in middle school where I got super interested in these sorts of strange viruses and did tons of nerdy research and wanted to work for the CDC and etc etc, so I'm seriously not squeamish about this stuff at all - but this was handled worse than I could ever have imagined.
posted by dialetheia at 1:40 PM on October 3, 2014 [6 favorites]

The NIH and other people at the current White House press conference are getting grilled with exactly the questions we've been asking; How can they be so confident in our system for dealing with this when the very first test of the system failed at virtually every step of the process.
posted by Justinian at 2:11 PM on October 3, 2014 [4 favorites]

According to this article, at least they're FINALLY moving this poor family, but it is about as bad as I thought it was: Jenkins said that the sheets, clothes and other potentially infected items that Duncan used are bagged and being stored in one of the apartment's two bedrooms with the door closed.

Well, as long as the door's closed! I honestly hoped I had been misreading things because the media is being a bit cagey about it - "quarantined in their apartment" is super different from "quarantined in the apartment Patient Zero got sick in." This article even goes with "sequestered" in the headline, like they're being put up in a hotel during a grand jury trial or something. "Imprisoned in an ebola den" is probably a more honest way to describe it. Just being in that space before it's been cleaned would giving me the howling fantods, much less if I was forced to stay there 24/7 for days.

From the conclusion: Jenkins specifically said that he wanted to make sure that the family would be moved somewhere with a washer and dryer.

Yeah, that would probably help!
posted by dialetheia at 2:26 PM on October 3, 2014

The upside here, I guess, is that in 21 days this all ends.

Twenty-one days and we're in the middle of flu season. This won't end until spring.
posted by dirigibleman at 3:21 PM on October 3, 2014

I think its highly likely that if no one exhibits symptoms in 21 days it is over but that isn't a guarantee. Ebola can live on surfaces for several months under reasonable conditions.
posted by Justinian at 3:40 PM on October 3, 2014

They finally moved the family out (thanks to one kind person who donated their house, I guess - I still can't understand why the CDC doesn't have resources for this and they have to rely on donations?!?!!!, but...) but now it's come out that Duncan slept on literally every mattress in the house while he was sick and they didn't even know that until they entered the apartment to clean it up. When they sent the cleaning crew in on Friday, they thought it would take "about three hours," but once they saw the apartment that increased to "several days," which doesn't exactly inspire confidence in the living conditions to which they subjected this family. If I was a religious person, I'd be praying for them hard - it'd be kind of a miracle if none of them get sick at this point if it's that bad in there.
posted by dialetheia at 12:30 PM on October 4, 2014 [2 favorites]

In 1976 I discovered Ebola, now I fear an unimaginable tragedy.
An interview with Peter Piot.
posted by adamvasco at 4:10 PM on October 4, 2014 [2 favorites]

When Piot is asked whether a pandemic may result of this most recent outbreak of Ebola he says something that makes me wonder just what level of contact is required to contract Ebola. Der Spiegel interviewers then pose two other questions and Piot's answers are illuminating.
Doctors and nurses in India, too, often don't wear protective gloves. They would immediately become infected and spread the virus.

The virus is continually changing its genetic makeup. The more people who become infected, the greater the chance becomes that it will mutate …

... which might speed its spread. Yes, that really is the apocalyptic scenario. Humans are actually just an accidental host for the virus, and not a good one. From the perspective of a virus, it isn't desirable for its host, within which the pathogen hopes to multiply, to die so quickly. It would be much better for the virus to allow us to stay alive longer.

Could the virus suddenly change itself such that it could be spread through the air?

Like measles, you mean? Luckily that is extremely unlikely. But a mutation that would allow Ebola patients to live a couple of weeks longer is certainly possible and would be advantageous for the virus. But that would allow Ebola patients to infect many, many more people than is currently the case.

But that is just speculation, isn't it?

Certainly. But it is just one of many possible ways the virus could change to spread itself more easily. And it is clear that the virus is mutating.
posted by mistersquid at 9:14 AM on October 5, 2014

Anti-Science Congress cut $600 mn. from Agency Leading Ebola Response.
posted by adamvasco at 2:23 PM on October 5, 2014 [2 favorites]

A Spanish nurse's assistant has been verified as the first person to have contracted Ebola outside of Africa after treating Ebola patients in Spain.
posted by Justinian at 1:44 PM on October 6, 2014 [1 favorite]

Nurses at the Carlos III Hospital where the priest died and the Nurse was infected have denounced the hospital for using inadequate protective clothing. (Spanish - El Pais).
Why am I not surprised.
posted by adamvasco at 5:30 PM on October 6, 2014

I'm not particularly religious, but I will pray that what unfolds over the coming months will not be as horrible as it seems it will be.
posted by mistersquid at 9:00 PM on October 6, 2014

More on the Spanish Nurse.
Doctors are using a serum taken from an anonymous donor with ebola, and whose body has generated antibodies.
Meanwhile the Political row is growing
“It was not human error,” said Elena Moral, the CSI-F spokesperson. “It was a protocol that was not properly activated and that did not work properly. We are not prepared to see her blamed,” she added, in reference to the infected nursing assistant, Teresa R. R.
posted by adamvasco at 9:57 AM on October 7, 2014 [3 favorites]

A second Spanish nurse is now suspected of having ebola; tests are in progress.

If the second nurse is confirmed to have the disease it means either it is easier to spread this strain than previously thought or, more likely in my opinion, they don't know what the hell they are doing over there.
posted by Justinian at 5:06 PM on October 7, 2014

Oh boy. In case it isn't clear, Spanish (and other) health care workers, if you've been caring for an Ebola patient who later dies from Ebola and you subsequently begin running a fever do not continue your vacation wandering around Madrid and being sick for four days before seeking medical attention.

One would have thought this was obvious but apparently it is not.

To reiterate: Caring for Ebola patient + subsequently running a fever = DO NOT WANDER THE STREETS OF A MAJOR EUROPEAN CAPITAL.
posted by Justinian at 8:23 PM on October 7, 2014

Justinian,; don´t blame the victim, this is what the venal Spanish government wish you to do. The nurse repeatedly tried to get the medical authorities to take notice.
This article is a shocking indictment of the callous inefficiency of what is happening in Madrid where those involved in unauthorised protests can now be fined up to Euro 600,000.
The fascist fellow traveller prime minister Mariano Rajoy, called for calm as he promised “total transparency in giving all the information that could be given” on the outbreak.
So everything is alright there then.
posted by adamvasco at 5:39 AM on October 8, 2014 [3 favorites]

Why did Duncan receive the ZMapp treatment so late in the course of his infection?

I recall initially seeing reports he was not going to receive it at all.
posted by mistersquid at 10:22 AM on October 8, 2014

When they initially announced they weren't going to give it to him, I assumed the idea was to discourage people from flying to the US when they knew they were sick just so that they could get fancy treatment that they never could have gotten in Liberia (not that people would do that, really, but I can see it being the kind of thing you'd want to discourage just because of the hugely increased risk of transmitting it to fellow travelers). I couldn't figure out what motivated the about-face on that decision, though.

Very sad to hear about Duncan this morning. Sending secular-compassion-prayers for Ashoka Mukpo and the Spanish nurses and their families and everyone in West Africa. What a terrible awful virus.

posted by dialetheia at 10:36 AM on October 8, 2014 [2 favorites]

mistersquid: probably because it was a last ditch effort to save him.
There is no more.
Supplies of the experimental drug, which has been used on patients who survived in the US and Liberia, have run out and manufacturers have admitted it will take months to make more.
posted by adamvasco at 10:39 AM on October 8, 2014 [2 favorites]

I'm upset about Duncan's passing and very sorry for his family.

I was impressed with the leadership and compassion shown by Dallas County Judge Clay Jenkins in this matter. The world needs more people like him.
posted by ob1quixote at 11:18 AM on October 8, 2014 [2 favorites]

Now a deputy who entered Duncan's apartment to get the quarantine order signed is exhibiting "ebola-like symptoms" and is being transferred to Texas Presbyterian. Here's hoping this is just an abundance of caution. I hope Duncan's family somehow escaped being infected even though they were locked in that same contaminated apartment (and sleeping on the contaminated mattresses!) for days. The way that family was treated ought to be a crime. Enforced quarantine is fine, but in the future, can we try harder not to quarantine people in the most contaminated possible location in the entire US?
posted by dialetheia at 1:43 PM on October 8, 2014 [3 favorites]

adamvasco is correct about the Spanish case. It sounds like the nurse had to literally beg to be tested for ebola and even then she was sent to the emergency room to sit and wait for many hours.
posted by Justinian at 5:05 PM on October 8, 2014 [2 favorites]

Duncan received the anti-viral brincidofovir, not ZMapp, mistersquid. I think the Norwegian doctor got the last ZMapp dose. Imho, a very sensible decision since Duncan was 19 days post infection, and ZMapp wasn't helpful with the Spanish priest, also quite late stage.
posted by jeffburdges at 6:07 PM on October 8, 2014

But don't send your exposed child to a public school around a bunch of other kids. What the hell were these people thinking?

Don't mess with Texas?
posted by Thorzdad at 4:23 AM on October 9, 2014


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