THCB

The Ebola Outbreak: The CDC Director’s Guidance for Health care workers

Tom Frieden optimized

There has been a lot of fear about Ebola. The health care workers who care for Ebola patients are right to be concerned – and they should use that concern to increase their awareness and motivation to practice meticulous infection control measures.

Ebola virus is transmitted through direct contact with bodily fluids of an infected person who is sick with Ebola, or exposure to objects, such as needles, that have been contaminated with infected secretions.

Travel from Affected Region

There is a risk for Ebola to be introduced to the United States via an infected traveler from Africa. If that were to happen, widespread transmission in the United States is highly unlikely due to our systematic use of strict and standard infection control precautions in health care settings, although a cluster of cases is possible if patients are not quickly isolated. Community spread is unlikely due to differences in cultural practices, such as in West Africa where community and family members handle their dead.

CDC has advised all travelers arriving from Guinea, Liberia, Nigeria, and Sierra Leone to monitor their health for 21 days and watch for fever or other symptoms consistent with Ebola. If they develop symptoms, they should call ahead to their hospital or health care provider and report their symptoms and recent travel to the affected areas so appropriate precautions can be taken.

Health care workers should take good travel histories of patients and, if the patient has traveled within the past three weeks to affected parts of Africa, ask them about fever and symptoms consistent with Ebola. Patients who show signs and have symptoms consistent with Ebola should be promptly isolated, and state and local health authorities should be notified.  There have already been a handful of travelers returning from the region who had fever and sought care – this is to be expected. Several were diagnosed as having malaria, and one with influenzaB.

Health care workers are at risk for infection only when strict safety precautions or sharps management procedures are not followed. Protective measures known as Standard, Contact, and Droplet precautions are considered sufficient protection against transmission: these include gloves, gowns, face masks, and eye protection (goggles, face shield) for personnel providing routine care.

Symptoms and Recommendations for Testing

CDC’s Health Advisory Notice distributed on August 1, 2014, outlines guidelines for evaluation of U.S. patients suspected of having Ebola virus disease. [http://emergency.cdc.gov/han/han00364.asp]

Health care providers should be alert for and evaluate suspected patients for Ebola virus disease who have both consistent symptoms and risk factors, as follows:

1)     Clinical criteria, which includes fever of greater than 38.6 degrees Celsius (101.5 degrees Fahrenheit) and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage;

AND

2)     Epidemiologic risk factors within the past three weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known or suspected to have Ebola virus disease; residence in – or travel to – an area where Ebola virus disease transmission is active or participated in a burial ceremony; or direct handling of bats, rodents, or primates from disease-endemic areas.

Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries.

CDC recommends making a risk assessment for all people with onset of fever within 21 days of having a high-risk exposure. A high-risk exposure includes any of the following:

  • percutaneous or mucous membrane exposure or direct skin contact with body fluids of a person with a confirmed or suspected case of Ebola virus disease without appropriate personal protective equipment;
  • laboratory processing of body fluids of suspected or confirmed Ebola virus disease cases without appropriate personal protective equipment or standard biosafety precautions; or
  • participation in funeral rites or other direct exposure to human remains in the geographic area where the outbreak is occurring without appropriate personal protective equipment.

For people with a high-risk exposure but without a fever, testing is recommended only if there are other compatible clinical symptoms present and blood work findings are abnormal (i.e., thrombocytopenia <150,000 cells/µL and/or elevated transaminases) or are unknown.

People considered to have a low-risk exposure include people in an affected country with a weaker public health system who spent time in a health care facility where Ebola virus disease patients are being treated (encompassing health care workers who used appropriate personal protective equipment, employees not involved in direct patient care, or other hospital patients who did not have Ebola virus disease and their family caretakers), or household members of an Ebola virus disease patient without high-risk exposures as defined above.

Those who had direct unprotected contact with bats or primates from Ebola virus disease-affected countries would also be considered to have a low-risk exposure.

Testing is recommended for people with a low-risk exposure who develop fever of greater than 38.6 degrees Celsius (101.5 degrees Fahrenheit) and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage and who also have unknown or abnormal blood work findings.

People with a low-risk exposure who have fever and abnormal blood work findings in the absence of other symptoms are also recommended for testing. Asymptomatic people with high- or low-risk exposures should be monitored daily for fever and symptoms for 21 days from the last known exposure and evaluated medically at the first indication of illness.

People with no known exposures as listed above but who have fever along with other symptoms and abnormal bloodwork within 21 days of visiting Ebola virus disease-affected countries should be considered for testing if no other diagnosis is found. Testing may be indicated in the same patients if fever is present with other symptoms and blood work is abnormal or unknown. Consultation with state and local health departments is recommended.

If testing is indicated, the state or local health department should be immediately notified. Health care providers should collect serum, plasma, or whole blood. A minimum sample volume of 4 milliters is recommended.

Do not ship samples in glass tubes. Samples should be shipped refrigerated or frozen on ice pack or dry ice. State guidelines may differ, and state and local health departments should be consulted prior to shipping.

CDC’s website [http://www.cdc.gov/ncezid/dhcpp/vspb/specimens.html] has detailed instructions and a link to the specimen submission form for CDC laboratory testing.

If You Have a Suspected or Confirmed Case

A suspected case needs to be isolated until diagnosis is confirmed or ruled out.

Patients should be placed in a single patient room (containing a private bathroom) with the door kept closed, and medical equipment should be dedicated to the individual patient.

Facilities should maintain a log of all people entering the patient’s room. Visitors should be avoided or limited.

Health care providers should wear gloves, gown (fluid resistant), eye protection (goggles or face shield), and a face mask. Additional personal protective equipment might be required in certain situations such as the presence of copious amounts of blood or other body fluids, vomit, or feces. Additional protection can include but is not limited to double gloving, disposable shoe covers, and leg coverings.

Health care staff should avoid performing aerosol-generating procedures on suspected or confirmed patients. If performing these procedures, personal protective equipment should include respiratory protection – N95 filtering facepiece respirator or higher – and the procedure should be performed in an airborne isolation room.

Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is of paramount importance, as blood, sweat, vomit, feces, and other body secretions represent potentially infectious materials.

Appropriate disinfectants for Ebola virus and other filoviruses include 10% sodium hypochlorite (bleach) solution, or hospital-grade quaternary ammonium or phenolic products. Health care providers performing environmental cleaning and disinfection should wear recommended personal protective equipment as described above and consider use of additional barriers such as shoe and leg coverings if needed.

Ebola is a fragile virus and is readily killed by soap and water, bleach, or other products as noted above.

Eye protection – a face shield or face mask with goggles – should be worn when performing tasks such as liquid waste disposal that can generate splashes. Standard procedures for cleaning and/or disinfection and disposal of environmental surfaces, equipment, textiles, laundry, and food utensils and dishware, per hospital policy and manufacturer instructions, should be followed.

For more information, see CDC’s updated infection control guidance for U.S. hospitals for handling patients with known or suspected Ebola: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

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52 replies »

  1. Ebola originate into straight contact with the bodily fluids of an individual who is diseased with the virus and already have the symptoms. Ebola does not transportable through the air. An individual in Delhi cannot fasten Ebola from an Ebola diseased individual in Mumbai without driving there and coming into straight contact with the Ebola diseased individual’s bodily fluids.

    But still it is dangerous as like as world war. Because it has no vaccine and so it is unstoppable. The wrong is that it is too far late to find out symptoms from an Ebola diseased individual and that time it out breaks already. So WHO and the well developed countries have to give more potential, more expert man-power, more financial help and be more concerned otherwise it will definitely be a world war.

    It’s highly unlikely that you’ll become infected with Ebola. So what are you so afraid of? Look briefly at the link below:

    http://www.washingtonpost.com/news/to-your-health/wp/2014/10/05/nothing-to-fear-but-ebola-itself/

  2. I wonder what the CDC’s answer is:

    NBC News: “A second health care worker at a Dallas hospital who tested positive for Ebola was isolated within “90 minutes” of her temperature being taken, officials said Wednesday.” [temps are taken twice per day]

    “The Centers for Disease Control and Prevention and Frontier Airlines have confirmed the new patient took a flight from Dallas-Fort Worth to Cleveland on Oct. 10 and returned to Dallas-Fort Worth on Monday evening — the day before she reported symptoms. Because of the proximity in time between the evening flight and first report of illness the following morning, CDC is reaching out to passengers who flew on Frontier Airlines flight 1143.”

    Since one nurse became sick already and it was known that the precautions taken must not have been adequate why was this nurse flying?

  3. seems anyone suspecting they have the Ebola virus should stay in their home with their family, call in an Ebola medical isolation team to their home, rather than going in to a hospital unidentified until after the exposure event…. kind of backwards what we do. patients get isolated after their trek to and through the ER, to the hospital floor, in contact with countless #’s of medical & non medical people, then their lab results are found to be positive, then the hospital goes berserk with isolation measures…usually after the horse is out the barn….then everyone thinks “job well done”…..

  4. I wonder if one could stimulate interferon–by, for example, giving live measles vaccine–whether this would inhibit the spread through the at-risk population? Interferon was discovered by the realization that people who had one viral infection did not get another. E.g. if you had chickenpox you did not get measels at the same time. Live viral vaccines may stimulate interferon production and giving many folks measles vaccine–I think we have plenty of this–would probably be safe enough as a desperate prophylactic procedure. Who knows, it might even help an active case.

  5. Peter1, if one doesn’t look one will never find and that is probably one of the reasons you think things are swell.

    I can’t generally listen to Rush Limbaugh because he is on the air at the wrong time, but sometimes I am able. I heard a bunch of things he said on this issue. They demonstrated good insight and provided a good set of opinions for a specific viewpoint. Can you tell us what he said that was so wrong? Of course not.

    I haven’t listened to him enough to be able to form an opinion about his broadcasts. You don’t listen to him at all yet your opinions about him abound. Yes, we know where you get your opinions and perhaps that is best for it seems you have none of your own.

  6. “however. We need more data to tell us the answer.”

    Yes we do, and the data will evolve (as the disease may) with scientific investigation and observation from organizations like the CDC, NOT from the Rush Limbaugh/Fox News mentalities looking for liberal plots behind every bush.

  7. I think we may be making two mistakes in our thinking about the mechanisms of Ebola spread.

    1. There seem to be hundreds of anecdotes about its being spread by fomites, contact, touching, handling clothes, bedding, ceremonial objects at funerals. If fomite spread is truly common, then the real world appearance begins to shade into aerosol spread. In other words, extensive fomite spread looks like air-born spread. After all, if everything we contacted were a functional fomite, the mechanism would appear to be almost air-born.

    Assume fomite spread is highly significant, which it appears to be. Wouldn’t it be likely that the virus is rather tough and hardy and robust, rather than fragile? E.g. herpes and athletic wrestling mats. Herpes is a tough DNA virus. Another reasonable assumption is that much fomite spread assumes a small dose effect…i.e. it takes only a few virions to pass the disease if its is via a fomite. Fomite passage implies that the virus is exposed to harmful things: air, oxygen, sunlight, ultraviolet, salt water, drying, physical trauma….and it still survives. In general, I think, fomites do not pass so many infectiious units, cf aerosols, food, body fluids.

    2. The second mistake we may be making is to assume that a patient is non-contagious if he is asymptomatic, progressing quietly in his incubation period. The host who contains a new pathogen such as Ebola is at least a fomite himself. He probably has virions on his body, clothes, effects and friends. And, in addition, he will surely begin to have virus replication in some subset of his cells and tissues. If those tissues are exposed to the outside world in any way, his replicating viruses must have a chance to escape:: mucus, feceal fluid, urine, saliva, tears, serum, blood, aerosol alveolar fluid from coughs.

    To say that these people who are asymptomatic and are infected are not contagious I think is not tightly logical. I’m willing to say you may be functionally correct, however. We need more data to tell us the answer.

    Accordingly, the importance of fomites and their suggestion that the virus is robust and hardy–or perhaps extremely numerous to overwhelm environmental toxicity–is a new thought that may influence management.

    Also, we need more data as to when people are contagious during their course of the disease, especially before symptoms. If people are spreading this stuff and don’t show any signs of illness, we may need to isolate and quarantine based upon something like a c-reactive protein or LDH test….some acute phase reaction. Whew, hard work.

  8. Really, you don’t recognize that the CDC responds to political needs? How naive. Take a look at our drug approval process. Why did the CDC state that heterosexuals could not get HIV (AIDS at the time)? How does one get appointed to the CDC? Why is the CDC expanding its role?

  9. “but it appears to me that it has been politicized ”

    Another anti-government conspiracy theory. Actually allan I think it’s a plot by the United nations and their liberal allies to take over the world.

  10. I wonder if Tom Frieden can elaborate on his statement

    “we are all connected by the air we breathe”

    which is an argument for all nations to become involved, but indicates that Ebola might be airborne. Was this statement made because there are reasonable fears of airborne activity or was it made more as a political statement to ‘rally the troops’? There are many infectious diseases which suddenly could become airborne. To trust the CDC it has to function outside of the political spectrum, but it appears to me that it has been politicized in many different ways and that affects each American. Amongst many examples I remember the CDC advising that HIV could not be transited to heterosexuals.

    Quote at 4:55 minutes @ https://www.youtube.com/watch?v=6Bxencye1cg&feature=youtu.be

  11. “Sorta like this country would be if if the Teaparty got what they wanted.”

    Sorta an ignorant statement.

  12. “Don’t need planes going in and out of failed governments,…”

    That maybe would work if direct flights to USA. People find a way to move, it’s silly to think we can build a virtual wall around these places.

  13. Right. No one in or out without substantial precautions, incubation lags and intense screening. Don’t need planes going in and out of failed governments, with inadequate infection control precautions and superstitions during a deadly disease outbreak. Most people find this sensible.

  14. “Why lend the virus a plane?”

    Since you say quarantine is “extremely difficult” would we need to quarantine the entire region from boarding planes?

    This outbreak is in areas of failed governments, no health care structure, little sanitation and high levels of superstition. Sorta like this country would be if if the Teaparty got what they wanted.

  15. I’m glad this post is being revisited with the first ebola case in the US. I think everyone needs to question why international travel and global agendas are being presented as a given in light of this outbreak. Again: Why lend the virus a plane? Quarantining is extremely difficult…it will become more difficult as it progresses.

  16. Kim Silverman
    Everyone should have knowledge and should be informed to take precautions about these diseases. Most especially those people who are traveling. We must be aware about its Initial symptoms that include fever, intense weakness, muscle pain, headache and sore throat. These symptoms are followed by vomiting, diarrhea, rash, impaired kidney and liver function and sometimes internal and external bleeding.

  17. Notagoodidea, you seem to have a very intelligent understanding of WHY? this new strain of the Ebola Virus has SPREAD SO QUICKLY and is OUT of control!! It’s airborne– and that’s the 5,000 lb ELEPHANT IN THE ROOM, that everyone including the CDC wants to ignore!!

    Admit it or not– the U.S. is ripe for an Ebola Outbreak because the American Public is being constantly deceived about HOW this new strain of Ebola is transmitted. It’s time to TELL THE TRUTH and let the American People know and understand what they’re up against…

  18. Not meaning to sound insensitive over the plight of West Africans who are suffering and dying of Ebola, but what about more news coverage here in the United States? It seems we have a U.S. Media News Blackout here!! Not much discussion or updates on what’s being done about citizens who will be infected by this horrific disease!!

    Are the employees of American Health Departments being trained and properly prepared for people who have been infected with Ebola coming to these facilities? Do the health department employees have the proper protection available? (PPE)

    These are the detailed answers that don’t seem to be available to the public as of yet!!

  19. The CDC has already confirmed that this new strain of EBOLA (this is NOT Ebola Zaire-discovered in 1976) can be transmitted through the air! The CDC has sent memos to U.S. airlines with specific instructions. http://www.infowars.com/cdc-concerned-about-airborne-transmission-of-ebola-virus/

    This is the type of information that’s NOT being made public. Why? As the health community says, “To AVOID panic!!”

    Of course the American Public isn’t being told the truth— http://scgnews.com/ebola-what-youre-not-being-told?utm_source=share-tw We’re getting less and less media news coverage on this Ebola Outbreak. Why is this? Why should we be so naïve and so ignorant to even think that this virus WILL NOT spread to the U.S.?

    “NO NEWS– IS GOOD NEWS??” We think not–

  20. One thing that seems nowhere to be covered is: what are statistics on false positives and false negatives in Ebola testing? How reliable are these tests? And, as we see from HIV testing, where a false positive or negative in one in 10,000 patients results in a 50% error rate in a population with around only one in 10,000 infected with the (HI) virus – how does a similar false positive (which would be less of a tragedy) or false negative (which could have enormous consequences) play out in various cultural scenarios?

  21. “in our interconnected society and lives, it’s simply not realistic to envision that there will be no movement of disease across borders and communities. So, there is a real value to the CDC proactively taking this disease on, both from humanitarian and public health reasons.”
    __

    Precisely.

  22. “Apparently you didn’t take the advice of getting some rest, but stayed up to f/u with this out of context response.”
    __

    Like Nixon before me, I am tanned, rested, and ready. 😉

    Your views here on the Ebola tx location relative risk appear to be poorly informed, and will soon be proven so, IMV.

    But, keep digging. “Yes, But…”ers never know when to quit.

  23. I must admit my initial take on transporting several Ebola patients to the US has been to ask why we were increasing the field of exposure. I think medical providers (of which I am one) and the general population are asking a similar question about the value of one vs the risk to many.

    But if the issue with such a deadly disease is really as straightforward as providing supportive care and meticulous infectious precautions, then it does seem like a real tragedy to just throw people’s lives away because we are afraid for our own, especially when relatively simple care can prevent the loss.

    One area we don’t discuss often is the testing the robustness of our own systems. When various health crises have hit societies over time, there is a realization of the vulnerabilities of the system. By having a controlled influx of a disease like this, I we are able to test our resources, infrastructure, knowledge and training and to refine them (including the use of social media to squelch rumors, update providers, and manage public opinion).

    I also remember the early days of HIV. As a provider in the west village of NYC in the early 90s, I recall the very real sense of HIV and AIDS being a disease that only affected the gay community. But in our interconnected society and lives, it’s simply not realistic to envision that there will be no movement of disease across borders and communities. So, there is a real value to the CDC proactively taking this disease on, both from humanitarian and public health reasons.

  24. They are not using a commercial plane and the sick people do not have free run of the plane. Did you see the picture of the plastic containment area they were kept in in the plane? As to why these people got sick – remember they were in Africa. It’s not like African hospitals have the luxury of rooms with negative pressure or protective suits with separate air supply, etc. Not to mention that they were working 7 days a week many hours a day surrounded by the sick people and changing clothes in rooms where local doctors who weren’t wearing protective gear there as well. Not only it’s easy to make mistake when working in these conditions, it’s also possible to be in contact with a local nurse who got infected from her family and who only started showing symptoms and doesn’t know it’s Ebola (apparently this is what happened – a local nurse was changing in the same room and she brought the infection).

  25. These people were brought in specially equipped plane, in a kind of a “bubble” inside the plane so that they don’t contaminate the plane surfaces. They were similarly transported. Where they are treated, they are kept in negative pressure room and the air that goes out goes through decontamination before it’s released. This is a far cry from the conditions in Africa. If I were you, I’d be more worried about someone’s e.g. a doctor or a nurse there who feels fine today, hops on a plane to the US via say Europe and then starts feeling sick in the plane to the US and vomits all over… Ebola actually mutates very slowly. The probability of this particular strain mutating during the time these doctors are treated is likely zero, but even if it did, the doctors are not sharing any air with these two patients. The protective gear in the US includes separate air supply and pressurized suits that have higher pressure than the room where the sick people are kept.

  26. Bobby, read in context. Peter1 brought up an interesting rationale for bringing Ebola patients to the US. It is one of many rationals, but not the only one nor is it a major one unless something hasn’t been reported.

    You have taken one sentence from a discussion out of context and made it seem as if that was the reason to bring the sick patients home when that was not the reason, but possibly a benefit in doing so.

    Apparently you didn’t take the advice of getting some rest, but stayed up to f/u with this out of context response.

  27. “The reason it is important here is we might be finding travelers returning from the hotspot who might already carry the virus.”
    __

    Conflation 101. Has nothing to do with the decisions to bring back these sick docs back to the U.S. for closely quarantined tx. The fact that infected travelers might bring disease x into the country is a separate, ongoing matter, that’s all.

  28. John, CDC has a downloadable section of questions and answers about Ebola at http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html and we are updating that document as well as all the information on our Ebola website constantly.

    Providers and patients can find updates about the outbreak in West Africa, the signs and symptoms of Ebola, the risk of exposure, and much more. Our Ebola home page is http://www.cdc.gov/vhf/Ebola.

    I appreciate your point about the “rumor report.” There is indeed lots of confusion and we’re working hard to address those points of confusion. For example, I talk about whether there’s effective, proven treatment for Ebola and whether special isolation units are needed to safely treat Ebola patients in my new op-ed on Fox News: http://www.foxnews.com/opinion/2014/08/09/truth-about-ebola-us-risks-and-how-to-stop-it/.

    Thank you for helping us share this information with our nation’s health care providers.

  29. Thank you for your comment. Yes, we are aware of limited experimental work that has raised the possibility of aerosol transmission among animals in a laboratory setting. However, this theory is not substantiated by what we currently know about the spread of Ebola among humans. From the information we have gathered through active work in disease-affected countries, we have no evidence to suggest that the disease in this outbreak has spread through means other than droplets and contact.

    In Africa, medical care frequently is delivered in clinics or households with far more limited resources – that is, little or no protective equipment, no running water, no climate control, no floors, inadequate medical supplies – than those available in developed countries. These conditions in Africa contribute to the spread of Ebola among people. We believe that meticulous adherence to proven infection control measures can protect people against the spread of Ebola. We continue to monitor the situation closely.

    Also, we are tracking the genome of this virus, and have not seen significant evolution to date. Furthermore, since it was first isolated more than 40 years ago, there has been little genomic change.

  30. Bobby for informational purposes and only because you are a nice guy.

    Take note of 3 recent events.

    June 2014
    CDC Anthrax exposures
    July 2014
    CDC Unintentional cross contamination of avian influenza with pathogenic H5N1 and shipped

    http://www.cdc.gov/media/releases/2014/p0711-lab-safety.html

    July 2014
    CDC finds smallpox vials from the 1950’s unsecured

    http://www.cdc.gov/media/releases/2014/s0708-nih.html

    Peter1, as I have said more than once I am not taking sides on this issue rather pointing out that neither side is right or wrong for it is a matter of how one asses the risk. It’s easy for you to draw conclusions because you don’t have to pay the price of what could occur.

    However, that being said and if I read you correctly you might be saying that a major advantage to treating them here is that while they get their treatment we might be able to more quickly investigate and find solutions for the Ebola problem. That is one of my considerations as well and a good reason to do so. It is something that could drastically alter the risk assessment. The reason it is important here is we might be finding travelers returning from the hotspot who might already carry the virus.

  31. “Now Ebola is the current infection most in the news with 1,700 cases and 930 deaths as of today. It took six months to cause that many cases in an area with a population of around 20,000,000. And this in an area with a horrible infrastructure for both health care and infection control. While a ghastly outbreak, Ebola does not appear to be particularly infectious or pose much of a pandemic risk.”

    allan, the biggest risk is from talking media heads inflaming controversy for ratings, while needing space to fill between commercials.

    I welcome the patients being brought here. Much better odds to finding a method of treating this, here and in Africa.

  32. Bobby, get some sleep and reread what I wrote.

    ” I’m not going draw a conclusion now”

    That means I haven’t drawn a conclusion with regard to risk, so what you are saying is meaningless. In fact I have made comments that demonstrate I don’t have a great fear from Ebola. I have had to deal and continue to deal with much greater threats from other organisms that are already in this country or are likely to appear in my lifetime.

    If you believe any of the things I have stated are not risks that one thinks about in their determination of risk quote them.

    Please, get some rest.

  33. Given that I am not a tropical disease public health virologist, I have NO rational reason to assume that the clinical/epidemiological authorities who green-lighted these Ebola tx transfers did so on some casual lark, one dismissive of quantified relative risks.

  34. So? That doesn’t change how decisions are made by intelligent people. It also doesn’t mean that those not wishing those health care workers to be brought into a major city are wrong. It also doesn’t mean there isn’t a risk.

    I personally believe in this country we could control the spread of Ebola and more successfully treat patients here or elsewhere. Our healthcare abilities in this area are probably the best in the world. I won’t even disagree with what you posted from the article. Bobby, plain and simple, it’s a risk assessment task where people will have differences of opinion. Have a good night.

  35. Tom

    Excellent post, as always. I know that given what the public has been hearing on the news, many providers will be dealing with a lot of panicked questions from the public about ebola in the weeks to come.

    Is there an online document that we can point people to that provides basic information for the public? I think a lot of providers will thank you.

    Come to think of it: It might not be a bad idea for CDC to put together a “rumor report” list responding to some of the stories flying around out there (the virus is already airborne, there is a free test, immigrants should be tested on etnry) and respond to each authoritatively …

  36. It seems like the last way to contain a serious disease like Ebola is to assist it’s mobilization by lending it a plane and increasing it’s contact with others. Oceans have a purpose sometimes, other than being a dumping ground for pollution. Wouldn’t it have been possible to transport any amount of supportive care to the hot zone? If infectious precautions were being followed in this outbreak, did they fail? In which case, how will they be more effective in this country?

  37. Dial back the drama? Where have I provided drama other than presenting a distinguished physician’s way of interpreting risk. Perhaps a bit more simplistic than that physician would actually be, but the questions presented cover most of the bases.

    Since I have dealt with biohazard risk most of my life one can only assume that the only way you can defend a position is by making accusations that everyone that disagrees with you is ignorant.

    That is similar to the lunatic in the asylum calling everyone else crazy.

  38. “Now Ebola is the current infection most in the news with 1,700 cases and 930 deaths as of today. It took six months to cause that many cases in an area with a population of around 20,000,000. And this in an area with a horrible infrastructure for both health care and infection control. While a ghastly outbreak, Ebola does not appear to be particularly infectious or pose much of a pandemic risk.”

  39. “People have a right to question why these patients were brought into the country.”

    You need to dial back the Drama. Where do you get from my posting a link from a HIGHLY respected medical science site that I don’t think people have such a right? Let a thousand opinions bloom. Most of them utterly lacking scientific merit.

    Moreover, it’s by now obvious that you have no acumen regarding quantitative assessment of biohazard risk.

  40. @BobbyG: “Yet another plague panic.”

    People have a right to question why these patients were brought into the country. I’m not going draw a conclusion now, but generally when someone wants to make an educated opinion they use certain well tested and well respected criteria.

    Ben Carson M.D. a respected physician from Johns Hopkins wrote a book on risk in 2007. He has written other books earlier that probably included the same message.

    Paraphrasing the criteria:

    If I do this what is the best thing that can happen?
    If I do this what is the worst thing that can happen?
    If I don’t do this what is the best thing that can happen?
    If I don’t do this what is the worst thing that can happen?

    In summary the best thing would be the lives would be saved.

    If the sick Ebola patients were not permitted in they could be treated on a hospital ship, an isolated area of the hospital where they are. Basically supportive treatment is what is needed. Other things can be added if needed anywhere in the world. The determinant factor as to their survival will be the treatment given and not the location.

    The worst thing is that Ebola could escape the institution by accident or by design. Is that likely? No, but then I am reminded of the small pox vials that were found where they weren’t supposed to be. That gives one reason to pause and think a bit more… How did these well trained individual catch the disease? Could it be that there is a flaw in our isolation techniques or our understanding of the disease. I believe Ebola can live outside the human body for a number of days and still be transmissible to another individual. That increases its danger.

    Before using such hyperbole I think consideration of all the factors would lead one to recognize that intelligent people might differ in their opinion on this issue.

  41. Many people disagree with the decision to bring a deadly disease into the country. Although CDC experts have publicly assured us that ebola can only be transmitted through physical contact, there are a number of plausible theories that suggest that ebola is already capable of limited airborne transmission in some situations. Many – if not all – diseases evolve. Some become capable of airborne transmission. Why do you not believe that this will happen in this case?

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