Ebola part 3: FOR THE LOVE OF GOD DON'T PANIC!

[MerenthaClone]

100.4F is 38c. Its basically the standard "okay I guess this is a fever now" point.

[Relic]

http://nypost.com/2014/10/16/alarm-after-vomiting-passenger-dies-on-flight-from-nigeria-to-jfk/

I can't tell you how reassuring it is to know that the CDC can tell an Ebola case by simply eye balling a dead body. The body of someone who'd flown in from West Africa and vomited his guts up before kicking the bucket.

Your problem here is you are quoting the NY Post. I worked for the NY Post for many years, and fact checking is not the name of the game there.

Anyway, the flight was from Nigeria where there has not been a new Ebola case in a month. But donlt let that stop you from chicken little-ing the thread every day.

[polishgenius]

You mock now, but when daskool and mudguard die of ebola, they're going to be feeling very, very smug.

[Ice Queen]

The madness continues. Belize has refused entry to a Carnival Cruise Line ship carrying a lab worker from Texas Presbyterian Hospital who may have--repeat, may have--handled Thomas Duncan's lab samples.

IMO the chances of infection are very slim indeed.

The worker set sail before CDC guidelines were in place and shows no symptoms of disease at ~Day 15.

But it brings up another point. Many of these cruise ships are registered in Liberia. Do we refuse them entry to the US?

[WrathOfTinyKittens]

Thanks for the info, guys. I am not worried about Ebola getting me, although I am a little concerned that if another case pops up in Dallas County that the mayor and/or sheriff will do something ridiculous like call in the TX Natl Guard just to show how seriously they take it after bungling everything so far.

Mudguard - if the previous CDC guideline was 101.5 and it's now 100.4, wouldnt that simply indicate an abundance of caution?

[Ice Queen]

Thanks for the info, guys. I am not worried about Ebola getting me, although I am a little concerned that if another case pops up in Dallas County that the mayor and/or sheriff will do something ridiculous like call in the TX Natl Guard just to show how seriously they take it after bungling everything so far.

Your governor has the authority to call in the National Guard. At this point, however, that would be overkill.

[Fez]

But it brings up another point. Many of these cruise ships are registered in Liberia. Do we refuse them entry to the US?

Ideally we'd do this anyway; even there wasn't an Ebola scare.

Thanks for the info, guys. I am not worried about Ebola getting me, although I am a little concerned that if another case pops up in Dallas County that the mayor and/or sheriff will do something ridiculous like call in the TX Natl Guard just to show how seriously they take it after bungling everything so far.

Well, yesterday the Dallas County Commissioners met to discuss declaring a disaster area and grant emergency powers to the county judge. They held off on doing that for now (apparently the mayor talked them out of it), instead announcing that potentially exposed healthcare workers would sign "voluntary agreements" restricting their travel. If another case pops up though, I wouldn't be surprised if they go through with it.

[IheartIheartTesla]

Your problem here is you are quoting the NY Post. I worked for the NY Post for many years, and fact checking is not the name of the game there.

Anyway, the flight was from Nigeria where there has not been a new Ebola case in a month. But donlt let that stop you from chicken little-ing the thread every day.

Also, when there is a little bit of panic permeating the zeitgeist, all kinds of uncorroborated stories begin popping up. I remember well during Katrina how we all talked about breakdown of law and order in a week, when most of the cases reported were fabricated out of thin air.

So we're still down to a handful of cases, and hopefully we've learned something about our response to crises. To me, the key learning is to have constant drills/refreshing your training yearly at least/not fall prey to hubris.

[Zoë Sumra]

But it brings up another point. Many of these cruise ships are registered in Liberia. Do we refuse them entry to the US?

IIRC the majority of ships registered in Liberia have never been anywhere near the country. Liberia is a frequently chosen flag of convenience for either tax or regulation reasons, I forget which.

[daskool]

The madness continues. Belize has refused entry to a Carnival Cruise Line ship carrying a lab worker from Texas Presbyterian Hospital who may have--repeat, may have--handled Thomas Duncan's lab samples.

IMO the chances of infection are very slim indeed.

The worker set sail before CDC guidelines were in place and shows no symptoms of disease at ~Day 15.

But it brings up another point. Many of these cruise ships are registered in Liberia. Do we refuse them entry to the US?

How is this madness? Belize is a small developing country with zero capacity to cope with an ebola outbreak. The risk is small but the consequence is catastrophic, seems like a pretty sensible decision to me. OTOH from the perspective of someone who sees nothing wrong with allowing complete open travel from countries where ebola is a pandemic that would seem unreasonable I suppose.

[Fez]

No articles yet, but its being reported that Obama is naming Ron Klain, former Chief of Staff for Biden and Gore, to be the "ebola czar." Unclear what job that exactly entails.

Also, if Obama wants a real czar on this, he should nominate another Surgeon General and get Reid to force them through.

[Relic]

Also, when there is a little bit of panic permeating the zeitgeist, all kinds of uncorroborated stories begin popping up. I remember well during Katrina how we all talked about breakdown of law and order in a week, when most of the cases reported were fabricated out of thin air.

So we're still down to a handful of cases, and hopefully we've learned something about our response to crises. To me, the key learning is to have constant drills/refreshing your training yearly at least/not fall prey to hubris.

Dude died of a heart attack but that wont stop people like daskool from posting every alarmist story he can find and yelling "see!!!?? see??!!!"

[Ice Queen]

How is this madness? Belize is a small developing country with zero capacity to cope with an ebola outbreak. The risk is small but the consequence is catastrophic, seems like a pretty sensible decision to me. OTOH from the perspective of someone who sees nothing wrong with allowing complete open travel from countries where ebola is a pandemic that would seem unreasonable I suppose.

It is madness because the worker in question hasn't been shown to have Ebola and in all likelihood doesn't have it.

An active case, that's a different story.

[awesome possum]

daskool in this thread reminds me of the old ladies working in the aisle next to me. Every day this week it's been, "did you hear that so-and-so (location within the state) had to shut down because someone might have Ebola?"

One of them literally said these words: "I might just take my vacation time early and not leave my house until Bill says it's okay."

She's talking about Bill O'Reilly, who she's said in the past that she would leave her husband for in a heartbeat and who is the best American living in the country currently. I should win a fucking metal for the amount of restraint I have shown in saying nothing.

[Mudguard]

Mudguard - if the previous CDC guideline was 101.5 and it's now 100.4, wouldnt that simply indicate an abundance of caution?

Yeah, I think that's pretty much the reason why they are moving the threshold down. And they've essentially have been treating Vinson's 99.5F temp reading as a symptom of ebola, recommending that the plane be cleaned and doing all the contact tracing. I really don't know why people still refuse to believe that their is no magical cutoff number where a person is or isn't infectious for ebola. Sure, the risk is very low, but that's the same for 99.5 and 100.4F. And I'm supposedly the one lacking critical thinking here.

[Aemon Stark]

Don't know, the numbers coming out of Africa, overall number of infections and mortality rates, are known to be complete bullshit. If a patient is put on inotropes and a ventilator and closely monitored in an ICU then it might be less than 50% mortality. Unfortunately if there's a major outbreak in the U.S. that option will not be available to the vast majority.

I don't think we have a good sene of what host factors might affect mortality or the clinical course generally.

In any case, I hope they're not using inotropes for hemodynamic support in shock-y Ebola patients. Dobutamine and milrinone don't strike me as good choices to counteract capillary leak and vasodilation. I assume you meant "vasopressors".

[Aemon Stark]

I've repeated my contention over and over already. That there is no magic temperature where a patient goes from not infectious to infectious. As a practical matter for screening purposes, you have to settle on a number, but it's not a number that is set based on degree of infectiousness. It's just a somewhat arbitrary way to classify people as showing fever and not showing fever.

As a demonstration of the arbitrariness and the fact that the threshold does move, some of the CDC's recent temperature guidelines specify the threshold at 101.5. And this.

According to this, you don't have a symptom of ebola, from a fever perspective, if your temp is below 101.5F. So if you have a temp of 100.4F, no symptom, right? Why is everyone talking about 100.4F? Apparently, the CDC has changed the threshold. So why did the magical threshold change?

There may no "magic" threshold in terms of active viral shedding, but your reasoning seems to be that anyone could have Ebola and hence temperature is unreliable. Except that the point is that only for temps over 38 or more should we consider Ebola likely in the presence of confirmed exposure. The fact that some people with early infections may not have any symptoms is crucial, as asymptomatic individuals should not be investigated for anything. This is a diagnostic question. No fever, no other symptoms means no reason to suspect Ebola even in someone with possible exposure. A mildly elevated temp within the range of normal is not a symptom of anything a priori, even if someone goes on to develop a temp of 39.5 and other symptoms.

[Aemon Stark]

Yeah, I think that's pretty much the reason why they are moving the threshold down. And they've essentially have been treating Vinson's 99.5F temp reading as a symptom of ebola, recommending that the plane be cleaned and doing all the contact tracing. I really don't know why people still refuse to believe that their is no magical cutoff number where a person is or isn't infectious for ebola. Sure, the risk is very low, but that's the same for 99.5 and 100.4F. And I'm supposedly the one lacking critical thinking here.

It has nothing to do with someone might be infectious, except someone with no symptoms and normal temp is NOT infectious. Doesn't mean they can't develop symptoms including actual fever later. It's certainly possible someone might be infectious for hours prior to symptoms but there's no evidence that this is the case.

[Aemon Stark]

Sorry, stupid Tapatalk

[Mudguard]

There may no "magic" threshold in terms of active viral shedding, but your reasoning seems to be that anyone could have Ebola and hence temperature is unreliable. Except that the point is that only for temps over 38 or more should we consider Ebola likely in the presence of confirmed exposure. The fact that some people with early infections may not have any symptoms is crucial, as asymptomatic individuals should not be investigated for anything. This is a diagnostic question. No fever, no other symptoms means no reason to suspect Ebola even in someone with possible exposure. A mildly elevated temp within the range of normal is not a symptom of anything a priori, even if someone goes on to develop a temp of 39.5 and other symptoms.

Don't put words in my mouth. I never said "that anyone could have Ebola and hence temperature is unreliable." Stop with all the strawmen arguments.