Will Ebola become a big problem in the United States?

[phan52]

Originally Posted by phan52

You have never felt fatigue or exhaustion? Especially after just travelling thousands of miles from another country and about 4-5 time zones? I walked 18 holes yesterday afternoon and I was beat afterward (probably had more to do with playing poorly).

If he didn't have an elevated fever, he was not symptomatic.

Originally Posted by newtogolf

Of course I have and had I not been exposed to any deadly diseases I'd not have thought twice about it.

Sometimes my stomach doesn't feel right after I eat something and I blow it off as indigestion but If I am exposed to someone with a stomach virus and the next day I feel nauseas I consider that I've caught the same bug and try to isolate myself from the rest of the house until I'm sure.

It's about common sense.  The doctor was exposed to Ebola.  Exhaustion / fatigue are known symptoms of Ebola.  Common sense would dictate given the circumstances that he'd quarantine himself for the day and re-evaluate.    Had he done that he'd have been right to do so since he exhibited fever the very next day.

So how many symptoms does one have to exhibit before you would consider him symptomatic?  If exhaustion / fatigue is one symptom of Ebola and it's been confirmed he has Ebola why do you not consider he was symptomatic?

As you have pointed out many times here, the guy is a doctor. Not only that, but a doctor who has personal experience dealing with the virus. He knew when he was symptomatic, as the critical component is an elevated fever. If he did not have an elevated fever he would not have reached the acute stage of the disease that would make him contagious.

You must think these people are stupid. They know better than anybody how dangerous the virus is if you catch it, so I am fairly certain that these people would immediately turn to medical authorities when they have symptoms with which they are familiar. That is exactly what Dr. Spencer did.

[Golfingdad]

Of course I have and had I not been exposed to any deadly diseases I'd not have thought twice about it.

Sometimes my stomach doesn't feel right after I eat something and I blow it off as indigestion but If I am exposed to someone with a stomach virus and the next day I feel nauseas I consider that I've caught the same bug and try to isolate myself from the rest of the house until I'm sure.

It's about common sense.  The doctor was exposed to Ebola.  Exhaustion / fatigue are known symptoms of Ebola.  Common sense would dictate given the circumstances that he'd quarantine himself for the day and re-evaluate.    Had he done that he'd have been right to do so since he exhibited fever the very next day.

So how many symptoms does one have to exhibit before you would consider him symptomatic?  If exhaustion / fatigue is one symptom of Ebola and it's been confirmed he has Ebola why do you not consider he was symptomatic?

Your common sense would dictate that.  And that's fine.  Mine would dictate that I follow the protocols set forth by the experts.  What is so wrong with that?  I get that your way is "better" - his chance of infecting somebody was 0% whereas doing it your way would lower those chances to 0.0% - but it's not necessary.

As you have pointed out many times here, the guy is a doctor. Not only that, but a doctor who has personal experience dealing with the virus. He knew when he was symptomatic as the critical component is an elevated fever. If he did not have an elevated fever he would not have reached the acute stage of the disease that would make him contagious.

You must think these people are stupid. They know better than anybody how dangerous the virus is if you catch it, so I am fairly certain that these people would immediately turn to medical authorities when they have symptoms with which they are familiar. That is exactly what Dr. Spencer did.

Right.  And it's no surprise to anybody that nobody from the bowling alley or the High Line or wherever else he went when he was not symptomatic ("but he was tired!") has gotten sick.

[RandallT]

http://www.huffingtonpost.com/2014/10/30/cdc-ebola_n_6078072.html?1414706913

I thought this was interesting.  Here's the original CDC Q&A; on spreading Ebola through cough/sneeze (available as late as October 29):

Can Ebola spread by coughing? By sneezing?

Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.

Then here's the updated CDC  version (noticed early today, I think, after being removed completely for a period of time):

Can Ebola be spread by coughing or sneezing?

There is no evidence indicating that Ebola virus is spread by coughing or sneezing. Ebola virus is transmitted through direct contact with the blood or body fluids of a person who is sick with Ebola; the virus is not transmitted through the air (like measles virus). However, droplets (e.g., splashes or sprays) of respiratory or other secretions from a person who is sick with Ebola could be infectious, and therefore certain precautions (called standard, contact, and droplet precautions) are recommended for use in healthcare settings to prevent the transmission of Ebola virus from patients sick with Ebola to healthcare personnel and other patients or family members.

It subtly different, just more emphasis on the unlikelihood (zero evidence) of transmission via cough/sneeze. I know some media outlets have been highlighting the transmission via droplets on various surfaces with Ebola surviving for some period of time.  Seems like CDC is really saying "nah- probably won't happen."

[Dave2512]

So how many symptoms does one have to exhibit before you would consider him symptomatic?  If exhaustion / fatigue is one symptom of Ebola and it's been confirmed he has Ebola why do you not consider he was symptomatic?

Everything I've read says it's a group of symptoms not just one. You get sick and the symptoms are concurrent.

[Lihu]

So how many symptoms does one have to exhibit before you would consider him symptomatic?  If exhaustion / fatigue is one symptom of Ebola and it's been confirmed he has Ebola why do you not consider he was symptomatic?

Everything I've read says it's a group of symptoms not just one. You get sick and the symptoms are concurrent.

We don't really know in our environment. Most of the data was taken in West Africa. It's hard to correlate exactly how the symptoms show up here, different individuals from different backgrounds also have slightly different reactions. For example, a very fit and healthy person might not show symptoms as readily as a malnourished person.

Also possible that a common influenza virus can also exhibit some of these symptoms especially in the colder and drier climates, whereas in warmer more humid climates the symptoms of flu are not as pronounced.

My guess is a lot more people will think they have Ebola when in reality they have a common flu.

[newtogolf]

Everything I've read says it's a group of symptoms not just one. You get sick and the symptoms are concurrent.

Okay, I'll buy that but - when I get a cold, it usually starts out where I feel tired, then I get a slight sore throat.  By the next day my sore throat is worse and I have a runny nose and congestion.  I might not get a fever until the 2nd or 3rd day but you guys are saying I should ignore the feeling of being tired or a slight sore throat as symptoms?

What I'm saying is there's a progression to the symptoms, you typically just don't just wake up with all of them at the same time.

[Dave2512]

We don't really know in our environment. Most of the data was taken in West Africa. It's hard to correlate exactly how the symptoms show up here, different individuals from different backgrounds also have slightly different reactions. For example, a very fit and healthy person might not show symptoms as readily as a malnourished person.

Also possible that a common influenza virus can also exhibit some of these symptoms especially in the colder and drier climates, whereas in warmer more humid climates the symptoms of flu are not as pronounced.

My guess is a lot more people will think they have Ebola when in reality they have a common flu.

Not sure where you heard/read that. Ebola is ebola no matter where and the symptoms will be the same, the severity may differ slightly but it is what it is. The difference is how it's treated, obviously the US health care system is better than rural Africa. Duncan died in the US, he wasn't malnourished, what killed him was lack of treatment. That's why they die in Africa.

[newtogolf]

Not sure where you heard/read that. Ebola is ebola no matter where and the symptoms will be the same, the severity may differ slightly but it is what it is. The difference is how it's treated, obviously the US health care system is better than rural Africa. Duncan died in the US, he wasn't malnourished, what killed him was lack of treatment. That's why they die in Africa.

That's not entirely true, the CDC has modified there position on transmission and symptoms in just the last month.  As @Golfingdad indicated, the poster for Ebola symptoms did not include fatigue / exhaustion but the CDC website does not specify it is a symptom.  The CDC has clarified their position on airborne transmission to cover the situation where droplets with infectious fluids are coughed or sneezed onto surfaces where people can come into contact with them and potentially become infected by them.

The science and positions of the CDC and WHO are evolving as they dedicate more resources to studying it.

[Lihu]

Not sure where you heard/read that. Ebola is ebola no matter where and the symptoms will be the same, the severity may differ slightly but it is what it is. The difference is how it's treated, obviously the US health care system is better than rural Africa. Duncan died in the US, he wasn't malnourished, what killed him was lack of treatment. That's why they die in Africa.

Yes, symptoms are different for different people. I agree, in general that treatment in the US is going to be much more effective here due to the environment. I did vote that Ebola will not be a major problem here, and in my first post here even stated that it will probably not be a major issue.

However, I think we can take it too far the other way as well. We should exhibit caution, not ostracism, just caution.

[Dave2512]

That's not entirely true, the CDC has modified there position on transmission and symptoms in just the last month.  As @Golfingdad indicated, the poster for Ebola symptoms did not include fatigue / exhaustion but the CDC website does not specify it is a symptom.  The CDC has clarified their position on airborne transmission to cover the situation where droplets with infectious fluids are coughed or sneezed onto surfaces where people can come into contact with them and potentially become infected by them.

The science and positions of the CDC and WHO are evolving as they dedicate more resources to studying it.

Organizations adding or subtracting symptoms doesn't mean the symptoms will be different for people in different areas, which is what Lihu said. Ebola is Ebola.

[Golfingdad]

That's not entirely true, the CDC has modified there position on transmission and symptoms in just the last month.  As @Golfingdad indicated, the poster for Ebola symptoms did not include fatigue / exhaustion but the CDC website does not specify it is a symptom.  The CDC has clarified their position on airborne transmission to cover the situation where droplets with infectious fluids are coughed or sneezed onto surfaces where people can come into contact with them and potentially become infected by them.

The science and positions of the CDC and WHO are evolving as they dedicate more resources to studying it.

I think you meant to say the website DOES specify it is a symptom.

I also think you were a little (intentionally?) vague on the next part.  According to @Dave2512 's post, they clarified their position from "you may become infected from a cough or a sneeze" to "there is no evidence that it's ever happened."  Your sentence spins it like they went the other way.

And nobody is disagreeing that they continue to learn more and more.  That is their job.  But we recognize that they exercise an abundance of caution in the face of what they don't know.  They don't say "we're not sure if you can get Ebola from a sneeze so we encourage everybody to stand next to a sneezing Ebola victim."  Using that logic and common sense, you can determine that if they do state something, such as "you can't get it from somebody that isn't exhibiting symptoms," then you know they've researched that.

[phan52]

We don't really know in our environment. Most of the data was taken in West Africa. It's hard to correlate exactly how the symptoms show up here, different individuals from different backgrounds also have slightly different reactions. For example, a very fit and healthy person might not show symptoms as readily as a malnourished person.

Also possible that a common influenza virus can also exhibit some of these symptoms especially in the colder and drier climates, whereas in warmer more humid climates the symptoms of flu are not as pronounced.

My guess is a lot more people will think they have Ebola when in reality they have a common flu.

And you know this . . . how?

[Lihu]

And you know this . . . how?

Observation, just like the scientists actually working on the problem.

[Jeremie Boop]

Observation, just like the scientists actually working on the problem.

I don't expect Phan will think that's very scientific. You'll have to find actual studies that back up what you said.

[phan52]

Quote:

Originally Posted by Lihu

We don't really know in our environment. Most of the data was taken in West Africa. It's hard to correlate exactly how the symptoms show up here, different individuals from different backgrounds also have slightly different reactions. For example, a very fit and healthy person might not show symptoms as readily as a malnourished person.

Originally Posted by phan52

And you know this . . . how?

Originally Posted by Lihu

Observation, just like the scientists actually working on the problem.

None of what you said has been documented, or frankly, even been speculated. Ebola is Ebola. A person with Ebola is going to show symptoms, fit or not. Mr. Duncan didn't die because he was unfit and the two nurses didn't survive because they were fit. The main difference in whether a person will survive is if they get supportive care.

[Lihu]

I don't expect Phan will think that's very scientific. You'll have to find actual studies that back up what you said.

I'm not sure how to quantify "symptoms". There's not really enough data to create a quantifiable metric. At this point qualitative data is really all we have as far as determining the depth of the symptoms.

This is why they need more funding to expand the knowledge of this and many other diseases.

[newtogolf]

None of what you said has been documented, or frankly, even been speculated. Ebola is Ebola. A person with Ebola is going to show symptoms, fit or not. Mr. Duncan didn't die because he was unfit and the two nurses didn't survive because they were fit. The main difference in whether a person will survive is if they get supportive care.

In general I agree but the age and overall health factors into the chance of recovery for just about any infectious disease.  People with pre-existing conditions, babies and the elderly die more from the flu than healthy middle age adults.

Another factor is the time elapsed from becoming symptomatic and receiving treatment.  Duncan may have died because he was symptomatic for days before they diagnosed him as having Ebola and starting treatment.

[phan52]

Quote:

Originally Posted by phan52

None of what you said has been documented, or frankly, even been speculated. Ebola is Ebola. A person with Ebola is going to show symptoms, fit or not. Mr. Duncan didn't die because he was unfit and the two nurses didn't survive because they were fit. The main difference in whether a person will survive is if they get supportive care.

Originally Posted by newtogolf

In general I agree but the age and overall health factors into the chance of recovery for just about any infectious disease.  People with pre-existing conditions, babies and the elderly die more from the flu than healthy middle age adults.

Another factor is the time elapsed from becoming symptomatic and receiving treatment.  Duncan may have died because he was symptomatic for days before they diagnosed him as having Ebola and starting treatment.

That is pretty much what I said. Mr. Duncan didn't get the requisite supportive care, while the nurses did.

And finally, some forward thinking . . .

http://www.nytimes.com/2014/10/31/nyregion/new-york-state-offers-protections-for-medical-workers-joining-ebola-fight.html

New York officials announced on Thursday that they would offer employee protection and financial guarantees for health care workers joining the fight against the Ebola outbreak in three West African nations.

The announcement was an effort to alleviate concerns that the state’s mandatory quarantine policy could deter desperately needed workers from traveling overseas.

Under the new protections, modeled after the rights granted military reservists, workers could not suffer any pay cuts or demotions for serving in Africa, and the state would make up any lost income if they had to be quarantined when they returned....

. . . “The state would also provide necessary reimbursements, to health care workers and their employers, for any quarantines that are needed upon their return, to help protect public health and safety in New York,” the statement Thursday said.

Also on Thursday, the World Bank announced an additional $100 million to speed deployment of foreign health workers to Liberia, Guinea and Sierra Leone.

Paul Allen, co-founder of Microsoft, pledged $100 million this month to help increase the flow of foreign health workers, with much of the money going toward medical evacuation services in case workers were infected. Lack of evacuation financing had been a major obstacle to getting more workers to sign up.

These are major developments which will encourage healthcare workers to assist in the fight at the source.