Obama - no quarantine of ebola HC workers

originally posted by: gorsestar

originally posted by: ManBehindTheMask
a reply to: gorsestar

The most sensible method to prevent exposure to others is to keep those who are from an area that its being passed around AWAY from others who have not.......

Put a stop on African passports entering the country and mandatory quarantine ..

*facepalm*

Let's put you in quarantine being that you're from an infected area (Texas).

Thats the most disingenuous post ever.........2 cases is a hell of a lot different then a country over run with it........and you know it......

Theres a lot of face palms for sure, and its with every post you make on here trying to state that quarantining people doesnt solve anything........

Seriously do you know the history of outbreaks and how they are handled? Why do you think they quarantine people with infectious diseases? Because it doesnt work?

Holy crap , no offense, but you either have to be working for someone or be completely stupid to think this precaution isnt valid.......

originally posted by: ManBehindTheMask

originally posted by: gorsestar

originally posted by: ManBehindTheMask
a reply to: gorsestar

The most sensible method to prevent exposure to others is to keep those who are from an area that its being passed around AWAY from others who have not.......

Put a stop on African passports entering the country and mandatory quarantine ..

*facepalm*

Let's put you in quarantine being that you're from an infected area (Texas).

Seriously do you know the history of outbreaks and how they are handled? ..

I don't think you do.

In the early stages of an endemic, quarantines should be used in a limited capacity to minimize the spread of fear and ignorance. If the disease progresses to a pandemic then our federal government will issue mandatory quarantine procedures. States have the right to isolate whomever they choose.

The historical perspective helps with understanding the extent to which panic, connected with social stigma and prejudice, frustrated public health efforts to control the spread of disease. During outbreaks of plague and cholera, the fear of discrimination and mandatory quarantine and isolation led the weakest social groups and minorities to escape affected areas and, thus, contribute to spreading the disease farther and faster, as occurred regularly in towns affected by deadly disease outbreaks. But in the globalized world, fear, alarm, and panic, augmented by global media, can spread farther and faster and, thus, play a larger role than in the past. Furthermore, in this setting, entire populations or segments of populations, not just persons or minority groups, are at risk of being stigmatized. In the face of new challenges posed in the twenty-first century by the increasing risk for the emergence and rapid spread of infectious diseases, quarantine and other public health tools remain central to public health preparedness. But these measures, by their nature, require vigilant attention to avoid causing prejudice and intolerance. Public trust must be gained through regular, transparent, and comprehensive communications that balance the risks and benefits of public health interventions.

source
Isn't this what I've been saying all along?

But of course I'm a government disinformation agent

a reply to: ManBehindTheMask

Its not disingenuous, he has a point - we have talked about it in our meetings that if we are to follow people from affected areas we need to follow up US and Spain, we discussed it in jest but it shows the difficulty of blanket bans.

Quarantining everyone is simply too much resources for such little gain. Its not an effective measure.

I understand you don't think we are doing anything and that all public health is incompetent but this is a profession that goes back 200 years, we deql with this stuff everyday (if people listened to us at the start of the year we wouldn't be in this situation) we draw on a huge range or social medical and scientific research in making decisions and it is unanimously agreed by all who actually know what they're talking about that a blanket quarantine will not work. All it will do is cost the government a huge amount of money, divert public health resources away from real threats and cause more chaos.

a reply to: D4rcyJones

Yet you think quarantining people who have been working closely with those afflicted is a bad idea?

And youre in the medical profession?

Sorry I work with doctors and nurses on a regular basis and not ONE has ever said anything close to what you have stated in that post......

hell there are doctors and nurses on these very boards, and most if not all directly contradict what you just said.......

IF you are truly in the medical field you wouldnt be saying that at all....you would know better

a reply to: gorsestar

prejudice and intolerance

Thats another word for "we cant quarantine because we want to be politically correct".........

Sorry I dont play that game..........

Sick is sick i dont give to rats craps what your skin color is.........

Political correctness is going to cause a lot of people to get sick ..........and thats the stupidest reason on the planet not to contain a biological hazard.........

a reply to: Bilk22

Can anyone give a valid reason why this shouldn't be done?

a reply to: ManBehindTheMask

....Why do you think they quarantine people with infectious diseases? Because it doesnt work?

Because "they" didn't know any better and acted out of fear. Quarantine only works in very specific circumstances, and history is full of examples of quarantines that didn''t work.

West Africa's Ebola epidemic has been "raging" since JANUARY - in areas with international mining operations staffed by people who travel to the US and all over the world, all the time. Fortunately, Ebola is just not that contagious - it has NOT spread worldwide - and does NOT fit the criteria for mass quarantine. Isolation of infected people yes, but quarantine of exposed no - mainly because there's no asymptomatic transmission.

....Mass quarantine for disease control was essentially abandoned last century. Does it deserve a second look?

An outbreak should meet the following three criteria for quarantine to be a useful measure of disease control:

* first, people likely to be incubating the infection must be efficiently and effectively identified;
* second, those people must comply with the conditions of quarantine; and
* third, the infectious disease in question must be transmissible in its presymptomatic or early symptomatic stages.

The use of quarantine in the Toronto outbreak failed on all three counts.

Can J Infect Dis Med Microbiol. 2004 Jul-Aug; 15(4): 204.
PMCID: PMC2094974

but quarantine of exposed no - mainly because there's no asymptomatic transmission.

a reply to: soficrow


I am not agreeing or disagreeing about the quarantine, thats not what I want to address directly. What I do disagree with is the validity of this statement you gave. The reason I do is that it is being thrown around with such confidence and it is not based on direct systematic empirical evidence. If you are in the research field I would think you would understand the differences. limited data in animal models and only anecdotal experience in humans regarding the efficacy of human to human transmission. The evidence you have to back up that statement is indirect and based on assumption. This is not the same thing as being able to support it with empirical evidence , which simply isnt out there. This has been directly asked to several virologist I know ( I do neuro research so did not want to leave room for my best estimate in a field I have only a basic understanding of) , one currently doing research on bio level 4 virus.....I asked if it is entirely and conclusively supported that a persons symptoms and viral shedding accumulated slowly versus the other possibility of occurring with a sudden onset. Their response: First, very limited data but in many cases sudden onset is often seen and the person infected can become very sick very quickly. Therefore, yes, I do think that raises the question and should allow for over precaution in the event someone can romp around a subway or board a plane after clearing screening... and then sudden onset could happen and they could become quite infectious before the person can isolate , even if a doctor/nurse knows all the info it isnt based on 100% certainty or even the current outbreak research which is also telling us that the rate of mutation is the same as the seasonal flu. I honestly would rather be safe than sorry wouldn't you? I provided quite a bit of resources below that support what I am saying about the limited data and past outbreak model limitations. Another great source of evidence supporting caution is based on this current outbreak can be found in this link, its a very good laymen format www.operonlabs.com.../13
do not wish to be antagonistic at all nor do I think it is the the end of times. We are very capable here in the US. What worries me is the over abundance of confidence skewing good judgement.

"From an epidemiological perspective, we cannot simply rely on our ability to contact trace asymptomatic Ebola patients after they walk off the tarmac. This is not a sustainable strategy. "

The presence and concentration of virus in organs, tissues, blood and other bodily fluids
changes during the course of the infection. The virus concentration peaks when the patient is most sick, and
viruses can be detected and isolated from breast milk and semen weeks after recovery [4]. There are limited data available on when patients become viraemic and infectious during the incubation period. The assumption is that the rate of virus replication and excretion into bodily fluids is not high enough in the pre-symptomatic phase to result in person-to-person transmission through day-to-day contacts in the community. However, there are no data on when viraemia starts during the incubation period
European Centre for Disease Prevention and Control

The latent and infectious periods: THERE IS QUITE A BIT OF VARIBILTY IN THIS!! NOTICE THE DATA IS ONLY AVAILABLE FOR TWO TIME PERIODS
Other parameters associated with the time course of EVD have not been rigorously ascertained. However, according to Bayesian model-based estimates from a past Ebola outbreak [33], the mean latent and infectious periods have been estimated at 9.4 and 5.7 days, respectively, using a vague prior and 10.1 and 6.5 days, respectively, for an informative prior. These exponential distributions based on a mathematical modeling study are the only available empirical evidence for these two time periods.


www.biomedcentral.com...

These studies fitted models of varying complexity to time series with date of disease onset and/or death. However, in both outbreaks, hospital-based infection played a substantial role in transmission (Borchert et al., 2011, Khan et al., 1999 and Francesconi et al., 2003). As the data were not stratified by likely source of infection, it was not possible to identify the relative contribution of different transmission routes to the reproduction number. It therefore remains unclear to what extent person-to-person transmission contributed to past Ebola outbreaks, and how community and hospital-specific control measures influenced the reproduction number in each setting.
www.sciencedirect.com...


In heterogeneous populations, however, the population average value of R0 is less predictive of transmission dynamics [14]. For example, in populations with highly right-skewed distributions of individual reproductive numbers, most individuals infect few, if any, others, but a few individuals infect many others. In such populations, there is a high probability that a disease outbreak will not be sustained in the population and will instead go extinct [14]. In some cases, however, those rare individuals in the tail of the distribution with a much higher-than-average individual reproductive number while they are infected, known as “superspreaders” [15], can have a significant impact on whether an outbreak becomes an epidemic or goes extinct. Epidemiological outbreak investigations, which track the spread of disease by a technique called contact tracing, have identified the existence of superspreaders in many well-known infectious disease outbreaks, including typhoid fever, measles, smallpox, Ebola, and severe acute respiratory syndrome (SARS) [14], [17], [18]. These rare individuals often make a significant, sometimes deciding, contribution to the dynamics of disease spread (Table 1).
www.plospathogens.org...


While it may be improbable that the case of Thomas Duncan results in a sustained chain of transmission in the United States, this event underscores the fact that for each case of Ebola that comes to the U.S. from West Africa, there will be several hundred people that need to be monitored. This is a ratio of 100:1 to 200:1 contacts per confirmed Ebola patient. The problem is that if the outbreak continues to grow in West Africa, asymptomatics will continue to enter the U.S., and will require rapid detection, isolation, and treatment by the CDC and our health infrastructure.
Eventually, however (if the outbreak in Africa is not brought under control), the United States will experience saturation of its contact-tracing capabilities. Incoming cases will saturate our response, and Ebola cases will eventually fly 'under the radar' for one to three incubation periods until the index case can no longer be identified through contact tracing. At this point, if the virus's effective reproduction number is sufficiently high (>1), the Ebola virus will be very difficult to stop within the U.S. From an epidemiological perspective, we cannot simply rely on our ability to contact trace asymptomatic Ebola patients after they walk off the tarmac. This is not a sustainable strategy.
www.operonlabs.com.../13

a reply to: ManBehindTheMask

Huh? I have said multiple times i support quarantining of returned hcws... perhaps i wasn't clear, what exactly do you disagree with and i will try clarify.

Ive never claimed to be a medical profession, im an infectious disease epidemiologist, ive worked in in various areas of public health for about 15 years. I have spent time in Gambia, DR Congo, Nepal, PNG and now back home in Australia. Ive worked in all levels of government and NGOs i was part of a WHO investigation team that responded to the 2007 DR Congo outbreak. my opinions are my own based off all my experiences i have had, you dont have to agree with me.

I have seen the effects of blanket quarantining - they dont work.

Can you provide me just 1 peer reviewed research article that supports a blanket quarantine?

originally posted by: D4rcyJones
a reply to: ManBehindTheMask


I have seen the effects of blanket quarantining - they dont work.

Can you provide me just 1 peer reviewed research article that supports a blanket quarantine?

That's what I'm waiting for too! Not just from him but from anybody.

There's a pattern of replies claiming that our objections are somehow PC (how?). Politicizing disease outbreaks will only stoke the fires, it ain't about dems or republicans.

a reply to: bella2256

Doctors Without Borders has been in the field fighting Ebola since it first appeared - they say quarantine is not science-based, and so does my own research. Not to worry though - the whole thing has been so politicized, looks like the epidemic won't be stopped in West Africa, so moot point. Doesn't matter really matter any more if there aren't any medical staff to man the new clinics, wear the new gloves, etc.

....Doctors Without Borders, an international aid organization that responds to public health crises, commented on Hickox’s isolation saying it “strongly disagrees with blanket forced quarantine for healthcare workers returning from Ebola affected countries.” The organization added that ]“such a measure is not based upon established medical science”.

“Kaci Hickox has carried out important, life-saving work for [Doctors Without Borders] in a number of countries in recent years, and we are proud to have her as a member of our organization. [Doctors Without Borders] respects Kaci’s right as a private citizen to challenge excessive restrictions being placed upon her,” the organization said in a press release.

Experts say this is the one thing needed to stop the Ebola crisis

a reply to: soficrow

Oh no sorry...I was sort of off topic. I know and have read the research about quarantine. I think her being cautious and staying close to home is reasonable though...at this point probably for her on safety as well. There is something very off about her and all this in particular. But that would be speculation!
I was more interested in what you thought about the new variant, the mutation rate and this new info about this outbreak. I think that it makes it very hard to pinpoint when someone can become contagious. There is a good bit of info on the one site about its adapting to its new host...humans.
I also am curious about their statements on diagnostics . Anyway, I was hoping to get your feedback on that mainly, sorry if I was not clear.

a reply to: bella2256

....I was more interested in what you thought about the new variant, the mutation rate and this new info about this outbreak. I think that it makes it very hard to pinpoint when someone can become contagious.

I think it's obvious. The epidemic started in West Africa back in December, smack in the middle of a 3-country mining region staffed by foreign internationals from around the world. Those staffers have been travelling in and out of the region for going on 11 months. ....Here's where it's obvious - if this new variant were contagious before being symptomatic, we'd already have a pandemic.

...Not to minimize the dangers of mutations in new hosts, but most of the mutations found occurred over a ten year period, before this epidemic. Still, more hosts means more mutations - which is why the epidemic needs to be stopped where it is. Quickly.