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City public-health doc: Boston won't be tossing any people with suspected Ebola into unheated tents in parking lots
By adamg on Mon, 10/27/2014 - 3:53pm
The head of the city's infectious-disease program says we're not going to see a replay of what happened to that nurse in Newark.
"You can't lock them up, it just doesn't work," Dr. Anita Barry, director of the Boston Public Health Commission's infectious-disease program, told the commission board today.
Barry said isolating patients - in decent conditions, rather than in an unheated tent - is hardly something novel for Boston hospitals, which know how to isolate people with communicable diseases such as measles and tuberculosis. "We do this all the time," she said. "It's not like we've never done this before."
Boston, its hospitals and first-responder programs have all geared up for possible Ebola cases, she said. She acknowledged there is still work to do, in part because of constantly changing guidelines from the federal Centers for Disease Control on how to deal with Ebola patients. She said her staff is in the middle of a series of meetings with city hospitals on details such as where EMTs would bring potential Ebola patients - some might not want them brought into the emergency room.
In addition to hospitals, BPHC has also worked with community health clinics and Boston Public Schools on recognizing possible infection and steps to take. The commission has also prepared fact sheets aimed specifically at local residents from the three West African nations that have had the bulk of this year's cases.
She acknowledged that people have "really, really, really gotten extremely anxious about this situation" - and that that has extended to the health-care community, especially after a hospital nurse in Dallas was diagnosed with the disease.
Barry said that in addition to three highly publicized cases - the guy in Braintree, the lady on the Orange Line and the passengers on the plane - her office has gotten several calls from local hospitals about potential Ebola cases.
But she said that, to date, not only has Boston not had a confirmed Ebola case, "I don't think we've had a person that met [all the federal] criteria" of possible symptoms - which can be caused by a number of other infections.
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Comments
Meanwhile in Italy:
Meanwhile in Italy:
http://www.cbsnews.com/news/ebola-outbreak-u-s-soldiers-returning-from-l...
At least our troops get a gym in their isolation center.
How about looking at real plagues?
While we're all shrieking and clutching our pearls over Ebola, roughly 1500 Americans have been killed by another contagious pathogen: methicillin resistant staphilocantspellitus aureus, aka MRSA.
That's right: DIED. Died painful humiliating deaths.
From an entirely manmade pandemic for which we can thank the same politicians who are posturing over Ebola.
And all of whom should be first up against the wall even before the revolution comes.
Not to mention that locking
Not to mention that locking up healthy people against their will who have no symptoms of Ebola but just have been to West Africa is not only morally repugnant, but probably also illegal.
"Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety."
Isn't the problem that you might be as yet asymptomatic
But still be able to pass the disease on to others? Which might then result in those other people dying? Wouldn't you want to be monitored in a hospital if there was a 20% chance (or something similar) you may have inadvertently contracted an extremely dangerous illness? This kind of thing doesn't happen all that often, and I really don't see these preemptive medical isolations as a particularly sinister threat to liberty. Is there any other way to guarantee that infected, but temporarily asymptomatic people aren't running around giving ebola to some unlucky statistical slice of the people they come into contact with?
asymtomatic
actualy, you can not be contagious if you are not symptomatic. That is why there is a huge emphasis on the fever...obviously fevers can be associated with many other conditions.
Good to know, thanks.
So the key is hoping people do what they can, voluntarily, to protect others when and if they do start experiencing symptoms. For some reason I anticipate a Law and Order episode being made about this at some point, if it hasn't been already.
Nope
We've known about ebola for four decades now - no one who is asymptomatic has ever been found to be contagious. Not. One. Person.
Generally someone coming down with Ebola first gets achy, then they get a fever, and then at some point after that they start to get diarreah and stomach upset. [b]That[\b] is when the virus starts to present in the body fluids in significant amounts and the person become contagious.
The virus doesn't do the airborne thing (unlike flu or measles or a hundred diseases that kill thousands of times more people) and it doesn't even survive long outside the body on random surfaces etc.
So calm the hell down and worry about getting the flu or forgetting to look both ways before crossing the street - that's way WAY more likely to kill you.
Follow up
Is it reasonable to quarantine someone who has treated symptomatic individuals if they have a fever -- yes or no?
Fever is a symptom. However,
Fever is a symptom. However, whether someone has a fever should be determined by a reliable method. A forehead "thermometer" is not reliable.
As other people have answered
As other people have answered already, asymptomatic people have a zero percent (0%) chance of infecting anyone else. So yes, I do see an involuntary quarantine outdoors in a tent for 3 weeks of someone who is not able to infect anyone else as a huge threat to liberty.
That's like saying that at some point there is a possibility that you may commit a crime. Let's lock you up for the next three weeks and monitor you against your will just to be sure that you will not turn into a criminal.
We do not lock people up who are no danger to society in the present, regardless of what may happen in the future.
In addition to the "doesn't work" idea this might be because
I (for one) cannot, off the top of my head, articulate a legal basis (under state law) for quarantining a person, who is not showing any signs of disease, for more than a reasonable amount of time to determine whether that person actually has the communicable disease.
Presumably, this involves some kind of exercise of the police powers reserved to the states, but can anyone articulate the basis under Massachusetts law?
I am aware that at the international frontier (e.g., the Customs area at Logan), our rights are at a bare minimum and there is a legal basis for detention for even "small" reasons (but even there, I am not sure that holding people beyond a reasonable amount of time needed to determine whether they actually have a communicable disease has a basis in federal law).
I just cannot see how someone could be held for something like 21 days in either case (I am increasingly confident that lawyers in NJ were asking the same question, and an inability to articulate the legal basis is why the nurse from Maine has been released - prediction: the State of NJ will be paying this woman some amount of money if for no other reason than her lawyers will want to pursue a claim).
Of course quarantine is legal!
See: http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html
Note that viral hemorrhagic fevers are one of the enumerated diseases for which quarantine is authorized.
It was routine in ye olden days for ships and travelers to be quarantined when they might be carrying contagious diseases with no vaccine or treatment -- especially smallpox. Hospital Point Light in Beverly was the site of a smallpox quarantine hospital.
Quarantine is a totally reasonable public health measure under certain circumstances, and it absolutely did work. I find it a little odd to hear public health officials repeating the claim that travel restrictions and quarantine don't work, when they (in addition to contact tracing) are the methods Nigeria used to eliminate Ebola infections.
No, it isn't
Not when someone is not contagious and is not any threat to anyone.
Absolutely did work? Really? CITATIONS PLEASE!
We also know a hell of a lot more right now about Ebola than people did about smallpox in Ye Olden Days. Should we be bleeding these returning medical workers, too?
This is more vacuous security theater bullying. This is a medical issue, not a security issue. Security theater avoids accountability and establishment of efficacy. Medicine and science require them.
Security theater is harmful absent pathogenesis. It is incredibly dangerous given potential pathogenesis.
Stupidity, ignorance, and fear have a great historic track record for spreading plague, not containing it.
http://www.dailymail.co.uk
http://www.dailymail.co.uk/sciencetech/article-2809803/Ebola-surfaces-TW...
Another source?
Something more reputable than the Daily Mail?
RTFA
The Daily Mail article is well sourced, mostly from the CDC!
Are you afraid actually reading it might be a thoughtcrime or something?
No, I don't want to waste my time
I realize the National Enquirer has actually done some legitimate journalistic work, but that doesn't mean that on the whole I'm going to trust it. Same for the Daily Mail.
You're off on the Mail
It's a bit higher up on the journalism specter from the National Enquirer. I would even put it above the Boston Herald. The article was interesting and informative. If it appeared in the Daily Mirror, sure, that's more entertainment than news, though it is theoretically a newspaper, but the Mail is a bit more than that.
Unless you are saying that the cited studies are bunk, too.
Considering this doctor is
Considering this doctor is complaining that the CDC keeps sending his hospital new guidelines on how to treat Ebola, you might want to entertain the hypothesis that the CDC doesn't actually know all that much about it, and is making up the rule book as they go along.
Mr. Duncan did not tell the
Mr. Duncan did not tell the truth about his exposure to Ebola when leaving to come to the US; he wasn't quarantined but would have been if quarantine were required.
In NYC the doctor after returning from helping in Africa was feeling a little sluggish but still got on the subway unconcerned.
One of Mr. Duncan's nurses, who contracted Ebola, got on a plane with a fever; she was a little concerned and called the CDC but was told the best medical science was that her fever wasn't high enough to cancel her trip.
The technician who did the blood work on Mr. Duncan wasn't ill at all so went ahead with her cruise plans; while on the cruise she realized the precariousness of her situation out there in mid-Ocean,if she were to get ill. This though the best CDC science said that it is OK for her to go on a cruise and be thousands of miles from medical care. Luckily, she didn't get ill.
Dr. Nancy Snyderman, under voluntary quarantine, because her NBC associate contracted Ebola, went out for fast food.
The fatality rate of this disease in Africa is 70%; save if you get hospital care it is only 63%.
Perhaps we should be careful; if not full quarantine then something more than the honor system of self-monitoring.
Of course its legal?
You glossed right over the most important part.
There is no hemorrhagic fever. There is no enumerated disease. The nurse in NJ was not sick, and was exhibiting no symptoms.
As to how things used to happen, well, slavery, child labor, Irish Need Not Apply, etc. Happily for us, times change.
The link you provided, while interesting, does not answer the question that I posed.
Quarantine has to be applied
Quarantine has to be applied preventatively for it to work. You don't wait until people are symptomatic and then quarantine them. You quarantine them for the length of the incubation period and wait to see if they become symptomatic. That's the origin of the word quarantine -- the 40 days you were required to wait outside the port before they could be sure you weren't carrying plague. (http://en.wikipedia.org/wiki/Quarantine)
For swirly, who never lets facts get in the way of the narrative, the evidence that quarantine works, even on a countrywide scale, isn't hard to find:
Strict quarantine prevented smallpox from ever entering Australia or New Zealand (http://en.wikipedia.org/wiki/Smallpox).
Compulsory quarantine for dogs allowed the UK to eliminate rabies (http://en.wikipedia.org/wiki/Prevalence_of_rabies#United_Kingdom).
Ebola is a viral hemorrhagic fever; therefore the government is authorized to use quarantine to contain it. Kaci Hickox had been in Sierra Leone treating Ebola patients and an airport thermal scanner showed a temperature of 101. The state quarantined her until more reliable tests showed that she did not have Ebola. This does not seem unreasonable in and of itself. Especially if we have medical tests that can rule out Ebola before the full 21 days are up.
I agree that, assuming Kaci's story is accurate, the bureaucracy charged with implementing the quarantine seems about as competent and friendly as the love child of the TSA and DMV, but, hey, government is a word for the things we do together, amirite?
Quarantine in ME
The funny thing about the Kaci Hickox case is that they should have just let her go home in Fort Kent ME. I mean, that's more effective than any quarantine program in NJ. Do you have any idea where Fort Kent is? It's not much different than putting her on a deserted atoll in the middle of the Pacific.
You do realize
She's an epidemiologist. Do you know what that is?
Oooh, wikipedia references!
My favorite!
Smallpox was vaccine-preventable since before Australia was taken over by Europeans. Rabies is also vaccine preventable.
Wanna try to find medical journal references for your assertions instead? You can start by googling PubMed.
Even with widespread
Even with widespread vaccination the last endemic case in Britain was in 1935. Australia and New Zealand are remarkable because they never employed widespread vaccination, and relied on quarantine instead.
The Rabies vaccine didn't come out until 1967, the last UK case was in 1922, sorry.
Thanks for playing though, we have some lovely parting gifts for you.
If you actually read the link
If you actually read the link, you'd see that it said:
"Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases."
It goes on to note that States have similar powers within their borders.
Ebola is a hemorrhagic fever, one of the enumerated communicable diseases. The nurse was detained, medically examined, and then released because she was suspected of carrying Ebola while arriving into the United States.
Everything was legal, even if it was too slow or bumbling for the nurse's taste, or you feel like the airport authorities suspicions were not entirely reasonable.
How is it legal to detain an
How is it legal to detain an asymptomatic person? Let's examine the facts:
Now. What part of that was legal, again?
Every. Single. Part.
Every. Single. Part.
Fever is a symptom. Kaci Hickox did not present as asymptomatic, the scanner at the airport showed a fever, as you admit. They released her from quarantine after the more reliable test for ebola antibodies came back negative.
A tent makes too much sense for me to get outraged about it. Disposing of a tent in an incinerator is probably cheaper than decontaminating a quarantine building between patients, and they probably didn't want bathrooms for potential ebola patients hooked up to the common sewer.
I don't think anyone denies they should probably spring for a space heater now that it's getting chilly at night.
Yeah it's rare
Isolation and Quarantine requirements are on a state by state basis: here is Massachusetts': http://www.mass.gov/eohhs/docs/dph/cdc/reporting/rdiq-reg-summary.pdf
Quarantine is often seen as a last resort for certain illnesses, especially the ones that have a period of communicability before a person realizes that they are sick, like measles, flu, pertussis, etc.
As others have mentioned, Ebola is not contagious when you have no symptoms, and some other infectious disease doctors also believe that the initial stages of illness (fever, general not feeling well) are also periods where transmission of the virus is unlikely - the family of the man that died in Texas are evidence of that, they were living with him and still didn't get sick.
The CDC is pushing for direct monitoring, aka checking your temperature twice a day and having someone from the health department check in on you every day, versus a forced quarantine: http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons...
A more life-saving quarantine
Round up all the people who refuse vaccination for measles and their unvaccinated children and put them in quarantine camps.
Measles being a vastly more dangerous filovirus than Ebola, of course. It would save a lot more lives than "Dr." Chris Creosote Christie "diagnosing" an exhausted traveler as "obviously ill".
When our kids were young...
... as well as when _I_ was young -- you had to prove your vaccinations were all up to date at the beginning of each school year. When did standard vaccinations become "optional"?
When?
When? About the time we started accepting the medical expertise of playboy models, especially when they get to display their expertise on Oprah.
...Whose son "outgrew" and
...Whose son "outgrew" and was cured of his Autism, despite those evil vaccinations he had as an infant.
Good news
No philosophical exemption in MA. Unless you have a valid medical reason or "sincerely held religious belief" you have to prove your kids were immunized to attend school.
Hell yeah. Also pertussis,
Hell yeah. Also pertussis, rubella, polio.
How many people have died from measles
in the U.S. in the past decade?
How many people have died
The answer is here
3 deaths per 1000 cases
Larger outbreaks have occurred in recent years because of anti-vaxxers. There were a couple of infants who died this summer after being exposed to unvaccinated people in public places (infants are not old enough to vaccinate).
Measles HAD been eliminated from the US by 2000 ... but now the death toll is picking up.
This is where we were ten years ago - the disease was nearly wiped out in the US: http://jid.oxfordjournals.org/content/189/Supplement_1/S1.long (this also gives a nice history of resurgent outbreaks when vaccination fails or is incomplete - such as 2014).
Worldwide the death toll is in excess of 100,000 per year.
So, while the deaths and morbidity have only picked up this last year, the 1989-91 surge demonstrates how easily it can reemerge and how costly such events are.
Therefore, given how deadly Measles is and how contagious it is, how it is contagious before it is symptomatic, and how babies cannot be vaccinated, we have a better case for quarantining unvaccinated kids than we do for asymptomatic adults returning from West Africa.
What about symptomatic adults
What about symptomatic adults?
Cognitive Dissonance
So govenrment has the power to compel vaccination, but not quarantine for disease with no vaccine or treatment. Interesting.
Serious question
Answer this only if you actually know.
Has there ever been a documented case of Ebola in someone who had not:
Difficult to validate given transmission conditions
It is theoretically possible to transmit sexually, too.
That said, here's an article where they look into viral loading in various bodily fluids and rate the likelihood of transmission: http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full
More layperson friendly, here's an interactive graphic from the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMp1410741
(my apologies if this isn't open access - most of their Ebola stuff is, but I can't tell because I'm a subscriber)
There are notes in the literature where people "don't know" where they got it, or deny caregiving or other contact in their households, but they were also living in communities and neighborhoods where infection rates were high and sanitation was iffy at best.
I dunno Swirly, why would I
I dunno Swirly, why would I trust the NEJM when I could read the Daily Mail? I think you need more reliable sources.
Actually,
Just because it's in NEJM doesn't mean it's wrong, but you're right that you should regard it as more likely to be false than true.
The CEO of New York
The CEO of New York-Presbyterian Hospital (really what could he know, right) has a letter in the NYT supporting Gov. Cuomo's quarantine policy. Part of his logic is that each Ebola patient requires enormous resources and thus even a small number of cases could hinder the delivery of other essential hospital services.
I recall that in Texas the medical team for each Ebola patient was some combination of 27 nurses/doctors. So let's see in BMC had 10 Ebola patients it would require around 250 staff members for their care.
IF they get really sick
Will they really keep them in unheated tents at the airport, stay away, and let them die horribly?
Really?
These facilities are not equipped to care for someone who is critically ill.
Also, incarcerating travelers won't keep them from becoming ill - in fact, it may predispose them to decompensate through stress effects on the immune system - IF they are infected!
Hospital CEO? Okay. A CEO is a businessman not wanting anything at *his* hospital or chargeable to *his* health insurance system. In other words, he thinks it is a great idea for the government to just pay for any and all Ebola events so his bottom line won't suffer and endanger his seven figure salary. Wonderful.
This "letter" has little or nothing to do with public health, nor the argument that quarantine is a joke.
Also, the staff to patient ratio with multiple patients is not going to be a linear multiple of a single case. That's crazy.
MSF Information Session on Ebola
http://www.msf.ca/en/stopping-ebola-msf%E2%80%99s-experience-front-lines...
This is a webinar - you can register for it at the link.