Yet another level to the story:

"Liberia to prosecute man who brought Ebola to US"

http://news.yahoo.com/dallas-er-sent-ebola-infected-patient-home-050718374.html

Apparently, the Liberian government is alleging that he lied on his exit questionnaire about his contacts with infected persons. The associated press claims they have a copy of the questionnaire he signed, which seems to confirm what the Liberian government is saying.

I found a glossary of some terms we have been hearing recently, and was the gist of what I was getting at regarding being careful about our choice of words, like "exposure," because they imply different levels of risk.

I'll paraphrase a bit:

A "contact" is someone who spoke to, touched, or was in promixity to a patient. Further follow up is necessary to determine what kind of interaction might have happened with the patient and what kind of risk the person is in.

An "exposure" is contact that puts a person at high risk of the disease, such as direct contact with bodily fluids without protection.

The list of contacts to Mr Duncan is around 100 as I write this, but the list of exposures is maybe a dozen or a bit more.

My opinion, but for people who have been exposed to Ebola and have seen first hand that there is no room in the hospital will do what they can to leave. With the funds to travel and family to stay with outside the hot zone, being prosecuted for lying on a questionnaire would be a small price to pay for escaping the HZ. The risk to friends and family is not part of the equation for a person who is scared and desperate to leave.
The current policy of using exposure/contact questionnaires depends on honesty and honor in those answering the questions; those two attributes will be pushed aside by desperation every time. Just my opinion.

It is the physician's duty to obtain a history, including, as appropriate, a travel history; this is a sad example of trusting someone else to do your work.

Allegedly, the patient was truthful to some degree when first seen in the ED; unlike when completing the form on departing Liberia.

Partially truthful. Saying you've recently been in Liberia should have been enough to get a response. When it didn't get a response, adding that he had had direct contact/exposure to an Ebola patient who died would have gotten a response. Speak loud enough and you'll probably clear the waiting room. He may not have been a medical professional, but he was probably the person in that ER with the most Ebola experience and he allowed them to send him home with an anti-b prescription.

The patient screwed up and put people at risk by not being fully open and honest. The medical staff screwed up by not being more suspicious of his history and asking the hard questions. Plenty of blame to pass around... but that's just my opinion too.

How many times did we hear House say, (paraphrasing) -- "People lie."

One thing that Martin alluded to in another thread was this:



I am firmly in Martin's camp on this. Like all major news events, the reporting in the media ranges from slightly incorrect to damningly wrong and the current Ebola reporting is certainly no exception. It remains to be seen when after this current outbreak is over, what was real factual reporting and what was poorly researched reporting hastily presented in the all important (and self serving) readership race.

here are some much better sources of info:

WHO Sitrep Reports and the CDC updates.

That all said, Ebola is not even on my radar as threat to me, My DW or family. After all, statistically speaking, we have a much better chance of dying during the typical yearly Influenza season.

I am extremely concerned about Ebola.

The probabilities of death for a typically influenza pandemic.

Kill rate x infection rate

Ebola Kill rate 0.6
Infection rate (lets assume CDC projections of 1 million by the end of January) out of a West African Population of 10 million = 0.1

= 0.1x0.6 = 0.06 i.e 6% of the population will die in the currently affected West African Countries .

influenza Pandemic kill rate 0.02 (these probabilities were from a UK NHS document for a pandemic which the NHS would begin to fail)
Infection Rate 0.4

=0.4 x 0.02 = 0.008 i.e. 0.8% of the population will die (this is not a typical Winter Influenza Outbreak but one of a serious National public health emergency)

If in North America, you have >20-30 infected from Ebola in 1 months time, I would start planning to head for hills to self quarantine in 6 months time as a 6% death rate in the US would mean a highly probable collapse of Society as is now happening already in Liberia.

A report from just nearly 2 months ago.

http://www.youtube.com/watch?v=qaGnuZT08vQ

Read the actual CDC report, especially the Abstract and Conclusion section:
The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.



I wish my wife would post her thoughts here about Samaritan’s Purse. They are a controversial organization and many NGO's will not associate with them. And it's too bad as they have deep pockets and leading logistics to respond to disasters globally. If you have enough incentive, go read the Wikipedia page on this organization. Also this 11 year old article goes into some great detail about SM.

It is not a good use of statistics to assume that an infection rate (or a death rate for that matter) in West Africa would be of any use for determining rates in first world countries. The situation for both quarantine and medical care is SIGNIFICANTLY different.

Respectfully,

Jerry

As I understand Ebola can survive on a surface for days. Read Workers Spray Ebola Patients’ Vomit Off of Sidewalk with Pressure Washer and No Protective Clothing and then ask yourself "Where will it turn up next?" How about that lady walking through the run-off in sandals -- where did she go next?

Peeps in general are not taking the Ebola threat seriously... just my opinion.