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#272521 - 10/27/14 09:46 PM Re: Ebola - prevention and mitigation [Re: chaosmagnet]
bws48 Offline
Old Hand

Registered: 08/18/07
Posts: 830
Loc: Anne Arundel County, Maryland
IMO, some form of quarantine is reasonable and legal.

But perhaps we need to be smarter about the "self monitoring" and tracking of the individuals.

It seems to me that much of the problems stem from the couple of folks (Doctors), at least one who was supposed to be in quarantine, running around in public places.

Maybe we should put the "ankle bracelet" that is used to keep track of folks on parole on the quarantined folks, let them stay at home, require that they stay there, and if the bracelet says they go out, then they get to go to a more restricted and supervised facility.

We might also be able to check that their temperatures are normal by having them do it over a video link.
_________________________
"Better is the enemy of good enough."

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#272529 - 10/28/14 01:19 AM Re: Ebola - prevention and mitigation [Re: James_Van_Artsdalen]
chaosmagnet Online   content
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 2948
Loc: USA
Originally Posted By: James_Van_Artsdalen
One could, for example, *test* them. I know it costs money, but we generally require the government to go to great lengths, and expense, before imprisoning people. The only reason for the quarantine is to avoid paying for tests, and to let an-abundance-of-ignorance masquerade as an-abundance-of-caution.


If the test is very good, and detects infection long before symptoms become apparent, then I would find myself entirely on this side of the argument. Is the test very good? How long must someone be infected before it works?

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#272531 - 10/28/14 04:50 AM Re: Ebola - prevention and mitigation [Re: MartinFocazio]
Bingley Offline
Veteran

Registered: 02/27/08
Posts: 1384

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#272532 - 10/28/14 06:05 AM Re: Ebola - prevention and mitigation [Re: James_Van_Artsdalen]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: James_Van_Artsdalen
I find the constitutional arguments against quite persuasive.

Here's a short primer from the American Bar Association on the legal aspects of quarantine/isolation orders. IMHO, the scientific basis of a quarantine can be argued either way, although the experience in Madrid and Dallas seem to support the argument that Ebola does not spread easily in First World conditions before symptoms appear.

No secondary contacts of any of the nurses in Madrid or Dallas came down with Ebola, and even the people in the same apartment with Thomas Eric Duncan when he was quite ill did not contract Ebola either. Dr Nancy Snyderman and members of her camera crew did not infect anyone and almost certainly Dr Spencer did not either (although it's still early in his case). But forcibly putting people in a tent with a port-a-potty and no shower makes no sense to me. There is no reason why people who are not symptomatic could not be quarantined safely at home.

While I think an argument could be made for the medical necessity of some sort of quarantine, from Hickox's description of her experience, sounds like her due process rights outlined in the ABA article were not respected, at least not for a while.

Gov Cuomo has modified NY's quarantine procedures, and although Gov Christie has not, he has already backtracked by allowing Hickox to leave quarantine and return to Maine.

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#272533 - 10/28/14 06:29 AM Re: Ebola - prevention and mitigation [Re: chaosmagnet]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: chaosmagnet
Is the test very good? How long must someone be infected before it works?

Real-time PCR is quite good at detecting Ebola, but it's not 100%, and I think people are looking for 100% when it comes to Ebola.

If a person has Ebola, then PCR will most likely detect it, unless the viral load is too low to detect in the blood. Someone who is infected but not yet symptomatic could have too low a viral load to detect. Therefore, a single negative PCR results may be erroneous, which is why repeat tests after a couple days are recommended.

But, if a person who is infected has a viral load too low to detect with PCR, they are not going to be infectious anyway. It is best to run the test against people who recently came from an Ebola region or had contact with an Ebola patient and is starting to show symptoms. Actually, even after symptoms appear, the viral load can still be too low for the first 48 hours.

For reference, here's a flowchart for determining whether an Ebola case is "laboratory confirmed." (This is a European protocol but I believe the CDC uses something similar)

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#272534 - 10/28/14 06:33 AM Re: Ebola - prevention and mitigation [Re: James_Van_Artsdalen]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: James_Van_Artsdalen
PS. Does the number 21 actually have any scientific standing?

The 21 days is the longest observed incubation period for Ebola. There have not been that many cases of Ebola before this current outbreak, so that number may change as more cases appear and more data is collected.

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#272538 - 10/28/14 03:43 PM Re: Ebola - prevention and mitigation [Re: MartinFocazio]
chaosmagnet Online   content
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 2948
Loc: USA
I think a balance between constitutional rights and protecting the public can be found. If the nurse in NJ was asymptomatic and had negative results from PCR testing, sending her home was the right thing to do. Ongoing surveillance and periodic PCR testing of people who were treating Ebola victims seems pretty reasonable.

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#272540 - 10/28/14 05:59 PM Re: Ebola - prevention and mitigation [Re: Arney]
bws48 Offline
Old Hand

Registered: 08/18/07
Posts: 830
Loc: Anne Arundel County, Maryland
Originally Posted By: Arney
Originally Posted By: James_Van_Artsdalen
PS. Does the number 21 actually have any scientific standing?

The 21 days is the longest observed incubation period for Ebola. There have not been that many cases of Ebola before this current outbreak, so that number may change as more cases appear and more data is collected.


From the WHO:

"Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over."

http://www.who.int/mediacentre/news/ebola/14-october-2014/en/
_________________________
"Better is the enemy of good enough."

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#272541 - 10/28/14 06:12 PM Re: Ebola - prevention and mitigation [Re: bws48]
AKSAR Offline
Old Hand

Registered: 08/31/11
Posts: 1113
Loc: Alaska
Originally Posted By: bws48
From the WHO:
"Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over."
http://www.who.int/mediacentre/news/ebola/14-october-2014/en/

bws48,

Make sure you take this document in its full context. Note that the 42 days without an ebola case in a region is the WHO criteria for declaring an outbreak is over.

For monitoring individual people, the WHO still recommends a 21 day period. From the same WHO document you link, see the following:

Quote:
According to WHO recommendations, health care workers who have attended patients or cleaned their rooms should be considered as “close contacts” and monitored for 21 days after the last exposure, even if their contact with a patient occurred when they were fully protected by wearing personal protective equipment.


Edited by AKSAR (10/28/14 06:28 PM)
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#272544 - 10/28/14 09:34 PM Re: Ebola - prevention and mitigation [Re: AKSAR]
bws48 Offline
Old Hand

Registered: 08/18/07
Posts: 830
Loc: Anne Arundel County, Maryland
Yes, good point.

Here is where I am confused and have concerns (help in understanding this appreciated):

1. 95% in 21 days, and 98% in 42 days. So, does that mean 3% of cases are diagnosed/occur between days 21 to 42? Doesn't that mean that at least 3 out of 100 cases will emerge after 21 days ? And what happened to the last 2 percent? When do they emerge?

2. "health care workers who have attended patients or cleaned their rooms should be considered as “close contacts” and monitored for 21 days after the last exposure, even if their contact with a patient occurred when they were fully protected by wearing personal protective equipment" The "fully protected" qualifier bothers me; what if they weren't "fully protected?" The Dallas nurses apparently were "fully protected" by the standards they had in place at the time---but still became infected (albeit within 21 days). So, no risk despite 3% of the cases emerging between days 21 and 42 or longer?

I hope that I am not being paranoid, but I keep feeling that the positive assurances and certainty I am hearing are not fully supported by complete and fully certain science and experience. IMO there is just too much emphasis on 21 days when there seems to be evidence that there can be up to possibly 5% (3% 21-42 days, 2% unknown) of cases that emerge after 21 days. That seems a big risk to me. The WHO statement says that it is "confident" that after 42 days no more Ebola cases will emerge, e.g. that an "outbreak is over." So, to me this says that up until 42 days, more cases can emerge.

Here is another of my points of confusion; our military are going to be quarantined for 21 days when (or actually before) they return, but apparently civilian travelers will not be, or at least will be let to "self monitor." IMO I simply can't resolve this into a consistent view of the precautions we should be taking.

Maybe I am missing something; I'm not arguing, I'm just trying to read and understand that implications of these statements says to me that there is a risk at least until the 42 day point. So why is 21 days the point at which the "all clear" is being sounded? To me it really sounds like it is a "95% clear" signal.
_________________________
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