Arney,

I think you hit some key aspects of the statistics. One further point regarding your comment ".....and it seems pretty clear that the intent of that passage is to say that there was someone with a confirmed case (although they don't define whether it was laboratory confirmed or just clinically confirmed) with an incubation period greater than 21 days....."

Keep in mind that until very recently, all the human data was from W Aftrica, and much of it during a raging epidemic. Since this is a situation where one cannot set up a controlled experiment, all the data that went into those statistics was by nature somewhat anecdotal. The folks compiling the data had to assume that the person became infected during their last known contact with an active ebola case. It is entirely possible that some of those outliers ( > 21 day incubation) actually became infected later, and hence their incubation period was actually within the 21 day period. Remember that infection is rampant in the area, and overall levels of sanitation may not be as good as they could be. It is possible they came into contact with the virus from some other source, either a sick person or some contaminated item, without realizing it. The greater than 21 day incubation data points may in fact be just be inacurate data points.

EDIT: One further bit of info. The New England Journal of Medicine (a very highly respected journal) just came out with an editorial on ebola and quarantines. One quote struck me as summing things up nicely:
Quote:
Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan's family members who were living in the same household for days as he was at the start of his illness did not become infected.


Edited by AKSAR (10/29/14 01:51 AM)
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