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Sunday, October 26, 2014

Ebola Today 10/26

(John Ehrenfeld, 2014)
The Story of Nurse Kaci Hickox and Ebola
Saturday, New York, and New Jersey, in a joint press conference, gleefully announced that any hero health technician returning from helping to STOP the threat of Ebola in West Africa, will now be quarantined for 21 days upon arrival. Well, at first, that might not sound like such a bad idea. Except these are healthcare professionals, and, as far as we can tell, none of them have allowed themselves to transmit the disease to anyone in the U.S. As soon as they felt sick, they cut themselves off, self quarantined, and got themselves into a hospital, safely, for treatment. Also, none of the professionals who have gone symptomatic here in the United States has died of the disease. Plasma from a recovered Ebola patient seems to be the key to a cure, and, of course, early detection and treatment.

Nonetheless, when nurse Kaci Hickox returned Friday from going to Africa to help quell the Ebola outbreak, she was placed under mandatory quarantine in New Jersey. In her own words, Hickox had just come back from the most difficult months of her life. Hickox said she was stopped at Newark Liberty International and was questioned over several hours after touching down Friday. She said none of those who questioned her would explain what was going on or what would happen to her.

"One after another, people asked me questions. Some introduced themselves, some didn't. One man who must have been an immigration officer because he was wearing a weapon belt that I could see protruding from his white coveralls barked questions at me as if I was a criminal," ~~ Kaci Hickox

Hickox is a nurse who had been working with Doctors Without Borders in Sierra Leone. Officials said she was taken to a hospital after developing a fever, but Hickox said she was merely flushed because she was upset by the process.
Photo taken by Hickox with her iphone of the inside of her quarantine tent.
After a seven-hour wait at University Hospital in Newark, she was put in an isolation tent inside a building adjacent to the hospital (There are reports she is outside, in the winter of New York, but they are false) At this point, she's twice tested negative for Ebola, including a test at the Centers for Disease Control in Atlanta.

What makes this even crazier is that she has not shown any symptoms. At a news conference Saturday, the Gov. Christie of New Jersey said, "I'm sorry if in any way she was inconvenienced, but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine. I hope she recovers quickly." Christie also asserted:

Kaci Hickox is “obviously ill. When I left this morning she still had a fever, and she was being tested for other illnesses after the Ebola test came back negative. She may to be tested for that again, because sometimes it takes a little bit longer to make a definitive determination,” adding, “There’s no question the woman is ill, the question is what is her illness.”

Of course, in the real world, Hickox is healthy, and has tested negative for Ebola, twice. In fact, Hickox says she has nothing to recover from. Her temperature is normal, and she feels fine.

"Everyone keeps asking how I'm feeling physically and of course I'm fine physically, but I don't think most people understand what it's like to be alone in a tent and decisions are being made that don't make sense, and show no compassion," Hickox said, starting to cry. "I heard my mother last night who called me concerned, and said, "Governor Christie just said in an interview that you were "obviously ill." And this is SOooo frustrating for me. First of all, I don't think he's a doctor, and second, he's never laid eyes on me, and thirdly, I have been asymptomatic since I've been here. I feel physically completely strong, and emotionally, completely exhausted."

Hickox said she worries that her experience will discourage other aid workers from going to West Africa to help quell the Ebola outbreak. And truth be told, so are we. The LAST thing we want to do is to have disincentives for health care workers to treat sick patients, either here at home, or in West Africa.

"To quarantine everyone, just in case, when you can not predict who may develop Ebola, or not, to put me through this emotional and physical stress, to not be with my family, is completely unacceptable." ~~ Kaci Hickox

Basically, there is a great deal of misinformation out there on this one. If it was so easy to catch, we would have case after case appearing from the plane ride that Eric Duncan took here from Africa. Members of Duncan's family, who took care of him, would have symptoms. But they don't. And we would have case after case from the planes that Amber Vinson took back and forth from Texas. But we don't. If it was so easy to catch, we would be hearing about case after case in New York, where Dr. Craig Spencer traipsed around the city. But we don't.

What's A Citizen To Do?
There is just altogether too much noise coming out about Ebola. I wake up thinking, wow, my friends who just catch a glimpse of headlines now and then, and who don't study the news like we do, are probably scared to death. In Oregon, we've seen people shopping at the grocery store with blue surgical gloves on. In Los Angeles, my mother saw someone at a restaurant with a surgical mask on. Now that doesn't even make sense.

In an attempt to keep our busy friends up to date on the realities of Ebola, and what it does or could mean to you, we plan on gathering today's headlines henceforth from vetted sources, and presenting them here. The hardest part about this, is that what we consider main stream news is making a mockery of passing along information. Long winded politicians talking about things they actually no nothing about, whatsoever, who Soapbox by blowing fear bubbles out into the electorate are much more troublesome than the virus itself. Selling fear should not be one of those things listed under special skills on an elected official's resume. But there it is. We've elected a bunch of callous, shortsighted, thoughtless money grabbers into the higher offices of our government, and most of our news pundits, also selling fear, don't help at all when they give equal time to these "officials."

As a result, this column will also probably show some of the stupid and the crazy, in order to squash the fantasy football version of Ebola in its tracks. It's the best vaccine for fear we can think of.
Gov. Cuomo of NY, and Gov. Christie of NJ announcing the 21 day quarantine.

Today's Course Correction
On Saturday, Governor Andrew Cuomo of New York and Governor Chis Christie of New Jersey proudly announced in a joint press conference a mandatory 21 day quarantine on any Ebola medical workers coming from the western part of Africa. Of course, there are no flights that go directly from Africa to any part of the United States, so these need to be self identifying health care workers, without symptoms.

Point of order, Dr. Craig Spencer, who self monitored, and called the hospital when he had a temperature of 100.3, was fully capable of diagnosing himself, and getting in a safe place for all as soon as was needed. Today, after his plasma infusion, all reports say that he "looks better."

Sunday, Mayor De Blasio of New York said in a press conference with health officials that the treatment of Kaci Hickox has been shameful, and vowed that "New York City will do all it can do to honor the work of the health care workers here and those who go to help fight the epidemic in West Africa," adding, "The problem here is this hero coming back from the front, having done the right things, was treated with disrespect."

Interestingly enough, just in, the New York Times is reporting Sunday evening that, under pressure, Gov. Cuomo has stepped back from his comments on Saturday. New York's revised plan allows all returning health care workers who have had contact with Ebola patients, but have no symptoms of illness, to return to their homes where they will be confined and monitored for 21 days. This new plan includes transporting the health official home in private transportation by the NY State Dept. of Health, or the local health department. Food and medicine, if needed, will be provided, as well as financial assistance for those who need it. "If the health officials organization does not pay for the three weeks, we will." said Governor Cuomo.

There is some vagueness surrounding what will be done with those returning from West Africa who have not been in contact with Ebola patients. Something about keeping track of them, and getting their temperature twice a day, for 21 days, but no quarantine. It is unclear if that is only for health care workers, or for everyone who traveled to west Africa recently.

"We have to be guided by facts, not fear." That's what POTUS said. And we'd have to agree.

Bioethicist Arthur Caplan contends that quarantining those without symptoms is not the way to combat Ebola. So far, nonsymptomatic quarantines have been declared in New York, New Jersey and Illinois. In Connecticut, nine people are in quarantine: two students at Yale; a worker from AmeriCARES; and a West African family.

At this rate, many others are or soon will be.

Caplan's 7 reasons for not isolating people without symptoms are clear. Quarantining people without symptoms makes no scientific sense because they are not infectious. The only way to get Ebola is to have someone vomit on you, bleed on you, share spit with you, have sex with you or get fecal matter on you when they have a high viral load. How do we know this? Because there is data going back to 1975 from outbreaks in the Congo, Uganda, Sudan, Gabon, Ivory Coast, South Africa, not to mention current experience in the United States, Spain and other nations. That's right, despite all the current interest in this disease, it has been around for more than a quarter century. If a patient is given the right care, and a little antivirus plasma from a recovered patient, it seems to work. But there are not the facilities, or the right public awareness campaigns, in Africa to adequately treat victims, and so the spread is vicious, and the death rate is high. Misinformation in Africa has led to locals breaking in to hospitals to break out patients, fearing the hospitals themselves are using the disease as an excuse to kill people. Of course, that is not logical, but this is also an area that believed having sex with a virgin could cure Aids.

Quarantine is next to impossible to enforce. Unless you are a health professional with an edict to do no harm, if you don't want to stay in your home, or wherever you are supposed to stay for three weeks, then what? Do we shoot you, taser you, drag you back into your house in a protective suit, or what? And who is responsible for watching you 24-7? Quarantine relies on the honor system. That essentially is what we count on when we tell people with symptoms to call 911, or the health department.

Large-scale quarantine has not been thought through, in terms of making it bearable for those confined. If government does not make it tolerable — and they show no signs of doing so, other than succeeding in stigmatizing people who are not dangerous — then people will not honor quarantine. Kaci Hickox has only had 3 days, she's a nurse, and she is hating every minute of it as it is. No shower where they put her. No flushing toilet. Facts are facts, and those are dismal.

Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk. If you quarantine them, you are taking your best professionals offline for three weeks — and there are not a lot of replacements. Most importantly, who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement when they get back? Those who go are heroes who face hell on earth. Can’t they be trusted to do the right thing and self-monitor when they get back?

When elected "officials" respond to panic with quarantine they are basically saying they can't trust our public health experts, or science, or even the ethics of doctors and nurses. Fox News broadcasts comments 24-7 from talking heads saying we can't trust doctors. There is no substitute for that trust. None. If state and city officials undermine trust out of panic or politics, then they destroy the best weapon we have to control Ebola — good science implemented by heroes.

Stay tuned for more info daily.

A Very Healthy Policy Geek

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