Ebola Today 11/12

The Ebola Virus

US is Ebola Free
Today, the news is better than last week, or the week before, but the struggle continues.

We’ll start with some good news, in fact, the best news. The only patient with Ebola in the United States, for the last couple of weeks or so, has been the subway riding, bowling doctor, who traipsed around New York City after returning from working with Ebola patients in Guinea. Spencer, 33, was infected with Ebola while working for Doctors Without Borders.

Well today, after receiving excellent care at Bellevue Hospital Center in New York City, Dr. Craig Spencer has been deemed free of the Ebola virus, and was released from Bellevue to much hugging and fanfare.

“It’s a very, very good day,” Mayor Bill de Blasio said in a press conference Tuesday. “Dr. Spencer is Ebola-free, and New York City is Ebola-free.”

Mayor Bill de Blasio hugging Dr. Craig Spencer
Ebola Survivor.

As a reminder, although Spencer wandered around the city that doesn’t sleep, he did so feeling and showing no symptoms. Only after feeling and then reporting symptoms of Ebola on Thursday, Oct. 23rd, was he transported to an isolation ward by ambulance, later testing positive for the virus.

"I’m elated,” said Ram Raju, M.D., president of the New York City Health and Hospitals Corporation, “because we were able to treat and cure a hero.”

That news out of New York brings the grand total of Ebola cases currently in the U.S. back down to zero. ZERO. In the United States, there are currently ZERO cases of Ebola. It bears repeating.

For now, the hysteria that began with the arrival, diagnosis, and subsequent death, of Thomas Eric Duncan in Dallas is resembling so many other Fox “news” crises of the moment, in with a bang and out with a “squirrel!” While the U.S. response faltered at the outset, with the misdiagnosis of Duncan and sending him home, and then with existing federal and state public-health protocols being inconsistent, the nation’s superior medical care ultimately prevailed: All three Ebola patients, whose infections were quickly and properly diagnosed, have been cured, and no one they came into contact with has reported symptoms.

Struggling with the losses.

Back In Africa
What’s happening in the rest of the world? So far, almost 5000 have died from Ebola during this outbreak. The death toll will go higher once they discover all the small villages and towns completely wiped out by the virus, ones that could not get to help that was 2 or more hours away. According to the CDC, the disease itself has been around since 1976, killing 431 that year. What you need to understand, is that there is a reason that Doctors Without Borders exists. This Ebola virus is just one of many diseases that have taken hold in the western part of Africa over the decades. And to understand Ebola, you need to understand that.

For instance, let’s talk about measles for just a moment. Ya know, the disease no one gets anymore. It has a .2% fatality rate, and since the endemic spread of measles was eliminated in the United States (2000), rates of measles had been fairly low. However, before the routine use of the measles vaccine (1963) and the MMR vaccine (1971), measles cases — and complications from those cases — were really high. There used to be about 500,000 cases of measles and 500 measles deaths each year in the United States.

Today, with vaccinations, no one needs to die from the measles. Or even suffer from it. Nonetheless, this year, in the United States, we had 600 cases of the vaccine-preventable disease, and no reports of deaths from measles. In comparison, in the poorest regions of Africa, 122,000 people died of the measles in 2012. DIED. 122,000 people died of a vaccine-preventable disease in one year. Let that soak in. Although that sounds like an incredibly grim death toll, health experts hail the figures as a sign of success of the U.N.’s mass vaccination programs, since the number has plummeted since the 1990s, when more than 500,000 people a year, or about 1,300 a day, died of measles.

What’s our point? We’ve lost 5000 total in this epidemic. Not 5000 a day. To put things in perspective, this isn’t our first rodeo, and it’s not as bad as many others we’ve fought before. And every one who has come to the United States, except for poor Thomas Eric Duncan, has been cured, so we are getting a hold on it.

Ebola Robot Zaps Virus To Instantly Clean.

Technological Solutions
What makes these patients so dangerous to treat is the big messes that are made. Liquids everywhere have to be cleaned up, and removed safely. We’ve found some help in that area from the technology sector.

The Xenex robot, from a company in San Antonio, was first introduced years ago, and it is capable of using ultraviolet light to mess with the virus’s DNA, thereby damaging it enough to essentially make it harmless. This is a clean up robot and, now that healthcare workers have a way to quickly kill off the virus in certain locations, entire parts of hospitals can be cleaned with it. This robot has been sent to 250 hospitals, and is actively being used at this time to keep medical workers out of harms way when cleaning up after one of these highly contagious patients.

When most people hear the word Ebola, they envision hazmat suits and quarantined hospital rooms. But UC Berkeley engineering professor Ken Goldberg envisions robots also helping with specific tasks. In fact, the White House Office of Science and Technology Policy reached out for Goldberg’s expertise in robotics, encouraging him and three other researchers and research centers to hold brainstorming sessions on ways to enlist robots in the fight against this deadly disease.

“People have an expectation that the robots are going to go in and do something dramatic.” Goldberg explained. “The capabilities are limited right now. There’s a lot of research that needs to be done. These are some tools that we hope will be useful in both the near term and long term.”

Goldberg sees at least two ways robots may be redeployed in the next three to six months to help contain the spread of Ebola. First, telepresence robots, with cameras and screens that allow doctors to remotely communicate and get a visual read of patients, could be useful in the diagnosis phase.

“When you’re trying to diagnose a patient, there’s a lot of nuance,” Goldberg said. “You want to be able to look from different angles, look at different parts of the patient. You also want to be able to have some kind of intervention. You want to be able to zoom in or hopefully touch, palpate part of a patient. So, there’s a lot of interesting research. How can you do that from a distance?”

Goldberg also sees robots being helpful in the near term with clean up and decontamination. But there’s one major obstacle to overcome: most robots have wheels that would immediately get contaminated. Goldberg explains,

“We don’t know, actually, how to sterilize them. There’s too many intricate, moving parts. So essentially, you’d have to throw the robot out afterward.”

First, engineers need to improve robots’ abilities to perceive clear objects. All the glassware used in labs, like test tubes, beakers and slides, can currently confuse robots.

The second way Goldberg says robots can play a part in the Ebola fight in the long term is by inserting IVs either for drawing blood or providing intravenous hydration. Technology could help cut down on the occurrences of patients being poked multiple times to tap a good vein.

“We use new imaging techniques to be able to find the vein more accurately,” Goldberg said, “and a robotic device that would be able to position the needle more accurately.”

According to Goldberg,

“It could be a couple of years before robots play an expanded role in the fight against Ebola. We’re looking beyond this current health crisis so we’re ready for the next one. Some of us feel this is the end of the world. But those on the forefront of technology know this stuff comes in waves, it has before, it will again, and this is not the biggest monster we’ve defeated.”

Ebola Affecting World Events
In Africa, because of the drastic numbers, there are also drastic results. When talking about soccer (football) “drastic” might be a big word, but not if you live in Africa. Well, things have gotten so bad there that the Moroccan government urged African soccer’s governing body to delay its flagship bi-annual continental competition over Ebola fears. To be clear, Morocco is reported to be Ebola free at this time.

Morocco was slated to host the African Cup of Nations, organized by the Confederation of African Football (CAF), from Jan. 17th to Feb. 8th 2015. The 16 team competition has run since 1957, and the north African country has already spent millions of dollars upgrading its stadiums for this event and December’s FIFA Club World Cup. But the outbreak of Ebola in west Africa has raised fears in Morocco that traveling fans and players could help spread the disease further, so Morocco wanted the cup delayed until June 2015 or early 2016.

As of today, Morocco has been removed as host of the 2015 Africa Cup of Nations and expelled from participating in the biennial championship. No replacement host has yet been named for the 3 week tournament. Any postponement could be financially crippling for the CAF. So, that happened.

Back In Maine
The boyfriend of Kaci Hickox, the nurse who defiantly refused to self-quarantine after she returned from West Africa, says the couple will move out of Maine this week after a state court order restricting their movement expires. Ted Wilbur, Kaci’s brave boyfriend, withdrew from his nursing program at the University of Maine at Fort Kent, where the couple lives, and said Friday that he and Hickox were “going to try to get our lives back on track” by leaving the state. So, as of now, her saga is over. Although, we wouldn’t be too surprised if she ended up testifying before Congress one day.

What Is Ebola Again?
Don’t be ashamed to ask. If you haven’t had to time to really learn about this particular disease, this is your chance, as Scientific American has published some insights under What You Need To Know that might be handy. If not, just skip down to the next section, if you please.

How does Ebola actually get a hold of your health? The Ebola virus gives itself a head start when it first slips into a human body by disabling parts of the immune system that should be leading the charge against the invader. It hijacks the functions of certain defense warriors known as dendritic cells—whose primary function is to alert the immune system of the incoming threat. Other targets include monocytes and macrophages, types of white blood cells whose job is to absorb and clear away foreign organisms. These are the first cells Ebola infects, and bends to the process of making more Ebola viruses. The maneuver is the viral version of invading a country by hypnotizing the army, and turning it against its own people. Then, having kicked the immune system’s feet out from under it, Ebola takes off in a run.

Although it only has seven genes, Ebola is an exquisitely effective killer of humans, once it enters a body. Unlike the spiky sea urchin that is influenza, or the golf-ball shaped poliovirus, Ebola resembles noosed ropes under the electron microscopes used to capture viral images. Classified as a filovirus, Ebola is one of two members of that family; the other is Marburg virus, named after the German city where it was first seen in researchers who caught it from imported non-human primates. Both pathogens are among the most lethal viruses that afflict people, but it is Ebola that has become the recognized and dreaded face of the filovirus family.

According to the Mayo Clinic, these are the symptoms, and they happen quickly once a high fever is detected.

• Nausea and vomiting.
• Diarrhea (may be bloody)
• Red eyes.
• Raised rash.
• Chest pain and cough.
• Stomach pain.
• Severe weight loss.
• Bleeding, usually from the eyes, and bruising (people near death may bleed from other orifices, such as ears, nose and rectum)

One of the things that makes the spread in Africa travel so fast is their burial customs. Once someone with Ebola dies, they are still quite toxic. It is customary to hold the dead person, to embrace them, etc. before burial, and that behavior, unsafe burial practices, is one of the major things that our military, and the west African governments are working to educate the public on at this time.

Can’t Africa Do Something On Their Own?
Africa’s wealthiest companies and individuals have clubbed together to raise $28.5 million for a fund to fight Ebola. African Union officials and business executives gathered in the Ethiopian capital Addis Ababa on Saturday, Nov. 8th to launch the emergency response fund, which they said would be distributed immediately.

New York's Keeping Track Of Those Possibly Exposed.

Really? No More Cases In The United States?
Monitor operations are working round the clock to keep track of West African visitors who have returned to The States. The New York Times reports today, November 11th:

“Hundreds of workers drawn from all corners of NY City’s Health Department are brought together on the 12th floor of the dept.’s headquarters to doggedly call one telephone number after another like telemarketers in an effort to find anyone who may have recently come to New York City from Guinea, Sierra Leone and Liberia. As you walk across the room, you can hear them speaking French, and at least five dialects of West African languages like Mandingo and Pulaar, to track these people down. This is a 24 hour a day operation now keeping track of almost 300 people, and is believed to be the largest monitoring effort in the country. Up to now, no one being monitored has registered any symptoms worrisome enough to prompt testing for Ebola.”

And that’s just one city, and one team. There are monitoring operations like this happening all over the country, and again, at this time, we have no active cases of Ebola in the United States.

That’s something to celebrate. Even if it might just be a brief respite.

Stay with us daily as we report what we find, and vet what we can.

Ebola Today 10/28

A Good News Day
OK, today we should lead with the best news. According to the The Washington Post, upon nurse Amber Vinson's recovery, and release from the hospital, there is only ONE patient left in the United States being treated for Ebola. That is to say, only one person of the 316 million people in the United States, has Ebola, at this time. Everyone else, except poor Thomas Eric Duncan, has recovered, and has been released.

More good news today
Although there is still a great need for international assistance, according to The New York Times, the spread of Ebola is slowing in Liberia. Health authorities in the region have come to that conclusion from the following facts:

• Liberia's health authorities are reporting lower numbers of new infections.
• Treatment centers in Liberia's capitol city of Monrovia, who were turning away victims for lack of space, are now reporting some unoccupied beds.
• The number of burials of victims has started to drop.

"Do we feel confident that the response is now getting an upper hand on the virus? Yes, in Liberia we are seeing a slowing rate of new cases, very definitely." ~~ Dr. Aylward, World Health Organization's Assistant Director-General in charge of WHO's operational response to the epidemic.

Bear in mind, nearly half of the total number of people infected have been infected in Liberia. Also note, about 5,000 of the almost 14,000 people infected, are reported to have died of the disease, and according to Dr. Aylward, in the three countries most affected, Guinea, Liberia, and Sierra Leone, there is still a 70% mortality rate. In the United States, of those who developed the virus while in the United States, our mortality rate is more like 20%. Of course, it looks like we know how to handle it better than we did when Thomas Eric Duncan showed up in Texas. And all of the cases after him in the United States have recovered. Just waiting for Dr. Craig Spencer to join that group. (There is some low level noise out there about Dr. Spencer lying about his whereabouts upon returning to the United States, but there are no accurate sources to back that one up. And no one else in New York has reported symptoms, including his girlfriend.)

That being said, there is still alot of scarem juice going around. If you pay attention to social media, the policy being suggested by the none scientific general public is to get your pitchforks, and guns, and take your country back from the Ebola Dictator Obama. It's Obama derangement syndrome on steroids. In the real world, however, Governor after Governor actually have to decide what is the best way to ensure the health and safety of their residents.

Under CDC guidelines that went into effect Monday, individuals at any risk of exposure to the virus should be actively monitored until 21 days after the last potential exposure, even if they show no symptoms of the disease. The guidelines are not mandatory.

Who's Being Monitored Now?
MICHIGAN ~~ Health officials are now monitoring ten people in Michigan for the Ebola virus, the Detroit Free Press reports. According to the health department spokesman, none of these people are believed to have had direct contact with anyone who has Ebola, and the Michigan Department of Community Health confirms none of the people being monitored have shown symptoms of the deadly disease. Nonetheless, the cases involve individuals who were in countries with widespread Ebola transmission within the last 21 days. MDCH is not releasing their identities or where they live out of respect for their privacy.

INDIANA ~~ Indiana was one of the first states to begin “direct active monitoring” of returning travelers. Gov. Mike Pence and the Indiana State Department of Health implemented the policy on Oct. 16. The local FOX affiliate in Indianapolis WXIN reports that state health officials are monitoring six people in Indiana for Ebola symptoms in accordance with guidelines from the Centers for Disease Control and Prevention. Two patients have completed the monitoring protocol while six others are currently under observation. They’re cooperating with the protocol, which lasts 21 days. State health officials aren’t releasing the names of the counties where travelers are being monitored in accordance with privacy laws.

All are considered low risk.

What Is Monitoring?
Monitoring includes twice-daily temperature and symptom checks by local health agencies. That's it. Hit a temperature of 100.4, you get packaged up, taken into a hospital for treatment, and, of course, quarantined. Until then, you just have to take your temperature.

The CDC’s new travel guidelines group people into four categories based on exposure to Ebola: high risk; some risk; low, but not zero risk; and no known risk.

• People in the high risk category, such as a healthcare worker who treated an Ebola patient, should be monitored by a health official and avoid commercial travel and large gatherings.
• Those with some risk should be monitored by a doctor, and would be allowed to travel on a case-by-case basis.
• Travelers with low, but not zero, risk should watch for symptoms.
• Those with no known risk don’t have to monitor their health. Duh.

Schools And Parents Overreacting?
Maureen Downey of the The Atlanta Journal-Constitution took a stab at the issue. Parents with school aged children are getting concerned, and most local mayors and school boards aren't doing much to help assuage that fear.

We may see the issue of kids being barred from attending school addressed in Connecticut sooner than in other states. A lawsuit has been filed in the state after a school district refused to allow a third-grader to return to school after she attended a wedding in Nigeria, a country declared Ebola-free by the World Health Organization. Her father is suing the Milford district for banning the child from school, noting the family was never quarantined by the city after returning from Africa, the school system felt safe enough to send a tutor to the house, a doctor who examined the girl proclaimed her healthy, and she had no contact with, nor was anywhere near, any Ebola patients while in Nigeria. The family attorney suggested the ban had more to do with public concerns than real health concerns.

Civil Rights Versus Public Safety
“Normally one can’t be locked up without suspicion of a crime or conviction, but because we are dealing with infections, and because they can be spread by people who are not visibly sick, the state has the right to protect society from disastrous consequences by temporarily limiting someone’s liberties,” said Eugene Kontorovich, a constitutional law scholar at Northwestern University Law School in Chicago.

Of course, given all the available evidence, Ebola patients would definitely be visibly sick when they were infectious. They would be vomiting, and liquid would be coming from every part of them. It causes bleeding inside and outside the body.

Hickox is on the front lines of this dispute. Now that she is back home in Maine, and still asymptomatic, and still virus free according to repeated tests, Maine officials are seeking a court order to force her to self-quarantine at home. Acccording to NBC News, Hickox emerged from her home today, Wednesday, to tell reporters that she and her attorneys had been in negotiations all day with state officials, but that the impasse remained.

"They will not allow me to leave my house, and have any interaction with the public, even though I am completely healthy and symptom-free," Hickox said as her boyfriend stood beside her — and as a state trooper, who has her under surveillance, looked on.

We've been here before. Health officials in the U.S. have a long history of taking steps in the interest of public health, including closing schools and ordering large-scale quarantines, such as the one imposed during the 1918 influenza epidemic that was credited with limiting the spread of the disease. Of course, in 1918, we weren't able to treat, and cure, patients with plasma infusions.

Some public health experts say aggressive, widespread quarantines may be illegal, are not based on medical evidence, and can be counterproductive. Health officials have a certain ethic to uphold, but ordinary citizens might hide their potential exposure, or recent travel history, as a result. Most importantly, as we have mentioned in previous articles, this kind of government reaction, in the current environment, could also dissuade health care workers from volunteering to fight Ebola in West Africa, where the epidemic is just starting to get under control due to the caring and fearless work of those very same healthcare workers.

Unnecessary quarantines create unnecessary fear.

Feeling Helpless?
Well, there is only so much each of us, individually, can do to help out here. Unless you are a health hero putting yourself on the line helping patients in the United States heal, or jetting overseas to help on the front lines, what can you do?

Without saying any charity is helping more than any other, we offer one option of a place to donate. Unicef USA.

Stay with us daily as we report what we find, and vet what we can.

The Policy Geek

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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