Ebola Today 10/31 ~~ Boo!

Birthers, let us introduce you to the continent of Africa.

Africa is huge, and very nationally subdivided. In fact, there are more than 50 nations on the continent, and at this time only 3 of them have an Ebola problem: Sierra Leone, Liberia, and Guinea, three small nations in the portion of Africa known as West Africa. And that’s it.

The other countries in Africa do not have the same problem. That is possible because Africa is big, it’s enormous, it’s diverse. Although that does not seem like a very complicated idea, in the United States we sometimes, embarrassingly, do not understand world geography. Low information, and even some middle information voters, conflate all of the different countries in all of the different parts, or regions, of Africa into one big giant thing, one big “Nation of Africa.” United States citizens, statistically, are not only confused, but quite often, especially amongst the Tea Party, the birther crowd, and Congressional Republicans, afraid of even the concept of Africa.

What Birthers see IF they have seen a map of Africa.

This flood of scary has parents panicking, and schools nationwide are knee-jerking, and basically, a bunch of jerks are pulling kids out of school, and sending them home, because either 1) they were born in, traveled to, or know someone who has lived on the continent of Africa, ever, OR 2) One or more of the children attending their school was, did, or does, and mom and dad aren’t taking any chances.

In the town of Hazelhurst, Mississippi, hundreds of kids were pulled out of their middle school after parents heard rumors about the principal’s recent trip to Zambia. Panic then spread to the local elementary and high schools. For the record, Zambia is in Africa, but it is literally nowhere near, 1000’s of miles away from, the countries that are currently dealing with the Ebola crisis. So 2 weeks ago, in Mississippi, that principal’s return to Hazelhurst was enough to start a youthful stampede out of the local schools, and back into the safety of their living rooms, and the Playstation 4s their parents were saving for Christmas. As Rachel Maddow puts it, “because…..Africa.”

On the same day, NBC reported that Navarro College, located in Corsicana, Texas, sent out a rejection letter to several students of Nigerian origin who had applied to go to that college.

“With sincere regret, we are forced to report that Navarro college can not offer you acceptance for the spring term. Unfortunately, Navarro college is not accepting international students from countries with confirmed Ebola cases.”

Now, the prospective students who received this letter are from, yes, a nation in Africa. In the case of Nigeria, however, the World Health Organization (The WHO) has actively affirmed there have no cases of Ebola.

Two days later, at an elementary school in the aptly named Friendswood, Texas — yes, Texas again, surprise — announced they would not be allowing one of their teachers to start the school year because she had traveled to apparently what many Americans believe is the Nation Of Africa. In reality, she went to Tanzania, which is actually farther away from the epidemic than Zambia is.

Two days after that one, in New Jersey, an elementary school there freaked out when dealing with a couple of kids that had moved to Burlington County, New Jersey this year from the East African nation of Rwanda. Rwanda, for the record, is over by Tanzania and also 1000’s of miles away from the countries troubled with the Ebola epidemic. From Tanzania to Liberia is like the difference between Bangor, Maine and San Francisco.

The state of Maine, who has been debating the issue of nurse Kaci Hickox — of the tent in New Jersey fame — has been stupid and made fear based policy decisions regarding Ebola even before Hickox returned to her home state. It was the town of Strong, in Franklin County, Maine, where an elementary teacher was told to stay home, and not come to work, because she had traveled to, wait for it, Texas, where Thomas Eric Duncan died of Ebola. This was the actual state of Maine deciding this. Needless to say, she went nowhere near the Dallas Presbyterian Hospital, nonetheless, no school for her. Of course, you can’t be too careful, right?

In Milford, Connecticut, the school district had decided to exclude from school a little 7-year-old girl because she had taken a trip to Nigeria with her family to be a flower girl at a relative’s wedding. Now remember, The WHO has gone out of their way to announce, at this time, that Nigeria is Ebola free. Sure, there are the wackos, WAY TOO MANY OF THEM, even educated wackos, who don’t believe anything they hear from government or officials, or health officials, or the CDC or the NIH. After all, they have plans to kill us all, right? RIGHT??!!! (Note: grab guns, run to shelter) This girl, who has never been sick, and never met a person with Ebola, and has never been to a country with Ebola patients, other than the United States, was being forced to stay home; but in this case, the family of this little girl decided to sue. They sued. The school acted quickly, and decided to settle, which included them publicly acknowledging that the 7-year-old is perfectly healthy, does not have Ebola, and does not pose a health risk to anyone. She was allowed to go back to school, today. Just in time for trick or treat.

Meanwhile, in Maine today, All Hallow’s Eve, Judge Charles C. LaVerdiere praised Kaci Hickox, the defiant and heroic nurse who went a bikeridin yesterday. Judge LaVerdiere ruled that, because she has no symptoms, Hickox should simply continue daily monitoring and coordinate travel with state officials. State police who have been monitoring her house, left her residence shortly after 12:30 p.m.

Hickox said that of course she is following the federal Centers for Disease Control and Prevention recommendations of daily monitoring for fever and other signs of the disease; however,

“I’m not willing to stand here and let my civil rights be violated when it’s not science-based.”

The legal action against Kaci Hickox by Maine’s health department and Governor was the nation’s biggest test case yet in the struggle to balance public health, and fear of Ebola, against personal freedom. In the court filing, the director of the Maine Center for Disease Control and Prevention backed away from the state’s original request for an in-home quarantine, and called instead for restrictions that fall in line with federal guidelines.

The history of fear driven, ignorant public health panics is a long one. It is not surprising that confronting something like Ebola has led to a bunch of irrational, inane knee jerk decisions. As of today, this week, we are continuing to make stupid decisions about public health, overriding, unnecessary decisions about public health. But we are also starting to push back. Former state health officers, along with the last two State Agent Epidemiologists from the great state of Maine, along with the head of the Maine Medical Association, have crafted a letter in protest which they presented to Governor La Page of Maine in response to his jumpiness and ignorant non fact based decision-making. The letter read,

“Ultimately, we need to be guided by science and not emotion. An epidemic of fear can be as dangerous as an epidemic with a virus.”

While it may be well intended, the actions against Kaci Hickox in Maine taken by the Governor have resulted in patients in Maine calling up the Northern Maine Medical Center and canceling appointments and procedures because of an unfounded fear that somehow having Kaci in the community has made their health care services unsafe. This chilling effect causes Maine residents to postpone their own health care needs, and that does much more harm than good. Every health care worker, everywhere, is being stigmatized by this treatment.

“If we quarantine every health care worker for 21 days who comes in contact with an Ebola patient, regardless of the science, we won’t have nearly enough infectious disease specialists and nurses to take care of people in Maine. Every day around the globe there are medical staff, based out of Maine, going to places under the worst imaginable conditions to take care of those in need, and we don’t want anything to discourage that. We need to help these West African nations control the epidemic. To make it any more difficult for these medical heroes, who take two weeks off to help people around the world, by making them take another 3 weeks off when they return…they just won’t go in the first place. Clearly, we don’t need this stigma placed on our brave and brightest when they are not the problem here. Our own elected officials, and many members of the public, are participating in vilifying these people, and it’s embarrassing.” ~~ Gordon Smith, Maine Medical Center

We are not saying that those showing symptoms shouldn’t be immediately quarantined safely. We are saying that in this situation, as it stands, with only two people contracting the disease in the U.S., both of which have recovered, we might just collectively want to take a deep breath. There are, in fact,patients across several states in the US who have recently come back from West Africa, and have fevers, and are being safely quarantined, treated, and monitored. None of them have tested positively for Ebola yet. But symptoms are symptoms and those quarantines not only makes sense, but they’re vital.

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

The Policy Geek

Ebola Today 10/30

Civil disobedience

It can be as subtle as a bike ride through Maine on a brisk fall morning while the leaves are turning and burning colors all around. In this case, it was a bike ride, a boyfriend, a state trooper, and a whole bunch of media, because this activist and hero was Kaci Hickox, the nurse from the tent in New Jersey.

“There is no legal action against me, so I’m free to go on a bike ride in my home town.” ~~ Kaci Hickox

As we are you sure you remember, nurse Hickox was released earlier this week from that weird tent Governor Christie put her in in New Jersey, and allowed to return home to Maine. Despite having a state trooper stationed outside her home, and the fact that Maine’s Governor is looking into a court order to force her to stay in, she is not under any legal obligation to stay indoors at this time.

“I don’t want her within 3 feet of anybody. I am going to use the legal provisions to the fullest extent that the laws allow me, and I just hope she recognizes that. Let’s just get to November 10th, and then she can do whatever she likes.” ~~ Gov. Paul LaPage

Can Kaci be arrested for leaving the house? Well, the state and the federal government do have the authority, but that authority is not all reaching, and at this time, they haven’t really used that authority. The science has to support whatever actions are taken. That’s what the courts will look at. And the science is clear. It is not airborne. And with Kaci running no fever at all, she’s doesn’t have Ebola. Remember, Thomas Eric Duncan was posted up in his apartment for four days with his girlfriend and relatives who LIVED with him, and no one developed symptoms.

Unnecessary quarantines, and over reaching isolations, are a civil liberties issue, and the very act stigmatizes our much needed brave and heroic health workers. It’s a bad idea all around. Civil rights are supported by the Constitution of the United States, so when you don’t have the facts, or the science, that backs up quarantine for low risk, or no risk, patients, people need to CALM DOWN.

When the other kid’s parents are around tomorrow, Halloween, and while the kids are out collecting candy, and you guys get to talking, just remember what you know. We only have one patient at this time in United States, and everyone who has contracted Ebola in the U.S. has recovered.

Meanwhile, Back In Africa
On the other side of the pond, they are also watching these quarantine guidelines popping up haphazardly, state by state. They understand our fear. They’ve been afraid for some time now.

The US Navy set up a mobile lab in Liberia that really started to help turn the tide. Facilities in that mobile lab decreased the wait time for Ebola test results from 6 days to 4 hours. Those test results will typically be taken back on a bumpy SUV drive inland to one of the clinics that are set up around the West African region.

It isn’t unusual to see as many as 10 American doctors at any of these clinics. And Permanent Representative to the United Nations Ambassador Samantha Power has been everywhere coordinating the American response on the continent, reportedly getting 3 -4 hours sleep a night. So, long before we put boots on the ground to help build new facilities, we had medical boots on the ground saving lives, embodying the real meaning of Johnny-On-The-Spot. It isn’t that easy to get these clinics staffed, and with the new American quarantine threats, we might get behind as quickly as we’ve gotten ahead.

Talk about tracking
Two weeks ago, The World Health Organization (WHO), announced Mali was Ebola free. Is Ebola In Mali Now? It was confirmed last week by the WHO that a 2-year-old girl in Western Mali had contracted the disease. The 2 year old’s grandmother told the doctor they had just returned from neighboring Guinea, where the girl had been staying with her father before he died of Ebola. Reports are that the toddler exhibited symptoms, and had a nosebleed, as she and her grandmother made the 600-mile journey from Guinea to Kayes, via the Malian capital, Bamako, on public buses. This does not bode well. The child died after two days in the hospital, just hours after the diagnosis came in. Yes, the test results took 2 days to process.

In the early hours of Friday, about halfway between the two cities, the bus was spotted.

“They literally chased down the bus, made the passengers get out, and disinfected the whole vehicle in the middle of the road,” says Shannon Strother of Unicef.

In the meantime, the job of tracing the girl’s route, and working out how many people she may have come into contact with, has begun. By visiting the villages and towns through which the girl and her grandmother had passed, health workers have so far identified dozens of possible contacts.

“From the passenger list, where people had put down their phone numbers, we were able to identify and track all the people travelling on the bus,” says Dr Lamine Diarra at the health ministry in Bamako, adding, “The hunt’s been complicated by the fact that in parts of Mali, a whole village shares the same Sim card.”

According to the World Health Organisation (WHO), 116 people in Mali are now being held under observation for the disease. How important is tracking? It’s everything. Xerox’s Maven software was configured to provide contact tracing for Ebola, and other communicable diseases. In the absence of a vaccine, contact tracing – analyzing who is at risk from contact with an infected person – is one of the most important tools available to prevent widespread outbreaks like Ebola. Maven has been deployed in public health agencies in 12 U.S. jurisdictions, and two states in Australia. What is really needed, however, is a system that can be used worldwide.

“Right now, the Ebola outbreak is a major global problem that requires our best thinking and resources. Health organizations of all kinds need technology to manage the identification, and diagnosis, of those who may have come into contact with an infected person. It’s this level of vigilance that will help stem the outbreak,” said Dave Amoriell, Xerox’s Public Sector COO, adding,“Maven is now available quickly and securely through the Xerox cloud.”

In Nairobi, developers announced Monday a “new mobile telephone based mapping service has been created in a bid to track Ebola, and better help communities hit by the virus in west Africa.” The system, a collaboration between technology giant IBM, mobile telephone companies, and academics, allows people in affected areas to send free text messages about Ebola to track problems and trends, with the program mapping the exact location from where it is sent.

“It has already brought to light specific regions with growing numbers of suspected Ebola cases which require urgent supplies like soap and electricity, as well as faster response times for body collection and burials. We saw the need to quickly develop a system to enable communities directly affected by Ebola to provide valuable insight about how to fight it. Using mobile technology, we have given them a voice and a channel to communicate their experiences directly” ~~ IBM Research Africa’s chief scientist Uyi Stewart

Tracking is what the CDC does in conjunction with the NIH, and it’s that vital work, literally tracking down all those who came in contact with any infectious patients, that will save the cheerleader, and save the world.

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

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