5 ms·

I hate to play Negative Ned, but some observations are in order. Contact Tracing works when you have one guy that you know has it -- and you fan out like wildf

I hate to play Negative Ned, but some observations are in order. Contact Tracing works when you have one guy that you know has it -- and you fan out like wildfire to catch all the people exposed. It'll probably work for the one U.S. case. It does not work when you have tens of thousands of people infected, like we do in other African countries. People who are dying at home. People who have been in contact with who-knows-whom. So we're entering a new phase of Ebola: places where the disease is everywhere and we have no contact tracing, and places that can catch one or two cases as they appear. Nigera is currently in the latter camp. I hope they stay there. This is why scientists think the U.S. and other more advanced countries will do better: we'll be able to stomp on new cases, track the contacts down, and catch the secondaries. This will continue to work -- until it doesn't. That is, if the disease can be contained elsewhere, a low volume of cross-border transmission should be manageable. If, however, it continues to spread to unknown places, and grows in immeasurable ways? Then at some point the trickle of cases overloads any healthcare system.

a8da6b0c91d 12y ago
If it spreads to central american slums a panicked wave of people will rush the US border. The current authorities are insane enough to not stop them.
- cdelsolar 12y ago
  Really?
  - a8da6b0c91d 12y ago
    I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case a of a global pandemic, but the recent experience of the enterovirus epidemic being brought here by central american teens who were not deported really makes things clear.
    - macspoofing 12y ago
      >I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case Like with scotch tape?
      - hga 12y ago
        No: if your passport includes a stamp from the 3 affected countries (no doubt later to be expanded), you don't get in, period. Or you go straight into isolation for 21 days. Our non-existent southern border is a further problem, mitigated to a degree by the extra time it takes to travel that way. Not to mention that if we're concerned, Mexico should be bat shit scared of Ebola breaking out in its various slums; they have little more chance of containing it in them than these three West African nations. A little bit of research into what everyone used to when we had widespread, often endemic incurable diseases running rampant, will show that we have solutions to Ebola.
        maxerickson 12y ago
        Are there a lot of social connections between West Africa and Mexican slums? Is travel from West Africa to poor areas of Mexico something the world should actually be concerned about? Why? (I think it is likely pragmatic to at least encourage people to not travel, for instance, I don't see why the nurse flew to Ohio in the first place, but I don't understand how the Liberia, Sierra Leone, Guinea->Mexican slum is a useful idea to focus on)
        hga 12y ago
        That's what I was intentionally thinking. But then I realized it might take only one index case to start another hell on earth like we see in the three current epidemic nations. So then you e.g. wonder about indirect vectors. Suppose, for example, those guys who pressure washed Duncan's vomit etc. outside his apartment without using any PPE, even had their water bottles too close, were directed to do it quickly, before a few days of heat and UV almost certainly killed the Ebola in it. And then one takes a visit back home. Or look at this 2nd nurse, who felt compelled to travel to Cleveland to continue organizing her wedding. Suppose that was south of the border instead (essentially no further by air, right?). Concepts like requiring "a lot" are potentially lethal when the real metric is "it only takes one". Not that Mexico's medical system is non-existent or hopeless by any means, I'd assume it would take another goof for it to get into an area where containment was impractical to impossible. My general point is that as long as we (the world at large, but the US has a special responsibility to our neighbors) allow unconstrained export of Ebola from its current epidemic nations, bad things are certain to happen. Look at the current Dallas nightmare. Surely, we hope, we'll do better next time. But other nations will also screw up their first cases, and plenty have less margin. When stakes this high ... well, here's a quick list of the big 3rd World regions and populations, in billions: Africa: 1.111 Latin America: 0.558 Southeast Asia: 0.618 South Asia: 1.591 Total for above: 3.378 PRC: 1.350 Just how comfortable are we with dicing with the lives of that many people? While it's hardly inevitable, especially if we can soon develop a safe, easily manufactured and distributed vaccine, what are we going to say to our children if we let 1 billion or more people die because we're now too [fill in the blank] to implement old fashioned quarantines.
coldcode 12y ago
Imagine someone gets infected by a borderline patient before they are quarantined, like the nurse. Imagine this person is an undocumented worker or poor individual who eventually gets sick and is afraid or unable to afford healthcare and infects those around them. At this point you have a real problem as people are walking around unknowingly infecting others who also eventually either find a doctor who is unprepared for patients walking in with Ebola, or hopefully a hospital that is ready. I don't find this scenario unlikely at all. In the US there is limited legal means to force quarantines on large masses of people much less any place to put them. Imagine one going to an NFL football game. How do you trace 60,000 people and all their contacts? Hopefully none of the exposed people will fit this scenario but you only need one free infectious person you don't know about.
- aaronbrethorst 12y ago
  Thomas Duncan didn't have health insurance: http://www.dallasnews.com/opinion/latest-columns/20141014-josephus-weeks-ebola-didnt-have-to-kill-my-uncle.ece http://www.dallasnews.com/opinion/latest-columns/20141014-jo...
  - k-mcgrady 12y ago
    How does the US health care system adapt if this does become widespread? Do people without health insurance receive 100% free treatment? Seems like the smart thing to do for everyone but the US health care system isn't exactly smart.
    - hga 12y ago
      For acute treatment of things like this the US health care system is "smart". If you present with stuff like this to an ER they take care of you, otherwise you, not to mention the whole world, would hear of people being dumped in alleys or hospices. That's been the law since after WWII BTW. Now, how many US hospitals will be bankrupted by the measures needed to get ready for, and deal with such patients, is another question altogether: http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-bankrupt-my-hospital-director-reacts-to-cdc-prep-call/ http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-...

a8da6b0c91d 12y ago

If it spreads to central american slums a panicked wave of people will rush the US border. The current authorities are insane enough to not stop them.

cdelsolar 12y ago
Really?
- a8da6b0c91d 12y ago
  I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case a of a global pandemic, but the recent experience of the enterovirus epidemic being brought here by central american teens who were not deported really makes things clear.
  - macspoofing 12y ago
    >I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case Like with scotch tape?
    - hga 12y ago
      No: if your passport includes a stamp from the 3 affected countries (no doubt later to be expanded), you don't get in, period. Or you go straight into isolation for 21 days. Our non-existent southern border is a further problem, mitigated to a degree by the extra time it takes to travel that way. Not to mention that if we're concerned, Mexico should be bat shit scared of Ebola breaking out in its various slums; they have little more chance of containing it in them than these three West African nations. A little bit of research into what everyone used to when we had widespread, often endemic incurable diseases running rampant, will show that we have solutions to Ebola.
      - maxerickson 12y ago
        Are there a lot of social connections between West Africa and Mexican slums? Is travel from West Africa to poor areas of Mexico something the world should actually be concerned about? Why? (I think it is likely pragmatic to at least encourage people to not travel, for instance, I don't see why the nurse flew to Ohio in the first place, but I don't understand how the Liberia, Sierra Leone, Guinea->Mexican slum is a useful idea to focus on)
        hga 12y ago
        That's what I was intentionally thinking. But then I realized it might take only one index case to start another hell on earth like we see in the three current epidemic nations. So then you e.g. wonder about indirect vectors. Suppose, for example, those guys who pressure washed Duncan's vomit etc. outside his apartment without using any PPE, even had their water bottles too close, were directed to do it quickly, before a few days of heat and UV almost certainly killed the Ebola in it. And then one takes a visit back home. Or look at this 2nd nurse, who felt compelled to travel to Cleveland to continue organizing her wedding. Suppose that was south of the border instead (essentially no further by air, right?). Concepts like requiring "a lot" are potentially lethal when the real metric is "it only takes one". Not that Mexico's medical system is non-existent or hopeless by any means, I'd assume it would take another goof for it to get into an area where containment was impractical to impossible. My general point is that as long as we (the world at large, but the US has a special responsibility to our neighbors) allow unconstrained export of Ebola from its current epidemic nations, bad things are certain to happen. Look at the current Dallas nightmare. Surely, we hope, we'll do better next time. But other nations will also screw up their first cases, and plenty have less margin. When stakes this high ... well, here's a quick list of the big 3rd World regions and populations, in billions: Africa: 1.111 Latin America: 0.558 Southeast Asia: 0.618 South Asia: 1.591 Total for above: 3.378 PRC: 1.350 Just how comfortable are we with dicing with the lives of that many people? While it's hardly inevitable, especially if we can soon develop a safe, easily manufactured and distributed vaccine, what are we going to say to our children if we let 1 billion or more people die because we're now too [fill in the blank] to implement old fashioned quarantines.

coldcode 12y ago

Imagine someone gets infected by a borderline patient before they are quarantined, like the nurse. Imagine this person is an undocumented worker or poor individual who eventually gets sick and is afraid or unable to afford healthcare and infects those around them. At this point you have a real problem as people are walking around unknowingly infecting others who also eventually either find a doctor who is unprepared for patients walking in with Ebola, or hopefully a hospital that is ready. I don't find this scenario unlikely at all. In the US there is limited legal means to force quarantines on large masses of people much less any place to put them. Imagine one going to an NFL football game. How do you trace 60,000 people and all their contacts? Hopefully none of the exposed people will fit this scenario but you only need one free infectious person you don't know about.

aaronbrethorst 12y ago
Thomas Duncan didn't have health insurance: http://www.dallasnews.com/opinion/latest-columns/20141014-josephus-weeks-ebola-didnt-have-to-kill-my-uncle.ece http://www.dallasnews.com/opinion/latest-columns/20141014-jo...
- k-mcgrady 12y ago
  How does the US health care system adapt if this does become widespread? Do people without health insurance receive 100% free treatment? Seems like the smart thing to do for everyone but the US health care system isn't exactly smart.
  - hga 12y ago
    For acute treatment of things like this the US health care system is "smart". If you present with stuff like this to an ER they take care of you, otherwise you, not to mention the whole world, would hear of people being dumped in alleys or hospices. That's been the law since after WWII BTW. Now, how many US hospitals will be bankrupted by the measures needed to get ready for, and deal with such patients, is another question altogether: http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-bankrupt-my-hospital-director-reacts-to-cdc-prep-call/ http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-...