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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

by 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.

maxerickson 12y ago
It's maybe excessively optimistic, but I think as long as the U.S. situation is limited to a small number of known, managed cases, the health care worker travel problem should more or less be solved. I guess a middle step would be to throw a bunch of resources at making a better voluntary quarantine available to people traveling out of the affected regions (not just the self quarantine like failed with the NBC crew, set up some facilities for it). edit: Also, unless something has again gone horribly wrong, they should be rinsing whatever disinfectant off the sidewalks, not anything directly (and it is clear enough that bleach is effective in denaturing Ebola, so obtaining effective disinfectant isn't an issue).
- hga 12y ago
  "I think as long as the U.S. situation is limited to a small number of known, managed cases" How do you reconcile that with my above "[we] allow unconstrained export of Ebola from its current epidemic nations"? According to Congresscritter Ed Royce, the US Embassies in the three afflicted nations are receiving 100 applications for visas every day. He doesn't say how many on average are getting them, there is of course some screening, but as Duncan shows an asymptotic carrier who doesn't declare close contact with an Ebola patient (for whatever reason, no need to go into the weeds there) can get through. An incubation period of as many as 21 days is a serious problem. This current US outbreak has, so far, a R nought of 2 (1 patient infected 2), and I don't expect other hospitals including the 4 specialist ones to necessary do a whole lot better when an unheralded patient arrives at their ER. (You're know we're finally serious about it when ERs station someone in isolation gear in outside to triage patients.) Unlike sending a known Ebola patient to one of those 4, as we've done 4 times, with 2 cases finished, I can't call cases like Duncan "known" or "managed", at least not initially. I fully support the known -> specialist hospital cases, if for no other reason than that we desperately need to learn more about EVD. But the random importation cases ... how can you be sure future ones will be qualitatively less of a nightmare like Dallas (which played out yet). E.g. I read someone mentioning how fortunate it was these two nurses are single and (appear to?) live alone. Imagine one having children and transmitting it to one or more of them ... that'll get ugly in a lot of ways. And in the meanwhile the authorities continue to shred their credibility and legitimacy. Which we may not be able to afford if it gets really bad. Ah, I didn't really answer your 2nd proposal. Why not a formal, enforced quarantine? It's not like that's required to be a terrible thing in this era of the Internet: put in the room a computer with a fast connection, a flat screen TV with a good package, and a cell phone (or more likely cell phone charger) and they should be OK until the watch period is over. Today's medical social distancing doesn't have to be severe in the directly social sense.
  - maxerickson 12y ago
    I don't agree with your premise that travel is unconstrained, especially air travel (I don't have a terrific understanding of the land borders, but they are fairly long and I guess much of it is wild, completely eliminating travel across them seems impossible). The first limit on travel is that a large portion of the population in the outbreak countries can't afford air travel. Then there is the Visa system. Then there is screening prior to boarding the flights. There is proof that this system is not 100% effective, but I don't take it as obvious that 100% effective is an attainable standard.

by hga 12y ago

maxerickson 12y ago

It's maybe excessively optimistic, but I think as long as the U.S. situation is limited to a small number of known, managed cases, the health care worker travel problem should more or less be solved. I guess a middle step would be to throw a bunch of resources at making a better voluntary quarantine available to people traveling out of the affected regions (not just the self quarantine like failed with the NBC crew, set up some facilities for it). edit: Also, unless something has again gone horribly wrong, they should be rinsing whatever disinfectant off the sidewalks, not anything directly (and it is clear enough that bleach is effective in denaturing Ebola, so obtaining effective disinfectant isn't an issue).

hga 12y ago
"I think as long as the U.S. situation is limited to a small number of known, managed cases" How do you reconcile that with my above "[we] allow unconstrained export of Ebola from its current epidemic nations"? According to Congresscritter Ed Royce, the US Embassies in the three afflicted nations are receiving 100 applications for visas every day. He doesn't say how many on average are getting them, there is of course some screening, but as Duncan shows an asymptotic carrier who doesn't declare close contact with an Ebola patient (for whatever reason, no need to go into the weeds there) can get through. An incubation period of as many as 21 days is a serious problem. This current US outbreak has, so far, a R nought of 2 (1 patient infected 2), and I don't expect other hospitals including the 4 specialist ones to necessary do a whole lot better when an unheralded patient arrives at their ER. (You're know we're finally serious about it when ERs station someone in isolation gear in outside to triage patients.) Unlike sending a known Ebola patient to one of those 4, as we've done 4 times, with 2 cases finished, I can't call cases like Duncan "known" or "managed", at least not initially. I fully support the known -> specialist hospital cases, if for no other reason than that we desperately need to learn more about EVD. But the random importation cases ... how can you be sure future ones will be qualitatively less of a nightmare like Dallas (which played out yet). E.g. I read someone mentioning how fortunate it was these two nurses are single and (appear to?) live alone. Imagine one having children and transmitting it to one or more of them ... that'll get ugly in a lot of ways. And in the meanwhile the authorities continue to shred their credibility and legitimacy. Which we may not be able to afford if it gets really bad. Ah, I didn't really answer your 2nd proposal. Why not a formal, enforced quarantine? It's not like that's required to be a terrible thing in this era of the Internet: put in the room a computer with a fast connection, a flat screen TV with a good package, and a cell phone (or more likely cell phone charger) and they should be OK until the watch period is over. Today's medical social distancing doesn't have to be severe in the directly social sense.
- maxerickson 12y ago
  I don't agree with your premise that travel is unconstrained, especially air travel (I don't have a terrific understanding of the land borders, but they are fairly long and I guess much of it is wild, completely eliminating travel across them seems impossible). The first limit on travel is that a large portion of the population in the outbreak countries can't afford air travel. Then there is the Visa system. Then there is screening prior to boarding the flights. There is proof that this system is not 100% effective, but I don't take it as obvious that 100% effective is an attainable standard.