First Ebola Diagnosis in US

[billvon 2,400]

>Incorrect we have a surgeon general. The current acting surgeon general is
>Rear Admiral Boris Lushniak.

From the New England Journal of Medicine:

====================
Where Is the Surgeon General?

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D.

October 22, 2014
NEJM

As an unchecked Ebola epidemic moves out of West Africa to touch the United States and the rest of the world, we should rightfully ask, “Where is the Surgeon General?” The answer is, quite simply, that we do not have one. We face a growing crisis of confidence in our ability to protect patients and health care workers, and the position of the chief public health officer of the United States remains unfilled.

How did this happen?

President Barack Obama nominated a highly qualified candidate, Vivek Murthy, to be the nation's next Surgeon General, but the nomination was not advanced to a confirmation vote in the Senate because conservative lawmakers and the National Rifle Association found his very reasonable views on firearm regulation unacceptable. A highly respected physician with impressive credentials who would have been an outstanding Surgeon General was turned away solely for political reasons.

That was in March, and nothing has happened since. Although we believe that Vivek Murthy would bring much to the job, the harsh political environment in Washington is unlikely to allow his confirmation. Given this impasse, and in these critical times, the Obama administration should select another candidate to be the nation's public health leader. Although the Acting Surgeon General, Boris Lushniak, is well qualified, he has not been confirmed and lacks the authority to actively pursue a public health agenda for the nation. We have heard little from him during the Ebola outbreak. Now, more than ever, we need a confirmed Surgeon General who can speak to the public with authority.
==========================

[Anvilbrother 0]

Quote

Although the Acting Surgeon General, Boris Lushniak, is well qualified, he has not been confirmed and lacks the authority to actively pursue a public health agenda for the nation. We have heard little from him during the Ebola outbreak.

I appreciate that it supports my claim he is there and shows he is qualified to be speaking out about this like you all claim(and I agree) we need someone to be doing. Now why isn't he?

Postes r made from an iPad or iPhone. Spelling and gramhair mistakes guaranteed move along,

[billvon 2,400]

>I appreciate that it supports my claim he is there and shows he is qualified to be
>speaking out about this

The thrust of the article is:
============
“Where is the Surgeon General?” The answer is, quite simply, that we do not have one.
============

Sounds like you disagree.

[muff528 3]

He is opposed for "political" reasons because he takes political positions on issues ...not just gun control issues. (BTW- he is supposed to do that.) That certainly doesn't mean he isn't "qualified" to be SG. I'm sure that there are many conservative-leaning physicians who are just as qualified to be SG as far as public health issues are concerned, but you don't see Pres. Obama nominating them for the position ....because it is a "political" office that promotes the President's political "public health" agenda. And, I wouldn't expect the opposition party to be too excited about confirming someone who co-founded "Doctors for Obama".

However:

113th Congress (2013-2015)
Majority Party: Democrat (53 seats)
Minority Party: Republican (45 seats)
Other Parties: 2 Independents (both caucus with the Democrats)

Reid is running the show up there. If they want him, just confirm him.

But I don't think we need a Surgeon General barking orders in response to the Ebola threat (real or perceived). Hospitals and doctors should just do the common, walking-around sense things that they should be doing with any dangerous virus. Try to keep it contained while pursuing a vaccine or cure, etc.

[Bolas 5]

billvon

> can you understand the rationale of associating deaths from a biological virus to
> an inanimate object?

Viruses ARE inanimate objects. Outside a host they are completely inert; a virus sitting on a table never killed anyone. Once a human picks up that virus it becomes dangerous. At that point how the infected person acts (i.e. do they act to prevent exposure to others, do they get treatment) determines how dangerous the virus is to themselves and others.

That actually sounds a lot like a gun.

Except the gun has no direct ability to alter one's mental and cognitive states.

Okay, I'll rephrase the original question.

Which would you rather be in a room with?

1. A gun.
2. A pertri dish of Ebola.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[billvon 2,400]

>Which would you rather be in a room with?
>1. A gun.
>2. A pertri dish of Ebola.

I'd honestly have no preference. They are both don't-cares. I suppose the gun could somehow spontaneously fire and kill me, or the petri dish could explode and embed the virus in my skin, but both are very low-likelihood events.

Now, if you postulated a guy with Ebola or a guy with a gun, their state would matter. Did the guy get Ebola yesterday and is otherwise fine? Then I'd go with the guy with Ebola. Is he symptomatic and raving? Then I'd avoid him. Basically the same thing with the gun. If the guy is reasonable I'd go with him. If he was crazy I'd avoid him.

[jakee 1,255]

Quote

Which would you rather be in a room with?

1. A gun.
2. A pertri dish of Ebola.

Who gives a fuck?

What is the connection between your question and reality?

Do you want to have an ideagasm?

[Bolas 5]

jakee

Quote

Which would you rather be in a room with?

1. A gun.
2. A pertri dish of Ebola.

Who gives a fuck?

What is the connection between your question and reality?

Irony score incalculable...

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[jakee 1,255]

Oh yeah? Explain why.

Do you want to have an ideagasm?

[kelpdiver 2]

jakee

Quote

I missed the part where he contracted his homicidal urges from a patient, which was the specific aspect I spoke of.

Oh, you probably should have specifically spoken of it then, because in the last post you didn't.

"doctor or nurse that cared for a gunshot victim" is pretty clear.

Quote

The fact remains that you are several orders of magnitude more likely to be in a room with a gun, held by a homicidal person, who is shooting it at you, than in a room with a person with ebola.

Currently, yes. We're still on the clock to see if there will be any level 3 infections from the current cases.

In large part because of (to date) limited opportunity and fierce responses. But if we write it off as a non issue, then we could find ourselves in a different world*. We used to put two patients in most hospital rooms to save costs. Now new hospitals are nearly always singles because of the scourge of MRSA.

* because of the fast flame nature of Ebola, I don't really fear it either. But I also don't fear "assault weapons."

[jakee 1,255]

kelpdiver

***

Quote

I missed the part where he contracted his homicidal urges from a patient, which was the specific aspect I spoke of.

Oh, you probably should have specifically spoken of it then, because in the last post you didn't.

"doctor or nurse that cared for a gunshot victim" is pretty clear.

Yeah, it means a doctor or nurse who cared for a gunshot victim. It doesn't mean anything else.

Quote

Quote

The fact remains that you are several orders of magnitude more likely to be in a room with a gun, held by a homicidal person, who is shooting it at you, than in a room with a person with ebola.

Currently, yes.

Always, yes.

Quote

In large part because of (to date) limited opportunity and fierce responses. But if we write it off as a non issue, then we could find ourselves in a different world*. We used to put two patients in most hospital rooms to save costs. Now new hospitals are nearly always singles because of the scourge of MRSA.

It's not being treated as a non issue, it's having a disproportionately massive amount of resources and emotional investment put in it.

MRSA is another good example. It's a real problem, but it's mundane now and no-one cares. Take a poll on the street of which one people are most scared of and will it be the one they might catch or the one they'll never catch? The only reason anyone gives a shit about ebola is because it's new and exciting. (Hey, didn't someone say that already?)

Do you want to have an ideagasm?

[kelpdiver 2]

jakee

It's not being treated as a non issue, it's having a disproportionately massive amount of resources and emotional investment put in it.

MRSA is another good example. It's a real problem, but it's mundane now and no-one cares. Take a poll on the street of which one people are most scared of and will it be the one they might catch or the one they'll never catch? The only reason anyone gives a shit about ebola is because it's new and exciting. (Hey, didn't someone say that already?)

Aside from the newness factor, people are afraid of it because they feel they can't protect themselves from it. It cannot be seen, and anyone riding the subways in a major city comes across slime and puddles and other ickiness. (The Underground is a step up from NY or Chicago or SF).

People can take measures to stay away from homicidal types. If you're not a criminal, the risk, despite there being more guns than people in the US, is quite low. People will even take unnecessary moves based on perceived threats. But "don't worry" and "wash your hands" is not comforting, not when it has a mortality rate between 30-70%.

And since you want to pretend it's not obvious - no one involuntarily catches homicidal urges from another. A doctor might choose to commit violence, but they made that choice.

[billvon 2,400]

>People can take measures to stay away from homicidal types. If you're not a
>criminal, the risk, despite there being more guns than people in the US, is quite
>low.

The risk from violence, however, is far higher. From stray bullets alone (for which there is no simple defense) there are 300 injuries and 60 deaths a year in the US, many of which are children. Compare that to ~8 infections and 1 death from Ebola so far.

> But "don't worry" and "wash your hands" is not comforting, not when it has a
> mortality rate between 30-70%.

It may not be comforting to some people, but then you're back to the irrational fear being spread over Ebola. It is very easy to make people afraid and uncomfortable, regardless of the relative risks.

(Not that irrational fear is all that bad in this case; it has driven a lot of research and a lot of flexibility in trial protocols, which is a good thing.)

[jakee 1,255]

Quote

Aside from the newness factor, people are afraid of it because they feel they can't protect themselves from it. It cannot be seen, and anyone riding the subways in a major city comes across slime and puddles and other ickiness. (The Underground is a step up from NY or Chicago or SF).

Ebola isn't in the subway.

Quote

People can take measures to stay away from homicidal types. If you're not a criminal, the risk, despite there being more guns than people in the US, is quite low. People will even take unnecessary moves based on perceived threats. But "don't worry" and "wash your hands" is not comforting, not when it has a mortality rate between 30-70%.

And an occurence of 0%

You could barricade yourself inside your home, never go outside and you'd still have a far higher chance of being shot by a burglar than catching ebola.

Quote

And since you want to pretend it's not obvious - no one involuntarily catches homicidal urges from another. A doctor might choose to commit violence, but they made that choice.

Of course that's obvious. What are you even talking about?

Do you want to have an ideagasm?

[kelpdiver 2]

jakee

Quote

And since you want to pretend it's not obvious - no one involuntarily catches homicidal urges from another. A doctor might choose to commit violence, but they made that choice.

Of course that's obvious. What are you even talking about?

You were attacking my post talking about this obviousness, so it wasn't obvious that you agreed.

[jakee 1,255]

kelpdiver

***

Quote

And since you want to pretend it's not obvious - no one involuntarily catches homicidal urges from another. A doctor might choose to commit violence, but they made that choice.

Of course that's obvious. What are you even talking about?

You were attacking my post talking about this obviousness, so it wasn't obvious that you agreed.

You didn't say anything about contagious urges.

Do you want to have an ideagasm?

[Andy9o8 0]

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Ebola isn't in the subway.

You'd certainly not think so.

Then again, SUPPOSE - just suppose - Dr. Craig Spencer was contagious when he rode the NYC subway.. and SUPPOSE he sneezed some saliva and phlegm carrying contagion onto a surface, and then someone else touched it, and then touched their face, etc. ..well, you see where this is going. And just like that nurse who rode the plane from Dallas to Cleveland, it has consequences. The perfection of keyboard layperson's hindsight suggests that Spencer should have been hyper-cautious enough to informally restrict himself to home, preferably alone, for at least a while until he was certain he was in the clear. He didn't, and that, too, has had consequences.

That's why I don't blame the NY & NJ governors for reacting to the Spencer case with enhanced emergency quarantine rules. Yes, Nurse Hickox's quarantine seems like it may have been handled a bit clumsily, and she's mightily pissed off about it, but I still think on balance the governors were more reasonably prudent than not on that call.

[wolfriverjoe 1,340]

Andy9o8

...That's why I don't blame the NY & NJ governors for reacting to the Spencer case with enhanced emergency quarantine rules. Yes, Nurse Hickox's quarantine seems like it may have been handled a bit clumsily, and she's mightily pissed off about it, but I still think on balance the governors were more reasonably prudent than not on that call.

I disagree with you Andy.

How many people have come down with Ebola through casual contact with Duncan, Phang or Vinson?

Duncan was symptomatic (and contagious) for at least two days prior to his hospitalization and isolation.
And he puked on the sidewalk outside the hospital when he was sent home the first time.

And how many have gotten sick?

I think the isolation and quarantine was the same sort of overreaction we've been seeing all over.

Simple panic and ignorance.

And Hickox reportedly has been released. She got a lawyer and threatened to sue.

"There are NO situations which do not call for a French Maid outfit." Lucky McSwervy

"~ya don't GET old by being weak & stupid!" - Airtwardo

[Andy9o8 0]

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How many people have come down with Ebola through casual contact with Duncan, Phang or Vinson?

The 3 anecdotes are important, but not the final word on risk. My point is still: contact with infected bodily fluid is what it is. (We could go back & forth forever about this.)

Quote

She got a lawyer and threatened to sue.

Well, every cloud has a silver lining.

[billvon 2,400]

>Then again, SUPPOSE - just suppose - Dr. Craig Spencer was contagious when he
> rode the NYC subway.. and SUPPOSE he sneezed some saliva and phlegm
>carrying contagion onto a surface, and then someone else touched it, and then
>touched their face, etc. ..well, you see where this is going.

Yes, there is a very, very small chance he could spread it.

Now let's compare it to tuberculosis. As of May there were about 600 cases in NYC, most coming from overseas. TB is far more contagious than Ebola, and so far in the US is about as deadly (about 12% mortality rate in both diseases.) You are FAR more likely to be exposed to TB in New York than Ebola, and are far more likely to die from it than Ebola.

But no emergency quarantine; no warnings about the subway system, no half-hour coverage per hour of news.

So while a quarantine might have been appropriate in both cases, the fact that this single case caused such an almighty stink and 600 cases of TB did not indicates that someone has some serious problems judging relative risk. (Or more likely knows what people want to hear - and tells them just that.)

[jakee 1,255]

Quote

The perfection of keyboard layperson's hindsight

I've been saying from the beginning that there won't be an ebola outbreak in the US.

If there is, I'll look stupid but if there isn't then my opinions won't be 'hindsight'.

Do you want to have an ideagasm?

[GeorgiaDon 340]

Quote

... but I still think on balance the governors were more reasonably prudent than not on that call.

Perhaps, then, we should enforce a quarantine on everybody who has not had a current flu shot and has been in contact with anybody who might have had the flu. Certainly we should involuntarily quarantine anyone who goes to work when they are feeling achy and might be running a bit of a fever. After all, the flu kills thousands of people every year just in the US.

It's quite clear that without significant effort from medical volunteers from around the world, the epidemic in West Africa will continue to escalate. There is a clear trade-off here: we can impose significant (and medically unnecessary) impediments to protect against the vanishingly small chance that doctors and nurses returning from West Africa will choose to ignore their symptoms until they are actually projectile vomiting on fellow movie goers, but we should understand that that increases the chance that the epidemic will expand beyond West Africa and ultimately increase the influx of actually infected people coming here via way-points in Europe or Asia.

Personally, I trust trained medical personnel more than I do travelers who lie about their travel history to evade embargoes and mandatory quarantines.

In Nurse Hickox's case, she was pretty much forced to travel through Newark as it is one of only five airports travelers from West Africa can enter the US through. She lives in Maine, so if she was permitted to go home she would not pose any risk to residents of New Jersey or New York. Instead she is (or was) being forced to remain in New Jersey, hardly a course of action consistent with "protecting the residents of New Jersey".

This would have been a great time for politicians to actually step up and take a leadership role, quieting fears instead of pandering to them for the sake of milking public panic for votes. Sadly that did not happen.

Since Chris Christie seems able to diagnose patients without every even having seen them, perhaps he should nominate himself to be the new Surgeon General.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[Andy9o8 0]

I acknowledge your point. But the 12% mortality rate is from the miniscule sampling in the US (I think). Sure, that's very important, but according to the WHO, the world-wide death rate is closer to 70%. Of course, you and I know that that's mostly in Africa, not in First World-treated patients. Still, that's what people hear and read, so I think they can be forgiven for taking it to heart. Nobody wants to risk putting their hand on Dr. Spencer's sputum in the subway when the WHO is telling people that if you get the disease, you've got a 50-70% chance of dying, and not gradually, like with TB, but really fast.

At some level, standards of care in risk management, especially in liability hindsight mentality cultures like in the US, require those in charge to employ very high levels of caution. It's that mindset that I think is guiding the various state governors' policies.

[Anvilbrother 0]

These people need to learn to take one for the team! They told us if we ran a call with someone suspected we were immediately getting into the Ems unit and going to isolation wherever the state epidemiologist tells us. Not getting back into the fire truck, going back to the station, or going home until we were determined to be ebola free.

Postes r made from an iPad or iPhone. Spelling and gramhair mistakes guaranteed move along,

[billvon 2,400]

> But the 12% mortality rate is from the miniscule sampling in the US (I think).
>Sure, that's very important, but according to the WHO, the world-wide death rate
>is closer to 70%.

Agreed - without treatment deathrate is over 70%. But without treatment deathrate for TB is over 50%. So again you have very similar numbers.

But let's forget those numbers. For the sake of argument let's say Ebola is 70% fatal and TB is 12% fatal. You are still far, far more likely to die from a disease contracted on the subway because someone with TB got on with you.

>Still, that's what people hear and read, so I think they can be forgiven for taking
>it to heart.

Sure, you can forgive people for being scared. Lots of people are scared of a lot of things. But you should not forgive leaders for making unbalanced and potentially harmful public health decisions based on fear rather than science. Indeed, it is their job to _not_ do that.