She needs to stay in her house until she is deemed Ebola free.
But why? There's no reason to think she has it, and even if she does but is not symptomatic, she can't transmit it to anyone--assuming she isn't spraying people down with her fluids.
White privilege. If she was black and African and pulling this shit....?
There was no public outrage when they forcibly quarantined Thomas Duncan's family, for instance.
Where was the Constitutional outcry?
I don't have time to go and look, but there was a lot of disgust at how both Duncan and his family were treated. His family was made to stay in an unclean apartment without power at times (storms) and family and friends did protest both their treatment and the hospital for it's lack of protocol. Plus they were quarantined at an "undisclosed" private residence in a gated community, so I remember friends being concerned that they were not accessible. I think we've also learned that the exposure potential is different for a direct non-medical care giver and a medical care-giver who has been trained to treat ebola patients (like this white nurse or the NY doctor, etc.). I think it was NPR that discussed most of this.
That's not to say that I think it's okay to do a blanket quarantine of all family members treating ebola patients or random people entering the US from countries with the ebola epidemic. And I definitely don't think we should quarantine potentially exposed people if they are treating/caring for ebola patients as part of the medical community and follow CDC protocol.
ETA - My view is probably skewed by the fact that I know someone IRL who is currently in Africa to treat ebola patients.
I like how she declared that the conditions of her own home are displeasing to her. Uhm, really?
Also, I didn't hear her worrying about paying her bills or about repercussions from her place of employment. She just doesn't want to because, well I don't know why. Because she's pissed at Christie?
MSF continues to pay their workers salaries for 21 days after they return from an Ebola affected area so they will not have to return to work and can take the time to rest and recover. So that shouldn't be a concern.
I understand her feeling on principle but she is definitely throwing away her PR advantage here.
Maybe I don't understand Ebola transmission (or virus transmission in general).
She's tested positive twice now. Is it possible for the virus to be in her system, but not "infecting" her (thus, tests for the virus show up negative)?
If she's testing negative now, back home in the US with no further contact with Ebola patients, how could she possibly test positive later on in the 21-day quarantine period?
NPR did an interesting story on this yesterday. I can't find the article on their website, but basically the virus starts out in organs like the spleen -- which is difficult to take a test sample from. As the virus progresses it moves to the blood and is then easily detectable at extremely low concentrations.
Are there other returning medical workers that have been quarantined also? Is she the only one who's speaking up? What about medical workers that treated patients in the US? Where does it stop?
Agree. @mx mentioned this but the US has successfully treated both Marburg virus and Lassa fever cases in the last year or two. Both of which have had active spreads in various parts of Africa and logically would be in areas where there other American healthcare workers. Ditto on measles, TB, you name it. I don't see 21 day quarantines for each and every returning healthcare worker (and missionary...) for anyone going to any country in Africa with any other scary outbreak.
So, that would be right now. Because, um, she doesn't have the Ebola.
But she's within the time frame where she could present, right?
I mean if I rub up on a dude with chicken pox* I don't get to claim two days later that I definitely don't have it, why you tripping, yo?
*yes, I understand chicken pox is a different beast and that this nurse wasn't rubbing up on Ebola patients.
True, she is within the time frame it could present.
BUT, if she remains asymptomatic, she snuggle your ass off and still not give you Ebola.
I don't think she needs to go on a handshaking binge right now. BUT, I could see her not being willing to stay cooped up at home after everything that happened to her. They treated her like shit, and I'm sure she feels she owes them nothing at this point.
She is no longer Christie's problem. She is now in Maine. Good luck.
People freak out when we have little to no leadership and no clear guidance they trust. The plan has changed several times.
And "If you like your Dr, you can keep your Dr." proves to not be true, you are less likely to believe the next promise "we are not going to be seeing Ebola in the US, and we are well prepared to deal with Ebola" -- and then 2 nurses become ill after dealing with a patient who died from Ebola - on US soil.
She is no longer Christie's problem. She is now in Maine. Good luck.
People freak out when we have little to no leadership and no clear guidance they trust. The plan has changed several times.
And "If you like your Dr, you can keep your Dr." proves to not be true, you are less likely to believe the next promise "we are not going to be seeing Ebola in the US, and we are well prepared to deal with Ebola" -- and then 2 nurses become ill after dealing with a patient who died from Ebola - on US soil.
She is no longer Christie's problem. She is now in Maine. Good luck.
People freak out when we have little to no leadership and no clear guidance they trust. The plan has changed several times.
And "If you like your Dr, you can keep your Dr." proves to not be true, you are less likely to believe the next promise "we are not going to be seeing Ebola in the US, and we are well prepared to deal with Ebola" -- and then 2 nurses become ill after dealing with a patient who died from Ebola - on US soil.
Can someone help me find my eyes? They rolled right out of my head.
White privilege. If she was black and African and pulling this shit....?
There was no public outrage when they forcibly quarantined Thomas Duncan's family, for instance.
Where was the Constitutional outcry?
I agree there wasn't nearly enough done for that family at the beginning, I can't imagine being trapped in an apartment with an ebola victim's clothes, dishes he used, etc. The whole situation in Dallas was effed up. But I think that case was different because Duncan did have symptoms while still in direct contact with his family (...due to being sent home from the hospital :?), so I think they were at a higher risk than a nurse who knew she was treating ebola victims and hopefully taking all the proper precautions.
I don't think we can use the mortality rate in Liberia as an accurate indicator of much. The mortality rate for people treated in the US and Europe is about ~20% and those who died had underlying conditions (Duncan who had kidney problems and a lifetime of third world healthcare) or were elderly (the Spanish priests).
Except that the article I read said they weren't really sure why our victims have overcome the illness as well as they have. There are a variety of factors they think are contributing, better quality of health of the patients, the age of the victims, being treated with the blood of survivors, or more interesting to me, that they were in contact with a lower viral load than those who were exposed in the nations currently affected. This seems interesting to me given that Dr Spencer is stable but still struggling while those who were exposed to the virus by one man in Texas are already headed home.
A doctor from Emory gave a press conference yesterday when the second nurse was released from the hospital. He said one hypothesis is that they treated the patients in a much more aggressive fashion than conventional wisdom dictates. That's poorly worded - lol. Basically, the assumption was that once the disease progressed to a certain point, certain treatments were futile. He inferred they gave the nurses dialysis, which wouldn't be as available in Africa.
Then what is it based on? It's not based on science, current best practices, or past history/risk.
I disagree. I think an at-home quarantine for folks who have had direct contact with a patient with Ebola is a very good way to handle the spread of this disease. As I noted in a post yesterday, I really don't think we can look back at the relative risk of past outbreaks to determine how we should handle this present outbreak. Past outbreaks were few and far between and resulted in relatively small populations being affected. Which is not to minimize the seriousness of those outbreaks, but this outbreak has already killed like twice as many people as all the other outbreaks combined. Two things occur to me because of that (1) MORE volunteers will be traveling back and forth to address this situation; and (2) there probably is some truth to the people who are suggesting this particular strain is more virulent - that you need come into contact with fewer antigens to "catch" it.
Because of that, because it's probably more contagious and because there are necessarily more people traveling through international airports who have come into contact with it, I DO think that this response needs to be more aggressive AND that a 21 day quarantine is, in fact, based on science. The temperature-taking at the airport is simply not enough and seems to me to be a very poor way to guard against contagious people wandering out onto the NYC subway.
I think I'm an outlier (and probably a bit flameful particularly because I'm a lawyer), but I fully and completely support a 21 day quarantine (that is compassionate and allows for the person to have the best access to comforts) for anyone who has come into contact with a person who had ebola. If I thought we were anywhere close to an adequate treatment or vaccine, I'd feel differently, but I think we're months and possibly years away from even being able to mass produce the ZMAPP drug that worked for the physicians in September. So, quarantine it is.
But... those who are treating patients medically are MORE aware of concerns and if following the CDC protocol is to take your temp twice daily (or whatever) and check-in if you have a temp increase as the medical community indicates, then why isn't that enough? Why do these people have to take an economic hit and isolation when they are some of the most knowledgeable on ebola? Plus, who is bringing them groceries and covering their jobs while they are quarantined - the government/CDC? What about their family they live with are they quarantined also or do you have extra housing costs b/c of this?
I agree there wasn't nearly enough done for that family at the beginning, I can't imagine being trapped in an apartment with an ebola victim's clothes, dishes he used, etc. The whole situation in Dallas was effed up. But I think that case was different because Duncan did have symptoms while still in direct contact with his family (...due to being sent home from the hospital :?), so I think they were at a higher risk than a nurse who knew she was treating ebola victims and hopefully taking all the proper precautions.
....Except for the simple fact that none of his family contracted the illness; while the caretakers taking proper precautions? Did.
I'm not convinced the nurses were really taking proper precautions (NOT from any fault of their own, from the failure of training/policies and available supplies). Just because thankfully none of his family ended up with ebola didn't mean they weren't at pretty high risk being around a symptomatic victim for days (I forget the timeline).
Can someone explain what the ideal at home quarantine policy actually is?
If you support it, does this mean you support it for the doctors, nurses, and janitorial staff dealing with the NYC doctor (or anyone else in the US who has it)?
I would assume then that those people would only be allowed to treat that one patient (or clean his room and nobody else's) for the duration of his illness, then remain in their homes for 21 days, correct? How do they get to and from the hospital and their homes? Are they quarantined in the hospital for the duration of the time they treat him? If they are allowed to go home, what are the transportation arrangements? Are those who live in their homes with them also subject to the quarantine?
I need to understand what we are proposing by mandating a quarantine for anyone with contact with an ebola patient before I can decide how I feel about it. To quarantine consistently seems like a major commitment, so I'm wondering if that's really what people are proposing.
Can someone explain what an ideal mandatory quarantine really looks like?
If you are OK with requiring the Maine nurse to stay home, what do you propose those treating the NYC doctor do?
I'm not convinced the nurses were really taking proper precautions (NOT from any fault of their own, from the failure of training/policies and available supplies). Just because thankfully none of his family ended up with ebola didn't mean they were at pretty high risk being around a symptomatic victim for days (I forget the timeline).
Well....okay, but that's kind of a stretch. Presumably being more knowledgeable about the virulence of this illness, one would assume a nurse would take at least better precautions than this man's family, who presumably knew next to nothing about Ebola and how to prevent transmission. Of course they were at high risk; my point is that the nurses are also at high risk, even with at least primary precautions and protocols and knowledge about the transmission of the illness.
Can someone explain what the ideal at home quarantine policy actually is?
If you support it, does this mean you support it for the doctors, nurses, and janitorial staff dealing with the NYC doctor (or anyone else in the US who has it)?
I would assume then that those people would only be allowed to treat that one patient (or clean his room and nobody else's) for the duration of his illness, then remain in their homes for 21 days, correct? How do they get to and from the hospital and their homes? Are they quarantined in the hospital for the duration of the time they treat him? If they are allowed to go home, what are the transportation arrangements? Are those who live in their homes with them also subject to the quarantine?
I need to understand what we are proposing by mandating a quarantine for anyone with contact with an ebola patient before I can decide how I feel about it. To quarantine consistently seems like a major commitment, so I'm wondering if that's really what people are proposing.
Can someone explain what an ideal mandatory quarantine really looks like?
If you are OK with requiring the Maine nurse to stay home, what do you propose those treating the NYC doctor do?
Except that the article I read said they weren't really sure why our victims have overcome the illness as well as they have. There are a variety of factors they think are contributing, better quality of health of the patients, the age of the victims, being treated with the blood of survivors, or more interesting to me, that they were in contact with a lower viral load than those who were exposed in the nations currently affected. This seems interesting to me given that Dr Spencer is stable but still struggling while those who were exposed to the virus by one man in Texas are already headed home.
A doctor from Emory gave a press conference yesterday when the second nurse was released from the hospital. He said one hypothesis is that they treated the patients in a much more aggressive fashion than conventional wisdom dictates. That's poorly worded - lol. Basically, the assumption was that once the disease progressed to a certain point, certain treatments were futile. He inferred they gave the nurses dialysis, which wouldn't be as available in Africa.
Dialysis or apheresis? I ask because the later isn't used nearly as often outside the US, probably because for a lot of the things it is used for here they don't know why it works, just that sometimes it does (as it did for me). That is fascinating that they would use a similar technique to combat a virus.
ETA: I think the government should compensate them and arrange for as much of their conveniences as possible. If we want a quarantine, we need to pay for it.
We also need a law saying that companies cannot fire, terminate, or retaliate against those subject to the quarantine. Since they do not actually have a serious medical condition, it is my understanding that they would not be FMLA eligible (not like the FMLA even applies to enough workplaces anyway). So as it stands now, companies are currently free to fire anyone subject to a mandatory ebola quarantine.
Good luck getting any legislature to pass something like that.
Can someone explain what the ideal at home quarantine policy actually is?
If you support it, does this mean you support it for the doctors, nurses, and janitorial staff dealing with the NYC doctor (or anyone else in the US who has it)?
I would assume then that those people would only be allowed to treat that one patient (or clean his room and nobody else's) for the duration of his illness, then remain in their homes for 21 days, correct? How do they get to and from the hospital and their homes? Are they quarantined in the hospital for the duration of the time they treat him? If they are allowed to go home, what are the transportation arrangements? Are those who live in their homes with them also subject to the quarantine?
I need to understand what we are proposing by mandating a quarantine for anyone with contact with an ebola patient before I can decide how I feel about it. To quarantine consistently seems like a major commitment, so I'm wondering if that's really what people are proposing.
Can someone explain what an ideal mandatory quarantine really looks like?
If you are OK with requiring the Maine nurse to stay home, what do you propose those treating the NYC doctor do?
This only talks about people coming from West Africa.
Does the quarantine only apply to them? I mean either people who have contact with ebola victims are a risk or they aren't. So why are we quarantining only people who have contact with West African ebola victims and not those who have contact with ebola victims here?
omg. I'm not debating this anymore. But I think it's ridiculous to assume that healthcare workers with at least a working knowledge of transmission were more careless than uneducated family members dealing with a man vomiting uncontrollably at home.
Was it confirmed that he was vomiting uncontrollably at home before his second trip to the hospital?
As I recall, he vomited on the sidewalk multiple times while they were getting him to the car to take him to the hospital the second time. So I'm guessing this was happening at home too.
A doctor from Emory gave a press conference yesterday when the second nurse was released from the hospital. He said one hypothesis is that they treated the patients in a much more aggressive fashion than conventional wisdom dictates. That's poorly worded - lol. Basically, the assumption was that once the disease progressed to a certain point, certain treatments were futile. He inferred they gave the nurses dialysis, which wouldn't be as available in Africa.
Dialysis or apheresis? I ask because the later isn't used nearly as often outside the US, probably because for a lot of the things it is used for here they don't know why it works, just that sometimes it does (as it did for me). That is fascinating that they would use a similar technique to combat a virus.
He said kidney dialysis. I assume they used some of the blood donated from survivors.
I haven't seen any scientific evidence to support the idea that across-the-board quarantines serve a necessary public interest. The (updated) CDC guidelines are very clear on categories of risk, and they only recommend a quarantine for people who have had direct contact with infected fluids. I'm going to side with scientists who are knowledgeable about transmission rather than politicians.
Can someone explain what the ideal at home quarantine policy actually is?
If you support it, does this mean you support it for the doctors, nurses, and janitorial staff dealing with the NYC doctor (or anyone else in the US who has it)?
I would assume then that those people would only be allowed to treat that one patient (or clean his room and nobody else's) for the duration of his illness, then remain in their homes for 21 days, correct? How do they get to and from the hospital and their homes? Are they quarantined in the hospital for the duration of the time they treat him? If they are allowed to go home, what are the transportation arrangements? Are those who live in their homes with them also subject to the quarantine?
I need to understand what we are proposing by mandating a quarantine for anyone with contact with an ebola patient before I can decide how I feel about it. To quarantine consistently seems like a major commitment, so I'm wondering if that's really what people are proposing.
Can someone explain what an ideal mandatory quarantine really looks like?
If you are OK with requiring the Maine nurse to stay home, what do you propose those treating the NYC doctor do?
I do think that a physician treating a patient with Ebola should definitely NOT be treating a single other patient. And I'll go a step further and say there probably should be a micro-staff that is responsible solely for that one patient. Should that person reside in the hospital and then complete his or her own 21 day quarantine? Well, I guess so. I don't think the fact a quarantine is complicated is a terribly good reason to not employ one. Arguments that it's not effective or truly not necessary seem more persuasive. I personally, have just been listening to the back and forth on that for a few weeks now and I think I've finally come down on the side of pro-quarantine.
I'm still not on team quarantine yet. However, the only quarantine proposal I would even consider was one that treated everyone consistently across the board, and put full resources behind it to ensure no loss of pay, loss of job, or other work-related retaliation.
The current approach of just relying on voluntary donations to MSF to support these people during mandatory quarentine and doing nothing more is bullshit. First, it doesn't offset salaries of those unaffiliated with MSF. More importantly, however, if a quarantine is truly necessary for public health (and I'd also argue that containment in West Africa is also necessary for public health here and there), the public should be willing to put tax dollars behind it, so that MSF can spend its money on direct patient care. And the public should be willing to treat those in quarantine with dignity and all the job protections offered to military service people, which includes the most extensive job protection laws on the books.