Do you trust health care providers who have worked with ebola to self monitor?

[uppityperson]

Coming home from an overwhelming situation in W African countries caring for, containing and tracing contacts of ebola patients, knowing full well what can happen if they get sick with ebola, having been dealing with life and death decisions there, do you trust them to take their own temperatures and get help if they become symptomatic?

Or do you believe these doctors and nurses who so many have trusted with their lives are incapable or unwilling to safeguard their own health and not take their temperatures or seek help if they develop symptoms?

14 votes, 1 pass | Time left: Unlimited
	I trust health care providers returning from W Africa to take their own temperatures and report if symptomatic
	10 (71%)
	I do not trust health care providers returning from W Africa to take their own temperatures and report if symptomatic
	4 (29%)
	1 DU member did not wish to select any of the options provided.
Show usernames Disclaimer: This is an Internet poll

[BlueJazz]

1. I vote no because the other choice could kill one person, ten..hundred...thousands.

I'm firm as a black hole regarding this subject.

[uppityperson]

3. You don't trust people who have seen 1st hand what ebola is to not take their own temperatures.

They can be trusted to take care of others, to do surgery, to place iv's, to give medicines, to take vital signs of others but not themselves.

wow.

[BlueJazz]

17. Of course I trust them. I would even have them over for dinner. Do I trust any human beings..

...to always be aware of what is happening to them ? No. ..not when it come to my fellow/sister country-persons.
Maybe one would have personal problems that I know nothing about.

In short: I trust them. I don't trust them for everybody else.
And besides..the 21 day isolation is not all THAT bad.
I'd be glad to do it.

Your mileage my vary and I'm OK with that.

[TwilightGardener]

2. No. I don't trust health workers not to infect patients with hospital-acquired infections,

because that happens all the time, even though there are policies in place for infection control...so I don't really trust them to "self-monitor" while continuing to go about their business among the rest of us. Speaking as a former health worker. It's really not that hard to camp out at home for a few weeks, is it? Do you NEED to go bowling or go to a restaurant or a school play?

[uppityperson]

4. You conflate issues rather than answer the simple question, can you trust a doctor to take own temp

[TwilightGardener]

7. If you're asking me if I trust doctors, the answer is, not really.

They're not saints or gods, they are human, some are horrific assholes, some are incompetent.

[uppityperson]

8. No, I am not asking if you "trust doctors". Do you trust health care providers who have worked

Do you trust health care providers who have worked with ebola to self monitor? Do you trust them to take their own temperatures?

[TwilightGardener]

9. Not really, no.

[uppityperson]

10. They are trusted to monitor, care for, acutely ill patients, yet you don't trust them to take their

own temperatures. They have seen first hand what ebola is about, and you don't trust them to monitor themselves.

Thank you for being so clear.

[TwilightGardener]

11. You are certainly welcome.

[polichick]

5. I trust them to take temp, but not to stay away from crowded places...

Like everyone else, doctors think it won't happen to them. And, like everyone else, they want to go where they want to go.

I don't think we know enough about Ebola to have high-risk people in crowded places during the incubation period.

[Crunchy Frog]

18. This. n/t

[Louisiana1976]

19. Excellent point. So far a couple who've come down with Ebola have been in crowded places.

[uppityperson]

25. You don't know enough about ebola for non-contagious people to be around others?

Incubation period signifies the period taken by the multiplying organism to reach a threshold necessary to produce symptoms in the host.

Before there are symptoms, they are not contagious. You can not catch ebola before they are contagious.

"Like everyone else, doctors think it won't happen to them"? Is that why Dr Spencer called for help BEFORE his symptoms reached the stage he needed to?

[scarystuffyo]

28. .

Ebola Incubation Period


The Ebola incubation period is the period between infection with the virus and the appearance of symptoms associated with the disease. The incubation period can be as short as 2 days or as long as 21 days. A person is still contagious during this time.



What Is the Incubation Period for Ebola?

When a person becomes infected with the Ebola virus, it enters the body and begins to multiply. The virus can travel in the blood to almost any part of the body, including the:


•Liver
•Spleen
•Pancreas
•Thyroid gland
•Lungs
•Kidneys
•Skin
•Brain.



After four to six days on average, symptoms of Ebola can begin. The period between the transmission of the virus and the start of symptoms is called the incubation period. For Ebola, the incubation period can be as short as 2 days or as long as 21 days.




Is a Person Contagious During the Ebola Incubation Period?

Even if a person exhibits no signs or symptoms of Ebola, he or she can still spread the virus during the incubation period. Once symptoms begin, the person can remain contagious for about three more weeks

[kestrel91316]

33. Yes, we see that you can cut and paste. But those of us with medical educations can

COMPREHEND what we read and interpret it in light of circumstances.

And we have a clue about the epidemiological DATA regarding ebola transmission. The CDC guidelines are extremely conservative and we don't need random rules that are even harsher without data to back them up.

You show ONE person who has gotten ebola mysteriously with no contact with a person sick with it or their still-infectious fluid or an animal host - or stop with the nonsensical fearmongering.

[scarystuffyo]

37. Do you disagree with it?

I didn't think so............

[kestrel91316]

41. I see that you failed to address my point.

Put up the data that proves your nonsensical, fearmongering nonsense - or shut up.

[scarystuffyo]

45. I'm right in what I posted but you seem mad about it

I guess sometimes it just happens like that...

[uppityperson]

48. You mean that false, inaccurate information you are trying to claim is real?

[uppityperson]

46. I disagree with that.

Last edited Sat Oct 25, 2014, 08:50 PM - Edit history (1)

"A person is still contagious during this time. "
False. They are contagious after they have symptoms.
http://www.cdc.gov/vhf/ebola/transmission/qas.html

Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease.

"Once symptoms begin, the person can remain contagious for about three more weeks"
False
http://well.blogs.nytimes.com/2014/10/24/ask-well-can-ebola-be-transmitted-in-semen/?_php=true&_type=blogs&_r=0

Ebola virus has been found in the semen of male survivors for up to 101 days after the onset of symptoms, according to the Centers for Disease Control and Prevention.

http://www.cdc.gov/vhf/ebola/transmission/qas.html

If someone survives Ebola, can he or she still spread the virus?
Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months

[scarystuffyo]

56. .Risk of transmission of Ebola virus via donated blood and other substances ,This is by the ECDC

Last edited Sun Oct 26, 2014, 01:16 AM - Edit history (1)

Background The epidemic of Ebola virus disease (EVD) in West Africa in 2014 has increased the risk of Ebola virus transmission via donated blood and blood components, cells, tissues and organs (substances of human origin - SoHO). There are no specific EU regulations or recommendations for the safety of SoHO donated by patients who have recovered from EVD; people exposed to Ebola virus; or people who have visited or reside in EVD-affected areas. Ebola virus transmissions through donated blood, tissues or organs have not been described. Asymptomatic replicative infections with Ebola virus have been described [1,2]. Travellers from Ebola-affected countries* are deferred for donation because malaria-risk countries overlap with the current Ebola-risk countries in Africa [3]. However, there is a need for specific guidelines to maintain the safety of SoHO donation by people who have been exposed to Ebola virus. There is a possibility that the current outbreaks in West Africa and the Democratic Republic of Congo will spread to areas where there is no malaria risk. Risk assessment The risk of Ebola virus transmission through SoHO is related to the presence of Ebola virus in the donor’s blood, tissues and organs. The presence and concentration of virus in organs, tissues, blood and other bodily fluids changes during the course of the infection. The virus concentration peaks when the patient is most sick, and viruses can be detected and isolated from breast milk and semen weeks after recovery [4]. There are limited data available on when patients become viraemic and infectious during the incubation period. The assumption is that the rate of virus replication and excretion into bodily fluids is not high enough in the pre-symptomatic phase to result in person-to-person transmission through day-to-day contacts in the community. However, there are no data on when viraemia starts during the incubation period. During the symptomatic phase of EVD, the virus is present in high concentrations in all bodily fluids, tissues and organs [5]. When the disease is fatal, the dead body remains highly contagious. After recovery from the acute phase, a patient may continue to excrete live and infective viruses for long periods [4]




It talks about donated Blood but there is no 100% assertion that a person during incubation is not contagious .
His blood very well could be so to say that it's impossible to spread it during just the incubation period is wrong











http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=12&ved=0CCEQFjABOAo&url=http%3A%2F%2Fwww.ecdc.europa.eu%2Fen%2Fpublications%2FPublications%2Febola-risk-transmission-via-donated-blood-substances-human-origin-october-2014.pdf&ei=hW5MVPuFL9KAygSa6YKoDQ&usg=AFQjCNErj_zkgyjcrXHyKbMRuqLops-hhg&sig2=ZYWOSKMndJRADfpmQDUfAw

[uppityperson]

58. Still no link. Fail. nt

[scarystuffyo]

59. I don't know how to link pdf files

[uppityperson]

60. Right click, copy link address, then right click, paste.

[scarystuffyo]

61. I know how to copy a link but this is a pdf file

There's no link at the top when I open it

It's dated 6 October 2014 from the ECDC

Can't you find it by the information I posted?

[scarystuffyo]

63. let me see if this works

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=12&ved=0CCEQFjABOAo&url=http%3A%2F%2Fwww.ecdc.europa.eu%2Fen%2Fpublications%2FPublications%2Febola-risk-transmission-via-donated-blood-substances-human-origin-october-2014.pdf&ei=hW5MVPuFL9KAygSa6YKoDQ&usg=AFQjCNErj_zkgyjcrXHyKbMRuqLops-hhg&sig2=ZYWOSKMndJRADfpmQDUfAw

[uppityperson]

65. That got it. It is about donated blood, cells, organs, not what you posted upthread reply

"His blood very well could be so to say that it's impossible to spread it during just the incubation period is wrong "

Are you seriously saying because someone with ebola should not donate blood and blood components, cells, tissues and organs, that they are contagious walking around, shopping, using mass transit, bowling? Good grief.

What you posted at this link, start of the subthread, is not there, no link to that post which contains many inaccuracies. Maybe by tomorrow you can find the link to that.
http://www.democraticunderground.com/10025714752#post28

[scarystuffyo]

66. Right I know it's about donated blood but

It also talks about the incubation period before you show any symptoms

They don't really know 100% when exactly the person becomes contagious

[uppityperson]

68. CDC and all the experts say when you show symptoms. Still waiting on your link to

This post still does not have a link and what is there is not from the "donating blood and organs" pdf. http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5715202

Here is from cdc, with link.
http://www.cdc.gov/vhf/ebola/transmission/qas.html
Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease.


Yes, they need to add in "don't donate blood or organs because that is risky" but seriously. When is the last time someone ran up to you on the street and donated an organ?

We DO know that MrDuncan's family lived with him while he showed symptoms, was sweaty, had diarrhea and vomitting, and were forced to remain in that contaminated apartment for several days and NONE of them got sick. Yes, 1 anecdote but worrying someone will come donate blood to you or organs?

[scarystuffyo]

67. We are being told by our CDC that it's impossible for a person to be contagious during the

incubation period before showing symptoms .

That's false because know one knows when it becomes contagious

They admit that in the study

[uppityperson]

40. Unsourced, no link, and false information. Fail.

[kestrel91316]

42. Plagiarized from one of several woo/CT/RWNJ websites.

Curious, that.

[pnwmom]

6. I trust them to take their temps and report AND I think the 21 day quarantine is reasonable.

If Dr. Spencer had quarantined himself, the city of NY could have avoided the contract-tracing after he was diagnosed, as well as quarantining three other people.

[uppityperson]

12. I understand my poll was limited, thank you for trusting them to take their own temps.

[pnwmom]

14. I agree with you that they have every reason to want to get diagnosed as soon as possible.

And I applaud him for asking for help when he did, despite not hitting the magic 101.5 number.

[kestrel91316]

35. Amazing how you have such strong opinions about imprisoning the harmless yet you don't even know

that the threshhold is 100.4F and not 101.5F.

[pnwmom]

39. I'm glad the CDC finally decided to lower their criterion for fever, assuming your info is correct.

But maybe you ought to tell the CDC to fix their website because it still says 101.5.



http://www.cdc.gov/vhf/ebola/hcp/case-definition.html

Person Under Investigation (PUI)
A person who has both consistent symptoms and risk factors as follows:

Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND

epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

[kestrel91316]

43. I believe the 100.4F applies to airport entry policy. Again, you'e been asleep for several days it

seems, since even a casual reading of news articles references the 100.4F again and again and again.

[pnwmom]

50. Then the CDC must be asleep, since they haven't updated their own criteria. n/t

[Erich Bloodaxe BSN]

15. Ditto.

If we're going to claim we're doing things out of an abundance of caution, then let's actually have an abundance of caution from the start, not just AFTER people start having signs and symptoms.

[seabeyond]

13. it certainly behooves them. between living and dying. pretty good incentive. nt

[Yo_Mama]

16. This is an overly simplistic poll that does not cover the real range of issues

I DO, in fact, trust returning HCW to check their temps and report if they appear to be developing significant illness.

I ALSO believe that a three week quarantine is necessary to ensure public safety. There are bunch of very small risks which are not covered with self-monitoring which are covered with a supervised quarantine. Here's a list of some:

1) Pre-acute phase spread to close contacts (highly unlikely, but apparently suggested by case histories from Africa, such as the little girl who just died in Mali).
2) Sudden acute illness NOT arising from Ebola (you can certainly be co-infected or have other conditions which may trigger collapse) causing public exposure.
3) Accidental injury in public.

Epidemiology is a numbers game. The reason why the contact tracing is being done in Africa is to catch the small risks which are adding up to continued contagion.

I think supervised quarantine away from families should be offered to all HCW caring for Ebola patients in the US and should be mandatory for all travelers with significant risks leaving the Ebola zones.

CDC has a summary of the Firestone methodology and its results up on its website:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6342a6.htm?s_cid=mm6342a6_w

The methods used successfully prevented Firestone's clinics from becoming sources of infection, although there are continued cases there, mostly stemming from outside the Firestone district. One of the issues in Firestone's experience were cases not recognized to be Ebola that needed treatment.

A little bit of overkill is the way to go given the history of this Ebola epidemic in Africa.

[uppityperson]

26. Yes, the poll was meant to ask 1 question. I am glad you trust people you trust with life and death

situations to take their own temperatures and monitor themselves.

Everyone caring for someone with ebola in the USA should be "offered" quarantine? Every day that might include 3 nurses doing direct care, 3 people supervising donning/doffing gear, lab workers, radiology staff, phamacists, iv tech, extra nurses needed for extra help, supervising doctor, anyone involved with any care including of course housekeeping?

[Yo_Mama]

32. I believe the special units set up to do this are capable of safely doing it

I'm not so sure about even Bellevue, although it will be light years ahead of Texas Presbyterian.

If we want HCW to do this, we need to concern ourselves with the concerns of the HCWs performing the care.

[oberliner]

20. Seems like a bit of a push poll

Especially in light of the paragraphs you included before the poll itself.

[uppityperson]

27. "a bit"?

a lot, indeed.

[morningfog]

21. Trust isn't necessary. Self monitoring works.

Despite what the handful of fearful idiots say.

[valerief]

22. More than I trust some open carry asshole in a supermarket. nt

[greatlaurel]

54. Great point. Those open carry nuts care not to be trusted.nt

[Laurian]

23. I trust the health care workers, but I don't trust the media

not to overhype every reference to Ebola as an apocalypse. The media's behavior has driven fear and panic to an unreasonable level.

[greatlaurel]

53. Good post.

[mythology]

24. Not by themselves

First medical people tend to be awful patients. They tend to ignore what they don't want to hear because they know best.

Secondly, as repeated evidence shows having a medical checklist drastically improves health outcomes and reduces medical error. But nobody wants to admit they are perfect. As a study at John Hopkins showed, doctors failed 33% of the time to follow the checklist for putting a line in a patient. Nobody is perfect. Expecting medical staff to treat themselves perfectly is silly. It's why when I had my first knee surgery to remove a growth that was visible through the skin, the doctor still wrote on my leg with me awake to sign off before surgery.

Third, if a doctor or other medical staff shouldn't treat family or friends, they also shouldn't treat themselves for the same reasons.

Fourth, while the risk of transmission is very low, the public has unfortunately not gotten that memo and so additional precautions need to be taken. We have people who in theory should be serious educated individuals (okay, admittedly working with Ted Cruz doesn't exactly scream serious or educated) "jokingly" linking ebola and the ACA. Somebody has to be calm, reassure the public and if that means taking some precautions that aren't strictly speaking necessary, then that is what it takes.

[uppityperson]

30. Even though all 3 nurses and doctor self monitored and got help when symptoms began, it didn't work?

Mr Spencer called for help BEFORE his temp reached CDC recommended level. He knew how bad ebola was and sought help as soon as he thought he might have it. "They tend to ignore what they don't want to hear because they know best. " is downright wrong for him.

Amber Vinson called the CDC and THEY told her it was ok. SHE was worried and sought help. You can not blame her for the CDC saying "ok, no worries". "They tend to ignore what they don't want to hear because they know best. " is wrong for her also.


" doctors failed 33% of the time to follow the checklist for putting a line in a patient" perhaps. But you are seriously comparing putting a "line in a patient" with taking their own temperature? Seriously?

"Fourth, while the risk of transmission is very low, the public has unfortunately not gotten that memo and so additional precautions need to be taken. " False. More education is needed, not more precautions.

"Somebody has to be calm, reassure the public and if that means taking some precautions that aren't strictly speaking necessary, then that is what it takes." Again, wrong. Taking away people's civil right to reassure others is downright wrong. More EDUCATION is need and less fear mongering. That sounds like the 80's calls to fear gay men, to not employ them, to make them hide, not to keep people safe from HIV but to make people THINK they were safe.

Like the teacher who went to a conference in Dallas and was unable to teach for 3 weeks because of the ebola hysteria in his community. Like the principal who went to South Africa and was forced to take 3 weeks off because of ebola hysteria in his community. Like the 2 boys from Rwanda, forced to stay out of school for 3 weeks due to ebola hysteria in their community.

Window dressing to make people "feel safe" doesn't work. Educating them does.

[Chemisse]

29. It is in their best interests to seek treatment the INSTANT they have symptoms.

I have full confidence that is exactly what they will do under self-monitoring.

The forced isolation being imposed now is done for political, not scientific reasons.

The media has the public in a panic over the chance someone could have caught Ebola from the doctor in the brief time he was symptomatic before being admitted. As we saw with Duncan, those close to him didn't get sick even though he was home ill for at least 3 days after symptoms began. It simply is not easily transmitted in those early days.

[uppityperson]

36. Exactly my thoughts also. Thank you.

[Avalux]

31. Yes. Those working in hot spots have seen the horror of it, and are extremely dedicated.

I trust that they know what to do. If I put myself in their shoes, I would seek medical attention at the slightest twinge or temp; for my own good and of those around me. We all need to remember how Ebola is transmitted.

I have no problem with self-monitoring.

[dilby]

34. If it was 1983 would you even ask if you trusted health care providers who have worked

with AIDS patients to self monitor?

[uppityperson]

38. Since I was one of those health care workers dealing with HIV+ people then, only if needle stuck

or if had sex with an HIV+ person. Otherwise, no. I had recently been to a conference talking about how it spread and was involved with calming the AIDS hysteria among others who looked at me when I told them I worked with HIV+ people. Needle stick, yes, self monitor, duh. Otherwise, no, not exposed, why bother.

[Autumn]

44. My Daughter was a phlebotomist at one of the leading hospitals here.

Four times she walked into rooms that were supposed to be quarantined. Because of mersa three times and once with TB. There were no quarantine sign because the nurses had forgotten or hadn't got around to it. I understand that they get busy but no I don't trust them to self monitor.

[REP]

47. I was a patient in a quarantine room

Mostly because of my numerous conditions were too much for Plastics to handle (I had a life-threatening hand infection) and for my protection, since my immune system sucks. I lost count how many times the nurses broke protocol - not just quarantine protocol, but correctly dispensing my meds or tending to my wound (I ended up cleaning, soaking and dressing it myself, which was fine because they rarely gloved or used hand sanitizer). They were all lovely and super nice, and I know I wasn't their only patient, but I was on an isolation ward.

Some nurses are just amazing. Some of those amazing nurses care for me as part of my doctors' team and some in the ER - they're everywhere. There's also a lot of very nice nurses who are fantastic people who care a lot - but aren't that great at being a nurse. Unfortunately with deadly diseases, sometimes control at the level of the lowest common denominator is implemented because individualized assessment of each person's ability, perception and truthfulness isn't possible.

[KMOD]

52. My mom succumbed to AML years ago

Well, she actually didn't succumb to AML, she succumbed to an infection due to the process of treatment for the AML. Her doctor, anxious to prove she was in remission before his vacation, ordered a spinal tap. The doctor did prove correct btw, but unfortunately, the site of the spinal tap became infected. With no healthy blood cells to fight off infection, due to the chemotherapy, she was overcome with clostridium. Numerous mistakes were made, even with me practically standing guard in her room. Hospitals are busy places, and many nurses are overwhelmed. I never blamed any of them. They did the best they could with a disease that at the time had a very high fatality rate.

And I absolutely trust these nurses, doctors, and anyone who is informed of Ebola to self-monitor. It's not a very difficult thing to do.

[davidpdx]

62. I've been in a quarantine room as well

Back in 2011 I got sick prior to leaving South Korea (where I live) and when I got to the US my condition got worse. I went to an urgent care clinic and was seen by a doctor and given a shot and some medication. After a few days things continued to get worse and I went into another urgent care clinic (I had traveled to another place by then) and they said they would not treat me and I needed to go to the emergency room immediately. When I was admitted they suspected pneumonia, but since I had come from outside the country they had to put my in a quarantine room while they continued running tests to eliminate several other possibilities. To add injury to insult, I had broken my ankle before the trip. So here I was on vacation in the hospital with pneumonia and a broken ankle. Best vacation ever...NOT!

[uppityperson]

55. Self monitoring is taking their temp and watching for symptoms, then calling if something shows up

You don't trust doctors and nurses who were working with ebola patients to do that? I know that there are errors made, especially in overworked hospitals, but I am talking about monitoring themselves at home or wherever they are.

[newfie11]

49. As a health care provider for 43 years I can't imagine anyone violating this.nt

[Stardust]

51. I trust health care providers but not the general public, I'm sorry to say. nt

[Warren DeMontague]

57. I do in general, however, doctors and health care workers are people, and not perfect.

http://www.who.int/mediacentre/news/ebola/3-september-2014/en/

The case history of the index case in Port Harcourt is important, as it reveals multiple high-risk opportunities for transmission of the virus to others.

After onset of symptoms, on 11 August, and until 13 August, the physician continued to treat patients at his private clinic, and operated on at least two. On 13 August, his symptoms worsened; he stayed at home and was hospitalized on 16 August.

Prior to hospitalization, the physician had numerous contacts with the community, as relatives and friends visited his home to celebrate the birth of a baby.

Once hospitalized, he again had numerous contacts with the community, as members of his church visited to perform a healing ritual said to involve the laying on of hands. During his 6 day period of hospitalization, he was attended by the majority of the hospital’s health care staff.

[davidpdx]

64. Good point Warren