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morningfog

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Member since: Thu Jan 12, 2012, 04:24 PM
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Maine Judge Eases Ebola Isolation Orders on Nurse Hickox

Nurse Kaci Hickox is free to leave her home in Northern Maine but must submit to active monitoring for Ebola symptoms by state health officials, a judge said, easing restrictions he placed on her yesterday.

Today’s order from Maine District Court Chief Judge Charles C. LaVerdiere removes prohibitions on her being in public places or within 3 feet (0.9 meters) of other people. The state hasn’t proved that further curbing Hickox’s movements is necessary to protect others from the dangers of infection, the judge said.

“The court is fully aware that people are acting out of fear and that this fear is not entirely rational,”
the judge said. “However, whether that fear is rational or not, it is present and it is real. Respondent’s actions at this point, as a health care professional, need to demonstrate her full understanding of human nature and the real fear that exists. She should guide herself accordingly.”

http://www.bloomberg.com/news/2014-10-31/nurse-hickox-ordered-to-follow-ebola-quarantine-rules-ap-says.html

As expected, she won this battle.

WTF? Maine seeking court order to keep Ebola nurse Kaci Hickox quarantined (Maine will lose)

The showdown between a nurse quarantined in Maine for treating Ebola patients and the state heated up Wednesday as officials said they were seeking a court order to prevent her from leaving her home.

“We will make it mandatory,” Mary Mayhew, Maine’s commissioner of health and human services, said at a news conference. Hours earlier the nurse, Kaci Hickox, vowed to defy the order keeping her at home while she is monitored for Ebola symptoms.

“There is no medical evidence that has been proposed or put forward by anyone that says Kaci is a risk,” Hickox’s attorney, Steven J. Hyman, told the Los Angeles Times.

“Kaci is a free individual, and how and when she acts is up to her,” Hyman said.

In an interview with NBC’s “Today” show, Hickox remained defiant.

“If the restrictions placed on me by the state of Maine are not lifted by Thursday morning, I will go to court to fight for my freedom,” she said.

Hickox spoke by Skype from Fort Kent, Maine, where she has been told to stay until the 21-day observation period ends next month. She says she remains symptom-free and therefore not a threat to anyone.

The 33-year-old nurse has become the face of a nationwide debate over treatment of healthcare workers returning from West Africa. The controversy erupted Friday when New York and New Jersey announced mandatory quarantines for such workers arriving in those states.

http://www.latimes.com/nation/nationnow/la-na-ebola-nurse-quarantine-20141029-story.html

Ebola appears to be slowing in Liberia: WHO

Liberia, the country worst-hit by the Ebola epidemic, may be seeing a decline in the spread of the virus, although the battle to contain the outbreak is far from won, the World Health Organization (WHO) said on Wednesday.

WHO Assistant Director General Bruce Aylward told a news conference the number of burials and new admissions had fallen and there was a plateau in laboratory-confirmed cases.

"All the data point in the same direction," he said. "Do we feel confident that the response is now getting an upper hand on the virus? Yes, we are seeing slowing rate of new cases, very definitely"

Aylward cautioned against overly optimistic conclusions but said: "We're seeing a reversal of that rapid rate of increase to the point that there seems to be a decline right now."

Liberian President Ellen Johnson told Reuters on Oct 8 that there were early signs the outbreak might be "in decline".

http://www.reuters.com/article/2014/10/29/us-health-ebola-who-idUSKBN0II1J220141029?mlt_click=Master+Sponsor+Logo%28Active=undefined%29_25_*Headlines+right_sec-col1-m2_News=undefined

I asked before-- number of current Ebola cases in each country?

I asked before and got some helpful links, but not quite what I was looking for, which may not exist.

How many current cases of Ebola, even an estimate, are there in each country?

I'm not trying to minimize the seriousness or the scale by any means, but seek a better understanding.

There have been around 10,000 cases this year, with about 5,000 deaths. Of the remaining 5,000, many survived. How many? How many people are sick and being treated (or not able to be treated)? Is it 1,000? Is it 250? Does anyone have a source with some indication?

US Ebola infection/incubation timeline 10.28.14 (Last day of incubation for Dallas health workers!)

Although the incubation period is up to 21 days, the incubation period of this strain is 7-10 days in most people who become infected.

Duncan-Dallas Line

Days since Duncan's death (Oct. 8)......20 days -- 76 people provided care to Duncan before his death. As of today, two nurses, Nina Pham and Amber Vinson, were infected, but recovered. No new infections have been reported. All of Duncan's contacts, pre-isolation and post-isolation will have survived the incubation period tomorrow!

Days since Pham was isolated (Oct. 10).....18 days -- One person was being observed as having direct contact with Pham after she recorded a fever. Pham is now Ebola-free. No new infections have been reported.
Pham's pre-isolation contacts will conclude the 21-day incubation period in 3 days.

Days since Vinson was isolated (Oct. 14)......14 days -- Vinson flew on a commercial flight (with some 100 other passengers) from Cleveland to Dallas with a temperature of 99.4 degrees. She was quarantined and transferred to Emory. Vinson is now Ebola-free. No new infections have been reported.

Days since Vinson reported Ebola-free (Oct. 23)......5 days.

Days since Pham confirmed Ebola-free (Oct. 24).....4 days.


Spencer-NYC Line

Days since Dr. Spencer was isolated (Oct. 23).....5 days. Dr. Spencer reported a slight fever, at 100.3, on the night of October 22 and was isolated on the morning of October 23.Dr. Spencer, like Pham and Vinson, was isolated quickly and before he had any symptoms other than a slight fever of 100.3. There is little to no chance that he infected anyone prior to isolation.

______________________________________________________

Tomorrow, October 29, the 74 health workers in the same class/timeline as Pham and Vinson who treated Duncan will have made it through the 21 day incubation period. It is clear now that Duncan infected only two people, Pham and Vinson, and they each survived.

Pham's one pre-isolation contact is on their 18th day. It is increasingly unlikely they were infected.

Vinson's pre-isolation contacts have made it through the most critical period at 14 days now. It is increasingly unlikely any of them were infected.

As of today, there is only one person with Ebola in the US, Dr. Spencer. There have been only 4 people to be diagnosed with Ebola in the US (Duncan, Pham, Vinson and Spencer). There has been only one Ebola death in the US, Duncan.

Quite simply, the fear, panic and paranoia associated with Duncan did not pan out. None of his housemates, family, or contacts were infected. None of the house (or parking lot!) cleaners were infected. Two nurses out of 76 were infected (and successfully treated early). No others were infected. None of the passengers on Vinson's plane have shown symptoms (and likely will not over the next 7 days).

I fully anticipate that the Dallas health providers will exit the incubation period with no infections tomorrow and that Pham and Vinson's pre-isolation contacts will do the same in the coming week. Considering they were isolated in the very early stages and then transported to very capable treatment facilities, I have no doubt that the Duncan-Dallas Ebola strain is no longer in the US.

New York child doesn't have Ebola, initial test shows

A child in New York City tested negative for Ebola on Monday, health officials announced.

The child, who had recently been in the Ebola-affected nation of Guinea, took ill Sunday night and was isolated at Bellevue Hospital in Manhattan, the officials said.

Additional Ebola tests will be conducted to make sure the child does not have the virus, and the child will stay in isolation until those results come back, the health department said in a statement.

The patient did not have a fever when first examined at the hospital but developed one at about 7 a.m., the department said.

Earlier on Monday, New York Mayor Bill de Blasio told reporters the child's mother was being quarantined at Bellevue and had "no symptoms whatsoever."

http://m.therecord.com/news-story/4947095-new-york-child-doesn-t-have-ebola-initial-test-shows/

FiveThirtyEight looks at Ebola's 21-day incubation, critiques study suggesting longer incubation

In Dallas this week, 43 people who came in contact with Thomas Eric Duncan after he contracted Ebola were released after 21 days of quarantine. In Madrid, people who were exposed to an infected nurse could be released from isolation soon if they get through 21 days without showing symptoms. The paramedics who brought Craig Spencer, the New Yorker diagnosed with Ebola this week, to the hospital will have their temperatures taken twice a day for 21 days.

Why 21 days? And is 21 days enough?

* * *

Haas ran that data through models created by other scientists to convert the raw counts of days into a probability curve. He showed that each data-model pair paints a slightly different picture of how long the virus can lie dormant in the body before making its carrier sick. The models broadly agree that the average case emerges in much less time than 21 days; the average time is somewhere between three and 13 days. That can translate into big disagreements about the tail end of the distribution: Anywhere from 0.1 percent to 12 percent of people got sick more than 21 days after exposure, by Haas’s calculations.

But did they really? Outliers could arise simply because sick people forgot when they were exposed. “I think there is some recall bias or respondent bias,” Gerardo Chowell, an associate professor at Arizona State University’s School of Human Evolution and Social Change, said in a Skype interview. “When you are in the field, people forget things. People don’t know exactly where they were when.” He pointed out that there are plenty of problems with data collected during an outbreak.2

Chowell’s studies of incubation times in earlier Ebola outbreaks in Congo and Uganda, cited in the Haas paper, show short incubation times, and he thinks the true maximum period may be less than 21 days. “That said, I think the policy of 21 days is good,” Chowell said. “I don’t think we need to change that or extend it.”

Haas doubts recall bias alone could explain cases with incubation periods longer than 21 days. He points out that some analyses didn’t use interviews at all, instead extrapolating incubation times from other data.

* * *

Chowell thinks a negative blood test before 21 days could be sufficient evidence to end isolation early. “I bet you, if you don’t find a virus in two weeks after exposure, you could release them quickly,” he said. “Then let them go with peace of mind.”

Chowell’s brother Diego, as it happens, is studying the potential benefit of testing asymptomatic carriers. Diego Chowell is a graduate student at ASU’s Center for Personalized Diagnostics. “The faster you can diagnose an individual infected with Ebola virus, the faster you can isolate the patient and then you can stop further transmission,” he said in an email.

Haas is open to the idea of early release with negative tests. He wants more evidence, though, before accepting that a negative test even at 21 days is enough. “There is more data that is needed on the efficacy of these tests — with aggressive and appropriate testing, it is entirely possible that 21 days is OK,” Haas said.

http://fivethirtyeight.com/features/is-21-days-long-enough-for-ebola-quarantine/?utm_content=bufferd395a&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

NYC boy being observed for possible Ebola symptoms

A 5-year-old boy is being observed in isolation at Bellevue Hospital in New York City for possible Ebola symptoms, according to media reports on Monday.

The boy, who arrived in the United States on Saturday from Guinea, had a 103 degree Fahrenheit (39 degrees Celsius) fever, ABC News reported. He has not been tested for the virus and is not under quarantine, ABC said, citing officials with New York City's health department.

The New York Post reported that the boy had been vomiting and was transported from his home in the Bronx by emergency medical workers.

http://www.reuters.com/article/2014/10/27/health-ebola-usa-newyork-idUSL1N0SM0N820141027

Governors Cuomo, Christie and Scott (and their defenders) are Ebola-truthers

No different than climate change deniers, anti-vaxxers and other anti-science idiots.

And they should be treated with the same ridicule. They are making the situation worse and their positions on quarantine are not supported by science. Their orders are likely unconstitutional and are inconsistent in many ways.

The mandatory quarantine does not apply to health workers who treat Ebola patients in the US. And the quarantine does not apply to non-health workers arriving from the three West African nations. The policy is both over-inclusive and under-inclusive.

Someone needs to get through to the Governors so that this ignorance does not spread. We need to quarantine the idiocy. An asymptomatic person is not infectious. It is simple as that.

US Ebola infection/incubation timeline 10.26.14(74 health workers EXIT incubation period in 3 days!)

Days since Duncan's death (Oct. 8)......18 days -- 76 people provided care to Duncan before his death. As of today, two nurses, Nina Pham and Amber Vinson, have shown symptoms and infection has been confirmed. No new infections have been reported.

Days since Pham was isolated (Oct. 10).....16 days -- One person is being observed as having direct contact with Pham after she showed symptoms. Pham is now Ebola-free. No new infections have been reported.

Days since Vinson was isolated (Oct. 14)......12 days -- Vinson flew on a commercial flight (with some 100 other passengers) from Cleveland to Dallas with a temperature of 99.4 degrees. She was quarantined and transferred to Emory. Vinson is now Ebola-free. No new infections have been reported.

Days since Vinson reported Ebola-free (Oct. 23)......3 days.

Days since Pham confirmed Ebola-free (Oct. 24).....2 days.

Days since Dr. Spencer was isolated (Oct. 23).....3 days. Dr. Spencer reported a slight fever, at 100.3, on the night of October 22 and was isolated on the morning of October 23.

______________________________________________________

Although the incubation period is up to 21 days, the incubation period of this strain is 7-10 days in most people who become infected.

Both Pham and Vinson were isolated when they had no symptoms other than a low-grade fever. Their viral load was low and it is unlikely they infected anyone prior to isolation. Dr. Spencer was isolated with a low-grade fever and is unlikely to have infected anyone pre-isolation.

The 74 other people in the same class/timeline as Pham and Vinson have passed through the most critical period, now at 18 days since exposure to Duncan. If more post-isolation workers had been infected, they would most likely have shown symptoms already. In 3 days the 74 health workers who treated Duncan will have made it through the 21 day incubation period. We are, essentially, 3 days away from confirming that Duncan infected no one other than the 2 nurses who fully recovered.

Pham's one pre-isolation contact is on their 16th day. They too are exiting the point were they would be most likely to show symptoms if infected. However, they do have 5 days before the 21 day incubation watch period expires.

Vinson's pre-isolation contacts have made it through the most critical period at 12 days now, with 9 to go to 21.

Pham and Vinson are each Ebola-free. We are nearing the point were we will be able to say that neither Pham nor Vinson infected anyone else, including all of Vinson's contacts.

Dr. Spencer, like Pham and Vinson, was isolated quickly and before he was very symptomatic. He had a fever of 100.3, similar to Vinson's. There is little to no chance that he infected anyone prior to isolation.

The good news is that the Duncan-Dallas line is nearing an end with only two infections and no subsequent fatalities.
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