<p>Quote]So what do you propose we do then, to plan for this “potential eventuality”? I’m curious.
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<p>I do need to think about it how to prioritize / order the steps of a pan. If people had an answer off the top of their heads, then there would be little need for the Johns Hopkins-type symposiums. </p>
<p>However, part of the answer will be to limit the mechanisms (social, medical, and cultural), which increase the chances of the “potential eventuality” and not beginning something only after it occurs.</p>
<p>I hope it’s okay to post this here - but I was just reading an article from USA Today, “Ebola raises worries over hospital infection controls.” It’s about the current state of hospital-acquired infections and the still-troubling incidence of serious, life-threatening bacterial infections in the hospital. I knew this stuff, but it was still amazing to me that abut **75000 people died of hospital-acquired infections in 2011 **. 75000!! That’s crazy! </p>
<p>I know there are some posters who don’t like this type of comparison (between Ebola and other deadly conditions), but here goes: 75000 deaths from hospital infections in 2011 versus 1 death from Ebola in 2014.</p>
<p>^^I’m glad if hospital infections are being scrutinized. I’ve always felt it is scandalous that you can go to the hospital for a relatively minor thing then catch a serious infection from being there. </p>
<p>Heart disease is the #1 cause of death - about 600,000 per year. Shall we stop talking about Ebola and make this a heart disease thread instead?</p>
<p>@busdriver11 (or anyone else recommending quarantines or travel bans)
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<p>Since the US is an effected country, would you support a 21 day quarantine on all Americans traveling abroad, and if so, how would you administer this quarantine?</p>
<p>I would whole heartily support talking about heart disease and obesity, despite the snarky cracks about not dying form bacon consumption. These are true health risks, and should get attention just like ebola. Why not make this thread about health risks in general? I’d be all for that.</p>
<p>As an aside, my mom died of complications of an infection she got while hospitalized. This is a true health problem as well.</p>
<p>OK, this popped up on a facebook page and appealed to my drole sense of humor: “More people have married Kim Kardashian than have died from Ebola (in the US)”. I shall duck now…</p>
<p>There are doctors who treat patients who disagree as well. See below.</p>
<p>It seems that Charles Hass (Drexel University), who was much ridiculed on the thread re his Ebola study, is going to have the last laugh. </p>
<p>Doctors have reviewed his work and are taking him seriously, and writing about it. Not surprising given the exhausting data and the corresponding peer review by top epidemiologists. Below is the first of what I expect to be a series of articles by doctors who take Hass seriously.</p>
<p>This article below, by Manoj Jain, MD MPH, gets to an issue I mentioned a while back and was also brought up by @collegealum314 - the issue of false comparisons of Ebola to other diseases (and other conditions) in terms of risk management and their infection profile curves. In this light, Dr. Jain explains well the concept of certainty in medicine and probability statistics required to develop an effective treatment plan and infection prevention plan. </p>
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<p>Notice how he correctly takes a distinction between two different conditions and the acceptable regimens based on certainty of cure accepted standards. </p>
<p>What is important is that the SAME distinction re percent certainty should be calculated for Ebola vis a vis other diseases. And it is this number which truly represents the risk issue surrounding Ebola, NOT the number of deaths. And this is why Ebola should not be compared to other viruses (and conditions) based on simply the number of deaths. </p>
<p>In fact, such comparisons serve no purpose scientifically. Maybe neat to think about, but useless in developing a public health solution to Ebola, in case it does spread more.</p>
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<p>Another way of saying the above is that it is erroneous to compare overall number of deaths of one disease with the overall number of deaths from another disease, if the infection profiles are different, i.e., the infection risk and mortality rates do not match up on an overlaid graph. (Note - these numbers do not have to be the same and could be millions of infections apart - what is being compared is the general shape of the graph and trajectory on the graph) </p>
<p>For example, of course, more people die from the flu each year, as compared to Ebola. That is like a duh statement. But, that is the number of deaths. However, the ratio of the number of people who actually die from the flu and the number of people who actually catch the flu each year is, by multiples, smaller number that the result one gets if those same parameters are calculated for Ebola. </p>
<p>In addition, the flu trajectory is very much controllable and can be actively changed in favor of patient survivability because there is a vaccine that is somewhere between 50 - 60% in helping fight of the disease. </p>
<p>However, there is no such available medically available trajectory control for Ebola, i.e., no vaccine. And this is why Hass’ study raised eyebrows. He showed that the trajectory profile of Ebola can be more deadly between Day 0 to 21, as compared to Day 30 to 40. And thus he illustrates that the infection trajectory can be controlled “prophylactic-ly” via quarantine measures, i.e., reduces the probability of infection.</p>
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<p>As usual, posters will choose what they want to believe, not necessarily based on data like presented above, but on dogma, as Dr. Osterholm has said. </p>
<p>However, there are people: who are not drones to current practitioner protocols, which may be outdated; who are not slaves to limited historical data, which when really examined show too many inconsistencies, as to be useful to make concrete statements; and who are willing to to ask the serious “what if” questions in an effort to getting ahead of the curve. </p>
<p>And currently, the problem is the CDC and other agencies are clearly in reactive mode AND defense never wins a war, and darn sure we (Africa and the world) are in one. </p>
<p>jym - sorry about your mother. That’s awful.</p>
<p>What surprised me about that newspaper article was the fact that some hospitals are STILL so lax about infection control! Doctors and nurses still not washing their hands correctly, people reusing medical equipment that has not been properly cleaned and/or sterilized, and technicians tracking blood through an operating room - eesh!</p>
<p>So part of me wonders: if some health professionals/hospitals are still so cavalier about “regular” infection controls in the hospital setting, then what does that suggest about the more rigorous controls necessary for curtailing an Ebola outbreak? (see…I did get back to Ebola after all…)</p>
<p>I’m not criticizing all medical professionals, of course - just the ones who don’t seem to abide by the rules. I think it was frugaldoctor who said he had to fire a colleague who reused syringes. Yikes.</p>
<p>Thanks for the additional definition of “airborne.” What threw me initially was the definition’s inclusion of the term “droplet nuclei,” of which I am unfamiliar (although I believe I know what a nucleus is), and I assumed it was simply a more precise term for “droplet,” and not a dried-out (evaporated) remnant of the droplet, which is what I now think it means. It makes sense that dry particles are more likely to be airborne than wet ones. </p>
<p>Having said that, CIDRAP apparently still recommends respiratory gear when dealing with Ebola patients.</p>
<p>The unit I used to work on was in a circle. Patient rooms were glass enclosed (blinds could be closed for sleep and privacy). There was one physician who we would observe as he went in and out of various rooms. It was not uncommon for him to walk out of one room and straight into another without using the sink or the foam dispensers outside of each room. We literally used to have one nurse assigned to watch him and point to the foam cleansers as he would attempt to enter the next room. He was a brilliant doctor but a crappy infection control minded person. It was frustrating.</p>
<p>Thanks, scout. Yes, basic infection control is hugely important in all hospitals.</p>
<p>And bay, glad that link was more helpful. And sure, caution is always good, and if many caregivers are around a patient who is perhaps spewing bodily fluids, stuff can happen. Sorry to be blunt.</p>
<p>As an analogy, if I were to toss a ball to you, that ball is temporarily “airborne” as a result of the momentum/velocity of my having thrown it to you. But that is different than perhaps a small down feather, or dust, that may remain in the air for a longer time and be carried further distances as a result of air current, etc. Hope that helps. </p>
<p>Right, but presumably face shields would be as effective if splashing was the only concern. Inhalation must also be a concern. But a caregiver could inhale a wet droplet if at close range, I suppose.</p>
<p>In the link pages and pages and pages ago when I first posted the definition of droplet transmission vs. airborne transmission, I noted that my source emphasized that for a level 4 isolation virus (ebola) in the health care setting, the distinction is really meaningless. The HCW needs the full protection because he is so up close and personal that he could be the recipient of every type of contamination.</p>
<p>I don’t understand why the original CDC precautions didn’t make that assumption. </p>