Maine Court Rejects State Request To Quarantine, Restrict Movements, Of Ebola Nurse Kaci Hickcox
A Maine Judge has largely rejected the efforts of the State of Maine to restrict the movements of Kaci Hickcox
After initially issuing an order that placed some significant restrictions on her movements at the request of state authorities, Maine District Court Judge, the equivalent of a trial level Judge in that state, has signed off on an Order regarding the case Kaci Hickcox, the Doctors Without Borders nurse who was initially detained in New Jersey upon arrival at Newark Liberty Airport from west Africa before being allowed to go home to Maine, that essentially just requires her to continue at home monitoring and immediately report any symptoms:
FORT KENT, Me. — Less than a day after restricting the movements of a nurse who treated Ebola victims in West Africa, a judge in Maine has lifted the measures, rejecting arguments by the State of Maine that a quarantine necessary to protect the public.
Within an hour of the decision, state troopers who had been parked outside the nurse’s house for days had left.
The order, signed on Friday by Judge Charles C. LaVerdiere, the chief judge for the Maine District Courts who serves in Kennebec andSomerset counties, said the nurse, Kaci Hickox, “currently does not show symptoms of Ebola and is therefore not infectious.”
The order requires Ms. Hickox to submit to daily monitoring for symptoms, to coordinate her travel with state health officials, and to notify them immediately if symptoms appear. Ms. Hickox has agreed to follow the requirements.
Ms. Hickox’s lawyers said the decision is likely to end a standoff between the nurse, who has resisted being quarantined on the grounds that she is not symptomatic for Ebola, and the state authorities, who say that a quarantine is needed to ensure the public’s safety.
The lawyers said there may be a further hearing on the issue on Tuesday, but said they do not expect it to change how things stand.
Maine had pushed for Ms. Hickox to abide by what it considers an “in home” quarantine, based on guidelines issued by the Centers for Disease Control and Prevention. Under those guidelines, anyone who has had direct exposure to Ebola should, during the 21-day incubation period of the virus, be monitored daily by health officials, coordinate travel with the authorities, stay away from public places and gatherings, not go to work, and maintain a three-foot distance from others.
On Thursday, Judge LaVerdiere issued a one-day order imposing restrictions on Ms. Hickox while he weighed the arguments. But in his order Friday morning, the judge rejectedquarantine and commended Ms. Hickox, saying, “We would not be here today unless Respondent generously, kindly and with compassion lent her skills to aid, comfort and care for individuals stricken with a terrible disease. We need to remember as we go through this matter that we owe her and all professionals who give of themselves in this way a debt of gratitude.”
He then cautioned her not to allow her newfound freedom to spread alarm in the community.
The court is fully aware of the misconceptions, misinformation, bad science and bad information being spread from shore to shore in our country with respect to Ebola,” the judge said. “The Court is fully aware that people are acting out of fear and that this fear is not entirely rational. However, whether that fear is rational or not, it is present and it is real. She should guide herself accordingly.”
Ms. Hickox’s lawyers said the decision was a victory for their client and for health workers everywhere.
The original order, which had been entered as a Temporary Order in response to an emergency petition had required Hickcox to submit to the following:
- Submit to Direct Active Monitoring, which means that she must agree to allow public health workers, presumably from the State of Maine, to come to her home on a scheduled, regular basis to measure her temperature and check for other possible symptoms;
- Coordinate travel with health authorities to ensure the continuity of the monitoring;
- No utilization of commercial travel or use local public mass transit;
- To avoid public areas where people congregate such as shopping malls, theaters, or other public gatherings;
- No presence in workplaces;
- To stay at least three feet away from others when engaging in “non-congregate” activities in public (i.e., walking, jogging, bike riding);
- To not leave the municipality of Fort Kent without direct consultation with public health authorities
The new Order, which Hickcox appears to be accepting only requires the following:
- Submit to Direct Active Monitoring as defined above;
- Coordinate travel with health authorities to ensure the continuity of the monitoring; and,
- Immediately report to health authorities any change in symptoms and comply with their directions if such symptoms appear
The Order is effective today and has no specific time limit; however, pursuant to Maine law the Judge has ordered that a hearing must be held no less than three and no more than ten days from today, which means that a hearing must be held roughly between November 3rd and November 10th. Technically, the matter would be sealed under Maine law since it involves a public health matter, but the fact that the Order has been made public and that Hickcox and her attorneys have spoken quite openly publicly about this issue, I would imagine that we’d know quite quickly after a hearing what the status of the case is after such a hearing. Of course, it’s worth noting that Hickcox’s twenty-one day incubation period would end no later than November 14th assuming that you calculate it from last Friday when she actually arrived in the United States. If the date is calculated from the last time she had contact with an Ebola patient, then it would be two or three days earlier depending on when that happened since one assumes that, at the least, she had left west Africa at least one day prior to arriving in the United States last Friday. One assumes that an end date for the Order would be something that will be touched upon in a subsequent hearing, or it could be something that the parties consent to on their own that will end up being contained in a Consent Order issued in lieu of any further hearing. In either case, if Hickcox does not show any symptoms by November 14th at the latest, then it would appear that the Order would not longer be necessary and the restrictions, such as they are, would be lifted.
It’s hard not to agree with the characterization of this subsequent Order as a victory by Hickcox’s attorneys if only because of the fact that it released all of the restrictions that the initial Order had placed on Hickcox’s movements and interactions with others during the period that the Order is in effect. In fact, even the initial Order fell far short of the in-home quarantine that Maine Governor Paul LePage had said the state would be requesting, although that was due in no small part to the fact that the petition that the state filed yesterday only asked the Judge to impose the recommendations of the Centers For Disease Control for people in Hickcox’s position, which do not include any kind of mandatory quarantine. Now, though, there are essentially no restrictions on what Hickcox can do for the next two weeks outside of her obligations to submit to monitoring, consult about travel, and report any symptoms and follow directions if they appear. Each of these seem to me to be reasonable requirements under the circumstances.
Perhaps most significantly, the Order that was entered today, which I’ve embedded below, goes through a series of actual statements regarding the incubation period for Ebola, when it becomes contagious, and the odds that a person might be infected if they haven’t developed symptoms by a given period of time. Presumably, this information is based on information received by the Court from both the State of Maine and Hickcox’s attorneys and based on affidavits or testimony from medical experts. One of the things that is apparent there is that the further we get into the incubation period, the less likely it is believed to be that a person potentially exposed to the virus is actually infected with it. Presently, we seem to be in the middle of the period when the odds are still somewhat high that Hickcox could be infected but that we’re fast approaching the point where it will become increasingly less likely. This is consistent with the experience we have from Dallas, where both Nina Pham and Amber Ray Vinson began showing symptoms within a week after Timothy Eric Duncan a died, which would have been the point at which he would have been secreting the most bodily fluids and most contagious. We don’t know when Hickcox was last exposed to someone with Ebola, but the fact that she apparently hasn’t developed symptoms by now is a positive indication that she does not have the virus inside of her the longer this goes on, the more positive it will arguably become. Hopefully, of course, Ms. Hickcox will never develop symptoms and this entire process will be over in two weeks.
This case is important, of course, because it is the first time that an American Court has dealt with issues related to Ebola and the ability of state health authorities to restrict the movements of persons who may have been exposed to the virus but are not symptomatic. While a court ruling from a trial judge in Maine isn’t going to be binding outside of this case, it will likely be seen as a guide by Judges elsewhere who may be faced with this situation in the near future. Indeed, given the number of Americans who are overseas dealing with this virus right now, and those likely to go over there in the future, it’s probable that some Judge somewhere will be called on to deal with a similar dispute. Different states have different public health laws, of course, but the laws cited here seem to be identical in substance to general public health laws so a Judge in, say, Virginia would likely at least find this decision to be something worth considering when asked to rule on a similar case. The alternative is that this decision will be seen by parties on both sides of a particular case elsewhere as a way to hammer out an acceptable agreement that could be issued as Consent Order, thus saving both the state and private parties the time and costs of litigation. Finally, this Order strikes me as a good balancing of the public health and personal liberty concerns I talked about earlier this week, which is good to see. So, I’d characterize it as a victory all around.
Here is the opinion:
Science wins over scaredy-cats.
Sam Wang captured this madness perfectly…you have a better chance of being a living member of the Beatles, than of being a person in America who has died of Ebola.
@C. Clavin:
I will admit I was wrong in my assessment that a Judge presented with a case like this would rule on the side of caution, and thus with the state. I’m glad I was wrong in that guess.
Yet,
U.S. Secretary of Defense Chuck Hagel is defending his new policy that military personnel be quarantined for 21 days after deployments fighting Ebola in West Africa as science-based and “thoroughly reviewed by health care professionals.”
“Science does dictate that there’s a 21-day monitoring period,” Hagel said during a wide-ranging press conference Thursday afternoon in Washington, D.C. “It was a smart, wise, prudent, disciplined, science-oriented decision.”
Either a quarantine is science based or it’s not.
One standard is enough.
@Jack: There’s a huge difference between trained medical personnel who are well versed in the symptoms and consequences of Ebola being responsible for monitoring themselves and a bunch of 18-25 year old untrained soldiers being asked to do the same. Not to mention the very bad security consequences of an Ebola outbreak among our armed forces.
@Jack:
Jack, you’ve been around here long enough to know that when Democrats enforce a quarantine it’s a “prudent, disciplined, science-oriented decision.” When Republicans enforce a quarantine it’s crazy, bed-wetting, fear-mongering.
Also, we don’t talk about the Defense Department quarantine of the military around here.
@Jack: The military quarantine almost certainly has as much to do with appeasing the freaked out family members (you should have seen the comment on the Fort Hood pages when these deployment were announced) as it does with any actual risk management. In fact, for troops that were over there building infrastructure, and not even in contact with sick Ebola patients, quarantining them is just silly. This is all about optics.
@beth: Beth, either a quarantine is SCIENCE BASED or it’s not. I don’t care if you are a medical professional or a circus clown.
@beth: The same trained medical personnel that lie about their whereabouts after being diagnosed? Those same professionals?
http://nypost.com/2014/10/29/ebola-doctor-lied-about-his-nyc-travels-police/
@Jack: What Hagel said was that MONITORING was science based. How do you propose the military monitor hundreds or thousands of people in different places? I hate to burst your bubble but the world does not always operate in strict black and white. ADULTS realize that.
@beth:
The Pentagon is calling it “controlled monitoring”.
There are few details on what that means.
Jack has gotten his bed all wet, again.
@Jack: You mean the same NY Post that posted a photo of two men identified as Boston Bomber suspects who, whoops, weren’t? The same paper that told me last year that Beyonce and JayZ were divorcing immediately? LOL
@beth: Beth,
They are quarantining military personnel in overseas locations..all of them, even those that have no contact, zero, nada with Ebola victims. Go build a hospital in a remote location and have zero contact…quarantine justified. Go treat Ebola patients…quarantine unjustified.
One mothereffing standard please.
@Gavrilo: Considering that almost everyone here criticized the NY and CT quarantines, I would say that your knee jerk reaction is most certainly in error.
@beth:
It doesn’t say monitoring while they go play softball or bowl. It doesn’t say check in on your way to the gym or chow, it says quarantine.
“The policy creates a separate set of rules for military members than what the White House has pushed for civilian health care workers. President Obama has argued that civilian volunteer health workers returning from aid trips to Africa should not be quarantined and the White House has urged states not to impose their own quarantine policies. Science, Obama has said, does not support the need for a quarantine.”
http://www.cnn.com/2014/10/29/politics/military-ebola-quarantine/
@Jack: Again, how do you expect them to monitor all those people in separate locations?
@beth: The same way they monitor Kaci Hickox.
Twice a day mandatory muster to undergo testing. Either people who don’t show symptoms are safe, or they are not.
@C. Clavin: Still pooping your tighty whiteys, skidmark??
@Jack: Whatever. It’s all a giant Obama conspiracy to give you Ebola. Be afraid Jack, be very afraid.
@beth: Suck my D1ck, Beth. Either we are debating the merits of a policy or you are making personal attacks. Which is it?
@Jack:
All leaves canceled, too.
Still, it’s a whole lot easier to accomplish that when everyone’s in one place.
As far as the difference in policy between DoD and everyone else…I did 20 years in the service and if I had a dollar for every time the military did something kinda stupid that was different from what civilians did, they could move the decimal on my retirement check a few spaces to the right.
@Jack:
You’re the one ranting like a lunatic.
You’re the one scared to death of something that you stand a near-zero chance of contracting.
You are the definition of a bed-wetter.
Repeating “tighty whiteys” and misspelling skid-mark over and over and over again means nothing. I mean seriously….the I know I am but what are defense?
I wanted to unpack this a bit. I’m a bit concerned with the certainty with which people are describing the current scientific understanding of this disease. Based on our present knowledge, quarantine is of low benefit. There do not appear to be asymptomatic carriers, for example. But we’ve never had an outbreak of this magnitude. Bruce Beutler, who is hardly a crank, has argued that we don’t have nearly as good a grasp on the transmissibility as we’d like to. Richard Preston, also hardly a crank, interviewed experts who worry that we will get a mutation that makes Ebola much more dangerous (not airborne, but with much higher infectiousness or less obvious early symptoms). We already know there are at least two different strains of this circulating. And diseases that only spread through bodily fluids have caused epidemics before (e.g., polio).
I’m not sure I agree with what the governors are proposing, but I don’t think quarantine is as crackpot as people are making it out to be.
I know many commentors–on both sides of the aisle–descend into personal attacks now and again without much interference from the administrators. And I get it.
However, this is the…8th?…time in 2 days Jack has descended into this drivel. This is a pretty flagrant violation of the site rules, IMO.
@C. Clavin: Awww, are you butt hurt, skidmark?
Totally OT:
DAMN!
RIP Rocket Rider…
http://www.bbc.co.uk/news/world-us-canada-29857182
@Jack:
Well now…it’s hard to counter such a cogent argument as that.
For some reason I doubt that beth is attracted to diaper-wearing lunatics.
@Neil Hudelson: Um, I have simply been responding to personal attacks on me. Fine clear the board, no one is blameless, to include yourself.
@Jack:
The military quarantine is a bit of overkill that the military can get away with because those affected are soldiers, and must do what they’re told. It’s somewhat more problematic to quarantine a civilian for no good reason.
Seems to me if we’re going to quarantine people who have treated ebola patients, we should use an “and also” criteria. As in, treated ebola patients “and also” displays symptoms.
Also….. “Suck my D1ck, Beth.”
Stop that shit. Now.
@C. Clavin: No, she is the typical liberal cum dumpster. You and her are sooo much alike.
@James Pearce: So, that’s where you draw the line at courteous discourse? Or is it only when flagrant jabs are pointed towards conservatives that you don’t care?
Seriously?
Did the moderator go to sleep?
@Jack:
As Todd pointed out, monitoring is science based, the quarantine is theater to calm a frightened public. The military has rather different standards for a variety of things, not the least of which is freedom of movement. The military justice system does not have the same standards as the civil justice system. Do you apply your one standard is enough every time you see a military trial? or do you just use that when there is a chance to score political points?
@Jack:
Stay classy, asshole.
@Grewgills: I’m simply stating that either non-quarantine for those not showing symptoms is science based, or they are simply making it up as they go.
This is not a “military” standard. Or it wasn’t before Hagel made this announcement. Last week, several members of Langley, AFB 633rd Med Group returned from a long deployment to Ebola stricken locations in Africa and they were not quarantined.
@CB: You too, fudgepacker.
And with that, I am out of here.
@Jack:
Show me where in this thread–or any thread–I have used the crass language you have used?
And down we go.
Seriously? cumdumpster?
This is why we can’t have nice things.
@Davebo: IMO that one warrants pulling out the ban hammer.
Oh, for Christ’s sake. It was bad enough when Cliffy was allowed to violate the rules about language, but now Jack has a free pass?
But on topic… Doug, Hickox was NOT employed or working for Doctors Without Borders. She was (and, as far as anyone knows, still is) an employee of the CDC, who was ASSIGNED to work with DWB.
Oh, and her roommate while she was in Africa is showing signs of Ebola. Good thing Ebola’s such a fine, moral virus that it respects the motives of the people exposed to it, and won’t attack those who are pure of heart and say their prayers by night.
@Jack:
You are way out of line and should go away.
@Jack:
At “suck my dick?” Sure, seems like a pretty good place to draw the line to me.
Heh…pretty much everyone who has the tendency for name calling (myself included) can finally agree on one thing: Jack needs to disappear.
@Neil Hudelson: Heh…pretty much everyone who has the tendency for name calling (myself included) can finally agree on one thing: Jack needs to disappear.
Only if he takes Cliffy with him. I find he provides a balance (well, OK, a bit of an overbalance) for Cliffy’s crassness.
@Jenos Idanian #13:
In you tendency for pathological lying…you seem to have forgotten that I was indeed admonished by the moderators.
And I typed nothing like what Jack is typing.
Seriously…why do you insist on lying about everything?
@C. Clavin: Shorter Cliffy: “Waaah! He’s mean! He hit me back! And it HURT!!!!”
You started with the personal insults, with the “bed-wetting” line. Then Jack turned around and went thermonuclear on you.
He overreacted (as he tends to do), but you gave him something to overreact to.
And you defend yourself with more personal insults with the “pathological lying” crap. What’s the matter — haven’t found another excuse to say “Dunning-Kruger Effect” so you can look like you actually aren’t a total idiot?
But back on topic… Doug, why do you keep calling HIckox a “DWB nurse” when she worked for the CDC? What is your intent in continuing to repeat this misinformation?
@Gavrilo:
I’ll just quote this, as it is the more polite version, and the thread doesn’t need to go any further downhill.
@Jenos Idanian #13:
facts are facts.
@C. Clavin: facts are facts.
And it’s a fact that you’re a homophobic rageaholic who gets a pass because you vent your rage at the “right” people, and use every singlet topic to impotently vent your rage at those you see as your enemies.
And it’s also a fact that Hickox was NOT employed by DWB, but the CDC, and there is a serious effort to push that falsehood and bury the truth. And it’s also a fact that her roommate from Africa is being treated for signs of Ebola — something else not being discussed.
@Jenos Idanian #13:
And BENGhazi!!!!!
Twice daily monitoring by a qualified health professional is what the science says is reasonable. A case can be made against self-monitoring, even if the person being monitored is otherwise qualified, because people really aren’t all that objective about themselves.
But, anything beyond that really is just catering to fear.
We should not be detaining people purely out of fear. People have rights (well, people outside the military and prisons, and even those people have some rights…), and we can’t be curtailing people’s rights just because other people are afraid and still be “the land of the free and the home of the brave”.
So, bravo to the court.
Also Gov. LePage’s weird threats of mob violence are entirely out of line. Fear brings out the worst in people (see above).
@Jenos Idanian #13:
Is there a better term for someone who is motivated primarily by fear, to the exclusion of all other principles? I don’t see how that can not be insulting, and how it can not be relevant. And at least “bed-wetter” is playful.
“Abject coward” seems more appropriate, honestly.
@Jenos Idanian #13:
I’m not sure where you’re getting your information but MSF (aka DWB) disagrees with you.
From their site
More from MSF
This bogus line about her being a CDC employee is based entirely on her completing a 2 year ”Epidemic Intelligence Service” course from the CDC. It doesn’t make her an employee of the CDC anymore than your doctor is a continuing employee of wherever he received his degree or did any other continuing ed training. It is BS manufactured to try and discredit her and anyone continuing to peddle it after being shown it is BS should be ashamed.
Now will you stop repeating that falsehood?
@Grewgills:
This, btw, required about 5 minutes with Google and an open mind. All of us should double check before credulously passing on accusations about anyone from partisans sites, be they from the left or the right.
@Grewgills: I’m starting to think that certain people out there are simply repeating the craziest theories out there for the lulz.
In otherwords, the mentality of Gamergate.
@Grewgills:
My guess is that Jenos is simply regurgitating whatever the Daily Caller has to say on the subject.
@Grewgills: Your second link Is from 2009, so it is five years out of date. And many of the more recent statements are “working with” rather than “working for”.
If I had to hazard a guess, she was getting a stipend from the CDC as part of the training program, and was doing much of that work in coordination with Doctors Without Borders, because that type of relationship happens pretty regularly. Public service often ends up funded by different grants and programs.
But, Doctors Without Borders is clearly claiming her as one of their own, and real media outlets are not raising any real questions because there aren’t any.
And, during my research, I discovered that her lawyer was a White House Visitor! And has some tenuous connection with known race baiter Al Sharpton! I have yet to figure out why a relationship with the CDC is a bad thing… I’ll keep you posted if I discover that.
@Jenos Idanian #13:
http://www.doctorswithoutborders.org/article/msf-nurse-held-isolation-new-jersey
@Gustopher:
More from MSF clearly stating she is one of their own
There isn’t the ambiguity of a ”working with” statement there.
She graduated from the CDC program in 2012, so if there was a stipend (for which no evidence has been presented) it wasn’t related to the training program.
I understand that you aren’t buying in to the BS, but wanted to address those points anyway as someone less scrupulous might glom on to your questions.
Ok, so here is the question that I asked my son. Suppose this crazy woman is seen in public by someone who does not appreciate her “lack of respect for the safety of others” and tells ms Petri dish to go home and supposed ms P says no way I have a right to be here and breathe all over you… or perhaps sneezes or coughs. Then suppose our hypothetical person takes matters into their own hands and takes care of the problem. Is this considered self – defense? After all this person has legitimate fears of catching ebola from ms Pretri Dish?
@daPengun:
Are you serious?
@Grewgills: From the CDC website:
So, if she was in that program, she was an actual employee of the CDC (I assume your information is correct, but I also assumed post-doc training would get a more modest stipend — although whether through an employee or contractor relationship, I wouldn’t hazard a guess).
Whether it is a traditional employee relationship, or whether this is just how the CDC helps fund people that work mostly independently while learning the skills the CDC clearly wants more doctors and nurses to know, I will not hazard a guess. But, I do know that one of the many requirements is to “Create a visual aid or graphic to illustrate scientific findings” (this is in the middle of a list of things that mostly do not sound like 3rd grade assignments, so it leapt out at me).
I still have no idea why having worked for the CDC while getting training on epidemiology is considered a bad thing, or even a suspicious thing, for someone who works for Doctors Without Borders handling epidemiological outbreaks.
Also, “Kaci Hickox, a Doctors Without Borders/Médecins Sans Frontières (MSF) nurse” could apply to a volunteer, as well as an employee. I would not be entirely shocked if the other shoe dropped and we discovered that she had volunteered to go to west africa! Or perhaps some other complicated arrangement of finances involving grants, either private or public! The horrors!
People really want to tear her down. They will grab onto anything they don’t understand. Scared, stupid people. Not sure what they are trying to accomplish. I just wish they would try to put enough of their conspiracy theories together to explain why X is a bad thing.
@daPengun: Are you, by any chance, actually Gov. Paul LaPage?
I’m a longtime reader (though never a commenter). After this exhibition , primarily by Jack but not just him, I will never be back. This is why we can’t have nice things.
@Grewgills: “@daPengun: Are you serious?”
More to the point:
Are you Jack?
Are you Jenos?
Are you all of the above?
@Gustopher:
That is actually pretty standard in a lot of scientific programs. People will present their posters at conferences as sort of a second tier to the speakers presenting their findings. That is neither here not there though.
I agree with the rest of what you said.
Whatever sympathy the public felt for Ms. Hickcox’s ill-treatment in New Jersey’s poorly implemented isolation tent is now gone due to her arrogance and publicity -seeking stunts. The judge erred in his decision. There are already too many cases of exposed individuals flounting the CDC guidelines. Not only did the now-hospitalized doctor in New York not follow protocol, he lied to public health officials about his activities in crowded public spaces until he was confronted with the evidence of his credit card charges and subway card usage. Dr. Nancy Snyderman, the TV reporter whose camera man was stricken with ebola while they were filming clinics, similarly deemed herself immune, violated voluntary isolation, and was caught driving around New York City. Sadly, health care workers are often the first to catch contagious diseases and become the vector that spreads them. Fortunately, ebola is not as contagious as SARS, but the institutional response to that epidemic in 2003 still serves as an example to study. Exposed to this deadly virus? Stay home!
@Jack: Hey look: Jack is also a four-lettered word. No wonder he can’t play nicely in the sandbox with others. Anyway to get this offensive, illiterate buffoon kicked off the discussion?
… and this morning we are treated to news stories of tourists avoiding Kent Maine businesses.
Ebola spreads through coughing and sneezing much like influenza, which most experts agree is spread “mainly by droplets made when people with flu cough, sneeze or talk,” according to documents by the Centers for Disease Control and Prevention.
A new CDC flyer describing the “droplet spread” of Ebola, which “happens when germs traveling inside droplets that are coughed or sneezed from a sick person,” is nearly identical to the CDC’s description of influenza which states “most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze or talk.”
“Droplet spread happens when germs traveling inside droplets that are coughed or sneezed from a sick person enter the eyes, nose, or mouth of another person,” the CDC Ebola flyer states, which was released on Monday. “Droplets travel short distances, less than 3 feet (1 meter) from one person to another. A person might also get infected by touching a surface or object that has germs on it and then touching their mouth or nose.”
“Droplet spread diseases include: plague, Ebola.”
@mannning: For asymptomatic people, the virus is not spread through casual contact or droplets. The viral load just isn’t there yet, and it isn’t a respiratory illness, so that’s not where the virus is going to be until it is quite developed. The best evidence, with fudge factors built in for safety, is that twice daily monitoring is sufficient to catch people before they become contagious.
The CDC has pulled this poster, likely because of the confusion and fear it caused.
But, think about this — how many cases of ebola are there in west Africa? If it was spread like the flu — contagious before significant symptoms, and spread through droplets at the first moment of symptoms — would there be less than 10,000 cases?
Nigeria stopped an outbreak in their largest city, with poor (by our standards) sanitation and medical infrastructure. Density of New York City, with open air markets, and the epidemic was contained. That’s not spreading like the flu.
But, don’t let someone symptomatic cough on you. If someone is bleeding out of their eyes, stay way way back and call 911. And, if someone at work is coughing, complain until they are sent home — it won’t protect you from ebola, because they almost certainly don’t have it, but you don’t want their cold or flu.
@mannning: Also, the media has done a terrible job of explaining the different stages of ebola. Simply put, you are not being well served by the media.
Short, over-simplified version:
Incubation: Up to 21 days, patient has no symptoms, and undetectable to very low viral load, not contagious. (This is why we cannot just do a blood test for ebola as people enter the country — there’s not enough there to detect.
Early Symptoms: 1 to 3 days. Fever, low viral load, concentrated in blood. Don’t swap blood, and the risks of infection are incredibly low. Theoretically possible, but never observed. We need to quarantine people at this point,mobile it is safe to transport, etc.
Later Symptoms: I forget how many days. This is exactly as scary as you think it is. Stay away, run and hide. No, really, this is terrifying.
The monitoring catches people in the early symptoms stage, before they are dangerous. With cold and flu season starting, I would expect we would see a fair number of false positives — someone was in west Africa, returns, gets a fever ten days later, and turns out to have gotten a cold rather than ebola and hilarity ensues when we quarantine them for a cold (which we will have to do, since the cold would mask the early symptoms of ebola.)
@Gustopher:
There seem to be very significant conflicts here among the experts in the field, and a real desire on the part of some to carefully minimize the threat of Ebola, perhaps to dampen the hysteria that has been evident recently. Others seem to want to tell their version of the truth about Ebola before it is too late. This is disturbing to laymen like myself.
Major centers of research have claimed either mutation of the virus to airborne transmission, or transmission by people not showing the classic symptoms of Ebola infection are entirely possible or even present now. Your comment is appreciated, but how does your authority stack up against the CDC and others. I simply do not know.
@ Manning
Perhaps you have some links you could share…
@mannning:
Potential transmissibility in very late stages via droplets (not aerosols) is not the same as can be spread like inflluenza. I have seen no meaningful disagreement among experts on this. If you have something I would love to see it. Any virus can mutate and it is theoretically possible that ebola could mutate in a way that would make it more easily transmissible. It is equally likely that it would mutate in a way that would make it less deadly as well. It has been under very close genetic surveillance for over a decade now and that surveillance is even tighter now.
Why is it you are more concerned that some people might be downplaying risks than the rampant fear mongering on this issue that is doing harm to the effort to contain this outbreak in West Africa where the real risk is?
@mannning: Again, the US media has done an absolutely piss poor job of educating people, and a pretty good job of scaring people. How do you know who to trust? That is always a problem. I would generally say the CDC, but that flyer is wildly misleading.
Here is an updated flyer which better matches my understanding.
http://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf
The earlier version basically left out the bolded part. It would be better with an explanation of what “very sick” means.
No one can say with 100% certainty that ebola will not mutate into something easier to catch. In fact, here’s what the CDC has to say about it:
Not entirely reassuring, but compare this to the flu, which changes so often that you need a new vaccine every year, the new vaccine is sometimes ineffective against that year’s dominant strain (they have to guess six months in advance), and where we have had pandemics.
Now, onto who you can trust — when you read something that says that ebola can be transmitted like the flu (for instance, that terrible CDC poster), stop and consider whether that matches up with what is happening.
The ebola outbreaks in west Africa have been in some densely populated areas — Lagos, Nigeria is a city of roughly 20 million people — and the total death toll is about 5,000, out of 14,000 infected, after months of the outbreak being out of control. That’s a disease that is not spreading fast.
Or, look at the fiasco in Texas. The nurses were not properly trained in protocols that were not strong enough, and the hospital was not prepared to deal with the patient’s bodily fluids, vomit and feces. Two nurses infected, complete, utter fiasco. The patient came in with symptoms, was sent home, returned three days later by ambulance with much worse symptoms.
The patient’s fiancé is fine, despite caring for him at home. The EMTs with the ambulance are fine. These are people who came into direct contact with the patient during the early symptomatic stage.
This scary poster aside, the CDC has not been doing a great job of educating people and correcting erroneous information. A lot of the scary scenarios are coming from people who understand a little tiny bit about viruses, apply that little tiny bit to ebola even if it doesn’t end up working that way, and then posting things on websites. The CDC really should be putting an effort into debunking them.
Anyway, generally trust the CDC, and if they tell you something that scares the daylights out of you, check back a few days later. They are human, they make mistakes (wow, the earlier version of that poster is misleading).
And, for those who worry that the CDC is a political tool of the Obama administration, desperately trying to hide the extent of the problem until after the elections… Obama would come across as awesome if he had federal quarantine centers and a “strong” response. The conspiracy theories make no sense.
@anjin-san: A googling comes up with the following:
http://www.dailymail.co.uk/news/article-2815903/New-CDC-confusion-Ebola-deletes-warning-virus-spread-coughs-sneezes-website.html
And, down the page a bit, there is a copy of the older version of the flyer. Honestly, it is a pretty terrifying flyer, since it doesn’t mention anything about this only being relevant during very late stage ebola.
@Gustopher:
Thanks