Thursday, October 30, 2014

Maine Nurse Refuses To Comply With Quarantine

   Uh...isn't this the kind of thing that could kill us all?
   I mean...I do understand that  20-day quarantine would be no picnic... And I'm not sure why it wouldn't be ok to go for a bike ride in which you did not get near anyone else... But there seems to be some kind of general view floating around that there is something wrong about imposing such quarantines.
   Speaking for myself, if there were a small chance that I had Ebola, and the experts said "quarantine yourself for three weeks"...I'd quarantine myself for three weeks...
   She seems to have been tested, and the results were negative. Perhaps the tests are extremely good.
   I suppose I'm still a bit unclear on why we might not want to err on the side of caution here...


Blogger Random Michelle K said...

The stupidity of that nurse makes me want to throttle her.

Yes, it is true that Ebola can only be transmitted when the victim is actually sick, and requires an exchange of bodily fluids.

However, the incubation period is such that you can be perfectly health and not at all contagious and testing negative for the disease until... you're suddenly sick and contagious and NOW the tests come back positive.

Should be be locked away? Of course not. But what I have heard of her statements make it sounds like she thinks it's perfectly fine to go to the mall (or, say, on a cruise).

Yes, she does have a low-likelihood of having Ebola, and an even lower liklihood of giving it to someone who is not a household member.



Sorry. Ebola is scary.

It has an incredibly high death rate, and even if you don't die, bleeding from everywhere is going to be REALLY unpleasant.

So why not lie low for awhile? Why not say, "yeah, I'm going to just hang out at home, and have groceries delivered and if I go for a walk for my health I'll just go ahead and wear a mask and otherwise I'll see y'all in three weeks?"

No, it wouldn't be convenient. But her actions are actually ramping up the hysteria rather than serving to reassure people. And that's just STUPID.

What she has been saying--and the manner in which she has been saying it--have come across as reckless. Ignore the fact that she's a nurse and theoretically knows enough to know when she's sick. Quarantine laws (like other laws) have to be applied uniformly. Her belief that she was not exposed isn't really the point. The point is that she *could* fall sick at any point in the three week period, and if she was out and started projectile vomiting, well, that would kinda suck for everyone.

And really, as a supposed medical professional, she should know that community and public health should take precedence over an individual's need. Her claim that she should be able to go anywhere she pleases while she is still in the incubation period strikes me as just as ignorant as parents who refuse to vaccinate their children. You do it for OTHERS just as much as for yourself, you morning.

And quarantine laws are kinda fascinating. I have a copy of Laurie Garrett's "The Coming Plague" somewhere around here, and I remember it discusses Ebola, and I thought it also talked about quarantine laws. I should probably dig it out. (It's a rather dry treatise on public health, but the section on hemorrhagic fevers (of which Ebola is one type) scared she shit out of me.)

OK, enough babbling, it's bedtime. :)

9:36 PM  
Blogger Random Michelle K said...

Oh. Right. The tests are NOT extremely good. Ebola incubates in the tissues, not the blood. So you don't get a positive blood test until you're already contagious.

9:37 PM  
Blogger Dark Avenger said...

She tested negative for the Ebola virus, Winston, so she's about as infectious as you or I. And she could only be shedding virus if she was symptomatic, would make her very unlikely to want to do anything but obtain medical treatment, instead of doing a bike ride.

This is what Anthony Fauci had to say about it:

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that the federal government has established Ebola guidelines that are "based on solid science," but he declined to classify states' quarantine efforts as a mistake.

"I don't want to use the word mistake because I think when people do things, the governor of New York, the governor of New Jersey, they're doing it in good faith to try and do what they feel is the best for their constituents," Fauci said in an interview with "Good Morning America." "What we're trying to do is set the bar that's based on scientific data, but that's not to criticize or to put down a decision that an official might make wanting to go the extra mile. That's just judgment on their part."

Here's the inside skinny about why Ebola going airborn isn't something to be concerned about:

There is no reason to believe that Ebola virus is any different from any of the viruses that infect humans and have not changed the way that they are spread.

I am fully aware that we can never rule out what a virus might or might not do. But the likelihood that Ebola virus will go airborne is so remote that we should not use it to frighten people. We need to focus on stopping the epidemic, which in itself is a huge job.

11:04 PM  
Blogger Pete Mack said...

No. There is no evidence of infectiousness prior to the onset of fever. So long as she tests herself every day for fever, she is perfectly safe. Also, Ebola requires fairly close contact to spread. A bike ride will not do it. It's a bit of a stunt, but she's making a valid political point.

2:30 AM  
Blogger Random Michelle K said...

The possibility of Ebola becoming an airborne contagion isn't that remote: in (IIRC) 1993, Public Health war games used a mutated airborne Ebola to test the Resistance of the world-wide ability to deal with a pandemic. So it's not beyond the realm of possibility that Ebola could mutate.

The point isn't that she's currently shedding virus and a threat to public health, the point is that she could fall sick at any time, and her insistance that she can do anything she wants is foolish. It's like people who insist on openly carrying handguns while grocery shopping. Yes, you may have the right to do that, but that doesn't mean you SHOULD do it.

No one should do things that cause public fear, just because they are *allowed* to do so.

7:25 AM  
Blogger Dark Avenger said...

in (IIRC) 1993, Public Health war games used a mutated airborne Ebola to test the Resistance of the world-wide ability to deal with a pandemic

Well, Michelle, that's 20 years old. We understand a lot more about Ebola than we did then:

Ebola’s transmission route hasn’t changed either. It is usually the result of close and direct physical contact with a patient’s infected body fluids, especially blood, feces and vomit. While the virus can also be transmitted indirectly—via contaminated surfaces and objects—that risk is low and it can be lowered further by disinfection procedures. Ebola can survive on dry surfaces, such as doorknobs, for several hours but is easily killed.

Viruses that store their genetic information in the form of the DNA chemical code, such as smallpox, typically don’t undergo a large number of mutations. By comparison, viruses based on the RNA chemical code, such as Ebola and HIV, are less stable. RNA is a molecule inside the cell thatamong other things, passes on genetic information. HIV’s high mutation rate is one reason why it is so hard to develop a vaccine for it.

So it wasn’t a surprise when a study published in the journal Science in August found the 2014 Ebola virus had undergone more than 300 genetic changes compared with the virus that caused earlier outbreaks in the region.

What did those changes amount to? Is Ebola changing in a way that allows its host to live a few weeks longer, so it could potentially infect even more people? Is it acquiring properties that could make it airborne?

The answer to those questions is no, researchers say. “There’s no evidence that a particular mutation is being selected,” said Dr. Jones. “We don’t see anything happening that’s changing the direction of the virus in one direction or another.”

From Reuters, last month:

But most of these mistakes, or changes, are just "irrelevant mutations", explained Anthony Fauci of the United States National Institute of Allergy and Infectious Diseases.

Fauci told a U.S. senate hearing this week that the changes so far observed in Ebola in this outbreak, while prolific, were generally "not associated with a biological change or a biological function" of the virus, meaning they were highly unlikely to give it an entirely new skill, such as the ability to transmit in droplets in the air.

"It is an unusual situation where a mutation would completely change the way a virus is transmitted," Fauci said. "It's not impossible, but it would be unlikely."

Jones added that the so-called tropism of the Ebola virus -- the tissue it prefers to infect -- is the vasculature, not the airway surfaces.

"As a result it is not in the right place to make the leap to a new transmission route," he told Reuters. "In fact very few viruses do this. Most stay in the niche they have established over evolutionary time."

In recorded medical history, there has been no instance of a virus changing from blood-borne to airborne or the other way around.

As the American writer and philosopher Damon Runyon put it:

"The race is not always to the swift, nor victory sure to the strong, but that's the way to bet."

BTW, anyone get their flu shot yet? I did already, it's a good idea.........

12:30 PM  
Blogger The Mystic said...

Dark Avenger needs a theme song. Maybe like "Batman" but instead of "Batman," using the words "quotin'" and "D.A."

Quotin' quotin' quotin' quotin' quotin' quotin' quotin' quotin'... D.A.!!!

Quotin' quotin' quotin' quotin'...

10:17 PM  
Anonymous DM said...

Risk assessment is determined by assigning a value to an outcome and the probability of that outcome. The outcome of an Ebola epidemic in the US would be very, very bad. So, taking measures to lower the risk of that happening to almost zero is not an unreasonable precaution. The main issue here is the trade-off between personal liberty and public safety. Ebola is such a terrible disease that the temporary restraint of personal liberty is justified. Tea Party radicals and others on the far right are unwilling to compromise personal liberty at any cost. We're now seeing that attitude being expressed in the debates about this nurse. It is just fanaticism to never compromise on the value of personal liberty. It is an important value, but it can and should be overridden. The nurse's bike ride seems to just extend her middle finger to the quarantine and that is a dangerous attitude to encourage in the face of a potential epidemic

11:44 AM  

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