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April 2018
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Ebola Scoreboard Update

Kaci Hickox stands up to Ebola hysteria and politicalization....and wins!

Kaci Hickox stands up to Ebola hysteria and politicalization….and wins!

Just updating  the  Ebola “crisis” in the United States:

Confirmed Ebola cases diagnosed in the United States: 4

Number of those cases contracted in the United States: 2

Number of non-healthcare workers to have contracted Ebola in the U.S.: 0

Number of U.S. citizens to die of Ebola in the United States: 0

Number of foreign-born citizens to die of Ebola in the U.S.: 1


Total confirmed Ebola cases in West Africa since March 2014: 13,015 (per the CDC)

Number of deaths: 4808

How to Decide Proper Public Health Measures for Ebola in the US

Ryan Byoko is one of two Harvard PhD candidates quarantined after returning from Liberia where they developed an Ebola tracking computer system for the Liberian government but did not treat patients with Ebola.

Ryan Boyko is one of two Harvard PhD candidates quarantined in Connecticut after returning from Liberia where they developed an Ebola tracking computer system for the Liberian government.  They did not treat patients with Ebola.

Among all of the hand-wringing, grandstanding, and debate taking place over what protocols are appropriate for implementation in the United States due to Ebola, seems no one is using some fairly easy statistics that would help make the decision easier….

I will use data that is available from Medicins Sans Frontieres (http://www.msf.ca/en/faq-msfs-ebola-response-and-protocols) as the baseline.  Currently they estimate they have 3200 staff working in Ebola affected areas, and the number working since March is “significantly higher”.  24 staff have become infected with Ebola, 7 of whom were international staff.  Most of the individuals  to have contracted Ebola were local staff who contracted it outside of MSF facilities. So 30% of Ebola cases among staff have been international workers.

Let us conservatively estimate that 6000 staff have worked to treat Ebola since March 2014.  To err on the side of caution, let us also assume all 24 staff members to have been infected with Ebola were international workers.

Percentage of workers to have contracted Ebola: 24/6000 x 100= 0.4% =  less than 1 in 200

This would be the worst-case scenario and assumes that every individual does not show symptoms of Ebola until after leaving Africa; AND that they all came to the United States (Remember only 1 MSF volunteer has developed Ebola after their return to the U.S.).  At the most, 1 in 200 returning healthcare workers would develop Ebola illness.  So if you impose quarantine you will quarantine 199 people who won’t get Ebola to catch 1 who will. Remember this is the worst case scenario: the actual probability would be much lower than this worst-case estimate.

Number of non-healthcare workers to be infected by another person with Ebola while in the United States: 0

Estimated number of contacts Ebola patients in U.S. had before being admitted to hospital: 250

Chance of contact getting Ebola outside of healthcare setting: less than 1 in 250

So, using the existing protocols where those who had treated Ebola patients in Africa would self-monitor for symptoms without any form of self-quarantine, there have been NO secondary infections in the United Sates besides healthcare workers in the hospital setting.

Neither self-imposed nor mandatory quarantines are needed at this point to protect the public. The protocols for returning healthcare workers that was in place before the first Ebola case in the U.S. works just fine.  Stop worrying America.   Governors Christie, Cuomo, and others ought to go ahead and ban automobile driving : they will prevent far more deaths and injuries, thus protecting public health to a far greater degree, by doing this than they will by cynically scapegoating valiant healthcare workers returning from Africa. 


“The Mob is Rome”: Fear, Ebola, the Media, and Government Response

Dallas-area nurse gets a hug from President Obama....Dr. Craig Spencer is accused of being "irresponsible" for not self-isolating himself though he did the same  as doctors and nurses from Medicine Sans Frontieres have been doing long before Americans cared about Ebola...

Dallas-area nurse Nina Pham gets a hug from President Obama after recovering from Ebola….in New York City Dr. Craig Spencer is accused of being “irresponsible” for not self-isolating himself though he did the same as doctors and nurses from Medicine Sans Frontieres have been doing long before Americans cared about Ebola.  It does not take us long to go from compassion to indignation.  At this rate,  we will probably stone the next healthcare worker who gets Ebola…

I was reading an article about the new movie “Nightcrawler” this afternoon, and the author quoted a retired newscaster who said that when he started in journalism in the 1960s the news was considered a form of public service, but now it caters to what the public wants rather than needs.

With Ebola we now see how much of the media is no longer the calm voice of reason and reliable information, but instead just reflects and confirms people’s fears and political point a view.  If you want to hear what you already think you know, there is probably a news channel for you. Not surprisingly, many public officials are capitalizing upon this to use Ebola for political gain.

Last night, apparently without much input from local, state,or federal public health officials, the governors of New York and New Jersey announced 21 day-quarantines of any individual returning from Ebola-stricken areas of Africa (of course they announced it before they bothered to work out any details).  Yesterday I wrote on Facebook this would make anyone thinking of volunteering to go fight the epidemic think twice.  Instead of medical heroes selflessly risking their health to save others, they become lepers, risking our health when they ride the subway or go for a jog. Today some medical professionals are confirming they are thinking twice.

What has been barely mentioned in the news discussions/analysis is: whether the governors in question even have legal authority to impose mandatory quarantines on individuals?  Most states, as well as the federal government, reserve the power to seek mandatory quarantine orders to public health officers, not political leaders, and such orders require the officer to obtain court approval of such restrictions on an individual’s liberty (see here for a summary of state and federal legal authorities for quarantine and isolation measures). Governors’ emergency disaster powers might, or they might not, be construed to include public health issues…although my feeling is a court will not look favorably upon the governors’ actions if  done without consultation of the public health officers legally authorized to make those decisions.

This might also be the underlying reason why Dallas County elected officials decided against signing a disaster declaration for the purpose of restricting the movement of individuals being monitored by public health-  legal counsel might have advised them that their legal authority for such an action was questionable at best, and certainly open to challenge.  I do not know for sure, but it is a reasonable possibility.

Who has caught Ebola in the U.S. so far?  Only two healthcare workers who cared for an Ebola patient during the time leading to his death where his viral load was at its highest.  But you hardly hear anyone discussing viral loads (though Dr. Sanjay Gupta on CNN has…thank goodness).  No, the media asks questions about doorknobs and sneezes and frightens people by asking those improbable, unlikely, but damning “what if'” questions that they know scientists, even if the chance of something happening is only %0.00001, will answer in a way that leaves people with just enough doubt to make them think their fear is justified.

Right now someone worrying about Ebola is probably sitting obliviously next to someone with an active case of tuberculosis…and they aren’t worried in the least.

In today’s world, the politicians know that perception is reality.  Last week when I spent a shift at the Dallas County Emergency Operations Center, I suddenly realized who was the voice of Ebola in Dallas: the County Judge and the city Mayor.  Who we didn’t see much of was the head of the Dallas County Health Department, or the state Public Health Officer.  Coincidence that the elected officials wanted to be seen front and center instead of the hired/appointed public health professionals? No coincidence here in Dallas, not in New York, not in New Jersey, and not in Washington.

The politicians know that it doesn’t matter whether you are doing something that works or not, it is that people think you are taking “real” action that matters. Ebola Czars, 21 day quarantines for everybody, travel bans…these are the bright ideas of blind and ignorant leaders leading the ignorant and blind masses.  Should we expect and demand more from our leaders and our media?  Probably.  Will we?  Probably not.

Just for the record, I prefer BBC News…

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