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Apollo 11, West Africa and Eyelids

I lived in Pearl Harbor when Apollo 11 went to the moon and back.  They used slide rules to make calculations back then.  Those guys were launched into space while sitting on a giant firework.  They got to the moon, made it back in one piece…

…and spent three weeks in an isolation unit in Hawaii.  They were heroes.  They deserved a ticker tape parade.  And they waited patiently until they were cleared of any nasty moon germs before they got it.

I understand Anthony Fauci’s concern that a mandatory quarantine will discourage volunteer health care workers at a time of crisis in West Africa.  However, the problem is a cultural one.  Here in the US, workers get very few vacation days.  If you spend them all in an Ebola hospital in Monrovia, it is an unfortunate likelihood that your employer is going to be unsympathetic to your do gooder status when you get stuck in Newark for three weeks.  That’s why I think politicians need to move on protecting workers from losing their salaries and jobs when they come back.

Nevertheless, I think Cuomo, de Blasio and Christie have done the right thing by mandating a quarantine for a very limited number of people coming in from West Africa to New York and New Jersey ports.  That’s because the NYC-NJ megalopolis is the most densely packed area of the country and an outbreak of ebola there could have a devastating impact.  If health care workers are diverted to less crowded areas of the country to disembark in order to avoid detention in Newark, then the quarantine may have served its purpose.

(Update: DeBlasio and Cuomo have moderated their quarantine policy and I approve their changes.  They will allow health care workers that are high risk to remain at home during the isolation period.  They will be monitored by public health officials twice a day AND they will be compensated for lost income.  There’s a lot to like here.  The twice a day monitoring should help to keep the person off the streets, subways and buses.  The compensation for lost income should assure volunteers that they’re not going to be punished for doing good things.  Christie hasn’t changed his policy yet.  Not sure where Hickox is from but she might have to tough it out in Newark until she’s been cleared to travel on domestic airlines.  I’m betting that no American airlines wants to have another Frontier incident.)

It would be the equivalent of keeping ebola infected individuals out of Kinchasa or Lagos, as Michael Osterholm explains in the video below from Johns Hopkins Ebola Forum a week or so ago.  This video emphasizes why it is so important to contain the outbreak in West Africa and why it is almost too late to do so.  Well worth the viewing.  Not too nerdy or complicated.

Finally, this article from the New Yorker illuminates the problems with diagnosing ebola and protecting health workers.  Inside the Ebola Wars is a must read. (Also not too geeky) Here are some things I learned from it that makes me think that quarantining Kaci Hickox was probably not a bad idea:

  • The diagnostic test for ebola was developed on an old strain of the virus.  For the current two strains, it has become much less accurate and may be an unreliable confirmatory test for ebola.
  • Dr. Kent Brantly was symptomatic when he went into isolation in Africa and had his blood sent for confirmation of ebola.  The test came back negative.  A few days later, Brantly was much sicker and had a second test.  This one was positive.  So, if Kaci Hickox is making the case that she shouldn’t be stuck in Newark (well, who should?  I wouldn’t wish it on my worst enemy) based on her ebola tests, she’s full of s#*}.  There’s no way to know whether she is carrying the virus until she gets sick. That could still happen.  So, I’d stop giving the general public the idea that I’m imprisoned on false pretenses.  First, it’s not imprisonment and second, we don’t know yet and neither does she.  That’s the whole point of a quarantine.
  • There has been some speculation as to how some health care workers are getting infected in spite of their expertise with PPE.  A proposed route is that a tiny droplet of infected bodily fluid is getting trapped behind the moist eyelid of the health care worker.  How it got there is anyone’s guess.  Maybe it’s a chance encounter with an tainted gloved hand.  Maybe its aerosolization.  No one knows yet.
  • A single viral particle can kill you.  Well, it has to replicate like bunnies in your body but it only takes one.  And a single drop of blood or sweat contains billions and billions of viral particles.  Yep, think that over and now project that onto the map of New York City and New Jersey.  {{shudder}}

Still not panicking but I am relieved that there are people trying to prevent an outbreak.  This is not a Texas scenario and for that we should be grateful.

14 Responses

  1. Inside the Ebola Wars was written by BY RICHARD PRESTON — who knows what he’s talking about … he wrote The Hot Zone which taught most of us everything we knew about Ebola before this summer.

    He’s very good at explaining timelines and research.

    Something about your post reminded me that when we had a suspected case here in Kansas City, the head of the hospital said that he thought we were going to be lucky and that it was just a case of typhoid — and that he never expected to call THAT lucky again. (hmm… we never did hear what that guy had)

    Could some of this “concern” about quarantine be from a growing habit of distrusting politicians and their motives for ANY decision?

    I keep seeing FB comments about more people marrying Kim Kardashian than getting Ebola in the US. What a dumb thought!

    While posting cute crap like that they aren’t saying that with 5000 hospital beds (this week) and some good quarantine camps this epidemic could probably be stopped in Africa by Christmas.

    And without them? It could go on until we aren’t making cute jokes anymore.

    • The NYTimes has a post on Asia getting nervous about ebola. When I was playing Plague, I started my bacterial infection off in China. I figured the population density was high and the medical establishment was only fair. Sure enough, it took off like, well, a plague.
      The depressing thing was when the world population got down to about 400,000 people and the race for a cure stalled at 92% finished, I couldn’t do anything to stop it. The human race died out without evolving immunity.
      It is kinda eerie to see the game and the real thing playing out. It might be a virus that isn’t airborne and the cure might come quicker than we think but there still is potential for a lot of deaths. And if Asia is starting to worry, we probably should too.

      • I’ll look up that NYT story. It turns out, I’m not as afraid of Ebola as procrastination.

        • Yeah, the “let’s take a meeting and form a committee to propose a process” thing is probably not the right approach. And then there’s the fact that Obama tends to be a reactive, not proactive kinda guy…

    • “While posting cute crap like that they aren’t saying that with 5000 hospital beds (this week) and some good quarantine camps this epidemic could probably be stopped in Africa by Christmas.”

      Good luck with that. In the first place, the infected Africans are the wrong color. And they don’t have any money to speak of.

      • The at-risk West Africans are the same color as the East Africans who have banned flights to East Africa from or through Ebolastan. Since they can’t plausibly be called “racist”, their travel ban goes unmentioned.

        India/China/Pakistan/Bangladesh will probably do the same very soon now.

        (And it is perfectly possible to send medical people in/out on military transports while keeping recreational tourist/bussiness aviation on lockdown).

  2. Nevertheless, I think Cuomo, de Blasio and Christie have done the right thing by mandating a quarantine for a very limited number of people coming in from West Africa to New York and New Jersey ports. That’s because the NYC-NJ megalopolis is the most densely packed area of the country and an outbreak of ebola there could have a devastating impact
    Yes, and I agree about the modifications.
    It’s all common sense.

  3. The nurse has been in an unheated tent in the hospital parking lot. If she had been allowed to go home, her exposure to other people would have been very limited due to where she lives – rural Maine. Rounding everyone up and putting them in a tent in a hospital parking lot for 21 days was not a good long-term plan. The new policy to have monitors check on them twice a day (take their temperature and ensure they are indeed staying at home) while also paying them any lost wages during the 21 days they are home quarantined, seems like a better policy solution.

    • First and foremost, no one knows, including Kaci Hickox, whether she is infected. If she says otherwise, she’s lying.
      Second, it’s nj. Newark is right across the harbor from Manhattan. It is the most densely populated area of the country. If hickox’s buddies at Johns Hopkins are so fucking concerned about an outbreak in Kinchasa, they should be just as concerned about an outbreak in nj or ny. There are plenty of uninsured people there and as far as I know, Christie only recently signed on to Medicaid expansion. You can’t use the best healthcare in the world if you can’t pay for it. Then there’s the crowding issue. If you’ve never lived in no, you have no concept of what I’m talking about but let me tell you, it could be a nightmare. I lived thru sandy. And if it hadn’t been for Christie getting on top of the problem before the hurricane hit, followed by some very strong armed tactics to prevent electrocution and gouging, it could have been even worse. He might be a total asshole in any other situation but he’s good in an emergency.
      Third, in nj, don’t complain or the people in charge will make it worse. I get it that the emergency quarantine situation was more like glamping but I’m pretty confident that conditions would have improved if hickox hadn’t thrown a fit like a two year old.
      I don’t think Christie did anything wrong here. An ounce of prevention would be worth billions of dollars in cure and uncontrollable panic.
      She’s actually made quarantine more likely outside the U.S. I prefer the Cuomo-deBlasio solution because they will now enforce isolation by twice daily visits.
      But this is a serious disease without a cure and I am very angry with Hickox and her supporters right now. She’d better not get sick because public opinion will turn with a vengeance.

      • I wonder if the police and etc. who interacted with her right at the start were polite and explanatory or whether they were the sort of asshole/shitheels who had such fun at Zugotti Park I wonder how much of Hickox’s bitterness might be due to aggressively bad treatment right at the start.

    • “Rounding everyone up and putting them in a tent in a hospital parking lot for 21 days was not a good long-term plan.”

      The US isn’t any good at long-term plans anymore, not since the ‘libertarians’ took over. Planning and preparing takes money. Expands the damned gobmint.

      The groundwork is already being laid for abandoning the afflicted.

      http://www.reuters.com/article/2014/10/22/us-health-ebola-usa-interventions-idUSKCN0IB2OM20141022

      Restricted treatment because some bean counters were unwilling to spend the money necessary to prepare to provide full treatment. It’s just a step from there to no treatment at all.

      What I fear will happen if a real pandemic strikes will be the quarantine of entire areas. Ring the stadium or city with frightened armed guards with instructions to shoot anybody who exits.

  4. I think it’s most likely that Nurse Hickox would have been quarantined at home, if Drs. Snyderman and Spencer hadn’t been such arrogant assholes.

  5. Quarantine outside the US would be more logistically and personell-wise manageable. Rather than have eleventeen thousand volunteers have to be quarantined by eleventeen thousand separate quarantine infrastructures and bureaucracies scattered all over the volunteering world, just have one big quarantine structure with one bureaucracy and one bunch of shift-rotating personell for every single volunteer to have to go through before being cleared to leave Ebolastan.

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