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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.

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Just because you’re a saint doesn’t mean you’re not infectious

Update: Kaci Hickox’s real friends should have a good long talk with her about her over-reaction to the quarantine for a very good reason.  Hickox does not know what her infection status is.  That’s because the diagnostic for ebola isn’t accurate until a person displays symptoms.  If it turns out that in a couple of days she does get sick, she and all her defenders who are trying to make her out to be a martyr to New Jersey’s oppressive public health system are going to suffer a severe backlash that will undermine their credibility.  Is that wise?? I mean, with all of the lunatic Republicans ready to seal the US off from the rest of the world, do we really need a potentially sick Nurse Hickox to become a poster child for ebola?  I’m surprised that they aren’t thinking about this and begging Hickox to dial it back and set a better example for others to follow.

Also, I am going to reiterate my suggestion to the politicians to work on getting employers to pay the salaries of employees who are involuntarily quarantined, make it possible for those who can work remotely to do so, and prevent discrimination when they return to work.  It’s part of their civic duty.  Oh, and get the states that refused to extend Medicaid to pay for the treatment of indigent patients.  Better to get in front of the problem now.  Ebola is not the only nasty disease in the world.

**********************************************************

I’m blogging from my iPhone because I am irritated with nurse Kaci Hickox’s pathetic whining about being put in quarantine when she returned from Sierra Leone after she treated ebola patients.

Apparently, she is taking umbrage at the fact that she was quarantined in NJ and they were terse with her.  She doesn’t have a fever, says she.  But Dr. Spencer also thought he was magically free of ebola when he returned from West Africa. He was so confident of his superpowers to fight off infection that he rode the subway while he was just shy of being violently ill.

Presumably, Dr. Spencer and other healthcare workers should be aware that they are not invincible and should keep themselves off of public transportation. But we have learned, much to our chagrin, that overconfidence trumps sanity and consideration for the lives of others. I don’t think a travel ban is necessary or useful but it is apparently necessary to keep an eye on health care workers if for no other reason than to keep major metropolitan areas from freaking out.

Quarantines used to be common back in the olden days when we didn’t have cures for deadly diseases, nurse Hickox. (See this PBS Nova primer on the history of quarantine) You are not special. Ebola doesn’t care how self-sacrificing you are.  If you are truly as good and wonderful as you say you are, you will take an old cold tater and wait out your time in isolation. You aren’t a criminal. Just a possible carrier. Grow up.

More on the quarantine: Viral infections don’t have a political ideology but our responses to them apparently do.  Republicans are nauseatingly reflexive when it comes to saving themselves at the cost of pissing off every other interest and people who voluntarily put themselves in danger to aid others.  Some lefties have their minds so wide open that their brains have fallen out and they move too far in the “there’s nothing to worry about, you stupid yahoos” camp.

There most certainly is something to worry about.  The epidemic in West Africa is a genuine crisis that has global implications if it is not controlled.  Ebola has no cure and we don’t know if any vaccine developed so far is safe or effective.  Likewise, we don’t know if ZMapp even works.  Add to this the absence of a “pee on a stick” diagnostic that would allow us to identify infected people before they potentially get on a subway and throw up on everyone within a three meter radius. This is no time to become complacent.

Quarantines are not prison sentences and anyone exaggerating the horrors of involuntarily detention in New Jersey* due to possible infection of a deadly disease is as careless and irrational as the morons calling for us to seal off our borders.  Stupidity, like viral infections, does not respect political affiliation.

One more thing: Yes, Yves, all bodily fluids are potentially infectious once people start getting sick.  Since we don’t know when they will cross that threshold from being merely fatigued to feverish, sweating and throwing up, it’s best they stay away from public transportation.  And here’s something else that is really disturbing: the ebola virus can persist in semen for up to three months after a victim has cleared it from the rest of his body.  So, there, Yves.  Look it up.

* Kaci Hickox’s complaints about her treatment sound like a litany of first world problems.  She was given a granola bar when she told her detainers that she was hungry.  She was held in a “tent” on the grounds of the hospital and it was unheated.  Please.  We’re having a nice Indian Summer here in the Northeast.  Put a fricking sweater on. (Now, she’s complaining to her mother that cell phone reception sucks in her isolation unit.  It’s NEWARK, for Pete’s sakes.  Cell phone reception is notoriously spotty anywhere in the Newark-Manhattan area.  New Jerseyans have to put up with this all year round.  The cell tower is not singling you out.)  Really, you’d think she’d just spent a month at Club Med instead of one of the poorest countries in the world.  I’m embarrassed for her.  Apparently, she’s never volunteered to provide health care in parts of North Philly where there is genuine American hardship and poverty that is rapidly devolving into third world conditions.  Hard to believe she made the front page of the NYTimes with her sob story.