Dr. Rick Sacra to Megyn Kelly: about those ebola patients without fevers
[NOTE: I’d like to get the following information to Megyn Kelly, so she can do some further investigating on this point. Just emailing her seems futile, because it will get lost in the shuffle. Any ideas?]
Last night I watched Megyn Kelly’s interview with Dr. Rick Sacra, a Massachusetts doctor who contracted ebola in August while working in Liberia and who was flown to this country and recovered. His answers during this part of their exchange especially interested me:
DR. RICK SACRA, SURVIVED EBOLA: You know, [Kaci Hickox is] not ill. She’s not sick. She doesn’t have a fever. She doesn’t have other symptoms. And the science suggests that she’s really not a risk to anyone at this time. So in that sense, yes, I support her contention. She’s not a risk.
KELLY: OK.
SACRA: The reason you confine someone is because they’re a risk. She’s not a risk.
KELLY: Here’s why people are concerned about her and other workers, I think. Because, first of all in 13 percent of an Ebola cases, you have no fever. So not having a fever isn’t the end-all tell-all about whether you have Ebola, right?
SACRA: I think, you know, you can’t take a statistic like that in the absence of context. Sometimes people with Ebola at the end of their lives will no longer be able to mount a fever because they’re so weak. So when someone arrives at the tent for treatment in West Africa and they’re about to die, they may not be having a fever.
Generally, healthy people like Miss Hickox, when they develop Ebola, they will have a fever. I think they will look behind those kinds of statistics.
KELLY: OK. Understood.
That seemed plausible. However, Dr. Sacra didn’t cite from where he got his information. Perhaps there is a bona fide study that backs up what he’s saying, but I couldn’t find one (which of course doesn’t mean it doesn’t exist). What I did find was much more curious.
Before I go into that, let me say that for quite some time I’ve been doing online research about ebola itself, particularly transmission and early symptoms, as well as symptoms in general. I now have enough information to write about twenty posts, which means I despair of ever getting the information all out there, although I certainly plan to write a couple of lengthy ones.
But the summary version of what I’ve found is that the bulk of the information we have so far about ebola is based on data from past epidemics, plus animal research. The first source is hampered by the fact that this epidemic seems to be going differently and spreading further and faster, although what has caused that difference is as yet unclear . The second source is hampered by the usual caveat that a disease acts differently in different species, although some species (in the case of ebola, non-human primates) are more similar to humans in their responses than others.
There’s also a third problem with the data, which is that the the data from previous ebola outbreaks is sketchy, to say the least. That’s because record-keeping in medical facilities in those parts of Africa has been haphazard (plus some patients may not be coming in for care or even recognized as ebola patients):
Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.
But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system””originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May””and the results of that record-keeping appear in the New England Journal of Medicine.
The article goes on to discuss some of the findings, none of which seem to deal with the main subject matter of this post: fever’s reliability as a symptom of ebola.
Back to Kelly, Sacra, and fevers—here’s a discussion of the study Kelly is presumably referring to when she asks the question of Dr. Sacra—the research that suggested that around 13% of ebola patients don’t appear to exhibit fever. Note, when you read it, how “garbage in, garbage out” the data seems, due mostly to lack of resources in that part of the world. Note, also, that “fever” was defined at a suitably low level (100.4) rather than the higher 101.5 level previous protocols have laid out [emphasis mine]:
The official assumptions about the frequency of fever in Ebola patients have not been challenged publicly. But Dr. Paul D. Stolley, former chairman of the University of Maryland’s Department of Epidemiology and Preventive Medicine, said the matter “requires further investigation.”
Given the stakes, he said, the “absolute” assumption that Ebola can be spread only when an infected person displays fever should be reevaluated.
“It may be true,” said Stolley, a member of the Institute of Medicine, part of the National Academies. “It just doesn’t sound very plausible to me.”…
The authors of the recent World Health Organization study said they analyzed “a detailed subset of data” on confirmed and probable cases, including information from forms completed by doctors and other healthcare workers in the affected countries, indicating whether a patient had a fever and at what temperature and whether the reading was taken by armpit, by mouth or rectally.
The study defined fever as 38 degrees Celsius ”” 100.4 degrees Fahrenheit.
“To create the fullest possible picture of the unfolding epidemic,” the authors said, they collected additional information from “informal case reports” and other sources.
The researchers described imperfections in some of the data. In a footnote, they wrote that “in practice, healthcare workers at the district level often do not have a medical thermometer and simply ask whether the person’s body temperature is more elevated than usual.”
Yet the lead author, Dr. Christl Donnelly, a professor of statistical epidemiology at Imperial College London, stood by the findings on the prevalence of fever.
Asked by email whether the study found no fever in 12.9% of confirmed and probable cases, Donnelly replied: “Yes.”…
Three studies of previous outbreaks, cited in the same World Health Organization report, provide further grounds to question whether fever is a fail-safe signal.
Researchers studying an outbreak in Uganda in late 2000 and early 2001 reported that “the commonest symptom ”¦ was fever, which occurred in 85% of the cases.”
Another study of that outbreak, focusing on 24 confirmed cases of Ebola, found fever in 88%.
The third study, which examined a 1995 outbreak in the Democratic Republic of Congo, found fever in 93% of 84 people who died and in 18 of 19 individuals who survived.
Asked Friday how many people infected in the current outbreak should be expected to display fever, a CDC spokeswoman, Sharon Hoskins, said “the vast majority” would, but added that it was “impossible to give an exact percentage.”
For doctors and nurses fighting the epidemic in West Africa, the risk of encountering Ebola in the absence of fever is more than academic.
Dr. Nick Zwinkels, a Dutch physician, last month closed a hospital he had been running with a colleague in central Sierra Leone after five nursing aides contracted Ebola ”” possibly from unprotected contact with three patients who were not promptly diagnosed with the virus.
Four of the nursing aides died, as did all three of the patients belatedly found to have Ebola.
Interviewed by email, Zwinkels said that hospital staff members took the temperature of one of the doomed patients four times a day for three consecutive days, and the patient never showed a fever. The readings were taken by a digital thermometer placed in the armpit, he said.
Based on what his staff observed, Zwinkels wrote, “it seems that only measuring the temperature as a form of triage is insufficient.”
He added: “It seems that Ebola can present without fever especially in the first phase.”
Zwinkels said that without fever as a trustworthy marker, it is difficult for medical professionals to treat the many West Africans suffering from everyday maladies…
If Ebola cannot be readily identified, Zwinkels wrote, “Ebola patients will be admitted in the normal ward and possibly contaminating health staff and caretakers. This is why a lot of hospitals in West Africa are closed.
I wonder how Dr. Sacra would square those findings with his statements to Kelly about the absence of fever in ebola patients. I’ve seen no evidence that the absence of fever involves those in late stages only; on the contrary, experts in this article state that it tends more to involve the earlier stages (although there were also patients in late stages who lacked a fever, they seem to have never had a fever, which delayed their diagnoses, although after death they were finally documented as having had ebola). There is no discussion whatsoever of the sort of phenomenon Dr. Sacra describes.
Who is Dr. Sacra? According to this, he’s a family physician from Massachusetts. He doesn’t seem to be an ebola researcher or even an ebola expert, although I would imagine he certainly knows something about it, and not just from his personal experience of having suffered from the disease.
I had assumed that Sacra had gotten infected in Liberia treating ebola patients. But this was not the case:
Sacra, a family physician from Worcester, Massachusetts, wasn’t treating Ebola patients when he got infected. He was helping pregnant women. Like Writebol and Brantly before him, when a fever came on, he desperately hoped it was malaria and not Ebola.
I can only conclude that the most likely way Dr. Sacra contracted ebola was from treating a pregnant woman whose undiagnosed ebola was advanced enough to be contagious (diagnosis of ebola in pregnancy is easier to miss, by the way). Dr. Sacra’s story would appear to be evidence that ebola isn’t necessarily easy to diagnose or recognize even in contagious stages, and that symptoms do not always point so clearly to the disease, even when Western physicians are treating the patient in a hospital or clinic setting (much less when laypeople such as Thomas Eric Duncan are dealing with a similar patient presentation).
In terms of judgment, denial, and quarantines—it’s fascinating that Sacra, Brantly, and Writebol all thought and hoped they had malaria, a disease far more common in Africa, and certainly a possible diagnosis at the beginning. This shows that doctors and nurses are not always the best judges of what they have contracted. You know the old saying: a physician who treats himself has a fool for a patient.
[NOTE: As I said, I’ve got a lot more information on transmission and symptoms. Rather than deal with it all now, I’ll just offer a smattering.
This:
“It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”
What’s more, we assume that diarrhea and vomiting are always present, but apparently they’re not:
Ebola virus RNA levels in the blood increase logarithmically during the acute phase of illness and significant numbers of EVD patients have vomiting (67.6%), diarrhea (65.6%) and unexplained bleeding (18% and generally late in the course of disease) presenting opportunities for EVD transmission.]
if “Miss Hickox” is a carrier she wont have a fever either, and tests require a certain amount of material to register (As they are not going to do a full sequencing that can drop to 100 virii)
on another note…
someons should tell her that she is going to destroy doctors without borders ability to get charity funding.
ie. people are going to say “if that is the kind of people that organization sends out, then why would i give to them?”
and note…
just as i said way back in the first posts, you can get it from the air. the CDC is now admitting it… i even linked to the study of rhesus monkeys that showed that happening…
but in order to appear reasonable, some decided to deny its possiblity… so the issue is a bit larger than what it is given peoples response to basic information which can come from a trusted source, but be passed on and negated given that the passer is not the trusted source.
like huxley, being reasonable is the positoin we decide to take when there is a crisis and we dont know what to think or do… so we posture reasonableness, and so, when there is a crisis or such things, nothing EVER stops it.
just think of the fascistic laws and changes being made to the state, and the attacks by race, and all that… the reasonable thing to do is sit and wait and not do much at all, letting others test the waters until its so late that only a nut job can deny it.. and they will.
the clock is ticking on the deadline for the ineffectual administration and the external entities wanting to maximise their taking advantage of it. not just from a desease like ebola, but from conflict in which the reasonable response is to freeze like a deer in the headlighs rather than be decicisve.
NATO Intercepts at Least 19 Russian Military Planes in 1 Day
ebola is the least of our worries..
there are some things more terrifying and capable of doing a lot more and not much can stop them
until now they have been moving so slow that one does not pay attention to them given other distractions
like a predator moving slowly, the prey does not see it
Maybe Sacra should talk with the doctor in California just back from Liberia who’s put himself in quarantine for 21 days — here’s what he said:
“I’m California’s most experienced Ebola physician. I won’t take a single chance. My wife is away, my dog is away – there’s no downside to a little personal convenience, 3 weeks will pass.”
So, apparently quite experienced with Ebola, and he “won’t take a single chance.”
Looks like Tom Lowell is the executive producer of her show.
I see his Twitter info:
https://twitter.com/FNCLowell
and LinkedIn:
https://www.linkedin.com/pub/tom-lowell/26/487/666
Don’t see an email address for him though.
Here’s confirmation of Artfldgr’s claim that the CDC now admits Ebola can be infectious through ‘airborne” transmission.
“CDC admits droplets from a sneeze could spread Ebola”
Here’s a visual of just how far a sneeze can travel.
Tom Lowell’s email address might be lowell@foxnews.com, since that seems to be the basic form for the email address there.
Carl beat me to it. I would think trying to reach a producer on the show would be the most likely way to get it to someone’s attention. The Producers invariably have admins reading their mailboxes, but if they would bring it to their boss’ attention if they found it significant.
Art-We gave a sizable gift to Doctors Without Borders last year and have already chosen a substitute charity (a retired Los Angeles doctor, with an outreach in Africa) to fund this year, based on the stupidity of Dr. Spencer & Nurse Hickox.
So, the bottom line here is that, as many of us divined from the cacophony of different placating administration, doctor, and supposedly official “authorities” statements concerning Ebola and its symptoms and methods of spread, ”the science is not settled.”
With so many open questions about such a deadly hemorrhagic virus, why in God’s name would anyone take any chances, such as—for instance–breaking a state ordered quarantine as Traci Hickox is arrogantly doing right now in Maine?
P.S.–I agree that the lack of candor and/or character demonstrated by the two Doctors Without Borders volunteers–the MD in New York now in the hospital with Ebola reportedly lying at first to authorities, claiming that he had self-quarantined himself and had not had contact with anyone, then his later admission that he had been “out and about “and travelled extensively throughout New York City, potentially exposing hundreds, if not thousands of citizens to the possibility of contracting Ebola, and Hickok deliberately and defiantly breaking the quarantine the State of Maine tried to impose on her–are both flagrant examples of bad character and bad behavior that I imagine will cause many people to reconsider whether they really want to donate to an organization that has this type of “volunteer” working for it.
In the case of Hickox, especially, does she have no comparable consideration and compassion for the anxious and/or frightened citizens of her own hometown?
Right now, in view of Hickox attitude it would seem that it is really all about her and her feelings and her rights, not anybody elses.
And yesterday Obama was having photo ops with returning US doctors and nurses from Ebola-stricken countries, none of whom have cleared quarantine, wherein he shook hands with them all and hugged some too. How dumb is that?
GJ…
It smacks of brilliance.
It’s the next best thing to sending Barry to Liberia.
Thanks for ebola information that is way beyond what the ‘journalists’ of the msm seem able to dig up. This latest cover up of another dangerous bho fiasco can be characterized as SNAFU.
Ditto on the thanks for the research, Neo.
When thinking about the plague of ebola, we are beyond the borders of the map. We don’t know where we are. We have no ability to determine latitude or longitude. There be monsters there. Thinking otherwise is suicidal.
Hubris is so thick you can slice it with a butter knife.
Wouldn’t it be great if we could find some supposed expert or person in authority in DC with just a tiny bit of humility?
“yesterday Obama was having photo ops with returning US doctors and nurses from Ebola-stricken countries, none of whom have cleared quarantine, wherein he shook hands with them all and hugged some too. How dumb is that?”
It’s an indication that he believes what he’s saying regarding infectious transferability.
GB…
Isn’t it just as likely that Barry figures Allah would never permit anything to go awry while he’s on jihad?
At a deeper, much deeper, level, Barry’s unconscious would love to reboot his persona by way of a medical emergency.
One is reminded of Nixon’s phlebitis — which only ever erupted when his emotional story-arc required a hiatus from critique.
It makes sense to me.
I wish I’d said it.
I watched the interview, too. My first thought was, ‘If you know so much why did you get Ebola?”
Actually, watching his responses and facial expressions I was also left wondering if the Ebola somehow affected his brain. It certainly seemed as if there were something wrong with him. I felt a little sorry for him.
He seemed most confused when he heard the CDC position that if you have been in close contact with Ebola patients you should not get on a commercial plane even if you are asymptomatic.
I had no trust in his opinion at all.
As others have said; these two “health care professionals” have done some damage to Doctors without Borders.
Because they clearly didn’t think through how their seemingly selfish behavior would reflect on that organization.
On a related note; I read the news article in which the NY Doctor at first lied to NYPD about his whereabouts. It wasn’t until they scanned his MetroCard (the card that is used for paying for riding the NY City subway) and it showed that it had been used recently and where he went.
Somehow this doesn’t surprise me. He is fitting the stereotype of so many do-gooders – “I’m a do-gooder, I help mankind, therefore the rules don’t apply to me as they do to everyone else.”
“yesterday Obama was having photo ops with returning US doctors and nurses from Ebola-stricken countries, none of whom have cleared quarantine, wherein he shook hands with them all and hugged some too. How dumb is that?”
Hey, they only SAID the nurses were from Ebola land. They could has just as easily been from Baltimore.
I watched the interview also, and was struck by his demeanor as being combative and overly confident- like a lot of the experts who have weighed in since the outbreak.. Which is possibly one reason he contracted it. If it’s relatively easy to know who is contagious, he was either reckless, or incorrect about how it’s transmitted.
Learning from personal mistakes is something people with average intelligence usually do. A supposedly trained medical professional who gets a deadly disease from “treating” affected patients, then afterwards fights common sense precautionary measures, is probably a dunderhead.
“Treating” is still a bit of a mystery to me. There’s no cure, so what are the doctors doing other than ordering hydration through IVs, and giving whatever drugs they can to make the patients more comfortable? How are they exposed to diarrhea, vomit, and other bodily fluids, and why would they be?
What about genetics?
Remember when medical studies were conducted on white males? Treatments for women and other races were not always correct – heart attacks symptoms in women and hypertension in blacks are two examples.
So, what about race, sex, age, past illnesses and general health – how do these factor in to determine the symptoms, treatments and eventual outcomes?
There is so much we do not know about this virus.
vanderleun,
I would go with Vegas over Baltimore.
FYI:
CDC Ebola information page
http://www.cdc.gov/vhf/ebola/index.html
Information for Healthcare Workers and Settings
http://www.cdc.gov/vhf/ebola/hcp/index.html
Liz,
Viruses and bacteria rarely, but sometimes, show no gender or racial discrimination, although sometimes there are preferences.
Wow Eric, I feel so reassured… the cdc has 0.0001 degrees of separation from the dnc.
Barry is true to his confused roots, choom boy with mixed emotions about his sexuality and his racial idenity, and later his religious affinity. He’s just a drift on the ocean of his narcissism.
southpaw:
Actually, from what I’ve read, Dr. Sacra was not treating affected patients. That is, he didn’t think his patients were affected. He was treating pregnant women. One (or more) of his patients had ebola and he didn’t know it.
For example, if a pregnant woman has ebola and miscarries (which usually happens if a pregnant woman has ebola), and the doctor or nurse didn’t know the patient had ebola, that situation is especially dangerous. Unless they wear hazmat suits to treat every pregnant woman, there is quite a danger of infection.
This article says he was also performing cesarean sections in Liberia. Seems very high risk in an ebola environment.
Kaci Hickox is probably correct, she probably is not contagious and she will probably not come down with Ebola. When she does survive the incubation period unscathed, she will take that as vindication for her actions. The fact that she may appear to be vindicated is the worst part of the situation. President Obama will lead the cheering for Kaci and for her brave stand for science against what he and she call ignorance.
The people who are responsible for protecting the citizens of Maine from an Ebola outbreak also know that Kaci will probably not contract Ebola. Their problem is that no one knows which healthcare worker will be the unlucky one who does come down with Ebola. Therefore they have to treat each returning medical worker as if he/she were the unlucky Ebola victim.
Neo – which makes his general position on Hicokox even more, dare I say, idiotic? He was defending her because she was “in good health”, which he judged by her “appearance”. Presumably, he made the same thorough diagnosis of the women he was seeing who were carrying it.
It’s beyond me how this position he is taking, and hers, is considered scientific.
And that isn’t the issue anyway. If a society is unable or unwilling to enforce a law that is designed to protect the majority of citizens from great harm, and cannot because one citizen arbitrarily decides it doesn’t apply to them, that is anarchy. I don’t understand why we are even having this debate with her.
But that seems to be the attitude this country has been leaning toward more and more. Whether it’s immigration law, tax law, or constitutional principles, we’re being conditioned to live with a legal system that is purely political and arbitrary. Like a banana republic. And it’s the citizens who are at fault for tolerating it or ignoring it, whichever is the case.
Despite Kaci Hickox’s grandstanding, the public health officials are actually quite relaxed in their quarantine standards. They have chosen 21 days even though a few patients may become ill later that 21 days.
As Neo has pointed out, Ebola sometimes presents is unusual ways so one can not rely on one criterion ie. fever to determine whether someone is contagious. Since there is no way to determine exactly when someone becomes contagious, a 21 day isolation is reasonable.
I believe I saw a report somewhere in the last few days in which some doctors noted that the “2 or 3 to 21 day incubation period” is just an average of the incubation periods during which most people manifested but that, because of the individual differences in humans, outliers can take as long as 31 days to manifest.
@Sharon W
Its a shame that such choices have to be made, but i applaud your deciding to share your wealth with others for some good purpose of your own choosing. (better than taxes, as charity comes post expense and self care, and taxes come before everything, including food, housing, and so on. not to mention how the politocos tax that tax as it goes by, redirects, it, etc)
ultimately, the issue with doctors without borders is that its become a political piece of BS. the docs who want a certain kind of career and cache decide to join into it, the way that a student vying for certain colleges will join the yearbook committee.
so what happens is that they join to “prove” they are compassionate and care, but as you can see by the behavior of TWO of them (not all of course), that they dont really give a flying f*ck as to other people, but care more as to the reputation they instantly garner for ‘sacrificing’ some time in another country so that later they can say, i did x, and have that status. oooh, ahhh, ohhhh goes the crowd.
sadly, this is the difference between people who really care for others, and really are sacrificing their time and expertise to such a thing, and those cargo cult narcissit opportunists, who do things for image and future cache.
is it any wonder that the latter of the two is dominated by surface cargo cultish liberalism and socialist/communist advocacy people?
after all, isnt the whole of socialism to garner looking good and kind to others while empowering the state to steal from faceless people and harm faceless people, while focusing on the presumptive stated reason for such (with little regard for the actuality of the outcomes)?
to the leaders of socialism, this is just power plays and a means to using people in a formal way in which they cant call you to the table on it. but for such doctors, it becomes just one more tick on a resume in which the person desires regard and defference as a reward for faux sacrifice and more.
after all, in africa, they seem so caring
but once they get here, where did their caring, compassion, and consideration go? it went no where, as they never had any of that, all they ever had was the self agrandizment and desire to be regarded in a favorable way in which no one would question it (until they see their return behavior)
sadly, if they cared for humanity, not just black down trodden victims of reality that when assisted gives them the rewards of the bibilcal hippocrits not hippocrates…
while vile creatures they are revealed to be if one cares to pay attention
for those who are not familiar with the biblical points on the subject, i offer this without offense:
these people love themselves so much as to act in such a way to get others to love and reward them for something that they should not care as to rewards.
Matthew 7:15 – Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.
Titus 1:16 – They profess that they know God; but in works they deny [him], being abominable, and disobedient, and unto every good work reprobate.
Jude 1:16 – These are murmurers, complainers, walking after their own lusts; and their mouth speaketh great swelling [words], having men’s persons in admiration because of advantage.
Matthew 6:24 – No man can serve two masters: for either he will hate the one, and love the other; or else he will hold to the one, and despise the other. Ye cannot serve God and mammon.
Matthew 6:2 – Therefore when thou doest [thine] alms, do not sound a trumpet before thee, as the hypocrites do in the synagogues and in the streets, that they may have glory of men. Verily I say unto you, They have their reward.
there is so much more..
Wolla Dalbo: Right now, in view of Hickox attitude it would seem that it is really all about her and her feelings and her rights, not anybody elses.
But isnt that what feminism is all about?
its never been about actual liberation, because going from a free person with a mate, to a state tax slave is not liberating. All there is, is the ME of ME, justified by some social communial cry that pretends to make such selfishness the order of the day, while pretending that its selfless
illuminati:
Yes, Kaci and her supporters have perverted the entire reasoning behind a quarantine, as opposed to isolation. You isolate people with a disease. You quarantine people who have been exposed to one and might get it.
They either don’t understand the principle (fool) or are purposely perverting it (knave). I think Kaci herself is probably the latter.
Illuminati: “Since there is no way to determine exactly when someone becomes contagious, a 21 day isolation is reasonable.”
This point seems nit-picky but the semantics matter, particularly as a legal matter: while isolating someone is part of quarantine, quarantine and isolation are not the same thing.
The key element of isolation is symptom. The key element of quarantine is exposure, not symptom. As such, the procedures are different. Yet pundits and Obama officials have (deliberately?) misrepresented symptom as an element of quarantine.
From http://www.cdc.gov/quarantine/qa-executive-order-pandemic-list-quarantinable-diseases.html :
As a legal matter, while Hickox is correct that there is a higher (different) bar for a quarantine-based involuntary detention than an isolation-based involuntary detention, I believe State passed that bar on Ebola quarantine because Ebola was already designated by the CDC and Executive Order as a “quarantinable (communicable) disease” before the current outbreak.
From http://www.cdc.gov/quarantine/historyquarantine.html :
The list of quarantinable diseases is contained in an Executive Order of the President and includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (such as Marburg, Ebola, and Congo-Crimean), and severe acute respiratory syndromes.
The CDC has also stated healthcare providers of Ebola patients are one of the highest risk groups for contracting Ebola.
From http://www.cdc.gov/vhf/ebola/exposure/index.html :
With Hickox’s defiant jogging on what appears to be a natural trail, note the risk from infected wildlife.
Finally, while federal quarantine is rare in the modern period (since the Ellis Island era of federal quarantine stations), Obama officials – especially any CDC official – who has opposed state-level Ebola quarantine is moving against normal CDC practice on quarantine.
From http://www.cdc.gov/quarantine/qa-executive-order-pandemic-list-quarantinable-diseases.html :
Obama’s vigorous opposition to state-level Obama quarantine is just odd and, more to the point, contrary to the CDC view of Ebola risk, designation of Ebola as a quarantinable disease before the current outbreak, and deference to state and local authorities on quarantine.
From http://www.cdc.gov/quarantine/quarantineisolation.html :
Oops. I left out a blockquote at October 31st, 2014 at 11:11 am :
As a legal matter, while Hickox is correct that there is a higher (different) bar for a quarantine-based involuntary detention than an isolation-based involuntary detention, I believe State passed that bar on Ebola quarantine because Ebola was already designated by the CDC and Executive Order as a “quarantinable (communicable) disease” before the current outbreak.
From http://www.cdc.gov/quarantine/historyquarantine.html :
The CDC has also stated healthcare providers of Ebola patients are one of the highest risk groups for contracting Ebola.
…
2nd oops, fix: Obama’s vigorous opposition to state-level
ObamaEbola quarantine is just odd and, more to the point, contrary to the CDC view of Ebola risk, designation of Ebola as a quarantinable disease before the current outbreak, and deference to state and local authorities on quarantine.Art–You encapsulate the sad truth perfectly. So when Jesus says there are those that say didn’t we do x, y and z in your name and He says, depart from me you doer of evil…I never knew you. We get an idea of why that is the case. Fortunately there are indeed many great people and organizations doing mighty works. As for the money, I’ve always said, I’ll compare our giving to any liberal’s charitable contributions (adjusted for income) any day of the week. Faux populists indeed. But I love that saying, “If you want to know how important money is to God, just look at who He lets have it.” And truly, there isn’t one problem this world faces, that money is the issue. ALL of our problems, are moral ones.
Megyn Kelly has a Facebook page (Kelly File not the personal one) – you might try letting her know there that you would like to contact her with info. She is also on Twitter.
Eric:
You are correct, but I believe I know what someone like Hickox would argue if it ever came to court.
Some diseases are highly communicable during the incubation period. That makes quarantine absolutely necessary, so people don’t communicate the disease before they exhibit symptoms.
The party line on ebola is that it is NOT communicable during the incubation stage, but only after symptoms are exhibited. Not only that, but the symptoms must be severe rather than initial ones such as fever alone (and even if severe, you have to come into contact with the body fluids, not just be in the same room or near them). So they say that we have plenty of time to get people into isolation before they become at all communicable.
Now, I haven’t studied the law of quarantine to see if there have been rulings on diseases that follow the same pattern as ebola—that are alleged to be communicable only after symptoms have developed.
Those on the other side of Hickox, et.al. say that the state of our knowledge is such that we cannot say people are not communicable in earlier stages, and the danger of the disease is so great that quarantine is justifiable even in the absence of frank symptoms.
Neo,
From the CDC’s answer to “What is the difference between isolation and quarantine?”:
Ie, the standard for quarantine is based on exposure, not symptom nor infectiousness.
Hickox is arguing against the textbook standard for isolation, not quarantine. But isolation and quarantine are different.
If and when you look into the federal, state, and local law of quarantine, I suggest starting the trail at the Executive Order – linked with other law and policy at
http://www.cdc.gov/quarantine/specificlawsregulations.html – that designates Ebola as a “quarantinable communicable disease”:
https://www.federalregister.gov/articles/2003/04/09/03-8832/revised-list-of-quarantinable-communicable-diseases
Isolation does not necessarily apply just to sick people. Take this definition for quarantine for example. According to this definition a quarantine is a subset of isolation.
quar-an-tine
1. a strict isolation imposed to prevent the spread of disease.
http://dictionary.reference.com/browse/quarantine
Illuminati,
Indeed. This is one of those issues where everyday plain language gets mixed up with related-but-not-same law and policy discourse.
You’re right that in plain language, quarantine is a form of isolation. But as healthcare procedures, Isolation and Quarantine (perhaps upper-casing the terms will help) are distinct with different standards.
Obama and Hickox are using the plain language that you point out in order to argue against Quarantine using the standard for Isolation.
Perhaps Iluminati would be happier with a 23 day quarantine… 🙂
http://en.wikipedia.org/wiki/The_Illuminatus!_Trilogy
Eric Says
“Obama and Hickox are using the plain language that you point out in order to argue against Quarantine using the standard for Isolation.”
Do you really think they are that sophisticated?
Artfldgr Says:
Perhaps Iluminati would be happier with a 23 day quarantine… 🙂
It would probably be hard to go more than 21 days.
Incidentally, I chose Illuminati years ago to tweak Muslims when I was talking to them about their conspiracy theories which all feature Jews as the master conspirators.
Illuminati,
Whether or not they’re that sophisticated, it’s what they’re doing.
It seems like a tack that a political operative like Ron Klain would formulate. Indeed, the Ebola quarantine controversy reminds me of the distorted politics and confusion even by supporters with Operation Iraqi Freedom despite that the Saddam problem and progression of the Gulf War ceasefire enforcement were headline news for over a decade before OIF. More than that, open-source, easily accessed on-line law and policy, coupled with the UN and ISG findings confirming and corroborating Iraq’s breach of the UNSCRs, provided a straightforward explanation for OIF.
In short, OIF shouldn’t have been controversial in the 1st place, but it was made to be. Neither should state-level Ebola quarantine be controversial in the 1st place like it’s being made to be.
Similar to how a cursory review of the law and policy of the Gulf War ceasefire shows the justification for OIF, a cursory review of the FAQ pages on the CDC website regarding quarantine and Ebola shows that state-level Ebola quarantine is justified.
@illiminati
i was just having a bit of fun, given the name. some people just grab the word, others know the depth of the wackiness around that word. i used to be in a group that referred to it, and the people in it were VERY good on the history, so we knew the degree that a partial knowlege of the history has flubbed people all around.
given that i figured you knew, i threw out the old 23
of which there is a huge cult around it 🙂
most muslims would not know the illuminati
and even less than the original, the cultish, new world order, secret society that controls everything
its like the priori of zion and the other zion stuff…
if you know the partial history, you would believe it was written a while back, ford distributed it, and that it talks of a cult of jews that seek to control the world and have done so… but if you know the whole history, it ends up being the longers anti semetic piece of fakery that the russians have been continually fomenting since they took over the thing
they still produce papers and put them out in the world with that one as disinformatzia…
Artfldgr Says:
“most muslims would not know the illuminati
and even less than the original, the cultish, new world order, secret society that controls everything”
It didn’t take them too long to figure it out.
anyway… given where i work i end up having to read stuff like this
Since being designated an Ebola Treatment Center by the State of New York, The XXX XXX Hospital has made extensive efforts to adapt its facilities and organize and train a team of dedicated individuals to care for any patient with suspected or confirmed Ebola Virus Disease (EVD). These efforts are in addition to the preparations being made throughout all emergency departments and ambulatory locations of the XXX XXX Health System.
We are extremely proud of our team of specially-trained staff from Nursing, Critical Care, Infectious Diseases, Emergency Management, Laboratory, and Environmental Services who are training in our interim Biocontainment Unit, located in the YYY Pavilion.
In a few days, this team will move to a freestanding Biocontainment Unit that is being completed in ZZZ Park, located between the OOO and HHH buildings. It is being constructed to provide complete safety and protection for our patients, staff, and visitors, and includes the same features as the nation’s other biocontainment units. Suspected or confirmed EVD patients may be taken to this location directly for all aspects of diagnosis and treatment.
yada yada yada…
New CDC confusion over Ebola as it deletes warning that virus can spread through coughs and sneezes from its website
It has replaced the old language with new guidance that says there’s ‘no evidence’ Ebola is spread through either
The CDC also took down on Thursday a poster that said that Ebola can be transferred through ‘droplets’ on hard surfaces, like doorknobs
It’s unclear why the CDC abruptly changed it’s Ebola advisories
The quiet removal of information follows a public health campaign by Sen. Rand Paul to get the CDC to be ‘forthright’ about Ebola transfer
no HUMAN evidence…
but as others may remember, i put up the link to the nih paper that pointed out how rhesus monkeys in a environment and with no physical contact gave it to each other (they all died).
i guess its time we forget the national anthem of the US as an anachronism…
time to learn new words
A Circuit Court judge in Virginia has ruled that fingerprints are not protected by the Fifth Amendment, a decision that has clear privacy implications for fingerprint-protected devices like newer iPhones and iPads.
Interesting. I once became very seriously ill because I lacked a particular symptom and the doctor decided not to check for that possible cause of my other symptoms. Instead, the doctor told me I was just depressed and sent me home. Consequently, I became REALLY depressed and lost weight at a dangerous rate because of my suppressed appetite.
So I’m a bit skeptical of depending too much on a symptom matrix if it means the proper diagnostic isn’t performed.
I have contacted Medcins Sans Frontiers and let them know their fund raising efforts with me will be in vain unless they condemn Kaci Hickox and demand that all their volunteers abide by their country’s quarantine protocols upon return home. I also wasted a stamp to express the same sentiment on an otherwise empty donation envelope.
I know I’m not alone.
Re getting Fox News’ attention:
I’d suggest you look for intermediaries. Do you have a personal or email relationship with a conservative talk radio host, for instance? Other conservative bloggers who’ve appeared as guest analysts on Fox or other networks?
Someone like that could forward a link that WOULD get through the filters.
Pingback:ebola | treatment | US patients | survivor transfusions
Pingback:ebola | Hickox | Salia | blood tests