Ebola

Is a 21-Day Ebola Quarantine Really Adequate?

|

Ebola Virus
CDC

Natural News nutjob Mike Adams (a.k.a. the self-styled Health Ranger) is certainly trying to fearmonger the idea that 21-days is not enough. First, remember that this is the guy who the FBI is investigating for surreptitiously setting up a website earlier this year where he likened crop biotech researchers to Nazis and then argued…

…it is the moral right — and even the obligation — of human beings everywhere to actively plan and carry out the killing of those engaged in heinous crimes against humanity.

So consider the source when Adams writes:

A jaw-dropping report released by the World Health Organization on October 14, 2014 reveals that 1 in 20 Ebola infections has an incubation period longer than the 21 days which has been repeatedly claimed by the U.S. Centers for Disease Control. …

This means that Ebola-infected U.S. citizens who are "cleared" of Ebola may still erupt with the deadly virus for a period of three more weeks. (emphasis his)

Why hasn't anyone reported this until now? How is this not one of the single most important pieces of information in the world at this moment when all human life on our planet is now legitimately threatened by an uncontrolled viral outbreak with a 70 percent fatality rate and no recognized treatments or cures?

Adams is essentially putting his panicky spin on the World Health Organization's situation assessment for Ebola in Nigeria and Senegal that states:

The period of 42 days, with active case-finding in place, is twice the maximum incubation period for Ebola virus disease and is considered by WHO as sufficient to generate confidence in a declaration that an Ebola outbreak has ended.

Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.

Presumably the WHO is also setting a 42-day time limit in order to make sure that unaccounted for cases do not emerge before for declaring an epidemic at an end.

Adams apparently thinks that people infected with Ebola who remain asymptomatic for more than 21-days are somehow like modern Typhoid Marys. This is wrong. Typhoid Mary was an asymptomatic carrier of that bacterial disease, whereas people infected with Ebola pass along the illness only after they become symptomatic.

Those interested in less senational and more accurate coverage, can go over to The National Journal, to read Brian Resnick's terrific article that asks, "Is 21 Days Enough for Ebola Quarantine?" Resnick is focusing on calculations published in PLoS Current Outbreaks by Drexel University researcher Charles Haas who finds:

While the 21 day quarantine value currently used may have arose (sic) from reasonable interpretation of early outbreak data, this work suggests a reconsideration is in order and that 21 days may not be sufficiently protective to public health.

Haas does importantly add:

The estimate of appropriate incubation time would need to explicitly consider the costs and benefits involved in various alternatives, which would incorporate explicit computations from transmission modeling.

Let's take a stab at roughly toting up the costs and benefits. In a first scenario assume notionally that 20 people are infected with Ebola and 19 become symptomatic before 21 days. If they are placed in effective quarantine, the 19 will either die or get well in which case they are no longer a threat to public health. What about the one who becomes symptomatic after 21 days? There is no magic to the 21-day incubation period, since an infected person who is symptom-free until 30 days or 42 days will anyway not be passing the disease on to anyone. (Remember: No Ebola Marys.) Once the person whose incubation period stretches beyond 21 days becomes symptomatic, he will presumably be quarantined as well and like the others die or get well.

In the current epidemic in West Africa, the number of people to whom each infected person passes the contagion on to is estimated to be around 2. In other words, each person ill with Ebola is now infecting 2 people. To control an epidemic, the reproduction number must fall below 1, at which point ever fewer people become infected. In order to drive the reproduction number below 1 in West Africa, it is estimated that 70 percent of infected people must be quarantined.

Bear in mind that in unvaccinated and uninfected populations, the effective reproduction number for measles, whooping cough, smallpox, and polio is estimated to be between 12-18, 12-17, 5-7, and 5-7 people respectively.

So the 1 person out of 20 who becomes symptomatic after 21 days will likely infect 2 people. The chance that these 2 newly infected people will remain symptom-free for more than 21 days is also 5 percent. As you can readily see, the number of infected people who remain symptom-free for more than 21 days declines steeply with effective quarantine.

But let's say that public health officials impose an even more stringent quarantine. In this case, if 100 people merely suspected of being exposed through casual contact (not body fluids) to Ebola are quarantined for 21 days, presumably 95 of them would either come down with the illness or show no symptoms. If quarantine works, then those who come down with the disease would either survive or die and the symptom-free will be released. In either case, 95 of those who had been in quarantine would no longer be a danger to the public.

What about the postulated 5 who become symptomatic after a 21-day quarantine? Aren't they a menace to the public's health? Let's begin by assuming that the 5 people who become symptomatic (and thus contagious) after leaving quarantine come into contact with 10 people each after their symptoms begin. I am postulating this as a reasonable number of contacts after symptoms occur because if the people who had been previously quarantined for 21 days due to possible exposure to Ebola are like me, they would be obsessively monitoring themselves and run to a hospital quickly if they feel ill. Although they were not in quarantine (self-monitoring instead) both of the Dallas nurses who are now infected with the virus basically did do this. Unfortunately, one nurse who reported an elevated temperature was told not to worry about it and flew off to Cleveland.  

In any case, my stringent scenario implies that 50 people exposed to the folks who become symptomatic after 21 days would subsequently be quarantined. Of the 50 people now in quarantine perhaps 10 would be infected (reproduction rate of 2). The chance that just one of the infected people now in quarantine would remain asymptomatic until after 21 days is low (5% X 10 people = ½ person). But let's assume the bad luck that one does become symptomatic after quarantine and they too come into contact with 10 people. Of those 10 who are now in quarantine, assume that two are infected. It becomes increasingly unlikely (5% x 2 people = 1/10th person) that the infected would become symptomatic after 21 days. And so on through subsequent stages of quarantine.

Anecdotally, three missionaries with SIM USA were quarantined for 21 days after being in contact with Ebola patient Nancy Writebol who was flown from Liberia and successfully treated at Emory University Hospital in August. None of them, including her husband, came down with the disease. It is also the case that the four quarantined people who lived in the Dallas apartment with Liberian Ebola patient Thomas Eric Duncan have so far not fallen ill. Their 21-day isolation period ends this Sunday.

Finally, as Haas notes, deciding what limits to place on quarantine come down to a benefit/cost judgment. At this point, the 21-day period for quarantine seems adequate for effectively protecting public health.

For more background, see my article, "How Cutting-Edge Medicine Might Have Spared Us the Ebola Epidemic."

NEXT: Obama Names Joe Biden's Former Chief of Staff "Ebola Czar"

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. How about Reason imposing a 21-day quarantine on Ebola stories?

    1. EC: Believe me, I hear you.

  2. So, all is not well?

  3. So because this guy is a nut job I should conclude that the government’s handing of Ebola is okay and 21 days is plenty of quarantine time?

    And the vomiting people who are flying in from Liberia?

    And the guy exposed to Ebola who is now on a cruise?

    And the health workers who contracted Ebola while wearing Hazmat suits?

    Yeah. No way Barack Obama could screw this up.

    1. LPW: Microbes observe no borders. The “screw-up” was not acting quickly to enclose the disease commons when the outbreak began in Africa.

      1. So, the initial screw up was not isolating the disease when it cropped up?

        Interesting.

        And quarantine–again isolation is an important aspect of the process now.

        But, for some reason, isolating
        –quarantining– the countries where the outbreak is would not only be bad somehow–several seem to believe it would exacerbate the situation.

      2. “Microbes observe no borders”? Are you freaking kidding me? This sounds like some soundbite from an Obama hack caught not doing one of the few things the constitution empowers him to do: protect the goddamn borders.

        Ever heard of epidemiology? You can stop/slow the spread of infection diseases even before you can cure them. In the middle ages they would saw the fucking handle off the village water pump.

        This is a serious fucking failure from Reason magazine. Given something more serious than a cop shutting down a kid’s lemonade stand, you guys suddenly decide that any danger=hysteria and then end up defending the worst bunch of statist whores in the last century.

        And what do our critics say about us? That in a real crisis we wouldn’t be able to do what is necessary.

        1. LPW-

          how many canned goods to you have in your prepper bunker?

        2. You’re being hysterical. Stop it.

  4. the 21-day period for quarantine seems adequate for effectively protecting public health

    Even more effective than either a 21- or 42- day quarantine would be a suspension on travel visas for foreign nationals travelling from the countries experiencing this epidemic.

    I fail to see the great cost which we would incur from undertaking this temporary moratorium; perhaps commenters could so inform me?

    1. LOSS OF DIVERSITY!

    2. TIT: Would this suspension also apply to folks like Brantly and Writebol who could just as well have infected U.S. hospital personnel, but fortunately did not?

      1. Not relevant to my original question, but let’s consider:

        The number of US citizens infected with Ebola is estimated at less than a dozen, and (at present) is not exhibiting exponential growth. The number of foreign nationals who have contracted the disease is ~9,000-10,000 and growing rapidly. We are obliged to allow US citizens return to the country; quarantining them will be expensive — but not as expensive as allowing free travel to the thousands already infected in their native-born countries. Even if only 1% of those already infected came through, these persons would dwarf the costs of quarantine and treatment for the Ebola-infected Americans.

        And again, what benefit are we supposed to gain so as to offset this cost?

        1. yes. and what if russia or ISIS intentionally infected people to send here because TERRORISM.

          At some point the hype is hype and the reality is that it’s not that bad here and the work should be fixing it where it’s coming from instead of treating entire populations like they’re death incubators.

          1. Obviously it’s not “not that bad here”. Anyone could have told me that. That’s not the point. The point is that there are still several unknowns with the disease, and that our immigration and health bureaucracies have already seriously fucked up in handling a disease that has killed thousands in a short amount of time — we have certainly stacked up a high bill from one case alone. No one can give me any benefits that we would gain in the event wrt foreign nationals travelling here; why are you so afraid of a cost-benefit comparison? If the costs are minimal, then perhaps you can find some minimal benefit to offset this cost. (And no, enshrining the right of infected foreign nationals to unobstructed travel does not count as a “benefit”.)

            1. so, the answer then is to overreact to 1 death and a few infections?

              There are 300 million + in this country. Ebola isn’t even a blip on a blip of a blip.

              I’m not afraid of a cost benefit comparison- and claiming such is just a bad argument.

              However, I don’t waste my time being afraid of cows or sharks or refusing to get on the freeways- all of which are deadlier than ebola in the USA.

              1. I don’t waste my time being afraid of cows or sharks or refusing to get on the freeways- all of which are deadlier than ebola in the USA.

                “I don’t waste my time worrying about how much I spend on candy bars and ice cream — my mortgage is much higher!”

                Unlike the freeway or agricultural products, the travel of infected foreign nationals does not have an established benefit to us (nor is the damage incurred from disease infection incidental). I am providing an opportunity for you or anyone else to step up to the plate and tell us what those benefits are. If you can’t and simply want to chalk up to hysteria what has been a fairly reasonable request for more information, then you are, in fact, afraid of a cost-benefit comparison. For what reason, I don’t know. I blame hysteria.

                1. The benefit is on of respecting universal individual freedom. Trade. Cultural exchange. Tourism dollars. I don’t know the answers- but must something have a benefit that you accept as a benefit to be allowed?

                  I mean, all 9-11 hijackers were saudi’s. What ‘s the benefit of letting saudi’s in to the country? shouldn’t be put a travel ban on people arriving from saudi arabia unless one can show tangible benefits to their entry?

                  Your argument is flawed. your premise is flawed.

                  1. all 9-11 hijackers were saudi’s. What ‘s the benefit of letting saudi’s in to the country? shouldn’t be put a travel ban on people arriving from saudi arabia unless one can show tangible benefits to their entry?

                    Sure, and if we do it that way we get the following:

                    Students who, on net, make us money, follow the law and improve their countries of origin.

                    Workers who contribute to our economy and follow the law.

                    We don’t get:

                    Proven nuts who train with terrorist organizations

                    Layabouts who will drain our taxpayer dollars and contribute to criminal behavior

                    If Al-Qaeda mastermind schemers were an equivalent fraction of the Saudi population as ebola-infected are in Liberia (and growing exponentially), the comparison would be more apt and similar procedures as I’m suggesting would be more warranted. As is, we are talking about a temporary ban until this all blows over, not some sort of ban on all African travel for all time.

                    1. but the saudi terrorists each killed exponentially MORE people than ebola patients here in the usa- which makes them more dangerous and higher risk.

                      so I’m willing to bet that, even with lower numbers, they would require much higher benefits to offset their costs.

                    2. I’m willing to bet that, even with lower numbers, they would require much higher benefits to offset their costs

                      Maybe they do. All that you are suggesting is that there are other potential scenarios are also cost-benefit deficits. I don’t think there’s much reason to consider 9/11 to be a regular, fixed cost of opening shop to Saudi Arabia in the same way that disease would be to opening up to Liberia at the current time — it seems more like a random element. However, if I believed that immigration from the rest of the world really was that detrimental that I couldn’t make a cost-benefit argument for it, I would be far less secure about my open borders position than you seem to be.

                    3. I’m very secure about my open borders position- i was pointing out the lunacy of closing them out of hysteria and knee jerk reactions. Of course closing the boarders to all saudi’s is stupid- just like closing them to all west africans is stupid.

                      One could simply, if one was inclined, make a better case against the Saudis than the west africans. it’s still a bad case though.

                    4. “Spencer|10.17.14 @ 12:16PM|#

                      but the saudi terrorists each killed exponentially MORE people than ebola patients here in the usa- which makes them more dangerous and higher risk.

                      They wouldn’t have killed any had they not been allowed into the country.

                      Anyone saying that a GDP cost/benefit analysis is the only consideration should greet all West Africa travelers at the airports with a big jucy tongue kiss.

                    5. Anyone saying that a GDP cost/benefit analysis is the only consideration should greet all West Africa travelers at the airports with a big jucy tongue kiss.

                      Why don’t you just call him a poppy-head while you’re at it?

                    6. He’s a poopy-head.

                      A big one.

        2. Sick people aren’t flying. Don’t be absurd.

          1. Did Thomas Duncan arrive here in a cloud of fucking green smoke? No. He flew here, a day after trying to take a bleeding out, sick woman to a hospital in Monrovia, only to be told “the Ebola ward is full”, and took her back to her home. Where she died 8 hours later. And then lied his ass off about all of this to the screener in Monrovia.

            Nurse #2 started spiking a fever, a few days after treating Duncan, and then thought it a good idea to hop on a plane back to Dallas. Though you could easily blame the shithead at CDC who said that’d be a great idea.

            Were these people not sick?

          2. You are the dumbest person on this site, and that’s saying something.

      2. humanitarian exceptions could be made. it’s a little unfair to compare diagnosed American aid workers, who the hospitals were prepared for, to Duncan, a non-citizen without a compelling reason to be here and who was sprung on Texas Presbyterian without warning.

    3. ONe more question- how many travelers have entered the USA that a “ban” would have stopped?

      1?

      1. If it saves one child, Spencer…

  5. Very well, then. A 21-*week* quarantine.

    1. With a reported 75 to 100 a day landing at JFK alone it’s a little to early to come to that conclusion.

      WHy are these Ebloa infected Africans wanting to come to the US anyway with our miserable healthcare system.

      Shouldn’t they want to travel to a country with single payer healthcare ?

      I’ve heard the weather is nice this time of year in Cuba.

  6. “In the current epidemic in West Africa, the number of people to whom each infected person passes the contagion on to is estimated to be around 2. In other words, each person ill with Ebola is now infecting 2 people.”

    We also have to consider what we see with our own eyes.

    Sorry to rehash what I’ve said elsewhere, but there have been no confirmed transmissions of HIV from patients to healthcare workers in the U.S. since 1999. Hepatitis transmissions from patients to healthcare workers is, likewise, extremely rare.

    We have one Ebola patient here in the U.S., and he transmits it to two healthcare workers. I understand they weren’t following the Ebola protocols properly, but out in the wild, average Americans won’t be following Ebola protocols properly either. How many of us have a spacesuit at home?

    Still, one Ebola patient transmitted the disease to two professionals in a hospital environment, professionals who were using protocols at least as stringent as those they use for HIV and hepatitis patients–and I’m supposed to believe each Ebola patient will only transmit the infection to two people outside of a hospital environment?

    I know we’re just talking about one patient, here in the U.S., and that’s a mighty small data sample. …but I don’t think that sample empirically supports the model of just two infections per case.

    1. The reproduction rate OVERALL is 2, if I understand Ron’s article correctly. That includes densely populated areas in West Africa that just so happen to have terrible practices and distrust of medical workers actively working to make that number higher.

      1. You get what I’m saying, right?

        Science is a consensus. When new data comes in that contradicts the consensus, the consensus has to change.

        There are some questions about this new data–it’s more like a single point of data rather than data itself.

        However, in West Africa, I’d expect that infection rate number to be higher than it is here in the U.S., where we have superior sanitation, etc. The infection rate number from our first data point here in the U.S., however, suggests that 2 number was too low–even here in the U.S.

        I should point out that the patient in Spain infected a healthcare worker, as well. Even in Spain, we should expect hospitals to provide environments that are less likely to encourage transmission than what we’d see outside of hospitals.

        Science isn’t a rule that tells us that we’re wrong if our data violates the rule. This one data point doesn’t support that 2 number. If we get more data points, I hope they do. What I’ve seen from transmission here in the U.S. so far makes me uncertain of that 2 infections per case rule, however.

        1. Your logic is flawed. Hospitals are the zones of most potential danger- so it should follow that they have a potentially higher than average transmission and infection rate.

          1. Not when there’s only one Ebola patient that’s ever been in the hospital.

            Why would treating the only Ebola patient that’s ever been in the hospital be more hazardous than treating him at home?

            1. NO. He was sick in symptomatic in the hospital longer than he was symptomatic out of it. It’s not about treating him at home- its about the fact that he wasn’t sick- or as sick- at home. He bled, shit, vomited, etc. at the hospital way more than at home. That makes it more dangerous.

              1. Okay, when you’re done running around with those goalposts, take a deep breath, and answer the following question:

                Are you or aren’t you saying that he would have infected fewer people if he’d stayed out of the hospital?

        2. Also, if 2 infections per case was the rule then the whole world is dead soon- so it doesn’t matter.

          1. Did you read the article?

            Other diseases have a much higher number according to the article.

            The fact that Ebola’s is so low is supposed to be reassuring.

            1. yes- and my point is that these numbers are temporary snapshots- not perpetual ratios.

        3. Ken, wipe the spittle off your mouth.

          Science is NOT a consensus, unless you’re willing to concede certain things w.r.t., say, AGW that I suspect you’re not willing to concede.

          *In the three countries where it’s “out of control”*, the reproduction rate is 2. This is with their awful conditions, and with patients and families actively hiding symptoms and running away from doctors.

          Here in the US, the reproduction rate on this SINGLE initial case is still 2 so far. There is one data point here, and it was in the highest-risk environment with a cascade of mistakes contributing (mistakes that won’t be repeated if widespread panic spurred on by people making very similar arguments as you are doesn’t happen).

          In Spain, the reproduction rate stands at 1, again on a single data point.

          Did you read Ron’s article? Like, at all?

          1. + 1 (that’s +2 in west africa… you know…)

          2. Science is NOT a consensus, unless you’re willing to concede certain things w.r.t., say, AGW that I suspect you’re not willing to concede.

            Science is a consensus, but science is not truth.

            If it can’t be falsified, it isn’t science. If it can’t be repeated, it isn’t science. If it hasn’t been peer reviewed…

            The scientific method is all about forming consensus. And a lot of it is about making generalizations from small amounts of data. If the small amount of data we have points us in the wrong direction, the scientific consensus will be and often is wrong.

            The scientific consensus changes in those situations when new data becomes available–the science can be, must be, and is, sometimes, wrong on the truth.

            If you believed that the earth orbited the sun without any scientific reason to think so, then you may have been factually correct–but your opinion was not scientific. Likewise, if new data becomes available tomorrow that shows we were all wrong about heliocentric theory, then what we think today may be scientific, but it’s factually wrong.

            As far as global warming goes, I don’t care what the scientific consensus is so much as I care that whatever solutions we use are and remain capitalist and libertarian. I’m certainly not going to deny what the scientific consensus is right now–even if I think it’s wrong because of the way I interpret the data.

            1. Incidentally, the things that are most likely to be true are the things that have been most thoroughly scrutinized. Again, this reenforces that science is a consensus–and it is never completely settled.

              It’s sort of like a market. That market sets a price, but as new information becomes available, prices change. The most stable prices are from markets with the most access and the most participants giving the available information the most scrutiny. We should feel much more confident in the price consensus we get from highly liquid markets, right?

              Science is like that, too. Given the information that’s available at the time, that consensus may be wrong about the future at any given point in time, but that’s because markets (like science) don’t happen in the future. They’re limited by what we know now.

          3. “Here in the US, the reproduction rate on this SINGLE initial case is still 2 so far. There is one data point here, and it was in the highest-risk environment with a cascade of mistakes contributing”

            I didn’t detail this because I thought it was implied:

            1) Would you expect the transmission rate to be higher in the U.S., where we have relatively excellent sanitation, or in West Africa, where they have relatively poor sanitation (if any at all).

            2) Would you expect transmission rates to be higher in a hospital setting (where no other Ebola patient has ever been before) or out somewhere in urban America?

            ………………

            Given that I expect transmission rates to be lower in the U.S. and lower in a hospital than out in urban America, I’m saying that the first data point suggests a transmission rate much higher than what’s been recorded in Africa–making me question that assumption about the 2 infections per case.

            There could be all kinds of things in West Africa masking those infection numbers. Everything from, say, infant mortality from other causes, to civil wars killing infected people, to local cultural reactions. I don’t know. I haven’t seen that data. I just know that given the difference between a U.S. hospital and what started out as rural Africa, our transmission rates should probably be much lower than theirs. …and that makes me question the validity of that number itself.

            1. Ken, you are taking ONE case – the FIRST one – and extrapolating it to apply to all future cases. That’s insane.

              Besides which, the reproduction rate is STILL 2. It’s 2 in the very place it’s been rampant AND the place it’s been studied in its current form since at least December. The aggregate rate there is 2.

              The transmission rate is likely to be lower in the US over time precisely because people have been more effectively taken care of than in Liberia or Guinea.

              If nurse #1 OR nurse #2 dies or gets well without any further transmission from them, we’ve already cut the rate below the WHO number from Africa.

              1. “Ken, you are taking ONE case – the FIRST one – and extrapolating it to apply to all future cases. That’s insane.”

                It isn’t insane.

                It would be improper to do so if I hadn’t pointed out that we’re just talking about one data point, but I pointed that out–didn’t I.

                1. You did point it out, yet you went ahead AS IF IT WERE INEVITABLE that it would increase, and probably wet yourself right then.

                  1. There’s this thing called “psychological projection”:

                    http://en.wikipedia.org/wiki/P…..projection

                    “spittle”, “wet yourself”: these things are in your mind.

                    1. I’m not the one wildly extrapolating based on one data point.

                    2. I’m not wildly extrapolating anything.

                      I’m saying that if the whole house of cards depends on that two infections per Ebola patient criteria, and that two infections per patient criteria was coming from statistics in West Africa? then given that the number should be lower in the U.S. but wasn’t, …

                      Jesus Christ, I’ve already gone through this. If you haven’t figured out what I’m saying yet, keep rereading what I wrote until you do. There are other people bringing the same number into question down below for other reasons, too. Have you read what they wrote? Suffice it to say, there are good reasons to question that number.

                      …and one patient infecting two healthcare workers despite all of our advantages here in the U.S. is one of them.

            2. You ought to expect the reproduction rate to be higher *inside* a hospital, because the various fluids exuding from the victim are being handled almost immediately by a captive audience of medical personnel who then make contact with the rest of the patients.

              Outside of a hospital, symptomatic victims will be more likely to self-quarantine (remember, this is like a really bad flu; you’re not going to want to leave your bed, much less your home) and anyone living with the victim will be relatively isolated from people outside the home for purposes of transmission. Keep in mind, the ebola virus can’t live outside the body for much over two hours, and it’s only contagious when the carrier is symptomatic, i.e. not inclined to go to the mall.

              1. “Keep in mind, the ebola virus can’t live outside the body for much over two hours,”

                Bullshit. I saw one hitchhicking on I-10 East just yesterday.

                I made a quick Uee but never could get a clean shot before two hippies in a old blue Ford P/U had picked it up.

      2. Timon, has there ever been an Ebola zaire outbreak before in an urban center like Freetown or Monrovia? I had thought that, most of the time, these outbreaks occurred in isolated areas, where it was easy to further isolate the sick? True, a guy in the throes of a hemorrhagic fever isn’t going to want to do much other than lay down and die, which is going to cut down the number of people who want to get near him, but that isn’t what’s happening in the cities of those three African countries, is it? It’s spreading to people who have had only limited contact near the dying patient. I’m not sure R0 of 2 is appropriate for this particular outbreak.

        1. People are being very superstitious and are employing very bad measures for treating the sick/disposing of the dead.

          The two people who contracted it from Duncan most certainly did NOT have limited contact.

          1. People are being very superstitious and are employing very bad measures for treating the sick/disposing of the dead.

            Not to mention raiding aid centers and carrying off their loved ones from them.

            I can’t blame them though. Would you trust the governments of those places, when all you see is a bunch of guys in moon suits come in and cart off your relative? Then two days later, another guy in a moon suit comes by to tell you s/he croaked.

            The thing that makes me feel better about all this is that, even cooped up in an apartment where Duncan was having bouts of diarrhea (for the life of me, I’m never going to spell that word right the first time.), his relatives haven’t caught the bug. Reuters had a chat with them on the 15th, so it’s not like your parents telling you that Rover’s been taken away to a farm to go chase chickens all day. So, if his GF—who I’m stunned hasn’t come down with this—and her relatives, who’ve been by him a lot closer than any airline passenger would get to that nurse: if they haven’t caught it, this bugger seems pretty hard to catch. Unless the carrier is just about dead and gushing everywhere.

  7. Douglas Adams was right: The answer is always 42.

  8. Wanna know how to not get ebola?

    Don’t touch the bodily fluids of people with ebola.

    out of the hospital environment, that’s pretty easily done. Inside the hospital environment it should also be easily done, but people made mistakes.

    1. If it’s really that simple, then why is the government going to the trouble to track everyone on that flight the nurse flew on when she had just a mild fever?

      Because I seriously doubt people on that flight were going out of their way to touch her bodily fluids.

      1. Because people are hysterical and stupid and they demand that the government does something.

        People don’t want to die- and they want to know that other people are making sure that doesn’t happen.

        There’s no coincidence that those who have it here are health workers and not his family who lived with him but didn’t touch his fluids.

        1. It’s not a coincidence, but it’s still an avoidable tragedy.

          1. yes- they could have easily avoided it by following proper procedures and protocols.

            1. If everyone would just do what they are supposed to and follow proper procedures and protocols…seems like that kind of reasoning would fix almost every bad thing that has ever happened to humanity.

              Now, if we can step away from wishing for unicorns…

            2. following proper procedures

              This is what you hysterics don’t understand. Government bureaucrats, BUREAUCRATS I SAY, have given instructions, which do change daily, about the prevention of the spread of this disease. If human beings will simply follow every instruction given without any mistakes, nothing can happen.

              1.Issue “procedures”.
              2.
              3.Utopia!

              1. +1

                …and pardon me for posting the same thing twice, but I think some of our friends, here, are having trouble recognizing the difference between what specialized healthcare workers in specialized hospitals can do when they’re wearing plastic space suits, one the one hand, and how the rest of us, on the other, are likely to fare out here in the wild during an epidemic.

                Because specialized healthcare workers using specialized equipment can dodge Ebola doesn’t mean the rest of us don’t need to worry about an epidemic.

                Sounds like we need to do what we can to make sure that epidemic never reaches us–instead of letting commercial jets land here daily from Monrovia.

      2. “Because I seriously doubt people on that flight were going out of their way to touch her bodily fluids”

        I don’t know about that. Have you seen a picture of her ? She’s pretty hot.

        There were two male strippers sitting 3 feet from her on the plane (in their words), I bet they would have been happy to touch her bodily fluids.

        Over and over.

      3. Dude, the “ebola czar” is Joe Biden’s ex-campaign aide. We’re not dealing with good decision-makers at the federal level.

        And that I have to point that out tells me you’re new here, Mike.

        1. “Dude, the “ebola czar” is Joe Biden’s ex-campaign aide. We’re not dealing with good decision-makers at the federal level.”

          Yes, and the Bass family sits on the board of directors of that Hospitals corporate parent!

          Can you imagine if it was George Soros sitting on that board?

          Hey, the hospital has now apologized over and over again. They made MANY stupid mistakes…

          This is not hard to imagine in a place like Dallas where money talks and poor people walk. The Bass Family one of the original Texas Oil Men who scorned the Big Gubment and all those silly taxes and regulations. They are tied in with the Bush family, etc. and a lot of right wing causes.

    2. Yeah, it’s totally not hard to not touch someone’s bodily fluids.

      I mean, it’s not like people wipe their noses with their hands and then touch door handles and shopping carts.

      1. Or sneeze all over the place.

        1. Shake hands when meeting, get patted-down at the airport…

      2. well, to play it safe how about you don’t stick your fingers in your mouth after opening strange doors until you’ve washed your hands.

        1. Or not have a microscopic abrasion on that hand you touched the door handle with.

    3. “Wanna know how to not get ebola?

      Don’t touch the bodily fluids of people with ebola.”

      One more time…

      There has not been one confirmed case of a transmission of HIV from a patient to a healthcare worker in the U.S. since 1999.

      We’ve had a million HIV patients treated by millions of healthcare staff, and not one of them has contracted HIV from their patients for 15 years.

      The healthcare workers who were infected with Ebola were, presumably, followed protocols at least as good as they always do with every patient to protect themselves from HIV.

      Shot of being infected with HIV from a patient using HIV protocols: more than a billion to one.

      Odd of being infected with Ebola using the same protocols: one in three?

      Those protocols were insufficient to protect them from Ebola.

      If you don’t want to get HIV, don’t touch bodily fluids infected with HIV. If you don’t want to get Ebola?

      Just not touching any fluids infected with Ebola apparently isn’t good enough. Ebola survives in different fluids at different times, and survives on various surfaces for various lengths of times. Use the kinds of HIV/Hepatitis protocols you’re referring to, and your odds of getting Ebola are still pretty good.

      1. you are wrong. HIV patients are typically not vomiting and shitting all over the place to be cleaned up by nurses. HIV patient fluids- and it’s not in sweat or saliva- are much more easily managed.

        The two things are not the same- also, what about HIV transmissions during the 80’s when it was new to us? It’s just a bad argument.

        1. “you are wrong. HIV patients are typically not vomiting and shitting all over the place to be cleaned up by nurses.”

          You don’t bother reading what people write.

          My comment was in response to the suggestion that simply avoiding contact with infected bodily fluids would be sufficient to protect someone from Ebola–like all nurses do with every patient to protect themselves from HIV.

          And, incidentally, you are wrong. AIDs patients are often sneezing, coughing, have diarrhea, etc., too. …and there hasn’t been one confirmed transmission from patient to healthcare worker in 15 years.

          1. HIV does not get transmitted that way!!!

            the fluids one must touch to contract HIV are much more specified than those that must be touched to contract ebola.

            Sweat and vomit do not transmit HIV.

            Even if it did- comparing rates from the first infection in the US to data 10-20 years after the first infections of HIV is apples and oranges.

            1. That would make it much more dangerous, wouldn’t it!

              Other viruses can survive outside the body for a long time by such vectors. I believe Hep B can survive outside the body for days.

              Point is that using the same protocols healthcare workers have used to successfully protect themselves from hepatitis and HIV for more than a decade are insufficient to protect them from Ebola.

              And that’s still my point regardless of where you’re trying to run with those goalposts.

              1. the goalposts are where they’ve been from the start- don’t touch the bodily fluids of someone with ebola. those who have been infected here didn’t follow protocols.

      2. Seems to me that if isolation is an effective local procedure then moving the isolation to some sort of temporary travel ban FROM certain areas would at worst buy time.

        Falling on the puritanical sword of open borders regardless of circumstances seems a bit primitive to me.

        1. Even when Cavanaugh used to make his open borders argument around here, it was always with the observation that immigrants should have to provide some kind of assurance that they don’t have a dangerous communicable disease.

          The only legitimate purpose of government is to protect our rights. We use the military to protect our rights from foreign threats. Why shouldn’t we use our discretion to grant visas to protect us from the foreign threat of Ebola, as well?

          If there were credible reports that ISIS was sending Ebola infected individuals to the United States, there are plenty of people here at Hit & Run, the Republican House, and Obama’s White House that would immediately call for sending troops to take out ISIS. Seems like denying people visas from West Africa (for a while) is a much lesser reaction to, more or less, the same threat.

          I mean, it isn’t the intentions of the carriers that makes a difference, is it?

          1. And let’s not talk about the Enterovirus that’s going around, killing…? Well, the CDC oddly isn’t listing that stat. They are mentioning that there have been 825 cases so far this year. A disease fairly uncommon here, and much more common in Latin and South America. (A question: is D-68 more prevalent in children than in adults?)

            Hmmm, is there anything different the Feds have been doing the last few months with Latin and South American immigrants that they haven’t done in the past?

            I’m sure everyone involved has had the best intentions though.

      3. HIV is blood-borne; ebola can be transmitted via any bodily fluid provided said fluid makes contact with the eyes, nose, an open wound, etc. The two are very different.

        1. Hepatitis can be like that, too. Actually, it doesn’t even need to be in a bodily fluid; it can survive outside the body for days.

          Anyway, you’re saying this is why Ebola is even more dangerous than HIV, right? Because that’s what I was saying, too.

  9. The number 2 seems unlikely since people with protective gear are getting infected.

    1. 2 reasons:
      1) they were dealing with him during late stages and in constant contact.
      2) They didn’t follow protocols and do what they were supposed to for infection prevention.

      1. Ummm, it has gotten almost no attention in the American media, but Doctors Without Borders has had at least 16 of their people infected and nine killed, and they follow the protocols to the letter.

        1. well, obviously not. It’s documented that if you have no contact with bodily fluids of people infected with ebola you will not get ebola.

          “How did two nurses get infected?

          From the beginning of the Ebola epidemic in West Africa, it’s been clear that health care workers such as doctors and nurses are at high risk of infection. That’s because Ebola spreads by close, physical contact with a patient’s bodily fluids. Taking care of a patient with vomiting and diarrhea is very messy, and that’s how the virus can spread.
          But they were wearing protective gear

          Protective gear works only as well as the techniques used to put it on and take it off. The virus doesn’t spread far, but fluids from a very sick patient are highly infectious, and it only takes a droplet in the eye, up the nose or into the mouth to cause infection. Health workers also use needles, which can slip and cause what’s called a needle stick injury. If an infectious droplet is left on protective gear, someone taking it off could touch it and then carry the virus to her eyes, nose or mouth without even thinking. Several accounts suggest that Thomas Eric Duncan, who died at a Dallas hospital last week, was very ill when he began receiving treatment. “

          1. “In laboratory settings, non-human primates exposed to aerosolized ebolavirus from pigs have become infected, however, airborne transmission has not been demonstrated between non-human primates Footnote 1 Footnote 10 Footnote 15 Footnote 44 Footnote 45. Viral shedding has been observed in nasopharyngeal secretions and rectal swabs of pigs following experimental inoculation Footnote 29 Footnote 30.”

            “In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20?C and 25?C and 30?40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53.

            http://www.phac-aspc.gc.ca/lab…..la-eng.php

            It’s one thing to question the data because it doesn’t follow the scientific consensus, lots of people do that, but you don’t seem to know much about the scientific consensus either.

            There are still a lot of uncertainties out there, and you keep talking about this stuff like it’s HIV or hepatitis.

            It isn’t.

            1. What, no quote from the article before “another study” that shows that one study couldn’t get any active ebola virus at ambient temperature at all?

              I have read this and understand the science. The science says it’s not something to worry about.

              The facts are this- ebola will not kill more than a few people at most in the united states. a few people dying is sad- but it’s not something I’m worried about and I don’t think we need to worry about it.

              I also, however, look both ways before crossing the street.

              1. No quote from the article before “another study” that shows that one study couldn’t get any active ebola virus at ambient temperature at all?

                I wasn’t going to paste the whole thing. I gave you the link. You can quote whatever you want.

                What I wanted to show is the part that shows the “science” (as you call it) is a little more uncertain than you seem to be willing to admit. In FACT, you seem to have already accepted certain conclusions are remain dismissive of anything that doesn’t support your predetermined conclusion. That isn’t science. That isn’t fact.

                “The facts are this- ebola will not kill more than a few people at most in the united states.”

                You used that word “facts”. I do not think it means what you think it means.

                That is your opinion. Facts have an important time component. They tend to happen in the present or the past–not so much in the future.

                1. Sorry, that is a conclusion drawn from the facts.

                  The facts are this- no people infected with ebola in the USA have died. The only people infected with ebola in the USA were health workers who didn’t properly follow protocol in dealing with the bodily fluids of someone dying from ebola.

                  So, factually, unless you are a healthcare worker in the USA who did not properly follow protocol when dealing with the bodily fluids of someone dying from ebola- you don’t have ebola.

                  The facts are also this- you are very, very, very, unlikely to get ebola in the USA.

            2. You’re right. It’s not HIV or Hep. You’re way more likely to be killed by either.

              1. You mean given the current infection level of Ebola in the United States?

                Yeah, I suppose, but that’s not what we’re talking about, are we? We’re talking about what would happen if there were an Ebola epidemic in the United States, right?

                Given that I’m probably not getting Hepatitis B unless I’m an IV drug user or have sex with a lot of people I don’t know very well, the chances of me dying from Ebola are actually higher than they are for HIV or hepatitis B.

                …especially given that healthcare protocols are effective against HIV and hepatitis–and the same protocols aren’t effective against Ebola. If your average healthcare worker isn’t able to protect themselves in your average hospital, what chance do I have out here in the wild?

                I think some of you are having a hard time grokking the difference between healthcare workers in specialized hospitals and the risks to average people during an epidemic. Because specialized healthcare workers in specialized hospitals can dodge infection using plastic spacesuits and special protocols, doesn’t mean the rest of us don’t have anything to worry about.

                1. “if there were an Ebola epidemic”

                  Except there won’t. The social conditions that give rise to an widepsread epidemic in Africa simply do not exist in the US. Period.

                  1. “The social conditions that give rise to an widepsread epidemic in Africa simply do not exist in the US.”

                    I hope you’re right about that, but I don’t know whether that is true.

                    I think we should suspend giving visas to people from West Africa for a little while, anyway. Just seems prudent until we get some of these questions answered, doesn’t it?

                  2. “Except there won’t. The social conditions that give rise to an widepsread epidemic in Africa simply do not exist in the US. Period”

                    This is very true – but there are parts of this nation’s underbelly which resemble some third world countries. Those are likely the places we have to worry about.

  10. Wanna know how to not get ebola?Don’t touch the bodily fluids of people with ebola.

    Microbes observe no borders.

    I love how it’s both unstoppable or nothing to worry about depending on whether we’re talking travel ban or contagiousness. I feel like John Matuszak. /chickenshit cocksuckers

    1. both things can be equally true. That microbes observe no borders is true.

      That you do not contract ebola without touching the bodily fluids of people with ebola is also true.

      I don’t see a problem here.

  11. people infected with Ebola pass along the illness only after they become symptomatic.

    People keep saying this as if it’s supposed to reassure. But what are the first symptoms of ebola?

    Fever, headache, muscle pain. Notice how bleeding from all orifices and uncontrolled diarrhea aren’t on that initial list?

    Sweat is a bodily fluid–and feverish people sweat. Saliva is a bodily fluid–and is present on an infected person’s drinking glass. Any sneeze, any cough puts more bodily fluids out there.

    And all of this before anyone has any clue that it might be ebola.

    1. A: In the stringent quarantine scenario, everyone knows that they’ve been in contact with an Ebola patient, thus a headache might be a tad more worrisome to such people.

      1. hysteria is definitely more infectious than ebola.

        1. It’s documented that if you have no contact with bodily fluids of people infected with ebola you will not get ebola.

          I’ll bite: Where is this documented?

          1. Also, given the stuff lives for a limited, though not zero, time in droplets, and the concentrations of virus are in the ballpark of something silly like 100 million (virii? Get Cyto to explain.) per mL, and it only takes something ridiculous like 1-10, hell, let’s say 100, virus particles to give you the disease….[takes breath] How would you know you hadn’t touched any fluids?

            Let’s assume 99% of the viruses in that droplet have been degraded environmentally. Let’s also assume that it takes a 1000 particles to infect you. Then the droplet only has to be a microliter big.

            Still sure you haven’t touched one? Inhaled one?

      2. The two big reasons why we stopped having essentially any more problems with HIV transmissions between patients and healthcare workers for two reasons.

        1) Insurance companies started pressing hospitals to discipline nurses for recapping needles.

        Needle sticks were a big problem.

        2) They stopped flagging HIV patients.

        Nurses were letting their guards down when they saw a patient wasn’t flagged for HIV. Once they stopped flagging HIV patients on readmission, the nurses had to start treating every patient like they were HIV positive.

        Transmission rates dropped like a rock ever since.

        ***I don’t think we can do that with Ebola. We can’t treat every patient like an Ebola patient.***

      3. Yes, Ron, but we’re not in the stringent quarantine scenario–we’re in the ‘it would be wrong to interfere with the free movement of the infected’ scenario.

  12. One person died???

    Quick! Impose a government restriction!

    WON’T ANYONE THINK OF THE CHILDREN!

    1. Just wait ’til it kills a white person. Imagine what the calls for change will be then!

      😉

      1. Jesus H. Christ. Fucking racebaiting bullshit.

      2. Worst case scenario is it infects a pretty white blonde girl. Full news cycle panic.

  13. So the kind of heuristic quasi-modeling the author is engaging in is pretty worthless for any sort of real analysis. My guess is that with large lag times the 1 to 2 ratio would eventually go chaotic in a densely populated area. The point is that doing a “thought experiment” for a non-linear problem is probably going to end in tears.

    1. I feel like we’re getting into our 17th round but whatever.

      No it won’t. The R naught projections aren’t based on population density but rather the transmission of the disease. Furthermore if density is what led to a higher R-value then we would have seen it in places like Monrovia or Freetown. We haven’t.

      I’ll start worrying when people in the US hug and wash dead bodies or we just shut down 80% of our hospitals.

      1. Explain how transmission rate is independent of density. In fact, after reading this paper I get the R0 = d*c*p where

        d = duration of the infection
        c = contact rate with susceptible hosts
        p = transmission probability

        Seems like c and p are a function of population density. I think you are wrong.

        Largish lag times plus travel that is a tiny fraction of the lag time plus doubling is going to give you some unintuitive results.

        Ebola was not a problem (well not a large scale problem) when it was confined to small villages with long travel times between villages. It just burnt itself out.

        1. All of which was factored in when arriving at the R-value.

          The argument that the “real R-value” must be higher because the US is more densely populated than Africa assumes a world in which,

          A. There are no densely populated centers in Africa (despite a case in J-burg, SA)

          B. Scientists since the 70s did not factor this in.

          Furthermore “c” is likely to be higher in Africa because here in the US, symptomatic people go to a hospital, even if they have no money. In Africa they just stay home or continue going about their business, infecting people they come in contact. Furthermore “c” in Africa is likely influenced by the rate at which people come in contact with dead bodies. Due to burial traditions, it is very common for people to come in close intimate contact with a dead or dying person. In the US this is unheard of.

          Lastly, while “p” is influenced by density, it is more influenced by transmission mode. This is why measles is R-18.

          This idea that this will rapidly change in the US if it spreads beyond the at most dozen people who will/have/could catch it is a bit Alex Jonesque for me.

          1. You said “The R naught projections aren’t based on population density”

            Since R naught is clearly a function of density, how can your statement be correct?

  14. If you disagree with Ron Bailey’s article you are an ignorant hysteric and need to shut up. Ebola is not a threat to America.

    1. If you disagree with Ron Bailey’s article you are an ignorant hysteric and need to shut up. Ebola is not a threat to America.

      Powerful argument their, dude. Good thinking hoping that any counter arguments might “shut up”. Wouldn’t want to have any of your religious beliefs challenged.

      Might I also suggest a book burning?

      1. If ebola fails to become an outbreak in the US, will you then credit the Obama administration? Or will you do that weird thing rightwingers do and promptly forget all about it and move on to the next bullshit?

    2. All Hail Ron Bailey !

  15. Ron seems mad that right after his stupid “Nobody has been infected yet so we’re fine” article 2 people were infected in quick succession.

  16. Man, this is really separating the real libertarians from the pot-smokin’ Republicans, isn’t it? We’ve got two infected nurses who were in direct contact with an ebola patient and within a week half the Reason forums want the TSA to start checking people’s temperatures. Jesus, some of you are actually using the exact same reasoning that got us the USA/PATRIOT Act. Seriously, unclench the cheeks, release the pearls, wash your hands, and take it easy. The chances of anyone reading this contracting ebola are statistically insignificant. You’re more likely to grow another head.

    1. Libertarians are pro Ebola.

      Who knew ?

    2. I haven’t called for the TSA to do anything.

      I think the State Department should suspend giving visas to people from hard hit areas for a while.

      1. This is not going to make you feel better, Ken. Obama Plans to Let Ebola-infected Foreigners Into U.S. for Treatment

        The link’s from Judicial Watch, and I have no idea where they fall on the scale of “do I trust them, even a little? Does Alex Jones think they’re crazy? Will Art Bell hang up on them?” Anyway, the blurb is small, and this quote pretty much covers the news:

        Specifically, the goal of the administration is to bring Ebola patients into the United States for treatment within the first days of diagnosis.

        It is unclear who would bear the high costs of transporting and treating non-citizen Ebola patients. The plans include special waivers of laws and regulations that ban the admission of non-citizens with a communicable disease as dangerous as Ebola.

        1. I linked to that exchange earlier today from that head of the CDC, where he kept saying that the reason they don’t want to restrict flights is so they can fly people back here to the U.S.

          https://reason.com/blog/2014/10…..nt_4838984

          We were speculating as to why that is, now we know why? I suspect Obama thinks keeping Africans out of the country is racist or something.

          Progressivism is all about using the coercive power of government to force people to make sacrifices for the common good, and I think Obama sees using the power of the U.S. government just for benefit of Americans as being inherently selfish.

          This doesn’t really surprise me.

          I hope it angers a lot of Americans.

          I’ve been fighting a lot of Republicans lately trying to explain that the purpose of the United States military isn’t to operate in the best interests of the Iraqis, and I hope people on the left can get their heads around the same concept. As much as I feel for the people of West Africa, I think U.S. policy should be about the interests of America–not West Africa–and if Barack Obama is putting the American people in danger of an epidemic to benefit the people of West Africa, then…

          He’s a traitor to his country.

        2. If this is true, I swear…

          Over the years, I’ve made fun of an awful lot of people for calling to impeach both Bush and Obama. It’s always a bad idea politically. But they usually want to do it over something terrorism related, and I’m always pointing out that the president is going to win that fight in the media. Anybody that tries to impeach a president for (as far as he’s concerned) keeping America safer from terrorism is gonna lose in the court of public opinion.

          If Obama starts bring commercial airliners full of Ebola patients to the U.S., I’m going to be the first guy in line to call for impeachment. Like I said, if terrorist sent a plane load of Ebola patients to the U.S., we’d call it an act of war and invade whatever country they originated from. If a sitting president bring a plane load of Ebola patients into this country on purpose, he has no business being the President of the United States.

          1. If, God forbid, this happens, and health care workers here get infected—doubtful unless they run out of beds, which couldn’t happen since the top facilities for BSL-4 shit like Ebola zaire have 20 beds between them…that will be tragic. We’ll lose a few people. By the numbers, we’ve a 1 in 4 chance or so for not losing either of those nurses. It maybe around 1 in 10 that we won’t lose one.

            But, and this is important, because it hasn’t happened yet even with the fuckups in Dallas, if we get tertiary infections from those patients, then impeachment will be the best thing he’ll have to look forward to.

            1. “if we get tertiary infections from those patients, then impeachment will be the best thing he’ll have to look forward to.’

              Yes, Obama should be impeached for his failure to declare marshall law, put millions of military on the streets and forcefully retain anyone remotely connected with this outbreak.

              1. On the other hand, if it the disease is contained and we can count the dead on one or two hands, we should also blame Obama and get rid of him or diss him.

                It’s a new Ebama game – heads you lose, tails I win.

        3. I think it is entirely clear who “would bear the high costs.”

    3. Wait – do I have the pearls between my cheeks?

Please to post comments

Comments are closed.