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Strongsidejedi got the TFmetalsreport to start another Ebola thread.

Pay close attention to the “more than 12 Ebola contacts are too big for local authorities to track/monitor” comment with the thought that there are now more than 100 in Dallas.

See also below for policy suggestions 1-5, none of which have happened.

He has harsh words for the pissinontheroses blog for technical inaccuracy and alarmism,

http://www.tfmetalsreport.com/forum/6180/ebola-conus-ebola-3-thread

Strongsidejedi

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@Turd Ferguson - OK I”m in - Here’s your answer Craig
@Craig,

Thanks for putting the site on notice for this thread. Seriously, Craig, this thing has the potential to neutralize a significant portion of our economy in the next 90 days.

Last night, I sent Cris a private email where I raised the concern that MENA radicals could intentionally infect themselves in Sierra Leone, Guinea, or Liberia; board a flight to the US; land in the US; spread the Ebola virus among the civilian population; and then leave the US after spreading the germ for one week; and then watch as our health system copes with a major national disaster.

The national security apparatus of this nation is set up to handle military threat and not biologic.

I have privately warned people in my area about the instability caused by HMO managed care type of medicine. I stand by that concern to this day.

The reason the patient was turned away from the Dallas area hospital on 9-26 needs to be explored in great detail. My guess is that the ER and primary care physicians were following established protocol for any feverish patient. Details need to be stated on his presentation and management on that day. But, they won’t. The reason is that the medical center is on the hook legally.

The situation in Dallas is serious because (a) CDC is not stating conclusive information the index case’s travel history and (b) US FDA has not prepared the nation’s healthcare system with diagnostic test kits to quantify on a regular basis the presence or absence of the virus in a patient.

In the first Ebola thread, SteveW chimed in with significant lab experience. SteveW and I figured out that you can at best run possibly 100 separate samples in an afternoon. We concluded in that thread that the US had to push pack the diagnostic kits to local jurisdictions in August.

As we were continuing to monitor the outbreak and behavior of the virus in Africa, we had interference in that original thread. My view is that the interference was from individuals who are not trained in infectious disease, do not know the epidemiologic protocols to intervene, and only had delusional views to block discussion. I am troubled by these individuals because they stopped our discussion before we could position policy and recommendations to prevent the current situation today.

Had we been able to continue the discussion publicly, it would have been clear to the national journalists who were frequenting the prior thread that the CONUS was at risk.

In the prior thread, Cris and I both concluded that a military option was required to secure travel from Liberia, Sierra Leone, and Guinea to other nations. Initially, I disagreed with Cris’ reaction but he had successfully predicted the behavior of the epidemic in the three nations. I noted that Nigeria had a shot at containment. This is where the 12 case tipping point observation originates.

When Cris is describing a 12 case tipping point, I agree with him. The number of possible infected contacts requiring screening and testing expands exponentially. Once you get beyond the 12 case tipping point, the ability of the local system to track the thousands of exposed people becomes nearly impossible.

Nigeria was able to contain their problem because their health system was not functioning on the day Patrick Sawyer arrived in Lagos. The physicians were on strike due to employment and labor issues in Lagos. This meant that the number of healthcare workers exposed was actually only 1 or 2 people. Unfortunately, those people also died 3 weeks later.

Hypothetically, if there are 10 contacts of the index case, then the ten cases might have another ten contacts who were possibly exposed in the “second generation” of the spread of the communicable disease. Therefore, when you get beyond the second generation to the third; you are talking 1000 contacts who require tracking.

The video that you posted makes ridiculous comments. The person commenting appears to lack medical experience and has no concept of how infectious disease occurs. He shows a chart that is a graph of days from hypothetical exposure to initial symptoms. However, there is seldom a singular event where a patient is exposed. Usually, there are a number of exposures or a gradual exposure over time. The person gets sick because the person’s immune system is unable to fully neutralize the infectious agent.

It is more appropriate to consider a person’s exposure over time and the strength of the person’s immune system in a tug of war. As the exposure builds, the person’s specific immunity would take 1 to 2 weeks to catch up. That is not possible. This is the reason that we immunize children and adults against infectious diseases. They can be healthy and react to the vaccine first. There is little lag in that situation and the person successfully fights off the offending virus or bacteria.

The author in the video suggests that the index case has a 50% chance of contracting the illness on the flight. That is technically flawed. First, it is impossible to know if another case is on the flight even at this time. Such an analysis would require the authorities to release the detailed flight itinerary. They haven’t. Second, if there were another person on the flight who was ill, they would be ill now in the destination city of the person. There has been no outbreak of Ebola of this sort.

Cris raised this issue in the original Ebola thread. I was not yet ready to sign off on the threat. Cris raised the issue of contagion on the plane flights and in the airports. Even with the significantly ill Nigerian index case, there were no confirmed cases from any airline flight or the airport itself. Therefore, the contagion risk in the aircraft cabin is very low.

It is far more likely that the index case became exposed in Liberia, boarded the flight as an asymptomatic person, exited the flight 1 day later with jet lag, never suspected that he was ill until 2 days later when he was getting worse, and then finally got to care four days after arrival.

If a second case is observed in Dallas in the next 72 hours, the President should act via Executive Order to declare a state of emergency nationally

1. Waive CLIA requirements for primary care, urgent care, and ERs nationally.

2. Push Ebola diagnostic kits to the ER, primary care, and urgent care settings nationally.

3. Immediately increase regional staffing at CDC networked testing centers for thousands of the diagnostic kits to be run daily.

4. Waive HIPPA requirements nationally and until the emergency is over such that national and regional news media can report personal information on the individual patients. This is a must-do because the speed of identification of the contacts is a critical element.

5. Set aside funds required for states to react immediately to enhance civilian healthcare systems to comply with pushing diagnostic kits for the seasonal flu. Because initial symptoms of Ebola can match influenza and other viral illnesses, diagnosis of influenza or other communicable disease is now required in a very timely fashion. This can only be done with the rapid diagnostic kits in the clinical setting. Delays in processing by for-profit lab companies will only spread potential contagion to additional carriers and labs.