Has The CDC Been Too Blasé?

Yesterday, the Centers for Disease Control and Prevention issued new guidelines for people at risk of coming down with Ebola, meaning primarily health workers returning from West Africa:

On Monday, the CDC broke down people in the orbit of Ebola into four categories. Those at highest risk are anyone who’s had direct contact with an Ebola patient’s body fluids, including health care workers who suffer a needle-stick injury during a patient’s care. For those people who are at highest risk and asymptomatic, the CDC recommended restrictions on commercial travel or attendance at public gatherings. The guidelines were not specific about where a person should stay, but officials said they meant home or hospital isolation. For those with some risk, like who lived in a household with an Ebola patient but didn’t have direct contact, travel restriction can be decided on a case-by-case basis, government officials said.

But states are not bound by these guidelines and are free to implement their own protocols, as several more states have done following New York and New Jersey’s lead:

Virginia Gov. Terry McAuliffe (D) and Maryland Gov. Martin O’Malley (D) held separate news conferences Monday announcing their plans for Ebola containment. Travelers from Guinea, Liberia and Sierra Leone will be assessed by health workers and asked to agree to a 21-day monitoring protocol. Higher-risk travelers will be visited at home by health workers and asked to stay there. Individuals refusing to sign the protocol agreement or not following the rules could be involuntarily quarantined, officials said.

Georgia Gov. Nathan Deal (R) on Monday announced a more aggressive Ebola-containment policy. Travelers from West Africa who don’t show symptoms, but who are considered high risk because of “known direct exposure” to Ebola patients, will be subject to quarantine at a designated facility, Deal’s office said.

With military personnel helping fight the epidemic in Africa, the Pentagon is also taking a more cautious tack than the CDC:

Army spokesman Col. Steve Warren did not call the move a quarantine in a statement issued on Monday. Rather, he said that “about a dozen” troops were being monitored. “Out of an abundance of caution, the Army did direct a small number of military personnel (about a dozen) that recently returned to Italy to be monitored in a separate location at their home station (Vicenza),” Warren stated. “There has been no decision to implement this force wide and any such decision would be made by the secretary of Defense. None of these individuals have shown any symptoms of exposure.”

According to reports, the soldiers are being monitored away from their families for 21 days. The Army refuses to call the isolation a quarantine, although separating people for medical reasons meets the Centers for Disease Control and Prevention’s definition of quarantine.

Allahpundit ridicules the CDC’s recommendations, which in his opinion are “one notch more casual than [they] should be”:

To this day, if I’m not mistaken, Kent Brantly and Nancy Writebol don’t know how they contracted the disease in Africa; Doctors Without Borders, which naturally follows strict protocols in treating patients, has nonetheless seen 16 staffers come down with it, nine of whom died. Presumably Spencer had no reason to think he’d contracted it or he wouldn’t have gone bowling. If even trained professionals are getting caught by surprise in their exposure, why would the CDC err on the side of less quarantine once they’re back home? The public’s confidence in the agency is going to get much, much worse, needless to say, if we end up with another transmission from the “low” or “some risk” category.

The irony of all this, as Tim Cavanaugh notes, is that it’s the doctors at the centers of it who are making the public more, not less, anxious (not “panicked,” as is often wrongly said). If Spencer and Snyderman had diligently quarantined themselves, the public would have greater faith that voluntary quarantines are an acceptable alternative to the sort of state-imposed measure that Christie’s getting hammered for today.

And Jazz Shaw insists that protocols that rely on voluntary quarantines and self-reporting simply aren’t good enough:

People facing a potentially dire situation will frequently be in denial. We see that all the time with folks who avoid going to the doctor only to find out later that all of those warning signs were, indeed, cancer. But if you can’t bring yourself to admit it in your own mind, you likely won’t be checking off those boxes on a form either. Further, you might be thinking that it can’t possibly be Ebola, so why would I go through all the hassle of reporting this? Where would they get that idea? Maybe from hearing an endless stream of government spokesmodels being paraded across your television screen telling you that it’s almost impossible to catch in the first place. And if you’ve had that drilled into your head often enough, who wants to go get locked up in their house for three weeks for what is almost certainly just a case of the flu?

Follow all of our Ebola coverage here, compiled primarily by Jonah Shepp, the irrepressible young Dish editor.

So When Should We Start To Panic?

Poniewozik characterizes cable news coverage of the Ebola outbreak as a struggle between the “story” and the facts:

Thursday night, the facts were: Someone in New York City had Ebola. Dr. Craig Spencer, who had been volunteering with Doctors Without Borders treating patients in Guinea, had come back to Manhattan. He’d followed the accepted guidelines for self-monitoring, checking his temperature twice daily, and watching, per the medical organization’s guidelines, for “relevant symptoms including fever.” When he detected a fever that morning–before which, he would not have been infectious–he went to the hospital.

But then there’s the story! The story was that the day before Spencer went to the hospital, he went bowling! He rode in an Uber vehicle! He went jogging and ate at a restaurant and walked in a park. He rode the subway–the crowded subway! None of this, according to medical science on Ebola, presented a danger from a nonsymptomatic person. But it felt wrong in people’s guts. And that makes a better story.

But using data on the focus and tone of media coverage from the GDELT project, Kalev Leetaru calculates that the MSM has actually handled this story more responsibly than we think:

Only when the disease literally landed on American soil did it suddenly become news.  Yet, Ebola Viruscoverage of the disease has remarkably become less negative over the past seven months, transitioning from graphic descriptions of the disease’s symptoms to the “miraculous” interventions of modern medicine and stories of survival. As William Randolph Hearst famously noted, conflict sells newspapers; yet in the case of Ebola it seems that coverage has trended towards emphasizing recovery than end-of-the-world panic. Even the level of anxiety, while trending higher in news reports, has not spiraled out of control.

A reader feels that much of the media commentary has actually been too blasé:

More people have died so far this year from Ebola than the entire history of the Ebola (first known human case is 1976). Prior to last year, 1,590 people died from Ebola. So over the last 40 years and 24 outbreaks, we have had 1,590 deaths. We are already past 5,000 this year.

Ebola is extremely infectious (it takes a very small amount of the virus to infect you, as little as a single virus) but only moderately contagious. Because only poor people in Africa have previously died of Ebola, and in very small numbers when compared to other illnesses, Ebola hasn’t been studied at the level that rich person illnesses have.  This is why I’m less than fully convinced that researchers have enough information to be 99% sure about how contagious Ebola is at any stage of illness. There just are not that many data points, and those they have (with regards to humans anyway) are under less than ideal conditions.

So, is there some middle ground between full quarantine and partying like it’s 1999?  Maybe not locked in their house, but also not allowed to go to restaurants or bowling alleys or mass gatherings of people or use mass transportation systems?

For more on the devastating nature of the disease, and how it could spiral out of control, check out Richard Preston’s disquieting piece in The New Yorker. On the “extremely infectious” nature of Ebola:

Experiments suggest that if one particle of Ebola enters a person’s bloodstream it can cause a fatal infection. This may explain why many of the medical workers who came down with Ebola couldn’t remember making any mistakes that might have exposed them. One common route of entry is thought to be the wet membrane on the inner surface of the eyelid, which a person might touch with a contaminated fingertip. … In a fatal case, a droplet of blood the size of the “o” in this text could easily contain a hundred million particles of Ebola virus.

On its ability to travel through the air:

Khan worked long hours in the Ebola wards, trying to reassure patients. Then one of the nurses got sick with Ebola and died. She hadn’t even been working in the Ebola ward. The virus particles were invisible, and there were astronomical numbers of them in the wards; they were all over the floor and all over the patients.

There are two distinct ways a virus can travel in the air. In what’s known as droplet infection, the virus can travel inside droplets of fluid released into the air when, for example, a person coughs. The droplets travel only a few feet and soon fall to the ground. The other way a virus can go into the air is through what is called airborne transmission. In this mode, the virus is carried aloft in tiny droplets that dry out, leaving dust motes, which can float long distances, can remain infective for hours or days, and can be inhaled into the lungs. Particles of measles virus can do this, and have been observed to travel half the length of an enclosed football stadium.

Ebola may well be able to infect people through droplets, but there’s no evidence that it infects people by drying out or getting into the lungs on dust particles. In 1989, a virus known today as Reston, which is a filovirus related to Ebola, erupted in a building full of monkeys in Reston, Virginia, and travelled from cage to cage. One possible way, never proved, is that the virus particles hitched rides in mist driven into the air by high-pressure spray hoses used to clean the cages, and then circulated in the building’s air system. A rule of thumb among Ebola experts is that, if you are not wearing biohazard gear, you should stand at least six feet away from an Ebola patient, as a precaution against flying droplets.

And finally, on the volatility of the virus:

A sample of the Ebola now raging in West Africa has, by recent count, 18,959 letters of code in its genome; this is a small genome, by the measure of living things. Viruses like Ebola, which use RNA for their genetic code, are prone to making errors in the code as they multiply; these are called mutations. Right now, the virus’s code is changing. As Ebola enters a deepening relationship with the human species, the question of how it is mutating has significance for every person on earth.

Read the whole riveting piece here. (Preston wrote the 1994 bestselling book, The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus.) One more reader:

If you want to read the scary stuff about where Ebola could be headed, here it is (and the primary source for the article is here). If we can’t find the strength to help Africa contain this, it could get much, much worse for the rest of the world. We shouldn’t be worried about isolated cases showing up in NYC or Chicago or Dallas. We should be worried about Mumbai and Karachi and similar places with similar slum populations.

Follow all of our Ebola coverage here.

(Photo via Getty)

Quarantanamo, New Jersey

https://twitter.com/ianbremmer/statuses/526762858739400704

Late Friday, governors Cuomo and Christie announced a mandatory 21-day quarantines for anyone arriving in the US through the Newark and JFK airports if they had direct contact with Ebola patients in Guinea, Liberia, or Sierra Leone. Cuomo blinked yesterday and relaxed the new rule for his state after strong objections from public health groups and the White House:

Originally, Cuomo and … Christie announced a joint initiative to require a governmental quarantine for 21 days for all health care workers flying into their states. Illinois soon followed suit. But under the new guidelines, Cuomo said returning health care workers can instead quarantine themselves in their homes for 21 days, and will receive at least two unannounced house calls from local health officials. The state will provide services like food and medicine if the health-care worker needs it. Health care workers will also monitor their symptoms, as has been the standard for the vast majority of people returning from work in the region. “If their organization does not pay for the three weeks, we will,” Cuomo said during a press conference Sunday night.

Christie has also walked back his order somewhat. Nurse Kaci Hickox, the first person subjected to the New Jersey quarantine order, is set to be released today and allowed to finish her quarantine at her home in Maine after threatening to take legal action against the state over her treatment:

The nurse’s treatment has drawn withering criticism from both public health officials and the nurse herself. At University Hospital in Newark, Ms. Hickox has been kept in an isolation tent with a portable toilet, but no shower or television. … Ms. Hickox called her treatment inhumane and castigated Governor Christie for saying she was “obviously ill” when she displayed no symptoms of Ebola.

Kent Sepkowitz calls these quarantine orders an overreaction that won’t do anything for public health:

Indeed, there is a consequence to Christie and Cuomo’s decision that endangers the safety of the rank and file of New Jersey and New York far more than it protects it. Searching for a bump in some internal poll or perhaps because it feels good to make a damn decision once in a while, the governors know but choose to ignore the obvious big fact: There is a larger crisis occurring in redoubts well beyond Trenton and Albany. Their move, though perhaps it plays well now, will have a desiccating impact on volunteerism; this in turn will make the African epidemic worse, which will make it more likely cases will appear in the United States, which will increase the risk of Ebola for John Q. Public as he wanders through Trenton and Albany, Brooklyn and Newark.

Cohn piles on:

It’s also an open question whether the quarantine reduces anxiety or intensifies it. That’s particularly true in this case, because Cuomo’s statements on Friday, at least as relayed by the press, left the impression that a non-symptomatic Ebola patient could spread the disease on the subwaythe very notion that public health officials had spent the previous 24 hours explaining wasn’t true. That’s one reason that officials from the Obama Administration, the CDC and the New York City Department of Public Health seemed not at all happy about Friday’s announcement. The other is that, based on what I’m reading in outlets like the Times and hearing from insiders, they weren’t so much consulted about the decision as informed of it at the last minute, as a fait accompli.

So does Josh Voorhees:

If Cuomo, a Democrat, and Christie, a Republican, do believe they’re acting in the public’s best interest, then they haven’t done their research. Public health experts have made it clear that quarantining asymptomatic individuals will do little if any good. More troubling is the risk of a cascade of unintended consequences that could make it more difficult to contain the virus in West Africa, where it has already claimed more than 5,000 lives and will likely claim thousands more.

At best, the bipartisan pair is giving in to the fears of a misinformed public. At worst, Christie and Cuomo—whose respective presidential ambitions are no secret—are capitalizing on those fears to score cheap political points by appearing to be guardians of their constituents’ safety. The chance to bolster their respective profiles appears too good for them to pass up, even if such gains are paid for by risking West African lives.

The orders might even be unconstitutional:

Lawrence Gostin, a law professor at Georgetown University who has been in touch with Hickox about her legal options, said he thought the quarantine order was illegal and unconstitutional. He noted that since you can’t catch Ebola from someone unless they are both infected and showing symptoms, Hickox poses no danger to the public. “The courts are very suspicious when you deny a whole class of people their liberty,” he said. “She’s being detained because she’s a member of a large class of people who happened to have been in the region.”

But Jazz Shaw is disappointed in Cuomo for backing off:

Having them stay at home is doable, but only if we have confidence that they actually will stay at home, rather than going out bowling, playing basketball and riding the subway. That will require monitoring, but the monitors need to look like bellhops more than prison bulls. It’s a tricky situation to be sure, but it could be handled. Sadly, it seems that Cuomo has left Christie hanging in the wind and will – as predicted – bend in the direction of Washington.

Why Do Americans Go Out Sick? Ctd

A reader shakes his head:

The post this morning in which Julia Ioffe blames American individualism for the tendency of Americans to go to work or school sick is missing the fundamental cause. According to a report by the Center for Economic Policy and Research, the United States is the only advanced economy that doesn’t guarantee paid vacation time and is one of only a few rich countries that doesn’t require employers to offer at least some paid holidays. A full quarter of the US workforce receives no paid vacation or holiday time. It shouldn’t be surprising to find that when faced with the prospect of not getting paid or giving up scarce vacation days, American workers choose to show up sick.

Another notes that even businesses with sick-leave policies discourage workers from calling in with the flu:

Many companies pay employees not to use sick time, encourage them to ration it for when things get “really bad,” or actively prohibit its use. For example, they have policies that don’t allow employees to use sick time during their “probationary period” of six months to a year. This makes it seem normal to go about business as usual even when you feel like something the cat dragged in off a pile of hazmat suits.

Another adds, “Even if you get sick leave and using it doesn’t cut your vacation, you’d better not use more than half of it in any given year unless you’re actually in the hospital”:

Because if you do, management will assume that either a) you’re calling in sick when you are not in order to get a paid day off, or b) you’re a slacker who is unwilling to put out a little extra effort in order to get the job done. Either of which is grounds for termination, or at the minimum a bad performance review, which will get you to the head of the queue next time layoffs come around. The job is, obviously, more important than something trivial such as the health of the staff.

Note also that, if your job allows telecommuting, you will be expected to be working from home, even if you stay home because you are sick.

Another illustrates how sick children can be a major factor:

I’ve lived in rural South Texas for 35 years, and my two children attended a public elementary school in a very small town. In order to encourage economically disadvantaged children with limited English skills to get all the way through high school, our area rewards children at the elementary level for “100 percent attendance.” This isn’t strictly a rural phenomenon; I believe our nearest metropolitan area, a city of several hundred thousand people, has a similar practice.

As a result, the number of children who would show up at my kids’ school with fevers and running noses was appalling. Their parents would drop them off with a cheery and proud assurance that this was at their child’s insistence: “They want to win that attendance award!” So civic responsibility was removed from the list of things learned at school early on. Lately, I believe, a regular school nurse has started removing children who are running a fever from class.

And consider the problem of families with working parents. What does one do with a sick child who should be at home in bed when no one is home to care for them and paid child care is out of the question? Indeed, many Americans, with or without children, go out sick because they have no other alternative if they want to pay their bills. These are not the people Julia Ioffe is describing – people who are, indeed, insufferably self-centered and who do more damage showing up for work sick than they realize.

Protestant work ethic? Nah. Just being a self-centered asshole? Could be. Just trying to get by? More likely.

Ebola Reaches NYC, Ctd

Noam Scheiber contends that NYC officials clearly lied when insisting “Dr. Spencer acted entirely appropriately and responsibly”:

Despite the fact that Dr. Spencer presented a miniscule risk to anyone around him when he decided to ride the subway, go bowling, and frolic at the High Line Park on Wednesday, he obviously should not have been out and about. His decision to do those things forced the city to shut down and extensively clean the bowling alley in question and dispatch its “medical detectives” all over the city to figure out whom he may have come into contact with. Spencer’s wanderings probably also put a crimp in all the retail establishments along his Wednesday route. And they have generally required the city to manage the suddenly tormented psyches of millions of New Yorkers. It doesn’t seem like asking a guy to hang out in his apartment for a few weeks would have been too much to ask in order to avoid this mess. (On top of which, it’s become our policy in this country to quarantine anyone who had direct contact with an Ebola patient, as Dr. Spencer did repeatedly. Why should someone be exempt from this rule just because the contact happened outside the country?)

So, as I say, we were some lies told last night.

But, he admits, “I kinda think Cuomo et al were right to lie”:

[P]ublicly calling out Dr. Spencer for his failure to self-quarantine could have turned into its own minor disaster. Cuomo, de Blasio, and Bassett were generally pretty effective: They correctly assured people that it’s very difficult to contract Ebola, that all the relevant protocols were followed once Dr. Spencer came forward with his symptoms, that the city had thoroughly war-gamed this scenario. Had they taken the additional step of criticizing Spencer for not isolating himself beforehand, you can imagine that dominating the headlines, drowning out most of what they said, and generally contributing to the very panic they were trying to defuse.

Sarah Kliff, on the other hand, defends Spencer:

Doctors Without Borders has a five-point procedure for doctors returning from West Africa, to monitor for signs of Ebola.

guidelines

There is no evidence that Spencer failed to follow these guidelines. Nor is there evidence that requiring doctors to quarantine for three weeks, if they are non-symptomatic, would do anything to stop the disease’s spread. “It’s completely unnecessary,” says Harvard University’s Ashish Jha, who has been studying the outbreak. “I’m a believer in an abundance of caution but I’m not a believer of an abundance of idiocy.”

Tell that to Jason Koebler, who visited the same bowling ally as Spencer on Wednesday night:

I know how Ebola is spread. I’ve spent lots of time writing about it and researching it and on calls with the Centers for Disease Control and watching press conferences and interviewing doctors. I know I don’t have Ebola. And still, all I could think about was whether or not I had touched or even seen this guy—only part of it being morbid curiosity. Maybe that’s the power of this thing. I’m a (relatively) rational and highly informed person (on this issue), and still I’d be lying if I said I wasn’t at least a little bit worried.

A reader lays into Spencer:

Why is it that some in the media and public health circles are calling Dr. Craig Spencer a “hero” and celebrating his “brave mission”?  MSF [Médecins Sans Frontières] is an amazing organization that does incredible work – but it doesn’t follow that everyone who volunteers for MSF workers is a hero. And we shouldn’t assume that doing good work is always driven by some deep self-less, altruistic, humanitarian motive. Being an MSF volunteer doesn’t make someone Mother Theresa.

Spencer is a physician, who after spending a month volunteering for MSF in Guinea treating Ebola patients then traipsed around New York City. He used public transportation after the outcry and panic at nurse Amber Vinson’s airline flights. (Vinson, by the way, had called the CDC to get permission for her flights.) He went out to a restaurant/bowling alley/dance floor after the very public backlash against ABC Medical Correspondent Nancy Snyderman for leaving the house and sitting in a car while her companion picked up some takeout. (Snyderman never treated any patients for Ebola.)

Maybe he justified this because he had always been careful when treating patients and knew he was not going to get Ebola. Maybe he justified it because he knew that he couldn’t transmit the virus until he was symptomatic. Maybe he thought no one would know. Whatever his justification was really doesn’t matter; at the end of the day, he simply didn’t think the rules applied to him, so he didn’t follow a 21-day quarantine. And he got Ebola.

The result of his hubris is going to be a public health crisis – not rampant Ebola infection, but already overcrowded emergency rooms and doctors offices overrun by nervous A-train commuters who have come down with a fever. A medical professional who incites a public health crisis isn’t a hero; he’s an arrogant narcissist. The kind of narcissist who posts a smug picture on Facebook wearing protective clothing to humble-brag his forthcoming humanitarian trip to West Africa masked as a plea to support MSF.

I hope he gets better, but I’m not going to celebrate his bravery or heroism.

Update from a reader:

The guy risked his life to volunteer for MSF. He willfully chose to expose himself to danger in order to ease the suffering of others. What’s happening now shows how real and serious the danger was. And as a doctor, he knew exactly what was he risking. If that doesn’t make him a hero, what would? We should all pray for him.

One word from a critic jumped out at me: frolic. He was frolicking on the High Line. Like, c’mon dude, try to butch it up a bit.

I ride around on the trains to read. It’s strange, but it’s what I do. I was on the A train on Wednesday night. I rode it to Lefferts Blvd, then back up to 207th st, and then down to 42nd street. So I spent a lot of time on the A train on Wednesday night. It’s a good train for reading, because it runs for a long time and it’s not too crowded.

I don’t think I’m going to get Ebola. Instead, I think: the odds of my getting Ebola are close to zero. But it would be truly awful to die because I wanted to read Robopocalypse. If I do die I hope my family will lie for me. “He just loved Joseph Roth, he talked about him all the time. And now he’s dead because that selfish doctor just had to go out frolicking.”

Why Do Americans Go Out Sick?

Howard Markel tries to understand why NYC’s first Ebola patient went out on the town the day before going to the hospital:

I cannot presume to know what Dr. Spencer was thinking when he went out bowling the other night. He might have just been bored. He might have just not been thinking at all about the potential risks to himself or others. But if he is like me when I was a bold, young physician out to conquer illness as if I were a soldier in a good war, I bet he just thought Ebola could not happen to him.

Julia Ioffe confesses that this was “something my Soviet family and I could never get used to in the States, the stubbornness with which Americans trudge to work or school with triple-digit fevers or noses like spigots”:

Just look at this survey by the National Foundation for Infectious Diseases, published at the height of flu season in 2011, that shows that a full two-thirds of Americans don’t stay homeas the CDC advises them to dodespite having symptoms of the flu and therefore being highly contagious. Forty percent said that the stuff they needed to do outside the homework, school, trying my beveragewas more important than the risk of spreading the flu.

She attributes this to more than simply the Protestant work ethic:

From where I sit, it often looks like the other side of American individualism, which becomes selfishness when you lay it on thick. It’s the belief that you and your needs are acutely exceptional and important, and take precedence over those of the people around you. It’s the unspoken belief that your day radiating sickness at the office is worth a couple of your colleagues being bedridden with your flu for a week.

Ebola Reaches NYC

New York's Bellevue Hospital Prepares For Possible Ebola Cases

Last night, New York’s first case of Ebola was confirmed. Margaret Hartmann has a helpful primer on what we know about the situation:

On Thursday, Dr. Craig Spencer, who had been working with Doctors Without Borders treating Ebola patients in Guinea, was rushed to New York’s Bellevue Hospital with a high fever. A few hours later, tests confirmed the worst: Spencer has Ebola, making him the fourth person diagnosed with the disease in the United States, and the first diagnosed outside of Texas. So far, the situation appears to be under control: Bellevue has been preparing for weeks, Spencer was hospitalized shortly after becoming symptomatic, and officials are already tracking down anyone he may have come into contact with. However, the fact that he went to a bowling alley, took a taxi, and rode the subway on Wednesday night is not likely to calm those already on edge about the virus.

Alexandra Sifferlin examines the city’s preparations:

New York City has been prepping and drilling its hospitals for the possibility of an Ebola patient since July 28, when it was confirmed that Americans Dr. Kent Brantly and Nancy Writebol had contracted Ebola in Liberia. “I wanted to know that our staff was able to handle [a possible Ebola patient],” says Dr. Marc Napp, senior vice president of medical affairs at Mount Sinai Health System.

“We’ve prepared for a variety of different things in the past: anthrax, H1N1, small pox, 9/11, Hurricane Sandy,” Kenneth Raske, president of the Greater New York Hospital Association (GNYHA) told TIME. “This preparation is not unusual.”

Cohn compares NYC’s Ebola response to the one in Dallas:

CDC has dispatched a “go” team of advisers and clinicians, although some were already in New York anyway. They will not simply track down possible contacts, as they did in Dallas. They will also help health care workers avoid infection, which they did not do in Dallas. That’s important, because the biggest threat right now almost surely isn’t to subway riders or bowlers. It’s the public health workers who will be taking care of Spencer.

Cohn also remarks that the response “looks and feels a lot different than what took place a few weeks ago, when the first American diagnosis took place in Dallas, Texas, and neither the hospital nor public health officials seemed quite certain what to do”:

The tragic horror of Ebola is that the people most at risk of getting the disease are those caring for the sick. That’s likely how Spencer got it, after all, and as a worker with Doctors Without Borders he presumably knew what he was doing. But what was true yesterday is true today. Experts expect isolated cases of Ebola to show up here and there, but they don’t expect outbreaks, because the U.S. has the resources and infrastructure to contain the spread and treat those who get it.

However, Ed Morrissey thinks this case “raises a whole lot of questions about the CDC’s latest approach to dealing with travelers from western Africa”:

They expect to control the potential spread of the disease by asking them to take their temperatures for 21 days and keep from being in public too much. If a health professional who’s had experience with Ebola can’t follow those guidelines, why should we expect anyone else to follow them?

Now we have a fresh case in the most populous city in the nation, and the potential for hundreds of contacts thanks to the subway ride, the cab, and the use of the bowling alley. Did he have a drink at the bowling alley? Eat food? Did wait staff handle any glasses or dishes? Did he use rental shoes and house bowling balls?

But Matthew Herper talks to infectious disease expert William Schaffner, who isn’t worried about New Yorkers getting Ebola from the subway:

“I think the risk is close to zero. I would even say it’s zero because none of those people had any contact with his body fluids,” Schaffner says. “I would feel no concern had I been standing next to him on the subway.”

The reason, Schaffner says, is because when patients first become sick with Ebola, there simply isn’t that much virus in their bodies. “It’s very hard to transmit the virus in those first days of illness,” he says. “As the illness progresses, for sure the viral load in the body increases. It can get into the skin cells or onto the surface of your skin. That’s when people are near death.”

The risk of transmission is not constant, he says. It gets worse and worse as patients get sicker and sicker. When they are very sick, Ebola is very much like cholera, with large volumes of fluid flooding out of the body as diarrhea or vomit. Those fluids are teeming with virus, and that is what health care workers are exposed to.

Sarah Kliff wants us to remember that Spencer “a doctor who decided, voluntarily, to go to Guinea to treat Ebola patients”:

This is a country that desperately needs more doctors to fight back an epidemic. The United States has 245.2 doctors per 100,000 people. Guinea has 10. Spencer is not part of the problem. From what we know, he did not put New Yorkers at risk for Ebola. He’s part of the solution, one of a small handful of doctors who worked to combat a deadly, overwhelming disease.

And Abby Haglage worries that Spencer getting sick will stop other doctors from following his example:

His brave mission, followed by a devastating diagnosis, complicates an already nightmarish scenario for health-care workers fighting against Ebola: It may be deterring doctors from helping—right when they’re needed most. The news of Spencer’s positive test for the virus, announced Thursday night in New York City, might achieve the exact opposite of his stated goal.

(Photo: A member of Bellevue’s Hospital staff wears protective clothing during a demonstration on how they would receive a suspected Ebola patient on October 8, 2014 in New York City. By Spencer Platt/Getty Images)

Patient Four?

[Re-posted and updated from earlier today, at 6.02 pm]

Still a big question mark surrounding a possible case of Ebola in New York is confirmed:

But Mali joins the dreadful club of countries:

New tweets posted below:

The Black Plague

https://twitter.com/InfectiousChris/statuses/524589007100186624

While Americans remain far safer from Ebola than you’d know from watching cable news, the epidemic still presents a real crisis in the three West African countries hardest hit, with the World Health Organization reporting almost 10,000 confirmed cases and at least 4,877 deaths, but probably a lot more:

The WHO has said real numbers of cases are believed to be much higher than reported: by a factor of 1.5 in Guinea, 2 in Sierra Leone and 2.5 in Liberia, while the death rate is thought to be about 70 percent of all cases. That would suggest a toll of almost 15,000. Liberia has been worst hit, with 4,665 recorded cases and 2,705 deaths, followed by Sierra Leone with 3,706 cases and 1,259 deaths. Guinea, where the outbreak originated, has had 1,540 cases and 904 deaths.

But how do the virus’s African origins affect the way we perceive it? For one thing, it leads to geographically ignorant nonsense such as this and, according to Lola Adesioye, it also inspires the media to stereotype the continent and its people:

[T]he media’s handling of the virus, its origins, and its propagation (which some in the media have suggested comes from people eating wildlife, even though this has not been scientifically proven) has reverted to an age-old reliance on lazy stereotypes, generalizations, and misleading information that once again disseminate a view of the African continent’s 1 billion people as wild-animal-eating, jungle-roaming, primitive, disease-carrying “others.”

Let’s take for example articles such as one that featured recently in the Washington Post, the headline of which was “Why West Africans keep hunting and eating bush meat despite Ebola concerns.” The reality is that not only do many West Africans not eat bush meat—defined as terrestrial mammals, birds, reptiles, and amphibians harvested for food—but that many Africans in general—whether from south, east, north or west—do not eat bush meat.

Philip Alcabes also ruminates on the role of race and “otherness” in the Ebola panic. In his conclusion, he laments “that the solipsism of self-protection makes it harder for us to see the crisis that Ebola really constitutes”:

The only reasonable path to prevent illness and death in America is to prevent further illness and death in western Africa. We can’t serve both our needs and those of the suffering countries when our only aim is to close our own borders, schools, or air lanes. And this self-referential panic, this intense attention by Americans to what is not a real threat to America and yet seems to embody so many of the unspoken fears that we harbor about ourselves—about race, our place in the world, health care, control, about what the sociologist Anthony Giddens called the unprecedented promise and unfathomable risks of “the double edge of modernity”—is going to make it impossible for us to devote our resources and our intellect to stopping the advance of Ebola.

A No-Drama Ebola Policy, Ctd

On top of the modest travel restrictions from the DHS, the CDC announced yesterday that anyone traveling from the epicenters of the epidemic will be monitored for 21 days after they enter the US:

Tom Frieden, director of the CDC, said that anyone arriving from the three countries – Sierra Leone, Guinea and Liberia – will be actively monitored on a daily basis and will also face new rules about where they can travel within the United States. He added that about 70 percent of all travelers stay in six states: New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia. People will receive a kit when they arrive at the airport that explains what the symptoms are, a guide to telephone numbers, and a thermometer, Frieden said. State and local officials will maintain daily contact with travelers for the entire 21 days.

Morrissey is skeptical these new measures will be effective:

The problem with this approach is that it’s still voluntary.

One assumes the CDC will follow the cases to ensure that the monitoring takes place, but they don’t appear to want to order anyone into quarantine — and how many subjects will they have to audit? If it’s just a few dozen it might work, but the more travelers who come in from these countries, the more stretched those resources will get. And who’s to say that even regular calls to those being monitored will result in truthful reporting anyway? Until they get sick, there doesn’t appear to be much incentive for honesty about abiding by the testing regime here, or for self-imposed isolation either.

David Francis also has doubts:

So far, none of the 562 who have been monitored under the CDC program has tested positive for Ebola. Details on how they would be monitored over the next three weeks were scant. According to Bryan Lewis, an infectious-disease expert at Virginia Tech University, the monitoring lacks true medical value. “It’s going to be very hard to implement and would have minimal yield in terms of finding other patients,” Lewis said. “It seems like an extra thing to assure the population that we’re doing every extra step that we can.”

But a couple of public health experts tell Jonathan Cohn that they approve of the new precautions:

“It is carefully layered, thoughtfully designed and will likely be effective,” said Howard Markel, a physician and historian of epidemics at the University of Michigan. “Remember, when employing socially disruptive measure or for that matter specific therapies, you don’t use a bazooka when a BB gun will do. These measures are in no way a BB gun, but they carry the advantage of not inciting restrictive travel bans against U.S. citizens or having a situation where the African nation in question won’t allow American, etc., health workers let alone military advisers into their country.”

“I think this really seals the leaks with regard to people entering the U.S. from those countries,” said Melinda Moore, a physician and CDC veteran who’s now at the Rand Corporation. “The numbers are relatively small. It will be interesting to see if this is really enforceable. It had better be.”