Thursday, October 16, 2014

Should medical personnel who treat Ebola patients be "federalized" and inducted into the military?; in Ohio, some "indirect contacts" are reported as quarantined; more on transmission, incubation


Vox Media, in its “one sentence” summary feature, offers an article from The Washington Post, “What it’s like to clean airplane cabins during an airplane scare”, link here.  The article emphasizes the low wage of the workers and the need to turn around the plane in a half hour.   And now, with the Ebola scare and CDC misstep earlier this week, an article like this takes on a whole new urgency.
   
CDC, as of the latest news, talks about putting health care workers who treat Ebola patients on no-fly lists.  Is that “only” those workers at Texas Presbyterian, or at any of the four treatment centers or any other future hospital?

Are “indirect” contacts going to be put on no-fly lists, even if the likelihood of contact is so remote?  (What about the 130+ passengers on the Frontier plane.)  What about trains, buses, subways?  (The TSA doesn't operate there now.) Where does this stop?  So far the information isn’t clear.
  
Would travel insurance policies be honored in these cases?  If the government grounds you, are you entitled to a refund on a ticket or hotel reservation?  (More and more hotel reservations these days are not cancellable.)   It seems like industry practices around this new issue need to be standardized quickly to be “fair” to consumers caught in the middle. Could Texas Presbyterian be held liable for all of this since it was its own negligence that started all of this?
  
It also sounds rather frightening for the government to forbid people to fly just based on the work they do (latest on CNN)  here ).  It would sound as if nurses and doctors who treat Ebola patients should be treated as military personnel.  The Public Health Service has always been a “quasi military” service, a point that was sometimes made by SLDN during the days of debate over “don’t ask don’t tell”.  (Yes, here I go, connecting the distantly separately dots again, by putting up new “strings” or dimensions to see them in.)
  
Since the military draft, while no longer active, is still “constitutional” (as of a 1981 Supreme Court decision), the idea of federalizing and “conscripting” some health care workers might hold water.  I can recall in 1996, while on a trip in Ohio, reading a specific news article that Bill Clinton didn’t want to do away with Selective Service (even in the DADT world) because of the possibility of a sudden, hard-to-foresee for military medicine, after some calamity, maybe like this.
  

In fact, the Washington Post has a stunning story today by Tina Griego, “America may never have a draft again. But we’re still punishing low-income men for not registering”, link here

The Ebola crisis, which could well be followed by other pandemics (bird flu being the most obvious risk) also mixes into the debate on national service, as Gen. Stanley McChrystal discussed about a month ago.   Health care service (in the developing world) could turn out to be as taxing as military service (or the two can mix, as US Army medical troops are deployed to West Africa and medical reserves are suddenly called up).  Is this a gauntlet (like a hajj) everyone should run between 18 and 28 to pay his dues? (No more teen stars in sports like Bryce Harper or RGIII?)

Maybe the best news in all this speculative gloom is from NIH, which seems to report progress on an Ebola vaccine which may actually also be useful if given after exposure, before severe symptoms develop.  The link is here. Medically, Ebola seems diabolical because it can hide from the immune system in the early stages (as does HIV, although with a different mechanism) and symptoms can be mild for a few days until the patient suddenly crashes.  It would be important to know if any of the cases now recovering actually avoided the most severe symptoms.  We don’t have a lot of detail yet, but it sounds as if this is true of the NBC cameraman Ashoka Mukpo  (NBC video here ).


Update:  4:;45 PM, Thursday Oct. 14

A television station in Akron Ohio reports that six persons in Summit County OH and two in Cuyahoga County (Cleveland) are quarantined after very remote contact with Amber Vinson over the weekend.  A bridal shop that she visited has closed as a precaution.  I hope that the shop owner can collect damages from the Texas Presbyterian Hospital or the CDC for loss of business.  The liability lawyers for the hospital must be busy.  The link is here.  The store "Coming Attractions" is reported to have closed voluntarily after talking to the CDC.  The CDC also seems to want to talk to other people in the store.  (No, if I had been there and had no real contact with anyone, I wouldn't call in, because I can't afford to be isolated for what someone else did -- unless I really thought there was a problem, which there isn't).  It seems that the only "secondary contacts" that can present a real risk to the public are the health care workers themselves -- so far.



Update:  later Oct. 14

The Denver Post reports the rollout of business interruption insurance, from a company in California called NAS, story here.  The article uses a bit of hyperbole, though, in suggesting that a hospital, airport or hotel could be closed because a single person who had been on the premises tests positive for Ebola.  Bars, restaurants and discos, however, should worry that local health departments could shut them down for good, for little good reason.

AC360 reports that authorities in Texas a requiring all hospital employees (besides the close contacts already mentioned before) who had contact with Thomas Duncan not to go into public places, here.  But the 21 day period for them may be coming to an end for them soon.
David Sanders of Purdue University suggests that Ebola can go into the lungs so it could some day mutate to become airborne.  However it has not as of yet.  But the great number of cases multiplying in Africa increases the odds that this could happen.  Other authorities dispute his speculations, however.  Fox and Breitbart have covered the speculation, but Gupta interviewed him on CNN.

As if all of this were not enough bad news, Yahoo! reports a study indicating that a 21 day incubation maximum may not be enough, and than maybe 31 days is more appropriate. However, a look at Wikipedia shows that Thomas Eric Duncan's incubation period was only nine days (Sept. 15 in Liberia to Sept. 24, when first symptoms appeared, to become explosive on Sept. 28).  A short incubation may indicate greater initial exposure, which appears likely in Duncan's history.  Putting  this all together, there is the imaginable or speculative possibility that an extremely small exposure (airborne?  household?) might result in the virus's hiding in the body for many months, making the scope of an outbreak here much more than we have imagined, if in fact a normal immune system can't neutralize tiny amounts of the virus on its own because it hides.  There might be a "geometric progression" in the way it multiplies in the body (even starting with one particle) until it blasts out and causes symptoms.  In such a case stricter quarantines could be necessary.  


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