Wednesday, October 22, 2014

Is the Ebola Quarantine Period of 21 Days Too Short? Dr. Oz Weighs In With New Research

"We have only sixty days to contain this epidemic or we face an unprecedented situation for which we have no plan" - World Health Organization

Dallas County Court Judge Clay Jenkins boldly asserted yesterday that the dozens released from quarantine in Dallas over the weekend posed "absolutely no risk" to the community. All of them had contact at some point with Thomas Eric Duncan, "Patient Zero", in the recent Ebola incident at Texas Health Presbyterian Hospital.

The problem is that this may not be accurate, given viruses change - in potency, as well as mortality rate and incubation period. This point was brought up two days ago by Fordham  Infectious Disease specialist Alexander van Tulleken, in a live interview with Dr. Mehmet Oz - on his Monday show. In his preface to the interview, Oz noted the "magic number being 21 days" for being safe,  but in the last week new research has emerged to controvert that. In other words, 21 days may not be a long enough period for those who've been exposed to the virus and they should be quarantined longer.

Dr. van Tulleken pointed out that we were "originally getting our ideas of what the incubation period should be from research done in the 1970s".  But recently a researcher, Dr. Charles Haas-  from Drexel University - has reviewed all the data from recent epidemics and found the actual incubation period is longer - with an average incubation period of 12 days (not 8 or 10) and the maximum being up to 30 days. So "if we want to catch everyone we need to probably extend it to thirty -one days" according to Dr. van Tulleken.

Thus, to have erred on the side of actual safety the Texas individuals should have been quarantined at least another ten days. The chance they may spread the disease to others while being infectious is admittedly small (about 12.5% of exposed persons are symptomatic after 21 days) but it is assuredly not "zero".  Thus, new cases could pop up in Big D and we shouldn't be surprised if that occurs and is traced to those released prematurely - based on this new research.

When asked about the WHO statement (top of post) van Tulleken observed that the response for stopping Ebola in West Africa is totally "inadequate" and he remains convinced this is the number one threat to global health at the moment - all the soothesayers babble to the contrary.

Oz then went on to give one of his trademark demonstrations to show why too many are not being serious enough (or humble enough) about Ebola.  He used a wall graphic depicting the spread of the virus in a body from 12 days after incubation -when symptoms begin- and also a 3D model of fluid expulsion and waste contamination. The first few days are when the virus just begins accompanied by a slight fever (e.g. 99.5- 100.4F) and muscle aches and pains. The problem with these symptoms is that most of us won't be able to tell the difference between what is happening and the flu. Thus, the Ebola virus is hiding in plain sight based on flu-like symptoms and causing too many to dismiss it as "just the flu" - meantime the virus is slowing down the body's immune response.

By day 6 or day 7 after the initial symptoms the virus is "exploding" in the organs: By a week out, blood pressure is dramatically dropping while there is highly infectious projectile vomiting, explosive bloody diarrhea and profuse bleeding from body cavities.

Oz observes that while a projectile bloody sneeze, for example, can travel far in the air (say from a passenger on a plane) that is not the primary fear, because it doesn't linger there. You'd have to have the sneeze droplets shot directly onto you.  It is thus "a weakling in the air".

The problems arise when the virus begins to overwhelm the immune system and the projectile vomit-diarrhea phase is underway.  Then, if the virus-laden fluids are ejected or expelled onto a surface - it can remain there "for up to three weeks" - according to Oz. In effect, it affects not only the nurses, doctors taking care of the patients, but also the janitor who has to clean the floors where the patient had problems. Even gloves may be inadequate because in pulling them off with even a couple drops of waste and getting it on the skin "could pose a major problem"

The huge issue then emerges as the VOLUME of this waste expelled and which then contaminates an area. Since each Ebola patient will generate 55 gallons of toxic waste PER DAY by the time of the immune system breakdown and fluid expulsion - that means any hospital purporting to treat Ebola patients must be prepared to deal with it. For example, if they take in two patients they will need to know how to eliminate up to 770 gallons of highly infectious waste each week. Where do they put it? They can't put it in regular trash. (For reference, one hundred and forty 55 gallon tanks of material were removed from Thomas Eric Duncan's apartment in Dallas, as noted yesterday morning on CBS News Early Show. This was incinerated at a facility in Galveston, Texas).

It must either be incinerated using specially designed medical incineration units, or it must be sterilized in an autoclave (which few hospitals have because they can't afford them). The medical waste incinerators are also rare - given many states have outlawed them on account of pollution. To make matters worse, neighboring states with specialized incinerators have refused to accept the waste from  other states.

As Sen. Barbara Boxer has aptly put it: "Storage, transportation and disposal of the waste will be a major problem".

She was referring to the two formidable aspects of the Ebola waste problem: 1) the highly contagious nature of the waste generated, and 2) the sheer volume of it.  Hardly any U.S. hospitals are prepared to cope with this no matter what they say, or the CDC says. They are, in fact, under-trained to the task and under-funded (no thanks to many state budget cuts) so have less than adequate resources.

Oz' other guest, Darriah Gillespie, M.D.,  pointed out that Emory "trained for years" before the first Ebola patients ever arrived. They made sure they already had state of the art isolation wards, the right sterilizing equipment and positive pressure suits and knew how to use them - especially in the arduous decontamination procedure. Only four special centers in the U.S. have such wherewithal, so let's not kid ourselves.

 This is why I totally agree with Mehmet Oz' recommendations for being proactive in view of the risks. These include:

- Four specialized hospitals and 11 beds is not enough if there is an Ebola outbreak of large magnitude so regional centers must be found - this means all funding taken away in earlier budget cuts must be reinstated.

- Training can't be done in a day or an hour. Weeks of training are needed - as Dr. Oz noted- merely to get "gowned up" for a regular hospital procedure. Ebola may require even more and can't be done "on the fly" (which likely happened in Dallas)

- As it is the focus of infections is to ensure only that doctors don't infect patients, not the reverse (more likely in the case of Ebola) so many more resources need to be provided which currently aren't there. "Providers should be protected with every resource possible" in the words of Darriah Gillespie.

- While no airport procedure will definitely,  100 percent stop an Ebola -infected person from coming to the U.S. and a total travel ban may not be practical (they can slip over into Mali, and obtain travel from there etc.)  we can still (Oz recommendation) limit the visas of those from the affected nations - especially Liberia - who want to come here to visit.

His reason is sound: Because these "put us at risk", while health care workers "have to be able to get in there."

This seems to me a balanced solution, midway between a total travel ban and simply allowing any and all non-essential travel from the hot zone. Given the obvious difficulty associated with hospital capacity to deal with a significant Ebola outbreak - including management and disposal of the infectious waste  - it is better to have a plan in place apart from simply checking people for fevers at selected airports.

Let me make it abundantly clear here, that I am not trying to spread "Ebola fear" or "Fear-bola" as some liberal websites have called it. I am not part of the whacky Right's memetic entourage, i.e. i using this in the mid-terms or against Obama. BUT... I do believe our officials aren't leveling with us or doing enough, and though the confirmed cases (3)  of the disease are so far rare- we need to be more proactive as Oz has said. If we want to quell the fear and panic then the gov't needs to be proactive and first show it's competent to deal with the crisis as it exists now - and that means adequately funding our gutted health care -medical system. Or let me put it this way, putting back in place the funding already cut. Until that happens, and our hospitals undergo specialized training to deal with this disease, fear and hysteria will reign. It is a natural outcome, flowing from the lack of political will to do anything substantive to show we can handle the worst IF it arrives!

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