A truly frightening thought experiment about Ebola

ThisBrotherOfHis · Oct 17, 2014

Senator Cheese said:
... but I can also assure you that anyone who's spent half a year in medical school and owns a television is capable of at least considering the disease when someone presents with the symptoms you described (hematemesis, fever). And ultimately, that's all it takes.

I'd love to believe this. But an ER nurse ... an ER nurse! ... at Texas Presbyterian Hospital was told by Duncan that he had come to the U.S. from Liberia, and despite CDC procedures (allegedly) sent out to hospitals nationwide after Dr. Kent Brantley and R.N. Nancy Writebol were brought back into the country ... she did not pass the information on to doctors seeing the patient!

So why would we have any confidence whatsoever that a doc-in-the-box physician is going to equate bloody vomit with Ebola?

Queller · Oct 17, 2014

ThisBrotherOfHis said:
How about we start with the fact that none of them are classified as Level 1 trauma centers and go from there?

Which does nothing to provide evidence for your claim.

Many of them have the disclaimer in their "services offered" page of their website that they are a good alternative to non-emergency medical services.

So? That doesn't mean they can't recognize or screen for Ebola.

They are not designed or staffed to treat emergencies, infectious diseases, or major medical issues. They are staffed to handle the problems that people would otherwise go to their doctor for -- sprains, trivial cuts, kids with ear infections, flu shots. No one goes there expecting much of anything else, and just as our doc in the story says, he doesn't see a lot of cases like these. Or ever, for that matter.

So? That provides no evidence for you claim that

"that kind of thinking simply does not happen in a "doc-in-the-box.""

Go to an urgent care clinic on the street, tell them you think you might have been exposed to Ebola. See what they do.

I think they will screen me to see if it is possible I have been exposed. What do you think they will do?

Cearbhall · Oct 17, 2014

Holy crap, there's epidemic fan fiction.

ThisBrotherOfHis · Oct 20, 2014

Queller said:
Which does nothing to provide evidence for your claim.

Really? Then if you should you begin to exhibit symptoms for Ebola, you'd go to your doctor's office? The walk-in clinics are no better equipped to handle an Ebola case than your GP or internist is. Those doctors would hustle you out of their offices to the nearest ER as quickly as possible.

Queller said:
So? That doesn't mean they can't recognize or screen for Ebola.

Your faith in the ability of the average medical team to "recognize or screen" for Ebola is badly misplaced. For one thing, there is no "screening" for Ebola beyond a blood test. At this point asking if you've been to West Africa is a meaningless screening question.

You could have been exposed through close contact with any one of over 400 people who were exposed secondarily by Vinson's trip to Cleveland, or by similar exposure to the over 150 per day who still arrive in the U.S. via international flights because the government doesn't seem to think flight bans from that part of the world are necessary, or that they are "inadequate" as a preventative measure. "Inadequate?" How does stopping the flow of potentially infected people from the outbreak zone get classified as "inadequate"?

Body temp screenings at airports are ludicrous. If the infected passenger isn't yet sick and therefore contagious, they won't show any signs of elevated temperature and will be allowed into the country -- and then get sick one day to a week or more later. The only real screening is a blood test, and an ER can do that much more quickly than your doctor, or certainly much faster than a walk-in clinic.

Queller said:
So? That provides no evidence for you claim that

Queller said:
[/size][/font][/size][/font][/size][/font]"that kind of thinking simply does not happen in a "doc-in-the-box.""

Actually, it provides ample evidence. But you feel free to believe that the medical system in our country is ready at all levels to address Ebola, if that makes you feel better.

Queller said:
I think they will screen me to see if it is possible I have been exposed. What do you think they will do?

Nothing. As with my fictional story, they'll call 9-1-1 for an ambulance and get you out of there ASAP.

Also, it appears, from your blindly loyal responses to our current medical system's ability to keep your health and safety intact that denial ain't just a river in Egypt.

Finally, the attacks on this story seem to utterly fail to get its point: It is not a predictor of the future.

Yes, there are doctors and nurses out there who will immediately think "Ebola." Yes, there are EMT crews out there who, upon seeing the symptoms of a given patient, will immediately opt for the best precautions to prevent infections. Yes, there are ERs more than adequately equipped and prepared to deal with infectious diseases of the absolute worst variety -- if they are on their toes and programmed to think "infectious disease" immediately. Unfortunately, there are at least as many, and perhaps more, that don't think in that vein until it's too late.

My story is nothing more than a "what if" speculation on the potential for an infected patient to come across a few of those in the healthcare structure of this country who won't immediately think "Ebola," who won't opt for the best preventative measures, who won't provide the necessary care. Why? Because too many have the attitude that "It can't be Ebola. That kind of thing would never happen in my office/clinic/hospital/ER."

Oh yeah?

Nithavela · Oct 20, 2014

Why did you even Post this in News and Events? This is certainly not news, neither is it an event.

bill5 · Oct 20, 2014

Ebola hysteria: An epic, epidemic overreaction - CNN.com

(did anyone actually read that entire OP?)

ThisBrotherOfHis · Oct 20, 2014

bill5 said:
Ebola hysteria: An epic, epidemic overreaction - CNN.com

(did anyone actually read that entire OP?)

A key quote from the CNN piece: "You can count the number of documented cases in America on two hands -- and still have fingers to spare."

Completely overlooked by the article is the fact that over 400 people were potentially exposed during Dallas nurse Amber Vinson's round trip to Cleveland and the subsequent continued flight service of that aircraft before it was sanitized, and further that over 150 people per day continue to arrive from West Africa without adequate screening. It is assumed they are not infected simply because they show no signs of a fever. That is not accurate. Since symptoms -- and therefore, contagion -- do no show up for two to twenty-one (or perhaps even more) days, they will be admitted to the country, only to get ill later -- in the process of visiting, conducting business, whatever, and coming in contact with anywhere from a dozen to hundreds of people.

The precautions prescribed by CDC are totally inadequate. The only sure course to prevent contagion at this point is to ban international travelers who have been in West Africa until they are five weeks beyond the last day they were there, and show no signs of illness. As for the healthcare workers perhaps exposed in taking care of Thomas Eric Duncan, they need to be closely monitored, not necessarily put in medical isolation but certainly encouraged to be aware of their coughs, sneezes and other bodily ejections, and have no intimate contact with anyone until they, too, are five weeks beyond exposure.

Why the CDC doesn't take those practical approaches is puzzling, to say the least. The "hysteria," if there is one, is not so much about the potential spread of the disease, but the lackadaisical approach by CDC in preventing that potential spread that is obvious to even the most uninformed layperson.

DaisyDay · Oct 20, 2014

2 African countries free of Ebola - CNN.com
http://www.cnn.com/2014/10/20/health/ebola-overreaction/

Your little fictional "thought experiment" is not real life either. iObama!

ThisBrotherOfHis · Oct 20, 2014

DaisyDay said:
2 African countries free of Ebola - CNN.com
Ebola hysteria: An epic, epidemic overreaction - CNN.com

Your little fictional "thought experiment" is not real life either. iObama!

Never said it was, did I?

Then of course, there's this: http://www.bbc.com/news/world-africa-29615452http://www.bbc.com/news/world-africa-29615452Ebola crisis: Outbreak death toll rises to 4,447 says WHO

(I'd love to know if the BBC headline writer did that on purpose)

Belk · Oct 20, 2014

bill5 said:
Ebola hysteria: An epic, epidemic overreaction - CNN.com

(did anyone actually read that entire OP?)

Are you kidding? I didn't need anything other then the title to tell me what to expect.

Cearbhall · Oct 20, 2014

bill5 said:
Ebola hysteria: An epic, epidemic overreaction - CNN.com

(did anyone actually read that entire OP?)

Nope. You could make that a poll thread.

I saw that CNN article this morning and I love it so much.

DaisyDay said:
2 African countries free of Ebola - CNN.com
http://www.cnn.com/2014/10/20/health/ebola-overreaction/

Your little fictional "thought experiment" is not real life either. iObama!

For a second, the first exclamation point looked like an "I" and I thought maybe he turned into an Apple product...

Joykins · Oct 20, 2014

I did read the OP but I have a weakness for apocalyptic science fiction about plagues.

Queller · Oct 20, 2014

ThisBrotherOfHis said:
Really?

Yes, really. Evidence for this claim would be actual statistics and surveys.

Then if you should you begin to exhibit symptoms for Ebola, you'd go to your doctor's office? The walk-in clinics are no better equipped to handle an Ebola case than your GP or internist is.

They are however, quite capable for screening me for the possibility of having contracted Ebola.

Those doctors would hustle you out of their offices to the nearest ER as quickly as possible.Your faith in the ability of the average medical team to "recognize or screen" for Ebola is badly misplaced. For one thing, there is no "screening" for Ebola beyond a blood test. At this point asking if you've been to West Africa is a meaningless screening question.

There are a lot of other questions to screen for Ebola than just "have you been to West Africa?"

My story is nothing more than a "what if" speculation on the potential for an infected patient to come across a few of those in the healthcare structure of this country who won't immediately think "Ebola," who won't opt for the best preventative measures, who won't provide the necessary care. Why? Because too many have the attitude that "It can't be Ebola. That kind of thing would never happen in my office/clinic/hospital/ER."

Oh yeah?

The problem is that you have given nothing to support your claim that any medical provider would think that in the first place.

ThisBrotherOfHis · Oct 20, 2014

Queller said:
They are however, quite capable for screening me for the possibility of having contracted Ebola.

Let me know when you find a walk-in clinic with an in-house lab, will you? Then I'll acknowledge you may have a point.

Queller said:
There are a lot of other questions to screen for Ebola than just "have you been to West Africa?"

Did you know that they are instructed to not ask specifically about Ebola? Here are the questions being asked by CBP officers at points of entry, for example:

Have you recently been outside the country?
Have you had contact with anyone who has?
Have you recently used mass transit by air, train, or bus?
Have you had your flu shot? (Really?? "Flu shot"?? And this has what to do with Ebola?
Has anyone in your household not had a flu shot? (Same stunned response as above)
Does your job put you in contact with the public?

These questions were being asked before nine U.S. airports began temp screenings as passengers arrived in customs. Those aren't the only airports where international passengers come into the U.S., however. They aren't asked about potential symptoms, either. And despite the gigantic error made by CDC in letting Amber Vinson travel, the agency hasn't updated its "fever guidelines" at points of entry, so that a passenger would have to be running a 100.4 degree fever before they would be referred to local medical care.

Queller said:
The problem is that you have given nothing to support your claim that any medical provider would think that in the first place.

You watch too many movies. Doctors are not all geniuses and they donh't all think fast on their feet, or jump to exactly the right conclusions. Why? Because life is not resolved in 127 minutes, plus credits.

Queller · Oct 20, 2014

ThisBrotherOfHis said:
Let me know when you find a walk-in clinic with an in-house lab, will you? Then I'll acknowledge you may have a point.

Which part of "screen for the possibility of having contracted Ebola" are you having trouble with. You do know what that means, right? IT doesn't mean confirm a person has Ebola.

Did you know that they are instructed to not ask specifically about Ebola?

No, and until you provide some evidence for that claim, I won't "know" it.

Here are the questions being asked by CBP officers at points of entry, for example:

Have you recently been outside the country?

Have you had contact with anyone who has?

Have you recently used mass transit by air, train, or bus?

Have you had your flu shot? (Really?? "Flu shot"?? And this has what to do with Ebola?

Has anyone in your household not had a flu shot? (Same stunned response as above)

Does your job put you in contact with the public?

Those are all questions used to screen for the possibility of Ebola (as well as other conditions). What is it about them that you have a problem with?

These questions were being asked before nine U.S. airports began temp screenings as passengers arrived in customs. Those aren't the only airports where international passengers come into the U.S., however. They aren't asked about potential symptoms, either. And despite the gigantic error made by CDC in letting Amber Vinson travel, the agency hasn't updated its "fever guidelines" at points of entry, so that a passenger would have to be running a 100.4 degree fever before they would be referred to local medical care.

Do you really think CBP personnel are trained medical providers?

You watch too many movies. Doctors are not all geniuses and they donh't all think fast on their feet, or jump to exactly the right conclusions. Why? Because life is not resolved in 127 minutes, plus credits.

And yet you seem to think that all doctor's outside of an ER are incompetent.

ThisBrotherOfHis · Oct 20, 2014

Queller said:
Which part of "screen for the possibility of having contracted Ebola" are you having trouble with. You do know what that means, right? IT doesn't mean confirm a person has Ebola.

No, of course not. I didn't say it did. (You seem to be very good at "discerning" what other people think, by the way.) But an Ebola screening should at least have something to do with Ebola.

Queller said:
No, and until you provide some evidence for that claim, I won't "know" it.

making you willfully ignorant, I suppose. The source for those questions is here. Sorry. I forgot to post the link the last time.

Queller said:
Those are all questions used to screen for the possibility of Ebola (as well as other conditions). What is it about them that you have a problem with?

Nothing -- other than they don't specifically address the potential for Ebola exposure.

Queller said:
Do you really think CBP personnel are trained medical providers

There you go, presuming to "know" what I think again. The answer should be obvious to you, but just in case it isn't: No, and this generic list of questions provided by CDC to CBP officers fails to take that into consideration, doesn't it?

Queller said:
And yet you seem to think that all doctor's outside of an ER are incompetent.

Wow, a record! Three assumptions about my cognitive processes in one post.

You don't pay much attention to what anyone but you says, do you?

Queller · Oct 20, 2014

ThisBrotherOfHis said:
No, of course not. I didn't say it did. (You seem to be very good at "discerning" what other people think, by the way.) But an Ebola screening should at least have something to do with Ebola.

All the questions you listed DO have something to do with Ebola.

What questions do you think should be asked to screen for the possibility of Ebola?

making you willfully ignorant, I suppose. The source for those questions is here. Sorry. I forgot to post the link the last time.

You claim that

ThisBrotherOfHis said:
Did you know that they are instructed to not ask specifically about Ebola?

And then when asked for proof you respond with a news story entitled "Doctors asking questions to screen for Ebola" and includes this line: "The doctors do not specifically ask about Ebola, but based on CDC guidelines, these would be relevant questions in screening for the virus."

That does not support your claim that "they are instructed to not ask specifically about Ebola?"

Nothing -- other than they don't specifically address the potential for Ebola exposure.

Actually they do specifically address the potential for Ebola exposure.

There you go, presuming to "know" what I think again.

No, that is an example of asking what you think. If I knew what you thought I wouldn't have asked you.

The answer should be obvious to you, but just in case it isn't: No, and this generic list of questions provided by CDC to CBP officers fails to take that into consideration, doesn't it?

No, you are wrong. Everyone of those question specifically address the possibility of Ebola and are easy for non-medical personnel to understand and explain.

Wow, a record! Three assumptions about my cognitive processes in one post.

You'll forgive me if I laugh at you considering that my post was made following your post implying that I think doctors are all geniuses, they all think fast on their feet, they all jump to exactly the right conclusions, and life is resolved in 127 minutes, not including credits.

You don't pay much attention to what anyone but you says, do you?

When they are credible, provide evidence supporting their claims, and don't resort to personnel insults such as

, I pay close attention to what people say.

bhsmte · Oct 20, 2014

ThisBrotherOfHis said:
Came across Rick Wilson's little Twitter story from last July -- beware, there is some coarse language in it -- and was kind of amazed he predicted the current outbreak so well.

It occurred to me the story could use some updating, given what has happened so far. I used his story as a foundation, changed a few things about it, brought the known facts into it, and made my own predictions. This is the result.
---
A (Revised) Thought Experiment

Tomorrow, or perhaps next week, someone will get on a plane in Cleveland. He hasnt been contacted by CDC because hes been out of town. This man was on the Frontier flight from Dallas to Cleveland on October 9. This man, a businessmen traveling to three U.S. cities to various corporate locations, has no outward signs of Ebola and he has no reason to think his nagging sore throat and a headache are anything but a cold or maybe the flu. Come to think of it, is he feeling the effects of a low-grade fever, too? Got to be the flu. Supposed to be bad this winter.

Headache? Has to be the pressures of the trip. Always is. He hates this part of the job, but its necessary. Still, he cant shake the feeling he isnt at his best when he gets in a cab in Kansas City. Wow, the crowds are infuriating. Leave it to him to schedule this trip during the first World Series in Kansas City in 29 years! He checks into his hotel, and rests. He wakes up, the headache worse, the cough and fever a definite factor. He fights through the day, feeling worse as it goes along. That afternoon, he gets on a plane to Phoenix.

Again, getting into the cab, he notes how he feels, and that can best be described as lousy. Checks into another hotel, manages to drag himself downstairs to the restaurant to eat, coughing and feeling achy the entire evening. Then he drags himself back upstairs to bed. Next morning, the sun shining through the narrow slit in his hotel curtains is blinding and painful. He walks into the bathroom and promptly throws up. But he's got meetings today. He swallows a handful of Tylenol and stands in the shower until his head clears a little.

His day goes downhill, with the headache roaring back. At lunch the businessman excuses himself, racing to the bathroom to vomit. By late afternoon, he's feverish, racked with pain in his back. His guts are like liquid fire. Hes seen Fox News, hes heard about Vinson, but they keep talking about the Cleveland-to-Dallas return flight for her. He has no reason whatsoever to think about being on a plane flying with her into Cleveland. Even if he did, she wasnt contagious going into Cleveland. Was she?

He Googles for the nearest walk-in clinic, takes a cab there and is still trying to get work done while he sits for two hours in the crowded waiting room. The sudden spike in his fever hits, and he vomits without warning, this time on the lap of his fellow waiting room patient. He's shocked. It's ... bloody.

The woman shrieks, grabs her ear-infected kid and drags him with her into the bathroom, panicking. If she knew what was happening, shed know she was not panicking enough. Now, the Doc-In-A-Box staff knows this guy is sick. They hustle him back, helping to clean him up. Gloves, but no masks at this point. After all, this guy isnt Thomas Eric Duncan. He didnt come here from Liberia. For goodness sake, hes from Cleveland! No one in the clinic stops to think thats where Vinson was about 10 days ago.

The patient is having trouble making himself understood the fever is so high. But hey, it's gonna be a pretty bad flu season, and this guy just has the bad luck to be an early victim ... thats gotta be it.

The doc, a graduate of a decent medical school in the Midwest and an internal medicine specialist hired by the hospital that owns this walk-in, rolls in after the two nurses have cleaned him a bit and takes his vitals. There's an important moment happening out in the waiting room. Ear-infection mom and her toddler? Tired of waiting. They've gone home to change clothes before going to the corner mega-drug store that also has a walk-in.

The doc doesn't see a lot of cases like this. Ever, in fact. He walks out of the room, unconsciously shoving his gloves into his pocket. Now, there are a whole bunch of CDC and DHS rules about early identification of outbreaks, and the reporting of same. But ninety percent of his cases are sprains, trivial cuts, kids with ear infections, flu shots. This cant be anything irregular. No way. Ebola would not stroll into a walk-in clinic in Phoenix. Would it?

This guy is spiking 103, is in distress. Obviously the flu, a very bad case. Doc walks out, washes his hands, and decides to make the call ... right after he looks at little Johnny's split lip, a local carpenters deeply imbedded wood sliver, and telling Mrs. Gomez antibiotics don't help the common cold but prescribing one anyway. He's dialing the phone when he hears loud, distressed shouts. The patient is standing in the hall, bloody diarrhea running down his pants leg. It's a mess, and hes obviously getting delirious. His two nurses and one orderly are trying to help get the patient in hand. Doc hangs up in mid-dial and hits the speed button for 911.

The nurses and orderly are scrubbing down. The floor is an unspeakable horror of watery feces and blood. A departing patient skirts the visible muck, but maybe not entirely. Midafternoon traffic is a horror, and the ambulance takes 24 minutes to arrive. The patient is quiet again, whispering for water. The EMT's know something is off about this one. One had spent time in Africa with Samaritans Purse. But even he doesnt automatically think "Ebola." And no one mentions the bloody mess they just cleaned up.

Banner Samaritan's ER procedures are a lot better. But just before Business Guys ambulance pulls up into the ER bay, another ambulance rushes a gunshot victim into the hospital. Probably a drug deal gone bad, thinks the doc on duty. Happens around here a lot. That ambulance crew that radioed in about a severely ill flu patient? Theyre just going have to drop him off and let him wait.

Meanwhile, the hotel maid enters room 618, currently housing the luggage and dirty clothes of our vomiting, feverish businessman. She's disgusted hed leave such a mess behind in the bathroom, but begins to clean it up. She's got on Playtex gloves, but she stops to wipe her brow ...

The doc at the walk-in surveys the mess of his day, and the cleanup continues, He fleetingly remembers the CDC disease reporting rules. But it was just flu, and the guys at Samaritan will report it if its serious. Wont they?

Meanwhile, our traveling businessman is on a gurney, on fluids. He's hallucinating and fever-shouting. He rolls his head to the side, and vomits out what looks to be mostly blood. It shocks the ER staff. Not exactly what theyre used to. They're careful, thinking blood-borne pathogens, because well, because it's blood. But they're really scared when they notice it's ... chunky, and not like when someone throws up lunch, either.

They ask one of the attendings working on the gunshot victim what to do. He takes a peak out through the curtain and goes pale. He shouts, Get that patient into isolation, stat. Nurses don masks and gloves, and roll him into an isolation room. The doc tells his colleagues they will have to work the gunshot themselves. He follows the gurney with Business Guy on it down the hall to the isolation room. But it's not hermetic, negative internal pressure. Its just a room, and when the door opens, the outside air and the inside air become mixed

They get blood panels running. No one has said the word, "Ebola." But now there's a weird feeling in the air. This isn't typical ER work. They havent seen Ebola before, but theyve all read the CDC bulletins over the last two weeks, and this is all seemingly very familiar. Two more doctors are called downstairs from internal medicine, and at a break, one of them says, "How do we report a suspected infectious disease again? Isn't there a website?"

One of the ER docs has training on the CDC's NORS system, but it's his day off. They ask around, and eventually hospital legal gets wind of it. The administrator and the hospitals general counsel both agree: "Wait for blood work to come back in first. No need to start a panic. Don't want our ACA score dinged." So Patient X is in isolation, feverish, given fluids, plenty of care. A very nervous, bordering on frightened staff, gets a virologist/epidemiologist consult ordered in.

The virologist hears the business guys symptoms over the phone, but the staff doesn't go into detail. When he arrives and gets briefed, he too turns pale and says, You called CDC, right? Blank stares. Uh He calls CDC, tries to find the right person. Too late in the day. He leaves a message. Calls back. Leaves another one on someone elses voicemail. Calls a third time. Voicemail again. Gives up.
---
See Post #2 ...

Has Steven Speilberg called yet for your script?

OlduvaiGeorge · Oct 21, 2014

What no "Outbreak"? Scientists (not fundamentalists) were right about the risks after all? Pfft boring! Thanks Obama.

Joykins · Oct 21, 2014

Of course, customs people would ask about flu shots at least in part because flu kills (and will kill) a ton more Americans than Ebola. But also the initial symptoms of Ebola are flu-like symptoms. Knowing whether someone or their close contacts has a flu shot is important information in screening.

A truly frightening thought experiment about Ebola

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