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    Ebola question for Thalassa?

    Thalassa, I know that you consider the Ebola panic over blown.

    I trust you more than I trust what I read.

    Why shouldn't I worry about Ebola? Or should I?
    Every moment of a life is a horrible tragedy, a slapstick comedy, dark nihilism, golden illumination, or nothing at all; depending on how we write the story we tell ourselves.


    #2
    Re: Ebola question for Thalassa?

    I'm not sure if I should be scared or flattered by that Corbin...

    So...the million dollar question. I'll try not to write a novel, lol.

    I don't think you should worry about Ebola here, in the US, as an epidemic (I will address this in "Part A"). I *do* think you should worry about Ebola...but not for any reasons having to do with your health or the health of your loved ones (I will address this in "Part B").


    Part A

    Short answer:

    Ebola isn't much of a threat in a nation with modern medical facilities with highly skilled, trained, and supplied professional staff that can identify and isolate patients (now that we know to look), a well-nourished population with relatively close access to medical care, good sanitation facilities (clean water in our home, a culture that practically idolizes antibacterial cleansers, etc), relatively uncrowded communities, a funerary culture that doesn't encourage close contact with the dead, and a religious culture that (for the most part) doesn't consider illness to be "the work of god for some sort of punishment" that should be hidden....the general public here has at least a very basic (if somewhat flawed) idea of what germs are and how they work (and the flawed part is, I think, why the panic is easy to buy in to). The reason that ebola has become a problem in these countries is because of the state of affairs in these countries rather than the scariness of ebola.


    Long answer:

    Infectiousness of ebola-- When it comes to infectiousness, epidemiologists use something called the basic reproduction ratio (Wiki conveniently has a decent synopsis)...I think I talked about this in another ebola thread, but basically, the infectiousness of ebola isn't that high, compared to other infectious diseases (there are some caveats here--for example, a person can live with and transmit HIV over a much larger time period than ebola).


    (image source NPR, the accompanying article is one I linked to in one of the other Ebola convos)

    Certainly, an R value of 1-2 isn't anything to sneeze at--1 case becomes 2 new cases in the matter of a few weeks, which becomes 4 a few weeks later, then 8, 16, 32, 64, 128, 256, 512, and pretty soon a couple thousand in just a few months, etc. But the thing to remember is that R values are based on real world numbers, and the R value assigned to Ebola comes from our experiences in West Africa, where the political systems are fractured, the medical system isn't as advanced or well funded as in first world countries, and where the culture is very, very different.

    Something else to keep in mind is that ebola is easy to kill: Hand washing, 1% bleach, UV light...

    The virus is quite fragile and is easily destroyed by UV light, drying out, high temperatures (which is helpful in west Africa) and disinfectants including soapy water and alcohol gel. The longest it is likely to survive is a few days, if left in a pool of bodily fluid in a cool, damp place.
    (Source--The Guardian)
    Part of the reason for the high death rate (about 70% in the current outbreak) seems to be that the immune response isn't complete in most patients, and the person's own immune response ends up working against them (its a long pathway that I don't even quite understand). The experimental medication that has been used for at least two of the recovered ebola patients (the initial health workers brought here for treatment) seems to work on the basis of boosting immune response by adding antibodies for ebola (but I might be missing something here).

    How Ebola Spreads & How Ebola Can be Stopped: Ebola spreads through direct contact with the bodily fluids of patients with symptoms--mostly blood, vomit, and feces. Theoretically, it could also be spread through sweat and tears...and there's some evidence that it may have been spread through breast milk during convalesence. There's seeminly mixed data (without spending all day on looking for more info) on semen and/or vaginal fluids (though theoretically, one could be infected even after recovery)...(here's a study on transmission risk) As symptoms progress, the viral population in the patient increases. At the stage where the patient is violently ill, there is a very high viral load. But before a patient is bleeding or puking or shitting themselves, the chance of getting the virus into your body isn't that high.

    Ebola virus RNA levels in the blood increase logarithmically during the acute phase of illness (Figure 1) 14 and significant numbers of EVD patients have vomiting (67.6%), diarrhea (65.6%) and unexplained bleeding (18% and generally late in the course of disease)2 presenting opportunities for EVD transmission. Persons who have direct contact with infected individuals or their blood and body fluids, such as healthcare personnel without access to appropriate personal protective equipment or other caregivers in hospitals or homes, and persons handling bodies of deceased EVD patients are at high risk for Ebola virus exposure and infection.3 Ebola virus RNA levels in the blood in patients who died are also on average 2 log10 higher than RNA copy levels in patients who survived.

    (Source--CDC)
    So, if you got blood, vomit, or feces from an ebola patient on your hands, and had a opening from a scratch in your skin or you rubbed your eye, or nose, etc...then you could get ebola. This risk is the highest for health care workers, because their job is to handle the patient at this stage of the illness and because its hard to work in protocols you aren't fully trained in and used to.

    And (as I can tell you from personal experience), its very easy to do contaminate yourself without even thinking about it, even if it means breaking PPE protection to do it--I see people in respirators pop them off to wipe their nose or whatever in a hazardous space more often than not when I'm sampling...or pull up their safety goggles or face shield to wipe their eyes with their fingers (covered in whatever)--they don't stop to wash their hands or leave the space or whatever.

    To stop ebloa, we need to contain cases that occur when symptoms show up. That means we need people to understand how ebola is transmitted (so they can avoid contact with potentially infected persons ore react appropriately if they do have contact), and to know what to look for when it is possible they were exposed. Those patients need to get early care in facilities that are equipped to deal with diseases such as ebola...the only bit I disagree with in terms of the official response here in the US is the idea that any large hospital can deal with this--theoretically, yes...any large scale hospital SHOULD have been able to handle a patient with ebola (and probably could now, with increased awareness and training and modified protocols, providing those protocols are being followed)--but in the early days of any response, there's a learning curve and responses aren't perfect.

    Medical system and health culture differences: In this country, when we get sick, we have access to relatively quick medical care. We go to the doctor or the emergency room. When I went to the doctor's office, the very first thing the doctor did (while I was calling on the phone) was ask me if I'd traveled internationally or had any contact with people that had traveled internationally in the past 30 days. Pretty sure, if I'd said "yes", I would have been further questioned and directed further on what to do. At some point in time I would have been isolated, examined, and quarantined.

    Because Ebola virus is spread mainly through contact with the body fluids of symptomatic patients, transmission can be stopped by a combination of early diagnosis, contact tracing, patient isolation and care, infection control, and safe burial.
    source
    In this country, we can (fairly easily) do this. Certainly there will be some health workers that contract ebola when we have ebola patients to care for. PPE can fail or be used improperly, as we have seen (in one case in this country, of a highly infectious patient during the advanced stages of his care, at a health care facility that was not fully prepared or compeltely equipped to take him as a patient--he was the first guy, and there's a learning curve). But we have the infrastructure set up to handle this. Yes, there will be mistakes...but I have faith in the system we have in place, beause it works all the time for diseases you and I never hear about in the news.

    Cultural and political differences: For as much as I bemoan the dismal state of scientific literacy in the US, its no where close to West Africa. In one village in Guinea, villagers killed 8 health workers coming to educate the community about Ebola...this was after a riot broke out in response to health workers decontaminating a market. This is an area of the world where a sizable portion of the population think that ebola is a lie, or that ebola is being planted from the government (or by outside agents)...

    Its also a part of the world that has long been marginalized as a result of colonialism and where development has been slow following civil wars in 2 of the 3 countries (Sierra Leone 1991-2002, Liberia 1989-1996 and 1999-2003). These three countries have soft borders, and travel and trade between the three countries is continuous and unimpeded. Combine that with a highly distrusted and ineffective governmental structure (in this country, we may not *like* politicians, but overall, as a people, we don't universally distrust the NIH, or the CDC, etc)--their governments are highly ineffective and corrupt.

    To be sure the Roadmap (the WHO health plan) contains a small section on the importance of community engagement and the need to understand local groups and traditional medicine. But so far the Western response and the public health campaigns have paid only scant attention to such things and have failed dismally to come to grips with local cultural and traditional views and/or enter the frame of reference of local people and understand how they evaluate risk, see infectious disease, understand the role of animal populations, and react to Western medical and foreign interventions. In many ways it is a significant failing.


    Add this to the fact that the literacy rate in parts of West Africa is among the lowest in the world and that countries affected by Ebola possessed at best fragile health systems and very poor disease surveillance networks and it is small wonder that we have ended up with social chaos and public hysteria.


    Throughout the area affected by Ebola and in many other parts of Africa, people including many health care workers, are scared and react accordingly. Denial, fear, hysteria and panic are the order of the day, and many hospitals and clinics are closed or avoided by people as well as by some health care workers who fear catching Ebola. Add this to the human reaction when confronted by alien-appearing figures dressed from head to toe in protective clothing, with confronting hoods, masks, goggles and long rubber gloves, and you can understand why the immediate response of many people is to deny the existence of Ebola, hide and/or flee.


    Health clinics and hospitals are often feared as being the source of the virus while many people remain fearful that if they report or identify a body of a relative they may well be ostracised by the local community and/or forced into formal quarantine. In many cases dead bodies have been left to lie on the streets. Formal government quarantine and isolation procedures such as road blocks have added another dimension and produced scenes of social chaos as people have often tried to storm through the barricades and in some places it appears that the state infrastructure is close to collapse.

    source

    PART B:
    But I am worried, very worried about ebola. I'm worried about what the coo coo over-reaction in this country and by other countries means, on a number of levels. I'm worried about a fear-based, anti-science public policy becoming the norm in America--between vaccine denialism, evolution denialism, etc--and now "Ebolanoia"...we have got to be one of the most scientifically illiterate first world nations, if not *the* most.

    It does not make the news when a two year old boy dies of Ebola in Guinea. Nor when his sister, his mother and his grandmother succumb. It takes time for local officials to recognize an outbreak. By the…

    I'm worried about the politicization of a heath crisis of our own making (because, lets face it, Western Civilization shat on the continent of Africa, set it on fire, and left it to burn--and then, of course, we blame them for all their ills and want nothing to do with it)...the world failed to act when this disease was early in its growth--we live in a global society, our world is smaller than it used to be--Libera is across the global street. Sure, you don't have to get a cold just because your neighbor has one, but you're an ass if you don't ask them how they are doing and if they need anything when you can hear them sneezing their head off... It could have easily been contained months ago if we had gotten together and devoted the resources to it...and now, we are paying the price as a society. My answer to people paniced about the possibility of ebola, is that they deserve it--in my observation, these are some of the most vocal opponents of any sort of foreign aid or involvement. THIS is why we need both.

    I'm worried about the rediculousness of the publics reaction to any mention of *Africa* and the stigmatization that causes for immigrants, or for people with relatives in Africa, or for people that travel (not to mention health workers and humanitarians). I'm worried that this political fear mongering will make the ebola crisis worse in Africa (this piece articulates my position fairly well--its too long to quote the whole thing, and there's too much that I'd want to quote to pick out the highlights). I'm worried about an area of the world that can scarcely afford this pressure on their cultures and on their people. I'm worried about a country whose pundits feel comfortable advocating for the euthanization of people with a disease because "they'll probably die anyway" (to paraprase).

    To me, the ebola panic is one more symptom of what is wrong with our country and our culture in the US...and I worry about that...but I don't worry about the almost nonexistant possibility that ebola is going to rampage through the US...

    (And, I think I'm going to stop there...but I'm pretty sure I could go an write more on almost every topic, and more if I had time...)
    Wonderful Life: The Burgess Shale and the Nature of HistoryPagan Devotionals, because the wind and the rain is our Bible
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      #3
      Re: Ebola question for Thalassa?

      This is why He asked you Thal...cause you lady are the one person that would really answer a question,and not go on a random explanation based on conjecture.

      You My dear are the WOMAN!
      MAGIC is MAGIC,black OR white or even blood RED

      all i ever wanted was a normal life and love.
      NO TERF EVER WE belong Too.
      don't stop the tears.let them flood your soul.




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      my new page here,let me know what you think.


      nothing but the shadow of what was

      witchvox
      http://www.witchvox.com/vu/vxposts.html

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        #4
        Re: Ebola question for Thalassa?

        I admit it, I'm slightly worried about ebola. But I'm slightly worried about all contagious diseases. I've already brought pityriasis home to my husband once, and some other rashy tropical disease that I've forgotten the name of. I never catch anything anymore, but I seem to carry it all home w/me. We get outbreaks of various noroviruses & rotaviruses. We get Legionnaire's outbreaks at the pools & spas. I've seen a tourist w/leprosy at my workplace. Granted, leprosy is pretty difficult to catch, and can be treated, and you'd probably have a greater risk of contacting it from a stuffed armadillo in a Texas gift shop, but still...

        If anyone works in a place w/a public restroom, you probably understand. You wouldn't expect it, but working in a major international resort/tourism mecca means you have the potential of coming into contact with bodily fluids at any given moment of your workday. People travel when they are sick, people come to work when they're sick, people do not wash their hands, and people touch everything. And the cleaning staff cannot be everywhere at once. I don't even work in housekeeping or internal maintenance, but I've stepped in vomit, urine & feces. Drunken tourists get very touchy-feely. I've had drunken tourists puke on me. Hell, I've had angry tourists spit at me.

        Many international tourists take long holidays, so yeah, they could pass all their airport screenings, and hit the ebola incubation period in the middle of their hotel stay. We might not even know they've got something truly nasty brewing, either - we value our guests' privacy even at risk of their safety.

        When stuff like MERS, SARS, or ebola comes around, I start envisioning scenes from The Stand - that one guy who broke protocol & all the people he came into contact with, and then all the people those people came into contact with, and soon the planet is annihilated by the flu. Of course, I usually keep my personal concerns to myself - I just bitch at everyone about washing their hands.
        The forum member formerly known as perzephone. Or Perze. I've shed a skin.

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          #5
          Re: Ebola question for Thalassa?


          And Now my OCD ISN'T killing me.
          Ebola is meh, all I hear is 'just another outbreak'. Too few new people come through where I live for me to be worried about it, I haven't had a cold in a couple of years at least xP
          Work hard Play hard.
          What is history?

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            #6
            Re: Ebola question for Thalassa?

            Don't be scared - I just wanted someone to give me the straight story, and, considering the news coverage ... from all sources... is either sensational or political... others might appreciate it as well.
            Every moment of a life is a horrible tragedy, a slapstick comedy, dark nihilism, golden illumination, or nothing at all; depending on how we write the story we tell ourselves.

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              #7
              Re: Ebola question for Thalassa?

              Hey thal could you make that into a blog post if you haven't already? Then i can share on fb and watch my family go nuts. ..nutser?
              We are what we are. Nothing more, nothing less. There is good and evil among every kind of people. It's the evil among us who rule now. -Anne Bishop, Daughter of the Blood

              I wondered if he could ever understand that it was a blessing, not a sin, to be graced with more than one love.
              It could be complicated; of course it could be complicated. And it opened one up to the possibility of more pain and loss.
              Still, it was a blessing I would never relinquish. Love, genuine love, was always a cause for joy.
              -Jacqueline Carey, Naamah's Curse

              Service to your fellows is the root of peace.

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