Dallas Ebola infection/incubation timeline 10.19.14 (Duncan's family in 21st day!)

[morningfog]

Days since Duncan showed symptoms (Sept. 24)......24 days.


Days since Duncan was isolated (Sept. 28).....20 days -- 48 people are being observed in this group, including his family and the first responders. No one from this group has shown any symptoms of infection. This is their 21st day!


Days since Duncan's death (Oct. 8)......10 days -- 76 people provided care to Duncan before his death. As of today, two nurses, Nina Pham and Amber Vinson, have shown symptoms and infection has been confirmed.


Days since Pham showed symptoms (Oct. 10).....8 days -- One person is being observed as having direct contact with Pham after she showed symptoms. She's being treated at NIH in Maryland.

Days since Vinson showed symptoms (Oct. 14)......4 days -- Vinson flew on a commercial flight (with some 100 other passengers) from Cleveland to Dallas with a temperature of 99.4 degrees. She was quarantined and transferred to Emory.

______________________________________________________


The class of people exposed to Duncan pre-isolation have not shown symptoms and likely will not. The incubation period of this strain is 7-10 days in most people who become infected. Today is the 21st day since exposure and tomorrow the incubation period will expire.

Both Pham and Vinson were isolated when they had no symptoms other than a low-grade fever. Their viral load was low and it is unlikely they infected anyone prior to isolation.

The 74 other people in the same class/timeline as Pham and Vinson are nearing the end of the most critical period.l period. If more were infected, they would most likely have shown symptoms by today, the 10th day. However, they have another 11 days before the 21 day incubation period expires.

Of course, the clock has just started (and will restart) for those treating Pham and Vinson. Pham has been upgraded to "good condition" following treatment and a blood transfusion from Dr. Brantly. VInson is to be transferred to Emory for treatment.


Duncan's pre-isolation contacts are out of the woods. No one outside of the hospital was infected by Duncan.

Pham and Vinson are being treated in centers who know what they are doing. It is unlikely any workers there will be infected, even i their current conditions deteriorate.

Pham and Vinson each had close contact with one individual after their temperature rose. Other than those two, there is little to no worry whatsoever of infection for those on the plane, in the general public, in schools,on cruise ships or anywhere in Ohio or Dallas.

In short, we are nearing a point, despite the fear and paranoia, where we can feel safe that Ebola in the US was contained to three individuals.

[cantbeserious]

1. Thank You For Sharing

eom

[PearliePoo2]

2. Nice post and good work.

It's definitely looking better, minute by minute, day by day.

[Baitball Blogger]

3. I hope they take blood samples from all the people who are monitored

to determine if they developed anti-bodies. It would mean that they might have a genetic predisposition to fight the virus.

[Fred Sanders]

17. No, it means they were never infected in the first place, never had symptoms, remember?

[Baitball Blogger]

87. What about being asymptomatic?

Can't someone have rare immunities which can handle the virus without being a danger to anyone?

[Fred Sanders]

94. Rare immunities? No.

[Baitball Blogger]

99. This doesn't compute with other virus.

Ebola is only contagious if people are symptomatic. But I have to believe that some people, maybe not many, have healthy immunities that can develop anti-bodies and ward the worst off.

The only evidence that this struggle occurred, would be the anti-bodies.

[Fred Sanders]

100. The evidence it occurred would be actual symptoms of the internal battle, Ebola is not like the virus

causing Typhoid Fever that was infectious even though a person could be asymptomatic.

Ask Typhoid Mary how that went.

Epidemiology 101. Medical terminology has meaning and can not be redefined by casual users.

[RiffRandell]

4. Too early to celebrate but that is good news. nt

[morningfog]

6. Definitely not time to celebrate. But clearly no cause for panic.

F

[RiffRandell]

7. No panic from me. nt

[Warren DeMontague]

90. I think people have differing defintions of "panic", around here.

Apparently talking about it-- and asking why the state department placing any temporary restrictions at all on the handful of people who, like Mr. Duncan did, already have travel visas from the 3 nations at the epicenter of the epidemic would be an unacceptable hardship, is the equivalent of "panic".

[morningfog]

96. That is not panic.

That is a valid question.

Panic is closing schools because someone was on a plane with a person later confirmed to be infected with Ebola was on the plane will a slight temperature increase. Panic is not letting a cruise ship dock because an asymptomatic person who may have handled vials of Duncan's fluid was aboard. Panic is claiming it is airborne. Panic is refusing to use logic and common sense.

[Warren DeMontague]

102. If it was airborne, we'd know it by now.

And I for one sure as shit wouldn't be bothering to make an argument for travel restrictions- like the flu, there'd be no point.

I actually think that a valid debate- which I've only seen brought up once or twice- is whether, if we are going to have a slow but steady stream of ebola importations, we ought to reexamine our standard approach to heroic end of life saving measures. Normally, ethically, in western medicine when someone is about to die they pretty much throw the kitchen sink at them; as I suspect they did with Mr. Duncan- dialysis, etc. and I also suspect that it was in those last terminal hours that the two nurses likely were exposed.

Thing is with ebola (as we see, the folks in the apt. thankfully don't seem to have caught it) it is in the last terminal phase of the illness when the body is most contagious. Really, it becomes as Preston puts it in the Hot Zone, a "viral bomb". And once the patient gets to that point, it is pretty unlikely they will survive.

I think a re-examination of how we treat ebola patients in that last phase may be in order if we really want to protect the lives of health care workers- maybe pain management and isolation is better than a whole bunch of invasive procedures which are not likely to work but may throw a ton of viral material up into the air (not the same, of course, as the virus being "airborne&quot

it's an ethical question, because it forces a re-examination of how we would normally treat someone about to die. But I think it's a conversation worth having.

On a different note, I appreciate your acknowledgment that restricting visa travel is a valid question. There has been a lot of knee-jerkery around that, and name calling.

[marions ghost]

124. Doctors already do what you are suggesting

they don't advise throwing kitchen sinks at anybody, just for the sake of it. In this case, there was a huge effort to keep Mr. Duncan alive, for many reasons--he might be able to receive further treatment, for one thing. I applaud the docs for giving him the best chance they could. It was just not done with the best of safety precautions IMO.

You are in tricky waters when you start defining what is "end stage" in an unusual case like this, with an otherwise healthy individual. Usually from what I've seen, the doctors as a group advise the best course of action. And nobody is demanding someone live if they are truly on the way out. Sometimes "heroic measures" are effective. Give the docs the edge--if they advocate it, go for it. This has been my experience.

[MineralMan]

5. During this period, we've come a long way in our preparations for

any new patients that appear, too. Our experience with the first patient who showed up at a regular hospital is now being applied in training and preparation at hospitals elsewhere. If another patient appears after traveling here from one of the affected countries, we'll be far better prepared to handle that patient without infecting caregivers and others.

Patient Zero always leads to learning how to handle any other patients.

Other patients may arrive in the U.S., but things will be handled much better from now on, at least in our major cities, which have all incorporated what has been learned.

All in all, it has been less bad than it might have been.

Perhaps we'll stop being so panicky.

[pnwmom]

8. "Panicky" people haven't hurt anyone. But smug, over-confident people with insufficient protocols

might have caused the infections of two nurses.

[LisaL]

9. Exactly.

And now we have to start the count over, since people who were exposed to the nurses haven't finished their quarantine.

[pnwmom]

10. Yeah, but somehow they're less important . . .

[LisaL]

11. A lot of people are monitored because Amber flew while already

feverish and potentially experiencing other symptoms.
So for OP to declare that this is somehow going to be over soon is ridiculous.
He already jumped the gun when he declared that Duncan likely didn't infect anyone, and here he goes again.

[morningfog]

18. Please. Learn to read.

[LisaL]

22. I know how to read, thank you very much.

Your OP is again misleading. We are not nearing a point where we can say the Ebola is limited to three cases.
We have hundreds of people monitored because of Amber Vinson's using commercial airlines to fly from Dallas to Cleveland and back.

[morningfog]

31. Lol, okay. You ignore Patrick Sawyer and now Duncan

in favor of fear mongering. Sick.

[pnwmom]

137. How is it "fear mongering" to accurately state the number of people now under quarantine? nt

[Fred Sanders]

23. She was not, why are you now so blatantly lying?

[LisaL]

27. WTF are you talking about?

She had a fever. That's a fact. She potentially had other symptoms (per CDC).
Hundreds of people are being monitored or were told to self-monitor.
It's a fact.
So if you are not aware of the facts, quit with your nonsense.

[uppityperson]

45. What does "potentially had other symptoms" mean? Thank you.

[LisaL]

47. Ask CDC, because that's what they say.

[uppityperson]

51. Link? either she had symptom or didn't. It is possible all the info has not been released though.

[LisaL]

54. Here.

"AKRON, Ohio -- Amber Joy Vinson may have had Ebola symptoms as early as Friday, a Centers for Disease Control and Prevention official said, and passengers on the Oct. 10 flight the Dallas nurse took to Cleveland will be contacted. "

http://www.cleveland.com/akron/index.ssf/2014/10/ebola_patient_amber_joy_vinson.html

[uppityperson]

57. Thanks, i was off looking at articles too. While terms like "may" have their uses, they can also be

misused. She had non-specific aches and tiredness (fatigue) which could be due to a number of reasons, most innocuous like not getting enough sleep to travel.

"May" is a weasel word, a cya word which means they are not willing to make a clear statement. Or that they don't know if the fatigue and aches were due to ebola, without clearly stating that.

And in this case, it'd be good if they would as it might help dispel anxieties and increase trust. imo.

My research shows the same, lack of clarity. One of the things I did as a nurse was observe and document without judgements. I ended up in court a couple times as a witness, describing what I observed, saw, heard, felt, smelled. I really wish the people releasing info to news media would simply be clear.

"she had aches, was tired, might be related to ebola, might not" along with what they have said that she was not vomitting and did not have diarrhea.

grumbling off now

[LisaL]

59. They are monitoring over a 100 people exposed to her.

And the list is growing.
Obviously they aren't clear as to when (and if) she started having Ebola symptoms. And they say as much.

[uppityperson]

62. I agree, question is was her tiredness and achiness due to ebola or another reason. Difficult to say

[pnwmom]

138. But the fact is she does have Ebola so the conservative medical presumption

has to be that the symptoms she was displaying were related to her disease.

The other Ebola patients have described the same symptoms she had in the same sequence -- first fever, fatigue, and aches, and then vomiting and diarrhea.

[morningfog]

15. Where the fuck did you get that?

[Fred Sanders]

20. Too many folks here, including LisaL, are determined to spread fear and she is on a big team.

[morningfog]

28. I know. There on some vultures hoping for mass casualty.

[Fred Sanders]

32. Do not call the liars and fear mongers to their digital faces, get alerted and too many live in the

same irrational fear at DU...I thought the site was more science based, not media hysteria based.

[LisaL]

46. Who exactly is the liar here?

[LisaL]

30. Get what?

WTF are you talking about? If you are not aware of the facts, why are you posting?

[morningfog]

34. Where did anyone say someone is less important!

[uppityperson]

48. Who has said anyone is less important?

[morningfog]

19. Which is clearly stated in the OP.

Duh.

[Logical]

43. LOL, you have been the most panicy person here. nt

[uppityperson]

12. A Haitian woman threw up in public, 911 call of "Liberian woman who says she has ebola" .

MBTA station shut down.
http://www.bostonmagazine.com/news/blog/2014/10/16/ebola-scare-mbta-station/

Maybe no one got hurt from that, beyond the sick woman, but a waste of resources and potential harm. How about these? Again, no one "harmed" beyond a waste of resources and people responding.

http://www.bostonmagazine.com/health/blog/2014/10/13/ebola-scare-hits-boston/

The Globe is reporting that United Arab Emirates flight #237 is on the ground at Logan and has been boarded by officials in full hazmat suits. Five people on the plane reported “flu-like symptoms” but none had traveled to West Africa recently.
(clip)
In the last few days, there have been a number of Ebola scares in the U.S. At the Las Vegas Airport Friday, a plane was quarantined when passenger reported feeling ill. At Los Angeles International Airport Sunday, another passenger, who reportedly had just visited West Africa, was feeling ill with “flu-like symptoms.” And Sunday, in Boston, a patient with “Ebola-like symptoms” visited Harvard Vanguard Medical Associates in Braintree. The patient was evaluated and taken by ambulance to Beth Israel Deaconess Medical Center (BIDMC) where he was kept in isolation.

[Fred Sanders]

26. Some folks are determined to be afraid and reject facts in favor of fantasy to support the fear.

[kdmorris]

71. OMG!!!! My son threw up today!!

What if he has ebola??? WHAT AM I GOING TO DO??????? He doesn't have a fever, but ebola because ebola!!!!!!!!!!!

Get your flu shots, people. You are more likely to get the flu than ebola.

[Louisiana1976]

76. It's the beginning of the flu season. So obviously people will be sufering from "flu-like symptoms."

Are people always going to think they potentially have Ebola?

[morningfog]

14. Panicky idiots have caused schools to close,

A cruise ship to wander, untold stress to thousands, generated hatred and hostility and more.

[LisaL]

42. And because travel restrictions were not put on Mr. Duncan's contacts ( I guess somebody was so

sure Mr. Duncan didn't infect anyone) a nurse was allowed to get on the plane while already experiencing a fever, resulting in numerous people being monitored or having to self-monitor.

[Warren DeMontague]

95. And NOT treating a level 4 pathogen with the respect it deserves may still end up taking the lives

of two front line health care providers.

Compared to needlessly endangering the lives of two human beings who were just doing their jobs, you'll forgive me if I don't get hair-tearing upset over some school closures and some folks' irritation about supposedly undue "panic"

[Logical]

39. LOL, need links to some stories about panic??? I have a lot of them! nt

[MineralMan]

75. They haven't? Really?

Sorry, but you're incorrect. Panicky people have cause enormous problems already for lots of people.

If you're calling me a smug, over-confident person, you're mistaken. My reply was about the fact that the first case in the U.S. that showed up in a public facility has taught us a great deal about how to handle future cases. Do you dispute that? Did we not learn from the Dallas case?

Were we ready for that first case? Of course we weren't. Did we learn from it? Absolutely. Will the next case that walks into an ER be handled better? Absolutely.

There is no outbreak in the United States. There has been one case, followed by two others who treated that first case and did not use best practices. We've learned from that, and it's far less likely to happen again.

I'm neither panicky nor over-confident. Instead, I'm following this closely and thinking about it carefully. I'm never panicky and I'm rarely over-confident. I'm analytical. I study the situation and analyze it. I go to factual sources and learn from them.

[Warren DeMontague]

86. I agree with you.

The only thing that might be hurt by people taking this TOO seriously, is someone's narrative.

[laundry_queen]

130. +1 nt

[840high]

131. ...^ that

[uppityperson]

134. Navarro College, TX, is rejecting students from Nigeria.

http://www.nbcnews.com/storyline/ebola-virus-outbreak/texas-college-rejects-nigerian-applicants-cites-ebola-cases-n226291

At least two students from Nigeria who applied to a Texas college were told they wouldn't be admitted because of Ebola.

Kamorudeen Abidogun, a Texas man originally from Nigeria, said he received two letters from Navarro College, a two-year community college with a campus about 58 miles from Dallas. Abidogun has five relatives in Nigeria who were applying to the school and who were using his home in Richmond, Texas, as a U.S. mailing address, he told CNBC.
(clip)

The letter begins: "With sincere regret, I must report that Navarro College is not able to offer you acceptance for the Spring 2015 term. Unfortunately, Navarro College is not accepting international students from countries with confirmed Ebola cases."

Idris Bello, a Nigerian who lives in East Texas, tweeted a photo of the letter to bring attention to the situation. Bello, in an interview with CNBC, called the college's purported policy "embarrassing."...

[JDPriestly]

24. Yes. Observation and when appropriate quarantine of those who could possibly

have contact with a person having the disease is the way to stop irs spread, Saying it can't happen here is folly. It isn't necessary to panic if you deal with the situation and din't just go into denialm

[kestrel91316]

13. I am very relieved to see all his post-hospitalization contacts in the clear.

Clearing all his hospital contacts is a huge hurdle.

[LisaL]

16. That's inacurate.

He died on Oct 8th. Only 10 days since his death. His post-hospitalization contacts are not in the clear.

[morningfog]

21. But they are at the end of the typical incubation period.

It is *possible* more could show symptoms, but not *likely*. I am sure they are sighing with relief each passing day.

[LisaL]

25. That's false. Only 10 days since he died.

That's in the middle of incubation period.

[Fred Sanders]

29. Look up "incubation period" for a dead body....sheesh.....

[LisaL]

33. Bodies are highly infectious.

Touching the infected body can spread disease. If you don't know that, then you clearly don't know anything about Ebola.

[Fred Sanders]

36. The body was properly disposed of...look up incubation period for a dead body....

[LisaL]

38. Look for what incubation period means.

[morningfog]

37. Look at the average and mean incubation rates.

[LisaL]

40. You can't assume that everybody and everything will be average.

[morningfog]

41. More than average, the vast majority.

And I have never, never said anything other than likely and possible. Educate yourself and slow down when you read.

[LisaL]

44. You are posting false information.

Vinson already had a fever when she flew.
I have never seen reported anywhere her viral load was low.
CDC now says it's possible she was already experiencing symptoms for days before she flew.
Numerous people are being monitored or ask to self-monitor.
And there you are making your claims that it's likely over.

"There are now 153 people being monitored in Ohio because of contact or potential contact with Vinson. That number was 116 on Saturday."

http://fox8.com/2014/10/19/number-of-those-quarantined-after-ebola-patients-visit-rises-to-3/

[morningfog]

50. Because she had only a 99.5 temp, her viral load was low.

It is virtually impossible that she infected anyone on her flight. Remember Sawyer. Remember Duncan. Try, if possible, to employ common sense instead circling like a vulture licking your lips.

[LisaL]

52. Again, what are you qualifications?

You are making these claims that I haven't seen reported anywhere-where is the link for that?

[morningfog]

53. I'm not an idiot.

There is vast reporting on viral loads. Google it, and read slowly.

[LisaL]

55. You made a claim. So it's not good enough.

Show me a study that says there is a correlation between a viral load and a fever.

[morningfog]

56. I have no interest in trying to educate you,

an impossible task. If you aren't interested in learning, I don't care.

[LisaL]

58. I have been trying to educate you, but it appears to be pointless.

You clearly can't provide the link (because there is no such study), so there you go with the insults.

[morningfog]

60. Holy shit! This is not debatable. It's basic stuff.

Viral loads increase as symptoms progress. You are hopeless.

[LisaL]

66. Again, all I have is your word.

Do you have any education in the field?
Some people with Ebola don't develop fever. I presume you aren't aware of that?

"Yet the largest study of the current outbreak found that in nearly 13% of "confirmed and probable" cases in Liberia, Sierra Leone, Guinea and elsewhere, those infected did not have fevers."

http://www.latimes.com/nation/la-na-1012-ebola-fever-20141012-story.html#page=1

[morningfog]

89. From your link:

Dr. Anthony Fauci, who is helping to shape the U.S. response to Ebola as director of the National Institute of Allergy and Infectious Diseases, was asked by a CNN interviewer on Oct. 4 whether a person could be "contagious without having a fever."

Fauci replied that "the answer to that is no."

He continued: "You never say 100% but it's essentially 100%. … In biology nothing is 100%, but that's quite a reasonable conclusion to make."

Asked in the same interview about screening of air travelers, Fauci said, "Almost invariably, fever is the thing that signals the onset."

The other point is this. Just because someone never showed a fever does NOT mean they were highly infectious or even infectious before they showed OTHER symptoms. You have not refuted the point that (1) people are less infectious with lower viral loads; and (2) that someone with ONLY a low fever has a low viral load.

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.

* * *

Ebola virus is usually detectable in patients’ blood at the time of fever and symptom onset,17 although Ebola virus RNA levels at the time of fever and symptom onset are typically low (near the detection threshold limits) and in some patients may not be reliably detectable during the first 3 days of illness (Figure 1).14 Ebola virus RNA levels in the blood have been shown to increase logarithmically during the acute phase of illness14 and the bodies of deceased Ebola-infected persons are highly infectious.3

http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html

Straight from the CDC. You are welcome, and I accept your apology.

[uppityperson]

61. Here you go.

http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html

Ebola virus is usually detectable in patients’ blood at the time of fever and symptom onset,17 although Ebola virus RNA levels at the time of fever and symptom onset are typically low (near the detection threshold limits) and in some patients may not be reliably detectable during the first 3 days of illness (Figure 1).14

This shows viral load comparisons of who lives/dies. Different thing but I thought interesting.

[LisaL]

63. That is not what I am asking.

I am asking for correlation between patient's fever and patient's viral load.
And we don't even know the day the onset of symptoms was for Amber Vinson.

[uppityperson]

65. "Ebola virus RNA levels at the time of fever and symptom onset are typically low"

[LisaL]

68. When was the onset of symptoms for her?

Even CDC can't tell.
Also, according to the latest study, some people with Ebola (~13 %) don't develop fever at all.

[uppityperson]

70. I thought you said " I am asking for correlation between patient's fever and patient's viral load."

I gave you the CDC info showing the correlation between fever and viral load.

The CDC is unable to say whether or not her aches and tiredness were due to ebola or not, true. But she had a fever. Y

You said "Show me a study that says there is a correlation between a viral load and a fever" so that is what I gave.

I am not sure what you mean since I gave you the link and info about fever and viral load.

[LisaL]

72. It doesn't.

The graph you posted shows correlation between viral load and time.
It doesn't say anything about fever.
Some Ebola patient have no fever.

[uppityperson]

73. The graph was extra. The link and copied bit talked about it.

http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html

Ebola virus is usually detectable in patients’ blood at the time of fever and symptom onset,17 although Ebola virus RNA levels at the time of fever and symptom onset are typically low (near the detection threshold limits) and in some patients may not be reliably detectable during the first 3 days of illness (Figure 1).14

I clipped the graph in this reply to not be confusing. I had added that because it was interesting otherwise, as I had said.

[LisaL]

74. No, it doesn't.

It doesn't say there is a correlation between how high the fever is and viral load.
And again, some people with Ebola never develop a fever.
And as we don't know when was an onset for symptoms for Amber, we can't make any conclusions on her viral load.

[uppityperson]

79. Are you looking for a study between how high a fever is and viral load or just

"a correlation between a viral load and a fever"?

Post 44, you said "
Vinson already had a fever when she flew.
I have never seen reported anywhere her viral load was low. "
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5687871

You and morningfog went back and forth. I jumped in after this next post, #55.

Post 55, you said "Show me a study that says there is a correlation between a viral load and a fever. "
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5687925

I did with this "http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html
Ebola virus is usually detectable in patients’ blood at the time of fever and symptom onset,17 although Ebola virus RNA levels at the time of fever and symptom onset are typically low (near the detection threshold limits) and in some patients may not be reliably detectable during the first 3 days of illness (Figure 1).14"

Post 66 you said "I am asking for correlation between patient's fever and patient's viral load. "

I replied "Ebola virus RNA levels at the time of fever and symptom onset are typically low".

Now you say "It doesn't say there is a correlation between how high the fever is and viral load."

I have given you the link and words showing a correlation between viral load and fever onset.

I am not sure what you are looking for.

CDC and others have said clearly that viral load increases as the symptoms progress. There is a list of common symptoms for ebola, not everyone has them all, and some of those symptoms are also symptoms of other things (achiness, tiredness, fever for instance). Vinson flew with a mild fever, then got sicker and was tested, showing positive on ebola test.

I am not sure what you are looking for as I seem to have given you the information you asked for. I will not mock or insult, just am trying to understand and share what I know and can find.

[LisaL]

81. The OP poster made a claim that because her fever was low, her viral load was low.

So I think it's pretty obvious what I am looking for.
Although it's very clear to me that claim is false, since some patients with Ebola don't have fever at all.

[uppityperson]

85. OK. There are several things being mixed together here.

1. Vinson's fever was low.
2. She was achy, tired. These can be symptoms of ebola, can be symptoms of a lot of other things.
3. Symptoms vary.
4. Viral load is lowest when symptoms first show, increase as the disease progresses.
5. I do not know of a study, or data analysis, that compare fever differences with viral load.


I am comfortable saying that her viral load was low because she was just starting to show symptoms, per CDC. As she gets sicker, the virus builds up, as the virus builds up, she gets sicker. I am not comfortable saying 99.5 is an fever indicative of ebola because even lack of sleep or hormonal changes can make a temp be there. I can not say whether or not her achiness and tiredness was due to ebola, or lack of sleep, or travel, or a uncountable number of other factors.

But she was just starting to show symptoms, whatever of those you want to attribute to ebola, and her viral load was low, compared to how it is now, or will be next week.

I found an article talking about lack of fever in ebola patients, tracing it back to NEJM but can't find the NEJM article. If you have a better source, please post it as I'd like to see what they are talking about beyond a one line bit.

http://www.latimes.com/nation/la-na-1012-ebola-fever-20141012-story.html#page=1

The study, sponsored by the World Health Organization and published online late last month by the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola.

This is the only recent online article about ebola there and I find nothing about that study.
http://www.nejm.org/doi/full/10.1056/NEJMp1405314

Humans infected with ebolaviruses commonly present initially with nonspecific symptoms such as fever, vomiting, and severe diarrhea, with visible hemorrhage occurring in less than half the cases,2 as in the current outbreak.1

[LisaL]

101. You can read the actual article in the New England Journal of Medicine.

It's free.

[uppityperson]

107. Link? I couldn't find it. Thank you.

[morningfog]

92. And when do those who never have a fever have a high viral load? You think they are just causually

walking about with high viral loads and no other symptoms whatsoever? Surely, not even you could believe that.

[morningfog]

91. They think it is possible for someone to have NO sypmptoms and a high viral load.

Which is silly.

[uppityperson]

98. It would be interesting to see time, temp, viral load, other sx all graphed as to

what happens to individuals over time. But for now, I would be more interested in getting enough help to treat and contain all those sick and exposed where they are, as well as getting health care for those other problems people have and they can't get treatment for.

[Demit]

78. She wasn't reported as spewing bodily fluids all over,

whatever her viral load was. That fact would seem to be more relevant than the (low) fever she had. More relevant to the cautious optimism people are expressing, that is. Which is how "likely over" reads to me.

[LisaL]

80. Dead bodies are said to be higly infectious.

But they are not spewing bodily fluids all over for obvious reasons (they are dead).
So it's not necessary to spew body fluids all over.

[Demit]

83. I don't think she was reported as flying while dead, either.

What exactly is it you are trying to say? That the virus is just as likely to be transmitted at the beginning of the infection as it is at the end?

[Fred Sanders]

104. Epidemiology 101 would be behind her capacity, no more need be said.

[LisaL]

108. Did you take epidemiology?

I suspect high school biology might be beyond your capacity.

[Logical]

122. You seem to be the one who is freaking out for no reason! nt

[Demit]

129. Argumentativeness, tho, that she's expert in!

She keeps deflecting to the position of demanding that other people prove their bona fides, instead of presenting her point straight. Why, I can't imagine. She needs to justify feeling afraid, I guess.

[uppityperson]

49. Maybe she meant "pre-hospitalization contacts".

[Logical]

35. GREAT POST! Logic and common sense and critical thinking. Wow, much needed on the DU! nt

[ecstatic]

64. several people have pointed out that your information is wrong

but you don't seem to be interested in correcting it. Why? Did you miss the entire day of reporting about Vinson's symptoms beginning on Friday the 10th? Did you also miss WHO research showing the incubation period can be as long as 42 days? Are Pham and Vinson's patients being monitored?

You stated "we are nearing a point, despite the fear and paranoia, where we can feel safe that Ebola in the US was contained to three individuals." Yet, in order to reach that point, you've omitted and ignored a lot of details.
That being said, I hope you're right and that we'll come out of this mess with no more people infected.

[uppityperson]

67. Doesn't this part talk about Vinson's and Pham's contacts? I am confused. Thanks.

The 74 other people in the same class/timeline as Pham and Vinson are nearing the end of the most critical period.l period. If more were infected, they would most likely have shown symptoms by today, the 10th day. However, they have another 11 days before the 21 day incubation period expires.

Of course, the clock has just started (and will restart) for those treating Pham and Vinson. Pham has been upgraded to "good condition" following treatment and a blood transfusion from Dr. Brantly. VInson is to be transferred to Emory for treatment.

[morningfog]

69. Nothing in the OP is inaccurate. The last bit is my opinion.

The 21 day mark is still the measure. I'm familiar with the 42 day study, but it is a small fraction and not likely.

As for Vinson, all that is confirmed is the 99.5 temp. Flight crew said no other symptoms. Her uncle said no others.

[LisaL]

77. I dunno.

When over a hundred people are just starting on their monitoring process, it's kind of premature to declare that we are likely in the clear.
But obviously you know best.

[Egnever]

82. LOL

One would think that the example of all of Mr Duncans contacts pre hospitalization remaining symptom free would back people away from the edge of all of this ridiculous panic.

Clearly the TV has done a wonderful job of throwing all reason to the wind and people still cling to the idea you can get Ebola from someone looking at you wrong.

Carry on.

[morningfog]

84. And Patrick Sawyer. The inability to engage in critical thought over fear is astounding.

[LisaL]

93. Why do you keep bringing up Patrick Sawyer?

He infected a number of people.
Here, read what survivors had to say.

"The survivors of the Ebola Virus Disease have narrated their experiences, speaking of the trauma they went through and how Patrick Sawyer, the Liberian-American who brought the virus to Nigeria, lied to health workers who attended to him."

http://allafrica.com/stories/201409191572.html

[morningfog]

97. How many people did he infect while flying?

He infected health care workers who treated him. Read: direct contact with bodily fluids.

He did not infect a single person outside the hospital, even thought he flew with hundreds of passengers in a far worse and more infectious condition that Vinson.

[LisaL]

105. You are misinformed.

The guy who escorted him to the hospital from the airport got Ebola and died.

"Sawyer was to have attended an ECOWAS meeting and Abdulqudir escorted him to hospital in the Ikoyi neighbourhood from Lagos airport, where he arrived on a flight from Monrovia via the Togolese capital, Lome."

http://news.yahoo.com/ecowas-official-dies-ebola-nigeria-regional-bloc-223636365.html

[Fred Sanders]

110. He infected no one while flying, this is a deflection from that fact. The guy could have been

infected from another source or could have had direct contact, which did apparently did not happen on the plane...your information lapses are getting desperate.

[LisaL]

118. Your insults are getting absurd.

Mr. Saywer infected at least two people that were not treating him in the hospital.
Maybe if you read the post I was responding to, you would see that the claim was made that Mr. Saywer didn't infect anyone outside the hospital. Here is direct quote "He did not infect a single person outside the hospital"
Which is blatantly false.

[Fred Sanders]

119. Did you know the ebola crisis in Nigeria is over, they contained it! You have no such faith in Obama

and America, I get it.

[LisaL]

115. And he also infected another ECOWAS diplomat who didn't die (but fled quarantine and infected

his doctor). So that's at least two cases of non-medical personnel being infected by Patrick Sawyer that I can find.

"The ECOWAS diplomat, Mr. Koye, was one of the primary contacts of the index Ebola case in Nigeria—the Liberian-American man, Patrick Sawyer, who brought the virus to Nigeria."

https://www.premiumtimesng.com/news/top-news/167732-nigerian-govt-seeks-to-punish-ecowas-diplomat-who-escaped-ebola-surveillance.html

[Ms. Toad]

103. The CDC, who got their information from Vinson,

reported fatigue and malaise (feeling funny) beginning on Saturday, and possibly Friday. A second unnamed federal official also reported muscle ache. Flight crews (who do not know her, and who don't know what might look like "under the weather" for Vinson) aren't qualified to determine whether she had the kind of symptoms the CDC has reported, and her uncle likely doesn't know the kind of questions to ask unless he is medically trained. If he is going by what he observed, he may be somewhat more qualified to judge what she looks like in the early stages of a viral infection - although I'm pretty sure none of mine know me well enough to make that kind of assessment.

[Logical]

126. Did you even read the WHO report?? It says......

95% at 21 days 98% at 42 days. No reference to the other 2%. So I assume people like you will assume it means forever in isolation? Explain the 2% to us please.

[ecstatic]

135. of course I did... as far as the other 2%

I'm assuming they don't have information on when their symptoms appeared. But nice try. Not sure why you and others have such a big problem with erring on the side of caution. Why does it make you so mad?

[Logical]

136. Needless panic and freaking out makes me mad! nt

[Warren DeMontague]

88. It's awesome if no one in that apartment caught it from him.

It doesn't mean this particular thing is over; as others have noted, the time window on any tertiary cases from Pham and Vinson is not over yet. I think it unlikely they passed it on, but the only way to be sure is to wait and be vigilant.

However, if we continue to allow 150 or so vacationing visa holders in from the 3 nations at the center of the epidemic every day, we can look forward to doing this over and over.

[Fred Sanders]

106. No, we can not look forward to more fear mongering as there are no direct flights and the points

of transit are doing excellent medical checking...but you carry on with the fear and supporting the con political positions, free country. So I hear.

[Warren DeMontague]

109. "no direct flights" has nothing to do with the state department issuing travel visas.

The "excellent medical checking" involves a temperature check and a form. The exact same screening Duncan got through in Monrovia.

Let's see, you've got 2 of the classics- arguing against a point I'm not making (no direct flights) and trying to imply the argument I am making - which you don't actually seem to understand? - must be wrong because it's supposed to be a "con political position".

If you want to run down the entire list of bad logic fails, go to town. Free country, as you say.

But maybe you missed the WaPo poll that said a majority of Americans, 67%- including Democrats (so much for a "con political position", hurr durr) - now support some form of restriction on travel from the 3 countries where ebola transmission is currently out of control.

What do you suppose happens to those numbers when the next visa traveler shows up at an ER with ebola? Smart dude like you ought to be able to read the writing on that wall.

[Fred Sanders]

111. I agree with the medical science , not Glenn Beck, but different strokes.

[Warren DeMontague]

113. And, again.

I guess if you got nothin, throw ye olde ad hominem and hope it sticks.

Do you realize that they have closed borders in Africa, and that's why with the exception of one guy in Senegal, every exportation of ebola has gone out on an airplane?

Do you realize that have geographical containment inside of Sierra Leone and Liberia, and it's working?

[Fred Sanders]

114. What about Nigeria, are you serious that the borders are leak proof, really?

[Warren DeMontague]

117. Will you please do your research, first?

Nigeria didn't have any travel restrictions when Patrick Sawyer came in. They sure as shit do, now.

[Fred Sanders]

120. Nigeria contained the virus and is officially free of it, you have no faith in America, I get it.

[Warren DeMontague]

127. Now I have to think you're just putting me on.

You can't really think you're making anything resembling a logically coherent argument.

Nigeria contained it, yes, after a series of nail-biting close calls, including one guy who bailed on quarantine, infected a doctor in Port Harcourt and very nearly set off another series of infections there. And AFTER that, Nigeria restricted entry from the affected countries, which is EXACTLY what I'm arguing for, and to which your only response is seemingly something about right wingers and glenn beck.

Are the Nigerians all right wingers, too, for instituting travel restrictions?

[Fred Sanders]

121. Travel restriction were imposed as they had shared borders, those were closed, no others.

But closing borders means little in Africa, the borders are porous in such poor countries. It was science that stopped the virus.





NAIROBI, KENYA —
OCT 17, 2014, 6:15 AM
by
TOM ODULA
LYNSEY CHUTEL
THE ASSOCIATED PRESS
Health officials battling the Ebola outbreak that has killed more than 4,500 people in West Africa have managed to limit its spread on the continent to five countries — and two of them appear to have snuffed out the disease.

The developments constitute a modest success in an otherwise bleak situation.

Officials credit tighter border controls, good patient-tracking and other medical practices, and just plain luck with keeping Ebola confined mostly to Liberia, Sierra Leone and Guinea since the outbreak was first identified nearly seven months ago.

Senegal did so well in finding and isolating a man with Ebola who had slipped across the border from Guinea in August that the World Health Organization on Friday will declare the end of the disease in Senegal if no new cases surface.

Nigeria is another success story. It had 20 cases and eight deaths after the virus was brought by a Liberian-American who flew from Liberia to Lagos, Nigeria's commercial capital of 21 million people, in July. Nearly 900 people were potentially exposed to the virus by the traveler, who died, and the disease could have wreaked havoc in Africa's most populous nation.

Instead, Ebola appears to have been beaten, in large part through aggressive tracking of Ebola contacts, with no new cases since Aug. 31.

[Warren DeMontague]

128. Also Nigeria does not share a border with the affected countries, in fact it's 1000 miles away.

And like I keep saying, the Nigerian "success story" was also followed by them restricting entry from Liberia/Guinea/Sierra Leone, so they wouldn't have to keep dealing with Patrick Sawyer situations over and over.

[Fred Sanders]

112. Well, you can always hope another one gets through, the media is salivating for one. Like I said

I trust the medical science. I trust if Nigeria and Senegal and Uganda can contain it, so can America. This is all deflecting from the main issue, contained Ebola in Africa which is genuinely threatened.

I trust the folks that understand transmission by aerosol and transmission by contamination.

[Warren DeMontague]

116. Funny you should mention Nigeria, which had upwards of 20 secondary and tertiary cases from one guy-

Patrick Sawyer.

So you know what they did, after that? That's right. Travel Ban.

[TorchTheWitch]

123. not all of the people who cared for Mr. Duncan have the same timeline

Since any of them could be infected at any time from the day he arrived for the second time at the hospital to the day he died... or even the last day his body was handled.

We also don't know what days Ms. Vinson cared for him and on what day she became infected. We don't know what day Ms. Pham became infected either. We don't know on what day either of them became infected.

Quarantine days start from the last day of possible exposure for each individual.

We can only estimate Pham's timeline since we know her last day of possible exposure (the last day she handled either him or his bodily fluids) was the day before he died. Anyone else we don't know what their last day of possible exposure was. Because of that, we can't know what their last day of quarantine is.

[840high]

133. Good point.

[Tweedy]

125. Good news. Thanks.

[WhiteAndNerdy]

139. Thanks for the summary.

I was going to put one together, but hadn't gotten around to it.