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Sunday, October 26, 2014

A nurse under mandatory quarantine in New Jersey after caring for Ebola patients in Sierra Leone has blasted more stringent state policies for dealing with health care workers returning from West Africa, saying the change could lead to medical professionals being treated like "criminals and prisoners." In a first-person account in the Dallas Morning News, Kaci Hickox wrote that she was ordered placed in quarantine at a hospital, where she has now tested negative in two tests for Ebola. Still, hospital officials told her she must remain under quarantine for 21 days. "This is not a situation I would wish on anyone, and I am scared for those who will follow me," she wrote. read more

Thursday, October 16, 2014

An entry from This Week in Virology (blog written by a virologist Vincent Racaniello) about a new biosafety level (BSL) 4 facility in Boston and what it's like to work in a BSL4. read more

Friday, August 15, 2014

The town of Ferguson, Missouri, has been flooded with heavily armed SWAT officers in the wake of the Aug. 9 killing of unarmed teen Michael Brown by a police officer. According to some reports, upwards of 70 officers decked out not just in riot gear, but in equipment suited for foreign battlefields, took to the streets Wednesday night in an attempt to disperse the largely peaceful demonstrations organized to protest Brown's death. If the nation needed a poster child for the militarization of its police forces, it just got one. "The general consensus here: if this is militarization, it's the ---------, least-trained, least professional military in the world, using weapons far beyond what they need, or what the military would use when doing crowd control," noted Kelsey Atherton on Storify in a collection of tweets titled "Veterans on Ferguson."


And if you still want to claim fear as my motivating factor I'll clarify that what drives my opinion is the training I have driven into my head professionally.

I work with multiple viruses in a BSL3 and ABSL3 (animal facilty) on a daily basis.

To work in a BSL3 I have to wear:
a. disposable foot covers
b. disposable gowns (not Tyvek)
c. two pairs of gloves that overlap the sleeves of the gown
d. face protection

To work in the ABSL3 I have to wear:
a. the above but two layers of gowns (partially to protect the health of the animals)
b. a mask

with specified training and procedures in donning and removing the PPE.

All of this despite the fact that the viruses I work with are
a. extremely difficult to infect myself with (would require a needle stick or the splashing of a large amount directly onto my face)
b. have a low likelihood of making me ill and an extremely low likelihood of causing severe disease or death
c. impossible for me to spread to people around me

So when I have to go through all the training and precautions to protect myself from viruses that are hard to contract, most likely won't cause severe illness and CAN NOT be spread to those around me because of CDC policy yet...that same CDC seems to think that waiting for an Ebola-infected individual to become symptomatic before quarantining them is sound policy I call bull[...].

The irony, of course, is that I'm sure the current policy is aimed at not causing panic. I wouldn't be surprised one bit if the current policy is being used largely out of a desire to not add to people's fear, irrational or not. In fact, I wish I could be a fly on the wall during some of the policy discussions that I'm sure have gone on.

Since the cool kids want to continue labeling any who disagree with them as "afraid" despite it being stated explicitly that that is not the reason, I'm going to lay out my position in its entirety.

I AM NOT AFRAID I'M GOING TO CONTRACT EBOLA. In fact, I LOLed for about half a day over this past weekend when I found out an immediate relative of mine canceled their airfare and instead opted for a 17 odd hour drive over two days because they were afraid of Ebola.

My position is based entirely on taking a conservative approach to controlling as many variables as possible as the only strategy for stopping Ebola's spread is breaking the chain of transmission.

There are two possible ways for Ebola to reach the US, importation by either a. a returning healthcare workers or b. a non-healthcare worker.

Option a is a controllable variable. We know when they're coming back (or should at least...), who they are and exactly where they're coming from and going. Those belonging to option b don't have that sort of accompanying information. Therefore, in my mind it's best to control that group as best as possible as they have as great or greater risk of being in contact with an infected individual with no guarantee they weren't exposed.

Controlling that group provides the benefits of:

a. immediate medical attention upon onset of symptoms without
a.1. exposure of additional medical personnel or individuals (ie EMTs or loves ones)
a.2. contamination of multiple locations (ie their living space, ambulance used for transport ect)
a.3. the need to track and monitor contacts, which may not be a complete list

Further, by guaranteeing treatment of a sick individual immediately in an isolation ward, quarantine would

a. guarantee treatment by personnel properly trained with the use of PPE, including how to put it on properly as well as how to take it off properly, and with access to proper PPE
b. guarantee treatment in a facility that is equipped to properly treat the patient
c. guarantee treatment of the individual in a designated area that is
c.1. properly set up to isolate the individual
c.2. has proper procedures and facilities in place to deal with the generated biohazardous waste

I've even stated that a full 21 day quarantine shouldn't be required for individuals who test negative for Ebola by laboratory testing. This is a tough one, however, as I'm not sure how long it takes for a patient to become viremic and would need to see some solid supporting evidence for the specified time frame for which laboratory testing is considered an accurate measure of whether or not an individual is positive for Ebola.

Following these measures would decrease the amount of resources spent by public health agencies in monitoring multiple people and, in the event of a person being positive, it would completely mitigate the need for resources to track a patients contacts and monitor them.

Considering the only way to beat Ebola is to break the chain of transmission, the most stringent procedures for doing so are a must. I feel the above is the most stringent measures and see no benefit in doing it half-assed.

And yes, IMO if only even a handful of people contract it (read no Ebolapocalypse) and there is no wide spread transmission, that constitutes half-assed. Those commenting that it poses no threat to the general population are misguided in the criteria in that we shouldn't be thinking about the general population, but the ways in which it could get to an unlucky few.

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