It’s interesting watching the conservatives and right wingers attacking Obama over his assurances that Ebola was unlikely to get into the US on flights.

For instance:

Let’s unpack this shall we?

1) The person who has Ebola was asymptomatic on the flight. He wasn’t feverish, wasn’t vomiting, and wasn’t showing any symptoms. How do we know that he wasn’t symptomatic? That’s based on the timeline that health officials have established.

Do we keep that person off the flight to the US, which wasn’t even a direct flight from the region?

2) How many other diseases have symptoms that mimic those of Ebola. I’ll wait. You might have to go through a lot of diseases first - including common cold or the flu (both of which can be spread by the patient even before showing symptoms) , and even malaria and other tropical diseases.

3) A person is only capable of spreading Ebola when the person is symptomatic. That’s according to the CDC and WHO, both of which have been studying the disease since it was first identified in 1976 and the ongoing outbreak intensively. They have a list of what to look for, and how to stop the spread of the outbreak - contact tracing is integral to the strategy.

4) It appears that the hospital screwed up - they released him even though he apparently told the intake nurse he’d been in Liberia. That’s a huge problem. That failure allowed additional potential and actual exposures.

Those persons are now being monitored for symptoms. That includes family members, who would have been exposed in any event.

5) Shutting down airline travel to the region will have only minimal impacts in the US since there are few direct flights.

The countries tightening their borders over Ebola fears (against expert advice) http://t.co/f7EZ0HQe4h pic.twitter.com/dAti3dR6EF — Adam Taylor (@mradamtaylor) October 2, 2014

Stopping even indirect flights will actually have a net negative effect because vital personnel going in-out of the region, let alone food and supplies, to say nothing of Ebola-related containment equipment, testing gear, and samples for further examination would be delayed or detained indefinitely.

The best way to stop the spread of the disease by air means addressing this at the source. I’m spitballing here, but a quarantine period of 3 weeks before leaving the country might be a good idea - that’d give a chance for authorities to definitively clear someone for travel. The problem, as I’ve mentioned before is that there’s so few doctors in the region and the authorities are stretched so thin that it’s tough to get those rules in place.

There’s also a real concern about how waste from Ebola isolation treatment here in the US is being disposed of. The CDC and hospitals are working on setting up a protocol for sterilizing the medical wastes, some of which can contain highly infectious bodily fluids. That includes the use of autoclaves and incineration.

As for point (4) above, there’s a bit more to evaluate here.

The intake apparently included the patient divulging that he had been in West Africa, but that wasn’t passed along to the right people, and he was released without further examination.

“A travel history was taken, but it wasn’t communicated to the people who were making the decision. … It was a mistake. They dropped the ball,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “You don’t want to pile on them, but hopefully this will never happen again. … The CDC has been vigorously emphasizing the need for a travel history,” Fauci told CNN’s “The Lead with Jake Tapper.” Hospital officials have acknowledged that the patient’s travel history wasn’t “fully communicated” to doctors, but also said in a statement Wednesday that based on his symptoms, there was no reason to admit him when he first came to the emergency room last Thursday night. “At that time, the patient presented with low-grade fever and abdominal pain. His condition did not warrant admission. He also was not exhibiting symptoms specific to Ebola,” Texas Health Presbyterian Hospital Dallas said.

If it can be shown that the issue was insurance, then the hospital broke federal law - Emergency Medical and Treatment Labor Act (EMTLA). EMTLA, passed way back in 1986, prohibits the denial of care to indigent or uninsured patients based on a lack of ability to pay. Hospitals can’t use unnecessary transfers while care is administered, and prevents suspension of care once initiated.

If it can be shown that the hospital basically engaged in patient dumping, then they could be on the hook for some serious liability - civil and criminal.

Still, it is disturbing that the patient notified the nurse he’d been in West Africa, but that didn’t raise red flags to any of the doctors in the hospital that this was a potential case warranting further examination.

It also highlights the problems that medical experts across the world have to deal with since the initial symptoms of Ebola are so similar to those of common ailments and this is a disease few people in the world have had direct exposure to - there are more cases in the current outbreak than in all the other outbreaks in the world until this point. Doctors are trained to not look for zebras when identifying a particular ailment - they’re looking for the common first and by ruling those out, you are left with the proper diagnosis.

Here, that can have potentially disastrous results, which means proper intake by the doctors is critical and communication with other staff is essential. Persons who identify as having been in West Africa or have come into close contact with someone from West Africa may have to be triaged differently going forward when they come in with these kinds of symptoms.

It’s not like this was the first time someone came to a hospital and was identified as being a potential Ebola victim. Dozens of other cases have popped up during the past few months where people were screened for Ebola and kept in isolation until the results came back negative. The CDC has taken at least 90 calls about potential Ebola cases before the Texas case was confirmed as Ebola. That included a patient who was admitted to Mt. Sinai hospital in New York City. Isolation and safety protocols should have been the proper course of action in Texas, but that did not happen.

Everyone is on a very steep learning curve, but that doesn’t mean we should freak out - those cases that may still develop here are still going to be a whole lot better off than those in West Africa, where the situation is dire and where there are a handful of doctors for entire countries coping with the disease.

The best strategy for dealing with the outbreak is containing it to its sources in West Africa, and that means spending a lot more on getting those necessary resources to the region.

But as a backup, hospitals around the country have to prepare themselves for potential cases and know to ask the right questions. And then act responsibly and properly by isolating those individuals until they can rule out Ebola as the infection.



RedState gets in on the action:

Barack Obama Bans Flights to Israel, But Not Flights From Ebola Affected Countries: http://t.co/oMHT8rTGIn — RedState (@RedState) October 2, 2014

And this is more from that feed - note the usual suspects from Erick Erickson to Jim Hoft to Twitchy are in on this too.





Man in U.S. with Ebola had been screened to fly, but system is spotty http://t.co/aK18au9Y73 — NYT Science (@nytimesscience) October 2, 2014

So, the Texas patient had been screened to fly, but somehow it was missed that he had helped a person who had Ebola. He had direct physical contact with someone with Ebola, a pregnant woman who was trying to get to a hospital but was refused for lack of space and later died.

That should have raised red flags in Liberia before he ever set foot on a plane.

The people screening in West Africa have to ask the right questions just as surely as those at hospitals doing intake have to do the same.

That means asking all of the following before the person ever boards the plane:

Have you come in contact with someone who was sick in West Africa with any of the following symptoms (provide list as above)?

When did that contact occur (count days)?

Check for actual symptoms (checking temperature is one part)?

If person is not symptomatic, but that person has had direct contact with someone who had any of the symptoms that could be Ebola, the authorities must warn the person not to fly and/or alert facilities at the destination that person may have been infected, but isn’t symptomatic. The authorities must insure that the person gets proper medical attention/clearances at destination or have person in quarantine in origination country until they clear the incubation window.