This morning I received this email from President Lee Bollinger:
Dear fellow members of the Columbia community:
As you may have seen in the media, Dr. Craig Spencer is being treated for Ebola at Bellevue Hospital in Manhattan. Dr. Spencer, an emergency department physician at NewYork-Presbyterian/Columbia University Medical Center, recently returned from a humanitarian mission with Doctors Without Borders to one of the outbreak areas in Western Africa. We admire and appreciate all of those willing to do this vital and selfless public health work around the globe.
It’s critical to bear in mind what our public health and infectious disease experts have emphasized €“ that the risk to people in New York City and at Columbia remains extremely low. If you or anyone has any concerns, please visit the University’s Ebola Preparedness site or the New York City Department of Health Ebola update page. You may also contact Student Health Services or Workforce Health and Safety for Faculty/Staff with Hospital Responsibilities.
We must keep Dr. Spencer in our thoughts and wish him a full and speedy recovery, as we do the vulnerable populations he serves. We will also continue to keep the Columbia community informed as we learn more from City, State, and Federal health officials.
Sincerely,
Lee C. Bollinger
The transition between incubation period (when there are no symptoms) and the first clinical signs is a dangerous period. During this time the patient may continue to move around in public despite having fever and other indications of infection. It will be important to trace as many of this physician’s contacts as possible, a difficult task in a city of over 8 million people. Apparently the physician traveled around the city, using the subways, the night before having a fever. Whether any virus is shed during this time, in amounts sufficient to infect others, is unknown, but could be determined by studying the contacts of such infected individuals.
I just don’t understand why a physician that has done such an amazing job in west Africa, and is wel aware of how dangerous the virus is and what the incubation times are, thinks it is ok to roam around a city such as NYC even though he should be well aware this could be a danger to the public health. I just don’t understand. Why not wait a few weeks (preferably 21days….) until roaming around the city taking public transportation.?
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I’m puzzled why everyone is so convinced that Ebola Virus Disease is not transmittable during its subclinical/inapparent infection phase. The emphasis upon “not contagious unless the patient is fully symptomatic” may be helping to sustain this epidemic in Africa. My guess is that there is viral shedding before symptoms through sweat glands and other secretions, although the viral load may be slight. It doesn’t sound like EVD requires a very high concentration of virus particles to initiate disease.
I agree. These health-care volunteers should remain in Africa for the extra 21 days and perform valuable administrative tasks that do not require patient contact or high-risk activities. These quarantined doctors & nurses would be very valuable in compiling statistics, performing biostatistical analysis, writing case reports etc. This would allow them to fulfill the 21 day quarantine period while remaining involved in very critical tasks.
Excellent suggestion, @CRS_DrPH:disqus !
Same puzzle as “Not airborne”, “hard to catch”, “Face Shield minimum”, 2-21 day incubation, and “quarantine is counterproductive”. It’s all about dogma, narrative, expedience, PC, and appearances-rather-than-reality.
We have lots of time to get it right if we can keep it from becoming pandemic in the meantime. We’ll catch more !!! Plenty more dilettante HCWs to go help for their month’s vacation. Ebola is a slow-motion-train-wreck.
MSF has been very up front why they won’t do this. They desperately need more help and any kind of enforced/21 day/ quarantine would decrease the numbers of volunteers. Their protocol is the expedient solution and should work most of the time (except when it doesn’t). Can you blame them ?
Slow-motion train wreck….God, ain’t THAT the truth! We really haven’t had much exposure to this filovirus up to now, so many questions (transmission, incubation periods etc.) have largely gone unstudied in the human model. As far as keeping it from becoming pandemic, I feel that we are losing this war, and we are only a plane-trip away from launching this thing in India or other at-risk location.
Well, if we continue to receive infected MSF volunteers in the US, they can just wrap it up…political support for this type of thing is waning from what I can see. An in-country “cooling off period” makes a ton of sense to me, a practicing epidemiologist! As long as I had a laptop & electricity, I’d be very productive for 21 days.
What are the cultural norms in India that would help perpetuate the spread of Ebola? Do they hand wash their dead too?
I am surprised to find so many posters here that seem to distrust the science that has been used to study this virus and the results that science has produced. This is a virus that is communicated by contact with bodily fluids, not air borne. The infectious phase does not include time before a person is symptomatic. There have been two cases of transmission occurring in the United States and those are the Texas cases. No other person, be they connected Mr. Duncan or the nurse that flew while contagious, have occurred. This is scary stuff for sure but folks need to not lose their sense of reality.
“…dilettante HCWs to go help for their month’s vacation.” I think this blog has become infected, infected by the nasty troll bug that ruins so many useful blogs. Dr. Racaniello are you monitoring this stuff because some of it is very vile.
Dr. Spencer acted in seemingly negligent ways because he is human, and humans, when faced with a threatening calamity March, post-haste, into the state of denial.
If you do an internet search for “heart attack” and “denial, you will find a wealth of information on the subject.
Dr. John Leach (http://myheartsisters.org/2010/12/04/denial-heart-attack/) describes the process:
“During a crisis, most of us will quite simply be stunned and bewildered. We’ll find that our reasoning is significantly impaired and that thinking is difficult. We’ll behave in a reflexive, almost automatic or mechanical manner. We’ll feel sick, lethargic, numb. Our hearts may race.
“And we’ll experience perceptual narrowing or tunnel vision. We’ll barely hear people around us. The brain has limited storage, so when we face sudden threats, it pushes other things out in order to process them. If we’re anxious or worried, our decision-making skills temporarily disappear.’â€
Then, when you add hubris (which so many physicians seem to have), there is a whole new layer to the problem.
I would rather the American workers return to our country for quarantine. They need to be home….In quarantine, but in our home country.
The fact that the first ebolavirus-infected patient caught America with its pants down, metaphorically speaking, is one good reason not to trust what the government is saying.
The fact that, despite knowing these catastrophic filoviridae viruses were (as Laurie Garrett wrote in “The Coming Plague” in 1994) “just a plane flight away from America’s shores,” our government slashed funding for the very programs we needed to prepare us for this inevitable national security risk is another reason.
And how about the under-funded CDC having conflicting, wrong and incomplete information on their website months after it was quite apparent this latest outbreak was a whole different critter from the previous outbreaks?
How about the fact that those government agencies who were supposed to have prepared us for this known threat are clearly making it up as they stumble from debacle to debacle?
I could go on, but you get my point.
Despite all of the science available, it didn’t make a rat’s patoot of difference. Our country was STILL caught unprepared, and they have been more concerned with keeping us meek and calm then giving us the truth about what is going.
I don’t read it as “vile.” I read it as “frightened and angry,” and Fred Trout has every right to be.
Our government, by lack of funding and neglect of a major national security risk, left us unprepared for the outbreak of ebola which we knew was going to surface again.
Worse, the government has not been transparent in keeping us informed. Instead, they were more concerned with keeping us calm, when it is sheer folly to be calm in the face of an ebola outbreak.
I mean, really. The outbreak in West Africa started in December 2013. By March 2014 it was clear the latest ebola version was a threat. Yet it wasn’t until October that our president and congress broached the issue.
So, yeah, we have a right to be frightened and angry, and someone telling us we don’t just puts an exponent on what we are already feeling.
I do believe it serves no purpose to disrespect the health care workers who have been on the front lines of this national security risk.
Yes and Trout’s disrespect of health care workers who risk their lives suggesting this is some sort of beach blanket bingo for those workers is vile in my opinion. I am not sure why you feel we in this country are so unprepared given the number of people infected here, seems to me we are doing quite well. As for the whole world communities lack of intense response to this outbreak in terms of providing resources to West Africa…yeah it is disgusting.
I am with you up to the point of accusing the government of having the intent of keeping us meek and calm. The lack of providing resources to West Africa in my mind is a function of the inability of congress to get any meaningful work done that involves increased allocation of money because we are supposed to be cutting all government expenditures and privatizing all services. The facts on this outbreak and the nature of this virus have been easily accessed all along. It is our leadership that was distracted with their own navels that was meek in response.
May I ask what are the good professor’s views are on MSF’s statement that quarantine is unwarranted, contrasted with NY/NJ’s mandatory quarantine measures for returning healthcare workers?
It won’t spread in India, as resident bacteria and Viruses will fight off.
The problem is that in order to get home they must embark on an often multiple flight airline journey. It would seem to me that if a person developed vomiting and diarrhea due to Ebola when the flight was halfway across the Atlantic, this may pose risk to his fellow passengers. I feel it would be wisest for the quarantine to be completed prior to boarding a flight and traveling to other countries.
“Plenty more dilettante HCWs to go help for their month’s vacation.”
So far, sixteen Doctors Without Borders volunteers have contracted Ebola, and nine have died from the infection. You really should show a bit of human decency and take back your thoughtless comment about such courageous people.
Source – http://www.theguardian.com/world/2014/oct/20/msf-volunteers-ebola-front-line
LOL, good thing I wasn’t drinking coffee. They dump their dead in rivers – the same ones they wash in and drink from, defecate in public and then use the dried product for cooking, and so on.
So, you actually believe that spending a month (or less) in Sierra Leone is an effective contribution and will allow us to get control of this outbreak ? Subtract off all the time to learn how to deal with PPE and procedures, to have someone with experience take time off teach you on the job so you don’t kill them or yourself. Recall how well you worked when you first started a new job. How much is the effective contribution really and how many DID Spencer scare away by perhaps making a noob mistake but in any case coming home infected ? The reality is nothing currently being done by the MSF will do anything that will allow us to regain control. Their efforts are laudable but doomed as they well know. Millions will die without draconian measures or a vaccine with draconian measures. They ‘cure’ a few (30%) and survivors starve to death or die of malaria, etc. since normal health care & food distribution has disappeared. You and those below need a reality check, and I am providing it because we are well past suffering fools gladly. Now is the time to plan for the worst because “winter is coming”. Reality is vile. PC & liberalism, being polite, has no influence on Ebola; but it IS an equal opportunity killer currently at 70% or so for all those folks stuck in their shacks without treatment. Meanwhile, Spencer gets the best treatment money can buy. The horror of it all must be sublimated, ignored, because it is just too terrible. Consider THAT instead of vile old me.
Please, singe, time for you to do your homework instead of spouting party line nonsense. Spend some time reading the literature, the podcasts, articles & discussions here are a great place to start. PubMed searches will answer many questions. Ignorance is curable.
Yes, 450 HCWs infected, 244 dead as of 25 Oct Think about that for a minute. They all had mothers, fathers, families, hopes and dreams. A laudable effort but the outbreak worsens. See my comment above to singe concerning that dilettante Spencer. Go ahead and hate me if it makes Ebola go away for you; nothing else seems to be working so you might as well dwell in LaLaLand. Ebola.does.not.care. (neither do I) Or you can stay angry and get the people who can fix this off the golf course.
Really, could not agree more. How about crowd sourcing on analysis and tabulation of data on the internet ? There’s a quickly fundable grant proposal if I ever saw one. Bet there would be millions of volunteers. And more short term volunteers with none-to-minimal-exposure-risks makes a great deal of sense; things like how long til onset of symptoms, which when, symptom percentages, mortality rates, what supplies are needed when, other logistics, on and on. So much to learn even if I am retired.
Thanks for that. But just plain angry will suffice. People who make it much worse deserve disrespect and I am grumpy enough to dish it out. Bowling ? You can’t make this stuff up.
Ah yes your defense of Fred Fish is illuminating. He writes “winter is coming” which is a quote from the HBO show “Games of Thrones”, not exactly a PubMed search, he accuses Doctor’s Without Borders of vacationing in Ebola riddled countries. You accuse me of touting a party line but it is you who write “…those government agencies who were supposed to have prepared us for this known threat are clearly making it up as they stumble from debacle to debacle…” which is as close to a “Savage Nation” hyperbolic line as one could find. So far no one in this country has been infected by any medical worker returning from West Africa and workers have been going and returning since at least June, none of the people who flew with the infected nurse have been infected, no one except the two nurses who worked with Mr. Duncan has been infected. Is the disease a nightmare…of course, does is deserve the kind of broad stroke, hysteria you and Fish are promoting….of course not.
I have a degree in Biology, I visit this site and others quite often. I too am worried about the future of our species, the destruction of the ecosystem, the lack of sanitation and medical resources in much of the world….but I will not accuse the scientists and medical workers of this country of running some sort of con game on the rest of us when they really know we are all doomed as you and your buddy Mr. Fish have done. Perhaps you and Mr. Fish are angling for appointments to Governor Christies science advisor team?
Gee Mr.Fish looks like earlier I confused your snotty response with the snotty responses of Ms. Malone….doesn’t matter much as you both seem to be towing a right wing “the gument is gonna kill you” line and puffing out your chest full of battle ribbons while denigrating any easy target you can find. Then again as we all know about the intertubes you two could be the same person….as could the three of us…
So, this may be a stupid question but I have no idea how this works. When we talk about “amounts sufficient to infect others”, what are we talking about? that is the amount is small the odds that you get in contact with one is small, or that just one copy of the virus by itself cannot infect you? I would think just one into your blood is enough to maybe kill you. Thanks
defend the indefensible – that will work – if you really have a degree, you too are a dilettante … or a political operative, con game indeed. Dr will deserve some jail time, if he lives.
hero doc lied to the police about his self quarantine –
“He told the authorities that he self-quarantined. Detectives then reviewed his credit-card statement and MetroCard and found that he went over here, over there, up and down and all around,†a source said.”
http://nypost.com/2014/10/29/ebola-doctor-lied-about-his-nyc-travels-police/
ah, the real agenda surfaces ! LOL the con…
so sorry, .ebola.does.not.care. about your political agenda
Lab experiments with animals demonstrate only 1 to 15 live viral particles are needed to initiate a fatal infection for this strain. Blood in advanced stages can have more than millions of viral particles in a few drops.
Hey Fish you’re along way from PubMed sloshing around in the NY Post….speaking of dilettante what laws did the doctor break and what are the chances he’ll do jail time for them…? Get a grip and while I am at it this all inclusive comment on the people of India you posted above gets filed under sick, racist rant “… They dump their dead in rivers – the same ones they wash in and drink from, defecate in public and then use the dried product for cooking…”. Don’t forget to have a nice day.
How it works: all it takes is ONE of any virus to bind with a cell, have it’s genome transferred within the cell, and then replication of that genome accomplished and the host is now INFECTED. The indications are that Ebola proliferates by a budding mechanism: http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm
which does not necessarily destroy the host cell immediately. Consequently the Ebola replicants infect other cells at an astonishing rate. Assuming that there is one replication every few seconds as the virus genome is only about 19,000 neucleotides in length, and each replicant genome successfully reinfects. The number of virri can quickly become the astronomical “billions upon billions”.
The question is at what point the immune system recognizes the invasion, and it’s effectiveness in knocking it back. This likely is different for each infectee. The longer the time before a response occurs the heavier the viral load becomes. At some unknown point this viral load will become ample enough to be present in various secretions. It is then a matter of how much virus is in each microgram of secretion, and how many micrograms are successfully vectored into another potential infectee.
PCR replication in a BSL-4 environment and a specifically designed RNA array chip should be able to detect who is infected and who is not before symptoms present.
The Golden Rule in any outbreak, is total lockdown of all likely exposed individuals. We are the ones that give a pathogen wings and legs. To forget this rule will in great likelihood bite us hard, much to our PC chagrin.
What say ye educated colleagues? yea or nay.
Let’s see now, Ebola contracted by people in the USA who had contact with the two nurses in Texas…zero, Ebola contracted by people in the USA who had contact with any medical worker returning from West Africa ever…zero. Seems like a few folks posting here got a bit carried away.
Despite doing all that their disease stats are better than the USA. Can you explain why?