People are being awfully quick to condemn this Doctor- a man who probably had more up-close experience and expertise with this virus than practically anyone on the planet. He self monitored. When it became clear he was showing possible symptoms, he acted appropriately. I wish him and his family/loved ones well. May the health care providers caring for him stay safe. I get that people are freaked out, but the risk here is incredibly, incredibly low for all but a very small number of people. Duncan was far, far sicker than this Doctor, and none of his contacts outside the two hospital workers contracted the disease.

and it looks like NYC is on top of this. Spencer acted responsibly and took the appropriate action.

and not doing things like renting bowling shoes, during that 21 day period?

Ebola not spread by anyone who is asymptomatic. It is also not spread by bowling shoes.

It is NOT airborne. Asymptomatic people who later develop symptoms are NOT contagious when asymptomatic. You need to be in actual contact with bodily fluids to be at risk. And so on.

When the victims are EXTREMELY ill.

probably should be quarantined. Health care workers can't be 100% positive they weren't infected until at least 21 days have passed since their last contact, and they might at any point during those weeks be a day or mere hours away from developing a fever or blowing chunks, which means the virus is replicating quickly inside them. People who just happened to be in the same space (planes), or handled the same objects (bowling shoes) should probably be monitored as you suggest.

When the person has just a fever, the viral load is low and not being transmitted. There is no evidence of anyone ever catching ebola from a person with only a fever and without direct contact with bodily fluids of a very sick person.

People who were on the same plane or touched the bowling ball are not even at enough of a risk to monitor, in reality.

and then places his saliva-droplet-moistened fingers into a bowling ball, and then removes them. A minute later, someone else sticks his fingers into the same ball, and then fishes a chunk of steak out of his teeth or rubs his eye. Easy transmission? No. Possible? Yes. There might be enough of the virus in the saliva for some particles to get into the eye membranes or mucus membranes of the mouth.

The virus doesn't appear in all bodily fluids at the same level. As it builds, it works in the blood first. Until there is fever or other worse symptoms, it isn't at levels in other bodily fluids to leave the body.

People get Ebola by treating dying Ebola patients. That is what the public needs to be educated on and quit freaking out.

Duncan got it after carrying a very ill woman who died hours later. Other positive cases in the US were health care workers who cared for very ill Ebola patients. None of the other people Duncan came in contact with in the days before being hospitalized became ill. Doctor Spencer was asymptomatic or barely symptomatic- nowhere near as ill or contagious as Duncan was.

But she was freaking DYING at that point.

There is no medical need to quarantine anybody who doesn't have symptoms. Isolation or partial isolation is fine, too.

As long as people have the sense to hole up and call authorities if they have a fever, everybody's SAFE.

you don't know the exact moment that virus particles begin to be present in various fluids and how that matches up with symptoms, because symptoms vary between individuals. This doctor in NY went from fine to 103 and GI distress in less than 24 hours. Where was the moment in which he went from non-contagious to contagious? Was it when he had sex with his girfriend, or shared a bottle of beer with a buddy on Wednesday night? You don't know and neither do I and neither do the "experts", and they are generally less sanguine than you.

theoretically contagious. But we do know that the virus is not really spread by things like sharing a beer. And it is not really spread early in the infection.

Again, no one has been able to provide an example of someone who was infected by Ebola and had not been dealing with an handling the bodily fluids of a severely ill or dying person or deceased. I have challenged many people to give an example of someone who was infected by a person in the early stages of infection, and have never been given such example.

Perception and insight are consequences of thinking, they are biased by temperament as well as education, experience (or lack thereof). That bias tends to make us imagine things that fit with our education and experience.

Without familiarity, people will be biased toward things they know.

With familiarity, people will be biased toward things they know.

Public policy has to understand and deal with both sources of bias.

We know that the virus is not, in actuality, transmitted in early infections. That is the point.

they cross the indeterminate, invisible threshold.

Most of them can't pinpoint a moment. Nancy Writebol doesn't know either. The NBC cameraman thinks it was when he washed the car of a deceased victim. Duncan's family didn't get sick when he started vomiting and having diarrhea and was taken to the hospital, and they had no PPE, but the very next day Pham took care of him and got infected. I don't think there are any hard and fast rules as to when someone officially becomes contagious, because there are obvious differences between leaving a few droplets of piss on a toilet seat that someone else encounters, and sharing a fork, and sexual intercourse.

She treated and handled Duncan's bodily fluids up until the day before he died, with skin exposed.

The point is as long as someone is asymptomatic, they are not infectious. When the have only headache, the are not very infectious. It increases from there. They are not suddenly infectious and infecting people. That is simply not the reality.

infectious to a guy sitting next to them on a train JUST BEFORE onset of symptoms (and symptoms are in some ways a matter of perception--a young man's "sluggish" might be an older man's "can't get out of bed this morning, feel crappy&quot . There wouldn't be a normal expulsion of body fluids then. But they might be infectious just before onset of symptoms during close relations with a partner involving, well, normal expulsion of bodily fluids. It's a matter of degrees, and while this doctor was out on the town on Wednesday, far from home, who's to say he wouldn't have had a sudden case of the runs in a public toilet, or had to puke? Sometimes illness slams you unexpectedly and you have to make a run for the nearest public or work bathroom, as has happened to me occasionally. There's a reason why they're tracking down this guy's activities and locations earlier in the week. Public-caught infections are unlikely from this man, but the problem is, if somebody DOES get sick from him unawares, they won't realize they have ebola, because they have no known exposure to ebola, and probably would just try to soldier through until they become a squirting fountain of virus.

No person have ever been documented to catch ebola from an asymptomatic person. Ever.

It takes at the minimum a high fever to actually be infectious. It simply is hard to catch until the patient's body is very ill.

There is simply no way to know THAT MUCH about every individual case of ebola--the current outbreak has people dying in the streets alone, or off under a tree somewhere. So I'll let you have your certainty, but take comfort that public officials and disease experts aren't listening to you.

Yes, people in West Africa are dying in the streets because they can't get the EARLY treatment we can in the US. There aren't enough beds, so only the most severely ill are treated, and that is when the disease spreads. Even though so many are dying now, the virus hasn't changed. It has been thoroughly studied for decades and ti well understood. It looks a little different when it comes to Western nations, which causes confusion and misunderstanding.

http://www.nbcnews.com/storyline/ebola-virus-outbreak/dont-panic-why-ebola-wont-become-epidemic-new-york-n232826

http://commonhealth.wbur.org/2014/10/reality-check-how-catch-ebola

other people can become exposed.

Ebola isn't a static condition. True, someone won't get sick from sitting next to someone with only a fever.But someone with a fever can get worse and then start vomiting and then be contagious. That's why people who are in the 21 day period should follow the directions of health authorities to isolate themselves.

to self isolate, by avoiding travel and public spaces.

Let's please not provide info that is not accurate, and which goes against the advice of health officials.

If one has potentially been exposed to ebola, they need to voluntarily self isolate, ie no traveling and no going out into public spaces until they have passed the incubation period.

There are reasons they are giving this advice and all who have been exposed should follow it.

They do not request everyone "who has been potentially exposed to ebola" to self isolate.

They request everyone who HAS been exposed to ebola to self isolate. My point is, even that is not necessary.

So, I hope persons put your advice aside and go with what the experts are telling them to do.

And yes, what I have stated is true.

flight, for example, are not quarantined nor have they been requested to avoid public transit. They were "potentially" exposed.

Docs who treated dying Ebola patients were exposed. That is the distinction.

The point of the OP is not for people to takes advice. No one would. The point is to analyze and understand the ACTUAL risk, not theoretical, to everyone in NYC. The actual risk of infection from Spencer pre-isolation is very close to zero.

Your statement that self isolation of those who are "potentially exposed" is not necessary, flies in the face of that expert advice.

Potentially exposed means those who came into close contact, and we all know that not all those in close contact will come down with ebola. Therefore the use of "potentially exposed". Because even though they were in close contact, they still may not have been exposed.

Now, please stop giving ridiculous advice and making declarations that go against what experts are saying.

Are they under quarantine?

in medical terms.

Go do some research, which is seems you don't really care to do. But you certainly do make declarations that go against what the health experts are recommending.

when they are speaking of "potentially exposed" to ebola.

necessarily. If that's what it means in the medical world, then the medical world has to do a better job of translating jargon. In many contexts, you can be "exposed" to something if you're in the same room with it. "Potentially" takes it even further away. What do they mean by potentially?? It's all too vague to be meaningful. Health officials have to be more precise.

by skin to skin in early or asymptomatic persons.

There are two steps at issue. The stage of the infection and the nature of the contact.

You've got to do this, otherwise we create a nightmare. If you go back and look at the CDC info again, you see a very curious thing - On day 0 the viral level for survivors is much higher than it is for those who go on to die.

My nightmare is that an asymptomatic carrier goes to the dentist and four weeks later we realize we've got a problem.

Given the reality that the health officials will have to mount expensive and extensive tracking of people someone with ebola may have come into contact with- every single time- self-quarantine is pretty much a necessity.

I understand why we are doing it. There is a lot of fear and misunderstanding.

This past month is the first time ever that Ebola has come to the US outside of the controlled transfer of patients. Ebola is essentially a different infection in the US for many reasons. Primarily, we have the resources to stay ahead of it and then isolate and treat at the earliest sign. That us the function of self monitoring. And it works.

Self monitoring caught Pham, Vinson and Spencer immediately. It caught it before there was an actual risk of infection.

In west Africa, the ONLY people getting treatment are those who are near death and highly contagious. There are no beds or means to identify and catch early infections. Contact tracing and isolation of everyone for those patients is critical. Exposure to dying Ebola patients is an entirely different case than exposure to someone asymptomatic or with only a fever.

We need to get to the point where we recognize this distinction. Otherwise, we have a long expensive, somewhere debilitating future. And it diverts resources from where they are needed in West Africa.

creates more fear amongst the population.

What is so difficult in understanding this?

And they don't know it all, like it seems you do. I'll go with what the experts are stating at this point.

Asymptomatic people are not contagious.

recommend.

Asymptomatic people are less contagious. They are not "not contagious"

Again, you are making unfounded, false declarations.

Asymptomatic people are NOT contagious, you are flat wrong about that.

Early symptomatic people are LESS contagious.

Duncan, Vinson, Pham, and now Spencer all were outside in general public with early symptoms, no one in the general public has shown any symptoms, nor are any likely too. Calm down.

People are infectious as long as their blood shows they have ebola.

I will agree that symptomatic persons are more likely to pass on the virus due to the fact that they expel copious amounts of bodily fluids where as someone who is not doing that is less likely to.

But that does not mean, nor will you find one Health Expert stating, that ebola is not infectious once it is in the blood of a person with ebola, symptomatic or not.

"...from experience, we know that this virus is not transmitted early in infection. If the viral titers are very low, if you’re not able to detect free viruses in the blood, then it seems Ebola virus is not transmitted to other people. Which is very good because, theoretically, that makes it really easy to control Ebola virus infection."

http://commonhealth.wbur.org/2014/10/reality-check-how-catch-ebola

Contagious means how easily the virus can be transmitted. Ebola is not easily transmitted.

That's what morning fog is pointing out. He's not saying ebola is not infectious.

Mr. Duncan stayed in one room with private bath, that was sufficient to keep his family members safe.

Once we have a vaccine we will not have to worry so much. Kind of like rabies exposure, err on the side of caution with deadly viruses.

I would rather medical professionals & travelers from ebola countries be monitored, required to report temp. twice daily. Any temp= to hospital, no out in public.

And I agree that once they report a fever they should be moved to the hospital.

I disagree with restricting their mobility or requiring quarantine when asymptomatic.

Vinson's contacts are entering day 10. While they will have to get through day 21 to be cleared, most infected persons start showing symptoms by day 10. I am quite hopeful that none were infected and don't expect any were since it was caught early.

Every Ebola patient began by being asymptomatic. There isn't any way to determine in advance when person may start vomiting or having diarrhea or have virus in their sperm and become contagious --that's why the health authorities have put the 21 day isolation into place.

or not, that's the reality, and that's why self-quarantine is a must.

It just isn't. Eventually we will have a transmission from one of these, and it will be random and not picked up (because case definition does not allow for testing). That transmission will generate more cases, and it's not clear if we will stop it then, because the odds that the cases derive from exposure in a health care setting are pretty damned good.

That is what is happening in Africa in this outbreak.

Your point about expense is almost insane. It costs 400-500K to take care of an Ebola case without risk to the HCW. Quarantine costs are miniscule compared to that.

They've used quarantine for household members very successfully in Africa to stop transmission. Quarantine does work.

One nasty thing we have is that the virus is more persistent at lower ambient temps. Wipe your runny eyes and touch the door handle, and you may leave viable virus for three hours to perhaps three days.

You seem to be living in a fantasy world. A very low-risk event becomes a high risk event through the multiplication tables. The risk of casual transmission through surface to surface contact here is probably on the order of 1%. Direct contact between household members was calculated about 15% in Africa.

So because Duncan's contacts didn't become ill, you are assuming that proves it doesn't happen - and you are wrong. Get five of those and it will happen.

Get 1000 very low risk exposures and you get a non direct contact transmission. This is just a numbers game.

.... if that is correct and sensible people do not wish to risk their life based on the suppositions of others. I don't think so.

yesterday, not 103. That was just reported on the WNBC top of the hour news break.

The ones who were spluttering & making a lot of suppositions based on the 103 temp.

Are you suggesting people somehow should have figured out that this number was wrong, even though that number was given out during the press-conference and in msm?
How do you propose anybody should have figured it out?

But maybe people won't be so quick to jump on things and make long detailed assumptions, getting themselves & others all worked up. I'm HOPING people pause now, and wait for confirmation that things are true, now that they have this example of how things can be misreported. Sort of like how newspapers used to make their reporters get TWO sources of information before they would publish.

What I DO feel comfortable in suggesting is that there exists a subset of people who WANT things to ratchet up, to get more dire, and they happily pounce on each new piece of "evidence" that gives them a reason to pronounce, and pontificate, and judge the actions of others.

You'd think they knew what they were talking about.

This isn't a case of health officials not knowing what they were talking about. It's a case of whoever the spokesman was having the wrong number handed to him & passing it along.

Somebody here on DU queried the high number last night. In other words, showed a little surprise & skepticism, on a thread that was full of damning judgment on the doctor. That person's face is not red. That person doesn't have to have someone to blame now for his own hysterical jumping to conclusions. That person is not a disaster junkie.

You can not resolve an exponential threat with incremental solutions.

There is a world of difference between doctors getting infected while treating severely ill and dying patients and an asymptomatic person. That is the ultimate point.

They are two very different beasts. I would have no problem sharing a soda, a handshake, shoes, a bus or a hug with anyone who is asymptomatic. Because I hear and understand what doctors have known for 40 years. The virus hasn't changed. It is not transmitted when people are not showing symptoms. Fucking period.

They were told to do this by the health authorities.

The NY doctor's fiancé was put in isolation at Belleview hospital by health authorities.

But you have decreed otherwise. They are acting "like a bunch of idiots who forget how to think critically every time."

I'm glad the people who are in charge, unlike you, have chosen to err on the cautious side. Dallas Presby showed us what over-confidence can lead to.

that are currently available expert, ebola-ready facilities. With that few beds, all precautions must be taken. We'll see how Bellvue does with its case, perhaps if they do a good job, the list can be increased to 6.