
Doctor in New York City Is Sick with Ebola - jbarrec
http://www.nytimes.com/2014/10/24/nyregion/craig-spencer-is-tested-for-ebola-virus-at-bellevue-hospital-in-new-york-city.html?hp&action=click&pgtype=Homepage&version=LedeSum&module=first-column-region&region=top-news&WT.nav=top-news
======
shirro
The smart thing would be for aid agencies that send workers to these hot spots
to pay for their employees to stay in a nice quite "resort" somewhere for a
month on their return for them to relax and as a thankyou for their efforts.
And to deflect growing negative public opinion about the risks returning aid
workers pose. Needless to say the "resort" could have daily health checks and
minimal contact between people but could otherwise be quite pleasant.

~~~
santaclaus
That strategy certainly worked for the Venetians. Merchant ships had to chill
off shore for 40 days before unloading their cargo to make sure no one
harbored deadly diseases. Hence the quarter in quarantine.

------
001sky
_" People infected with Ebola cannot spread the disease until they begin to
display symptoms, and it cannot be spread through the air. As people become
sicker, the viral load in the body builds, and they become more and more
contagious."_

This is sort of misleading in this context, unfortunately. The WHO considers
(sustained presence) within 1 meter of EBV carrier to be ~physical exposure.
The young doctor appears to have been on a NYC subway within 12 hours of
having a fever of 103. Creating a potential group of exposures that may be un-
traceable.

Maybe someone can correct me if I'm wrong. But this would be highly
unfortunate if these reports are correct. Presumably the uber driver is also
in this group now, but records should be able to provide some data on that one
much easier.

~~~
wfjackson
Many signs point to the viral load not being highly infectious at the
beginning. Duncan was sent back to his home by the hospital and lived with his
fiance who was taking care of him for two days before being readmitted. She
wore no PPE yet appears to be uninfected. If sitting next to someone infected
on a bus or subway is enough to pass it on, there would be a million cases in
West Africa by now, not 10K. It appears to be primarily caregivers at the
later stages of the disease, and the custom of kissing corpses that appear to
be spreading the disease because the viral load is extreme at that stage. This
doesn't mean that the potential contacts of this person should not be traced
or that it was good idea for him to go bowling, but the sky isn't falling just
yet.

~~~
kamaal
Ebola can spread only after a person begins to show symptoms. And that takes
~21 days. Or putting it straight, for it to spread from one person to another
it would take 21 days of period in between getting infected and spreading it
to others.

Though the growth of number of patients with Ebola is definitely exponential.
Please note it takes 21 days for the each multiplication to happen. It started
in March and has been been spreading since, 10K is pretty large for a 7 month
period.

>>but the sky isn't falling just yet.

In things like this you won't know when the sky will start falling apart. And
generally when that happens its already too late, and you would be staring at
a pretty big damage.

No body knows how many people have been infected, or will be infected in the
next multiplication.

Which is why WHO suspects ~1.4 million could get infected by January. By then
it would be too late.

------
msie
The doctor should have known better than to go to a bowling alley soon after
he returned. Whether or not he was contagious now they have to perform contact
tracing and disinfect the place.

~~~
natch
Not to mention riding the subway. Good luck doing contact tracing with that.
I'm not saying he was contagious. I hope he wasn't.

Was the bowling alley public subway trip really a must-do thing, for someone
who had just directly worked with ebola patients? Could this kind of thinking
not be part of the training for this kind of work, I wonder?

~~~
maxerickson
I think discipline is the bigger issue than awareness. Even someone who
absolutely knows better can end up thinking that the bad thing can't happen to
them.

~~~
georgemcbay
Yup.

In my experience with experts I'd say _especially_ someone who "knows better"
can end up thinking that the bad thing can't happen to them right up until
they, in a fit of being human, have an oops and it does.

~~~
bjz_
Yeah. I hate this 'holier than thou' attitude that some folks on this thread
are displaying. We are all human, and we all do stupid things based on our
psychology. The best we can do is create systems to help guard against our own
mistakes.

~~~
jeffdavis
"The best we can do is create systems to help guard against our own mistakes."

Like enforced isolation of some kind? The thing that people have been asking
for since the beginning, but is a bad idea for some reason that nobody can
explain?

~~~
EliRivers
Perhaps it's illegal to imprison people who have committed no crime, on the
guess that because they were interacting with people who had a disease, they
might have it too.

Also, in this case and many like it, imprisoning this man would have been much
more expensive than simply testing him for the disease.

There you go; one reason it's a bad idea to imprison someone you think might
be carrying ebola is that you can just test their blood and know for sure if
they are. Seems a lot cheaper and better all round than imprisoning people.

~~~
dhimes
Quarantine is not imprisonment, and is certainly not illegal. In fact, it is
customary if you, for example, sail a boat from one country to another.

The point here is that it's not clear that there's a reason to enforce a
quarantine- yet. But if it becomes clear, then we need to have the balls to do
it.

~~~
DanBC
Detaining people against their will is the definition of imprisonment.

While not illegal there should be comprehensive legal safeguards around it.
And, if it's not illegal, what are the laws that regulate quarantine in the
US?

~~~
maxerickson
CDC has a bunch of information about this:

[http://www.cdc.gov/quarantine/index.html](http://www.cdc.gov/quarantine/index.html)

The sub pages are lengthy and cite specific laws and so on.

Skimming, CDC has broad authority to detain travelers and states and local
health departments usually have the power to enforce a quarantine (with
violation of the quarantine being a misdemeanor).

------
googler_314
Before judging this man for going bowling etc., we should bear in mind that he
caught Ebola working for Doctors without Borders in Guinea. I would guess that
without workers like him, the risk to Americans and others outside Africa,
would be much higher, since the disease would be spreading much faster within
Africa. Hopefully he recovers and we can improve travel policies if necessary.

~~~
rustyconover
To borrow an idea from math, "doing good" isn't a commutative, infections and
diseases are. Have some respect for others and slow your roll before going out
during the 21 day post exposure window.

It's a bit like saying, "Hey I've saved lives over here so I have earned the
right to be irresponsible over here". Because you know, karma balances out.
No, the world doesn't work like that. And you aren't doing any good
propagating this idea either because it encourages this privileged way of
thinking.

As much as this guy isn't being vilified (and say what you want about the
government spinning its story of ebola being hard to transmit), lets think
clearly and rationally. He knew the risks that he could possibly be infected
and decided to endanger others when he could have easily stayed home or gone
anywhere to a more isolated environment (upstate NY is calling). It is well
known symptoms generally show up by the 10th day. Today is his day 10.

It's very interesting that the government has locked down this guys apartment,
yet if you need contact with bodily fluids to contract the disease why
quarantine the apartment and surroundings? Could it be that droplets are a
transmission method as many people are starting to suspect. Sneezing and
coughing may spread these droplets to the floors and walls? And if that is the
case, what about other objects that come in contact with saliva and other
fluids like utensils, door handles, glasses...

~~~
blergh123
I thought it was well known that ebola can be spread through any bodily fluids
and that this includes droplets from coughing and sneezing. What they don't
yet know is whether ebola is 'airborne' \- i.e. dried droplets that can float
in air as is the case with measles for example.

~~~
hackuser
> I thought it was well known that ebola can be spread through any bodily
> fluids and that this includes droplets from coughing and sneezing. What they
> don't yet know is whether ebola is 'airborne' \- i.e. dried droplets that
> can float in air as is the case with measles for example.

I would suggest to everyone: Don't comment on questions like this one (how
Ebola spreads) unless you know for certain what you are saying and can back it
up. We have complete saturation of rumors and bad information; adding to it
won't improve the situation.

I don't mean to criticize the commenter above; they just happened to have the
top-most comment of this kind.

EDIT: What a strong signal of over-reaction when a post that says you should
know what you are talking about, on HN, is modded down. (I don't care how it's
modded, it's just depressing to see this response here.)

EDIT: The same applies to my other post, which asks serious, legitimate
questions in a non-offensive way. How sad.

~~~
001sky
This (above) comment has no citations and the one you are responding to (GP)
is substantially correct.

[http://www.ncbi.nlm.nih.gov/pubmed/15588056](http://www.ncbi.nlm.nih.gov/pubmed/15588056)

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113787/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113787/)

 _Ebola and Marburg viruses are the sole members of the genus Filovirus in the
family Filoviridae. There has been considerable media attention and fear
generated by outbreaks of filoviruses because they can cause a severe viral
hemorrhagic fever (VHF) syndrome that has a rapid onset and high mortality.
Although they are not naturally transmitted by aerosol, they are highly
infectious as respirable particles under laboratory conditions. For these and
other reasons, filoviruses are classified as category A biological weapons.
However, there is very little data from animal studies with aerosolized
filoviruses. Animal models of filovirus exposure are not well characterized,
and there are discrepancies between these models and what has been observed in
human outbreaks. Building on published results from aerosol studies, as well
as a review of the history, epidemiology, and disease course of naturally
occurring outbreaks, we offer an aerobiologist 's perspective on the threat
posed by aerosolized filoviruses."_

or

 _Our study has shown that Lake Victoria marburgvirus (MARV) and Zaire
ebolavirus (ZEBOV) can survive for long periods in different liquid media and
can also be recovered from plastic and glass surfaces at low temperatures for
over 3 weeks. The decay rates of ZEBOV and Reston ebolavirus (REBOV) plus MARV
within a dynamic aerosol were calculated. ZEBOV and MARV had similar decay
rates, whilst REBOV showed significantly better survival within an aerosol. "_

Reston is not Ebola, but a close relative.

~~~
hackuser
What you posted is from good sources and is interesting, but I'm not sure it's
conclusive or helps. They are two studies/reports of possibly many and I don't
know their credibility or if they represent consensus or fringe, good science
or bad. Also, they require expertise to interpret and draw conclusions from.

We're not qualified to perform our own analysis; what we need are conclusive
analyses from experts about the scientific consensus and range of
possibilities.

~~~
bradleyland
So we should all be quiet and listen for the experts to give us guidance?
Sounds like the antithesis of hacker culture to me. It also sounds like
horribly bad advice based on large establishments' historical propensity
(categorically) to act from what they know, fail to react to changing
environments, and cover up what might make them look bad.

Yes, this is all dangerous thinking. Yes, this is acting from one's gut,
rather than waiting on the data. But when it's my life on the line, I'm going
to err on the side of caution. When death is on the other side of the
decision, I'm going to be a little more skeptical of other people's certainty.

~~~
hackuser
> when it's my life on the line

The risk to your life hasn't changed, unless you are writing from West Africa.
I would be happy to make a bet with anyone on HN that they will not contract
Ebola (assuming they are not posting from West Africa), and that the flu will
kill far more Americans this year.

Let's be honest; people are acting on fear. It's very compelling to people in
the moment, but I think we all know better and know that it's how people make
dumb decisions for themselves and do very bad things to others. The person who
stays calm when everyone else is panicking is much safer.

Fear is dangerous and contagious -- much more so than Ebola, because fear can
spread over HN. Don't follow the herd; set the example for those around you.

~~~
bradleyland
I'm not speaking specifically about the risk to my life, but in the effect
that potential outcomes have on evaluating risk. The flu argument you make is
a common example thrown around in this conversation, but it's not an accurate
comparison. What is the mortality rate of the flu versus ebola? When I assess
risks related to ebola, I tend to favor a more cautious approach, because the
mortality rate is so high.

This is part of a popular meme that is showing up on the news. They ask
questions like, "True or false, _you_ are more likely to die from ebola than
the flu." The mark replies "true", and a doctor (medical doctor, not a
statistician) is quoted explaining that "You're actually more likely to die
from the flu." This could not be more incorrect.

Mortality rates for diseases like the flu (or any disease) are not homogenous
for all members of the population. It's not like a roll of the dice. You
simply cannot extrapolate an individual's odds from the broad population
mortality rate for the flu (or any disease). It is extremely unlikely that _I_
will die from the flu. I am a middle-aged male in good health and fitness. My
chances of dying from the flu are extremely low. The reason the flu kills so
many americans is because it is so prevalent. It could be said that flu kills
so many precisely because it is so non-lethal. This allows it to fly under our
radar and infect people who are at risk. I'm not arguing that we shouldn't
take action to prevent the spread of influenza, I'm arguing that the flu
presents a different set of problems.

My chances of contracting ebola are also extremely low, but if I do, my
chances of dying from it are very high. Across the board (all ages and
classes), the mortality rate for ebola are much higher than the flu.
Unfortunately, we don't have a strong grasp on ebola mortality rates in the
west, because we haven't (thankfully) experienced an outbreak. Even in
develping countries, the mortality rate varies widely [1].

I agree that we shouldn't let fear run away with our sensibility, but when
dealing with a highly infectious disease [2] with a remarkably high mortality
rate, we should be cautious. If not fully quarantined, a period of sensible
precaution is a reasonable expectation. When the sun is at its strongest we're
advised to wear sunscreen and limit our exposure. When an individual spends
time with ebola patients, they should be advised to avoid situations where
they would expose a large number of people to the pathogen. Flying, taking
public transit, and participating in sports are all activities that put you in
direct or indirect contact with large numbers of people. This seems like an
unreasonble amount of risk to me.

1: [http://www.npr.org/2014/10/23/358363535/why-do-ebola-
mortali...](http://www.npr.org/2014/10/23/358363535/why-do-ebola-mortality-
rates-vary-so-widely)

2: Even though ebola must spread through bodily fluids, it is extremely
infectious. A small amount of the virus can infect you.

~~~
hackuser
> What is the mortality rate of the flu versus ebola? When I assess risks
> related to ebola, I tend to favor a more cautious approach, because the
> mortality rate is so high.

I think that raises a several good points. A few considerations:

1) The 'proper' way to evaluate risk, as I understand it, is (likelihood *
cost). A 10% chance you'll lose $100 costs you $10 each time you take that
risk, over time.

2) I agree that some costs are so high that the math works poorly even with
low likelihoods. A 1% chance of death is far too high a risk to take, unless
there is some high payoff such as saving someone else's life -- a risk the
infected doctor and nurse took.

3) The cost of Ebola is that high, but the likelihood is so infinitesimally
low that it's still not worth worrying about. You'll add more life years
exercising or simply reducing other risks with the same time spent thinking
about Ebola. It's a complete waste of time (I realize the irony of writing
that! :) ).

4) There are many more equally deadly and far more likely risks for healthy
middle-aged people: Lightening strikes, natural gas explosions, being shot in
the head, carbon monoxide poisoning, food poisoning (of certain kinds), other
contagious and non-contagious diseases, etc.

5) > When an individual spends time with ebola patients, they should be
advised to avoid situations where they would expose a large number of people
to the pathogen ... This seems like an unreasonble amount of risk to me.

Generally I agree that we should minimize risks, but again I'm not sure there
is one here:

* It's very possible that it's very safe. Nobody in the United States (in fairness, that we yet know of) has contracted Ebola in this manner from the infected 3, though two of them spent much time around others. Also, wouldn't Ebola be rampant in the hospital where the infected nurse worked, if this was a risk? Wouldn't it be rampant among medical staff in W. Africa, given the prevalence in their environment (higher than flu in those facilities)? * HIV spreads via bodily fluids but we don't quarantine the infected or their caregivers. However when HIV first become known, people were afraid to be near the infected (resulting in a lot of discrimination). I think we should not repeat that mistake. * I would guess that hospital workers encounter many contagious, deadly diseases, yet nobody worries about those spreading.

People want to treat Ebola differently despite many similar and much greater
risks. That's why I believe it's fear and not real risk that drives it.

Anyway, I'm approaching redundancy. Good talking to you!

~~~
001sky
_That 's why I believe it's fear and not real risk that drives it._

What other BSL-4 pathogen are you referencing here? Or are you suggesting
BSL-4 is an unappropriate classification? Maybe you think the scientific and
biosafety community erred when they created the BSL-4 designation?

There is plenty of research out there that documents the objectibe risk.

There is very little research that documents supports a strategy of "see no
evil, hear no evil, speak no evil".

People don't need to panic.

But that's entirely seperate from lack of comprehension of the actual risks
involved. After all, you can't solve problems you don't admit to having.

Trying to deal with a BSL-4 pathogen with BSL-2 safety gear is a fools errand.
We might not havy any better options, especially in backcountry settings, but
lets not pretend its "not risky".

In densely populated urban areas those risks are simply not tolerable. They
are not tolerable for two reasons: (1) we can do better; and (2) the
technology that allows for (1) makes the risks of not doing (1) more
problematic.

Technology allows us to isolate patients; but it also allows non-isolated
patients to spread the pathogen further/faster. People with hemoraggic fever
don't walk 1000Ks or cross continents on their own power. They only do so by
using technology.

It makes sense that the appropriate technology be dedicated to helping contain
these bio-hazards and to compassionately care for the afflicted.

But seriously, what do we have to gain by sticking our heads in the sand? It
seems this is a cynical strategy by people who don't want to "get their hands
dirty"? Mayb we can continue to provide false confidence to 'volunteers' to go
to africa and do our dirty work for us?

Why do we need to play this charade? Lets just give these people the tools
they need (including time, money , and gear) and properly de-brief them and
the public about the risks and what is at stake from either mistakes or
inaction.

------
joe_the_user
"Many signs point to the viral load not being highly infectious at the
beginning. Duncan was sent back to his home by the hospital and lived with his
fiance who was taking care of him for two days before being readmitted. She
wore no PPE yet appears to be uninfected. If sitting next to someone infected
on a bus or subway is enough to pass it on, there would be a million cases in
West Africa by now, not 10K. It appears to be primarily caregivers at the
later stages of the disease, and the custom of kissing corpses that appear to
be spreading the disease because the viral load is extreme at that stage. This
doesn't mean that the potential contacts of this person should not be traced
or that it was good idea for him to go bowling, but the sky isn't falling just
yet." wfjackson
[https://news.ycombinator.com/item?id=8501792](https://news.ycombinator.com/item?id=8501792)

Please look at this first

~~~
jeffdavis
People move through the stages at different rates with a high variance. That's
still pretty scary.

------
westward
Based on the timeline, he had to have contracted Ebola pretty much the day he
left.

That seems pretty unusual, isn't it? How long was he there, a couple months?

"Symptoms usually occur within eight to 10 days of infection and Dr. Spencer
had been home nine days when he reported feeling ill." That's not including
travel time local and international.

That's a tight schedule!

~~~
tsotha
That's just the average. It can be over 42 days.

~~~
fourstar
Got a source for that?

~~~
001sky
"Background: 21 days has been regarded as the appropriate quarantine period
for holding individuals potentially exposed to Ebola Virus (EV) to reduce risk
of contagion. There does not appear to be a systematic discussion of the basis
for this period.

Methods: The prior estimates for incubation time to EV were examined, along
with data on the first 9 months of the current outbreak. These provided
estimates of the distribution of incubation times.

Results: A 21 day period for quarantine may result in the release of
individuals with a 0.2 – 12% risk of release prior to full opportunity for the
incubation to proceed. It is suggested that a detailed cost-benefit
assessment, including considering full transmission risks, needs to occur in
order to determine the appropriate quarantine period for potentially exposed
individuals."

[http://currents.plos.org/outbreaks/article/on-the-
quarantine...](http://currents.plos.org/outbreaks/article/on-the-quarantine-
period-for-ebola-virus/)

------
uptown
He was a passenger in an Uber. It doesn't sound like they've made any effort
to ensure the vehicle was cleaned.

[http://blog.uber.com/nyc-statement](http://blog.uber.com/nyc-statement)

------
knappador
How about "Doctor Returning From Guinea..." to more accurately reflect the
geographic relationship instead of creating a bomb of a headline as if some
random, yet-unknown vector resulted in Ebola in New York.

~~~
Houshalter
Why does it matter who he was? The title is pretty accurate.

~~~
knappador
Where they just returned from makes the news highly generic, unsurprising, and
it drops off the main page rapidly instead of being an attention grabber. Even
the article that is linked to says "Doctor..." which at least leads me to
believe that the just returned from treating someone. This is not incredibly
surprising news, but if someone who just happened to be in New York with no
obvious connection to the Ebola outbreak in West Africa caught Ebola, that
would be pretty obviously significant since there might be someone who was
unidentified and contagious in New York recently, suggesting that an outbreak
could flare up in New York. News that misleads wastes time and makes money,
but not my money.

~~~
ASneakyFox
Of course it's being spread from a region with an ev outbreak. That's how it
works. The news is that it has now officially spread to the US and there is
potential of more cases popping up soon since he wasn't quarintined.

------
akjetma
Do location-based services work in the NYC subway? I suppose you could also
infer locations and transfers based on train schedules and tower handoff times
upon emerging from stations. I mean, if there is a 21-day gestation period
between infection time and the ability to retransmit the disease, it seems
like it would be worthwhile/possible to look into.

Apologies for the cliche 'use technology to solve all the problems' HN
comment.

~~~
uptown
Not the underground tunnels. Some of the stations have service, but not most.

~~~
malandrew
But you should be able to infer location from the gaps. If someone was at
station A, then disappears and 2 minutes later is recorded at station be, it
should be possible to know they took the train between those two stations.

~~~
uptown
Yup. There's ample data from metrocards and security cameras to follow his
route. The more difficult challenge would be finding everyone he had come in
contact with on those trains since data granularity of which cars he took
would likely be unspecific.

------
hackuser
This response is poor risk management. I'm not sure the risk is significant:
What is the chance that someone else will get infected? Higher than the many
other risks we face every day?

What is higher risk?: 1) Going to the Ebola zone in W. Africa (EDIT: And
taking the proper precautions to protect yourself), 2) Walking as a pedestrian
on NY streets, or 3) Sharing a subway car with someone who has been in the
Ebola zone?

There are around 3 cases of Ebola in the United States. I expect most of the
resultant suffering will be because the public reaction is causing us to
divert resources from where they could do more good (including West Africa).

------
jeffdavis
I'm not afraid of Ebola as much as the "experts" who keep intentionally
misleading us about Ebola. I don't know why they do it, and that scares me.
But it's very obvious that it's intentional.

See the first three sources I found about Ebola transmission in sweat:
[http://well.blogs.nytimes.com/2014/10/03/ebola-ask-well-
spre...](http://well.blogs.nytimes.com/2014/10/03/ebola-ask-well-spread-
public-transit/?_php=true&_type=blogs&_r=0) (claims that sweat doesn't contain
Ebola) [http://www.afro.who.int/en/clusters-a-
programmes/dpc/epidemi...](http://www.afro.who.int/en/clusters-a-
programmes/dpc/epidemic-a-pandemic-alert-and-response/epr-
highlights/3648-frequently-asked-questions-on-ebola-hemorrhagic-fever.html)
(claims that Ebola can be transmitted through sweat)
[http://www.cdc.gov/vhf/ebola/transmission/qas.html](http://www.cdc.gov/vhf/ebola/transmission/qas.html)
(hard to tell whether they think sweat is a transmission mechanism or not...
they define "body fluids" twice, once including sweat and another excluding
it)

I also heard on NPR that sweat contained a lot of the virus (don't have a
reference handy).

Real experts don't shoot their mouth off with false assurances about a disease
we don't know much about. The "hard to catch Ebola" mantra was going on long
after that was discredited[1]. These aren't experts, they have some kind of
agenda, and I'm not sure what it is. For some, it's probably just being on TV.
For others, it's to feel smug about how the ignorant masses under them are
panicking irrationally. As for the rest, probably political.

Again, I'm not panicking about Ebola. We'll have a few isolated cases in the
West. It will remain in Africa in all of the hot zone countries until we have
a vaccine. And hopefully that happens before it spreads to Nigeria, India,
Brazil, or other areas where it might be hard to control.

I am not panicking. I am just mad at the irresponsibility of these "experts"
we keep hearing from.

[1] No references here, but I think everyone remembers that the first story
was that, unless you were engaging in some unsanitary funeral practices deep
in an African village, it was impossible to catch. After doctors began to
catch it, the story changed to be that they don't have enough resources to
protect themselves. Then several Western doctors got infected while in
hospitals in Western countries (Spain and the US at least), and the story
changed into something about how the protocols will protect us, but were just
not followed properly these few times (despite not knowing the specific
protocol violations that lead to infection).

------
uptown
NYCs Ebola Patient Visited:

-Harlem

-An Uber car

-The High Line

-A restaurant

-A Train

-Jogged 3 miles

-L Train

-1 Train

-The Gutter

------
imaginenore
Wow, this moron went bowling and took a taxi.

Unbelievable.

