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Once again, it is a nurse who has taken the Ebola media spotlight this week. Kaci Hickox, a nurse who cared for Ebola patients in Sierra Leone found herself quarantined against her will in New Jersey upon her return to the US, in spite of the fact that she tested negative for the virus. After a 3 day isolation in less than desirable accommodations, she was transported home where she was supposed to remain under home quarantine but is now declaring that the quarantine is unnecessary and counterproductive, and is openly defying the order by going out in public.
Additional breaches in voluntary quarantine from those returning from Ebola-plagued Africa occurred when NBC medical correspondent, Dr. Nancy Snyderman in New Jersey and Dr. Craig Spencer in New York left their homes and ventured out into public spaces.
On Monday, the U.S. Centers for Disease Control and Prevention (CDC) called for voluntary home quarantine for workers with the highest risk for Ebola infection. It also specified that most medical personnel returning from Sierra Leone, Liberia and Guinea would not need to be kept in isolation.
In spite of this, New Jersey Gov. Chris Christie, mandated a 21-day mandatory quarantine policy for all healthcare workers exposed to Ebola. Although this move has received much criticism, it did get the support of Dr. Bruce Beutler, an American doctor and researcher and Nobel Prize winner for Medicine and Physiology for his work researching the the body’s overall immune system. He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Center in Dallas. He favors Christie’s quarantine policy “because it’s not entirely clear that they can’t transmit the disease,” referring to asymptomatic healthcare workers like Kaci Hickox.
New York and Illinois have also have followed suit and mandated mandatory 21-day home quarantine policies. Although there is plenty of scientific evidence indicating there’s very little chance that a random person will contract Ebola unless they touch bodily fluids of an infected person, the thought is that the authorities need to do something to calm Americans’ fears. As Mike Osterholm, an infectious disease epidemiologist at the University of Minnesota, says, "You want to try to eliminate not just real risk, but perceived risk."
There are thoughts on both sides of this issue which has led to heated discussions at times. There are concerns about the potential impact with both pathways of re-entry requirements for Ebola healthcare workers. What are your thoughts about this? Please take our survey to share your opinions. Let your voice be heard.
During the incubation period the ebola virus exists almost completely within liver and spleen tissue and typically does not enter the bloodstream. Both the liver and spleen are fully capable of initiating a partial inflammatory response, such as fever, due to viral infection even without transmission of the virus into the bloodstream (as well as numerous other conditions that don't involve the process entering the bloodstream).
I have never seen a in-Vivo study that has shown that. Please share your citation.
"Cell entry and tissue damage
Whatever the point of entry into the body, macrophages and dendritic cells are probably the first cells to be infected. Filoviruses replicate readily within these ubiquitous "sentinel" cells, causing their necrosis and releasing large numbers of new viral particles into extracellular fluid [5,91] (figure 1). Spread to regional lymph nodes results in further rounds of replication, followed by dissemination of virus to dendritic cells and fixed and mobile macrophages in the liver, spleen, thymus, and other lymphoid tissues.
Rapid systemic spread is aided by virus-induced suppression of type I interferon responses [92]. As the disease progresses, hepatocytes, adrenal cortical cells, fibroblasts, and many other cell types also become infected, resulting in extensive tissue necrosis."
"Patients with Ebola virus disease typically have an abrupt onset of symptoms 8 to 12 days after exposure (range 2 to 21 days) [90,114]. There is no evidence that asymptomatic persons still in the incubation period are infectious to others. However, all symptomatic individuals should be assumed to have high levels of virus in the blood and other body fluids and appropriate safety precautions should be taken [115]. "
Circulating cytokines, a common cause of fever, have been found to exist in asymptomatic carriers of ebola, which one study described as finding "high circulatory levels of proinflammatory cytokines" in asymptomatic carriers of ebola.
Circulating cytokines, a common cause of fever, have been found to exist in asymptomatic carriers of ebola, which one study described as finding "high circulatory levels of proinflammatory cytokines" in asymptomatic carriers of ebola.
The EBV was detectable via RNA PCR without detectable ELISA ABs in asymptomatic individuals. The acute phase lasted 2-3 days. Not a matter of hours. There is also no evidence these individuals with contagious.
He is an expert, but not an expert on ebola. There is a key difference. Experts will spend years sometimes decades studying one disease or phenomenon. Dr. Buetler is an expert in immunology, specifically as it relates to HPV and lipopolysaccharides.
This is the same as cherry picking literature except now people are cherry picking experts even though Dr. Buetler is not really an expert on ebola.
I am not an expert on ebola, but I would consider myself proficient in the use of scientific literature. My proficiency in evaluating research comes from the education I received in my MSN, DNAP, and current instructions in my PhD program.
Can you say the same thing that you have been evaluated on the masters and doctoral level to show that you have proficiency in the use of literature?
So, your expertise versus a Nobel Prize winning physician's?
A nurse practitioner and a nurse anesthetist (please correct me if I am wrong) have greater scientific expertise than a Nobel Prize winning physician.
I really don't understand why you keep coming back to "a Nobel Prize winning physician." Does this make him the Ebola Messiah, or something? WTBCRNA (or is it BostonFNP?, I'm starting to get confused) has stated several times that the problem is that this physician isn't an Ebola expert. Does the fact that he has a Nobel Prize somehow make his opinions facts for you? If he suddenly opines about gynecology, does that make him the Gyno Guru? Why do you care so much about this one physician's opinion? Is he a relative? I am just wondering why you are beating everyone over the head with this. Honestly, we get the "Nobel Prize" part, you've repeated it ad nauseam.
A degree does not makes one's opinion trump the scientific process.
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Yes, the same process that allows a "lowly" ADN RN to question/dispute the board certified chief medical director that writes questionable orders.
One opinion is just one opinion; those of a Nobel prize winner may hold more weight than the opinion an advanced practice nurse. However, this is not pitting their opinions against each other.
If the Nobel winner presented his scholarly review of relevant scientific literature on Ebola, I'll probably rate his findings above those of our forum members. But this is not the case. Our forum member's scholarly review of relevant literature carries the cumulative weight of the quality of the literature they review.
See, what our BostonFNP & wbtcrna (is that the right username?) have been posting is not really their opinions, but well executed reviews of relevant literature.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
The CDC actually has published guidelines on the use of different types of thermometers for screening, and backs the use of infrared "forehead scanner" thermometers and refers to them as being "relatively accurate". The CDC guidelines only recommend that a temperature obtained by a non-FDA approved device be confirmed with an FDA approved device which is not required to be an oral thermometer. There are a variety of FDA approved infrared thermometers that are used in airport and other screenings.
A single temp does not indicate automatic quarantine, but it also separates her from those who have had no positive triggers. All quarantine orders are issued for each specific situation.
And when her temp was checked at the hospital, maybe even in the ambulance, with an approved device; she was afebrile.
So, your expertise versus a Nobel Prize winning physician's?
Let's look at this from Dr. Buetler's point of view. He is a full-time professor and researcher, and from a theoretical point of view it makes sense to quarantine everyone for 21 days that comes into contact with Ebola. That would effectively limit the spread of Ebola except in rare cases.
The problem is that is not a practical clinical solution. As I have already pointed out hospitals would decimate a large part of their clinical staff with just one Ebola patient. It has also been pointed out by Doctors Without Borders and others this policy would deter healthcare workers from volunteering in Africa and could actually increase the spread of Ebola since the main problem with the ebola epidemic is the lack of qualified healthcare professionals and healthcare facilities in Africa.
BostonFNP, APRN
2 Articles; 5,584 Posts
I have never seen a in-Vivo study that has shown that. Please share your citation.
"Cell entry and tissue damage
Whatever the point of entry into the body, macrophages and dendritic cells are probably the first cells to be infected. Filoviruses replicate readily within these ubiquitous "sentinel" cells, causing their necrosis and releasing large numbers of new viral particles into extracellular fluid [5,91] (figure 1). Spread to regional lymph nodes results in further rounds of replication, followed by dissemination of virus to dendritic cells and fixed and mobile macrophages in the liver, spleen, thymus, and other lymphoid tissues.
Rapid systemic spread is aided by virus-induced suppression of type I interferon responses [92]. As the disease progresses, hepatocytes, adrenal cortical cells, fibroblasts, and many other cell types also become infected, resulting in extensive tissue necrosis."
"Patients with Ebola virus disease typically have an abrupt onset of symptoms 8 to 12 days after exposure (range 2 to 21 days) [90,114]. There is no evidence that asymptomatic persons still in the incubation period are infectious to others. However, all symptomatic individuals should be assumed to have high levels of virus in the blood and other body fluids and appropriate safety precautions should be taken [115]. "
UpToDate
Sent from my iPhone.