Support Kaci Hickox

[nurse2033]

She is the nurse who returned from Africa and was placed in quarantine despite not being sick. I'm not going to give all the details here, they are readily available online. I support her position and hope you do too. She is not sick, she should not be quarentined.

[houtxn]

The country should be UNITED in everything we do against Ebola. If some people are more comfortable with healthcare workers having a period of home quarantine upon return then do it. Science based or not, mental pandemonium is almost just as bad as an epidemic. Going to volunteer is all "your choice" (an amazing unselfish choice), so do it knowing that you must quarantine when you get home.

That's great, but when she left, that was not the policy. Hundreds of healthcare professionals from the U.S. have volunteered in Africa and not one has brought the disease back with them and infected others. Why start this now?

[MunoRN, RN]

I support the argument Kaci Hickox failed to make. I keep hearing how she helped educate people about the EBP behind Ebola prevention, although I can't find any examples of where she did, and the statements she did make were ones that I can see how the general public might have interpreted them as being misinformed and/or selfish. I have nothing against her being feisty, I think that's actually a pretty good attribute in a nurse, but I don't really see how she helped inform the public, maybe somebody could point me in the right direction.

[RNsRWe, ASN, RN]

Few topics are more divisive, and more filled with misinformation, than this one. Maybe none, even.

Kasi Hickox is a hero; no, she's the devil.

Ebola is spread as easily as mayonnaise on a hot day; no, it's harder to get than the common cold.

One person who "might" have been in the same room with an infected person can cause a pandemic in just a day or two. No, you have to be oozing bodily fluids from every possible orifice to contaminate anyone.

Quarantine for all; quarantine for none.....quarantine for some. Maybe. Probably.....or not.

I now have quite the headache from reading these threads for the last hour.

ACCKKKK......I probably have EVD!!

[Selfie]

Did you read what the above poster md777 said? Did you read the links he/she provided? This poster discussed the possibility of transmission of the virus during the incubation period.

It's maddening.

I think if we fast forward six months, we will see a completely different set of opinions expressed on this board.

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer, German philosopher (1788 – 1860)

[TiffyRN, BSN, PhD]

I think if we fast forward six months, we will see a completely different set of opinions expressed on this board.

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer, German philosopher (1788 – 1860)

Well, I agree with you that in 6 months most of us will see our opinions evolving.

I respect Mr. Schopenhauer however I feel his quote is not applicable universally, especially in the realm of science. There are many "truths" that are commonly accepted either due to prevalence or untested theory (world is flat, sun orbits the earth, the hypoxic drive). In those cases; 1. Truth is accepted. 2. Truth is questioned and the questioners are ridiculed. 3. Truth is tested. 4. Truth is either supported or redefined.

Good news? We are gathering thousands of data points on Ebola at this point so hopefully our knowledge will closer approximate "truth".

[APRN., DNP, RN, APRN, NP]

I support K.H. in her attempt to spread reason, not Ebola.

[wtbcrna, MSN, DNP, CRNA]

According to the following New England Journal of Medicine article, 89% of patients with Ebola presented with a fever; this means that 11% do not. This also means that health care workers returning from Africa after taking care of Ebola patients and having them self-monitor by taking their temp twice a day is not 100% effective. We need to err on the side of caution with this serious illness in order to prevent its spread. After reviewing the science, I think anyone who comes in contact with someone with Ebola needs to be quarantined for the full incubation period in order to prevent the spread of this disease. Here's the article: http://www.nejm.org/doi/full/10.1056/NEJMoa1411680#t=article

In this study all the patients were symptomatic. No, not all presented with a fever, but they were symptomatic and suspected of viral/EBV infection. This is why the CDC policy states that people should be screened for symptoms of EBV not just a fever. The whole purpose of this article was to look at outcomes/mortality rates based on the symptoms the patients initially presented with. This study in no way was designed nor did it look at asymptomatic patients ability to spread EBV, which has been proven not to be true so far.

http://www.nejm.org/doi/full/10.1056/NEJMoa1411680#t=article

[wtbcrna, MSN, DNP, CRNA]

Many against the quarantine are saying to look at the science. OK, let's do. Dr. Bruce Beutner, a Nobel prize-winning physician and medical researcher, currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas supports the quarantine. He won the Nobel Prize for Medicine and Physiology in 2011 for his work researching the cellular subsystem of the body's overall immune system- the part of it that defends the body from infection by other organisms, like Ebola, so he ought to know what he is talking about. He says, "It may not be absolutely true that those without symptoms can't transmit the disease, because we don't have the numbers to back that up," said Beutler, "It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can't transmit Ebola. I'm not sure about that being 100 percent true. There's a lot of variation with viruses." This article further states, "In fact, in a study published online in late September by the New England Journal of Medicine and backed by the World Health Organization, 3,343 confirmed and 667 probable cases of Ebola were analyzed, and nearly 13 percent of the time, those infected with Ebola exhibited no fever at all." Beutner further states, "The thought of an afebrile parent passing Ebola on to a child - as ostensibly can happen 13 percent of the time, "would disturb me. The point of quarantine of is to make sure they [Ebola viruses] are not carried elsewhere. It's a little bit frustrating. Some of the things that are being done are not completely motivated by safety. For some reason, there's an imperative to maintain open borders no matter what - to err on the side of total individual freedom rather than on the side of public health," he said, adding, "If you really want to isolate a disease, then you have to isolate the people who carry it." To read the entire article go to . Christie's controversial Ebola quarantine now embraced by Nobel Prize-winning doctor | NJ.com

Until the time period for the incubation period is up, no one knows if Kaci has Ebola or not. This is a serious disease. If we err anywhere, we need to err on the side of caution.

Dr. Buetler is not an expert on EBV. His main expertise is in the immune system as it relates to HPV and lipopolysaccharides. Being a physician and nobel prize winner alone does not qualify him as an expert in ebola.

It is important to remember that Dr. Buetler is a full-time researcher and professor. His solution of quarantining everyone would theoretically eliminate the spread of ebola, but this solution is not clinically or sociologically feasible.

1. One ebola patient could effectively close a small to medium size hospital if we quarantined everyone that came into contact with an ebola patient. Assuming the patient presented in the ER then most of the ER shift would have to quarantined for 3 weeks. Then the ward would lose 1-3 nurses per day plus physicians and other healthcare staff that had to enter the room d/t quarantine procedures. Just quarantining people returning from Africa that came into contact with an ebola patient doesn't address the problem at all and is nothing more than a political solution.

2. The bigger problem, at least in my mind, is the quarantine policy deters qualified healthcare workers from volunteering in Africa. This has been specifically discussed by Doctors without Borders and the federal government. The most prevalent problem that has been noted in these African countries with large outbreaks of ebola is the lack of qualified healthcare providers and healthcare facilities, and if we don't control where the virus is originating we will never really control spread of ebola virus anywhere else.

We need to control the fear mongering and listen to the actual ebola experts and utilize clinical relevant solutions to the ebola problem.

[wtbcrna, MSN, DNP, CRNA]

Many nurses are saying to "look at the science." Here's some more science. In the following article by the WHO, they say the incubation period for Ebola is 21 days, but then they admit that for 3% of Ebola cases, the incubation period was up to 42 days. For that reason, the WHO does not declare a country to be Ebola free until there have been no new cases for 42 days. See the article by the WHO at WHO | Are the Ebola outbreaks in Nigeria and Senegal over?

So, Kaci could have Ebola and not develop symptoms for up to 42 days.

The confidence interval for patients to develop symptoms in 1-21 days is 95% and 98% at 42 days per WHO. The actual study, which discusses that the incubation time estimates has to do when the surveillance was done so the estimates maybe flawed. On the Quarantine Period for Ebola Virus – PLOS Currents Outbreaks

The only thing this study indicates is that there is 0.1-12%, per the article, that someone could develop symptoms up to 42 days. The only changes that are needed is for further studies to see if these same results can be replicated sense we don't make wide ranging changes to practice based on one study, and that we may need to tell people that they need to report ebv symptoms up to 42 days.

This doesn't suggest in any way that we should have a mandatory quarantine for asymptomatic individuals.

[wtbcrna, MSN, DNP, CRNA]

Here's some more science. The Ebola virus can survive on a surface for quite a while. This fact alone shows that we need to be very cautious with Ebola and err on the side of caution. Here's the article: The survival of filoviruses in liquids, on solid substrates and in a dynamic aerosol - Piercy - 2010 - Journal of Applied Microbiology - Wiley Online Library

How is this study even clinically relevant? They tested the ebv at 4 degrees celsius or 39.2 Fahrenheit at normal room temperature ebv does not survive for very long.

[Horseshoe, BSN, RN]

If this disease is so easy to get before a person shows symptoms or even in the immediate aftermath of experiencing symptoms, we should have seen NUMEROUS infections of people exposed to Mr. Duncan during the period of his arrival in Dallas (9/20) and after he began experiencing symptoms (9/24) but before being admitted while actively ill 9/28).

Nope. Not a one. NOT ONE PERSON. The only people infected were health care workers exposed to him during the period of time where he was really, really sick.

All of these people posting about the risk Kaci Hickox, who has shown NO symptoms of illness, is inflicting on others conveniently seem to steer REAL CLEAR of the subject of Mr. Duncan. They also seem really hesitant to talk about Amber Vinson, who apparently exposed hundreds of people when she traveled on an airplane while febrile. For some reason, they don't talk about the fact that NOT ONE PERSON who came into contact with this early symptomatic person has fallen ill.

The people who avoid talking about the clear lack of evidence to their claims have about zero credibility as far as I am concerned.

[Crazynut]

The science is weak! Because there is so much we dont know.