Ebola at Emery - (Aug/08/2014 )
hobglobin on Fri Aug 8 18:50:50 2014 said:
pito on Fri Aug 8 18:14:05 2014 said:
Of course: evacuating all of them is impossible, thats why I am talking about setting up the necessary facilities right there!
I can undertand all your points, but you either make a progress or stand still...
And some point we will also be faced with this problem!
(think about malaria that is popping up in europe and predicted to be a problem the next decades in europe too)
I sometimes feel its often needed to be faced with the problem at the "home place" before its taken seriously....
but how many years it will take to build up such a hospital there with all the financial, bureaucratic and organisational hurdles? it surely needs also a working infrastructure (electricity, educated staff, water supply)...much too long for such an outbreak I think.
And well we had malaria in Europe until the 1950s I guess...but since the transmission path is broken (not enough infected hosts, mosquito eradication programs) it's difficult to come back.
And we have no apes and flying foxes in the wild here...
Of corse it takes years/time!
Thats just it: when will they start it?
The malaria is a different story: the weather is changing and providing the mosquitos to survive! But at the moment, the winter is still a dealbreaker for many of them.
Altough, I admit: malaria is perhaps not the biggest problem, spiders are!
We already find many spiders (dangerous ones) and the "borders" are moving more and more and some of those exotic problematic spiders are managing to survive here!
pito on Fri Aug 8 18:57:58 2014 said:
hobglobin on Fri Aug 8 18:50:50 2014 said:
pito on Fri Aug 8 18:14:05 2014 said:
Of course: evacuating all of them is impossible, thats why I am talking about setting up the necessary facilities right there!
I can undertand all your points, but you either make a progress or stand still...
And some point we will also be faced with this problem!
(think about malaria that is popping up in europe and predicted to be a problem the next decades in europe too)
I sometimes feel its often needed to be faced with the problem at the "home place" before its taken seriously....
but how many years it will take to build up such a hospital there with all the financial, bureaucratic and organisational hurdles? it surely needs also a working infrastructure (electricity, educated staff, water supply)...much too long for such an outbreak I think.
And well we had malaria in Europe until the 1950s I guess...but since the transmission path is broken (not enough infected hosts, mosquito eradication programs) it's difficult to come back.
And we have no apes and flying foxes in the wild here...
Of corse it takes years/time!
Thats just it: when will they start it?
The malaria is a different story: the weather is changing and providing the mosquitos to survive! But at the moment, the winter is still a dealbreaker for many of them.
Altough, I admit: malaria is perhaps not the biggest problem, spiders are!
We already find many spiders (dangerous ones) and the "borders" are moving more and more and some of those exotic problematic spiders are managing to survive here!
Actually I'd go further then: These countries do not need a specialised hospital but a continuously well working health system with many well equipped hospitals and educated stuff which are affordable to people. Then I guess most of these problems would not occur in such a dimension...
And well the here occurring Anopheles species (A. maculipennis mostly) are surprisingly cold-hardy (or survive well-protected in basements) and usually the water (larval habitats) during spring and summer is the limiting factor...
hobglobin on Fri Aug 8 19:20:32 2014 said:
pito on Fri Aug 8 18:57:58 2014 said:
hobglobin on Fri Aug 8 18:50:50 2014 said:
pito on Fri Aug 8 18:14:05 2014 said:
Of course: evacuating all of them is impossible, thats why I am talking about setting up the necessary facilities right there!
I can undertand all your points, but you either make a progress or stand still...
And some point we will also be faced with this problem!
(think about malaria that is popping up in europe and predicted to be a problem the next decades in europe too)
I sometimes feel its often needed to be faced with the problem at the "home place" before its taken seriously....
but how many years it will take to build up such a hospital there with all the financial, bureaucratic and organisational hurdles? it surely needs also a working infrastructure (electricity, educated staff, water supply)...much too long for such an outbreak I think.
And well we had malaria in Europe until the 1950s I guess...but since the transmission path is broken (not enough infected hosts, mosquito eradication programs) it's difficult to come back.
And we have no apes and flying foxes in the wild here...
Of corse it takes years/time!
Thats just it: when will they start it?
The malaria is a different story: the weather is changing and providing the mosquitos to survive! But at the moment, the winter is still a dealbreaker for many of them.
Altough, I admit: malaria is perhaps not the biggest problem, spiders are!
We already find many spiders (dangerous ones) and the "borders" are moving more and more and some of those exotic problematic spiders are managing to survive here!
Actually I'd go further then: These countries do not need a specialised hospital but a continuously well working health system with many well equipped hospitals and educated stuff which are affordable to people. Then I guess most of these problems would not occur in such a dimension...
And well the here occurring Anopheles species (A. maculipennis mostly) are surprisingly cold-hardy (or survive well-protected in basements) and usually the water (larval habitats) during spring and summer is the limiting factor...
True!
But a first step would be "an international hospital" , with teaching facilities too...
As far as I remember it was more about the "african" mosquitoes being able to survive here for a short (mid long) period and infecting people during this period (the summer I assume), but than again, its been a while since I was following this topic, might be mistaken.
pito on Fri Aug 8 19:57:22 2014 said:
True!
But a first step would be "an international hospital" , with teaching facilities too...
As far as I remember it was more about the "african" mosquitoes being able to survive here for a short (mid long) period and infecting people during this period (the summer I assume), but than again, its been a while since I was following this topic, might be mistaken.
Oh, yes I forgot the new species...Stegomyia albopicta etc..not sure if they transmit here too, but surely a new danger...
Anyway it's an Ebola thread here 
pito:
No I was not answering you, I was just addressing the original notion "what do you think about bringing back our infected citizens, that may perhals pose a risk of infecting us".
Diseases happen, that's bad a you cannot safe the whole continent from that, sadly. But in the countries where the disease is not present, or may even be only very unlikey present at all, some people that have knowledge, some people that care enough, they go there, into the very "primitive" (regarding the infrastructure) conditions and try to help people there. They don't need to do it, thay may sit safe at their homes or make money treating people with a minor diseases, compared to this. But those people choose to go there and risk it. And then someone can question, whether it is safe for the rest of us, who stayed at home caring much less about whole the disease problems in some other part of world, to bring them back to provide them with the maximum care our countries can provide. We owe it to those that take care of the needed, when they are in need.
We cannot safe all the african victims of Ebola, or of many other diseases, or ship a hundreds of them here (not only we don't have much better treatment anyway and same as you can't ship hundreds of thousands people starving there, to feed here, where we throw oout food regulary, you cannot ship all the diseased here to treat. That is a completely different thing I wasn't addressing, a different, more complex problem. But we can save "our" people, who risk their lives and we should.
So my response was a bit harsh, yes, and sarcastic, but this kind of thinking really irritates me.
The primary concern should be public health, not that the 2 ere US citizens somehow owed care back here. The overall effort bring them back was probably of very low risk, tho' quite expensive. I'm sure the Emery facilities have been established and validated to function as expected but doubt the transportation was validated.
As to Pito's observation of US vs. European (Spanish) attitude re. repatriation, I don;t think there was anger in US as much as concern prob at a higher level of worry from recent failures at CDC in containment and control (smallpox, anthrax). If the 2 were being brought to Spain, their perspective may have been different.
Phil Geis on Sun Aug 10 14:01:39 2014 said:
The primary concern should be public health, not that the 2 ere US citizens somehow owed care back here. The overall effort bring them back was probably of very low risk, tho' quite expensive. I'm sure the Emery facilities have been established and validated to function as expected but doubt the transportation was validated.
As to Pito's observation of US vs. European (Spanish) attitude re. repatriation, I don;t think there was anger in US as much as concern prob at a higher level of worry from recent failures at CDC in containment and control (smallpox, anthrax). If the 2 were being brought to Spain, their perspective may have been different.
But they did bring a patient with ebola back to spain and yet the public was very much pro the evacuation to spain.
There was not as much as "upset" as in the usa.
What is owed to those who volunteer to place themselves at risk does not preempt control of the public health risk. Playing the devil's advocate - If those individuals could have been treated remotely, why accept even the very small risk of returning them?
That said, Emery offers the best opportunity for clinical study of the monoclonal treatment but probably not much for effectivneess with only a couple of subjects.
Phil Geis on Sun Aug 10 17:58:33 2014 said:
What is owed to those who volunteer to place themselves at risk does not preempt control of the public health risk. Playing the devil's advocate - If those individuals could have been treated remotely, why accept even the very small risk of returning them?
That said, Emery offers the best opportunity for clinical study of the monoclonal treatment but probably not much for effectivneess with only a couple of subjects.
That is why I said that they should invest in a good treatment facility in africa.
Its more an ethical discussion, I think, in the end.
pito on Sun Aug 10 15:06:19 2014 said:
Phil Geis on Sun Aug 10 14:01:39 2014 said:
The primary concern should be public health, not that the 2 ere US citizens somehow owed care back here. The overall effort bring them back was probably of very low risk, tho' quite expensive. I'm sure the Emery facilities have been established and validated to function as expected but doubt the transportation was validated.
As to Pito's observation of US vs. European (Spanish) attitude re. repatriation, I don;t think there was anger in US as much as concern prob at a higher level of worry from recent failures at CDC in containment and control (smallpox, anthrax). If the 2 were being brought to Spain, their perspective may have been different.
But they did bring a patient with ebola back to spain and yet the public was very much pro the evacuation to spain.
There was not as much as "upset" as in the usa.
The priest brought back to Spain was for political reasons (influence of the church and the political party in the power). Amongst my contacts, at least, there was nobody supporting such evacuation for several reasons (by the way I'm Spanish):
- The hospital planning to receive him was nearly emptied of resources during the last year due budget cuts, with no even ICU.
- The hospital was evacuated in few hours with no real emergency plan
- Personnel was instructed in a couple of hours.
- Decision was not medical. Despite of other Spanish political matters, the priest was working for an organisation that makes 25 million euros/year but the cost of repatriation was spent by the Spanish government, estimated in more than 1 million to try to save 1 life and risking many others while it has been cases of Spanish emigrants requiring repatriation for medical conditions for months who ended dying.
- The priest wasn't the only Spanish there.