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Ebola carriers may not have to show symptoms to be contagious.

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http://www. nj . com / politics/index.ssf/2014/10/christies_quarantine_policy_attacked_by_aclu_cdc_and_even_the_un_is_embraced_by_2011_nobel_prize_win.html#incart_river

 

 

Christie's controversial Ebola quarantine now embraced by Nobel Prize-winning doctor

 

Claude Brodesser-Akner

 

on October 28, 2014 at 6:00 AM, updated October 28, 2014 at 2:47 PM

 

TRENTON — After days of blistering criticism from the ACLU, the CDC and even the United Nations secretary general over Gov. Chris Christie’s new, 21-day mandatory quarantine policy for all healthcare workers exposed to Ebola, the New Jersey governor has gotten a much-needed vote of support from a heavyweight name in the medical community: Nobel Prize-winning doctor and medical researcher, Dr. Bruce Beutler.

 

Dr. Beutler, an American medical doctor and researcher, 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.

 

He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas — the first U.S. city to treat an Ebola patient and also the first to watch one die from the virus. In an exclusive interview with NJ Advance Media, Beutler reviewed Christie’s new policy of mandatory quarantine for all health care workers exposed to Ebola, and declared: “I favor it.”

 

Unfortunately, while the doctor’s support might provide much-needed credibility for Christie as he threatens to quarantine ever more healthcare workers returning from the Ebola fight in West Africa, it also comes with some chilling words.

 

“I favor it, because it’s not entirely clear that they can’t transmit the disease,” Beutler said, referring to asymptomatic healthcare workers like Kaci Hickox, a Doctors Without Borders nurse returning from treating Ebola patients in Sierra Leone who was quarantined in New Jersey for 65 hours before being transported to her home state of Maine on Monday afternoon.

 

“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.”

 

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.

 

Why, then, does he think the CDC would so emphasize Ebola is not communicable in patients without symptoms?

 

“There’s some imperative to prevent panic among the public,” says Dr. Beutler, “But to be honest, people have not examined that with transmissibility in mind. I don’t completely trust people who’d say that as dogma.”

 

As such, allowing home confinement for medical workers exposed to Ebola but currently without symptoms was, as Beutler put it, “a move away from goodness,’ as an engineer might say.”

 

The U.S. Centers for Disease Control and Prevention (CDC) on Monday changed direction and called for voluntary home quarantine for workers with the highest risk for Ebola infection. However, it also specified that most medical personnel returning from Sierra Leone, Liberia and Guinea would not need to be kept in isolation, as Hickox had been ever since she arrived at Newark International Airport on Friday up until her release and transfer to home quarantine in Maine early Monday afternoon.

 

“Even if someone is asymptomatic you cannot rely on people to report themselves if they get a fever,” said Dr. Beutler, adding, “You can’t just depend on the goodwill of people to confine the disease like that – even healthcare workers. They behave very irresponsibly.”

 

Christie has repeatedly pointed to the fact that NBC’s chief medical editor, Dr. Nancy Snyderman, after returning from Ebola besieged West Africa, was spotted violating her voluntary quarantine to get takeout from a Princeton eatery last week.

 

Despite her forced detainment by the New Jersey health department, Hickox insisted hat she was “feeling physically healthy” and except for a single, non-contact thermometer reading that registered her as having a 101 Fahrenheit fever, has had normal 98.6 F temperatures ever since her quarantine began.

 

“These are no arguments at all,” said Beutler. “Anyone could say that about any disease. It doesn’t matter that she was afebrile – she should be quarantined for 21 days.”

 

Hickox has complained that “her basic human rights were violated” and has since retained a civil rights attorney, but Beutner says he is puzzled by the argument.

 

“These people act like they are returning as conquering heroes — and they should be treated as conquering heroes, but part of being a conquering hero means making sure no one gets infected by you. Just look at the the foolish quarantine where astronauts came back from the moon [where there were no germs] and in this case, we know there is an infection.”

 

From a global perspective, it’s unlikely that the virus will take hold as an epidemic in the U.S., but in Africa, Beutler says it already “has gone ballistic – way, way beyond the past epidemics. One could project that maybe millions could be infected. It may be that it won’t spread like wildfire in the United States but even if one or two more people die, it will be too many.”

 

So, does Gov. Chris Christie have it right?

 

“I’d be a little bit more strict than he is being,” said Beutner, “I realize this would be inconvenient, but I don’t think it would prevent treating the disease.”

 

Christie has not been willing to publicly explain how home quarantine would work in cases like, for example, where a healthcare worker also had children at home.

 

“You’re in your home,” Christie deadpanned to the question when asked it was asked of him in Groton, Connecticut Monday night, “and you’re quarantined.”

 

“I know at times that you all would like to make things a heck of a lot more complicated than they are,” said Christie, “In home quarantine means: In-home. Quarantine. If they are asymptomatic, they can be quarantined in their home.”

 

Beutler disagrees with this, saying “the ideal scenario is where a patient is isolated from all family members,” preferably in an specialized hospital ward, not in a home.

 

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.”

 

Claude Brodesser-Akner may be reached at cbrodesser@njadvancemedia.com. Follow him on Twitter @claudebrodesser. Find ******* Politics on Facebook.

 

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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2800%2902405-3/fulltext

 

 

Background

 

Ebola virus is one of the most virulent pathogens, killing a very high proportion of patients within 5—7 days. Two outbreaks of fulminating haemorrhagic fever occurred in northern Gabon in 1996, with a 70% case-fatality rate. During both outbreaks we identified some individuals in direct contact with sick patients who never developed symptoms. We aimed to determine whether these individuals were indeed infected with Ebola virus, and how they maintained asymptomatic status.

 

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This part concerns me...

 

He is a far more qualified voice than Obama or the Obola Czar, perhaps the following is the reason why he was overlooked for appointment.

 

“I favor it, because it’s not entirely clear that they can’t transmit the disease,” Beutler said, referring to asymptomatic healthcare workers like Kaci Hickox, a Doctors Without Borders nurse returning from treating Ebola patients in Sierra Leone who was quarantined in New Jersey for 65 hours before being transported to her home state of Maine on Monday afternoon.

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“Even if someone is asymptomatic you cannot rely on people to report themselves if they get a fever,” said Dr. Beutler, adding, “You can’t just depend on the goodwill of people to confine the disease like that – even healthcare workers. They behave very irresponsibly.”

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If the nurse or anyone that has ebola be sued for transferring the disease ???  

 

i wonder how that would be proved (based on the preponderance of the evidence) in a court of law.

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i wonder how that would be proved (based on the preponderance of the evidence) in a court of law.

 

The RNA of the virus has all the fingerprints needed.

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The RNA of the virus has all the fingerprints needed.

 

Every strains RNA has markers that provide a pedigree of its source as well as its mutations.

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But I assume this outbreak is a single strain and the victims all had an identical virus. The virus does not necessarily mutate often or pick up DNA artifacts from its last host, correct? That would make it impossible to show for a fact who infected an individual.

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*cough* ebola is an RNA virus *cough*

 

That's fine, I hadn't checked, but the principle is similar. Though I don't know how an RNA-based virus would retain any elements of the host genetic material. My college microbiology is about 30 years old...which means about useless.

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*cough* ebola is an RNA virus *cough*

 

Thanks for the heads up. Only the acronym changes, the pedigree will show the mutations.

 

Ebola's genome is made of RNA instead of DNA, and it mutates quickly. “Each infection event is a new opportunity to mutate,” says Pardis Sabeti, a geneticist at the Broad Institute at Harvard University in Boston. Five known strains of Ebola infect humans, and the one responsible for this outbreak was identified early on as EBOV, also known as Zaire ebolavirus.

 

Since its emergence in Guinea in February 2014, this strain of Ebola has spread across West Africa, killing thousands to date. Until this outbreak, Ebola had been restricted to central Africa, making this event unprecedented in both its sheer numbers and its geographic reach. In addition, the virus has been undergoing tiny but potentially significant genetic mutations as it spreads.

Read more: http://www.smithsonianmag.com/science-nature/tracking-2014-ebola-outbreak-through-its-genes-180952487/#hI2h14GgFLhod2G6.99

Give the gift of Smithsonian magazine for only $12! http://*******/1cGUiGv

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