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Showing posts with label CDC Director Dr Tom Frieden. Show all posts
Showing posts with label CDC Director Dr Tom Frieden. Show all posts

17 October 2014

Financiación Ebola no conseguirá una audiencia de republicanos de la Cámara, pero Ebola pánico Will & Separar preocupaciones legítimas de Ébola de temor innecesario y Legisladores llaman a las agencias de salud para dar cuenta de los errores de Ébola 16OKT14


EL obstruccionista gop / té-bagger en el Congreso son expertos en fomentar el miedo y el pánico al tiempo que evita una adecuada (por falta de financiación) la respuesta del gobierno federal a cualquier amenaza importante o desastre. Ébola es una amenaza, y el Partido Republicano y el té-empacadores, junto con los medios de comunicación están aullando como desaforados , aterrorizando gran parte de la opinión pública estadounidense, y están tratando de usar una muerte Ébola y dos casos confirmados de Ebola en los EE.UU. políticamente contra Pres Obama y todos los demócratas y el candidato independiente que se ejecuta en estas elecciones mediados años plazo. Pero los demócratas se están defendiendo, señalando la situación amerita una respuesta vigorosa pero el liderazgo republicano de la Cámara no ordenará el subcomité de Apropiaciones de Salud vuelta en la sesión de audiencias sobre la financiación para el CDC y los NIH. Para ello proporcionaría un foro muy público para el pueblo estadounidense para encontrar a cabo la preparación de los CDC y los NIH y la respuesta al Ébola está paralizado debido al secuestro y los recortes presupuestarios impuestos por el gop / cábala té-bagger en el Congreso . He aquí un video de + Erica Payne en el Proyecto de Orden del Día, + Daily Kos y un informe muy SANE, muy informativo de la  PBS NewsHour + .....

http://youtu.be/c3D0DxjgPB0

Financiación Ebola no conseguirá una audiencia de republicanos de la Cámara, pero Ebola pánico


. Nueva congresista Cory Gardner (R-CO) reacciona después de recoger el número uno en la lotería de la oficina para todos los nuevos miembros de la Cámara del Congreso en Washington, 19 de noviembre de 2010. & nbsp;  & Nbsp;  & Nbsp; REUTERS / Larry Downing (ESTADOS UNIDOS - Tags: POLITICS) - RTXUTKJ
Cory Gardner toma tiempo de su apretada campaña ocupado para hacer algo de difusión del miedo Ebola.
Termómetro Meta
El testimonio de los funcionarios públicos de salud en el Senado hace unas semanas y media posteriores de seguimiento ha señalado un grave déficit de financiación de la salud pública. De hecho, dijo el director del NIH Francis Collins, a quemarropa "si no hubiéramos pasado por nuestra diapositiva de 10 años de apoyo a la investigación, que probablemente habría tenido una vacuna a tiempo para este que han pasado por ensayos clínicos y habría sido listo ". Estos informes condujeron demócratas de la Cámara para pedir una audiencia sobre la falta de financiación para la crisis del Ébola .
"A medida que lloramos la muerte de Thomas Eric Duncan y oramos por los dos trabajadores de la salud infectados en Dallas, reiteramos nuestro llamado a la Presidente [Jack] Kingston convocar nuestro subcomité de inmediato", los demócratas en el subcomité de Asignaciones de la Salud dijo en una articulación comunicado. [...] "El Comité de Seguridad Nacional se reunió hace casi dos semanas, y un subcomité de Energía y Comercio se reunirá mañana. Para nuestro subcomité, el encargado de la financiación de los NIH y CDC, para continuar a eludir su responsabilidad y venir sin mucho como una audiencia es inaceptable ", dijeron en su comunicado el miércoles.
Kingston, el primer legislador del Partido Republicano para pedir el "zar de Ebola" , obviamente, se ha negado a sostener que oír o decir por qué. El portavoz del comité, dijo simplemente que el
actualmente Comité no tiene audiencias programadas como el Congreso está en receso. "Recess puede ser interrumpido, sin embargo, para el Subcomité del Comité de Energía y Comercio de la Salud de Supervisión e Investigaciones, como los demócratas señalaron. Eso es porque que la audiencia es sobre "Ebola indignación," en el que "director de los CDC, Thomas Frieden probablemente se enfrentará a una serie de preguntas difíciles." Ellos también parrilla NIH director de enfermedades infecciosas, Anthony Fauci, y funcionarios del Hospital Presbiteriano de Texas, donde dos enfermeras han contraído la enfermedad después de tratamiento de Duncan. Siempre hay tiempo para golpear a la administración Obama por republicanos de la Cámara.
Cuando los demócratas ganan, la salud pública gana. Por favor chip en $ 3 a asestar un golpe para la ciencia.

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La audiencia se llevará por lo menos proporcionar la oportunidad de los demócratas del comité de preguntar acerca de los niveles de financiación de las agencias, pero la intención de esta audiencia es claramente bashing administración política-Obama. Duda de que? "Colorado congresista republicano Cory Gardner, que está encerrado en una carrera competitiva para el Senado contra el senador demócrata Mark Udall, viajará a Washington el jueves para asistir a la audiencia."

Originalmente publicado a Joan McCarter el Jue 16 de octubre 2014 a las 08:49 AM PDT.

También reeditado por Daily Kos . 

La separación de las preocupaciones legítimas de Ébola de miedo innecesario

 
16 de octubre 2014 a las 6:40 pm EST
Como nuevos casos han sido diagnosticados en los EE.UU. y los Centros para el Control de Enfermedades amplía su investigación, la preocupación nacional se ha disparado. Gwen Ifill explora la psicología detrás de la ansiedad pública con el Dr. Eden Wells de la Universidad de Michigan y Valerie Reyna, de la Universidad Cornell.

TRANSCRIPCIÓN

GWEN IFILL: Late hoy, los Centros para el Control de Enfermedades informó que está ampliando su investigación Ebola incluir los pasajeros de un segundo vuelo efectuada por una de las enfermeras ya diagnosticados con la enfermedad. Y la línea aérea está notificando a los pasajeros que pudieran haber volado a otra parte en los mismos jet.As nuevos detalles emergen, y como audiencia en el Congreso de hoy mostró, preocupaciones internas más Ébola están por las nubes. Un nuevo sondeo de Reuters / Ipsos encuentra el 41 por ciento están muy preocupados por el brote, 36 por ciento está algo preocupado. Y el 45 por ciento dicen que están evitando los viajes internacionales.
Una encuesta separada por la Escuela de Salud Pública de Harvard encontró que más de la mitad de los adultos están preocupados de que habrá un gran brote de Ébola en los EE.UU. en los próximos 12 meses.
Es una buena tiempo para preguntar, ¿cómo deberíamos estar preocupados? ¿Y cómo debemos evaluar cualquier nivel de riesgo?
Nos dirigimos a Dr. Eden Wells, profesor de epidemiología de la Universidad de Michigan. Y Valerie Reyna, profesora de Desarrollo Humano y Psicología en la Universidad de Cornell.
Bienvenido a los dos.
Dr. Wells, ¿cuándo empezamos a pensar que se trata de un miedo legítimo y cuándo es la paranoia? DR. EDEN WELLS, Universidad de Michigan: Bueno, esa es una excelente pregunta, pero que es difícil de responder, ya que creo que cualquiera que tenga una preocupación tiene - se justifica tener esa preocupación. Y, por lo tanto, tenemos que abordar que con una buena información. Paranoia es probablemente demasiado fuerte de un término. Yo diría que las personas tienen preocupaciones después de que todos los ciclos de noticias que hemos estado viendo en la última semana o así, ya vienen de mi propia familia, mis compañeros, mis amigos, y, en total, a finales de el día, podemos decir hoy que este virus no ha cambiado. El riesgo es aún baja para aquellos de nosotros que no están involucrados en la atención de salud, al igual que estas dos enfermeras heroicos que eran realmente íntimamente involucrado con el cuidado del Sr. Duncan, y , por desgracia, se infectaron. GWEN IFILL: Déjame seguir con usted en una pieza más de eso, que es, me pregunto hasta qué punto las cuestiones lingüísticas. Cuando estos casos son aislados y cuándo es un brote? DR. EDEN WELLS: Esa es una pregunta muy buena. Yo diría que en este momento tenemos dos casos que estuvieron involucrados en la atención médica directa de este paciente. Sabemos que este virus se transmite por contacto corporal directo con la persona o los fluidos de esa persona. Un brote de - en mi mente, realmente significaría que si el virus comienza a ocurrir más allá de lo que decimos es la transmisión secundaria que estamos viendo en este momento, el hecho de que estas enfermeras se enfermaron, que si empezamos a ver los casos que se producen en otras personas de la comunidad, que en mi mente sería un brote. Una vez más, que el riesgo de un brote es realmente muy bajo. Esto no ha cambiado en lo que hemos estado diciendo acerca de este virus en los últimos seis meses. GWEN IFILL: Valerie Reyna, cómo hacen las personas a manejar este riesgo, sobre todo emocionalmente, psicológicamente, hacer la diferencia entre tener que preocuparse por el presente y preocuparse por el futuro ? VALERIE REYNA, la Universidad de Cornell: Bueno, hay una gran cantidad de la ciencia psicológica en este tema. Y es muy comprensible que la gente estaría preocupado por el riesgo de un brote de Ébola. La gente piensa realmente en términos de - de dos maneras sobre el riesgo. Piensan en posibilidad vs. imposibilidad, y, por supuesto, hemos repasado esa barrera psicológica. La gente se les dijo inicialmente que la transmisión era esencialmente imposible. Les dijeron que de buena fe. Y entonces sucedió, y sucedió dos veces. Así que ahora, psicológicamente, la gente ha pasado de, esto es una imposibilidad para, no sólo es una posibilidad, pero es uno que está en aumento. Y la mente humana está muy en sintonía a los cambios, a los aumentos en el riesgo, así como los cambios de imposible a posible. GWEN IFILL: Por lo tanto, es parte del problema como lo ve que al decir, por ejemplo, para tratar de calmar la público la semana pasada, el Dr. Frieden decir o Dr. Fauci decir esto se detendrá en sus pistas en los Estados Unidos? ¿Era parte del problema en el cambio de expectativas? VALERIE REYNA: Bueno, no estoy seguro de que eso es parte del problema. Yo creo que es bueno para tranquilizar a la gente de que hay medidas en vigor. Creo que la respuesta psicológica humana al riesgo es - tiene varios componentes. Tiene un componente emocional a ella, amenaza y alarma. Esa amenaza y la alarma pueden dar sentido a veces. Y ahí es donde la comunicación de riesgos entra. Cada vez que tenemos una epidemia como esta o un desastre natural o un incidente que tiene que ver con el terrorismo, la comunicación de riesgos se convierte en una clave entre los funcionarios y el público. A menudo es algo que damos por sentado. Es una especie de fuerza invisible, pero es el tipo de cosa que se conecta a la seguridad de las personas a los recursos que podemos tener para lidiar. GWEN IFILL: Dr. Wells, cómo hace el factor de riesgo para el Ébola, como usted lo entiende, en comparación con los factores de riesgo para otras enfermedades que han causado este tipo de gran temor generalizado con - pienso en el SIDA en los primeros días o SARS o la gripe aviar. DR. EDEN WELLS: . Oh, sí En primer lugar, me gustaría decir que estoy absolutamente de acuerdo con nuestro otro altavoz aquí esta noche. Y está muy bien, dijo acerca de la comunicación de riesgos. Y tenemos que abordar el hecho de que esta es una enfermedad. Como Ébola ha sido conocido desde mediados de la década de 1970, es una enfermedad que da miedo de sonar. Tiene una alta tasa de mortalidad conocida. Es bastante horripilante en cómo las personas sufren de ella, sobre todo cuando se convierten en gran medida los malos, si no muere. Y esto ha sido en nuestra conciencia colectiva, si se quiere, desde que fue descubierto por primera vez en 1976. Pero a medida que se compara en términos de riesgo, a pesar de que esto es difícil de comunicar, ya que, en estos momentos, todo el mundo está preocupado por lo que " re escuchar acerca de la reciente noticia, pero, en cuanto a los riesgos, cuando pienso en las enfermedades que hemos visto transpirar, el VIH, la gripe aviar, si pensamos en sustos rápidas, ya sabes, la poliomielitis, la gripe española, esto es menos transmisible, gracias a Dios, que muchas de las enfermedades que hablamos acerca. Se requiere el contacto directo con una persona infectada o con sus fluidos corporales. Así que el riesgo es menor que el de la gripe aviar, el SARS que hemos tratado en el pasado. Pero, de nuevo, tenemos que ser capaces de transmitir que el riesgo de una manera que la gente puede sentirse más reconfortados, ya que esto es una preocupación, y los cambios recientes han aumentado la preocupación, ya que mi compañero orador dijo. GWEN IFILL: Bueno, Valerie Reyna, brevemente, ¿cómo calmar el miedo sin subestimar el riesgo? VALERIE REYNA: Sí, creo que eso es muy importante. Creo que realmente tenemos que ser abiertos y transparentes. Tenemos que explicar a la gente la naturaleza de la transmisión. Ahora, este es un reto muy difícil. Usted tiene la información técnica que tiene que salir a una amplia variedad de personas con diferentes tipos de fondos de conocimiento. Pero ese es el reto de la comunicación de riesgos. Existe información científica disponible que pueda facilitar eso. La gente tiene que saber cómo sucedió esto, por qué sucedió. Si hay incertidumbre, y no sabemos ciertas causas, tenemos que estar abiertos a eso. Creo que las personas pueden estar tranquilos cuando se les da la información. Hay elementos de aquí, también, que tienen que ver con la confianza en el gobierno. Y creo que la confianza se fomenta en la medida que somos sinceros con la gente. GWEN IFILL: . derecho Valerie Reyna, de la Universidad de Cornell, y el Dr. Ellen - Eden Wells de la Universidad de Michigan, que tanto agradecen mucho. VALERIE REYNA: Gracias, Gwen.

Legisladores llaman a las agencias de salud para dar cuenta de los errores de Ebola

 
16 de octubre 2014 a las 6:50 pm EST
Creciente ansiedad sobre el Ébola en los EE.UU. provocó una audiencia en la Cámara de cuestionar los altos funcionarios de salud de la nación. Mientras tanto, presidente de la Cámara John Boehner y otros sugirieron que los límites pueden colocar en los viajeros procedentes de África occidental, pero un portavoz de la Casa Blanca desestimó la idea de una prohibición de viajar. Gwen Ifill informa.

TRANSCRIPCIÓN

GWEN IFILL: Las principales agencias de salud federales fueron llamados a explicar hoy por los errores en el manejo de Ebola. Los legisladores de ambos partidos dispararon las críticas y preguntas en una audiencia en Washington. REP. FRED Upton, (R) Michigan:   . Vida de las personas que están en juego, y la respuesta hasta ahora ha sido inaceptable GWEN IFILL: ansiedad creciente ante la posibilidad de propagación del ébola en los EE.UU. trajo un comité de la Cámara de regresar de hacer campaña y puso de salud más importantes del país funcionarios en la línea de fuego. Michigan republicano Fred Upton: REP. FRED UPTON: Vamos a mantener sus pies al fuego en hacer el trabajo y conseguir que se haga bien. Tanto los EE.UU. y la comunidad sanitaria mundial hemos logrado hasta ahora poner en marcha una estrategia eficaz con la suficiente rapidez para combatir el brote actual. GWEN IFILL: Las quejas eran bipartidista. demócrata Diana DeGette de Colorado: REP. DIANA DeGette, (D) Colorado: Sería un eufemismo decir que la respuesta a la primera paciente con sede en EE.UU. con el Ébola se ha administrado mal, causando riesgo a decenas de personas adicionales. GWEN IFILL: La audiencia se produjo en medio sugerencias de la Cámara de Representantes John Boehner y otros que los límites deben colocar sobre los viajeros que entran en el país de África occidental, donde miles de personas han muerto de Ebola. republicano Tim Murphy de Pennsylvania presidió la audiencia. REP. TIM MURPHY, (R) Pennsylvania: Esta es la pregunta que el público estadounidense está pidiendo. ¿Por qué seguimos permitiendo a la gente a venir por aquí y por qué, una vez que están aquí, ¿no hay cuarentena? GWEN IFILL: Pero el jefe de los Centros para el Control de Enfermedades, el Dr. Tom Frieden, sostuvo una prohibición de viajar podría ser contraproducente. DR. Thomas Frieden, Director de los Centros para el Control y Prevención de Enfermedades:  Si la gente fuera a entrar, por ejemplo, ir por tierra a otro país y luego entrar sin saber que eran de estos tres países, que en realidad perder esa información. GWEN IFILL: En la Casa Blanca, un portavoz dijo que la prohibición de los viajes no está bajo consideración. Pero las proyecciones de pasajeros han comenzado en los principales aeropuertos internacionales en Nueva York, Atlanta, Chicago, Newark, Nueva Jersey, y Washington. El proceso incluye tomar la temperatura y la entrega de cuestionarios a los viajeros procedentes de Guinea, Sierra Leona y Liberia. En Washington Dulles Airport, algunos pasajeros se sintieron tranquilos, otros no tanto. ERIC MORENO: Cualquier proyección dentro o fuera, yo estoy a favor, ya sea seguridad para el terrorismo o si es para cuestiones de salud. Obviamente, yo no quiero nada traído. RAMYA SINGH: No sé qué tan efectivos serán, con toda sinceridad, porque usted sabe que usted está viniendo, pero no sé dónde ha estado antes. GWEN IFILL: En Dallas, continuó preguntas acerca de cómo dos enfermeras se infectaron después de tratar a un hombre de Liberia, Thomas Eric Duncan, que murió de Ebola en el Texas Health Hospital Presbiteriano. Un funcionario del hospital superior apareció en audiencia en el Congreso de hoy a través de vídeo. DR. DANIEL VARGA, Director Clínico, de Texas Health Resources: Por desgracia, en nuestro tratamiento inicial del Sr. Duncan, a pesar de nuestras mejores intenciones y un equipo médico altamente cualificado, que cometieron errores. Nosotros no diagnosticamos correctamente sus síntomas como los de Ebola. Y estamos profundamente apenado. GWEN IFILL: Una de las enfermeras, de 29 años de edad, Amber Vinson, ahora se ha trasladado al Hospital de la Universidad de Emory en Atlanta. La otra enfermera, Nina Pham, se está enviando a los Institutos Nacionales de Salud en Bethesda, Maryland. Más tarde, el presidente Obama llamó a los líderes clave del Congreso, se reunió con altos funcionarios del gobierno, y autorizó a la llamada a filas de las tropas de la Guardia Nacional y la Reserva, si necesario para ayudar a lidiar con el brote en el África occidental. Tendremos más sobre la respuesta a la amenaza del Ébola tras el resumen de noticias.

Ebola funding won't get a hearing from House Republicans, but Ebola panic will & Separating legitimate Ebola concerns from unnecessary fear & Lawmakers call health agencies to account for Ebola mistakes 16OKT14


THE gop / tea-bagger obstructionist in congress are experts in encouraging fear and panic while preventing an adequate (due to lack of funding) federal government response to any major threat or disaster. Ebola is a threat, and the gop and tea-baggers along with the mainstream media are howling like banshees, terrifying much of the American public, and they are trying to use one Ebola death and two confirmed Ebola cases in the U.S. politically against Pres Obama and every Democrat and Independent candidate running in this years mid term elections. But Democrats are fighting back, pointing out the situation warrants a vigorous response but the republican house leadership will not order the House Appropriations Health subcommittee back in session for hearings on funding for the CDC and NIH. To do so would provide a very public forum for the American people to find out the CDC and NIH preparation and response to Ebola is hamstrung due to sequestration and budget cuts imposed by the gop / tea-bagger cabal in congress. Here's a video from +Erica Payne at the Agenda Project, +Daily Kos and a very SANE, very INFORMATIVE report from the +PBS NewsHour .....
http://youtu.be/c3D0DxjgPB0

Ebola funding won't get a hearing from House Republicans, but Ebola panic will


New U.S. Rep. Cory Gardner (R-CO) reacts after picking number one in the office lottery for all new House members of Congress in Washington, November 19, 2010.      REUTERS/Larry Downing (UNITED STATES - Tags: POLITICS) - RTXUTKJ
Cory Gardner takes time from his busy campaign schedule to do some Ebola fearmongering.
Goal Thermometer
Testimony from public health officials in the Senate a few weeks ago and subsequent media follow up has pointed out a serious deficit for public health funding. In fact, NIH Director Francis Collins said, point blank "if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would've gone through clinical trials and would have been ready." These reports led House Democrats to call for a hearing on the lack of funding for the Ebola crisis.
"As we mourn the death of Thomas Eric Duncan and pray for the two health care workers infected in Dallas, we reiterate our call for Chairman [Jack] Kingston to convene our subcommittee immediately," Democrats on the House Appropriations Health subcommittee said in a joint statement. […] "The Homeland Security Committee met nearly two weeks ago, and an Energy and Commerce subcommittee will meet tomorrow. For our subcommittee, the one in charge of funding the NIH and CDC, to continue to shirk its responsibility and go without so much as a hearing is unacceptable,” they said in their statement Wednesday.
Kingston, the first GOP lawmaker to call for an "Ebola czar" obviously has refused to hold that hearing or say why. The spokesperson for the committee said simply that the
Committee currently has no hearings scheduled as the Congress is in recess." Recess can be interrupted, however, for the Energy and Commerce Health Committee's Subcommittee on Oversight and Investigations, as the Democrats noted. That's because that hearing is about "Ebola outrage," in which "CDC Director Thomas Frieden will likely face a series of tough questions." They'll also grill NIH infectious disease director Anthony Fauci and officials from Texas Presbyterian Hospital, where two nurses have contracted the disease after treating Duncan. There's always time for bashing the Obama administration for House Republicans.
When Democrats win, public health wins. Please chip in $3 to strike a blow for science.

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The hearing will at least provide the opportunity to committee Democrats to ask about funding levels for the agencies, but the intent of this hearing is clearly political—Obama administration bashing. Doubt that? "Colorado Republican Congressman Cory Gardner, who is locked in a competitive race for the Senate against Democratic Senator Mark Udall, will travel back to Washington on Thursday to attend the hearing."

Originally posted to Joan McCarter on Thu Oct 16, 2014 at 08:49 AM PDT.

Also republished by Daily Kos. 

Separating legitimate Ebola concerns from unnecessary fear

October 16, 2014 at 6:40 PM EDT
As new cases have been diagnosed in the U.S. and the Centers for Disease Control expands its investigation, national concern has skyrocketed. Gwen Ifill explores the psychology behind the public anxiety with Dr. Eden Wells of the University of Michigan and Valerie Reyna of Cornell University.

TRANSCRIPT

GWEN IFILL: Late today, the Centers for Disease Control reported that it is expanding its Ebola investigation to include passengers on a second flight flown by one of the nurses since diagnosed with the disease. And the airline is notifying passengers who may have flown elsewhere on the same jet.As new details emerge, and as today’s congressional hearing showed, domestic concerns over Ebola are skyrocketing. A new Reuters/Ipsos poll finds 41 percent are very concerned about the outbreak, 36 percent are somewhat concerned. And 45 percent say they are avoiding international travel.
A separate poll by the Harvard School of Public Health found that more than half of adults are concerned that there will be a large outbreak of Ebola inside the U.S. within the next 12 months.
It’s a good time to ask, how worried should we be? And how should we assess any level of risk?
We turn to Dr. Eden Wells, a professor of epidemiology at the University of Michigan. And Valerie Reyna, a Professor of Human Development and Psychology at Cornell University.
Welcome to you both.
Dr. Wells, when do we begin to think that this is a legitimate fear and when is it paranoia?
DR. EDEN WELLS, University of Michigan: Well, that’s an excellent question, but one that’s difficult to answer, in that I think anybody who has a concern has — is justified to have that concern.
And, therefore, we need to address that with good information. Paranoia is probably too strong of a term. I would say that the concerns people have after all of the news cycles that we have been seeing in the last week or so, they’re coming from my own family, my colleagues, my friends, and, in all, at the end of the day, we can say today that this virus has not changed.
The risk is still low for those of us that are not involved in health care, like these two heroic nurses that were really intimately involved with the care of Mr. Duncan, and, unfortunately, became infected.
GWEN IFILL: Let me follow up with you on one more piece of that, which is, I wonder to what degree the language matters. When are these isolated cases and when is it an outbreak?
DR. EDEN WELLS: That’s a very good question.
I would say that we right now have two cases that were involved in the direct health care of this patient. We do know that this virus transmits from direct bodily contact with the person or the fluids of that person. An outbreak to — in my mind, would really mean that if the virus begins to occur beyond what we say is the secondary transmission that we’re seeing right now, the fact that these nurses became ill, that if we began to see cases that were occurring in other people in the community, that in my mind would be an outbreak.
Again, that risk for an outbreak is really very low. This has not changed in what we have been saying about this virus in the past six months.
GWEN IFILL: Valerie Reyna, how do people manage this risk, especially emotionally, psychologically, make the difference between worrying about the present and worrying about the future?
VALERIE REYNA, Cornell University: Well, there’s a great deal of psychological science on this topic.
And it’s very understandable that people would be concerned about the risk from an Ebola outbreak. People think really in terms of — in two ways about risk. They think about possibility vs. impossibility, and, of course, we have gone over that barrier psychologically. People were initially told that transmission was essentially impossible.
They were told that in good faith. And then it happened, and it happened twice. So now, psychologically, people have shifted from, this is an impossibility to, not only is it a possibility, but it’s one that’s increasing. And the human mind is keenly attuned to change, to increases in risk, as well as changes from impossible to possible.
GWEN IFILL: So, is part of the problem as you see it that by saying, for instance, in trying to calm the public last week, Dr. Frieden saying or Dr. Fauci saying this will be stopped in its tracks in the United States? Was that part of the problem in changing expectations?
VALERIE REYNA: Well, I’m not sure that that’s part of the problem. I think it’s good to reassure people that there are measures in place.
I think that the human psychological response to risk is — has multiple components. It has an emotional component to it, threat and alarm. That threat and alarm can make sense sometimes. And that’s where risk communication comes in. Whenever we have an epidemic like this or a natural disaster or an incident that has to do with terrorism, risk communication becomes a key between officials and the public.
It’s often something we take for granted. It’s a kind of invisible force, but it’s the kind of thing that connects the safety of people to the resources that we can bring to bear.
GWEN IFILL: Dr. Wells, how does the risk factor for Ebola, as you understand it, compare to risk factors for other diseases which have caused this kind of great widespread fear with — I think of AIDS in the early days or SARS or avian flu.
DR. EDEN WELLS: Oh, yes.
First off, I would like to say that I absolutely agree with our other speaker here this evening. And it’s very well said about risk communication. And we have to address the fact that this is a disease. As Ebola has been known since the mid-1970s, it’s a scary-sounding disease. It has a known high fatality rate.
It is rather gruesome in how people suffer from it, especially when they become greatly ill, if not die. And this has been in our collective consciousness, if you will, since it was first discovered in 1976.
But as it compares in terms of risk, even though this is difficult to communicate because, right now, everybody is worried because of what we’re hearing about the recent news, but, as far as risk, when I think about the diseases that we have seen transpire, HIV, avian influenza, if we think of fast scares, you know, polio, the Spanish flu, this is less transmissible, thank goodness, than many of the diseases that we speak about.
It does require the direct contact with an infected person or their body fluids. So the risk is less than the avian flu, the SARS that we have dealt with in the past. But, again, we have to be able to relay that risk in a way that people can feel more comforted, given that this is a concern, and the recent changes have increased the concern, as my fellow speaker said.
GWEN IFILL: Well, Valerie Reyna, briefly, how do you calm the fear without underestimating the risk?
VALERIE REYNA: Yes, I think that that’s very important.
I think that we really have to be open and transparent. We have to explain to people the nature of the transmission. Now, this is a very difficult challenge. You have technical information that has to get out to a wide range of people with different kinds of knowledge backgrounds. But that’s the challenge of risk communication.
There is science available that can facilitate that. People have to know how this happened, why it happened. If there’s uncertainty, and we don’t know certain causes, we have to be open about that. I think people can be reassured when they’re given information. There’s elements in here, too, that have to do with trust in government. And I think trust is fostered to the degree that we’re candid with people.
GWEN IFILL: Right.
Valerie Reyna of Cornell University, and Dr. Ellen — Eden Wells of the University of Michigan, thank you both very much.
VALERIE REYNA: Thank you, Gwen.

Lawmakers call health agencies to account for Ebola mistakes

October 16, 2014 at 6:50 PM EDT
Growing anxiety over Ebola in the U.S. prompted a House hearing to question the nation's top health officials. Meanwhile, House Speaker John Boehner and others suggested that limits be placed on travelers coming from West Africa, but a White House spokesman dismissed the idea of a travel ban. Gwen Ifill reports.

TRANSCRIPT

GWEN IFILL: Major federal health agencies were called to account today for mistakes in handling Ebola.  Lawmakers from both parties fired off criticism and questions at a hearing in Washington.REP. FRED UPTON, (R) Michigan:  People’s lives are at stake, and the response so far has been unacceptable.
GWEN IFILL: Growing anxiety over the prospect of Ebola’s spread in the U.S. brought a House committee back from campaigning and put the nation’s top health officials on the firing line.
Michigan Republican Fred Upton:
REP. FRED UPTON: We’re going to hold your feet to the fire on getting the job done and getting it done right.  Both the U.S. and the global health community have so far failed to put in place an effective strategy fast enough to combat the current outbreak.
GWEN IFILL: The complaints were bipartisan.
Democrat Diana DeGette of Colorado:
REP. DIANA DEGETTE, (D) Colorado: It would be an understatement to say that the response to the first U.S.-based patient with Ebola has been mismanaged, causing risk to scores of additional people.
GWEN IFILL: The hearing came amid suggestions from House Speaker John Boehner and others that limits be placed on travelers coming into the country from West Africa, where thousands have died of Ebola.
Republican Tim Murphy of Pennsylvania chaired the hearing.
REP. TIM MURPHY, (R) Pennsylvania: This is the question the American public is asking.  Why are we still allowing folks to come over here and why, once they’re over here, is there no quarantine?
GWEN IFILL: But the head of the Centers for Disease Control, Dr. Tom Frieden, argued a travel ban could backfire.
DR. THOMAS FRIEDEN, Director, Centers for Disease Control and Prevention:  If people were to come in by, for example, going over land to another country and then entering without our knowing that they were from these three countries, we would actually lose that information.
GWEN IFILL: At the White House, a spokesman said banning travel is not under consideration.
But passenger screenings have started at major international airports in New York, Atlanta, Chicago, Newark, New Jersey, and Washington.  The process includes taking temperatures and handing out questionnaires to travelers from Guinea, Sierra Leone and Liberia.
At Washington Dulles Airport, some passengers felt reassured, some less so.
ERIC MORENO: Any screening in or out, I’m all for, whether it’s security for terrorism or whether it’s for health issues.  Obviously, I don’t want anything brought in.
RAMYA SINGH: I don’t know how effective they will be, quite honestly, because you know where you’re coming from, but you don’t know where you have been before.
GWEN IFILL: In Dallas, questions continued about how two nurses got infected after treating a Liberian man, Thomas Eric Duncan, who died of Ebola at Texas Health Presbyterian Hospital.
A top hospital official appeared at today’s congressional hearing via video.
DR. DANIEL VARGA, Chief Clinical Officer, Texas Health Resources: Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes.  We didn’t correctly diagnose his symptoms as those of Ebola.  And we are deeply sorry.
GWEN IFILL: One of the nurses, 29-year-old Amber Vinson, has now been moved to Emory University Hospital in Atlanta.  The other nurse, Nina Pham, is being sent to the National Institutes of Health in Bethesda, Maryland.
Later, President Obama called key congressional leaders, met with top administration officials, and authorized a call-up of the National Guard and Reserve troops if needed to help deal with the outbreak in West Africa.  We will have more on the response to the Ebola threat after the news summary.

15 October 2014

McCain: We were 'told' there'd be no Ebola in the United States 12OKT43

sen john mccain r AZ has a big mouth and he is a liar. He needs to get his head out of his ass. I don't care that he is a military vet and was a POW, neither of those excuse and make it mandatory we tolerate his ignorance or his penchant for lying. Consider his really stupid and false comments on Ebola in America. This from +PolitiFact .....

False
McCain
"We were told there would never be a case of Ebola in the United States."
— John McCain on Sunday, October 12th, 2014 in comments on CNN's "State of the Union"

McCain: We were 'told' there'd be no Ebola in the United States

On CNN's "State of the Union," Sen. John McCain, R-Ariz., said, “We were told there would never be a case of Ebola in the United States.”
Early Sunday, the Centers for Disease Control and Prevention announced a second person had contracted Ebola in the United States.
The patient is a female nurse in Dallas, who had treated the first patient diagnosed in the United States -- Thomas Eric Duncan, who came into contact with Ebola in Liberia, fell ill in Dallas and died there Oct. 8. The CDC believes the nurse, who had been taking CDC-mandated precautions, was exposed to Ebola because of a "breach in protocol."
The new case is fanning the fears of those who think the government is not doing enough to prevent an Ebola outbreak in the United States -- despite the CDC’s repeated assurances that it is highly unlikely the disease would spread here.
In light of the news, the Sunday talk shows shifted from their scheduled topics to discuss the case. On CNN’s State of the Union, Sen. John McCain, R-Ariz. -- invited on the show to talk about U.S. military activity in Iraq -- said it’s not obvious to the public that anyone in the government is taking charge over Ebola.
"Americans have to be reassured here," McCain said on Oct. 12, 2014. "I don’t think we are comforted by the fact that we were told there would never be a case of Ebola in the United States, and obviously that’s not correct."
At a press conference Sunday, CDC Director Dr. Thomas Frieden said there’s a risk that the Dallas area might see additional cases in coming days because of this possible "breach in protocol." However, the organization remains "confident that wider spread in the community can be prevented."
We decided to look back and see if any official said that a case of Ebola would "never" come to the United States. Although many media outlets and health care officials have urged people not to panic about Ebola, we could not find a single instance where someone said it would "never" get here.
As far as we can tell, the CDC and the President Barack Obama’s message has been the same throughout the epidemic, which began in Africa in December: It’s possible a case might make its way to the United States, but a full-fledged outbreak is highly unlikely.
(We reached out to McCain’s staff, but they never got back to us.)
The administration’s reasoning: America’s health system is much better prepared to fight diseases like Ebola than those in places like Liberia and Sierra Leone, where the disease has been spreading.
Here’s some of the CDC’s statements:
  • July 28, after two Americans contracted the disease in Africa: "There is no significant risk in the U.S. While it is unlikely that the disease would spread if imported into the United States, the recent infections in U.S. health care workers working abroad highlight the need for vigilance."
(The CDC has issued periodic updates on Ebola since March, but this was the first one we could find that addressed the disease spreading to the United States.)
  • Aug. 13, press release: "A disease threat anywhere in the world is a threat everywhere in the world, and CDC is preparing for any possibility, including that a traveler might become ill with Ebola while in the United States.  Although Ebola poses very little or no risk to the U.S. community at large, CDC and health care providers in the United States need to be prepared."
  • Sept. 17, testimony at congressional hearing: "We do not view Ebola as a significant public health threat to the United States. … It is possible that infected travelers may arrive in the United States, despite all efforts to prevent this; therefore we need to ensure the United States' public health and health care systems are prepared to rapidly manage cases to avoid further transmission."
The White House:
  • July 31, press briefing by Press Secretary Josh Earnest: "The CDC has concluded that there is no significant risk in the United States from the current Ebola outbreak. And while it is unlikely that the disease would spread if the virus were detected in the United States, the CDC is taking action to alert health care workers in the U.S. and remind them how to isolate and test suspected patients while following strict infection control procedures."
  • Sept. 16, Obama’s remarks at the CDC: "First and foremost, I want the American people to know that our experts, here at the CDC and across our government, agree that the chances of an Ebola outbreak here in the United States are extremely low."
  • Oct. 8, Obama’s statement to state and local officials, after Duncan (the first Dallas patient) died: "Because we’ve got a world-class medical system, because we’ve put in place tough safety measures, because of the work that many of you have done in conjunction with organizations like the CDC and dealing with infectious disease generally, and because of the nature of Ebola and the fact that it’s not something involving airborne transmission, the chance of an Ebola outbreak in the United States remains extremely low. … I’m confident that so long as we work together, and we’re operating with an appropriate sense of urgency that we will prevent an outbreak from happening here."
The common refrain in all those comments? A widespread outbreak is extremely unlikely in the United States. But individual or isolated cases were possible, hence the need for the CDC to be ready.
Our ruling
McCain said, "We were told there would never be a case of Ebola in the United States."
Based on public statements, Obama and CDC officials have repeatedly said there’s a chance an Ebola case could appear in the United States, but the possibility of an outbreak is extremely low. We found no instance in which an official said Ebola would "never" make it here -- rather, it has always been acknowledged as a possibility.
We rate McCain’s claim False.

About this statement:

Published: Sunday, October 12th, 2014 at 4:22 p.m.
Researched by: Lauren Carroll
Edited by: Aaron Sharockman
Subjects: Health Care, Military, Public Health, Public Safety

Sources:



30 September 2014

First U.S. Case Of Ebola Confirmed In Dallas & (VIDEO) CDC’s Frieden confirms first U.S. case of Ebola is in Dallas & This is how you get Ebola, as explained by science 30SEP14

THERE will be a host of conspiracy theorist, doomsday preppers and right wing fanatics that will seen this case of Ebola in the U.S. as a government plot orchestrated by Obama to wipe out the elderly, the vets, the poor, and to distract from the economic and political problems of the nation and an illegal war in Iraq and Syria. I bet there is already a hot time on the internet tonight. And stupid people will believe some or all of their rants and ramblings and pass them on adding to fear and near panic in some communities. For those who want to know what is actually going on consider these from +NPR and the +PBS NewsHour .....
A patient at the Texas Health Presbyterian Hospital in Dallas has a confirmed case of Ebola, the Centers for Disease Control and Prevention says. He is being treated and kept in strict isolation.
A patient at the Texas Health Presbyterian Hospital in Dallas has a confirmed case of Ebola, the Centers for Disease Control and Prevention says. He is being treated and kept in strict isolation.
LM Otero/AP
The Centers for Disease Control and Prevention confirmed Tuesday that the first case of Ebola has appeared in the U.S.
A man in Dallas has tested positive for the virus, the agency said. The man flew to the U.S. from Liberia, arriving on Sept. 20, NPR has learned. He wasn't sick on the flight, and had no symptoms when he arrived.
He first developed symptoms on Wednesday, Sept. 24, according to the CDC, and first sought care on Friday. On Sunday, he was placed in isolation at Texas Health Presbyterian Hospital in Dallas, according to the Texas Department of State Health Services.
Health officials have already started reaching out to people who may have come into close contact with the man. The virus is spread only through direct contact of bodily fluids, and it isn't contagious until a person starts showing symptoms.
Update at 7:15 p.m. ET. Handful Of People Exposed
A "handful" of people may have been exposed to the virus, the CDC's Director Dr. Tom Frieden said Tuesday at a news conference. These include several family members of the man and a few people in community, Frieden said.
The man could have passed Ebola to these people during the four days when he was sick but not yet isolated.
But passengers on the plane with the man were not exposed to Ebola, Frieden said. "There is zero risk of transmission on the flight. He was checked for fever before getting on the flight."
The CDC has been planning for an Ebola case in the U.S, Frieden said. And the agency, together with state health departments, has successfully dealt with similar viruses — Lassa and Marburg — on five previous occasions.
"The bottom line here is that I have no doubt that we will control this importation, or case of Ebola," he said, "so that it does not spread widely in this country."
Our Original Post Continues:
This isn't the first time somebody has been treated for Ebola in the U.S. Several American aid workers in recent months caught the virus while working in West Africa and were flown back to the U.S. for treatment.
But it's the first time the disease has been diagnosed in a person in the U.S. The CDC is sending a team to Dallas to work with state and local health officials.
The Ebola epidemic in West Africa continues to grow rapidly. As of Thursday, there have been more than 6,500 cases across Liberia, Sierra Leone and Guinea. More than 3,000 people have died of the disease, the World Health Organization says.
Specialists studying infectious diseases have predicted for weeks that a few Ebola cases would likely turn up in the U.S. And hospitals around the country have been preparing to diagnose and treat such cases.
Because Ebola only spreads through body fluids, officials say that any case like this will likely be quickly identified and contained, and not lead to a widespread outbreak like the one happening now in West Africa.
 A mock patient is wheeled in an isolation pod during a drill at the biocontainment unit in the Nebraska Medical Center in Omaha.

Goats and Soda

How Do You Catch Ebola: By Air, Sweat Or Water?

Medical workers with the nonprofit Doctors Without Borders treat a patient for Ebola in Gueckedou, Guinea. Despite their protective gear, the workers try to maintain human contact with patients by talking with them and getting close enough to look into their eyes.

Goats and Soda

Ebola 101: The Facts Behind A Frightening Virus

Air traffic connections from West Africa to the rest of the world: While Guinea, Liberia and Sierra Leone don't have many flights outside the region, Nigeria is well-connected to Europe and the U.S.

CDC’s Frieden confirms first U.S. case of Ebola is in Dallas

BY Ellen Rolfes  September 30, 2014 at 6:53 PM EDT
 

Watch Tuesday’s CDC news conference discussing the first diagnosed U.S. case of Ebola
The first ever case of Ebola in the U.S. has been diagnosed in Dallas.
Centers for Disease Control Director Tom Frieden confirmed the diagnosis in a news conference Tuesday afternoon.
The patient, only identified as a male, traveled from Liberia and arrived in the U.S. on Sept. 20, but did not start showing symptoms until four days later. The patient was later admitted to Texas Health Presbyterian Hospital Dallas on Sunday, Sept. 28, and put under isolation and treatment.
The patient had traveled to Texas to visit family members living in the U.S., Frieden said.
There was no other information released as to the identity or the status of his conditon, other than that he was critically ill at this point and under intensive care.
While all other patients treated for Ebola have been sent to Emory University in Atlanta, Frieden said there were no plans to transfer the most-recent patient from the Dallas hospital.
The CDC, along with Dallas County Health and Human Services, will now follow procedure for contact tracing in order to identify all possible persons who may be at risk for Ebola infection because of direct contact with the Dallas patient.
Since the patient did not start exhibiting symptoms until four days after flying to the U.S. on a commercial airliner, Frieden said there was “zero risk of transmission on the flight.”
“Ebola is a scary disease because of the severity of the illness,” Frieden said. “At the same time we are stopping it in its tracks.”

This is how you get Ebola, as explained by science

BY Ruth Tam  September 30, 2014 at 8:24 PM EDT
A colorized, magnified electron microscope image of the Ebola virus growing out of an  infected VERO 46 cell. Image by NIAID
A colorized, magnified electron microscope image of the Ebola virus growing out of an infected VERO 46 cell. Image by National Institute of Allerfy and Infectious Diseases
This post was originally published on Aug. 21 and updated on Sep. 30 to reflect the latest numbers from the World Health Organization.
As of Sep. 30, the Ebola virus had killed more than 3,000 people in the West African countries of Liberia, Sierra Leone, Guinea and Nigeria, according to the latest numbers released by the World Health Organization.
As the virus spreads and medical workers feverishly battle to contain it, we wanted to know, how exactly is this virus transmitted from human to human?
What is Ebola?
Illustrations by Ruth Tam
Illustrations by Ruth Tam
Ebola is one of the world’s most virulent diseases. It comes from an extended family of viruses called Filoviridae, which also include the deadly Marburg virus. It is a swift and effective killer, known to kill up to 90 percent of those it infects. And it is a “hemorrhagic fever virus,” which means it causes fluid to leak from blood vessels, resulting in a dangerously low drop in blood pressure.
Understanding Ebola requires an understanding of viruses and how they work. “Viruses,” science writer Carl Zimmer writes in his book “A Planet of Viruses”, “can replicate themselves, despite their paltry genetic instructions, by hijacking other forms of life. They… inject their genes and proteins into a host cell, which they [manipulate] into producing new copies of the virus. One virus might go into a cell, and within a day, a thousand viruses [come] out.”
All viruses contain “attachment proteins,” which, as the name suggests, attach to host cells through the cells’ “receptor sites.” This is how they invade healthy human cells.
EbolaWhile some virus particles are shaped like spheres, the particles that make up Ebola are filament-like in structure, giving them more surface area to potentially attack a greater number of cells. Each Ebola virus particle is covered in a membrane of these attachment proteins, or glycoproteins.
“[The virus] has a tremendous number of glycoproteins, which can increase its ability to affect cells,” said Richard Cummings, chair of Emory’s Dept. of Biochemistry and director of the National Center for Functional Glycomics. “It’s extremely infectious in that regard.”
Imagine Ebola’s glycoproteins as giant oak trees with branches and leaves, said Erica Ollmann Saphire, a structural biologist at the Scripps Research Institute. The Ebola virus has its own critical receptor site, which lies beneath these branches and leaves to avoid detection from the immune system. Each glycoprotein can attach itself to a host cell in a number of different ways, but once its branches fasten themselves to a host cell’s molecules, that host cell pulls in the attachment protein, slicing off its leaves and branches and exposing the trunk, the virus’s receptor site.
“The previously hidden receptor rearranges itself and spring loads like a spear fishing rod,” said Saphire. “It uncoils, springs forward and penetrates the membrane, driving itself into the cytoplasm.”
science-wednesday
The cells then internalize the virus, and Ebola’s race against the human immune system begins.
How Ebola moves from person to person
Ebola spreads through direct contact with infected bodily fluids or tissue. The virus can be transmitted when an infected person’s vomit, blood or other fluids contact another person’s mouth, eyes or openings in their skin, said Dr. Ameesh Mehta, an infectious disease doctor at Emory University.
Even after a person has died, the virus persists. In West Africa where funeral rites include washing, touching and kissing corpses by family members, putting the dead to rest can be just as deadly as caring for a living patient.
“Contact with any aspect of it is considered very dangerous,” Cummings said. “Any physical contact.”
BloodEbola’s sucker punch is its speed of replication. At the time of death, a patient can have 1 billion copies of the virus in one cubic centimeter of blood. In comparison, HIV, a similar virus, has the same rate at the time of death. But unlike HIV, which only infects two types of immune cells, Ebola first infects white blood cells that disable the body’s ability to destroy foreign substances,  then seizes nearly every cell type.
“It’s a systemic viral infection throughout your body as opposed to an infection of just your immune system,” Saphire said. “Patients may die before they’re able to mount much of an immune response.”
This process takes anywhere from two to 21 days (though it’s typically between four to 10 days). When the immune system begins breaking down, the symptoms begin to show.
Patients experience fevers, headaches and fatigue early on. After the virus overwhelms healthy cells, they burst, causing a chemical release leading to inflammation. Their remains are taken over by other cells, perpetuating the virus. As the symptoms worsen, patients suffer from bloody diarrhea, severe sore throat, jaundice, vomiting or loss of appetite.
Infected cells that haven’t yet burst carry the virus through the bloodstream to invade different parts of the body like the lymph nodes, spleen and liver. When infected cells attach themselves to the inside of blood vessels, it weakens them, causing fluids to leak. This triggers the uncontrollable bleeding for which Ebola is known, though it only happens for about 50 percent of patients and occurs mostly inside the body.
In fatal cases, blood pressure plummets after blood vessel damage, and death from shock or multiple organ failure occurs within six to 16 days.
The path ahead
Saphire is part of a large, multi-site team made up of 25 laboratories that’s mapping Ebola’s glycoprotein to better understand and defeat the virus. Among the potential strategies they’re studying is an antibody cocktail called ZMapp, an experimental drug that drew media attention after its use on two U.S. aid workers and three Liberian doctors. First developed by the U.S. Army Medical Research Institute for Infectious Diseases a decade ago, this “Ebola serum” potentially works to neutralize the virus by preventing its rearrangement and flagging it for destruction by the immune system.
Clinical trials for ZMapp are set to begin in 2015, but according to Saphire, doses for “experimental compassionate therapy,” treatment provided to critically-ill patients before the drug has been approved, could be ready in three months.
“The central dogma of molecular biology is that sequence dictates fold, which dictates function,” Saphire said. “But Ebola does more with less. While the human genome has 20,000 kinds of genes, Ebola has seven, and by rearranging its protein structure, it can carry out far more than seven functions.”
Transformers
Ebola, Saphire explained, remodels its molecules “like a Transformer: those toys that unfold and refold to change between a robot and a truck,” she said. “We don’t typically expect molecules in biology to do that. We expect proteins to have one particular form – just the robot. If you didn’t know that the Ebola robot would also refold into a truck, you would design all your drugs against the robot structure.”
In addition, due to its extreme nature, there are far fewer human studies on Ebola than other similar viruses.
“Ebola patients are often too sick to consent to research,” Mehta said. These cases are occurring in poor environments where it’s hard to collect the samples to really understand the pathogens. But hopefully science catches up with the clinical phenomenon.”
While the recent outbreak is not expected to reach far beyond West Africa, researchers like science writer Richard Preston fear the beginning of a more deadly and longer-lasting epidemic if the virus finds its way to metropolitan areas like Lagos, Nigeria, which has a population larger than the state of New York.
Despite Ebola’s pervasive spread, Cummings says the biggest misconceptions are that Ebola is easily transmitted and that the outbreak in West Africa could reach global levels.
While one should still exercise caution, Cummings says the requirement of transmission of fluids makes the disease more difficult to get if you’re not directly treating patients.
“It is more controllable than people realize.”