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The key to an effective response is to limit transmission. Quarantine requires providing food for everyone, which is the largest scale essential activity, so we focus on leveraging early detection of illness and subsequent isolation and care on the f

The key to an effective response is to limit transmission. Quarantine requires providing food for everyone, which is the largest scale essential activity, so we focus on leveraging early detection of illness and subsequent isolation and care on the f

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The key to an effective response is to limit transmission. Quarantine requires providing food for everyone, which is the largest scale essential activity, so we focus on leveraging early detection of illness and subsequent isolation and care on the f

The key to an effective response is to limit transmission. Quarantine requires providing food for everyone, which is the largest scale essential activity, so we focus on leveraging early detection of illness and subsequent isolation and care on the f

Photo of Yaneer Bar-Yam
2 6

Senegal http://www.ibtimes.com/ebola-miracle-how-senegal-has-dodged-outbreak-1695858 and Koinadugu District http://www.washingtonpost.com/news/storyline/wp/2014/10/10/the-fight-to-save-the-last-ebola-free-district-in-sierra-leone/

Senegal http://www.ibtimes.com/ebola-miracle-how-senegal-has-dodged-outbreak-1695858 and Koinadugu District http://www.washingtonpost.com/news/storyline/wp/2014/10/10/the-fight-to-save-the-last-ebola-free-district-in-sierra-leone/

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Yaneer commented on A THREE WEEK QUARENTINE BEFORE LEAVING THESE COUNTRIES WOULD PROTECT THE REST OF THE WORLD -- NOT ONLY FROM THE DISEASE -- BUT FROM THE INFECTION OF FEAR. WORLDWIDE EFFORTS WOULD CREATE AN EXIT CENTER THAT ALLOWS FOR INDIRECT PARTICIPATION.

As an additional point: It is my understanding that the approach which precludes quarantines is responsible for the problem that we have today. If there were boundaries enforced at earlier times during the epidemic within the countries affected it would not have spread within those countries as much as it has. It would have been confined to smaller regions. Note that Senegal successfully avoided transmission by closing its border as of March!

I see the reluctance to use travel restrictions as a failure of basic understanding of how contagions must be controlled in general. The problem arises because the public health officials are trained to think in terms of individual care rather than community vulnerability. They are focused on treating the individual who is sick, and presents him or her self to the hospital. The public is an aggregate of individuals without structure of its own. This is the standard medical model today. It works for many problems. The addition of contact tracing is effective also for a limited number of types of diseases, including TB which is the epidemiological background of CDC Director Frieden. It works for TB because there is a latent population whose number changes only very slowly that is the source of infective individuals. Detecting the latent individuals and treating them reduces the number of infective individuals. There is no exponential growth of the population affected as there is in Ebola. An exponential growing outbreak requires direct attention to the transmission not just the specific care that is needed for individuals. Stopping the transmission cuts off the number of cases that then need care. This is the key to controlling outbreaks --- i.e. prevention of new cases.

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Yaneer commented on A THREE WEEK QUARENTINE BEFORE LEAVING THESE COUNTRIES WOULD PROTECT THE REST OF THE WORLD -- NOT ONLY FROM THE DISEASE -- BUT FROM THE INFECTION OF FEAR. WORLDWIDE EFFORTS WOULD CREATE AN EXIT CENTER THAT ALLOWS FOR INDIRECT PARTICIPATION.

That is a very important point, Delise.

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Yaneer commented on A THREE WEEK QUARENTINE BEFORE LEAVING THESE COUNTRIES WOULD PROTECT THE REST OF THE WORLD -- NOT ONLY FROM THE DISEASE -- BUT FROM THE INFECTION OF FEAR. WORLDWIDE EFFORTS WOULD CREATE AN EXIT CENTER THAT ALLOWS FOR INDIRECT PARTICIPATION.

Having people go there is not the problem. Anybody who is traveling there to help people surely wants to make sure that they are not transmitting the disease when they get back.

If you want to consider hurt you have to make a reasonable comparison. What is the hurt you are causing if an outbreak happens in a different part of the world. Even if you are confident that an outbreak will be well controlled in the US (which we now know is only a guess), then surely an outbreak in India or Chiina will cause a greater problem. So compare.