URGENT PETITION: REVISED RESTRICTIONS ON ALL INCOMING TRAVEL WHICH MAY CONTAIN POTENTIALLY INFECTIOUS MATERIAL AND PERSONS ORIGINATING FROM A COUNTRY OR STATE EXPERIENCING AN OUTBREAK OF THE EBOLAVIRUS

PETITION FOR REVISED RESTRICTIONS ON ALL INCOMING TRAVEL WHICH MAY CONTAIN POTENTIALLY INFECTIOUS MATERIAL AND PERSONS ORIGINATING FROM A COUNTRY OR STATE EXPERIENCING AN OUTBREAK OF THE EBOLAVIRUS 

To:

President Barack Obama

Tom Frieden, MD, MPH Director-Centers for Disease Control and Prevention

Asst. to the President for Homeland Security: Lisa Monaco

Secretary of HHS: Sylvia Burwell

Director of the National Institute of Infectious Diseases: Dr. Anthony Fauci

USAID Administrator: Dr. Raj Shah

Commander of AFRICOM: General David Rodriguez

In the wake on significant concerns surrounding the screening of infected person(s) traveling from Liberia, more stringent controls be in place during this Public Health Emergency of International Concern (WHO, August, 2014).

The Ebola virus has reached unprecedented epidemic proportions in West Africa, and has been joined by another unrelated concurrent outbreak in the Congo.

Despite recognizing the combined effort of the global health communities to prevent this current epidemic of the Ebolavirus reaching pandemic status, the disease was unfortunately brought here to the United States by an individual infected with the Zaire strain of the Ebolavirus who legally entered our country from the West African nation of Liberia, where Ebola is rampant threatening health, peace, stability, and the economic prosperity of the citizens of the United States of America.

We understand many of our own citizens of the United States of America and military personnel have a right to return following deployment to these outbreak areas, we must ensure they also must return in such a manner to minimize any potential transmission, in accordance with the international standard as well as community Standard of Care here in the United States of America.

WE AGREE with GENERAL RODRIGUEZ that, “Prior to redeploying service members back home, we will screen and identify anyone who faced an elevated risk of exposure. We take all necessary steps to minimize any potential transmission, in accordance with the international standards  that our medical professionals have given us.”

WE AGREE with HOMELAND SECURITY LISA MONACO that: “The most effective way to go about controlling this is to prevent those individuals from getting on a plane in the first place.”

WE AGREE Infectious disease outbreaks are a national security priority.

WE AGREE the escalating Ebola epidemic in West Africa highlights the necessity to establish global capacity to prevent, detect and rapidly respond to biological threats of any origin.”

WE AGREE they threaten peace, stability, and the economic prosperity of our world; the consequences of not acting are unfathomable.

WE AGREE to stand together with our West Africa partners to end the Ebola epidemic, and to communicate with clarity we need to accelerate our global capacity to prevent, detect, and rapidly respond to disease threats like Ebola and other infectious disease outbreaks – before they turn into epidemics.”

WE AGREE that a biological threat such as Ebola anywhere is a biological threat everywhere, and it is the world’s responsibility to respond as one.

SUMMARILY,

WE, THE CITIZENS OF THE UNITED STATES OF AMERICA HEREBY REQUEST that all agencies of the United States Government to be redirected to take all appropriate measures within their authority to carry out the following, but not limited to:

  1. Immediate ban on all incoming commercial passenger aircraft, ambulatory person(s) crossing international borders into the United States of America, sea travel, and other means within the construct of this PETITION who may possess, contain, or be infected by Potentially Infectious Material and Persons originating from a country or state experiencing an outbreak of the Ebolavirus; and
  2. US government provide for a designated Landing Zone (LZ) military hospital facility appropriately designed, staffed, and constructed to accept incoming authorized persons travelling from those areas within the last 30-45 days for monitoring no less than 21 days; and
  3. Not restrict humanitarian relief agencies, US military personnel, and authorized person(s) involved in the delivery of necessary aid and assistance travelling to and returning home from the affected countries to the extent limited to (1) above. 

References:

  1. Executive Order 13295, April 4 2003 section 1(a)
  2. Global Health Security Agenda on February 13, 2014
  3. U.S. GOVERNMENT RESPONSE TO THE EBOLA EPIDEMIC IN WEST AFRICA, 10/3/2014
  4. Declaration of Public Health Emergency of International Concern (World Health Organization, August, 2014)
  5. Pathogen Safety Datasheet for Ebola

Please find this PETITION at:

Change.org

Authored by and in conjunction with the Ebola Preparedness Team by RA Perez-Ricketson, MD and N. Duke-EPWAV

 *Please contact us to print this petition and get it out in the public for signatures if you can. Also for factual information regarding Ebola please join us at:

https://www.facebook.com/groups/297130027159349/ *

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Ebola Virus Disease and the Variable Febrile and Subjective Response

I am going to West Africa soon with full knowledge of the risks to ourselves but the purpose of screening is to contain further transmission of the disease. There is no screening checkbox for “not feeling right”. Subjective fever.
Always a good topic as to what constitutes fever. We all remember the days when “normal” was 98.6 degrees F. Now, with digital read outs, Harrison’s textbook of internal medicine defines a fever as’ “a morning oral temperature of >37.2 °C (>98.9 °F) or an afternoon oral temperature of >37.7 °C (>99.9 °F) while the normal daily temperature variation is typically 0.5 °C (0.9 °F).”

Additionally, so we are all on the same page, we would really like to have it as close to the “core body temperature” as possible but, in reality, most of us don’t want an esophageal probe every time we feel uneasy, so we do need another way that best approximates our own, individual core body temperature. Only you know what that is.

Also the manner in which it is measured and observed by another is critical in its accuracy. A rectal thermometer is the best, then oral (mouth closed!), temporal artery (not across the forehead, not a strip), then tympanic in that order. A lot of variability. Because of that, and my soap-box statement is I am weary of “check-box” medical history taking, a blanket check box that specifies a single number to fit every single individual is simply thoughtless.

Let’s take a scenario of infection.

image

Image 1. Clinical course of single patient found to have been infected by the Tai Forest Ebolavirus (TAFV). His temperature varies during the viremia stage.

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