Quote:
Originally Posted by sunnyatlast
The original post is an opinion piece by the editorial board of NEJM.
An opinion piece by editorial staff is not an original article publishing research findings that are scientifically proven.
It's almost funny when the sycophant proponents of the nurse and other anti-quarantine followers here keep saying "a quarantine must be decided by science, not emotion, fear, irrationality or opinion"…… but here in this thread, we are being told we're fools if we don't agree and decide based an OPINION piece!
THIS is an original article based in SCIENCE and scientific method, not opinion:
The Lancet
Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak
Summary
Background
Decision makers worldwide are in need of empirical data to inform and implement emergency response measures. Our aim was to assess the potential for Ebola virus to spread across international borders via commercial air travel and assess the relative efficiency of exit versus entry screening of travellers at commercial airports.
Methods
We analysed International Air Transport Association data for worldwide flight schedules between Sept 1, 2014, and Dec 31, 2014, and historic traveller flight itinerary data from 2013 to describe expected global population movements via commercial air travel out of Guinea, Liberia, and Sierra Leone. Coupled with Ebola virus surveillance data, we modelled the expected number of internationally exported Ebola virus infections, the potential effect of air travel restrictions, and the efficiency of airport-based traveller screening at international ports of entry and exit. We deemed individuals initiating travel from any domestic or international airport within these three countries to have possible exposure to Ebola virus. We deemed all other travellers to have no significant risk of exposure to Ebola virus.
Findings
Based on epidemic conditions and international flight restrictions to and from Guinea, Liberia, and Sierra Leone as of Sept 1, 2014 (reductions in passenger seats by 51% for Liberia, 66% for Guinea, and 85% for Sierra Leone), our model projects 2.8 travellers infected with Ebola virus departing the above three countries via commercial flights, on average, every month. 91 547 (64%) of all air travellers departing Guinea, Liberia, and Sierra Leone had expected destinations in low-income and lower-middle-income countries. Screening international travellers departing three airports would enable health assessments of all travellers at highest risk of exposure to Ebola virus infection.
Interpretation
Decision makers must carefully balance the potential harms from travel restrictions imposed on countries that have Ebola virus activity against any potential reductions in risk from Ebola virus importations. Exit screening of travellers at airports in Guinea, Liberia, and Sierra Leone would be the most efficient frontier at which to assess the health status of travellers at risk of Ebola virus exposure, however, this intervention might require international support to implement effectively.
Introduction……..
Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak : The Lancet |
I have taken the opportunity to change some of the phrases in bold font. I guess I am the sycophant to whom you refer. (Are you sure you know what that word means?)
The Lancet is a world class journal. Its articles are peer reviewed and carry significant weight in forming evidence based medical care. In this article which you heavily praise as scientific the authors have provided a mathematical analysis of risk of ebola spread. The goal of the article is to attempt to offer an opinion of the relative merits of different screening at airports. Their estimate of risk of spread is totally based on there being no screening of air travelers. The authors caution that all of their numbers are based on past data and that those assumptions may or may not be accurate.
"these numbers must be considered in the context of potential travel restrictions, the intensity of Ebola virus activity in affected countries, and the underlying assumptions of our model"
So given all that, what did the Lancet article have to say about the options for travel from these 3 countries. Screen 1. at departure airport, 2. At direct arrival airport, 3. At non-direct arrival airport
1.They carefully discuss the relative utility of screening at the exit airport in Africa. Keep in mind that their assumption in producing risk estimates is that there in NO AIRPORT SCREENING in Africa. In fact since the writing of the article every of the airports in the discussion has instituted screening using WHO guidelines. So this critical assumption is wrong. Nonetheless, the authors recommend departure screening as the best thing to do (and now it is being done)
"Our analyses show that exit screening at international points of departure would offer greater efficiency, and might be simpler to operationalise, than entry screening all flights arriving directly from affected countries"
2. Direct arrival airport (not done in their analysis of risk)
"the short flight durations out of affected countries, compared with the much longer incubation period of Ebola virus, indicates that if exit screening from affected countries were implemented effectively, the incremental gains from additional entry screening would be negligible"
3. Multi-segment arrival screening (not done in their analysis)
" screening travellers on multisegment flights to their final destination would probably have minimum benefits to unaffected countries but could incur important opportunity costs"
They offer an opinion which they clarify is not even addressed in their study about what might be a good approach:
"Although not directly assessed in this study, educational and communication strategies could be used to further reduce the risk of international spread of Ebola virus or to rapidly identify new imported cases. These strategies could include advice for individuals before travelling, with emphasis on international aid workers and foreign-born diaspora populations returning home to visit friends and relatives in affected areas. In some cases, international aid workers have agreed to a self-imposed 21-day monitoring period post-return from affected countries"
This is the only part of the Lancet article that is germane to the nurse. They offer that some aid workers have agreed to a 21 days monitoring period. I do believe that the nurse fully agreed to that and only objected to a far more intense quarantine in a tent in New Jersey or on house arrest with a cop outside her door in Maine.
It is nice to see that this article in Lancet is in accord with the NEJM editorial. In fact if you understood how NEJM editorials were produced you would be aware they are evidence based using the most up to date relevant scientific literature. They are an attempt to inform policy both within the medical community and in the world at large as to what the data, the science, points to as the best way forward. It is in effect the conclusion after consideration of many many studies on the topic. And like everything in science, it may be wrong. But each article itself is an "opinion" on interpretation of its own data and constrained by its own assumptions. Science does not claim infallibility but IMO policy should be based on what evidence is available. The editors of the NEJM you can be sure were very aware of this Lancet article and included its contribution in their formulation