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Comment by Bud | Hacker News Reader

At some point, we're going to have to talk about how this black, uninsured man walked into a Dallas hospital, which discharged him and then later lied about his condition when he first went to a hospital. And we're going to need to talk about Republicans slashing CDC funding and every other type of public health funding they could get their hands on. And we're going to need to talk about how the two white Christian missionaries got flown directly to a specialized hospital in Nebraska immediately upon diagnosis, and survived.

(edit: very predictable downvoting on this. But it's simply a fact that politics and race have played a part here. I don't like posting it any more than you like admitting it to yourselves.)

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What is your preferred explanation? That a doctor suspected ebola but, because Duncan was an African without insurance, thought it better that he walk around for four more days?

When would you like to talk about the fact that an unmarried unemployed man traveling from the Ebola hot-zone of Liberia (also 5th highest rate of visa overstay) but with Ghanaian citizenship, who had a sister living in the United States, was even allowed into the country to begin with?

By all accounts Mr Duncan got the best care possible once he was diagnosed properly. He had the misfortune of not matching blood types with the earlier U.S. patients whose blood had been used to treat others.

The late diagnosis was absolutely devastating to his prognosis. I think it's quite likely he would have survived if it had been caught during his first ER visit. I think it's a stretch to chalk that up race (or a lack of insurance) though...

But isn't that precisely the point? He was not diagnosed properly when he first presented, despite extraordinarily clear signs. He's a Liberian national who recently helped treat a pregnant Ebola victim just before flying to the US, for chrissakes. He presented with extreme pain and a very high fever.

But he was black and uninsured, and it's Texas, and they summarily discharged him and took no notice.

Perhaps you are right, and it's "a stretch" to mention the factors that may or may not have played a role in why this man was treated so very callously in the midst of a very very well-publicized epidemic of scare-mongering over Ebola.

I simply disagree. I think it is quite possible indeed that these were factors.

While we're not sure whether he said "West Africa", "Liberia", or what, press reports universally say he never reported his close contact with that pregnant Ebola victim.

Fever plus pain are not "extraordinarily clear signs"; they're common for a host of diseases, including a host of common to African diseases, like malaria.

Nothing I've seen suggests the hospital egregiously dropped the ball in this first visit, however I'm entirely certain that widely casting blame at generic targets when anything bad happens, like "Republicans", racism and our medical system, does no good and rather a lot of harm.

And yet the hospital initially diagnosed him with sinusitis, the symptoms of which clearly do not include abdominal pain.

    Based on his review of the medical records,
    Dr. Adalja said the diagnosis given to Mr.
    Duncan before his discharge included
    sinusitis, a sinus infection.

http://www.nytimes.com/2014/10/12/us/ebola-victims-family-bl...

HE WAS NOT DIAGNOSED WHEN HE FIRST PRESENTED BECAUSE HE DIDN'T TELL ANYBODY HE HAD BEEN IN CONTACT WITH SOMEBODY WHO DIED OF EBOLA!

What don't you get?? If Thomas Eric Duncan had stated "I'm a Liberian national who recently helped treat a pregnant Ebola victim just before flying to the US" he would have been isolated immediately. He didn't and now other people might die because of it!

Everything is clear and more evident in hindsight. It seems that as far as Duncan knew, that pregnant woman was suffering from malaria, not ebola. She died while he was in transit or shortly after. He would not have had that knowledge.

"Knew", or very possibly hoped. She died in the house he was living in, and the end symptoms are sufficiently different that if you know which is which, you'd know. But we can't assume he would know to be able to do a differential diagnosis.

Please don't write in all-caps on HN.

Sometimes the yelling is necessary to draw attention to something that's being mistakenly or willfully overlooked.

If someone's not paying attention to a calm, rational argument, then they're probably not worth convincing of anything.

It's the Internet; they're a stranger. Move on.

No, not really. Not ever.

For the haters: https://news.ycombinator.com/newsguidelines.html

> Please don't use uppercase for emphasis. If you want to emphasize a word or phrase, put asterisks* around it and it will get italicized.

Using words like "fact" to describe your opinion is what's going to get you down-voted.
Using uncorrelated and unrelated events to form race-baiting statements is another.

That is a nice theory...except that that word did not appear in my original comment; only in the parenthetical edit after it was downvoted. I take exception to you describing my comments as "race-baiting"; that is offensive and uncalled for. It was also certainly not my intention. I think the way we treat the uninsured is criminal in this country, and it's also very dangerous from a public health standpoint, and this example illustrates that problem quite well.

> But it's simply a fact that politics and race have played a part here.
You just described your entire "pre-edit" opinion as a statement of fact.
> I take exception to you describing my comments as "race-baiting"; that is offensive and uncalled for.
Bringing race into this is what someone might consider as offensive and uncalled for.
But that's okay, you are entitled to your opinion, and I don't downvote anyone I respond to, so you have nothing to lose here from me.

The WHO cut its infectious disease budge 50% in 2013, shifting the funds to various chronic disease programs.
http://www.scientificamerican.com/article/world-health-agenc...
Its overall budget was flat -- WHO decided to reduce infectious disease activities to fund other priorities. In complete fairness, the article suggests that WHO intended to shift some detection and emergency response responsibilities to member countries, and put some resources in that new paradigm. But even if so, the management of that transition now seems suspect.
I've seen various press references that the WHO had its budget cut after the financial crisis. But as near as I can tell (its budget transparency is almost zero), its budget in 2006 was $3.3bn, vs $4.0bn in 2014.
The CDC, by the way, has an ample budget, much of it dedicated to non-infectious disease activities like tobacco and chronic disease. A bit goes to gun control. These activities may be worthy, but it isn't clear that they protect public health in the same sense that epidemic control does.

Thomas Eric Duncan took a pregnant woman who later died of Ebola by taxi to look for treatment. He lied on a questionnaire at the airport in Monrovia that asked if he had been in contact with anybody infected by Ebola. Because he lied his own country said that it would prosecute him if he survived!
If Thomas Eric Duncan had not lied at the airport he never would have been allowed onto an airplane. If Thomas Eric Duncan had told the hospital in Dallas that he had cared for a person with Ebola he would have been isolated immediately.
Thomas Eric Duncan isn't dead because he was black. Thomas Eric Duncan isn't dead because he didn't have insurance. Thomas Eric Duncan isn't dead because Republicans. THOMAS ERIC DUNCAN IS DEAD BECAUSE HE LIED!

Actually, what Mr Duncan did was help his neighbors drive a woman who was 7 months pregnant to the hospital. The woman was presenting symptoms that are not unique to Ebola (fever & convulsions). The woman was not hemorrhagic. The group was turned away at the hospital and so they drove her back home. Mr Duncan then assisted in helping the woman back into the house. This is almost certainly the point at which he was exposed. The woman was not tested for Ebola until after her death, so Mr Duncan could not have known but he could have suspected.
Thus the possibility that Mr. Duncan thought he was only helping a pregnant woman get to the hospital to help with a troubled birth. At that point, the most information he could provide is that he cared for a sick pregnant woman.
Relying on the fact that Liberia would prosecute him is a bad idea, due to the precarious nature of justice in that country. I would imagine that Liberia would say just about anything to prevent public opinion in the US from going sour. Liberia is facing an existential crisis and are in desperate need of all the help the US can give.
Mr Duncan's trip to the US was planned weeks in advance, so he was not fleeing the country in response to his exposure.

> Mr Duncan's trip to the US was planned weeks in advance, so he was not fleeing the country in response to his exposure.
Citation for that?

He needed a visa to enter the U.S. (probably to even board the plane).
It's easy to find articles talking about him receiving the visa in August (I guess he would have applied for it some weeks or months before that).

Actually, Thomas Eric Duncan is dead because he came in sufficiently close contact with the Ebola virus, and it was fatal as it is for most who contract it.
It's this healthcare worker, and the likely other contacts who are not yet symptomatic, who are sick and statistically going to die who are dead because he lied.
And those who expect people to tell the truth on such forms, which flies in the face of all we know about human nature.

If Thomas Eric Duncan hadn't lied to get on the plane, he would have died too.

Nah. Lies are not terminal.

You don’t know that.

My understanding is that Duncan told the ER staff that he had helped to treat a malaria patient. At the time of his first visit to the hospital, he didn't know, himself, that he had been exposed to Ebola.
But don't let the facts get in the way of a good race-card rant.

One possibility is that the CDC should spend more of its (rather ample) budget on responses to infectious diseases and less on "playground safety and occupational hazards." http://www.usatoday.com/story/opinion/2014/10/05/ebola-cdc-j...

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