Jim White

Ebola Transmission: Health Care Worker Practice Most Important Consideration

Not long after we learned that a health care worker treating Thomas Duncan has tested positive for Ebola, I ran across this terse tweet from Mackey Dunn, the pen name of Don Weiss, who is “a medical epidemiologist with the New York City Department of Health and Mental Hygiene”. The tweet linked to this short but incredibly important blog post. In the post, Weiss notes the baffling development that a health care worker, who wore full personal protective equipment (PPE), contracted Ebola from Duncan even though at this point, none of his family or other close contacts, who did not have full PPE, have developed symptoms of the disease.

That set of facts prompts Weiss to pose the question “So, what does this tell us about Ebola and how we can attain control?” His answer begins:

One, that Ebola patients become more infectious as the illness progresses. The newly reported case in a healthcare worker had onset on October 10th. If we take 9 days as the mean incubation period for Ebola this means the healthcare worker’s exposure was sometime around October 1, which was day 8 of Mr. Duncan’s illness. This is similar to what was seen with SARS, that patients become more infectious (and dangerous) with time.

In setting up the circumstances for his question, Weiss had noted that Duncan was hospitalized, ending exposure to family members, on day 5 of his disease.

Although he doesn’t mention it, this aspect of Ebola, where patients produce more virus and become more infectious during the course of a fatal infection, also accounts for why burial practices are so important to containing the spread of Ebola. Patients produce the most virus and are thus at their most infectious at death.

The converse also appears to be true. Duncan was symptom-free when he flew from Liberia to Dallas on September 19 to 20. At 24 days since the end of that trip, we have now passed the incubation period, commonly given as 2-21 days, for Ebola to develop in anyone who could have been exposed during the flights. No infections among those airline passengers have been reported. I have yet to see a major media outlet mention this point, though.

We are now at 16 days since Duncan was hospitalized, ending his family’s direct exposure, so we have passed the two-thirds point of the incubation period for them (and well past the 9 days that Weiss gives as the average incubation period for Ebola).

The second part of Weiss’ musings on the infection of the nurse is extremely important:

Second, that only hospitals that are well prepared to care for highly infectious patients should be allowed to do so. Standard practice is to have a staff person dedicated to observing the donning (putting on) and doffing (taking off) of PPE. This observation should continue throughout the period of clinical care (from an ante-room with a window). Perhaps gentle reminders during the doffing can avoid the presumed situation in Spain where the nurse may have touched her face with a gloved hand.

When a patient presents to a hospital early in the illness there is time to transfer to such a facility. That’s the plan here in NYC. Bellevue hospital has a specially equipped ward to care for Ebola patients. Their staff are well trained. The number of healthcare workers entering the room should be kept to a minimum, especially after day 7 of the illness.

Weiss was prescient in his push for an observer for workers putting on and taking off PPE. In today’s New York Times, we have this on the CDC’s thoughts regarding improving practices for health care workers treating Ebola patients: Continue reading

Described Focus of Protest in Kabul Dependent on News Outlet

Khaama Press photo of Sunday's protest in Kabul.

Khaama Press photo of Sunday’s protest in Kabul.

A protest variously described as featuring “over a hundred”, “hundreds” or “over 500″ protesters took place in Kabul on Sunday. The object of the protest, however, was very dependent on whose report (or even whose headline) on the protest is being read.

The Wall Street Journal ran with the headline “Islamic State’s Siege of Kobani, Syria Sparks Protest in Kabul, Afghanistan” while Iran’s PressTV went with “Afghan protesters blast US-led forces, BSA”. Remarkably, Afghanistan’s Khaama Press did not see it necessary to spin the focus of the protest in a particular direction, using the headline “Afghans protest against Islamic State, US and NATO forces in Kabul”.

The Khaama Press article quickly sums up the protest:

Over 500 people participated in a demonstration against the Islamic State and presence of US and NATO forces in Afghanistan.

The protesters were shouting slogans against the presence of US and NATO forces in Afghanistan and in support of the Kurdish people who are fighting the Islamic State militants.

Protesters were also carrying signs purporting crimes committed by US and NATO forces in Afghanistan and resistance of the female Kurdish fighters against the Islamic State.

The US and NATO were also accused by protester for supporting the extremist groups in Afghanistan and Kobane.

We learn in the article that the protest was organized by the Solidarity party of Afghanistan, which Khaama described as “a small and left wing political party in the country”. Presumably, since they were allowed to stage the protest, the ban on the party issued in 2012 must have been lifted.

One has to read the Wall Street Journal article very carefully to find any evidence of the US criticism that was in the protest. The article opens:

Residents of Kabul have a war on their own doorstep: The provinces around the Afghan capital have seen an upsurge in violence this year.

But the conflict in Syria was on the minds of demonstrators who marched Sunday in solidarity with the town of Kobani, Syria, currently under siege by Islamic State militants.

Over a hundred Afghans—most of them women—held placards supporting Kurdish fighters defending the city.

Near the end, the article mentions, but dismisses as “conspiracy theory”, the accusations of US involvement in the creation of ISIS:

Conspiracy theories often thrive in Afghanistan, and at Sunday’s protest, many demonstrators expressed the belief that Islamic State was a U.S. creation. Some held placards saying, “Yankee Go Home.”

The article then mentions the BSA without stating that it was also a target of the protest other than citing the “Yankee Go Home” sign.

PressTV, on the other hand, focused exclusively on the anti-US aspects of the protest. In fact, the video accompanying their story does not match the photo that is used in the video frame while the video isn’t playing. The photo, which is full-frame, shows protesters somewhere burning an American flag, but the video itself-which appears to match the same event in the Khaama Press photo-only partially fills the frame and does not show any flag-burning. PressTV opens:

Afghan protesters have staged a rally in the streets of the nation’s capital, Kabul, to reiterate their opposition to the continued presence of US-led troops in the war-ravaged country.

Hundreds of demonstrators marched through the capital on Sunday to also express their outrage against the so-called Bilateral Security Agreement (BSA) signed by the newly-inaugurated President Ashraf Ghani Ahmadzai.

The protesters were reportedly carrying banners pointing to alleged crimes committed by US and NATO forces across Afghanistan

Remarkably, even though Iran is staunchly opposed to ISIS, the PressTV story makes no mention of the protest also being aimed against ISIS, or even of the accusations of a US role in the creation of ISIS.

Congratulations to Khaama Press for choosing to not spin a story that major outlets in the US and Iran used as propaganda pieces.

Moral Rectitude? No, John Brennan is a Honey Badger

A tweet yesterday by Arif Rafiq noted that there was a US drone strike in North Waziristan yesterday just a few hours before Pakistani Prime Minister Nawaz Sharif would visit a spot only 20 miles away. At the New York Times article Rafiq linked:

Prime Minister Nawaz Sharif of Pakistan visited a military camp in the tribal district of North Waziristan on Thursday in what was seen as a pointed show of support and an attempt to bolster his troubled relationship with the country’s top generals.

The rare visit by Mr. Sharif to the tribal belt came three months after the military launched a sweeping offensive against the Taliban in North Waziristan, a hub of Taliban and Qaeda activity.

/snip/

His visit to Miram Shah, the main town in North Waziristan, on Thursday showed Mr. Sharif standing staunchly behind the country’s generals. “Our courageous troops are fighting a difficult war against an invisible enemy,” he told soldiers. “This is a war for the survival of Pakistan.”

Pakistan’s military claims that 80 percent of North Waziristan has been wrested from the militants and that at least 1,000 militants have been killed in the offensive, known as Zarb-e-Azb, which started on June 15. The figures are impossible to independently verify because the area is out of bounds for most reporters.

According to Pakistan Today, Sharif was emphatic in claiming victory by Pakistan over the militants they were attacking in North Waziristan:

Praising Pakistan Army for the success of Operation Zarb-e-Azb, the prime minister said he visited areas of North Waziristan which used to be havens for terrorists but now the army had purged all anti-state elements from there.

Despite Sharif’s claim of total victory over the terrorists, the US obviously feels the job is not complete, as drone strikes this week have been heavy, including the strike Rafiq notes in the Times article as only 20 miles from where Sharif would visit a few hours later.

The beginning of this week was marked by observance of Eid-ul-Azha, but the religious holiday had no bearing on the timing of drone strikes by the CIA. This Express Tribune article notes that US drone strikes in North Waziristan killed five in the pre-dawn hours Monday, another five later on Monday, six early Tuesday, and another eight also on Tuesday.

And then as AP recounts, there were two separate attacks overnight Wednesday and Thursday that killed five more. Near the end of the Times article linked by Rafiq, we get the observation of how close in location and timing it was to Sharif’s visit:

In an unexpected turn, Mr. Sharif’s visit also had an unusual dimension in terms of his relationship with the United States. Hours before he arrived, an American drone fired a missile at a vehicle in Datta Khel, 20 miles west of the camp where Mr. Sharif visited. Four people were killed and two were wounded, a Pakistani security official said on the condition of anonymity.

Clearly, when it comes to drone strikes in Pakistan, John Brennan is a honey badger. He don’t care about religious holidays. He don’t care about the Pakistani military claiming to have established control of North Waziristan. He don’t care about the Prime Minister entering the area. John Brennan just don’t care.

Who ever heard of a honey badger with moral rectitude?

Parchin Blast Site Far From Disputed Chamber

Yesterday, I described what was known at the time about a mysterious blast near the Parchin military site in Iran. I postulated that satellite imagery would soon be available to help sort out the mystery of what took place. A tweet this afternoon from @dravazed alerted me to this article at the Times of Israel, which, in turn, linked to this story posted at israeldefense.com.

Satellite imagery described as from Sunday night’s blast at the Israel Defense site shows several buildings destroyed. The article claims that the blast looks like an attack on a bunker:

Satellite images obtained by Israel Defense and analyzed by specialist Ronen Solomon clearly show damage consistent with an attack against bunkers in a central locality within the military research complex at the Parchin military compound.

Because of the unique shape of the large building adjacent to those destroyed by the blast, I was able to find the location of the blast on Google Maps. Also, with the help of this article from 2012 in The Atlantic, I was able to locate both the area inspected by IAEA in 2005 and the site of the disputed blast chamber where it is alleged that research to develop a high explosive fuse for a nuclear weapon has been carried out. None of these three locations, the blast site, the chamber site or the area inspected in 2005, lies within the boundaries marked as Parchin on Google Maps. The blast site looks to be near a populated area of what is marked on Google Maps as Mojtame-e Maskuni-ye Parchin (which appears to translate as Parchin Residential Complex A if I used Google Translate appropriately). In fact, the blast site appears to be just over a mile from an athletic field. On the map below, #1 is the disputed blast chamber location, #2 is the blast site and #3 is the area inspected in 2005. Note that both the blast chamber site and the area inspected in 2005 are more removed from what appear to be the populated areas.

Final

I am far from an image analysis expert, but the blast site looks to me to be more like an industrial site than a cache for storing explosives. If a bunker were indeed located here, that would put the local planning in this area on a par with West, Texas.

It will be very interesting to see how US officials describe the damage and the site where it occurred.

Blast at Parchin Kills at Least Two; Timing Stinks

Detailed information is not yet available, but by all accounts there was a very large explosion east of Tehran Sunday night, around 11:15 local time. Many believe that the explosion took place at Parchin, the military site that has been at the center of controversy raised by those who accuse Iran of carrying out work there to develop an explosive trigger for a nuclear bomb. Some of the most detailed information comes from Thomas Erdbrink of the New York Times:

A mysterious explosion at or near an important military complex rocked the Iranian capital on Sunday, lighting up the skies over the city.

Iranian official sources denied the explosion had taken place at the complex, the expansive Parchin military site east of the city, where international monitors suspect Iran once tested triggers for potential nuclear weapons. But the enormous orange flash that illuminated Tehran around 11:15 p.m. local time clearly came from that direction, several witnesses said.

Officials at Iran’s Defense Industries Organization, though also denying that the explosion took place at Parchin, confirmed that two people were missing after “an ordinary fire” caused by “chemical reactions of flammable material” at an unspecified production unit, according to the semiofficial Iranian Students’ News Agency. There was no word on the location of the fire.

Witnesses in the east of Tehran said that windows had been shattered in the vicinity of the military complex and that all trees in a hundred-yard radius of two villages, Changi and Hammamak, had been burned. The villages are on the outskirts of the military site.

The map below shows the area in question:

Google Map of Parchin showing outlying villages of Changi and Hammamak.

Google Map of Parchin showing outlying villages of Changi and Hammamak.

As seen on the map, Changi is very close to Parchin, but Hammamak is on the other side of Parchin and the two villages are over three miles from one another. A blast fireball that scorched trees over three miles apart must have been quite spectacular.

Many factors go into calculating the strength of blasts, including the type of explosive and what type of containment might have been present. However, FEMA provides (pdf) this rough guideline (via DTRA) of the radius over which various types of damage might be expected to occur as a function of the amount of explosive material used:
Blast radius

Because it relates to assessing damage from terrorist bombs, the FEMA figure breaks the amounts of explosives down into the amounts that can be carried by cars, vans and large trucks. The Times story doesn’t report on how far away from the complex windows were shattered, but the effect of burned trees in villages over three miles from one another suggests that such damage would reach quite a ways. At the very least, it would appear that the blast had the equivalent of more than 10,000 pounds of TNT, and perhaps significantly more than that.

A report from BBC does give a blast radius for window breakage: Continue reading

Reuters Reporter Dan Williams Tries to Help Israel Sell Iron Dome, Ignores Problems

In a story published at 7:28 am this morning, Reuters more or less transcribed a sales brochure for Israel trying to get other countries to buy their own versions of the Iron Dome system. I have written on Iron Dome a couple of times, noting that it amounts to a billion dollar boondoggle and that Congress now wants US contractors to get their portion of the take from the huge funds the US is pouring into the program.

A recent summary of how the effectiveness of Iron Dome has been over-hyped can be found here. The New York Times also addressed problems with Iron Dome here.

Remarkably, it seems that Reuters reporter Dan Williams could find none of this information about problems with Iron Dome while he copied from Israel’s sales brochure for Iron Dome:

Normally, an advanced new weapon system with a battle-proven success rate of 90 percent would have global defense procurement agencies on the phone in minutes. But Israel’s Iron Dome rocket interceptor is yet to prove a hit with buyers abroad.

In terms of operational achievement, tested on the Gaza, Lebanese and Egyptian Sinai fronts, Iron Dome is unrivalled in the arms market. However its uniqueness – developed for a particular threat in a particular place – also limits its appeal to countries dealing with more conventional military adversaries.

But the praise for Iron Dome doesn’t stop there. Later in the piece, Williams says:

So far the system – its effectiveness against Palestinian rocket fire demonstrated beyond doubt since 2011 – has been bought by just one foreign country. Its identity is being kept secret by both sides.

So far, at the time of this writing, about two hours after Reuters posted the article, I have had no response from Williams on Twitter to my calling out his uncritical transcription of Iron Dome effectiveness and Reuters has posted no comments on the story even though I submitted a comment about an hour ago.

Bigger Problem in US Than Ebola: Enterovirus D68 Spreading Respiratory, Paralytic Diseases in Children

Electron micrograph of enterovirus particles. Photo by Linda M. Stannard, University of Cape Town as reproduced in Wong's Virology online.

Electron micrograph of enterovirus particles. Photo by Linda M. Stannard, University of Cape Town as reproduced in Wong’s Virology online.

It has now been five days since we learned that Thomas Duncan, who came to Dallas from Liberia, tested positive for Ebola. His condition has been downgraded to critical, but so far none of his contacts have come down with Ebola symptoms. Because those most likely to have been infected by him are now under close observation and have limited contact with others, it seems quite likely the disease will not spread in the US beyond the small handful of people under close monitoring.

By contrast, the US is in the midst of an ongoing outbreak of a virus that has put many children into intensive care units with severe respiratory illnesses. A handful of children in Colorado initially having respiratory illness have progressed to paralysis of some limbs and have tested positive for the virus. Four children who died from severe respiratory illness have tested positive for the virus but the CDC states that the role of the virus in these deaths is not yet known. Late yesterday, a medical examiner in New Jersey stated that the virus was the cause of death for a four year old boy.

The virus involved in this outbreak is Enterovirus D68. Background on the virology of enteroviruses in general can be found here, courtesy of Wong’s Virology online. There are five groups within the enterovirus genus. By far, the most well-known group is the one that comprises the polioviruses. Enterovirus D68 falls within the newest group of enteroviruses that are designated with numbers.

These are some of the smallest and simplest viruses known. The viral particle contains only a single piece of RNA. Inside the host cell, this RNA is turned into a single protein that then is capable of chopping itself into the four smaller proteins found on the viral coat. There is no membrane around the virus and the particles are stable at acid pH, so inactivation is best achieved with bleach or other disinfectants whose label say they are active against non-enveloped viruses.

The CDC released information on the outbreak on September 12, noting that hospitals in Kansas City and Chicago first alerted CDC to unusual numbers of children presenting with severe respiratory symptoms. The latest CDC information on the outbreak includes:

From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68.

The report continues:

EV-D68 has been detected in specimens from four* patients who died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate.

The difficulty for healthcare providers with this virus is that symptoms for those infected can range from very mild to severe. As also seen with poliovirus, only a small fraction of those infected get the most severe form of the disease. In the current outbreak, a very high proportion of the children with the worst respiratory symptoms already suffered from asthma:

Of the 19 patients from Kansas City in whom EV-D68 was confirmed, 10 (53%) were male, and ages ranged from 6 weeks to 16 years (median = 4 years). Thirteen patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness.

/snip/

Of the 11 patients from Chicago in whom EV-D68 was confirmed, nine patients were female, and ages ranged from 20 months to 15 years (median = 5 years). Eight patients (73%) had a previous history of asthma or wheezing.

Parents and school administrators are being encouraged to monitor children with asthma more closely during this outbreak and to be especially vigilant about measures to prevent spread.

Transmission of the virus, according to CDC: Continue reading

Once Again, Iran Protests IAEA Leaks

Iran’s Ambassador to the IAEA is not happy. Speaking to PressTV today, he protested a report yesterday that final plans are in the works for the next round of meetings between Iran and the IAEA to discuss long-standing issues on Iran’s nuclear program:

A delegation from the International Atomic Energy Agency (IAEA) plans to visit the Iranian capital, Tehran, in the coming days to continue talks with Iranian officials.

Iran’s Ambassador to the IAEA Reza Najafi said on Friday that Tero Varjoranta, the deputy director general and head of the Department of Safeguards of the nuclear monitoring body, will head the team.

The envoy also expressed concern about Iran’s secret nuclear information obtained by the IAEA leaking out.

“It is regrettable that classified information in the agency has not been protected again, and while Iran and the agency were busy planning [the meeting], the news was published by a Western media outlet,” he said.

“This issue once again confirms Iran’s misgivings that spying exists in the agency,” Najafi said.

But wait, you might say. Where is the harm in breaking the news that a meeting is planned? The first clue might come from the suspect report itself, a Reuters article by Fredrik Dahl:

The U.N. nuclear agency is expected to make a new attempt soon to advance its investigation into suspected atomic bomb research by Iran, diplomats said on Thursday, more than a month after Tehran missed a deadline for cooperation.

They said experts of the International Atomic Energy Agency and Iran may meet early next week in Tehran, with the IAEA seeking to achieve progress in the slow-moving inquiry into the country’s nuclear program.

There was no immediate comment from the IAEA, a Vienna-based U.N. agency which for years has been trying to investigate Western allegations that Iran has worked on designing a nuclear warhead. Iran says its nuclear program is entirely peaceful.

True to the usual path employed by Dahl and his fellow Vienna-based colleague from AP, George Jahn, Dahl relies on “diplomats” for his inside information. Note also that Dahl reports that the IAEA did not have a comment for him to include in the report. This suggests that the IAEA and Iran were still in the process of planning the next meeting and not ready to announce it publicly yet.

If meeting plans were the only leaks to come out of IAEA through “diplomats” in Vienna, then this would be a non-story. But there is much more. Here is PressTV in January of 2012 after an Iranian nuclear scientist had been assassinated:

Iran’s Foreign Ministry Spokesman says confidential information on the country’s nuclear experts has been leaked to the terrorists by the so-called inspectors of the International Atomic Energy Agency (IAEA).

“Certain individuals who came to Iran under the pretext of inspecting the country’s nuclear facilities have identified Iranian scientists and given their names to the terrorist groups,” Ramin Mehmanparast said on Friday.

The Iranian official highlighted that Tehran would pursue the case in relevant international bodies.

The comments came in the wake of the assassination of Iranian scientist Mostafa Ahmadi Roshan on January 11 when an unknown motorcyclist attached a magnetic bomb to his car near a college of Allameh Tabatabaei University in Tehran.

He was killed immediately and his driver, who sustained injuries, died a few hours later in hospital.

Just who are the “diplomats” in Vienna who cause all this harm? Much attention focuses on Israelis: Continue reading

CDC Director: “Zero Risk” to Passengers on Flights With Dallas Ebola Patient

Although not yet widespread, panic and disinformation are emerging surrounding the case of the first patient to have been diagnosed with Ebola while in the United States. The worst of the hysteria surrounds the fact that Thomas E. Duncan flew from Liberia to the United States on a trip that required 28 hours, ending at the Dallas-Fort Worth airport on September 20. It is known that Duncan was screened in Liberia and found not to have a fever when he boarded the first flight. Persons infected with Ebola but not yet exhibiting symptoms are incapable of spreading the disease, primarily because the disease spreads through direct contact of mucous membranes or open wounds with bodily fluids and symptom-free patients are not yet vomiting or having diarrhea, so no virus-carrying fluids are being produced or at risk of being spread in ways that other people will come into contact with them.

On Tuesday, the Director of the CDC, Dr. Tom Frieden, stated outright that there is zero risk to passengers who were on a flight with Duncan:

A national public health official today said there was “zero risk of transmission” of Ebola on a commercial airline flight that a Dallas patient who has tested positive for the disease flew on from Liberia earlier this month.

Centers for Disease Control and Prevention Director Tom Frieden said today in a live briefing from Atlanta that the person — a male who remained unnamed — showed no symptoms before boarding the plane and was not contagious. The CDC doesn’t “believe there is any risk to anyone who was on the flight at that time,” he said.

Despite Frieden’s clear statement that other passengers face no risk, the press continued to hound CDC and the airlines until Duncan’s itinerary was released. While CBS was moderately responsible in their coverage of the flight information, the Daily Mail asked breathlessly in their headline whether YOU were on a flight with Duncan. Even more incredibly, stocks in US airlines were dumped yesterday in response to the news of Duncan’s flights:

Investors were also selling stocks following news that the first case of Ebola had been diagnosed in the U.S. Investors dumped airline stocks and bought a handful of drug companies working on experimental Ebola treatments.

The story of just how Duncan became infected is a sad one. On September 15 (recall that he left Liberia on the 19th and arrived in Dallas the 20th), Duncan helped neighbors take their 19-year-old daughter to the hospital. Sadly, the hospital was already overwhelmed with patients and she was turned away, only to die early the next morning after returning:

In a pattern often seen here in Monrovia, the Liberian capital, the family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help on Sept. 15 after failing to get an ambulance, said her parents, Emmanuel and Amie Williams. She was convulsing and seven months pregnant, they said.

Turned away from a hospital for lack of space in its Ebola treatment ward, the family said it took Ms. Williams back home in the evening, and that she died hours later, around 3 a.m.

Mr. Duncan, who was a family friend and also a tenant in a house owned by the Williams family, rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Mr. Duncan then helped carry Ms. Williams, who was no longer able to walk, back to the family home that evening, neighbors said.

The hospital in Dallas where Duncan is being treated has received a lot of criticism because he first went there on September 26 but was sent home when only exhibiting a low grade fever:

When Mr. Duncan first arrived at the hospital last Friday, six days after he had arrived in America, he told a nurse that he had come from West Africa. Public health officials have been urging doctors and nurses to be on the alert for Ebola in anyone who has been in Guinea, Liberia or Sierra Leone. But information about Mr. Duncan’s travel was not “fully communicated” to the full medical team, said Dr. Mark Lester, executive vice president of Texas Health Resources, the parent organization that oversees Texas Health Presbyterian Hospital.

As a result, that information was not used in the clinical diagnosis and Mr. Duncan was sent home, with the diagnostic team believing he simply had a low-grade fever from a viral infection, Dr. Lester said.

Those with whom Duncan had contact from the time of the onset of his symptoms until he returned the hospital on September 30 28 (corrected; September 30 was when tests confirmed Ebola after he returned to the hospital on September 28) in much worse condition and was then isolated are being monitored for signs that they may be infected:

Officials said Wednesday that they believed Mr. Duncan came into contact with 12 to 18 people when he was experiencing active symptoms and when the disease was contagious, and that the daily monitoring of those people had not yet shown them to be infected.

The incubation period (the time between exposure to the disease and the onset of symptoms in an infected person) for Ebola varies from 2 to 21 days. Recall that Duncan was exposed on September 15 and visited the hospital for the first time on September 26, so his incubation period was around eleven days. We are now around six days into the time since Duncan first visited the hospital, so those with whom he came into contact will need to be monitored for for another two weeks or so until at least 21 days have passed since their last contact with Duncan.

While there is some chance that one or more of those with whom Duncan had contact while he was contagious will become infected, as long as everyone who was in contact with him during that critical period is under observation now, there is virtually no chance of the disease spreading outside that small group of people. And you can rest assured that nobody from any of the flights Duncan was on will come down with disease from exposure to him.

US Air Strikes in Syria Proceeding as Expected: Civilian Deaths Documented, ISIS Recruitment Up

Last week, besides pointing out the obscene fact that the US Senate approved $500 million for the US to get more involved in the Syrian civil war on the same day the UN announced a $352 million funding shortfall for feeding civilian refugees of the war, I predicted that the “training” of Syrian rebels would fail just like training in Iraq and Afghanistan but civilian deaths from the US air strikes and at the hands of the rebels would greatly aid recruiting in extremist groups like ISIS.

It turns out that ISIS recruiting shot up even on Obama’s announcement of the US effort:

At least 162 people joined the radical al Qaeda offshoot in northeast and eastern Aleppo in the week after Obama’s speech on Sept. 10, said the Britain-based Syrian Observatory for Human Rights, which gathers information on the conflict.

Islamic State has put particular pressure on rival insurgent groups in this part of Aleppo.

An additional 73 men had joined the group on Sept. 23 and 24 in the northeast Aleppo countryside since the start of the strikes, the Observatory said, bringing the total number since Sept. 10 to at least 235.

“This means these people are not scared. Even if there are air strikes, they still join,” said Rami Abdelrahman, who runs the Observatory.

And, just as could be expected from the “pinpoint” US air strikes, for which we have virtually no on-site intelligence to guide the strikes (other than reconnaissance flights by drones), we are now getting reports of civilian casualties. From Reuters yesterday:

U.S.-led air strikes hit grain silos and other targets in Islamic State-controlled territory in northern and eastern Syria overnight, killing civilians and militants, a group monitoring the war said on Monday.

The Britain-based Syrian Observatory for Human Rights said the strikes hit mills and grain storage areas in the northern Syrian town of Manbij, in an area controlled by Islamic State, killing at least two civilian workers.

Isn’t that nice? Our intelligence-gathering for the air strikes can’t distinguish ISIS bases from silos used to distribute grain to starving civilians. How many new recruits will ISIS get from families whose only food supply was bombed in that strike or whose family members were killed by it?

Of course, the US military refuses to believe any evidence that it could possibly make a mistake. From the same Reuters story:

The U.S. military said on Monday an American air strike overnight targeted Islamic State vehicles in a staging area adjacent to a grain storage facility near Manbij, and added it had no evidence so far of civilian casualties.

“We are aware of media reports alleging civilian casualties, but have no evidence to corroborate these claims,” said Colonel Patrick Ryder, a spokesman at the U.S. military’s Central Command. He promised that the military would look into the report further, saying it took such matters seriously.

You betcha. I’m sure Central Command will get right on that investigation of how it killed silo workers (and see below for the military admitting that it can’t properly evaluate the effects of strikes). Just as soon as they get the next fifty or so new targets for air strikes put on their targeting lists.

Sadly, this strike on the silos is not the only instance of civilian deaths from the US strikes. The Daily Mail has more information from the Syrian Observatory for Human Rights about yesterday’s strike and the overall civilian death toll from all strikes:

Mr Abdulrahman, said today: ‘These were the workers at the silos. They provide food for the people.’ The airstrikes ‘destroyed the food that was stored there’.

The group says at least 19 civilians have been killed so far in coalition airstrikes.

And, of course, the US has not acknowledged any of the previous civilian casualties, either. All they will say is that the evidence is “inconclusive”:

Earlier Monday, the Pentagon admitted that some assessments of civilian casualties were “inconclusive” since the U.S. was only using drones to assess the results of strikes from the air.

“The evidence is going to be inconclusive often. Remember we’re using [intelligence, surveillance and reconnaissance] to determine the battle damage assessment,” Pentagon spokesman Army Col. Steve Warren said Monday.

A defense official told The Hill earlier this month that accurate assessments of damage from strikes are impossible without U.S. forces on the ground to exploit the attack sites, since Iraqi and Syrian partners did not have the capability.

Gosh, I don’t understand how we can have sufficient analytical ability to select targets but insufficient ability to assess the results of strikes on those targets. Sounds to me like the military is just bombing Syria for shits and giggles.

And to help contractors sell more bombs.

Emptywheel Twitterverse
bmaz Wait, Clair Williams is "under investigation" because she cannot attend Bernie Ecclestone's crappy press conference? http://t.co/9Cw2UUFL1g
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bmaz @Gaius_Publius @nakedcapitalism @mattkbh Yeah, sorry, you lost me when you stab at First Look yet take the bleatings of Pando credibly.
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JimWhiteGNV I assume libertarians will be taking candy from the kids who come to their doors tonight expecting handouts. Just to teach them a lesson...
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emptywheel @billmon1 Nah, He's saying, "we've figured out how to extend this hot war for a year longer than the Cold War lasted."
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emptywheel RT @ZFTWARNING: Secretive Mexican police unit questioned over 3 murdered Americans | Fox News Latino http://t.co/uCWrXsxSM9 via @foxnewslat
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emptywheel @ChrisInParis A little early, I guess. They say we're gonna have another Polar Vortex year.
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emptywheel @bmaz Gonna tell Ol' Noodle Arm your commitment is waning. Gonna replace Peyton for the local 6-1 team, are you?
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bmaz Okay, nobody tell @emptywheel but I haz to go to the Angry Crab Shack+BBQ before I can even think about trashing her.
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bmaz @AZBobLord @noprezzie2012 @ArizonaLuke They got smart and distanced themselves from an ignorant destructive idiot?
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bmaz RT @michaelbkiefer: Media seek transcript of shuttered Jodi Arias hearing http://t.co/vXVQJVhaFt via @azcentral
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JimWhiteGNV It IS airborne! RT @MarkusJ: it was right there in front of us all along #obama #ebola #tcot #benghazi #illuminati http://t.co/PnceDWW6mu
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emptywheel @GregoryMcNeal Cool. Look forward to it.
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