Ebola in Texas

[sheehs1]

I think the jury may still out on the family members of Duncan. Isn't the quarantine a minimum of 21 days? While the family may not have been exposed to his blood, I would most certainly think exposure to his saliva or sweat would have been relatively easy, not to mention other possible ways such as tissues, towels, etc. I know they decontaminated the house but still.
What is disconcerting to me is the "reason" given for contracting this virus has been "a breach in protocols but they remained stumped as to where the breaches occur. Like Moemg said, you can be certain that nurse was extremely careful.

[Meadbh]

Quote:

Originally Posted by Moemg I do not buy the break in protocol .If you are a RN who works in an Infectious care unit you are super careful your life depends on it . IMO ebola is much more contagious than originally thought .

+1.

[MooreBonds]

What gets me is that they won't say which department they are in or how the healthcare worker that caught it cared for the Liberian. It should be fairly obvious to figure it out ASAP where the healthcare worker came across the patient (as a nurse directly caring for them, processing used medical instruments, etc.) Given that we haven't heard about any other people that came into contact with the initial patient developing Ebola (yet), it sounds like the healthcare worker had a lapse in their vigilance, rather than it being far more contagious than expected...but time will tell.

[Ronstar]

I don't think the hospital will release much info as to how the nurse contracted Ebola in an effort to avoid liability issues.


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[Bestwifeever]

Quote:

Originally Posted by MooreBonds What gets me is that they won't say which department they are in or how the healthcare worker that caught it cared for the Liberian. It should be fairly obvious to figure it out ASAP where the healthcare worker came across the patient (as a nurse directly caring for them, processing used medical instruments, etc.) Given that we haven't heard about any other people that came into contact with the initial patient developing Ebola (yet), it sounds like the healthcare worker had a lapse in their vigilance, rather than it being far more contagious than expected...but time will tell.

This information is out there, as reported on CNN (http://www.cnn.com/2014/10/12/health/ebola/):

Quote:

The woman had on a gown, gloves, mask and a shield during her multiple visits with Thomas Eric Duncan.... The patient is a nurse at Texas Health Presbyterian Hospital in Dallas, an official who is familiar with the case told CNN.... She was involved in Duncan's care after he was placed in isolation -- his second trip to the hospital after coming to the United States from Liberia -- said Dr. Tom Frieden, the director of the CDC.

I have also read that the Dallas medical staff (per CDC protocol, I assume) was not wearing the full body-suit preventive clothing that those in Africa wear when dealing with Ebola patients.

[M Paquette]

It's not particularly contagious, but it is extremely infectious. There's a huge difference.

Even a slight error in handling contaminated material such as gloves or the exterior surface of the anti contamination suit can transfer virus to the worker. One to ten live virus particles is sufficient to cause an Ebola infection.


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[ls99]

Quote:

Originally Posted by M Paquette It's not particularly contagious, but it is extremely infectious. There's a huge difference. Even a slight error in handling contaminated material such as gloves or the exterior surface of the anti contamination suit can transfer virus to the worker. One to ten live virus particles is sufficient to cause an Ebola infection. Sent from my iPhone using Early Retirement Forum

Ah yes. Procedures do matter, as Gumby pointed out earlier. Failure to follow can cost one's life while in close proximity to an inficted one.

[Brat]

This virus is scary indeed!

[rodi]

Quote:

Originally Posted by kiki What's the benefit for dealing with an ebola patient? Especially if you're already wary that the facilities don't have the necessary precautions in place to protect the staff. And now you find our a nurse wearing full protective gear was infected. Not good.

What are you suggesting? That infected people be denied access to treatment?

I am saddened to hear about the nurse. But I still think giving the ebola patient treatment was the right thing to do.

[Telly]

Some local color

"Patient Zero" at THPD was isolated in a 24 bed ICU. So that whole particular ICU was out of service for any other patient use. I wonder how many hospitals have a small isolation unit that is trustworthy, building systems and equipment-wise. Comments here locally that the isolation at THPD was loading the other hospitals in the area. It wouldn't take too many of those events across hospitals to effectively strangle our urgent hospital healthcare.

THPD's ER is CLOSED. All incoming patients diverted.

I wonder if the design of the new big Parkland has small isolation units? May not have been thought of as a important need. The under-construction New Parkland hospital has undergone major design changes while under construction already.

I think many of us were under the impression that health care workers in contact with patient zero or his hazardous extracts were wearing full isolation spacesuits. Apparently not. It may be one thing to wear the get-up they used often, and another to wear it when your life depends on it. One unnoticed mistake in other times likely would not be a big deal. This time it is.

Nurse associations commenting on the lack of real training, no matter what the talking heads are saying.

Director of CDC saying "it WILL be stopped in Dallas"... OK, first task, annex all cities in Dallas county and surrounding counties all to Dallas.

Clay Jenkins, Dallas County Judge and lead Dallas County homeland security official, needs to can the parrot talk. He is a sensible person, but he is way out of his league on this one with his prior visit to the infected apartment, and his continuing parroty pronouncements. A good friend needs to tell him to shut up already. Politicians making puff the chest out happy talk on this one is a bad idea. I'm surprised they are sticking their necks out so far on this. The urge to get in front of the camera is exceeding sense.

As the days go by, if more healthcare folks turn up positive with Ebola from patient zero, the whole healthcare scheme could crash. If they feel they may not be getting the protection it requires, and decide to say F-it, I'm not going in there, who will? If the boss says you go, or you're fired, and they won't go, then what? It all assumes people will do their jobs. But if people "doing their jobs" possibly ends in their death, while possibly infecting others too, then it grows outward instead of containment. Very tough questions then. Now that is a disaster scenario.

[Meadbh]

This.

CDC head criticized for blaming 'protocol breach' as nurse gets Ebola | Reuters

[tulak]

Quote:

Originally Posted by rodi What are you suggesting? That infected people be denied access to treatment? I am saddened to hear about the nurse. But I still think giving the ebola patient treatment was the right thing to do.

I wasn't really suggesting anything, just pointing out the problems in the current system. Health care workers are amazing folks. They deal with messy situations, many of which are incredibly unpleasant to most people. But for the most part, they are also not life threatening. When you add that factor into the mix, then I think it's only natural to have a bit of self-preservation kick in. And keep in mind, the administrators of hospitals deciding that they can take in ebola patients have little to lose, since they leave the actual care to others. I don't know about you, but if somebody tells me to do something that might cause me to catch a life threatening disease and I'm compensated the same as if I take care of the guy with something benign, I'm going to seriously think over my options. I think that's only natural.

But yes, somehow infected patients need to be taken care of. I don't have any easy answers as to how, but a dedicated facility that has staff that is trained in handling patients with infectious diseases might be a good start. I can only hope that's the case in Dallas, even with the infected nurse, but I also believe there's going to be a lot of variability in patient care depending on the facility.

[tulak]

Quote:

Originally Posted by Meadbh This. CDC head criticized for blaming 'protocol breach' as nurse gets Ebola | Reuters

+1

This a great article and what I was trying to convey earlier: just because hospital thinks it can take care of a patient with an infectious disease does not make it true. There's a lot of we can handle this talk and then when something happens that contradicts the talk, it must have been the fault of a protocol breach, aka the health care workers.

Quote:

It was not immediately clear whether the Texas hospital prepared its staff with simulation drills before admitting Duncan, but a recent survey of nurses nationwide suggests few have been briefed on Ebola preparations. Officials at the hospital did not respond to requests for comment.

Based on my admittedly small sample set, this seems to be true. And this is at a facility that supports a region, which is where they are proposing to send infected patients.

[eytonxav]

Quote:

Originally Posted by Telly Some local color "Patient Zero" at THPD was isolated in a 24 bed ICU. So that whole particular ICU was out of service for any other patient use. I wonder how many hospitals have a small isolation unit that is trustworthy, building systems and equipment-wise. Comments here locally that the isolation at THPD was loading the other hospitals in the area. It wouldn't take too many of those events across hospitals to effectively strangle our urgent hospital healthcare. THPD's ER is CLOSED. All incoming patients diverted. I wonder if the design of the new big Parkland has small isolation units? May not have been thought of as a important need. The under-construction New Parkland hospital has undergone major design changes while under construction already. I think many of us were under the impression that health care workers in contact with patient zero or his hazardous extracts were wearing full isolation spacesuits. Apparently not. It may be one thing to wear the get-up they used often, and another to wear it when your life depends on it. One unnoticed mistake in other times likely would not be a big deal. This time it is. Nurse associations commenting on the lack of real training, no matter what the talking heads are saying. Director of CDC saying "it WILL be stopped in Dallas"... OK, first task, annex all cities in Dallas county and surrounding counties all to Dallas. Clay Jenkins, Dallas County Judge and lead Dallas County homeland security official, needs to can the parrot talk. He is a sensible person, but he is way out of his league on this one with his prior visit to the infected apartment, and his continuing parroty pronouncements. A good friend needs to tell him to shut up already. Politicians making puff the chest out happy talk on this one is a bad idea. I'm surprised they are sticking their necks out so far on this. The urge to get in front of the camera is exceeding sense. As the days go by, if more healthcare folks turn up positive with Ebola from patient zero, the whole healthcare scheme could crash. If they feel they may not be getting the protection it requires, and decide to say F-it, I'm not going in there, who will? If the boss says you go, or you're fired, and they won't go, then what? It all assumes people will do their jobs. But if people "doing their jobs" possibly ends in their death, while possibly infecting others too, then it grows outward instead of containment. Very tough questions then. Now that is a disaster scenario.

I would never have guessed that THPH would have been the best facility, but I guess it got that distinction by default, as that is where Duncan first sought treatment and then returned to again after his situation got worse.

As to Clay Jenkins, I am surprised this County Judge (with political aspirations) would be chosen to head Dallas' Homeland Security matters. He shows very poor judgement and talks way to much. To me this is the worst of what can happen when politics over qualifications govern such appointments.

[rodi]

Now that they are screening patients... Are the airlines going to honor delayed flights if someone has a fever? Lets say you show up at the airport having been in western africa - you have a fever... You are bumped from the flight. Does the airline refund the ticket or honor a later flight (when it's been confirmed you don't have ebola.) Knowing how reluctant airlines are to refund or credit changes in flights - I suspect this will be an issue going forward.

I'm not suggesting they don't increase screening - I *AM* suggesting airlines need to not give passengers a financial incentive to lie. If a passenger is going to have to eat the cost of a ticket from Liberia to Dallas (for example) - that's a big incentive to lie.

[Rich_by_the_Bay]

Agree. If a well-meaning courageous qualified provider got exposed, it was not his/her "fault." They have a system problem, not a provider problem.

[MichaelB]

An interesting article contrasting three US hospitals that have treated patients with ebola without any contamination. The big difference, according to this article, is the training. 3 US hospitals stopped Ebola from spreading. Why didn't*Texas? - Vox

Quote:

And, perhaps more importantly, they're staffed by doctors who have spent years training, preparing and thinking about how to stop dangerous infections from spreading.

[Bestwifeever]

Quote:

Originally Posted by Rich_by_the_Bay Agree. If a well-meaning courageous qualified provider got exposed, it was not his/her "fault." They have a system problem, not a provider problem.

Yes plus 1,000. Throwing some guilt on her as she fights this illness is just wrong.

[W2R]

Quote:

Originally Posted by MichaelB An interesting article contrasting three US hospitals that have treated patients with ebola without any contamination. The big difference, according to this article, is the training. 3 US hospitals stopped Ebola from spreading. Why didn't*Texas? - Vox

Thank you. This was a very worthwhile article for me to read. It explains in very general terms how hospitals prepare for dealing with diseases like ebola.

It points out that right now ebola patients can't be as effectively treated at just any random hospital, as they can at those very few hospitals that have made painstaking efforts to be fully prepared for dealing with such diseases. The article points out that:

Quote:

Emory, the University of Nebraska, and the National Institutes of Health have all received and successfully discharged Ebola patients. These three hospitals are among just four in the nation with specialized biocontamination units.

[frayne]

Quote:

Originally Posted by Bestwifeever Yes plus 1,000. Throwing some guilt on her as she fights this illness is just wrong.

Yes, easy way cop out for those in charge. The old adage that **** rolls down hill comes to mind. It seems the protocols may be missing some redundancy, if in fact she failed to follow procedure. When dealing with a virus like Ebola, one would think there would be all sorts of checks and balances in place.