Ebola in Texas

[2B]

What is interesting is that so far non of the people who actually lived in the same apartment as the fellow who died of Ebola have contracted the disease. Or am I wrong?

Nothing has been announced. If they make it to the end of the incubation period, it will be very good news. That would mean that transmission is really only a serious problem in the later stages of the disease.

 

[BTravlin]

The hospital in Dallas is totally unsuitable for this type of care. They would be totally incapable of handling more that a couple of cases. This type of care is not something they are equiped to deal with let alone on a large scale.

The obvious incompetents at the CDC needs to do more than send people to whichever facility "won" the Ebola lottery. A whole facility needs to be established geared towards handling multiple cases. This can start as a small area but it need to be able to grow as needed if this thing gets out of hand.

I would avoid this Dallas hospital and I suspect most people will. A dedicated facility is needed.

I saw on CNN yesterday that of the four dedicated facilities that have isolation wards with specialized training, Nebraska is the largest with 20 beds. The Nebraska facility said that caring for more than two Ebola patients at a time would stress their system since Ebola patients require a lot of care that is quite intensive when adding in the safety precautions.

 

[tulak]

Nothing has been announced. If they make it to the end of the incubation period, it will be very good news. That would mean that transmission is really only a serious problem in the later stages of the disease.

Luckily, this seems to be the case. Even Duncan was wandering around a few days before he was admitted and the only people infected were exposed during the late stages of the disease.

 

[Telly]

As I reported here many days ago, the head of infectious diseases at THPD quacked away early on in a televised meeting that they had been waiting for Ebola, they had practiced, and were all ready for a possible first patient (if one came along). At the time, I thought he was just a stuffed parrot.

Nowhere to be seen or heard, now.

Now the real story is coming out. The DMN Sunday issue said that on September 28th:

By evening, he was suffering from explosive diarrhea, abdominal pain, nausea and projectile vomiting. Efforts to bring down his fever failed.

And now we hear they were wearing flimsy gowns, no face masks, no shoe/ankle protection. Heaven forbid if any of those workers then went to neonatal or anywhere like that!

At this point, it seems early comments by hospital officials including that doctor, are lies.

More from inside, the nurses view of what went on:
Dallas nurses describe Ebola hospital care: 'There was no protocol'

Heads will need to roll at that hospital, and at the hospital group. Big Heads, not nurses.

 

[eytonxav]

The second infected nurse flew from Cleveland to Dallas the day before reporting her symptoms.


The CDC says she flew Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth International on October 13, landing at 8:16 Dallas time. The CDC is asking all 132 passengers who flew on that trip to call 1-800-232-4636.

This is really shocking. I would think that any nurse would have enough common sense to not use public transportation for at least the 21 day period even if she had not be warned to not do so by the hospital. Also, makes me wonder what she was actually told by hospital staff Drs or CDC experts as to going out in public, let alone travel on a plane.

 

[tryan]

Geez ... I am just waiting for the terrorists to make themselves into dirty bombs after a "vacation" in west africa .

Just keep those flights coming .... nothing to see here folks!

 

[frayne]

Doesn't look like our health care system is going to get its arms around this Ebola thing anytime soon. Sounds like procedures or protocols were lacking in Texas and I doubt the result anywhere else in the country would have been much different. All that said, maybe this is a blessing in disguise and the CDC and hospital administrations will finally wise up and take this threat a little more seriously. Personally I think there should be travel restriction from the affected countries with mandatory quarantines in place, at the minimum. Right now it is a game of Russian roulette and all the cylinders are loaded. Just my two cents.

 

[Meadbh]

There have been so many lapses in infection control since Mr. Duncan arrived in the US that canceling flights from West Africa (which, AFAIK, all connect in other countries) is closing the barn door after the horse has bolted. Ebola is quite capable of spreading in North America all by itself, and the measures put in place so far have been criminally negligent, IMHO.

And I don't think Canada is much better prepared. We shall see.

 

[Senator]

I think that it will not be long and we will find out which people in the world are immune to Ebola, and which are not.

It turns out that the second nurse was traveling the day before, and the airplane was still in use. So, we will get another test of when people can actually spread Ebola. So much for any quarantine enforcement.

At some point soon, a vaccine will be available. Until then, maybe it’s time to create Ebola camps, like they did for leprosy.

 

[BBQ-Nut]

Lovely. Now a healthcare worker in Texas has tested positive for Ebola.

Still think this isn't very contagious?

I am not all that confident that the CDC has a workable strategy and Administration resolve to get a control on this.

I have travel planned in November, but now I'm going to watch how this progresses and may opt out of traveling.

 

[Meadbh]

This is really shocking. I would think that any nurse would have enough common sense to not use public transportation for at least the 21 day period even if she had not be warned to not do so by the hospital. Also, makes me wonder what she was actually told by hospital staff Drs or CDC experts as to going out in public, let alone travel on a plane.

And now we hear she had a fever before getting on the plane.

New Texas nurse with Ebola had fever on airliner | Reuters

 

[ERD50]

And now we hear she had a fever before getting on the plane.

New Texas nurse with Ebola had fever on airliner | Reuters

OMG.

From that article (bold mine):

Chances that other passengers on the plane were infected were very low, but the nurse should not have been traveling on the flight, U.S. Centers for Disease Control and Prevention (CDC) Director Dr. Thomas Frieden told reporters.

Ya think? What the heck is with "should not have"? Where is the enforcement? You would think a health care professional should know better, but when you have a communicable disease with something like a 60% fatality rate, "should" is not a term to be used. The CDC needs a list of "Must do" and "must not do" with enforcement policies.

At this point, they better start quarantining everyone that has come into contact with an infected person. Better now than later. Geez. This is a time to over-react, better safe than sorry. And they've done a sorry job so far.

I wasn't concerned when they brought the two workers in from Africa. It was clear they were taking extreme precautions. But these more casual walk-ins, and now the people who worked with the walk-in are a real threat.

-ERD50

 

[meierlde]

The preparation of a 'pad' for a module for infectious disease patients can be done in advance. Water, electricity connections is easy to do. I would design a separate sewerage containment facility, perhaps an incinerator. The module can be moved to the site as needed. IMHO it needs to be designed to accommodate several ganged together. If not Ebola then another deadly disease.

Agreed. Also you need to put a site to bring in a truck mounted autoclave to handle the waste. It appears that you can't take the waste offsite without running it thru the autoclave or an incinerator. It may be a matter of repurposing some industrial models to do this. (Since industries cook material at such temps)

 

[Ronstar]

I'm at the airport in Phoenix now, getting ready to fly to chicago. I overheard the word "fever" in a discussion between 2 TSA agents, but I couldn't hear much more - and I didn't ask. I'm sitting at the gate doing my own visual diagnoses of fellow passengers.


Sent from my iPhone .using Early Retirement .//82339)

 

[Throwdownmyaceinthehole]

Lucky me, I get to fly Saturday with a Connection thru DFW and Miami. I know they said they cleaned the planes, but I fly American all the time and the planes, tray tables, seats are always dirty, so I can't imagine the Frontier does a much more thorough cleaning. And I'm headed to a third world country, where there is minimal health care and lots of foreign workers. Yes, I know it is hard to catch, but I'm still taking Clorox wipes...

 

[Meadbh]

My hope is that President Obama will appoint an Ebola Czar with emergency powers. No "should have" or " could have", just do it right!

 

[aja8888]

My hope is that President Obama will appoint an Ebola Czar with emergency powers. No "should have" or " could have", just do it right!

That's a great visionary thought, but I hope not as we don't need politics to mess this up any further. Remember, we have a Homeland Security head and that's not worked out well when the chips were down.

 

[samclem]

My hope is that President Obama will appoint an Ebola Czar with emergency powers. No "should have" or " could have", just do it right!

I appreciate the positive spirit in which this suggestion is made, but the "czar" thing has already been overdone (and not just by the current president). We have a constitution and it is designed to give our legislature "advise and consent" authority over key appointments by the President. There are good and sound reasons for this. The appointment of "czars" is a means of avoiding this process.
The President has all the authority he needs to deal with the present situation. So do the governors of our respective states. Appointing a new person, creating a new office, or convening a special committee is unlikely to be the answer. What we need is competence and accountability--that's not a political indictment at all -- maybe the folks already in their positions are supremely competent and are being held accountable. The judgement on that is left to the reader.

 

[aja8888]

I think Sam and I said the same thing, except he said it better.

 

[Chuckanut]

I appreciate the positive spirit in which this suggestion is made, but the "czar" thing has already been overdone (and not just by the current president). We have a constitution and it is designed to give our legislature "advise and consent" authority over key appointments by the President. There are good and sound reasons for this. The appointment of "czars" is a means of avoiding this process.

+1000!!!!!!!

Well said, SamClem.

 

[Meadbh]

I appreciate the positive spirit in which this suggestion is made, but the "czar" thing has already been overdone (and not just by the current president). We have a constitution and it is designed to give our legislature "advise and consent" authority over key appointments by the President. There are good and sound reasons for this. The appointment of "czars" is a means of avoiding this process.
The President has all the authority he needs to deal with the present situation. So do the governors of our respective states. Appointing a new person, creating a new office, or convening a special committee is unliekly to be the answer. What we need is competence and accountability--that's not a political indictment at all -- maybe the folks already in their positions are supremely competent and are being held accountable. The judgement on that is left to the reader.

OK, then I hope President Obama will issue executive orders which must be obeyed. However, not being an infection control expert, he will need advisors to guide his orders.

 

[Bestwifeever]

Meadbh, does Canada have protocols in place and equipment on hand?

 

[imoldernu]

The devil is always in the details.
Rich-by-the-Bay posted links to some of the details. Worthwhile to do a full reading.

The part that gets confusing, is the period when the virus can be transmitted. While there are many conflicting stories on this, but a more recent explanation from one of the doctors on AJAM, stated that the point of highest risk was when an infected person was suffering the worst symptoms. He explained that the virus was relatively slow in propagating, but that during the period when the victim's body was beginning to shut down the virus was replicating at a quantum rate, with millions of new virus particles being created.

These two paragraphs from the "Up to Date Pages" get into some of the details that support this.

Person-to-person — Person-to-person transmission occurs through direct contact of broken skin or unprotected mucous membranes with virus-containing body fluids from a person who has developed signs and symptoms of illness [60]. The most infectious body fluids are blood, feces, and vomit. Ebola virus has also been detected in urine, semen, and breast milk. Saliva and tears may also harbor the virus. Thus, contact with any of these fluids can pose potential risk. At present, it is unclear whether infectious virus exists in sweat [61]. As described below, such person-to-person transmission leads to outbreaks [40].

****************************************************88
..PATHOGENESIS — Ebola virus enters the body through mucous membranes, breaks in the skin, or parenterally. The pathogen infects many cell types, including monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells, and epithelial cells [88]. Because of the difficulty of performing clinical studies under outbreak conditions, almost all data on the pathogenesis of Marburg and Ebola virus diseases have been obtained from laboratory experiments employing mice, guinea pigs, and a variety of nonhuman primates.

Cell entry and tissue damage — Whatever the point of entry into the body, macrophages and dendritic cells are probably the first cells to be infected. Filoviruses replicate readily within these ubiquitous "sentinel" cells, causing their necrosis and releasing large numbers of new viral particles into extracellular fluid [13,89] (figure 1). Spread to regional lymph nodes results in further rounds of replication, followed by dissemination of virus to dendritic cells and fixed and mobile macrophages in the liver, spleen, thymus, and other lymphoid tissues......................................

Epidemiology, pathogenesis, and clinical manifestations of Ebola and Marburg virus disease

When we get down to the nitty gritty, both in the technical/medical part, it allows for a better understanding of the means, and rate of transmission. The probabiity of quarantining thousands of victims, with a multiple caregivers per patient in some kind of massive concentration facility is nil. The fact that this is not an airborne disease makes that unlikely IMHO, but Public awareness will be a major key.

One of the more interesting facts that is being generally ignored by the media scaremongers, is that the transmission history is that one person (historically) infects one or two others. The image of spreading infection is most commonly described by images of "Typhoid Mary". Not likely.

My two cents.

 

[Meadbh]

Meadbh, does Canada have protocols in place and equipment on hand?

Major centres do, and there have already been several patients isolated and tested for Ebola. To date, all have been negative. It's only a matter of time. My educated guess is that the level of preparation in Canada is about the same as in the US.

http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-eng.php

Here is a policy example from September 2014. Actually, it's an Operational Directive, which means compliance is mandatory.

http://www.wrha.mb.ca/prog/ipc/files/EVDMgmt-OD.pdf

 

[clifp]

One of the more interesting facts that is being generally ignored by the media scaremongers, is that the transmission history is that one person (historically) infects one or two others. The image of spreading infection is most commonly described by images of "Typhoid Mary". Not likely.

My two cents.

The outbreak in West Africa initially had Ro=2 (one person infect two) it is now down to 1.4-1.8. It was relatively easy to understand why. The caretaker got infected, and the person who washed the body before burial also got infected. (traditional the body washer was not immediate family).

One is beyond disturbing is that first case not handled by a specialized hospital has the same transmission rate.

I am generally not a big fan of unions. But I have noticed that nurses unions have been outspoken critics of our current level of preparedness, and good for them.