Ebola in Texas

[Throwdownmyaceinthehole]

I opened a good bottle of Pinot tonight, to watch the news, cuz we are all gonna dieeee.....

 

[brewer12345]

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

There is almost nothing else more likely to bring out the armed militia groups and political opposition than this. Bad idea.

 

[Meadbh]

There is almost nothing else more likely to bring out the armed militia groups and political opposition than this. Bad idea.

If you were in charge, how would you manage the situation?

 

[Chuckanut]

I opened a good bottle of Pinot tonight, to watch the news, cuz we are all gonna dieeee.....

Known that for years and been doing that for years. Well maybe a bottle of Sangiovese instead of Pinot.

 

[steelyman]

If you were in charge, how would you manage the situation?

That's a piker's argument.

 

[meierlde]

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.

Actually the states already have those powers. They remain from the early part of the 20th century when they were used for TB among other things. Note that for example the Dallas county judge discussed travel bans for those being watched. Here is a link to the state laws on communicable disease health emergencies: State Quarantine and Isolation Statutes
The federal role is related to interstate travel, mainly.

 

[Meadbh]

Actually the states already have those powers. They remain from the early part of the 20th century when they were used for TB among other things. Note that for example the Dallas county judge discussed travel bans for those being watched. Here is a link to the state laws on communicable disease health emergencies: State Quarantine and Isolation Statutes
The federal role is related to interstate travel, mainly.

That's good to know, thank you.


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[6miths]

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.

Ebola virus disease - Infectious Diseases - Public Health Agency of Canada

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

Some areas of Canada may be somewhat better prepared due to past experience. The response to the SARS outbreak which killed 44 in the Toronto area in 2003 was very impressive and somewhat frightening. The infectious agent (which was subsequently identified by a research group in British Colombia) originated in China. Although Ebola is much less contagious, it seems unbelievable that an exposed healthcare provider (who was 'being monitored') was permitted to travel on a commercial airliner. Seems like asking for trouble. This thing needs to be taken seriously and nurses and doctors should be raising the alarm if precautions and equipment are not in place. Many health care providers died in the SARS outbreak. Also, in Africa, many of the worse outbreaks of Ebola and Marburg viruses have been the result of medical 'errors'. Talk is cheap, doing the right thing when faced with a crisis - less so.

 

[brewer12345]

If you were in charge, how would you manage the situation?

I would kick some asses at the CDC and make sure someone competent who takes ebola seriously is in charge. I would NOT do anything that even remotely hinted at imposing martial law.

 

[JoeWras]

I would kick some asses at the CDC and make sure someone competent who takes ebola seriously is in charge. I would NOT do anything that even remotely hinted at imposing martial law.

Center for Disease Control. We don't need a czar. We don't need anything. We need CDC to do their job. This is their bailiwick!

I'm hoping this current fiasco wakes everyone up and is ultimately a blessing. My best to those who are infected. It is terrible. It sounds like initially they were just wearing the kind of outfit I've seen for other cases like pneumonia or c-diff. Terrible oversight.

 

[clifp]

I am not sure that CDC deserve that much of the blame. If I even a layman like myself understands that when treating a patient from West Africa who is projectile vomiting it is really really important, to not have any skin exposed, than I would think that hospital administrators would make sure such gear is available.

I have been watching Dr. Freiden on the Newshour at least once a week since May sounding the alarm about the Ebola. The US along with Cuba, and of course the remarkable folks at Doctors with Borders, have been at the forefront of trying to do something. It is Dr. Freiden that has send hundreds of CDC workers to the front-line,long before this was headline news. I'm not willing to sacrifice him for one screw up which was only partially his agencies fault.

 

[samclem]

If you were in charge, how would you manage the situation?

I'll take a swing:
1) Go on the offensive. The disease is presently confined largely to West Africa. It is worth it (from a humanitarian perspective but also out of our own national self-interest) to work wth other nations and NGOs to send material aid to assist in slowing the spread of this disease while we work on other approaches. We should continue our present efforts.
b) Those vaccines? That's the best hope for a real solution. If money or expertise is needed (to accelerate the present trials, to explore alternative approaches, etc) then we should do that.
c) Significantly increase the ability to rapidly test for ebola in symptomatic individuals. We should have the capacity to test tens of thousands of people a day for ebola using ELISA.
2) A more effective defense.
a) Send US persons to screen airline passengers bound for the US from all of the affected countries--before they board the aircraft for the US. We issue visas, this is why--so we know who is coming. Eliminate the Visa Waiver program for travel that transits these countries. US passport holders get checked, too. Yes, it would be possible to get around such a system, but it would require intent to do so on the part of the traveler. We're VERY lucky that ebola appears to not be contagious before the patient has a fever, this makes screening much easier.
b) Another screening when people arrive from West Africa
The intent of the screening is just to buy time. They will not be 100% effective, and if the disease is readily communicable then it will eventually reach S America, Mexico, Canada and Europe and screenings will become far less likely to be useful. But for now, while we are working on the next steps (see if it burns out again in Africa, or if it spreads to Europe, etc), they are worthwhile.
c) Regional isolation centers in the US, and a means to get patients to them. We may need more than the 4 presently identified.
d) We certainly need a "worst case" plan that provides for treatment of thousands of cases in the US. I think it is very unlikely we will need this, but it is clearly in the realm of the possible. As presently treated, the disease does not require extremely high-tech approaches. We need good, solid, safe supportive care in settings that don't place health care professionals at risk, that don't degrade the rest of the health care system, and that don't expose other patients or the public to this disease. I don't know if new physical structures are actually needed (it's a lot cheaper and faster to rapidly convert an abandoned industrial site or KMart into a field-expedient hospital than to erect a new structure with HVAC, power, sewer, parking, road access, etc). The US military does have the ability to establish field hospitals (and we do have very well equipped hospital ships), but these are limited in their size, are expensive to deploy, and the personnel which staff them are in large part reservists so calling them up can be expected to reduce the civilian medical system's capacity to some degree.

I'm sure I've left a lot out.

 

[JoeWras]

I'm not willing to sacrifice him for one screw up which was only partially his agencies fault.

I'm not looking for heads. Too much of that in today's political world.

Just looking for them to do their jobs. Part of their job is to train the hospitals on this. How about training the people in isolation. ("Don't get on a plane.")

Sounds like all this is now happening at a higher intensity now which is good.

 

[Bestwifeever]

The second Texas nurse was sent to Emory for treatment, where the first two patients were treated. Perhaps this will be the sop from here in, to be treated at the highest level of hospital. Meanwhile hoping and praying that both nurses recover of course and that Mr. Duncan's family and all the peripheral contacts with the nurses are okay.

 

[brewer12345]

I'm not looking for heads. Too much of that in today's political world.

Just looking for them to do their jobs. Part of their job is to train the hospitals on this. How about training the people in isolation. ("Don't get on a plane.")

Sounds like all this is now happening at a higher intensity now which is good.

I'll take heads if offered but really I just want the powers that be to stop the gherkin jerking and take this threat seriously. The glaring slip ups tell me that everyone is still doing the bureaucratic hokey pokey. The US populace is frightened and is looking for answers. Why have the clowns running things not got the message?


The incompetence of the gubmint is part of the inspiration for me to learn more self sufficiency.

 

[powerplay]

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.

According to the gofundme fundraiser linked in the article for the first nurse all her belongings have been destroyed. These items includes furniture, appliances, kitchenware, clothing, etc. so this is another significant issue for those stricken with Ebola who will have to start over from scratch after recovery.

 

[RAE]

Just looking for them to do their jobs. Part of their job is to train the hospitals on this. How about training the people in isolation. ("Don't get on a plane.")

+1. I could not believe that one of the Dallas nurses supposedly in isolation after the first nurse got infected decided to fly from Dallas to Cleveland to visit her mother, during her 3-week isolation period. That is the height of irresponsibility! And why was she even allowed to get on a commercial flight?? Now, 132 people who were on that flight with her (from Cleveland to Dallas) will have their lives disrupted (possibly in a major way), because of her stupidity. Unbelievable.

 

[powerplay]

NBC's Snyderman apologizes for violating quarantine - CNN.com

Dr. Nancy Snyderman has evidently violated the 21 day quarantine she and her team were supposed to be under. She apologized for violating the quarantine. Perhaps she didn't think she had to take it seriously.

This stuff is just unbelievable and no wonder there are additional cases surfacing and possibly more to come.

 

[MuirWannabe]

+1. I could not believe that one of the Dallas nurses supposedly in isolation after the first nurse got infected decided to fly from Dallas to Cleveland to visit her mother, during her 3-week isolation period. That is the height of irresponsibility! And why was she even allowed to get on a commercial flight?? Now, 132 people who were on that flight with her (from Cleveland to Dallas) will have their lives disrupted (possibly in a major way), because of her stupidity. Unbelievable.

Don't blame the nurse. She actually contacted the CDC prior to her flight. She reported her fever at 99.5. They told her she was clear to fly since it wasn't a 100.5 fever. Per their 'protocol'. Apparently she called the CDC more than once and got the same answer.

The nurses keep getting tossed under the bus. They are the victims.

Muir


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[REWahoo]

The nurses keep getting tossed under the bus. They are the victims.

+1

 

[Chuckanut]

After 9-11, I thought we made plans to handle a biological attack by terrorists. Would not that help if Ebola threatens to get out of control or does so?

Whatever, I hope you folks in Texas don't get caught up in a big mess.

 

[RAE]

Don't blame the nurse. She actually contacted the CDC prior to her flight. She reported her fever at 99.5. They told her she was clear to fly since it wasn't a 100.5 fever. Per their 'protocol'. Apparently she called the CDC more than once and got the same answer.

The nurses keep getting tossed under the bus. They are the victims.

Muir

Thanks for the clarification, I was not aware of that. In that case, I'll have to redirect my frustration at the CDC, and not the nurse. Why anyone currently in isolation for possible Ebola infection was allowed to fly on a commercial airliner with ANY fever or other health abnormalities whatsoever is beyond me. Given the fact that all the nurses that treated the Liberian Ebola patient in Dallas were admittedly (by the hospital) not properly protected for the first 3 days he was treated, it seems like the prudent thing to do would have been to require those individuals to be truly isolated for 21 days (minimal contact with others, absolutely no travel). Pay them their normal salary, of course, but no work and very minimal contact with others. It seems like that would have prevented a whole lot of problems down the road (that we are now going to experience.....)

 

[growing_older]

The hospital in Dallas was not designed for or intended to ever handle anything like ebola. The crime here was their attempt to handle it.

I doubt that this is the root cause of the problems. Sure a better facility would be great, but the problems so far are a lot more about not even wearing the protective gear for the first few days while waiting for the Ebola test to be confirmed. Common sense would have been to act like the test was positive and protect, then you can always relax if it turns out to be a false alarm. To treat it like a routine problem until the test says otherwise is common in some medical settings but should not have been for something as infectious as this.

Likewise, all the caregivers were not monitored or isolated or even on the tracking lists, because it was assumed the "protocols" were perfect protection. Clearly they weren't. A nurse with a fever taking a plane, and a reporter deliberately violating an isolation order are not going to be solved with a better building. We need good information, we need sensible precautions, proper protective suits and protocols and we need people to follow common sense rules. This shouldn't actually be as hard as it has been in Dallas.

 

[Klubbie]

While I am in the camp that the nurses should be applauded for knowingly risking their lives for treating Mr. Duncan, it is still an incredible lapse in judgment to hop on an airplane knowing you are in the 3 week incubation period. I don't care what the CDC told her, that just shows an extreme lapse in judgment in my opinion. Maybe I am overly paranoid, but I am sure Ms. Vinson saw what Mr. Duncan went through during his battle with Ebola and to even consider taking a commercial flight knowing that there was a possibility she could have the virus just shows a lapse in judgment.

Or it could be that this just hits to close to home as my fiance is a nurse, and I know what she deals with on a daily basis so I am not trying to beat up on these nurses. But the thought of her caring for an Ebola patient and then trying to get on a plane would certainly be a source of conflict between her and I if we were in that situation. To top it off it makes me uneasy to think that Ms. Vinson was in the Cleveland/Akron area. That is my hometown and I have family there. I realize the likelihood of any of them contracting Ebola is extremely low, but the sheer number of lapses by the CDC and Texas Presbyterian makes me sick to my stomach. I can't help but ask "what if"? It seems like all of this could have been avoided.

That being said, it goes back to the CDC giving poor direction to Ms. Vinson, and not isolating all of the healthcare professionals right away after Mr. Duncan's passing. Heads SHOULD roll at Texas Presbyterian. The thought that the nurses had to treat Mr. Duncan in those conditions is a joke and quite frankly a disgrace to healthcare everywhere. It's almost as if there was a degree of arrogance by the hospital administration (not the healthcare professionals) that their way would be sufficient to handle this. I agree with what RAE says, it seems to me that there were many options to handle this case much better that would have prevented two additional people from being sick, and prevented the fear mongering that is going on in the media (which I am well aware I have fallen victim to to a certain degree).

 

[haha]

While I am in the camp that the nurses should be applauded for knowingly risking their lives for treating Mr. Duncan, it is still an incredible lapse in judgment to hop on an airplane knowing you are in the 3 week incubation period. I don't care what the CDC told her, that just shows an extreme lapse in judgment in my opinion.

She did exactly what she was told to do- go upstairs and get orders.

Remember Katrina? What a stellar job everyone did? Washington is just keystone cops, being so vigilant about covering their a(ss)s that they screw up everything.

Does anyone think the "war on ISIS" is being well handled? Me neither, so why expect any other federal department to do any better? Just pretend it's the Black Death. With luck, we'll escape. Otherwise, we won't.

Ha