Ebola in Texas

[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]

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]

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]

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]

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.

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]

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

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]

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]

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:

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]

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.

 

[Gumby]

I heard back from the CDC. It appears that I made a mistake. Their submission form asks for business contact information and I foolishly provided it. Once they saw that I was a lawyer, they immediate shunted me off to their General Counsel's office, because communications from lawyers can only go through the GC. I have a feeling that this is an automatic screen and no one bothered to read my message to see that it was merely a suggestion as to personal protection equipment, not a legal communication. Any member of the general public could have made the same suggestion.

I am discouraged by the unthinking bureaucratic nonsense, but I think this is important, so I plan to call their GC tomorrow.

 

[samclem]

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, I think the head of the CDC was way out of line to lay this on the afflicted nurse. Folks at that level are supposed to know how to speak to the public, and what you say is:
1) We have confidence in our equipment. It has been proven and it works.
2) We know from experience that health care workers have used this equipment and our present procedures to protect themselves when providing care to ebola patients, and that these health care workers did not get sick.
3) We don't yet know exactly how this infection occurred. We are studying that, and hope to learn how to improve our equipment, procedures, and training.

We probably can't afford to shut down an entire ER to treat a single patient as we are now doing. It's time to at least study the idea of establishing regional isolation/treatment facilities so we can concentrate the expertise and training in a few locations, and reduce the impact on the rest of our health care system.

 

[sengsational]

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.

Yeah, how surprised should we be that an infection spread in a hospital when the most likely place in the country of getting an infection is, wait for it, in a hospital. Do they have procedures that should prevent all cross infections, yes. Are they even close to completely effective? Absolutely not.

 

[haha]

We probably can't afford to shut down an entire ER to treat a single patient as we are now doing. It's time to at least study the idea of establishing regional isolation/treatment facilities so we can concentrate the expertise and training in a few locations, and reduce the impact on the rest of our health care system.

No matter how this is done, it is going to be very expensive unless it somehow gets nipped in the bud. IMO the idea of regional centers, or even supra-regional centers is best as you said.

Actually, our health care would likely be both better and cheaper if this concept were applied to many highly specialized procedures and events.

When a nuc worker or someone who is going to disarm bombs trains, he knows that his life will be on the line. Not always, but for the most part, when a health worker is trained in microbiological control he or she knows that likely third parties will suffer the consequences of slips. If chip fabs were as poorly managed as hospitals, no chip would ever work.

This must explain why it seems to be so hard to get many doctors to clean their hands. But when experienced busy and specialized joint replacement surgeons get an infection in one of their operated patients, it shows in their individual stats. Makes a big difference.

Ha

 

[HFWR]

We probably can't afford to shut down an entire ER to treat a single patient as we are now doing. It's time to at least study the idea of establishing regional isolation/treatment facilities so we can concentrate the expertise and training in a few locations, and reduce the impact on the rest of our health care system.

This...

 

[Meadbh]

Yes, I think the head of the CDC was way out of line to lay this on the afflicted nurse. Folks at that level are supposed to know how to speak to the public, and what you say is:
1) We have confidence in our equipment. It has been proven and it works.
2) We know from experience that health care workers have used this equipment and our present procedures to protect themselves when providing care to ebola patients, and that these health care workers did not get sick.
3) We don't yet know exactly how this infection occurred. We are studying that, and hope to learn how to improve our equipment, procedures, and training.

We probably can't afford to shut down an entire ER to treat a single patient as we are now doing. It's time to at least study the idea of establishing regional isolation/treatment facilities so we can concentrate the expertise and training in a few locations, and reduce the impact on the rest of our health care system.

+1000

 

[MRG]

I heard back from the CDC. It appears that I made a mistake. Their submission form asks for business contact information and I foolishly provided it. Once they saw that I was a lawyer, they immediate shunted me off to their General Counsel's office, because communications from lawyers can only go through the GC. I have a feeling that this is an automatic screen and no one bothered to read my message to see that it was merely a suggestion as to personal protection equipment, not a legal communication. Any member of the general public could have made the same suggestion.

I am discouraged by the unthinking bureaucratic nonsense, but I think this is important, so I plan to call their GC tomorrow.

Gumby,

I know nothing about the CDC's inner workings. I've worked in insurance back office processing. As soon as a lawyer is mentioned they change all proceesses out of fear of liability. You are correct, they don't think/read the idea presented, just pass it to GC.

As a backup, perhaps a friend, family member could send a very similar message and not get blocked by GC. I appreciate your sharing your knowledge, and your pursuit of a great idea.

 

[Rich_by_the_Bay]

Sound information

This is my favorite for reliable information about this horrendous disease. I realize it is pretty technical but I would be glad to clarify if I can.

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

Diagnosis and treatment of Ebola and Marburg virus disease

Rich

 

[ls99]

I heard back from the CDC. It appears that I made a mistake. Their submission form asks for business contact information and I foolishly provided it. Once they saw that I was a lawyer, they immediate shunted me off to their General Counsel's office, because communications from lawyers can only go through the GC. I have a feeling that this is an automatic screen and no one bothered to read my message to see that it was merely a suggestion as to personal protection equipment, not a legal communication. Any member of the general public could have made the same suggestion.

I am discouraged by the unthinking bureaucratic nonsense, but I think this is important, so I plan to call their GC tomorrow.

Sad, but for you another learning experience. As usual no good suggestion ever gets accepted. The NIH syndrome. NIH=Not Invented Here.

 

[brewer12345]

I heard back from the CDC. It appears that I made a mistake. Their submission form asks for business contact information and I foolishly provided it. Once they saw that I was a lawyer, they immediate shunted me off to their General Counsel's office, because communications from lawyers can only go through the GC. I have a feeling that this is an automatic screen and no one bothered to read my message to see that it was merely a suggestion as to personal protection equipment, not a legal communication. Any member of the general public could have made the same suggestion.

I am discouraged by the unthinking bureaucratic nonsense, but I think this is important, so I plan to call their GC tomorrow.

By all means, call the general counsel and see if you can use the lawyer secret handshake. That said, if I were you I would find another way in. You are likely in the bureaucratic BS vortex. Call your congresscritter and see if they can get through. Look at your LinkedIn or meatspace contacts and see if anyone has a connection in the CDC. Heck, if anyone on the forum has a CDC connection please PM Gumby.