Ebola in Texas

[Meadbh]

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.

Wow. This gets more surreal.

 

[DallasGuy]

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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C'mon, even though the nurse might not have been told not to travel, wouldn't common sense tell you NOT TO TRAVEL in the first place? I agree that the medical staff was put in a horrible position but I still think that the decision to travel after caring for someone with Ebola was sheer stupidity. She should have never gone to Cleveland in the first place.

 

[Telly]

Back in the early 1980s, Johnson & Johnson set the standard on how to react in a "product" disaster. For those who don't remember/not around then, people started dying in the Chicago area due to OTC Tylenol capsules laced with cyanide. In the beginning, it was unknown whether the poison was introduced in the manufacturing process (turned out it wasn't), or introduced by someone tampering with products on the store shelves (it was). It turned out it wasn't J & Js fault at all. But every step of the way they kept the public informed. No puffing the chest out posturing, no lying. Tylenol was removed from the market, and they developed the solid caplet, and the whole concept of tamper-proof we have today. They are often cited as the best response to a disaster ever for a company.

Late today I saw video of Dr. Daniel Vargas, Chief Clinician of Texas Health Resources, they are the parent of the Texas Health hospitals, of which THPD is one. This guy said "there are no systemic or institutional problems at THPD", and further more "they have been serving the community for many years, blah blah blah" smearing off the topic at hand. What a jerk. They are the complete opposite of the J & J response. I am surprised that someone in that corporation doesn't have enough guts to say we screwed up big time, don't lie to people, don't make up stories, quit trying to shift the blame to cover our own azzezs, etc. etc. But no.

The nurses work for the hospital. It is the hospitals duty to provide the equipment they need to do the job safely and efficiently. It is the hospitals duty to provide or arrange for any training needed, especially for something beyond the usual day-to-day, like this! It is the hospitals duty as employer, to direct and require any addition procedures, limitations, etc. as required to keep their employees, the Doctors that come in, patients, visitors of patients, volunteers, etc. safe.
The hospital should have clearly identified which employees would be under a self-quarantine, what the procedure and rules were for the self-quarantine, answer questions of those involved, and continue to monitor it to make sure it WAS being followed.
Complete abdication of responsibility by that hospital, in my opinion.

A background note to those not in Texas, about hospitals here. The doctors that see the patients and do the work are NOT employees of the hospital (by state law, IIRC). You are billed separately and outside for them. However, hospitals and their governing structure DO have Doctors on their payroll for their own functionality.

 

[Meadbh]

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

On the CTV news tonight:
Ottawa looking to contribute another $30M in fight against Ebola | CTV News

From The Globe and Mail:
Ottawa readies Ebola response team, provinces designate treatment centres
http://www.theglobeandmail.com/life...-designate-treatment-centres/article21121980/

 

[2B]

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.

This is easier said than done. There are tens of thousands of hospitals in the USA. Except for this random event they do not need or use the types of very specialized equipment necessary. If they don't use it, they don't buy it and don't train anyone to use it. Are you ready to have the cost of heath care go up to cover this up until now unnecessary equipment? If you are, it will still take years to get a vast majority of the facilities up to the necessary levels of equipment and training to do what needed to be done in Dallas.

The cases up until the Dallas fiasco were all "imported" health care workers from Africa. These were flown into top tier facilities designed for this type of illness. The biggest problem I see in the Dallas debacle is that it was left to run its course in Dallas. The hospital should have screamed for help. The CDC should have facilitated moving the patient to one of the qualified facilities. I blame the hospital and CDC for obvious blatant stupidity.

 

[eytonxav]

The one thing that should be no surprise is all the false and misleading info that is being circulated. Not sure we will ever know all the real facts of what did or did not happen or who said what or didn't say. We might end up with conspiracy theories for years to come on this sad situation, after all, this is Dallas.

 

[Senator]

The Dallas County DA, who was going to charge Duncan for crimes, should consider charging this nurse if anyone else gets Ebola from her.

She should have been a professional and stayed home.

 

[2B]

The one thing that should be no surprise is all the false and misleading info that is being circulated. Not sure we will ever know all the real facts of what did or did not happen or who said what or didn't say. We might end up with conspiracy theories for years to come on this sad situation, after all, this is Dallas.

Are you suggesting that the ebola infection occurred at the grassy knoll?

 

[brewer12345]

And now Dallas county is contemplating declaring a state of emergency:

Dallas County May Declare State of Disaster From Ebola Virus - Bloomberg

Expect the start of backlash from those deeply suspicious of gubmint exercising powers in times of supposed crisis...

 

[2B]

And now Dallas county is contemplating declaring a state of emergency:

Dallas County May Declare State of Disaster From Ebola Virus - Bloomberg

Expect the start of backlash from those deeply suspicious of gubmint exercising powers in times of supposed crisis...

This seems premature but why is the first infected nurse still in Dallas?

 

[travelover]

The Dallas County DA, who was going to charge Duncan for crimes, should consider charging this nurse if anyone else gets Ebola from her.

She should have been a professional and stayed home.

They should charge everyone infected with Ebola. Then they wouldn't be so darn careless endangering OUR lives.

 

[2B]

They should charge everyone infected with Ebola. Then they wouldn't be so darn careless endangering OUR lives.

She probably had a non-refundable ticket and Frontier wouldn't let her reschedule. If that was the case, they are probably kicking themselves now. I can see it now. The recorded conversation of the nurse telling the customer no-service agent that she's under observation for ebola. The agent says that no exceptions can be made. The rest is history. Just a WAG.

 

[sengsational]

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.

Let's examine what you mean by not an airborne disease. This disease will spread through the air via small droplets from, say, a sneeze for instance. In this regard the disease is very similar to the influenza virus, or the common cold. The reason that a sneeze of an ebola affected patient will contain the virus is because once the patient become significantly full of the virus, then the patient's cells begin to break down and the virus is released from the cells that are breaking down.

As for the Typhoid Mary scenario, I think there is reason to worry there as well. For instance let's say a person with an ebola fever comes into an emergency room and sneezes into their hand and uses the doorknob or a magazine in the waiting room. Then someone else in the emergency room picks up that magazine or uses that door knob. That person may not infect themselves by rubbing their eye or putting their fingers in their mouth but What if that person that has the virus on their hands but is not infected touches a toy in the waiting room that ends up in a child's mouth? So there might be a person, in that previous example, that transmits the virus yet never has the virus in their system.

 

[MuirWannabe]

They should charge everyone infected with Ebola. Then they wouldn't be so darn careless endangering OUR lives.

+1

Ridiculous statement that the nurse should be arrested or criminally pursued. There are many screwups going on. But I don't see the nurses at fault for doing what they were told was safe by both the hospitals and the CDC. If anything, the nurses probably have a good suit against the hospitals and CDC. That is...IF THEY LIVE.

Strange the rush to blame the little guy (gal).

Muir

 

[BBQ-Nut]

Let's examine what you mean by not an airborne disease. This disease will spread through the air via small droplets from, say, a sneeze for instance. In this regard the disease is very similar to the influenza virus, or the common cold. The reason that a sneeze of an ebola affected patient will contain the virus is because once the patient become significantly full of the virus, then the patient's cells begin to break down and the virus is released from the cells that are breaking down.

As for the Typhoid Mary scenario, I think there is reason to worry there as well. For instance let's say a person with an ebola fever comes into an emergency room and sneezes into their hand and uses the doorknob or a magazine in the waiting room. Then someone else in the emergency room picks up that magazine or uses that door knob. That person may not infect themselves by rubbing their eye or putting their fingers in their mouth but What if that person that has the virus on their hands but is not infected touches a toy in the waiting room that ends up in a child's mouth? So there might be a person, in that previous example, that transmits the virus yet never has the virus in their system.

[my bolding]Not sure about the bolded part...several websites state ebola can be transmitted via eyes or mouth.

Or are you saying that the virus would not be on the doorknob or magazine from an ebola infected person who sneezes then touches those objects

 

[Brat]

The person in charge of infection control at the Dallas hospital should be replaced immediately with someone who knows their stuff. Can you imagine sending an suspected Ebola patient's blood sample through the hospitals' pneumatic tube delivery system?

It seems to me that major hospitals can have 3-5 hazmat suits in inventory for immediate use where Ebola is suspected, borrow more from facilities nearby and backfill from a central warehouse. Each major hospital should have a plan for just such an emergency. They don't need to train every nurse how to care for such a patient but they should have a cadre of 20 (some will be on vacation or otherwise unavailable) trained and prepared to respond. These caregivers should be paid a premium when they are delivering care to such a patient.

The nurse's association statement claims that the two infected nurses cared for Duncan before Ebola was fully diagnosed and cared for other patients concurrently. They wore normal hospital scrubs. Nurses group slams Dallas hospital for sloppy Ebola care

 

[Chuckanut]

+1

Strange the rush to blame the little guy (gal).

Have you ever seen the movie "The Paths of Glory"? Very good. And, IMHO, all to often what happens in real life when the Big Boys and Girls screw up.

 

[sengsational]

[my bolding]Not sure about the bolded part...several websites state ebola can be transmitted via eyes or mouth.

Or are you saying that the virus would not be on the doorknob or magazine from an ebola infected person who sneezes then touches those objects

From what I understand, the virus can be transmitted if absorbed through any mucus membrane. But what I was getting at in the bolded portion, was that an uninfected person could have the virus on their skin (only) and transmit the virus to an object and that object could infect someone else. So in other words the person with the virus on their skin could possibly remain uninfected , but could be a transmitter of the virus by simply moving a bodily fluid from an infected person to a third person. Not really a Typhoid Mary scenario, but it would make tracing the virus transmission more challenging, since the intermediate person was never infected ( only transmitted the virus on the outside of the body).

 

[imoldernu]

Excerpt from the CDC on transmission:

Because the natural reservoir host of Ebola viruses has not yet been identified, the manner in which the virus first appears in a human at the start of an outbreak is unknown. However, researchers believe that the first patient becomes infected through contact with an infected animal.

When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with
- blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
-objects (like needles and syringes) that have been contaminated with the virus
-infected animals
Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.

 

[BBQ-Nut]

From what I understand, the virus can be transmitted if absorbed through any mucus membrane. But what I was getting at in the bolded portion, was that an uninfected person could have the virus on their skin (only) and transmit the virus to an object and that object could infect someone else. So in other words the person with the virus on their skin could possibly remain uninfected , but could be a transmitter of the virus by simply moving a bodily fluid from an infected person to a third person. Not really a Typhoid Mary scenario, but it would make tracing the virus transmission more challenging, since the intermediate person was never infected ( only transmitted the virus on the outside of the body).

Here's the website I found on how it can be transmitted
How Ebola spreads

From this, I read it that it would be possible for an infected person to sneeze or cough directly on or via covering with their hands and then touch some object, such as a doorknob or magazine, then as long as that object is still 'wet' (cuz according to the above link, once dry the virus 'dies') - someone else could then touch that object and infect themselves if they rub their eyes or put their fingers in their mouth.

That is what makes the thought of future air travel so worriesome...for me, at least.

Of all the objects touched as you make your way thru an airport or on a plane, the virus could have been laid down by someone infected and still 'alive' when you touch it.

Then, all it takes is a touch to your own eye, wipe your mouth and you've got it to.

(I must sound like Felix Unger......still....)

 

[sengsational]

Excerpt from the CDC on transmission:

It's unfortunate the way transmission is described when it comes to the quote "not spread through the air". Neither is influenza "spread through the air" but we don't want someone with influenza coughing on us and then having droplets with the virus enter our lungs. If I am wrong about this, I would be super grateful. Unfortunately though, I don't think I'm wrong.

 

[MRG]

While not in the medical field, so much of this reminds me of disaster recovery exercises in IT. The first tests always failed, regardless of the amount of thought that was invested. Management was content to look the other way, as it was just a test.

The only way recovery was improved, was repeated failures and learning from those failures. Problem is, now we're learning with human lives. I'm sure there were DRs that had concerns, but were told they were just 'doom and gloomers, get a better attitude'.

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[sengsational]

Then, all it takes is a touch to your own eye, wipe your mouth and you've got it to.

(I must sound like Felix Unger......still....)

We ALL could use a bit more Felix when in public!

I agree 100% with your assessment. A tray table even undetectibly coated with cough residue of an infected person gets touched by someone else, and that someone else rubs their eye...that's it...another infection!

 

[samclem]

We ALL could use a bit more Felix when in public!

The trick to avoiding picking up germs in public seems to be:
- keep your hands away from your face. There's no avoiding touching all the surfaces we need to touch with our hands, so they are going to get germy.
- Wash hands frequently (or use a glob of the sanitizer stuff). Because eventually you >will< touch your face, or something that you eat, etc.
- Avoid being near people who are visibly sick. This isn't always possible.

 

[Brat]

I remember the day when ladies wore gloves in public, you took them off to eat. I thought it was a style issue, now I wonder if it was the result of experience with the flu epidemic in my grandmother's day.