Jump to content

Menu

Second Ebola Case in Dallas


emzhengjiu
 Share

Recommended Posts

It would be so helpful if you could link to that assertion.

 

 

The document in the PDF is a standard illustration of how to use PPE.  It is not specific to ebola and at the very top it suggests that the protocol may vary depending on what type of PPE is being used.  It describes the main points of how to don and doff PPE.

 

It has the word ebola right in the CDC's web address to the document.

 

For some reason I can't paste into this site so I'll type in the words from the transcript on Megyn Kelly's show (from last night):

 

Kelly: You would go into a highly infected Ebola patient's room without covering your head, with only wearing one pair of gloves, and with you feet exposed? You would do that?

 

Frieden: Absolutely. More is not always better. Better is better. Sometimes you put on more layers, it's harder to put on, harder to take off, you increase your risk of exposure. That's what the science tells us.

 

 

The interview is on Youtube, and the transcript is on the Fox News site. The whole interview was interesting (and not confidence inspiring vis a vis the CDC), she asked him a lot of pointed questions.

 

 

Link to comment
Share on other sites

  • Replies 755
  • Created
  • Last Reply

Top Posters In This Topic

I heard the head of the CDC, Dr. Frieden, say that he'd have no problem taking care of a patient without shoe covering. In fact I looked at the CDC ebola PDF and is said you needed a mask, face shield (hair exposed on the PDF), no shoe covering, gown to the knees. I can't link but it was quite startling to see what the protocols for hospitals are.

 

They ARE falling down on the job. I have yet to see them get back up!

 

I do not think the CDC is falling down on the job. I think there is a big learning curve going on here since prior to this latest outbreak there were only 1400 or so cases for the past 40 years. I suspect that even though ebola is transmitted the same way as HIV and Hepatitis, that ebola is much, much more contagious when a patient is very ill with the disease compared to HIV and Hepatitis. The precautions listed above have been very successful in preventing healthcare workers from getting HIV and Hepatitis from work. In fact, no healthcare workers has gotten HIV from work since 1999 from what I can tell. I also had a patient with Hepatitis B cough bloody sputum onto my face and never got Hepatitis. I think if it was ebola, then I would have gotten it. I could be wrong, but ebola seems to be a different animal so to speak due to its astronomical viral load in the end stages of the illness. Therefore, the CDC needs to re-work precautions needed for healthcare workers. I am somewhat relieved that ebola seems difficult to catch in everyday life since many of the contacts of Duncan are almost in the clear. I am praying no more healthcare workers get it.

Link to comment
Share on other sites

There does not need to be any break in the skin barrier.  Ebola can easily enter the body through the eye or nose.  I think I read in some article about that first US doctor that contracted it in Africa (and who also followed all protocols as far as he knew), that transmission through touching the eye is one of the most common ways for Ebola to be transmitted.  We touch our eyes all the time without even thinking about it.  The eye is a much larger opening than any small cut or chapped skin would offer, and the eyes are full of liquid, not scabbed like a cut or protected with mucus like the nose.

 

Just adding that I'd heard transmission can occur through "micro" abrasions -- cuts in our skin that are so small we're not aware of it.

 

Alley

Link to comment
Share on other sites

... none of the workers in Emory, or in Nebraska contracted ebola.

 

The Emory and  Nebraska facilities are 2 out of a total of 4 in the USA that are especially equipped--and which have staff trained -- to deal with this sort of thing.

 

That is why the known cases arriving from overseas were sent to these facilities. And the people at these facilities knew what illness the arriving patients had, and were ready. 

 

Even as a specially prepared unit, people at Nebraska have said they do not feel able to take care of more than 1 or 2 ebola cases at a time.

 

 

 

The situation with people specially airlifted with known ebola to the special units and  Emory or Nebraska is a different situation than someone walking into (or otherwise arriving at) the emergency room or an urgi-care center near where ever he (or she) happens to be, and dealing with whomever happens to be behind the desk at that moment, whomever happens to be on duty in the next room, and so on.

Link to comment
Share on other sites

But ebola is not transmitted like HIV. You can't get HIV if someone coughs on you. You can't get it if you touch something they sweated on and then touched your eye. It is much more contagious than HIV. 

 

Ebola is a level 4 biosafety hazard. HIV and hepatitis and measles are biosafety level 2. 

Link to comment
Share on other sites

I do not think the CDC is falling down on the job. I think there is a big learning curve going on here since prior to this latest outbreak there were only 1400 or so cases for the past 40 years. I suspect that even though ebola is transmitted the same way as HIV and Hepatitis, that ebola is much, much more contagious when a patient is very ill with the disease compared to HIV and Hepatitis. The precautions listed above have been very successful in preventing healthcare workers from getting HIV and Hepatitis from work. In fact, no healthcare workers has gotten HIV from work since 1999 from what I can tell. I also had a patient with Hepatitis B cough bloody sputum onto my face and never got Hepatitis. I think if it was ebola, then I would have gotten it. I could be wrong, but ebola seems to be a different animal so to speak due to its astronomical viral load in the end stages of the illness. Therefore, the CDC needs to re-work precautions needed for healthcare workers. I am somewhat relieved that ebola seems difficult to catch in everyday life since many of the contacts of Duncan are almost in the clear. I am praying no more healthcare workers get it.

 

Based on what's happening in Africa, with doctors who DID have better protective gear contracting the disease, I don't see how the CDC protocols (gown to the knees, no foot or head covering except for the face) can be adequate AT ALL. I saw how they transported Brantley, and based on that, could not believe what they were allowing the nurses to do in Dallas. Yes I know that's the hospital's call, but surely they were in contact with the CDC. The CDC did not apparently tell them the spacesuit was essential, and they don't appear to think it is even now.

 

On Megyn Kelly's show, Dr. Frieden said, "Our information is clear and correct."

 

You know, the CDC is made up of human beings. Maybe they as an agency, or at least the people at the top, are suffering from "normalcy bias."

 

Link to comment
Share on other sites

Did you miss his point- More is not better.  Better is better.

 

This has nothing to do with hair being exposed.

 

I think BOTH infected nurses would agree with me that MORE was better in their instance.

 

Health care workers were covering their necks with medical TAPE, for Florence Nightingale's sake!

 

Point is, the CDC does not appear to know what level of protection is adequate for health care workers. And there is a good chance they don't know how contagious this is or what all the routes of transmission are, notwithstanding their claims.

 

They seem to be on the "learning curve" right along with the rest of us.

 

Link to comment
Share on other sites

The second nurse said, and the CDC admitted, that they told her multiple times that she was fine to fly with a low-grade fever. That's just ridiculous. How could they know how quickly she'd deteriorate and be contagious if it was Ebola (which we now know it is)? I am appalled that she was given the go-ahead to get on that plane.

Link to comment
Share on other sites

 

Oh, the irony.  Last I heard, Nigeria managed to stop Ebola there at 20 cases and there are currently no more?  While there's three cases and counting right in Texas (and nobody seems in the least able to even use the slightest amount of common sense even to slow it down?)

 

I think the Nigerians should stay home because they have less likelihood of catching Ebola there than in Texas!

Link to comment
Share on other sites

Again this is not accurate and the conclusions drawn are not logical.  

 

The CDC guidelines have nothing to do with tape.

 

The CDC poster does in fact show an exposed neck. I'm sure using the medical tape was an improvisation.

 

I don't know what's logical, but we DO know the health care workers in Dallas did not have adequate protection. If they aren't addressing foot protection, I think that's a problem. It would be pretty easy to tramp through some fluids.

Link to comment
Share on other sites

But ebola is not transmitted like HIV. You can't get HIV if someone coughs on you. You can't get it if you touch something they sweated on and then touched your eye. It is much more contagious than HIV. 

 

Ebola is a level 4 biosafety hazard. HIV and hepatitis and measles are biosafety level 2. 

Yes but from what I understand it is transmitted via blood and body fluids and therefore the hospital would have used the similar precautions which obviously needs to be upgraded in the case of ebola. I did not say coughing. The example I used was some coughing very bloody mucus onto my face including my eyes. Now I agree it is much, much more contagious especially when you are talking about sweat being contagious. I never worried about anyone's sweat before. 

Link to comment
Share on other sites

I watched the second nurse boarding the plane to ATL.

 

She and about 4 caregivers were gowned in protective suits and heads covered.

 

There was one guy in a shirt and slacks.

 

I guess he forgot to don his plague apparel.

 

I told DH what you said here and he laughed and laughed!!

Link to comment
Share on other sites

It would be so helpful if you could link to that assertion.

 

 

The document in the PDF is a standard illustration of how to use PPE.  It is not specific to ebola and at the very top it suggests that the protocol may vary depending on what type of PPE is being used.  It describes the main points of how to don and doff PPE.

I've linked this page twice before, but I'll do it again. CDC Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals  I would not feel comfortable walking into an Ebola patient's room wearing essentially the same protective equipment that my dental hygienist wears to clean my teeth (gown, face mask, eye protection, and single pair of gloves). Since two nurses have now been diagnosed with Ebola after wearing that, I'm surprised that the PPE recommendations haven't changed yet, despite some assurances that the CDC was reconsidering how to protect health workers. Those folks are putting their lives on the line to help people. They deserve much more protective gear.

 

 

Why are you so insistent on blaming the CDC and not local authorities?  Isn't this the ultimate in subsidiarity?  Local people deal best with local problems.  Fed govt lends support.  

 

Really? You expect a local hospital and a local government to have as much (or more) expertise in caring for Ebola patients as the CDC? Of course local hospitals need to be able to rely on CDC recommendations!

Link to comment
Share on other sites

I agree with this.  There had to be some kind of denial going on, because I just can't believe it could be purposeful.  But people can become very irrational in the face of something like that. Which is a good reason for better enforcement of restrictions.

 

(Sort of related, we knew a woman who had breast cancer so advanced she had oozing sores on her breast, yet insisted she was fine and refused to go to the doctor.  Denial is not uncommon in severe health situations.)

 

Yeah, but what is scary is to find out that the CDC authorized the flight knowing she had a fever and that one nurse had already contracted it at that facility. http://www.cbsnews.com/news/ebola-nurse-called-cdc-several-times/  

 

I just don't even know what to say.  I was one of the ones not anxious about it, believing what the CDC said about how we were prepared,etc. . I'm still not anxious because I think they have GOT to figure it out now, though, right? RIght? (See, I'm an optimist). But what the heck. This is unbelievable.

Link to comment
Share on other sites

I've linked this page twice before, but I'll do it again. CDC Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals  I would not feel comfortable walking into an Ebola patient's room wearing essentially the same protective equipment that my dental hygienist wears to clean my teeth (gown, face mask, eye protection, and single pair of gloves). Since two nurses have now been diagnosed with Ebola after wearing that, I'm surprised that the PPE recommendations haven't changed yet, despite some assurances that the CDC was reconsidering how to protect health workers. Those folks are putting their lives on the line to help people. They deserve much more protective gear.

 

 

 

Really? You expect a local hospital and a local government to have as much (or more) expertise in caring for Ebola patients as the CDC? Of course local hospitals need to be able to rely on CDC recommendations!

 

Nurses have come out and said some supervisors said face masks were not necessary and protocols were not carefully followed or even trained.  I posted a video up stream showing how easy contamination is when removal protocols are not followed carefully by Sanjay Gupta.  CDC should have had a team on the ground to ensure they were following protocol.  Hospitals have been in communications on this for months.  If a hospital didn't think they could handle it, they should have requested immediate transfer.  I know local hospitals in a top 5 health care state have been immediately isolating any patients with flu symptoms who have traveled since July.  

 

http://abcnews.go.com/Health/dallas-nurses-hospital-sloppy-ebola-protocols-union/story?id=26205956

 

Link to comment
Share on other sites

 

 

I think rejecting Nigerians because of fear of ebola is absurd.  (Though perhaps it would be best for countries not currently dealing with ebola to avoid the USA for their own safety.)

 

 

 

At the same time, noting this quote from that article:

 

"For the record, the CDC is only recommending that school clinicians be alert for symptoms from students who traveled from countries where Ebola outbreaks are occurring."

 

I think that the CDC mere "recommendation" that school clinicians (do all colleges even have school clinicians?) be "alert" (whatever that is supposed to mean) for symptoms....   etc.   is egregiously insufficient. 

 

And, yes, if/when some college becomes the first to have a student with ebola, and people are then trying to deal with the hundreds of people that student might have shared classes, dining facilities, dorms, bathrooms, etc. with, as well as medical workers, I will certainly consider the CDC at fault, not exclusively, but along with whatever local school clinicians might possibly not be fully prepared and equipped with correct protective gear, isolation facilities and so on. I would expect the CDC right now, having I would hope realize that Dallas hospital was not properly prepared, to get to work toward proper and appropriate preparedness, and if in doubt, over-preparedness, elsewhere, including colleges.

Link to comment
Share on other sites

She was being sarcastic. :) We need a sarcasm font.

 

About Sadie being sarcastic.  I'm sorry I didn't catch it; it was followed immediately by a sincere, heartfelt statement.  (I think.)  

 

What's more appalling is that I didn't catch it:  I thought I spoke sarcasm fluently.

 

In the light of some of the extreme statements in these threads over the past week, I thought she was just voicing her opinion.

 

Resume normal programming....

 

Link to comment
Share on other sites

The Duncan case was hard for me to watch, because I feel there was discrimination involved.

 

What is happening now, is just fascinating me. If I was asked a week ago, if outside of discrimination, could such stupidity take place, I don't think I could have imagined that this was possible. Some of this can be explained away by greed, denial, etc., but some of it is just STUPID, with no possible benefit to anyone. It's humbling to be a part of the human race right now.

Link to comment
Share on other sites

insane is the second nurse's reports the CDC!!!! said she could fly with a temp of 99.6? - the day before she was put into isolation.  (she was concerned and called them, and it was repeated attempts before she got through.)

Insane.

 

 

Link to comment
Share on other sites

The Duncan case was hard for me to watch, because I feel there was discrimination involved.

 

What is happening now, is just fascinating me. If I was asked a week ago, if outside of discrimination, could such stupidity take place, I don't think I could have imagined that this was possible. Some of this can be explained away by greed, denial, etc., but some of it is just STUPID, with no possible benefit to anyone. It's humbling to be a part of the human race right now.

 

One of DH's favorite phrases is, "Never assume malice when incompetence will do."

Link to comment
Share on other sites

The Duncan case was hard for me to watch, because I feel there was discrimination involved.

 

What is happening now, is just fascinating me. If I was asked a week ago, if outside of discrimination, could such stupidity take place, I don't think I could have imagined that this was possible. Some of this can be explained away by greed, denial, etc., but some of it is just STUPID, with no possible benefit to anyone. It's humbling to be a part of the human race right now.

I never thought the Duncan case was mishandled because of discrimination, though I suppose it's possible. I assumed it was just stupidity, greed, or both.

 

But I've been sadly aware of how stupid people who are supposedly top level proffesionals can be for many years. There can be a real lack of common sense among those in charge that can cause serious issues. Having had 3 children in NICUs in 3 different states, I've seen negligence and incompetence in supposedly top notch facilities first hand. I've also had the privelage of working with some amazing doctors and nurses. But I know that there is never a complete guarantee that you'll get quality care for anyone, and often whether my child had a good night depended on who was working that shift.

 

My mother, two of my aunts, two of my uncles, my brother and two of my cousins are veterans. Don't even get me started about the VA.

 

I'm sadly not surprised by any of this. But I'm glad it's recieving so much attention, it will cause them to fix their mistakes and hopefully avoid further tragedies.

Link to comment
Share on other sites

The nephew's piece is interesting. One thing that stood out was the hospital "not allowing them to communicate with Duncan." I read numerous reports that they were provided a video feed to him and that it was very painful for them to see him, and that when another viewing was offered they refused because it had been so difficult for them to see him.

 

I'm also pretty skeptical that he ever said the word Ebola in the ER during the first visit. Was the nephew there? Was Ebola recorded in the notes, or just the comment about Liberia? When would Duncan have told the nephew that he'd never helped the pregnant woman? After he was in isolation? On the video feed the hospital provided (or didn't provide?)? And this "story" is mentioned in an October 9 NPR article after Duncan's death, mentioning how the woman's father then had contracted Ebola and Duncan had reportedly rented a room in the pregnant woman's home (where three of her siblings have since died and her father is sick). He may not have carried her or had any contact with her, but I have a hard time believing he had no contact sufficient to contract Ebola and that he had no clue that what that family had might possibly be Ebola.

 

 

 

 

Link to comment
Share on other sites

I have been rather doubtful about how effective travel restrictions, passport checks etc for people from West Africa would be. But given this current mess I don't think there is too much need for concern. Honestly, if I was in West Africa and worried about possibly having contracted ebola and I had the money/means/know-how to travel overseas I at this point wouldn't choose to go to the US. Lots of nice hospitals in Europe (not saying they would handle it better but they haven't made negative headlines yet).

Link to comment
Share on other sites

For those discussing travel restrictions for health care workers, that might be impossible to restrict.  Apparently more than 60 HCW interacted with the first patient. Those people have had trips planned for months with nonrefundable tickets and it would be difficult to restrict their freedom with that number of people, especially when they were initially told this disease is not very contagious and that their risks were "very low."

 

If

 

I know that Americans are paranoid about their "freedom" but surely the right of other travelers would overweigh the supposed "freedom" of someone who was actively working with someone with Ebola to travel while in quarantine

Link to comment
Share on other sites

What is really baffling to me : There is a huge fire spreading and we want to put out the little sparks that fly to other places and ignore the large fire that causes those sparks. 

The virus is spreading exponentially in Africa and it is becoming more virulent. If we do not stop it there, it will spread elsewhere, eventually. Even if it didn't come to the US and it did, the consequences of it spreading to a populous country like India and China will  reverberate and affect us for years decades to come. The global community needs to understand the community part and start working to contain the spread in West Africa.

 

I personally are not concerned about an outbreak occurring in China. they have an excellent record of completely isolating communities and towns when they have had outbreaks of disease. not pleasant for the people that are isolated, but very effective in stopping the spread. I think that they can do this in a way that is possibly not possible in other countries.

 

I do agree that an outbreak in India would be disastrous.

Link to comment
Share on other sites

Don't we have factories capable of mass producing hazmat suits and respirators for every regional hospital designated for Ebola patients? Surely there is demand for this increase in production? These nurses are wearing what I wear to access my son's port. Totally unacceptable level of protection imo.

Link to comment
Share on other sites

The nephew's piece is interesting. One thing that stood out was the hospital "not allowing them to communicate with Duncan." I read numerous reports that they were provided a video feed to him and that it was very painful for them to see him, and that when another viewing was offered they refused because it had been so difficult for them to see him.

 

I'm also pretty skeptical that he ever said the word Ebola in the ER during the first visit. Was the nephew there? Was Ebola recorded in the notes, or just the comment about Liberia? When would Duncan have told the nephew that he'd never helped the pregnant woman? After he was in isolation? On the video feed the hospital provided (or didn't provide?)? And this "story" is mentioned in an October 9 NPR article after Duncan's death, mentioning how the woman's father then had contracted Ebola and Duncan had reportedly rented a room in the pregnant woman's home (where three of her siblings have since died and her father is sick). He may not have carried her or had any contact with her, but I have a hard time believing he had no contact sufficient to contract Ebola and that he had no clue that what that family had might possibly be Ebola.

Watching someone via video feed isn't communicating. It sounds like a security or closed circuit type set up.

Link to comment
Share on other sites

I know that Americans are paranoid about their "freedom" but surely the right of other travelers would overweigh the supposed "freedom" of someone who was actively working with someone with Ebola to travel while in quarantine

We Americans are so very good at placing personal freedom above ethics.

Link to comment
Share on other sites

There's a very interesting news conference happening on 

http://www.nbcnews.com/storyline/ebola-virus-outbreak/watch-live-cleveland-hospital-officials-hold-briefing-ebola-concerns-9-n227196

 

Near the beginning of when I started watching the dark haired woman said while two patients were in Emory, I'm assuming Dr. Brantly and Mrs. Writebol, they did environmental assessments.  Checking doorknobs they'd touched, table tops and such and they were unable to find any Ebola transfer environmentally, and this was when folks were severely ill.  Only directly on the patients were they able to find Ebola.  That's reassuring to me.  I'm glad they were able to do some experiments while those two were in there

 

ETA - About 14 minutes after I started watching she address the worries of it going airborne and states that this outbreak is 97% similar to the original 1970's outbreak.  She also talks about the VERY sick man who traveled by plane from Liberia to Nigeria and how terribly ill he was on the plane and how no one on that plane contracted Ebola.

Link to comment
Share on other sites

Speaking of Dr. Brantley, they should have him as a top consultant on how to handle Ebola, what the protocols should be, what works and doesn't.  Is there another US doctor with more hands-on experience treating Ebola (not to mention first-hand knowledge about what happens when protocols fail)?  If they are not using his expertise, they sure should be.

Link to comment
Share on other sites

There's a very interesting news conference happening on 

http://www.nbcnews.com/storyline/ebola-virus-outbreak/watch-live-cleveland-hospital-officials-hold-briefing-ebola-concerns-9-n227196

 

Near the beginning of when I started watching the dark haired woman said while two patients were in Emory, I'm assuming Dr. Brantly and Mrs. Writebol, they did environmental assessments.  Checking doorknobs they'd touched, table tops and such and they were unable to find any Ebola transfer environmentally, and this was when folks were severely ill.  Only directly on the patients were they able to find Ebola.  That's reassuring to me.  I'm glad they were able to do some experiments while those two were in there

 

ETA - About 14 minutes after I started watching she address the worries of it going airborne and states that this outbreak is 97% similar to the original 1970's outbreak.  She also talks about the VERY sick man who traveled by plane from Liberia to Nigeria and how terribly ill he was on the plane and how no one on that plane contracted Ebola.

 

That's great news!

 

Thanks for sharing.

 

Link to comment
Share on other sites

Notes from a conference on Ebola a couple days ago:

http://www.cidrap.umn.edu/news-perspective/2014/10/symposium-vaccine-seen-best-hope-arresting-ebola

 

"At a wide-ranging symposium on West Africa's Ebola epidemic today, much of the attention focused on the hope of an effective vaccine, as a US official announced that a large clinical trial of two candidate vaccines may be launched in Liberia in December.

Peter Jahrling, PhD, of the National Institute of Allergy and Infectious Diseases (NIAID), announced that plans call for a trial involving 30,000 participants, with 10,000 getting one of two candidate Ebola vaccines and 10,000 receiving a hepatitis vaccine as a control."

 

There's also some other stuff of interest, such as a bit of a discussion about whether "convalescent serum" actually does anything.

Link to comment
Share on other sites

Have you seen the picture of "Clipboard Guy" this morning? Four people in hazmat spacesuits are escorting the Ebola Nurse onto the plane to Atlanta. Clipboard Guy is in the same group with NO protection. Well, let me take that back. He had his anti-ebola clipboard standing between him and the virus. He also took the plane with them, also sans suit!

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share


Ă—
Ă—
  • Create New...