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Second Ebola Case in Dallas


emzhengjiu
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I think the ethics of giving out a hepatitis vaccine to a control group when ebola is spreading in the country are sketchy. I understand the need for a good experiment but this makes me feel a little ill. 

 

I completely agree.  Sadly, ugly problems rarely have pretty solutions. Or attempted solutions.

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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!

 

They've explained "Clipboard Guy". He is the supervisor and doesn't wear a suit because it limits visiblity and mobility. His job is to make sure they are careful and don't do anything wrong. They said it actually helps protect everyone involved. I'm not really worried at all about him.

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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!

I saw that on fb. Quite odd.

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They've explained "Clipboard Guy". He is the supervisor and doesn't wear a suit because it limits visiblity and mobility. His job is to make sure they are careful and don't do anything wrong. They said it actually helps protect everyone involved. I'm not really worried at all about him.

 

So I guess that means the OUTSIDE of the patient's suit has been thoroughly decontaminated? Since he seemed to board the plane with his clipboard.

 

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I just read that they are now also moving the first nurse to a hospital in Maryland. So, it definitely looks like the moves are because the Dallas hospital can't handle it and they want the patients somewhere that is better equipped not to spread it further.

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I just read that they are now also moving the first nurse to a hospital in Maryland. So, it definitely looks like the moves are because the Dallas hospital can't handle it and they want the patients somewhere that is better equipped not to spread it further.

There's a CNN article that says it's due to "staffing issues."

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There's a CNN article that says it's due to "staffing issues."

I really hope that is the case and not because the nurse is not recovering as expected.

 

I was hoping that she would recover quickly because they started the treatment very early in the infection. She has been on my thoughts.

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So I guess that means the OUTSIDE of the patient's suit has been thoroughly decontaminated? Since he seemed to board the plane with his clipboard.

 

He didn't touch her that I saw, and it seems her fluids and germs would be contained within her space suit.

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There's a CNN article that says it's due to "staffing issues."

 

This is probably true . . . I believe one of the press briefings said approximately 70 health care workers were being monitored.  I would take that to mean that those people are self-monitoring at home and are not working.  That is a huge number of personnel and would greatly impact the hospital's ability to care for anyone who needs specialized care.

 

I think it is fair to say that the hospital which treated Mr. Duncan was not equipped for ebola.  What is frightening is that there are 19 beds total among the 4 biocontainment facilities in the US (now there are 17).  What will happen if more people become ill?  I am praying that will not be the case but watching this unfold is not instilling confidence.

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http://www.nbcdfw.com/news/health/Dallas-County-Judge-Clay-Jenkins-Creates-Order-to-Restrict-Travel-of-Ebola-Health-Care-Workers-279336932.html

 

Dallas County Commissioners will hold a special meeting Thursday at 2 p.m. to declare a disaster over "the potential for widespread or severe damage, injury, loss or threat of life resulting from the Ebola virus."

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This is probably true . . . I believe one of the press briefings said approximately 70 health care workers were being monitored.  I would take that to mean that those people are self-monitoring at home and are not working.  That is a huge number of personnel and would greatly impact the hospital's ability to care for anyone who needs specialized care.

 

I think it is fair to say that the hospital which treated Mr. Duncan was not equipped for ebola.  What is frightening is that there are 19 beds total among the 4 biocontainment facilities in the US (now there are 17).  What will happen if more people become ill?  I am praying that will not be the case but watching this unfold is not instilling confidence.

 

I think those four facilities are the ideal for bio-containment.  But I think there are quite a few other facilities throughout the country that are quite capable of dealing with an Ebola patient.  Locally we're being told that there are 18 beds available.  Ten at a hospital that's part of a chain that has designated three of its fifteen hospitals as Ebola treatment facilities, and eight beds at a university hospital.  Both facilities say they have ALL the necessary equipment for staff protection and for disposal of wastes, isolation rooms with separate entrances from the ER departments, negative pressure rooms for long term isolation, and have done extensive training for handling patients with Ebola or similar issues.  I suspect there are many such facilities around the country.

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We had three ebola cases in the US already and none of the workers in Emory, or in Nebraska contracted ebola.

 

Yes, but Emory and Nebraska have specialized isolation units that were designed for treating diseases like ebola. They also have highly trained staff. There are only four hospitals in the US that have that capability.

 

Ă¢â‚¬Å“Given some of the complexities, patients who have this disease are probably best cared for by those who have experience caring for it, and whose healthcare workers are highly trained and drilled in self-protection,Ă¢â‚¬ says Dr. Gabe Kelen, the director of the Johns Hopkins Office of Critical Event Preparedness and Response. Ă¢â‚¬Å“ItĂ¢â‚¬â„¢s not appropriate to think that each and every hospital in the country could bring the resources, the intense training for the healthcare workers that is required.Ă¢â‚¬Â Â  http://time.com/3510197/ebola-cdc-hospitals/

 

 

Susan in TX

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I think those four facilities are the ideal for bio-containment.  But I think there are quite a few other facilities throughout the country that are quite capable of dealing with an Ebola patient.  Locally we're being told that there are 18 beds available.  Ten at a hospital that's part of a chain that has designated three of its fifteen hospitals as Ebola treatment facilities, and eight beds at a university hospital.  Both facilities say they have ALL the necessary equipment for staff protection and for disposal of wastes, isolation rooms with separate entrances from the ER departments, negative pressure rooms for long term isolation, and have done extensive training for handling patients with Ebola or similar issues.  I suspect there are many such facilities around the country.

 

There's a hospital where I am locally saying that too.

 

But, the staff is currently freaking out over that fact, and also the fact that NO ONE has been trained, and so far no training has been scheduled. Much as we would want them to welcome ebola patients, that has not been the reaction of people actually working there.

 

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I'll bet there are a lot of places around the country that would serve in a pinch. I was involved in cholera and yellow fever studies at the local university hospital. They have a separate wing for tropical infectious diseases. Seems like the best place locally to handle such a thing.

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There's a hospital where I am locally saying that too.

 

But, the staff is currently freaking out over that fact, and also the fact that NO ONE has been trained, and so far no training has been scheduled. Much as we would want them to welcome ebola patients, that has not been the reaction of people actually working there.

 

 

I've heard nothing to that effect here.  And my brother is a volunteer EMT and fireman, so is pretty much in-the-know about what's going on at all the hospitals.  He's reported nothing other than about how much continuing training is being done.

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Two unrelated things I've been pondering on and off:

 

1) Why has ebola not showed up in a country such as India or China or Canada? I have some ideas in mind but I'd like to hear what others think.

 

2) The NBC cameraman's friends/family had to start a online donation campaign for his $500k in bills. Apparently his insurance didn't cover this illness and as he was a contractor for NBC, he wasn't covered under their health plan either. This publicity wrt the campaign caused pressure to be applied to NBC, which has agreed to cover his expenses. Does a public health crisis such as this allow us to move closer to universal health care? Do people want to band together to pay for the healthcare of people who have contracted easily spread and highly fatal illnesses? Are people concerned that uninsured people will not seek help as soon as they could have, causing them to appear at the hospital in later, more contagious phases?

 

Like I said, just some things that keep popping into my mind.

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I'm watching CNN and at the bottom of the screen it said schools in Ohio and Texas are closed due to ebola fears.  Is anyone local to those school that can fill in why?

 

Everything I've heard and read says it has to do with people on the plane that she traveled on and they just wanted to close to clean.

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They closed a college near San Diego after a student vomited in class. It is unclear whether she or her family member was on the same flight as the nurse with ebola. They are quarantining many college students who were in the same room at this time and the CDC is responding. This is ongoing, so there are a lot of confusing reports.

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Two unrelated things I've been pondering on and off:

 

1) Why has ebola not showed up in a country such as India or China or Canada? I have some ideas in mind but I'd like to hear what others think.

 

Largely because the incubation period is fairly short, and once people have symptoms they get severely ill very rapidly. They aren't contagious before they have symptoms, and once they have symptoms they're far too sick to travel.

 

In addition, Liberians aren't nearly as mobile as many Westerners.  There just aren't that many Liberians traveling to China. 

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In addition, Liberians aren't nearly as mobile as many Westerners.  There just aren't that many Liberians traveling to China. 

I have a Chinese friend who runs several manufacturing businesses in the Guangdong province. He regularly flies to countries like Sierra Leone, Cameron, Ivory coast and Liberia because he sources the raw materials for all his manufacturing from there. And, I am told that his business contacts from these countries also fly into China often. You might be surprised at how much traffic there is between China and many parts of Africa.

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I have a Chinese friend who runs several manufacturing businesses in the Guangdong province. He regularly flies to countries like Sierra Leone, Cameron, Ivory coast and Liberia because he sources the raw materials for all his manufacturing from there. And, I am told that his business contacts from these countries also fly into China often. You might be surprised at how much traffic there is between China and many parts of Africa.

 

I would still wager there are more Liberians traveling to Europe/the US than China or India.

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I have a Chinese friend who runs several manufacturing businesses in the Guangdong province. He regularly flies to countries like Sierra Leone, Cameron, Ivory coast and Liberia because he sources the raw materials for all his manufacturing from there. And, I am told that his business contacts from these countries also fly into China often. You might be surprised at how much traffic there is between China and many parts of Africa.

 

He probably isn't coming into contact with many bodily fluids though.  It really is the HCW and the caregivers that are at high risk. 

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1) Why has ebola not showed up in a country such as India or China or Canada? I have some ideas in mind but I'd like to hear what others think.

 

 

 

I think the operative words are "not yet"...  

 

If cases continue to multiply in Africa, which at least at this time is what is happening, cases outside of Africa will tend to increase also, with the greatest increase being places with much travel between the one and the other.  Basically just math and statistics.

 

 

 

We have 150 people per day roughly arriving in USA from the affected West African countries said one report I heard. I would guess that there are fewer people going from affected countries into the countries that have not yet had a case.  Particularly with Liberia there are many strong ties between USAers and Liberians as we saw with Duncan who had not only fiancee, but also siblings, mother, and son in USA. And Europe is where planes tend to go first, plus there are groups like MSF.

 

 

But there is also always Chance as to  who happens to go where when. Or also animal imports that could bring a case, potentially.  Could be a country has only one visitor in a decade, but that one person happens to be infected. 

 

WHO is also currently saying that 95% of cases show up within 21 days of exposure, but that some take longer.

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Two unrelated things I've been pondering on and off:

 

1) Why has ebola not showed up in a country such as India or China or Canada? I have some ideas in mind but I'd like to hear what others think.

 

2) The NBC cameraman's friends/family had to start a online donation campaign for his $500k in bills. Apparently his insurance didn't cover this illness and as he was a contractor for NBC, he wasn't covered under their health plan either. This publicity wrt the campaign caused pressure to be applied to NBC, which has agreed to cover his expenses. Does a public health crisis such as this allow us to move closer to universal health care? Do people want to band together to pay for the healthcare of people who have contracted easily spread and highly fatal illnesses? Are people concerned that uninsured people will not seek help as soon as they could have, causing them to appear at the hospital in later, more contagious phases?

 

Like I said, just some things that keep popping into my mind.

 

I've been wondering about this also.  What about people who are uninsured?  I can't imagine the cost already with just the three cases that were diagnosed here.  Was Duncan insured?  Do the nurses have coverage for this disease?  (Do some insurance plans actually exclude ebola?)  If more and more people get this, I don't know that these people will be flown across country to specialized hospitals.  I've also wondered about the number of hospitals that are even equipped to deal with this. 

 

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The nurses employers will cover the costs as part of workers comp.  They can't receive cash benefits directly unless gross criminal neglect is found, which is doubtful, considering CDC's evolving guidelines.   Here's a link to a NY Times article on how the gear recommendations have changed and how they will likely change again: http://www.nytimes.com/interactive/2014/10/15/us/changes-to-ebola-protection-worn-by-us-hospital-workers.html

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I've been wondering about this also. What about people who are uninsured? I can't imagine the cost already with just the three cases that were diagnosed here. Was Duncan insured? Do the nurses have coverage for this disease? (Do some insurance plans actually exclude ebola?) If more and more people get this, I don't know that these people will be flown across country to specialized hospitals. I've also wondered about the number of hospitals that are even equipped to deal with this.

 

I would say the situation in Dallas has proved that local hospitals may be ill equipped, hence the patients now being taken to regional centers with all the higher levels of training, expertise and equipment. This level of care can't be provided for say hundreds or thousands in a large outbreak, but the point of the isolation and rigorous protocol is to avoid a large outbreak.
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I'm watching CNN and at the bottom of the screen it said schools in Ohio and Texas are closed due to ebola fears.  Is anyone local to those school that can fill in why?

 

The nurse who cared for Mr. Duncan and was recently diagnosed with Ebola was in NE Ohio visiting family over the weekend.  It is now coming out that she was starting to show symptoms before flying out of Cleveland and being diagnosed the following day.  Local health departments and the CDC are trying to contact everyone who had contact with the nurse.  Some of the people who were in contact with her are employees at the schools.  In "an abundance of caution", the schools are closing so they can be cleaned.  Her family members and anyone else who had physical contact with her (which could even be a brief handshake) are under mandatory quarantine.

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I would say the situation in Dallas has proved that local hospitals may be ill equipped, hence the patients now being taken to regional centers with all the higher levels of training, expertise and equipment. This level of care can't be provided for say hundreds or thousands in a large outbreak, but the point of the isolation and rigorous protocol is to avoid a large outbreak.

 

That's why quarantine is important for people coming from heavily infected regions. If this continues to spread exponentially in the three most afflicted countries, outbreaks elsewhere are highly probably, but delaying the travel while quarantine procedures are followed can keep this to a reasonable level. If not, sooner or later someone is going to screw up at a time when there are multiple outbreaks, and another country will have a runaway epidemic. It might happen anyway, but there are certainly things we can do to limit the likelihood of that while we develop a vaccine.

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I have many friends who are nurses and they are concerned. They are all telling me that their hospitals are not equipped to handle Ebola, despite what the hospital spokespeople say.  One nurse said that her hospital doesn't have any gowns that would meet CDC requirements for containing Ebola.  Another said the hospitals are scrambling to update training on infectious disease and include Ebola.

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I spoke with a nurse who is within one hour of a major US city.  She says they are totally unprepared.  They have some equipment on order...

Not only are the schools (that closed) being cautious and cleaning up, but it's probably a cost saving measure as well.  They have to have so many butts in chairs before they get state/federal funding, so if enough parents pull their kids out of school, it isn't worth it.  Not to mention the lessons that would have to be retaught due to so many missing etc.  I think it is one of the wisest decisions.  And even if there's little risk of Ebola being there, it's not like they couldn't use it anyways.

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Well I was predicting the next region to have a case of ebola outside Africa to be the UK. I was thinking about where people might have relatives, good healthcare, and standing visas. Another approach would be to see which countries are sending the most aid workers. Anyone got a list? I found an interesting WSJ article about how Cuba is sending lots of people but it seems to have become password-protected.

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As horrible as all this is, Mr Duncan's arrival in the US might in the end save lives.

 

I was truly shocked by how unprepared the hospital/CDC were (previously I had assumed that the US would be really on top of something like this). I am not very worried that ebola will lead to a major epidemic in the US or Europe at this point. Ebola in its current state really isn't that "smart" a disease as it doesn't appear to be very contagious early on. Once patients are really contagious they are unlikely to travel, walk around unnoticed etc.

 

However, I do think there could be another disease in the near future (or a mutation of the current ebola). Let's say with the same fatality rate but more like chicken pox as far as passing it on to others is concerned (i.e. the infected person is already contagious several days prior to the first signs of the disease). It appears that with the way things currently stand this would be a true disaster and by the time hospitals stepped up training, ordered supplies etc. the virus would have spread to such an extent that it couldn't be stopped anymore. But now that it is out in the open how much still needs to be done I do hope the CDC/hospitals/law makers will improve matters so that if a more dangerous virus comes along the hospitals are better prepared to handle it.

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This morning, I read on FoxNews.com that the Colombian government has banned entry of people who have been in one of  5 countries in Africa, during the past 4 weeks.  That the 2nd Nurse was permitted by the CDC to travel on civil turbojet aircraft within the U.S.A. is astonishing to us. I hope and pray the CDC and the U.S. Government will begin take Ebola much more seriously.  We flew back to Cali Tuesday afternoon and the idea of someone like the 2nd Nurse being in an aircraft with us is not comforting to us. Apparently if one is within 3 feet of someone like the 2nd Nurse, they can catch Ebola and in an aircraft that distance is quite possible, especially when boarding or deplaning. To say nothing of sitting near someone like that...

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As horrible as all this is, Mr Duncan's arrival in the US might in the end save lives.

 

 

I am not bothered that it was Mr Duncan who brought the disease to America. The world is so small that this disease was bound to show up in America (and other parts of the world as well) sooner or later. 

 

If this disease gets into densely populated countries with poor sanitation, public hygiene, low funding for public health etc, then, there is going to be a calamity. I am hoping that this disease gets eradicated by containment.

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As horrible as all this is, Mr Duncan's arrival in the US might in the end save lives.

 

I was truly shocked by how unprepared the hospital/CDC were (previously I had assumed that the US would be really on top of something like this). I am not very worried that ebola will lead to a major epidemic in the US or Europe at this point. Ebola in its current state really isn't that "smart" a disease as it doesn't appear to be very contagious early on. Once patients are really contagious they are unlikely to travel, walk around unnoticed etc.

 

However, I do think there could be another disease in the near future (or a mutation of the current ebola). Let's say with the same fatality rate but more like chicken pox as far as passing it on to others is concerned (i.e. the infected person is already contagious several days prior to the first signs of the disease). It appears that with the way things currently stand this would be a true disaster and by the time hospitals stepped up training, ordered supplies etc. the virus would have spread to such an extent that it couldn't be stopped anymore. But now that it is out in the open how much still needs to be done I do hope the CDC/hospitals/law makers will improve matters so that if a more dangerous virus comes along the hospitals are better prepared to handle it.

 

I completely believed that the Texas hospital would be up to the task. I'm still shocked by how all this has been bungled. One of the things that shocked me the most was that caregivers for Mr. Duncan continued to serve other patients.

 

I am proud of my hometown of Lubbock, Texas. They have a suspected case of Ebola--person showing symptoms and has been to West Africa recently--no confirmed diagnosis yet. According to news reports I heard on my way home from Costco, that person has been installed in an isolation unit in the hospital and will have a dedicated staff to attend him or her. Whether that hospital is able to do anything else correctly, it seems as if they are starting off on the right foot.

 

One of the people from the airplane is sheltering in his home with his family just a *few* miles from where I live--crossing over county lines from the original cases. Sobering.

 

Dh and I are discussing sending a donation to both Doctors without Borders and Samaritan's Purse. It sounds as if cash is the best way our family can help. And as sad as it is to say, maybe this outbreak in Texas will wake a few more people like me up. I'm involved in good things in other countries...now we are adding Africa to that short list.

 

I am hopeful that we are finally getting ahead of this in the US...hopeful...not certain.

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This morning, I read on FoxNews.com that the Colombian government has banned entry of people who have been in one of  5 countries in Africa, during the past 4 weeks.  That the 2nd Nurse was permitted by the CDC to travel on civil turbojet aircraft within the U.S.A. is astonishing to us. I hope and pray the CDC and the U.S. Government will begin take Ebola much more seriously.  We flew back to Cali Tuesday afternoon and the idea of someone like the 2nd Nurse being in an aircraft with us is not comforting to us. Apparently if one is within 3 feet of someone like the 2nd Nurse, they can catch Ebola and in an aircraft that distance is quite possible, especially when boarding or deplaning. To say nothing of sitting near someone like that...

 

.....not to mention that air in an airplane cabin is recirculated.  I'm pretty sure that airline cabins are not equipped with air scrubbers like the ones in the CIDRAP articles.  

 

And my daughter is flying three times this coming week.  I guess I'm thankful this nurse flew already, so that bit of learning curve is behind us. (Dumb, dumb, dumb--what were they thinking?!?) 

 

ETA:  apologies for my grumpiness over this...

 

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