Ebola outbreak - general thread #3

[SStarr33]

If a person with ebola coughs or sneezes, the virus can be spread.

Period.

 

[LinasK]

As was pointed out a few pages ago, malaria is not contagious.

http://www.cdc.gov/malaria/about/faqs.html

I'm aware of that, but had he even said I think the dying pregnant lady I handled 3 days ago had malaria, I can almost guarantee that the ER in Dallas wouldn't have been so quick to discharge him with antibiotics. They would have questioned him more thoroughly about the area he was from and her symptoms. He would have gotten their attention, and then they would have made the connection to Ebola. That's my point.

 

[popsicle]

[h=1]Spain to kill dog of Madrid woman with Ebola[/h]
Authorities said in a statement Tuesday that available scientific knowledge indicates there's a risk the dog could transmit the deadly virus to humans.

http://www.cbsnews.com/news/spain-to-kill-dog-of-madrid-woman-who-contracted-ebola/

 

[DeDee]

Thomas Eric Duncan physically carried the convulsing pregnant lady as she was too weak to walk. She, her brothers and three neighbors died. Once in America, Duncan informed the hospital that he had been in Liberia.

http://www.dailymail.co.uk/news/art...ur-neighbors-died-So-allowed-step-flight.html

It is my impression that the neighbor was bleeding from multiple orifices that led the others to believe that she was miscarrying a 7mo fetus. Since she died the very next day, we know she was showing the final stages of the ravaging Ebola.

 

[DeDee]

What do they do with these protective garments once removed? Gee, it would be hard to get one of the moon suits off without touching the outside. I wonder what the price of one of them costs. They couldn't be reusable.[/QUOTE

They are burned in special medical incinerators which are constructed for the purpose of disposing of infected or harmful waste.

The items gathered from the contaminated apartment were wrapped and sent to Kansas for proper disposal. The official's kept a photo album + her passport. The rest was loaded on a vehicle and hauled out of state for incinerating.

 

[SStarr33]

A vexing mystery in Spain: How did a nurse contract Ebola?
October 7 at 3:23 PM

http://www.washingtonpost.com/news/...rs-raise-concerns-about-protective-equipment/

From the photo, it seems like Spain's PPE standards are more strict than the CDC.

 

[Detective Klimpt]

Hey, new pics. Here's one of Louise. And guess what. Louise's nephew in the pic just arrived from Liberia a couple weeks before Duncan. Pics of JesseJ, Duncan's mom, and all the usually goodies the MailonLine generally provides. They sure do get more details than the US papers.

http://www.dailymail.co.uk/news/art...tml?ITO=1490&ns_mchannel=rss&ns_campaign=1490

 

[Redux]

I'm aware of that, but had he even said I think the dying pregnant lady I handled 3 days ago had malaria, I can almost guarantee that the ER in Dallas wouldn't have been so quick to discharge him with antibiotics. They would have questioned him more thoroughly about the area he was from and her symptoms. He would have gotten their attention, and then they would have made the connection to Ebola. That's my point.

Just trying to stick to facts. You said he would have been isolated if he mentioned malaria but malaria is not contagious.

 

[Lyra500]

http://www.nytimes.com/2014/08/16/health/hospitals-in-the-us-get-ready-for-ebola.html

The C.D.C. says that health care workers treating Ebola patients need only wear gloves, a fluid-resistant gown, eye protection and a face mask to prevent becoming infected with the virus. That is a far cry from the head-to-toe “moon suits” doctors, nurses and aides have been seeing on television reports about the outbreak.

Some hospital officials are skeptical of the new advice. “It’s not going to be enough for my health care workers to feel comfortable going into an isolation room,” said Peggy Thompson, the director of infection prevention at Tampa General Hospital.

This is the UK guidance:

I think they advise graded protection depending on whether patients are:

• possible cases of EVD (minimal risk)
• probable cases of EVD (staff at risk)
• confirmed cases of EVD (staff at high risk)

This is what is in the UK algorithm (I hope I can reproduce it in a legible way)

INFECTON CONTROL MEASURES
MINIMAL RISK Standard precautions apply: Hand hygiene, gloves, plastic apron (Eye protection and fluid repellent surgical facemask and for splash inducing procedures)

STAFF AT RISK Hand hygiene, gloves, plastic apron, fluid repellent surgical facemask, eye protection (FFP3 respirator for aerosol generating procedures ) Patients that have extensive bruising, active bleeding, uncontrolled diarrhoea, uncontrolled vomiting: Hand hygiene, double gloves, fluid repellent disposable gown/suit, eye protection, FFP3 respirator

STAFF AT HIGH RISK Hand hygiene, double gloves, fluid repellent disposable gown or suit, plastic apron (over disposable gown/suit) eye protection, FFP3 respirator

So the high risk clothing is not unlike what CDC have described. I think the bit which is missing is the hood - I am sure this must be a requirement in high risk situations - there is no way you would want bits of virus shedding blood, vomit or worse stuck in your hair.

 

[SStarr33]

This is the UK guidance:

I think they advise graded protection depending on whether patients are:

• possible cases of EVD (minimal risk)
• probable cases of EVD (staff at risk)
• confirmed cases of EVD (staff at high risk)

This is what is in the UK algorithm (I hope I can reproduce it in a legible way)



So the high risk clothing is not unlike what CDC have described. I think the bit which is missing is the hood - I am sure this must be a requirement in high risk situations - there is no way you would want bits of virus shedding blood, vomit or worse stuck in your hair.

How do you predict when someone is going to vomit?

ETA--

But Dr. Michael V. Callahan, an infectious disease specialist at Massachusetts General Hospital who has worked in Africa during Ebola outbreaks, does not think it is wrong for hospitals to opt for more protective equipment.

The minimal precautions recommended by the C.D.C. “led to the infection of my nurses and physician co-workers who came in contact with body fluids,” Dr. Callahan said. “I understand the desire to maintain absolute protection in U.S. hospitals.”

 

[trigger]

Coast Guard sector issue
PROVIDENCE, R.I. (AP) — One U.S. Coast Guard sector says it will contact ships that have recently been to Ebola-affected countries to ask whether passengers have symptoms of the virus before they are allowed into port.s new steps on ebola.

http://m.sfgate.com/news/medical/ar...es-new-protocols-to-prevent-Ebola-5806464.php

 

[Lyra500]

How do you predict when someone is going to vomit?

The clothing for high risk would be for nursing confirmed cases of Ebola. I was merely saying that whilst not obviously specified, I could not believe this outfit would omit a hood to completely cover the head (obviously with a hole for the face) This would be standard wear for anyone nursing a high risk patient - so no need to predict vomiting or anything else.

 

[SStarr33]

The clothing for high risk would be for nursing confirmed cases of Ebola. I was merely saying that whilst not obviously specified, I could not believe this outfit would omit a hood to completely cover the head. This would be standard wear for anyone nursing a high risk patient - so no need to predict vomiting or anything else.

Well, according to the CDC, it is overkill.

 

[LinasK]

How do you predict when someone is going to vomit?

You don't! When I was working in a nursing home, I had a patient projectile vomit all over me. I did NOT have personal protective gear on. Fortunately, this particular patient wasn't contagious.

 

[Lyra500]

Had a look in the appendices of the Public Health England document and there is further guidance for staff at high risk which does suggest the complete coverall that we see in the video coverage from West Africa.

https://www.gov.uk/government/publi...orithm-and-guidance-on-management-of-patients

9. The PPE/RPE combination has to establish a barrier against contact with contaminated surfaces, splash, spray, bulk fluids and aerosol particles as follows:

64
 Should provide complete adequate coverage of all exposed skin, with sufficient integrity to prevent ingress or seepage of bulk liquids or airborne particles, under foreseeable conditions of usage;  The materials from which the PPE is made should resist penetration of relevant liquids/suspensions and aerosols;  The various components (body clothing, footwear, gloves, respiratory/face/eye protection) should be designed to interface sufficiently well to maintain a barrier, e.g. sleeves long enough to be adequately overlapped by glove cuffs.

 

[Hiandmighty]

Yeah, links to Fundraising sites aren't allowed.

 

[SStarr33]

Had a look in the appendices of the Public Health England document and there is further guidance for staff at high risk which does suggest the complete coverall that we see in the video coverage from West Africa.

https://www.gov.uk/government/publi...orithm-and-guidance-on-management-of-patients

I sure would feel more comfortable in the head to toe gear. It is crazy to me that Dr. Brantley's caregivers took them off

 

[AlwaysShocked]

A vexing mystery in Spain: How did a nurse contract Ebola?
October 7 at 3:23 PM

http://www.washingtonpost.com/news/...rs-raise-concerns-about-protective-equipment/

From the photo, it seems like Spain's PPE standards are more strict than the CDC.

Maybe in that photo. But in reality, the nurse who caught it was given a suit that was not impervious to liquids.

There are health care workers marching in protest in the streets in Spain.

-----------------

At least here in the U.S. it is certainly the obligation of the employer to provide workers with appropriate protective gear. It is part of the OSHA laws. Often the worker himself may not know exactly what type of protective gear they need. The burden to know what is required for each situation rests on the employer.

But it sure does behoove a worker to educate him/herself as to what is required. Some employers are known for cutting corners when and where they can.

 

[Lyra500]

http://www.who.int/mediacentre/news/ebola/06-october-2014/en/

The Ebola virus is transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious being blood, faeces and vomit

The Ebola virus has also been detected in breast milk, urine and semen. In a convalescent male, the virus can persist in semen for at least 70 days; one study suggests persistence for more than 90 days.

Saliva and tears may also carry some risk. However, the studies implicating these additional bodily fluids were extremely limited in sample size and the science is inconclusive. In studies of saliva, the virus was found most frequently in patients at a severe stage of illness. The whole live virus has never been isolated from sweat.

The Ebola virus can also be transmitted indirectly, by contact with previously contaminated surfaces and objects. The risk of transmission from these surfaces is low and can be reduced even further by appropriate cleaning and disinfection procedures.

The article goes on to discuss the potential for airborne and droplet infection and what the chances of mutation to become airborne are.

 

[Sophieandme]

I watched ALL of the CDC press conference and there is no indication that Ebola Zaire ( the strain affecting people in W. Africa, and Mr. Duncan and scattered health workers) has or will mutate to become airborne.
It has remained 99.4% stable for over 20 years.
As an aside, and perhaps a teaching guide,aerosolized does not mean the same thing as airborne in a medical setting.
Secretions such as blood or other fluid in the lungs can and do become aerosolized when a person is on a mechanical ventilator and coughs. Or is suctioned and the suctioned airway is cleared with sterile saline. That's why the right kind of masks with the correct usage time limits are important.

So MANY things that occur with an infected person's body secretions can be classified as a health care worker or the machinery they are hooked up to causing aerosolization within the Isolated Area and Field.
This is definitely not the same thing as John Doe contracting Ebola and breathing without presence of the signs and symptoms of the disease ( which are respiratory as well as GI and generalized systemic disease later on).
Ebola is NOT spread through the air with normal breathing. It is not a disease transmitted through the respiratory tract of asymptomatic individuals.

Good distinction between airborne and aerosolized.


BBM
However, I think it can be risky to compare Ebola Zaire's stability in the past to this current outbreak. From NPR:

Ebola Is Rapidly Mutating As It Spreads Across West Africa
(snipped)

For starters, the data show that the virus is rapidly accumulating new mutations as it spreads through people. "We've found over 250 mutations that are changing in real time as we're watching," Sabeti says.

While moving through the human population in West Africa, she says, the virus has been collecting mutations about twice as quickly as it did while circulating among animals in the past decade or so.

"The more time you give a virus to mutate and the more human-to-human transmission you see," she says, "the more opportunities you give it to fall upon some [mutation] that could make it more easily transmissible or more pathogenic."

http://www.npr.org/blogs/goatsandso...dly-mutating-as-it-spreads-across-west-africa
________

According to the WHO, there have been 6,574 cases in this outbreak as of Sept. 23rd, as opposed to only 2300-2400 cases of all Ebola strains (excluding Reston) from 1976 through 2013. That's quite an explosion of human to human transmissions which will likely increase the number of mutations. That's unsettling, IMO.

http://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a4.htm?s_cid=mm6339a4_w