Ebola outbreak - general thread #5

[Ladylub]

Again, droplet transmission.

I won't be offering my knowledge or experience to this thread any further.

The problem is the local health officials and the CDC are not talking or acknowledging the fact that droplet transmission can occur. They stop at it's not airborne they do not hint at droplet transmission. Again a lay person will not even think there is much of a difference between airborne and droplet transmission.

 

[Gardenlady]

I'm frankly confused as to why so many blame the CDC for this situation in Dallas.

Due to how both our healthcare system and how our very government (federal/state/local) is set up, the responsibility for implementing protocols lies with the state and local health departments and the facilities themselves. The CDC is not a police force. It cannot enforce rules even if it had the manpower to do so. The CDC regularly issues advisories, etc regarding ALL kinds of communicable diseases. Whether there is follow through or not is the responsibility of the states/localities and facilities, unfortunately.

Those who wish to blame the CDC and say it should do more should follow through on that by pressuring your elected officials to earmark more funds for the CDC and to legislate to expand it's function. Or vote for candidates who support such expansion and more robust funding.

I have a sneaking suspicion though that the segment of the public who want to blame CDC are the same segment of the public that objects to most all federal oversight of absolutely anything ("too much regulation!") and are the same who are in favor of budget cuts to things like public health.

Some need to ask themselves what on earth the state and local health departments down in Texas were doing over the summer when CDC was already warning about future Ebola cases, and already had information regarding protocols out. I know they did because I saw them at the practice I worked at last summer. After all, if the "ideal" way to deal with problems is at the state and local level rather than the federal, then why weren't they carrying out their responsibility down there? And why wasn't this facility training it's staff in preparation? one would think the free market would dictate that it's in the facility's interest to protect it's workers (an thus it's profit), no?

Can't have it both ways.


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[ClaireNC]

JMO I just thought that PERHAPS there is some ancient genetic immunity..........but that is just wishful thinking. It does make me wonder, though, why the numbers of the afflicted in West Africa aren't even greater than they already are, considering the burial rituals and denial and close quarters and environmental conditions. JMO

The part about Louise and her family not contracting the disease so far it also very interesting to me. Thanks to nrdsb4 and Sonya610 for your professional insights. Thanks Cady for bringing it up. Could it be a combination of the "it is not a contagious earlier on" and some level of "genetic immunity"? Since it is fair to assume that the people living in the US have generally better nutrition and living conditions than those living in West Africa, their immune systems might be stronger than people in their home country.

As for "why the numbers of the afflicted in West Africa aren't even greater than they already are". There are far greater than the number of cases reported by WHO. I've seen some estimates that more than half of the actual cases are not being reported.

 

[SCHMAE]

Matthew Keys just tweeted that WFAA-TV stated that the second healthcare worker to contract Ebola in Texas was not among workers previously examined.


wow....

On my phone so can't copy paste the tweet. @MatthewKeys

Arggh, WTAF ?

 

[CARIIS]

I am just curious. I was in management (psyc) at several stops along my career. Admin has some very serious issues here. I am curious:

How many ceus are rquired per renewal?

If I wanted to address moral (and I understand $ does not = putting peoples lives in danger! But I had better try to address this

Would me retaining approved CEU providers, develop training per WHO mandates, and I make the training meet requirements for CEU requiremnts, and paid for everything so at least you could take care of your CEU obligations on me for free?

would that have some value -

I would need to make a face to face, no recirmations options to encourage staff to vent at me, to outline their needs. I need to acknoledge I dropped the ball not you.

Would that be helpful?

Would me offering hazard pay (offensive?)

Would best I could provide more staff per shift be perceived as hearing you?

I mean , I know nursing is in short supply and high demand - I had better do what I need to retain my nursing staff - but a pis4ed off staff is certainly an issue!

wWhat could admin in dallas do to at least address moral - but since we are in Dallas

Would it be offensive if I said I am working out with Emory and Neb to take any new cases we might have as a result of my failings - is that insulting or a releif!

Anyone know off hand how many total beds avail in the 4 facities?

Why cant they (they have more than 4000) have the military pros trained with biohazard issues be sent to the main hospitals, with the right ewquipemtn and do the praciticing the suits - they , all of em , just look like a mess to me!
Each nurse here, on WS, your notins here

TIA

 

[SStarr33]

I'm frankly confused as to why so many blame the CDC for this situation in Dallas.

Due to how both our healthcare system and how our very government (federal/state/local) is set up, the responsibility for implementing protocols lies with the state and local health departments and the facilities themselves. The CDC is not a police force. It cannot enforce rules even if it had the manpower to do so. The CDC regularly issues advisories, etc regarding ALL kinds of communicable diseases. Whether there is follow through or not is the responsibility of the states/localities and facilities, unfortunately.

Those who wish to blame the CDC and say it should do more should follow through on that by pressuring your elected officials to earmark more funds for the CDC and to legislate to expand it's function. Or vote for candidates who support such expansion and more robust funding.

I have a sneaking suspicion though that the segment of the public who want to blame CDC are the same segment of the public that objects to most all federal oversight of absolutely anything ("too much regulation!") and are the same who are in favor of budget cuts to things like public health.

Some need to ask themselves what on earth the state and local health departments down in Texas were doing over the summer when CDC was already warning about future Ebola cases, and already had information regarding protocols out. I know they did because I saw them at the practice I worked at last summer. After all, if the "ideal" way to deal with problems is at the state and local level rather than the federal, then why weren't they carrying out their responsibility down there? And why wasn't this facility training it's staff in preparation? one would think the free market would dictate that it's in the facility's interest to protect it's workers (an thus it's profit), no?

Can't have it both ways.


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CDC had people on the ground in Dallas within hours of Duncan being admitted.

CDC had an increase in budget this year.

"No doubt in my mind we will stop it here." Dr. Thomas Frieden, CDC conference. September 30, 2014, 5:46 pm E.T.

Not saying the hospital has no culpability, but this is why they are being blamed.

 

[Isabelle]

I agree. They are missing a MAJOR opportunity to educate the public.

Prevention is nothing we didn't know for a very long time, at least since the work of Van Leeuwenhoek. Education of the general public needs to be reinforced. Simply, hand washing is number one! Others include, cover mouth to cough or sneeze and wash hands if you don't use a tissue. These are used to prevent the spread of flu and common cold, both of which are viruses. I, retired an I learned about these prevention methods when I was a young child.

 

[nrdsb4]

I just meant that my sister heard another healthcare worker has Ebola now.

Actually, after I posted, it occurred to me that maybe I misinterpreted the "interpretation."

My bad.

 

[Hatfield]

The problem is the local health officials and the CDC are not talking or acknowledging the fact that droplet transmission can occur. They stop at it's not airborne they do not hint at droplet transmission. Again a lay person will not even think there is much of a difference between airborne and droplet transmission.

Right. They were definitely being disengenous. And it could have serious consequences. Like when the poor cleaning crews were pressure washing the puke outside the 1st victims apartment, and they were originally wearing no protective clothing. Thank goodness so far those cleaning crew guys have not come down with it.

The bottom line is this nasty diseases needs to be treated with an OVER-abundance of caution. There is absolutely no need to downplay it in the news. And frankly it is very dangerous to downplay the serious of it.

 

[SCHMAE]

» What is transmission by droplet contact?
Some diseases can be transferred by infected droplets contacting surfaces of the eye, nose, or mouth. This is referred to as droplet contact transmission. Droplets containing microorganisms can be generated when an infected person coughs, sneezes, or talks. Droplets can also be generated during certain medical procedures, such as bronchoscopy. Droplets are too large to be airborne for long periods of time, and quickly settle out of air. Droplet transmission can be reduced with the use of personal protective barriers, such as face masks and goggles. Measles and SARS are examples of diseases capable of droplet contact transmission.

» What is airborne transmission?
Airborne transmission refers to situations where droplet nuclei (residue from evaporated droplets) or dust particles containing microorganisms can remain suspended in air for long periods of time. These organisms must be capable of surviving for long periods of time outside the body and must be resistant to drying. Airborne transmission allows organisms to enter the upper and lower respiratory tracts. Fortunately, only a limited number of diseases are capable of airborne transmission.

http://microbiology.mtsinai.on.ca/faq/transmission.shtml

So airborne transmission would be loosely like someone with an airborne bug we'll call XYZ walks down the street , not sneezing or puking or anything else , just walking along. A group of people walk down the same street some minutes later and walk into the XYZ particles somewhat hanging around in the air and they can get sick from it . Is that right? I'm picturing the pigpen kid from charlie brown and hes' got this little debris cloud that follows him and encircles him full of XYZ particles.

 

[Island_Chica]

Hi folks! I didn't realize there was an ebola thread 'round these parts. Anyway, I'm jumping in to share what little I know. My husband works for the CDC (he's not a scientist, but is involved in developing proprietary disease reporting software for the agency) and my cousin (also a close friend) is a healthcare provider at Emory, where the two aid workers (Kent Brantley and the older lady) were treated. I don't want to be much more specific than that, but I can shed *some* light on transmission methods, prevention techniques, etc from what I've been told.

From what I understand from my Emory contact, healthcare providers at that hospital used full hazmat suits with respirators. The respirators in particular help eliminate the risk of transmission from mucus droplets, etc. The workers are decontaminated while still in the suits, then suits are removed, then they are decontaminated again. I don't believe the respirator was used by the Texas workers. I *think* the full hazmat suit is called a "Level 4" precaution, and current CDC guidelines for ebola only require use of Level 3 precautions, or something similar. Note that none of the providers from the Emory team got infected. Granted, they have the highest level secure ward for dealing with such diseases, but I'd think their practices would be the gold standard moving forward.

CDC guidelines be damned. If I were the CEO or director of a hospital, I'd require Level 4 precautions for my team in dealing with any ebola patients.

Also, please note there is no widespread panic among CDC employees about ebola. It is being taken extremely seriously, but there is not a sense of panic. Take from that what you will.

 

[nrdsb4]

The part about Louise and her family not contracting the disease so far it also very interesting to me. Thanks to nrdsb4 and Sonya610 for your professional insights. Thanks Cady for bringing it up. Could it be a combination of the "it is not a contagious earlier on" and some level of "genetic immunity"? Since it is fair to assume that the people living in the US have generally better nutrition and living conditions than those living in West Africa, their immune systems might be stronger than people in their home country.

As for "why the numbers of the afflicted in West Africa aren't even greater than they already are". There are far greater than the number of cases reported by WHO. I've seen some estimates that more than half of the actual cases are not being reported.

There has been talk of the possibility of a genetic mutation which allows some people to have an inborn immunity. I don't know if that has been established.

 

[oh_gal]

We thank you for being in the field of helping others.

Our lives (general public) are on the lines as well with this horrific disease.

YES!!! Your life may be on the line, at first....but when you peruse the aisles at the same grocery store I'm in, or sit behind me in the theater, you're putting my life on the line, as well, should you become infected. We're all in this together.

 

[Gardenlady]

CDC had people on the ground in Dallas within hours of Duncan being admitted.

CDC had an increase in budget this year.

"No doubt in my mind we will stop it here." Dr. Thomas Frieden, CDC conference. September 30, 2014, 5:46 pm E.T.

Not saying the hospital has no culpability, but this is why they are being blamed.

The CDC brought in it's contact tracing people, as I understand it. They cannot, in their current form be expected to oversee each and every case that comes up. It is simply not possible. They are now sending in a stronger team because locally it has been FUBARed.

I believe also this will be stopped there in Dallas, if protocols and training are implemented and followed.


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[nrdsb4]

So airborne transmission would be loosely like someone with an airborne bug we'll call XYZ walks down the street , not sneezing or puking or anything else , just walking along. A group of people walk down the same street some minutes later and walk into the XYZ particles somewhat hanging around in the air and they can get sick from it . Is that right? I'm picturing the pigpen kid from charlie brown and hes' got this little debris cloud that follows him and encircles him full of XYZ particles.

Yes, that's getting close. But remember that airborne particles can also float far from the source. If ebola was spread by airborne route (consider chicken pox which could be spread from aisle 7 to an unsuspecting victim in aisle 9), it would change EVERYTHING in terms of how easily it is contracted to how patients are isolated, etc. The people trying to minimize the difference between droplet and airborne transmission don't seem to realize the implications of an airborne virus.

 

[SStarr33]

The CDC brought in it's contact tracing people, as I understand it. They cannot, in their current form be expected to oversee each and every case that comes up. It is simply not possible. They are now sending in a stronger team because locally it has been FUBARed.

I believe also this will be stopped there in Dallas, if protocols and training are implemented and followed.


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Actually, they announced yesterday they will be going to EVERY hospital with an ebola patient to oversee the care.

 

[WideOpen]

:juggle:

Wait, who is they, CDC? Virginia has been since the first week of August, with all health care workers.

Thanks!
Yes, the CDC.
I am just trying to say that as a nation, our health care workers and hospitals need to be able to combat this effectively. Who knows where the next sick ebola patient will turn up...will your city be ready?:juggle:

jmo

 

[nrdsb4]

Right. They were definitely being disengenous. And it could have serious consequences. Like when the poor cleaning crews were pressure washing the puke outside the 1st victims apartment, and they were originally wearing no protective clothing. Thank goodness so far those cleaning crew guys have not come down with it.

As far as the cleaning crew goes, they were lucky in that they were cleaning that sidewalk four or five days later, after several days of sunshine and 95-97 degree temps. Had they gone in immediately without protection, could be a different story.

 

[Isabelle]

Again, droplet transmission.

I won't be offering my knowledge or experience to this thread any further.

Have officials acknowledged that the spread of Ebola can occur via droplet transmission (airborne in usual terms, not the spraying or splashing body fluids)? Thanks

 

[nrdsb4]

Hi folks! I didn't realize there was an ebola thread 'round these parts. Anyway, I'm jumping in to share what little I know. My husband works for the CDC (he's not a scientist, but is involved in developing proprietary disease reporting software for the agency) and my cousin (also a close friend) is a healthcare provider at Emory, where the two aid workers (Kent Brantley and the older lady) were treated. I don't want to be much more specific than that, but I can shed *some* light on transmission methods, prevention techniques, etc from what I've been told.

From what I understand from my Emory contact, healthcare providers at that hospital used full hazmat suits with respirators. The respirators in particular help eliminate the risk of transmission from mucus droplets, etc. The workers are decontaminated while still in the suits, then suits are removed, then they are decontaminated again. I don't believe the respirator was used by the Texas workers. I *think* the full hazmat suit is called a "Level 4" precaution, and current CDC guidelines for ebola only require use of Level 3 precautions, or something similar. Note that none of the providers from the Emory team got infected. Granted, they have the highest level secure ward for dealing with such diseases, but I'd think their practices would be the gold standard moving forward.

CDC guidelines be damned. If I were the CEO or director of a hospital, I'd require Level 4 precautions for my team in dealing with any ebola patients.

Also, please note there is no widespread panic among CDC employees about ebola. It is being taken extremely seriously, but there is not a sense of panic. Take from that what you will.

Thank you for posting. Another question I have is: how many times a day would a nurse need to suit up, decomtaminate, re-suit up, etc. in a given 8 hour shift? It seems the more times they have to do this, the more the risk.