Ebola outbreak - general thread #5

[Elley Mae]

On Tuesday, Dr. Tom Frieden, head of the CDC, acknowledged that the government wasn't aggressive enough in managing Ebola and containing the virus as it spread from the infected patient in Texas.

http://www.latimes.com/nation/natio...la-patient-20141015-story.html#navtype=outfit

...........................

http://www.bloomberg.com/news/2014-...ining-lags-with-gap-in-federal-oversight.html

snippets

Even as the CDC has hastened to reassure the public that the virus won’t spread in the U.S., the agency doesn’t monitor hospitals and has no authority to make sure they comply with official guidelines, according to Abbigail Tumpey, a CDC spokeswoman who is leading the education outreach to hospitals.

Many nurses have been directed to look up the recommendations on the CDC website or they are handed one sheet of paper and given a kit with Ebola equipment in it, but they haven’t received training on how to use it, Burger said.

The CDC doesn’t have the authority to determine whether hospitals are qualified or not, Tumpey, the agency spokeswoman, said. “Sometimes moving patients is not possible if they are too ill,” she said in an e-mail. “We are looking into this issue further.”

http://www.bloomberg.com/news/2014-...ining-lags-with-gap-in-federal-oversight.html

It’s up to each hospital to enforce infection control, and standards vary depending on funding for infection experts and time devoted to training.

 

[alwaysonmymind]

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

I saw this as well. What kind of contact did this worker have to not be included in the observation group?

I'm wondering how many more people should have been under observation??

 

[nrdsb4]

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

Yes, I have seen this discussed MANY times. It has been qualified, by some of the virologists, that there are nowhere near the amount of virus particles in nasopharyngeal secretions as there are in vomit and feces. It's been said that theoretically it could occur, but in most cases you really need to blame the feces and the puke.

 

[Gardenlady]

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

This will be feasible for now, sure. But if people want that to keep up indefinitely then the way to do that is keep budget spending up for CDC, NIH, etc, and ensure more spending on health at local/state levels.


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[Isabelle]

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.

OMG, can you imagine if it could be transmitted via airborne route. All of Texas Presbyterian Hospital would have to be quarantined. Wonder if they are using isolation rooms with laminar air flow?

 

[Yoda]

MOO :moo:

Omaha, Emory and Presbyterian hospitals- we need to look at their procedures and facilities and compare what was done, step by step. What equipment was used, what number of staff, etc.

We already know Omaha and Emory had several advantages over Presbyterian: special containment areas, teams already in place trained to handle the highly contagious, and time. Time being, they were informed their patients were coming and had time to prepare.

I wonder if it would have been different if Mr Duncan walked into Omaha or Emory's emergency room for care? He still would have exposed other patients, staff, emts, all before being transfer to the special units.


Highly contagious: From the first day, it needed to be stressed, Ebola is deadly and dangerous. Instead of the "don't worry" and then "not contagious until showing symptoms". It should have been said to the public "the chances of getting ebola increase as the virus progresses. When a person starts showing symptoms they begin to be contagious. Be smart. If you or someone you know has traveled to the these three countries in the last 21 days: guinea, seirra leone, liberia watch for fever, headaches, body aches. At the first sign of symptoms call your doctor or 911. Let them know of your symptoms and that you have traveled to a country that has an ebola outbreak. It is most likely the flu be we would rather you erred on the side of caution "


jmo

 

[nrdsb4]

Yes, I have seen this discussed MANY times. It has been qualified, by some of the virologists, that there are nowhere near the amount of virus particles in nasopharyngeal secretions as there are in vomit and feces. It's been said that theoretically it could occur, but in most cases you really need to blame the feces and the puke.

I also suspect that like feces and vomit, the sicker the patient gets, the more virus in the secretion. Hence all the second guessing about the wisdom of intubating and ventilating an end stage patient.

 

[SStarr33]

Anybody know if they are monitoring the hazmat people?

 

[Isabelle]

Yeah well they are all wearing masks so they ARE worried about droplet transmission. And the fact some get very huffy over the definition of airborne (instead of just calmly explaining) hints at the bigger problem here.

Also consider mucus membranes are a portal of entry (lips, tissue lining the nose, eyes). Face mask would also prevent nor from rubbing their nose or around the mouth)

 

[cady]

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.

....and who all stepped in it? There were lots of little kids in that neighborhood, from the photos I remember seeing. JMO

 

[nrdsb4]

MOO :moo:

Omaha, Emory and Presbyterian hospitals- we need to look at their procedures and facilities and compare what was done, step by step. What equipment was used, what number of staff, etc.

Totally agree.

I wonder if it would have been different if Mr Duncan walked into Omaha or Emory's emergency room for care? He still would have exposed other patients, staff, emts, all before being transfer to the special units.

I think definitely it would have. Because they, unlike PHD, had "Ebola on the brain."

So far, and keeping fingers crossed, no one Duncan exposed that day or in the next two days has become ill.

Highly contagious: From the first day, it needed to be stressed, Ebola is deadly and dangerous. Instead of the "don't worry" and then "not contagious until showing symptoms". It should have been said to the public "the chances of getting ebola increase as the virus progresses. When a person starts showing symptoms they begin to be contagious. Be smart. If you or someone you know has traveled to the these three countries in the last 21 days: guinea, seirra leone, liberia watch for fever, headaches, body aches. At the first sign of symptoms call your doctor or 911. Let them know of your symptoms and that you have traveled to a country that has an ebola outbreak. It is most likely the flu be we would rather you erred on the side of caution "


jmo

A little too late, but based on all the false alarms, I'd say that message has been duly noted. I think one of the cases turned out to be a cold.

 

[WichitaFalls]

Good Morning. Waking up here in Dallas with a heavy heart and a knot in my stomach. Those poor heath care workers.

http://www.wfaa.com/story/news/local/2014/10/14/support-the-scrubs/17265491/

 

[nrdsb4]

....and who all stepped in it? There were lots of little kids in that neighborhood, from the photos I remember seeing. JMO

I don't know if anyone did. Certainly no one who lives near that apartment has gotten ill. Makes me think no one did. Remains to be seen.

 

[SStarr33]

This will be feasible for now, sure. But if people want that to keep up indefinitely then the way to do that is keep budget spending up for CDC, NIH, etc, and ensure more spending on health at local/state levels.


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Like I said, the CDC is being blamed because of the reasons I stated.

 

[nrdsb4]

Also consider mucus membranes are a portal of entry (lips, tissue lining the nose, eyes). Face mask would also prevent nor from rubbing their nose or around the mouth)

excellent point. I think research has been done which shows we are CONSTANTLY and unconsciously touching our faces.

 

[SStarr33]

Good Morning. Waking up here in Dallas with a heavy heart and a knot in my stomach. Those poor heath care workers.

http://www.wfaa.com/story/news/local/2014/10/14/support-the-scrubs/17265491/

Sorry WF

#supportthescrubs

 

[Isabelle]

I suspect DPH will have more that 2 cases among staff. Being an RN, if I were a patient at the hospital I would be fighting to get out and might leave AMA. Hopefully they are not floating caregivers as is so often done. That is a major concern, IMO.

 

[Hatfield]

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 so much for joining the discussion.

I do have a question if you can give your opinion on it.

There has been quite a few patients in Africa that claim they did everything right and they have no idea how they contracted the disease. We do know of the 1 guy at least who caught it by washing the vehicle and probably got back spray droplets on him from the washing.

My question is do you think its possible that maybe Africa's humidity and maybe more rainfall is contributing to human to human transmission through close quarter contact?

I was out in the yard just the other day on a cold evening and it was one of nights where you could see your breath.
I immediately wondered if perhaps small microscopic breathed particles were traveling through the air and maybe Africa has more humidity and rainfall which could be making their cases spread more than it would here in US.
The particles may not travel far, but maybe with the humidity, they travel further over there.

When I was in the yard with my flashlight, I watched how my breath particles basically got carried in the wind for quite a long ways.

Anyway, just something I was wondering about.

 

[nrdsb4]

I saw this as well. What kind of contact did this worker have to not be included in the observation group?

I'm wondering how many more people should have been under observation??

You have misinterpreted what was said, thanks to Mr. Keys' poor wording. I recorded that press conference and here is what was said, from post 689:

That's NOT WHAT WAS said at the press conference.

Here was the question:

"A couple of days ago, it was communicated to employees that two employees were being examined for ebola. Was this worker one of those two people?"

Answer:

"No."

She was not someone examined under suspicion of ebola a couple of days ago, but was one of the 75 being monitored.

 

[Hatfield]

excellent point. I think research has been done which shows we are CONSTANTLY and unconsciously touching our faces.

The eyes are one of those things that I truly wonder a lot about.

How many times in our lives have we been talking with someone in an excited discussion, and the person basically spit on you. Not a lot of course, but enough to notice where you would back away from them. If an infected person did that and it got in your eye, I honestly think that could be where some of the strange cases of catching it has come from.