Ebola outbreak - general thread #1

[SallyLu]

he wasn't exposed until the 15th I'd say he clearly already had his trip planned. You can't decide to leave and have a visa ready in 4 days.

He got his visa at the beginning of September.

 

[Elley Mae]

The Texas Ebola patient is named Thomas Eric Duncan, according to the Associated Press. Duncan’s sister told the AP he was sent home with antibiotics that day.

http://www.washingtonpost.com/news/...itial-visit-he-had-traveled-from-west-africa/

The Dallas Independent School District said it was told Wednesday morning that five students who attend four of its schools — one high school, one middle school and two elementary schools — may have had contact with the Ebola patient.

 

[Le Singe]

who did he breathe on when he was released? to include all those in the waiting room that he passed by?

it seems to be here now doesn't it. IMHOO very poor job of containment by the WHOO and the CDC. I do not fault ER employees.. they are thinking the guy has a fever and give him a zpac and send him home but no.. the guy has EBOLA.

If every guy with a fever in the ER was suspected to have EBOLA we would have to build entire isolation buildings to triage all these people!

Very sad day to hear that here it is in the US but when we brought those other patients over it was clear to me, in my opinion, that it was just a matter or time.

1. you can't get it by being breathed on...
2. they ask him where he was from and depending on who version you believe he told them he was from africa or specifically liberia. Does the hospital treat you with out some type of ID he wasn't even an american citizen obviously he didn't have a texas DL they should have know. The hospital dropped the ball.

 

[sloane7777]

remind me how lucky we are if i ever whine!

 

[okmom23]

As a nurse, I will say what is the point of asking a question if a positive response was not communicated? That was badly done and I'm a little surprised that the hospital administration admitted it.

Totally agree! JMO here but I'm guessing the triage nurse never saw the treating doc. I know there are times that I will go for several hours in triage and not see the docs especially when we are busy. It is still a failure to communicate properly and there is absolutely NO excuse for that. I would bet that their charting program has been updated to include travel history when asking TB screening and immunization. Questions

 

[nrdsb4]

It is not bizarre at all. More like expected behavior from some people.

In many African countries the men eat first, the women and children eat what is left (if there is any). When the men start to starve the famine is considered "severe".

In addition if you have ever watched shows about combating HIV in Africa, many men will NOT get tested if their wife is informed of the results. It is none of her business, kwim? The female is only his wife, no reason for her to get info about his HIV status.

Thank you. Yes, I'm guilty of applying my own value and belief system here. I honestly can say I know little of Liberian culture.

 

[popsicle]

This is so hard to read:MONROVIA, Liberia — A man who flew to Dallas and was later found to have the Ebola virus was identified by senior Liberian government officials on Wednesday as Thomas Eric Duncan, a resident of Monrovia in his mid-40s.
Mr. Duncan, the first person to develop symptoms outside Africa during the current epidemic, had direct contact with a woman stricken by Ebola on Sept. 15, just four days before he left Liberia for the United States, the woman’s parents and Mr. Duncan’s neighbors said.
In a pattern often seen here in Monrovia, the Liberian capital, the family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help on Sept. 15 after failing to get an ambulance, said her parents, Emmanuel and Amie Williams. She was convulsing and seven months pregnant, they said.
Turned away from a hospital for lack of space in its Ebola treatment ward, the family said it took Ms. Williams back home in the evening, and that she died hours later, around 3 a.m.

I'll let you read the rest of this heartbreaking story here:




http://www.nytimes.com/2014/10/02/w...m-texas-thomas-eric-duncan.html?smid=tw-share

My heart is not breaking for Mr Duncan though.

9 days from exposure to symptomatic.

 

[Lyra500]

I think I read somewhere that Ebola is almost invariably fatal in pregnant women. Very, very sad.

I think dealing with pregnancy emergencies has been the cause of quite a few medical staff contracting Ebola. Certainly that is how the outbreak in DRC kicked off. The index case was a pregnant woman and then a doctor and two nurses who operated on her also died (I don't think they realised she had Ebola until it was too late).

 

[nrdsb4]

who did he breathe on when he was released? to include all those in the waiting room that he passed by?

You don't transmit ebola simply by sitting in the same large room or "passing by" others. Why do people keep perpetuating this misinformation?

I've been in that ER waiting room many times. It's very large and people keep to themselves within it. There is no way that guy was slinging his body fluids around onto other people without them realizing it. At that point he was allegedly complaining of vague symptoms such as fever and malaise. He was not actively vomiting or passing stool in the waiting room.

 

[sloane7777]

9 days from exposure to symptomatic.

Yes 9 with him and 10 with the friend, if he saw the friend on the 20th, the day he returned.

 

[nrdsb4]

Totally agree! JMO here but I'm guessing the triage nurse never saw the treating doc. I know there are times that I will go for several hours in triage and not see the docs especially when we are busy. It is still a failure to communicate properly and there is absolutely NO excuse for that. I would bet that their charting program has been updated to include travel history when asking TB screening and immunization. Questions

As a nurse, I always want to hear all of the data before I am willing to accuse another medical professional of negligence. But from listening to the hospital administration's version, I must sadly conclude that this was a huge fail on the part of the ER staff. Allegedly the nurse checked off that the patient admitted he had traveled from Liberia. The doctors or treating staff within the ER didn't know this why? Because they didn't read the triage assessment? That's a fail. As a nurse, if a symptomatic patient told me he had recently traveled from Liberia, I would be up out of my chair arranging an isolation room and testing. While I believe this could have and would have happened at any number of ERs accross the country since we've never actually been confronted with ebola, it didn't happen somewhere else, so that facility and medical team will have to take ownership of this huge mistake.

That said, it does NOT explain or excuse the patient's (willful?) failure to reveal that he had recently had DIRECT CONTACT with a dying ebola patient. Had he admitted this, there likely would have been no failure to communicate the dangerous nature of this person's circumstances. It also doesn't explain how he could expose his family and friends to his illness knowing what he had experienced before he left Liberia. It's completely inexcusable.

 

[Le Singe]

I hate to ruin a good freak out but allow me to remind you that ebola was brought to Nigeria in almost the exact same situation except the guy was already sick. It got spread around to some people 21 and 8 of them died BUT as of today there is no EBOLA in nigeria no new cases in over 21 days. So to have the attitude some of you are having you would have to believe we are less able to handle this than nigeria which is an utterly illogical thing to believe. And don't come with the we live closer together 21 million ppl live in Lagos (the main city it was in). All previous outbreaks have been contained, by treating ppl in tents no less.

Is this a very serious thing and we do need to keep our eye on the ball and not have anymore colossal screw ups. But as long as we do its going to be ok. Probably a few more ppl are going to get it. People that where staying in the house with him but it absolutely can and should end there.

nigeria ....

oh and there were two other deaths in nigeria because people freaked out so hard that they believed a rumor that drinking salt water protected you and they drank so much 20 ppl where hospitalized and 2 died!

keep calm carry on.

one more thing yes in Africa the mortality rate is 70% but their treatment is to put you on a cot in an isolation ward and tell you to drink lots of gatorade and thats it. They don't even have IVs. Allow me to again point out, out of the like seven ppl that have been treated in western hospitals only 1 has died and that was a seventy five year old man who was nearly dead already by the time they got him to spain. In our healthcare setting its likely the mortality rate could be lower than 20%.

 

[Le Singe]

Thank you. Yes, I'm guilty of applying my own value and belief system here. I honestly can say I know little of Liberian culture.

i doubt their characterization is accurate of Liberia culture they have a female president....

 

[okmom23]

As a nurse, I always want to hear all of the data before I am willing to accuse another medical professional of negligence. But from listening to the hospital administration's version, I must sadly conclude that this was a huge fail on the part of the ER staff. Allegedly the nurse checked off that the patient admitted he had traveled from Liberia. The doctors or treating staff within the ER didn't know this why? Because they didn't read the triage assessment? That's a fail. As a nurse, if a symptomatic patient told me he had recently traveled from Liberia, I would be up out of my chair arranging an isolation room and testing. While I believe this could have and would have happened at any number of ERs accross the country since we've never actually been confronted with ebola, it didn't happen somewhere else, so that facility and medical team will have to take ownership of this huge mistake.

That said, it does NOT explain or excuse the patient's (willful?) failure to reveal that he had recently had DIRECT CONTACT with a dying ebola patient. Had he admitted this, there likely would have been no failure to communicate the dangerous nature of this person's circumstances. It also doesn't explain how he could expose his family and friends to his illness knowing what he had experienced before he left Liberia. It's completely inexcusable.

You are spot on, couldn't agree more. We knew it was only a matter of time before Ebola showed up on US soil but I know living just 90 miles north of Dallas I didn't expect it to show up so close to home first. My feeling is the staff didn't expect it to show up there either, just goes to show how important those screening questions-that too many nurses, myself included at times, pass right over-truly are!!

 

[popsicle]

I also want to know why they gave him antibiotics because there is an issue with over prescribing them.

 

[SweetT]

The cdc hasn't even talked with the apartment manager or any other residents there.. Not convincing me they have this all locked down and under control.. More like fubar in my opinion

 

[okmom23]

I also want to know why they gave him antibiotics because there is an issue with over prescribing them.

This is whole other topic that I could rant about for days!

 

[popsicle]

Scott MacFarlane ‏@MacFarlaneNews 1m1 minute ago
Ebola patient in Texas flew United Airlines .. through Dulles Airport .. on September 20th

Shimon Prokupecz ‏@ShimonPro 3m3 minutes ago
#ebola patient flight, United Airlines: Brussels to Washington Dulles, Flight 951 Washington Dulles to Dallas-Fort Worth, Flight 822

 

[nursebeeme]

1. you can't get it by being breathed on...
2. they ask him where he was from and depending on who version you believe he told them he was from africa or specifically liberia. Does the hospital treat you with out some type of ID he wasn't even an american citizen obviously he didn't have a texas DL they should have know. The hospital dropped the ball.

droplettes. coughed. sneezed. and yes more should have been done and why wasn't it? NPR (live radio sorry no link) saying that at least five school aged children were exposed so you can multiply that times at least ten. If 5 kids were exposed you can multiply out the exponential increase of where any of those kids coughed, sneezed, or touched a fomite. Yes, I realize it does not come from exhaled air per se. From someone infected and sneezing any exhalation is potentially infectious and should be treated as such. I don't think we will hear the magnitude of it as I feel that in the reporting they are trying to cover all the bases and make everyone feel secure that anyone coughing or sneezing could just as well have the common cold? There is also a huge media hype with the latest respiratory virus. hitting the midwest and other parts of the US.

I agree that if they asked the guy where he came from (and NPR is reporting that he was screened for fever after his flight), that they would take that into serious consideration much like if you think someone has a case of varicella and they are immediately put into the appropriate area. This guy was simply discharged. I agree that that some sort of ball (huge ball in this case!) was dropped. Am I just a proactive nurse to think that anyone coming from that area of the pandemic would be asked to report any fever or symptoms for 21 days? (incubation period) and that the CDC would perhaps give out a card or two to report any illness within the incubation time frame from passengers coming off of planes with passengers that came from the affected areas? For all we know that did happen and the person did not heed the warning but for something of this magnitude I would think there would be better tracking here in the US. From what I am hearing of others that are currently flying or have flown in the past month several have been contacted by the airline about symptoms to watch for so I am not sure where the disconnect happened here. from what npr is reporting he was on a 15 sept flight so he was early on in this entire thing and may have fallen through the primary prevention cracks? Not sure. Very sad and scary all around.

 

[popsicle]

Shimon Prokupecz ‏@ShimonPro 2m2 minutes ago
Associate of U.S. #Ebola patient says he contacted the CDC with concerns Dallas hospital wasn’t moving fast enough. http://cnn.it/YOXu2X

The close associate, who does not want to be identified because of the sensitivity of the case, said he contacted the CDC with concerns that the hospital wasn't moving quickly enough after Duncan's second hospital visit.