Ebola outbreak - general thread #4

[jjenny]

Let's define Biosafety Level 4 (BSL-4) directly from the CDC doc - here (this doc includes very thorough definitions for each level of biosafety, a bit lengthy but worth understanding the differences): http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf





Agents with a close or identical antigenic relationship to agents requiring BSL-4 containment must be handled at
this level until sufficient data are obtained either to confirm continued work at this
level, or re-designate the level.

As far as I know they have not downgraded the level for Ebola... so. There you go.

Level for Ebola has not been downgraded. But cdc guidelines for health care workers do not specify level 4 protective measures.
Dallas hospital does not have level 4 containment unit, like the one in Nebraska and Emory.
But CDC thinks regular hospitals without level 4 containment units should be fine treating Ebola patients.
Oops.

 

[Lyra500]

OMG. He just said this isnt a virus that travels through the air so they don't need to treat it as such.... This is a BSL-4 pathogen, people! Why would scientists and researchers treat it as such if it wasn't HIGHLY contagious?? Also, if it isn't highly contagious and CDC admits they don't know for sure if it could be airborne, why are you downplaying it? I get perhaps they are trying to not incite mass hysteria through MSM, but honestly IMO I feel that mass hysteria needs to happen so that people will take this MUCH more seriously.

The fact remains they don't know 100% this isn't airborne contagious, and they don't know 100% that a patient isnt highly contagious BEFORE they exhibit symptoms - again, the common cold/flu is known to be more contagious *before* you are even showing symptoms, why would Ebola be any different if not worse? Arrrggghh :gaah:

The outbreak in West Africa started last December and was officially declared in March 2014. If Ebola was truly airborne (or even just transmissible via droplet infection like coughs and colds), then the whole world would have cases and we would be in some horrific post apocalyptic scenario already.

The information they have on when it is contagious etc has been gathered from observing and documenting previous outbreaks.

The reason it is treated as a level 4 pathogen in CDC labs is due to the effect it has on humans if they do become infected. Are there any other infectious diseases with a higher death rate?

People working with Ebola in the lab are at really high risk because there is no doubt that if they make a mistake they will be exposed to Ebola. So, they have to operate with the highest level of infection control and protective procedures.

The first thing to know is that very few infections are truly airborne - I believe measles is one.

Flu and the common cold are transmissible via droplet infection which is not the same as it is less transmissible. Whilst Ebola virus is present in saliva, coughing and sneezing are not symptoms of Ebola (yet). If a patient with Ebola did cough or sneeze and the droplet hit someone else in the eye or mouth, then they could transmit the infection, but this is not how Ebola gets spread if current experience is anything to go by.

If people are wanting to know more about the disease, have a look here:

http://www.who.int/csr/disease/ebola/faq-ebola/en/

 

[jjenny]

I don't think they even know how exactly Ebola gets spread. Nurse who was treating Duncan somehow got infected, despite protective gear in accordance with cdc guidelines.

 

[Harmony 2]

Leave conspiracy theories at the door, please, preferably under the mat. Thanks

 

[CARIIS]

I am a visual person. I am not in panic mode as it relates to industrialized nations. However, IMO, there needs to be some serious attention and focus on , over there, speeding things up – a lot. My god getting into the suits is exhausting to watch(!)



We have sent men to the moon, and someone can develop a user friendly ha Matt suit. I mean really duct tape? Velcro on top of Velcro maybe? The way it is now, if I needed to get into one of them (not obese!) chances are good with the leg part I could breach a little place!!!


I also envisioned , just like the dry cleaners, when the suits are off, run em around being sprayed. Speed it up folks. The boots can be under the suits! Buckets can be in there you get me.


Maybe with the military over there now efficiency will be improved. IMO, The folks over there are precious commodity for the folks over there. I believe we are losing lots of help in getting suited up, working , getting out of suits . Etc


A shower to step in with the suits on and the end of the day, a shower for people once out of suit ( we have that already) so I am thinking that will be implemented once our military folks get set up!


IMO,We need to not keep wasting their time with all this in and out stuff -chop chop get rolling over their!


Also! Media keeps criticizing -we all need to understand this is new – there will be mistakes and accidents

 

[trex]

Leave conspiracy theories at the door, please, preferably under the mat. Thanks

Sorry Harmony2 - I thought this was general discussion and I totally wasn't going conspiracy theory at all - or trying to - just trying to talk about the why's and what's of the intricacies of this issue.

My apologies - I did not mean to offend or get in trouble at all

I'm newer around here so I guess I didn't understand where the line is - and I am sorry, I truly mean no harm at all. Just to discuss... Sorry

 

[Sigh Sister]

The outbreak in West Africa started last December and was officially declared in March 2014. If Ebola was truly airborne (or even just transmissible via droplet infection like coughs and colds), then the whole world would have cases and we would be in some horrific post apocalyptic scenario already.

The information they have on when it is contagious etc has been gathered from observing and documenting previous outbreaks.

The reason it is treated as a level 4 pathogen in CDC labs is due to the effect it has on humans if they do become infected. Are there any other infectious diseases with a higher death rate?

People working with Ebola in the lab are at really high risk because there is no doubt that if they make a mistake they will be exposed to Ebola. So, they have to operate with the highest level of infection control and protective procedures.

The first thing to know is that very few infections are truly airborne - I believe measles is one.

Flu and the common cold are transmissible via droplet infection which is not the same as it is less transmissible. Whilst Ebola virus is present in saliva, coughing and sneezing are not symptoms of Ebola (yet). If a patient with Ebola did cough or sneeze and the droplet hit someone else in the eye or mouth, then they could transmit the infection, but this is not how Ebola gets spread if current experience is anything to go by.

If people are wanting to know more about the disease, have a look here:

http://www.who.int/csr/disease/ebola/faq-ebola/en/

BBM - It is apparent that this is the case for a healthcare worker caring for an ebola patient as well.

 

[popsicle]

The facility I currently work at ( I am an RN ), gave us a " Mandatory Education" on EBOLA. (via the internet of the facility), which was a three page read with illustrated instructions. Took me 3 minutes to complete, and of coarse sign...( covers their buts). No additional hands on training or available q & a experience was offered. This is BS!

My hospital is at least doing Ebola drills but.... that doesn't do crap for the floor RN.

 

[lawstudent]

So the law of averages , or whatever it's called, would dictate that one or more of the original, 4 or 48 or 80 or 100 depending on who said it, close or possibly close contacts have tested positive for Ebola. IMO we are not being told the truth - for whatever reason. Most likely because the want to stop a panic. Thing is, I want the truth.

I read that on average, an ebola patient infects 3 or 4 people before dying. But keep in mind that the vast majority of the cases occurred in a few countries with certain conditions. In his end stages, Mr. Duncan was in a hospital. Most patients are going to be cared for by family, and their body will be prepared by the family. The odds of infection in Mr. Duncan's case would seem to be much lower - the majority of the time he was contagious, people were taking precautions.

It is entirely possible the staff was trained, but people mess up. Everyone makes a mistake at work every so often and can't believe how they could have done such a silly thing, no matter how diligent, even if only once a year. If you are a doctor or a pilot or a soldier, that one off day has horrible consequences. I've said this before, but look at how many doctors have scientists have died as a result of sticking themselves with a needle or dropping something radioactive. They may be very bright, responsible people, but it only takes a second of distraction when it is something they are comfortable with because they do it so often.

 

[Isabelle]

I

I do think there has been "economizing" probably due more to ignorance than a lack of budget. A few threads back someone posted a link about a hospital manager that was ordering a dozen PPE suits for her staff (package rate of $179 per dozen).

High quality PPE suits used for serious pathogens are far more expensive, this may sound bad but I suspect the folks buying suits for many of these hospitals are doing exactly what "regular people" are doing, hitting up Amazon and reading a few reviews and buying something that seems well priced. I do NOT think they are actually doing hard core research regarding how effective those suits will be during high exposure.

Hospitals and the medical industry are businesses. They must provide a high level of care for the least cost.
Direct hands-on caregivers must use whatever protection is available and have no way of knowing whether the equipment is inferior. Also remember management in hospitals is not involved in patient care, so they don't give a rat's a$$ what direct caregivers have to go through to provide care.

An aside: a hospital I worked at was cutting budget and one thing they did was keep small styrofoam cups in a lockbox. I had to justify the reason I needed two cups to warm a bottle of breast milk for two different babies in each one so neither would be contaminated by the other. Charge nurse had trouble making that connection.

 

[BetteDavisEyes]

Detroit Metro Airport Will Not Conduct Extra Ebola Screenings

October 11, 2014 6:53 PM

ROMULUS (WWJ) — Travelers arriving from West Africa are now subject to extra screening for signs of Ebola at some U.S. airports. Screeners will check the temperature of travelers arriving from the affected region starting Saturday at New York’s Kennedy International Airport.

The checks will expand to four other major airports, but not Detroit Metro. Airport spokesman Mike Conway, though, said that the airport is equipped to handle any problems...

http://detroit.cbslocal.com/2014/10...port-will-not-conduct-extra-ebola-screenings/

 

[Sonya610]

FYI...just in case anyone actually thinks the Feds can help if this gets out of control....

A 2014 report by the Department of Homeland Security with the ominous title “DHS Has Not Effectively Managed Pandemic Personal Protective Equipment and Antiviral Medical Countermeasures” found that the DHS “did not adequately conduct a needs assessment prior to purchasing pandemic preparedness supplies and then did not effectively manage its stockpile of pandemic personal protective equipment and antiviral medical countermeasures.”

Its authors discovered that, among other things, 84% of the department’s store of hand sanitiser was expired – some as much as four years out of date – and that 81% of the department’s antiviral medication would expire by the end of 2015. To solve this problem, the department is “applying for a shelf-life extension with the Food and Drug Administration” for the influenza drug Tamiflu.

http://www.theguardian.com/world/2014/oct/03/-sp-ebola-outbreak-risk-global-pandemic-next

 

[WichitaFalls]

This case has far reaching ripple effects that aren't and won't be reported. I have a dear friend (a healthy, vibrant 82 year old) that is due to check into Presby at 4:30 in the am for a complicated surgery. Her surgery will involve three different surgery specialists that has taken months to schedule due to the number of surgeons involved. During the wait period, my friend has been physically uncomfortable and looking forward to her surgery date as the beginning of her recovery. I had lunch with her on Thursday and even though her immediate family is anxious they eventually summarized that there probably wasn't a safer hospital in Dallas at this point in time due to the eyes of the world watching Mr. Duncan's case. I wonder how this morning's news will change or not change her plans. I wonder what I would do.

 

[Lyra500]

I don't think they even know how exactly Ebola gets spread. Nurse who was treating Duncan somehow got infected, despite protective gear in accordance with cdc guidelines.

It is not just a case of the quality and style of the PPE though - the protocols you follow to put it on, look after the patient and take it off are also essential. Just because the nurse was wearing the specified PPE does not guarantee that everything else was OK. This could either be a failing on her part or that the hospital provided inadequate training.

If the procedure you use to take off PPE and wash your hands is not adequate, it does not matter how good the PPE is, you might as well not have worn it.

This is from the WHO information page I just linked to

http://www.who.int/csr/disease/ebola/faq-ebola/en/

Is protective equipment required when caring for these patients?
In addition to standard health-care precautions, health-care workers should strictly apply recommended infection control measures to avoid exposure to infected blood, fluids, or contaminated environments or objects – such as a patient’s soiled linen or used needles.
All visitors and health-care workers should rigorously use what is known as personal protective equipment (PPE). PPE should include at least: gloves, an impermeable gown, boots/closed shoes with overshoes, a mask, and eye protection for splashes (goggles or face shields).

Is hand hygiene important?

Hand hygiene is essential and should be performed:
before donning gloves and wearing PPE on entry to the isolation room/area;
before any clean or aseptic procedures is being performed on a patient;
after any exposure risk or actual exposure with a patient’s blood or body fluids;
after touching (even potentially) contaminated surfaces, items, or equipment in the patient’s surroundings; and
after removal of PPE, upon leaving the isolation area.

It is important to note that neglecting to perform hand hygiene after removing PPE will reduce or negate any benefits of the PPE.

Either an alcohol-based hand rub or soap and running water can be used for hand hygiene, applying the correct technique recommended by WHO. It is important to always perform hand hygiene with soap and running water when hands are visibly soiled. Alcohol-based hand rubs should be made available at every point of care (at the entrance and within the isolation rooms and areas); running water, soap, and single use towels should also be always available.

 

[trex]

I

Hospitals and the medical industry are businesses. They must provide a high level of care for the least cost.
Direct hands-on caregivers must use whatever protection is available and have no way of knowing whether the equipment is inferior. Also remember management in hospitals is not involved in patient care, so they don't give a rat's a$$ what direct caregivers have to go through to provide care.

An aside: a hospital I worked at was cutting budget and one thing they did was keep small styrofoam cups in a lockbox. I had to justify the reason I needed two cups to warm a bottle of breast milk for two different babies in each one so neither would be contaminated by the other. Charge nurse had trouble making that connection.

Just.... Wow. Cups in a lockbox to save $$?! My first reaction was to ask if you were serious but I totally believe this.. Sad the lack of transparency between admin and hands on care staff, the lack of knowing what the other needs, or maybe they do know but just look the other way because of the bottom line It just sucks that $$$ always has to come before doing the right things, all of the time.

 

[Lyra500]

BBM - It is apparent that this is the case for a healthcare worker caring for an ebola patient as well.

It does not indicate that Ebola is airborne though, which I think was the argument being put forward.

 

[hockeymom]

Dr. Freidman specifically mentioned that over protecting would not necessarily help and in fact might make matters worse. A CNN expert explained.For instance, she said protocol calls for double gloving. If you triple glove,its against protocol and in trying to get 3 gloves off,may actually contact the contaminate. Is it possible the nurse was too cautious?

 

[Muffet]

OMG. He just said this isnt a virus that travels through the air so they don't need to treat it as such....

BSBM
As if intubation doesn't aerosolize the virus.

Friedan has zero credibility in my eyes and those of countless others. His comments, going back these last months, show why.

His under-stating the risks and needs for sufficient PPE are inexcusable, imo. He's going to blame people, because otherwise, he'll have to admit that following the protocols he calls sufficient can get people killed.

Many of us have been warning about it for months.

He can shoot off all he wants about its not being "airborne," but if she got it from an an *aerosolized* route, he'll have to explain (or finally face) the things he's apparently tried so hard to avoid.

JMO

The human factor has to be accounted for in any protocol. It's like a programmer who points to his code to say it's great software, regardless of how non-user-friendly it is.

And who was it just saying last week that any hospital in America can manage it?

Edit for space/focus.

 

[SStarr33]

This case has far reaching ripple effects that aren't and won't be reported. I have a dear friend (a healthy, vibrant 82 year old) that is due to check into Presby at 4:30 in the am for a complicated surgery. Her surgery will involve three different surgery specialists that has taken months to schedule due to the number of surgeons involved. During the wait period, my friend has been physically uncomfortable and looking forward to her surgery date as the beginning of her recovery. I had lunch with her on Thursday and even though her immediate family is anxious they eventually summarized that there probably wasn't a safer hospital in Dallas at this point in time due to the eyes of the world watching Mr. Duncan's case. I wonder how this morning's news will change or not change her plans. I wonder what I would do.

I had that same thought earlier about elective procedures and physicians. This is going to have far reaching effects and they won't be positive financially.

 

[Lyra500]

FYI...just in case anyone actually thinks the Feds can help if this gets out of control....

OT

Sonya - I wouldn't worry about the Tamiflu. If the clinical trial evidence which Roche 'forgot' to publish is anything to go by, it is pretty much useless anyway.

I believe the UK also has several million pounds worth of (worthless) Tamiflu.