Ebola outbreak - general thread #8

[jjenny]

Ok. So why isn't everyone demanding that the health care workers here be quarantined after working on Ebola patients as well?

Our system of protocols is simply not better. No evidence of that at all. The fact that so many people from DWB are handling such patients and not contracting the virus tells me we have something to learn from them - not the other way around.

Further, Nigeria, which stopped the virus in its tracks, depsite being a populous third world country with poor sanitation, isolated and monitored but did not quarantine. Their success in eradicating the disease was due from help by WHO, the US CDC, the Nigerian CDC and strong leadership.
http://www.who.int/mediacentre/news/ebola/20-october-2014/en/
http://news.nationalgeographic.com/news/2014/10/141024-ebola-nigeria-outbreak-lessons-virus-health/
http://www.washingtonpost.com/poste...es-wont-stop-ebola-from-spreading-in-the-u-s/

Nigeria quarantined. Here is a story of one guy who escaped this quarantine and infected some other people.

"A contact of Nigeria's first Ebola patient fled quarantine in August and passed the disease to a doctor, who subsequently infected at least two other people, offering a textbook example of how not to deal with the disease, the World Health Organization (WHO) reported today."

http://www.cidrap.umn.edu/news-perspective/2014/09/quarantine-escapee-sparked-more-ebola-nigeria

 

[XXXXXXXX]

Putting aside whether quarantine for asymptomatic HCWs is necessary or not, the wording may make a difference for those like Kaci, RN. If the term voluntary home self monitoring or required home self monitoring (with enforcement if needed) makes people agreeable why not use these words. Sometimes it's just semantics and the psychological aspect of not wanting to be ordered to do something.

Makes a weird bit of sense. Some people are just anti-authoritarian and interpret their own actions as not being brought into question.

When she presented at the airport, she was determined to have a fever along with her reporting she had just returned from treating Ebola patients.

She subsequently claimed that her "fever" was a result of being flushed and flustered. But considering the latest CDC guidelines of having returned from W.A. and having a detectable fever at the time, why shouldn't she have been "detained" and tested?

 

[annahanna]

http://www.doctorswithoutborders.org/article/q-msf’s-ebola-response-and-protocols

How many MSF staff members have been infected with Ebola in the field, and why were they infected given the precautions taken?

At present, there are more than 3,200 MSF staff working on Ebola in West Africa. The total number of people who have worked in Ebola projects since MSF began its intervention last March is significantly higher. To date, 24 MSF staff have contracted Ebola and 13 have died. Ten have survived, and one, our colleague now in New York, is in treatment. Twenty-one of the 24 have been national staff, people who live in the country in which they were working (national staff make up the vast majority of MSF staff around the world). Three were international staff, or “expats.”

MSF Staff on the Ground (as of October 21, 2014)
Guinea: 54 international, approximately 360 national (+48 from Ministry of Health)
Liberia: 109 international, around 1,241 national
Sierra Leone: 107 international, around 1,417 national
Total: 270 international, around 3,018 national
MSF/DWB
http://www.doctorswithoutborders.org/our-work/medical-issues/ebola

The 3200 number often quoted by DWB does not break down their employees by national and international staff. The majority of their international international staff are trained health care workers. The majority of their national or local staff are support personnel who may have little or no contact with patients but, of course do have community acquired risk.

 

[Sweet Fox]

NJ Ebola quarantine policy embraced by Nobel Prize-winning doctor

http://www.nj.com/politics/index.ss...e_un_is_embraced_by_2011_nobel_prize_win.html

LOL

Excellent article. He is absolutely right. Thank you for posting it.

 

[nrdsb4]

Makes a weird bit of sense. Some people are just anti-authoritarian and interpret their own actions as not being brought into question.

When she presented at the airport, she was determined to have a fever along with her reporting she had just returned from treating Ebola patients.

She subsequently claimed that her "fever" was a result of being flushed and flustered. But considering the latest CDC guidelines of having returned from W.A. and having a detectable fever at the time, why shouldn't she have been "detained" and tested?

The reports I have read stated that initially she had no fever. Only after being detained for 3 hours did she suddenly show a fever. I imagine had they checked her blood pressure after 3 hours of being detained, it would have also been sky high. Vital signs are very frequently influenced by emotions, particularly being angry or upset. The fact that it was normal after being tested with an oral thermometer should have been significant.

 

[gitana1]

Excellent and succinct post! I hate to be so suspicious, but I DO consider that some of these health care workers go to West Africa for personal gain. It looks good on their resumes to say "I volunteered to treat Ebola patients in West Africa".

What THEY won't put on their resumes is that when I returned home and found the rules had changed while I was on my crusade, I DID NOT expect to be told I was going to be evaluated by the state I flew into.

There is STILL such a thing as "states rights" here in the U.S. Meaning that the feds can't trump an individual state to enact their own measures when it comes to perceived protection of their state's citizens.

This woman repeatedly squawked about being detained in a "tent" as though she were outside of the hospital and being detained in a tent outside with no heat, no running water, and no flushable toilet. In reality, she was always INSIDE the hospital and surrounded by a protective tent barrier.

She was NOT in an outside tent in the open elements. Gah! This woman lost all credibility when she failed to recognize the authority of the state she flew into just because the change of policy surprised her and she took objection to it.

Wow. This post makes me very sad. These people are risking their lives to go help people in a living hell, in order to prevent spread of the disease and to save lives. Yet they are simply doing it to "pad their resumes"?

I'm quite saddened by that accusation. MSF are liars and the health care workers from the west going to fight a deadly disease are doing so for "personal gain"? Wow.

I have a different view. I say God bless these heroes. I have never in my life approached the courage and selflessness it takes to risk everything to help others in such an incredible manner. This is what Jesus taught. Precisely what they are doing. I can only hope that one day I can come even a tad bit close to being the type of person these health aid workers and others over there fighting to give assistance, are.

The world is a more beautiful place, IMO, because of those whiners.

 

[nrdsb4]

Excellent and succinct post! I hate to be so suspicious, but I DO consider that some of these health care workers go to West Africa for personal gain. It looks good on their resumes to say "I volunteered to treat Ebola patients in West Africa".

Good grief.

I guess it's true that no good deed goes unpunished.

 

[XXXXXXXX]

The reports I have read stated that initially she had no fever. Only after being detained for 3 hours did she suddenly show a fever. I imagine had they checked her blood pressure after 3 hours of being detained, it would have also been sky high. Vital signs are very frequently influenced by emotions, particularly being angry or upset. The fact that it was normal after being tested with an oral thermometer should have been significant.

Her excuse of having a fever because of being flustered and nervous and upset? I suffer from SEVERE panic/anxiety disorder.

I've gone to the ER because I felt like I was dying from my panic attacks, yet never ONCE have I had a fever from being anxious or flustered. My pulse can race, my blood pressure is high, BUT no fever.

I will still maintain that presenting with a fever and admitting she had just come from W.A. was sufficient to detain and test her.

 

[nrdsb4]

Her excuse of having a fever because of being flustered and nervous and upset? I suffer from SEVERE panic/anxiety disorder.

I've gone to the ER because I felt like I was dying from my panic attacks, yet never ONCE have I had a fever from being anxious or flustered. My pulse can race, my blood pressure is high, BUT no fever.

I will still maintain that presenting with a fever and admitting she had just come from W.A. was sufficient to detain and test her.

Why did they detain her when she first presented without a fever?

With all due respect, why would you assume that the the fact that you have never spiked a fever when upset means that this could not be the case with other people? The instrument which was used to take her temperature is the one which scans the forehead. Flushing causes blood to rush to the surface of the skin and this could conceivably have affected the accuracy of the test. In the medical world, we get inaccurate readings all the time due to various reasons. It's always recommended to re-test any abnormal finding which is in dispute.

 

[SteveS]

Makes a weird bit of sense. Some people are just anti-authoritarian and interpret their own actions as not being brought into question.

When she presented at the airport, she was determined to have a fever along with her reporting she had just returned from treating Ebola patients.

She subsequently claimed that her "fever" was a result of being flushed and flustered. But considering the latest CDC guidelines of having returned from W.A. and having a detectable fever at the time, why shouldn't she have been "detained" and tested?

To be fair, she had no detectable fever. That spin is obvious political BS-ery, not that such statements by pols are rare.

"why shouldn't she have been "detained" and tested?"

She was. It didn't change anything, though.

After their imprecise scanners said she showed a fever, they stopped her, took her fever and she had none. They then tested her for ebola, twice, and it came back negative, twice. And she was STILL kept in jail and told she wasn't leaving for 21 days.

 

[Woe.be.gone]

That is factually not true. The tent, which has been approved by the CDC, was located within the climate controlled hospital building. Moreover, she had computer access, use of her cell phone, reading material (magazines, newspaper) and requested and has received take-out food and drink.

Oh yeah, compared to her stay in Africa, the conditions of her quarantine in NJ must have been sheer hell.

There is no way I can keep up with this thread so I'm not going to even try anymore.

Since posting, I read a post where someone explained the way the situation came about for the nurse, she being the first person held directly after landing on home ground. She was hit from behind. After being in Africa, I'm sure she was excited about returning home and looking forward to enjoying the comforts of her home and family. The situation was handled without thinking it through in a way, if the pages were turned, one would like to be treated. Psychologically the nurse was excited and preparing to receive her reward (to be home after giving of herself and talents). Then, she was surprised by actions she encountered that were totally different from what she was expecting.
Hope this makes sense. A combination of errors occurred in the way she was taken hostage imo.

People aren't responsible for conditions in Africa except those who are in Africa. We can only do what we can and can't solve all problems everywhere. People who are trying to help go above and beyond imo.

 

[chipmunk]

Makes a weird bit of sense. Some people are just anti-authoritarian and interpret their own actions as not being brought into question.

When she presented at the airport, she was determined to have a fever along with her reporting she had just returned from treating Ebola patients.

She subsequently claimed that her "fever" was a result of being flushed and flustered. But considering the latest CDC guidelines of having returned from W.A. and having a detectable fever at the time, why shouldn't she have been "detained" and tested?

Please look at my response, post #551. If in doubt be screened by physician. Errors happen but I'm fine with physicians making the decision.

 

[jjenny]

It's important to keep in mind that right now we have one patient in the whole United States.
While it's good to have concern, this panic seems to be out of proportion.

 

[Woe.be.gone]

Ok. So why isn't everyone demanding that the health care workers here be quarantined after working on Ebola patients as well?

Our system of protocols is simply not better. No evidence of that at all. The fact that so many people from DWB are handling such patients and not contracting the virus tells me we have something to learn from them - not the other way around.

Further, Nigeria, which stopped the virus in its tracks, depsite being a populous third world country with poor sanitation, isolated and monitored but did not quarantine. Their success in eradicating the disease was due from help by WHO, the US CDC, the Nigerian CDC and strong leadership.
http://www.who.int/mediacentre/news/ebola/20-october-2014/en/
http://news.nationalgeographic.com/news/2014/10/141024-ebola-nigeria-outbreak-lessons-virus-health/
http://www.washingtonpost.com/poste...es-wont-stop-ebola-from-spreading-in-the-u-s/

Especially when considering the amount of virus the doctors and nurses are exposed to in West Africa versus here so far. Mr. Duncan was the worst so far. It seems, our two nurses here recovered quickly because they were infected by a lesser amount of the virus.

On two levels - the number of patients one is exposed to and the amount of virus one becomes infected by.
Those factors may be at play.

 

[XXXXXXXX]

Why did they detain her when she first presented without a fever?

With all due respect, why would you assume that the the fact that you have never spiked a fever when upset means that this could not be the case with other people? The instrument which was used to take her temperature is the one which scans the forehead. Flushing causes blood to rush to the surface of the skin and this could conceivably have affected the accuracy of the test. In the medical world, we get inaccurate readings all the time due to various reasons. It's always recommended to re-test any abnormal finding which is in dispute.

Even when my body FEELS hot and (frankly sweaty) I have never had a fever although internally I FEEL like I must have a high fever.

So let's carry this a bit further. My panic/anxiety disorder is hard to manage. My mind tells me I'm physically sick, yet despite an accelerated pulse, dizziness, fainting, and arrhythmia heart beat and sky high blood pressure, I've been dismissed as a hypochondriac a few times when I went to my local ER.

Still, not ONCE have I had a fever. Which contributes to my health problems being dismissed at my local ER. But at this point, now that this disease has entered the U.S. those forehead scanners are our one defense however "inaccurate" some claim them to be.

I'll let it go at that since I'm NOT trying to make this discussion about ME. I'm going to end my contribution by saying that being "flustered and anxious", in my personal experience, does NOT result in registering a detectable fever.

 

[nrdsb4]

Especially when considering the amount of virus the doctors and nurses are exposed to in West Africa versus here so far. Mr. Duncan was the worst so far. It seems, our two nurses here recovered quickly because they were infected by a lesser amount of the virus.

On two levels - the number of patients one is exposed to and the amount of virus one becomes infected by.
Those factors may be at play.

Maybe, but we don't know that. Could it be early treatment? Nina Pham was in the hospital within 90 minutes of noticing a fever. Is it survivor plasma (Mr. Duncan unfortunately didn't receive it)? Combination of early treatment, plasma, anti-virals? Other unknown factors?

 

[jjenny]

Maybe, but we don't know that. Could it be early treatment? Nina Pham was in the hospital within 90 minutes of noticing a fever. Is it survivor plasma (Mr. Duncan unfortunately didn't receive it)? Combination of early treatment, plasma, anti-virals? Other unknown factors?

Today, during the press conference when Amber was released, doctor speculated that they got over Ebola quickly because both of them were young (Amber and Nina) and possibly got a small dose of virus because they were using PPE.
Dr. Spencer seems to be having a harder time of it, even though he is also young. And he got into the hospital quickly. So maybe he got a higher dose of virus?

 

[nrdsb4]

Today, during the press conference when Amber was released, doctor speculated that they got over Ebola quickly because both of them were young (Amber and Nina) and possibly got a small dose of virus because they were using PPE.
Dr. Spencer seems to be having a harder time of it, even though he is also young. And he got into the hospital quickly. So maybe he got a higher dose of virus?

I worked today and was unable to see the press conference. That's very interesting to consider.
As awful as these infections are, they are surely giving researchers some valuable information. Let's hope so, anyway.

 

[nrdsb4]

When I heard that the second Presby nurse had become ill, I was horrified to think we might see dozens of other caregivers sickened as well. It's looking less and less like that will be the case. That and the fact that Louise didn't get sick has been such a welcome surprise.

 

[Sweet Fox]

Even when my body FEELS hot and (frankly sweaty) I have never had a fever although internally I FEEL like I must have a high fever.

So let's carry this a bit further. My panic/anxiety disorder is hard to manage. My mind tells me I'm physically sick, yet despite an accelerated pulse, dizziness, fainting, and arrhythmia heart beat and sky high blood pressure, I've been dismissed as a hypochondriac a few times when I went to my local ER.

Still, not ONCE have I had a fever. Which contributes to my health problems being dismissed at my local ER. But at this point, now that this disease has entered the U.S. those forehead scanners are our one defense however "inaccurate" some claim them to be.

I'll let it go at that since I'm NOT trying to make this discussion about ME. I'm going to end my contribution by saying that being "flustered and anxious", in my personal experience, does NOT result in registering a detectable fever.

I am unaware of any factual proof that blushing can make one’s temperature rise. Even during severe blushing (as in menopausal hot flashes, which does not apply in this instance), the core body temperature does not raise above normal.

But for merely argument sake, let say the airport scan thermometers are inaccurate. That indeed would make the CDC telling us to rely on them as an effective measure laughable. I don’t care if she had a fever or not. She should have been quarantine for 21 days.