Ebola in my Machine

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narcusprince

narcusprince

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Watching the case of ebola on television has really struck home. The physician was a classmate of mine in medical school. My question would be what would happen to a ventilator or anesthesia machine if you placed a patient with active ebola on it? Also, have you seen the sterile isolation coffin those guys are placed? How could you intubate someone in one of those coffins? I imagine the glidescope would be very helpful in that circumstance.
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I would imagine that isolation precautions for Ebola would be no different from those for TB or any other airborne pathogen. In fact, TB would probably be more of a concern. Most viruses, even Ebola, cannot survive very long in an environment without a cellular host. I would imagine that any residual virus in the machine would die off quickly anyway.

With that said, I doubt this would ever be an issue. Patients with active Ebola would not be candidates for elective surgery, and probably not for emergency surgery either (once DIC sets in). If I were being called to the ward/ICU to do an intubation, then it may be a concern. Do you have a picture of these 'isolation coffins'? I tried doing a search and came up blank.
 
It's not transmitted through aerosols. It's transmitted by contact with blood and bodily fluids and it's highly infectious. Nothing like TB. It requires much more precautions; it's biological weapon-grade. It kills up to 90% of the patients.

I grew up in a country where TB was endemic in certain regions. TB is to Ebola as common cold is to Pseudomonas pneumonia with septic shock.

Narcusprince, if you get a patient with hemorrhagic fever, you ask for a BSL-4 positive pressure suit, or you don't go in anywhere where the patient has been. Otherwise, chances of you dying will be much higher than being able to help the patient. If the patient has been in an OR, the OR should be sealed until cleared by the CDC or equivalent level of experts. Same goes for anybody who has come in contact with the patient or who has been wherever the patient has passed through without proper protection. Chances are that, if you get one of these patients, the entire hospital will go immediately into quarantine, exits sealed by police/national guard/ feds etc.

Go watch "Outbreak". ;)
 
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I am waiting with my breath abated to see what happens following this incredibly poor decision to bring these patient's to U.S. soil.

These people volunteered to go help in Africa. No one forced them to go. And while I feel badly that they contracted the disease I don't think that bringing them back to the U.S. is something that's "owed" to them. I also think that Emory is getting a lot of tertiary gain out of the situation. Bad, bad idea. Anyone see Jurassic Park?
 
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BuzzPhreed said:
I am waiting with my breath abated to see what happens following this incredibly poor decision to bring these patient's to U.S. soil.

These people volunteered to go help in Africa. No one forced them to go. And while I feel badly that they contracted the disease I don't think that bringing them back to the U.S. is something that's "owed" to them. I also think that Emory is getting a lot of tertiary gain out of the situation. Bad, bad idea. Anyone see Jurassic Park?
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My thoughts exactly.
 
Does any one know if physicians at Emory can choose not to take care of these patients? I guess some may be specifically trained for this scenario but those persons will not always be at the hospital.
 
You can't compare American and African medical care, that's for sure. They are light-years apart. Especially the comfort.
 
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No, what they should have done is park a ship like this one...

20100412102642190.jpg


... off the coast of Africa and put them on board and not bring that **** onto U.S. soil. You can get all the comfort and treatment you need in a big medical boat like that.

I'm really having my doubts about the so-called intelligence of the decision makers involved in this thing. I can think of at least a dozen scenarios off the top of my head where something could go horribly wrong and then, BOOM, you now have Ebola in the U.S.
 
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We already have Ebola in the US. It's been at the CDC for decades. ;)
 
No, it's locked up in Ft. Dietrick in Frederick, MD (along with smallpox and a ton of other nasties) and not in some "special" ward at a marginally secure civilian hospital inside an actual patient near downtown of the 11th largest metropolitan area in the country.
 
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The sort of strange irony is that Ebola isn't even an airborne threat, yet everyone acts like being in the same building with this guy will result in their demise.

I work at the pediatric hospital across the street from Emory hospital so needless to say the whole area has been a zoo the last few days.
 
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btbam said:
... Ebola isn't even an airborne threat, yet everyone acts like being in the same building with this guy will result in their demise.
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This:

Ebola can stay alive on a surface for at least several days, you could also get it from touching bedding or other inanimate objects contaminated with those bodily fluids.
Click to expand...

http://www.vox.com/2014/7/31/5952515/facts-you-should-know-about-the-ebola-outbreak

I've worked in hospitals for 11 years now. I've seen the lack of vigilance firsthand from people who not only care for patients to the people who clean up after them. I know too much.
 
btbam said:
The sort of strange irony is that Ebola isn't even an airborne threat, yet everyone acts like being in the same building with this guy will result in their demise.

I work at the pediatric hospital across the street from Emory hospital so needless to say the whole area has been a zoo the last few days.
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The case fatality rate is much worse than an aortic dissection and it is contagious. That is why people are concerned.
 
Sounds like the only way to make sure is to incinerate everything in a closed combustion chamber. The safest route would be to put everything the patient had contact with into his room when he was in it, and burn the whole bloody thing out.

I was going to say nuke the room from orbit, but the last thing I want is a real life version of The Andromeda Strain.

This brings up something equally terrifying. There was an episode of prion disease from instruments in a craniotomy, after the instruments were processed and sterilized. I was talking to a neurosurgeon, and he relayed to me that the only way to get rid of JKD was to smelt all the instruments back down and recast them, as the prions were resistant to pretty much all hospital available sterilization techniques.

I dread to think how this virus will adapt to standard sanitation techniques. Anyone have information on that? How hard is Ebola to kill on surfaces?
 
Ronin2258 said:
Sounds like the only way to make sure is to incinerate everything in a closed combustion chamber. The safest route would be to put everything the patient had contact with into his room when he was in it, and burn the whole bloody thing out.

...

I dread to think how this virus will adapt to standard sanitation techniques. Anyone have information on that? How hard is Ebola to kill on surfaces?
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Or you could just close the door for a week and let it die on its own...

I don't understand why you guys are so worked up over this. It's one patient with a virus that requires direct contact to spread, and one in which people are taking extreme precautions to avoid. Think about how careful and meticulous you'd be if you were in there treating the guy. Even if a few people did get sick, they'd just be quarantined too, and the problem would be solved. If they can get this thing under wraps in 1970's Zaire, I'm sure they've got a handle on it in 2014 America.

You're even posting links that talk about how unlikely it is to be an issue here to support your fears.

As for decontamination: SUSCEPTIBILITY TO DISINFECTANTS: Ebola virus is susceptible to sodium hypochlorite, lipid solvents, phenolic disinfectants, peracetic acid, methyl alcohol, ether, sodium deoxycholate, 2% glutaraldehyde, 0.25% Triton X-100, β-propiolactone, 3% acetic acid (pH 2.5), formaldehyde and paraformaldehyde, and detergents such as SDS (20, 21, 31-34).

PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating for 30 minutes to 60 minutes at 60ºC, boiling for 5 minutes, gamma irradiation (1.2 x106 rads to 1.27 x106rads), and/or UV radiation (3, 6, 20, 32, 33).

SURVIVAL OUTSIDE HOST: The virus can survive in liquid or dried material for a number of days (23). Infectivity is found to be stable at room temperature or at 4°C for several days, and indefinitely stable at -70°C (6, 20). Infectivity can be preserved by lyophilisation.

And per the article posted earlier, it's apparently a very genetically stable virus, so it's not going to suddenly become resistant to decontamination.

The guy will live or die, and that'll be that. Then people can go back to fretting over the next coming of the swine flu or whatever the media decides to scare them about while remaining completely oblivious to serious illnesses that have happened or could actually happen here...
 
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I also don't understand why people are getting so worked up about one infected person being transferred to the country under the strictest isolation standards available when it is likely that some traveler will eventually enter the US unknowingly with the virus. There is a large West African population in my home state and there was an article in its leading paper recently about how the husband of a local woman recently died of Ebola while in Africa. It would have been a much different story had he traveled back to the US during the incubation period.

Is it the financial resources needed to bring them back that irritates you all (referring to post #5)? Of course there are risks when volunteering abroad, but to dismiss the fate of those affected as "a consequence they knew the risk of" is sad. I would want my potential colleagues to be the object of targeted efforts for treatment such that Dr. Brantley has experienced so far. Surely this can be done within reason for just a couple individuals; of course it would be a different story with many affected individuals.
 
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Druggernaut said:
If they can get this thing under wraps in 1970's Zaire
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The Zairian outbreak with 88% mortality? That is not "under wraps" - that is nearly the definition of a "hot zone" outbreak. Almost everyone died in the hot zone, without making it into the warm zone. I don't know that I would call that so much of a victory. Hell, all they had to do was dig a trench around the area, and let it burn out (not that they did that).
 
I'm amazed a physician here would ask why are people upset about bringing an ebola infected patient back to the United States. Let's see? 88% mortality in the Zaire outbreak. Hmm. Can this thing go airborne? Well, look up Reston, Virginia in a monkey holding facility, I believe they call this the Reston strain of Ebola. There were dead monkey's in the morning when an infected monkey's ebola virus did in fact go airborne. That doesn't really sound like a stable nonmutating virus to me.

This thing is a clear and present danger to the people of the United States and Mr. Obama should be ashamed for not making the correct decision letting this guy stay in Africa along with the nurse. I guess she is on the way to Atlanta too. This liberal nonsense is a sure way to endanger 300 million americans.

I just hope no accidents happen so Atlanta, Georgia doesn't become the hot zone.

And the truth of the matter in the 1970s for how quickly the virus popped up, it mysterisously dissapeared and it is really not known why.
 
Apollyon said:
The Zairian outbreak with 88% mortality? That is not "under wraps" - that is nearly the definition of a "hot zone" outbreak. Almost everyone died in the hot zone, without making it into the warm zone. I don't know that I would call that so much of a victory. Hell, all they had to do was dig a trench around the area, and let it burn out (not that they did that).
Click to expand...

Well, that's kind of what I meant by "under wraps." Containment. It's not great, but if supportive care is all you've got, it just becomes a matter of preventing it from spreading across the continent until it burns itself out. The data they have on newer treatments seems promising, but I think there's been promising Ebola treatments that've failed before. We'll have to see how that pans out.

My multi quote doesn't seem to be working on my tablet, but does anyone have any information from a reliable source regarding cincincyreds' concern over mutation rates? The Reston virus is apparently not a threat to humans, but it does make me wonder a bit more if another strain could also become airborne. If I'm going to be dismissive, I'd like to at least be informed about it.
 
The individuals who have been transported back to Emory were well informed and careful and they were still infected. So were a couple of other physicians who have died during this outbreak. If it is so easy to control and contain, why is this happening?
 
Thus far, it isn't airborne.

Do we know what vector the virus does its mutation/recombination? Monkey? Zebra? Fleas? Aunt Edna's apple pie?

When they work for the flu vaccine, they take the best samples from the animals from where they undergo recombination/mutation (swine and chickens.) We all know it's a hit or miss depending on the strains the scientists in China think are going to spread.

If we know the vector it recombines in, we can see how it mutates. All it takes is a strand of genetic material that coats the virus for airborne durability to get recombined and we are going to be in trouble.

If Emory is working tight with the CDC, and if people put their A-game on when they handle our infected colleague, I am hopeful they will keep it contained and have a chance to fight this thing with a vaccine.

I detest the amount of fear and paranoia I have around this virus, and trying to be rational is difficult. It is an intimidating virus that needs the utmost caution in handling it. But it is important to see how it works to stop it.
 
FFP said:
Bats. Apparently some people in Africa eat them.
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That explains it. If memory serves, those fruit bats over there can make quite the meal for a family, they're that big.

So, if we keep him away from the Southwest, Mexico, and South America where he could be attacked by the three strain of vampire bats, we should be OK.

http://en.wikipedia.org/wiki/Vampire_bat
 
nimbus said:
The individuals who have been transported back to Emory were well informed and careful and they were still infected. So were a couple of other physicians who have died during this outbreak. If it is so easy to control and contain, why is this happening?
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This is the question that they don't want you to ponder. Just "trust" the people in charge. After all, they always get it right. In the meantime, I consider this a weird contradiction to the zero-risk bias that has runs amok with the proliferation of "evidence-based medicine" in the modern practice of healthcare.
 
Triple AAA said:
I would imagine that isolation precautions for Ebola would be no different from those for TB or any other airborne pathogen. In fact, TB would probably be more of a concern. Most viruses, even Ebola, cannot survive very long in an environment without a cellular host. I would imagine that any residual virus in the machine would die off quickly anyway.

With that said, I doubt this would ever be an issue. Patients with active Ebola would not be candidates for elective surgery, and probably not for emergency surgery either (once DIC sets in). If I were being called to the ward/ICU to do an intubation, then it may be a concern. Do you have a picture of these 'isolation coffins'? I tried doing a search and came up blank.
Click to expand...
??? CDC personnel wear level 4 hazmat suits around Ebola. It is in another galaxy compared with TB.
 
Bostonredsox said:
??? CDC personnel wear level 4 hazmat suits around Ebola. It is in another galaxy compared with TB.
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http://www.cdc.gov/vhf/ebola/transmission/

According to the CDC:

When an infection does occur in humans, there are several ways in which the virus can be transmitted to others. These include:
  • direct contact with the blood or secretions of an infected person
  • exposure to objects (such as needles) that have been contaminated with infected secretions
This really isn't much different from HIV or Hep C, which most healthcare workers deal with on a daily basis. I won't contract ebola simply by virtue of being in the same room as a patient, so long as I am reasonably far away from any infected fluids and don't have any breaks in my skin.

The reason people are ramping up the precautions here is because Ebola can be transmitted through virtually any bodily fluid (HIV doesn't typically spread through contact with urine, saliva, sweat, etc), the resilience of the virus in said fluids is stronger (hence, more rigorous decontamination protocols), and the mortality is considerably higher without any vaccine/cure.

The first reason is the reason why people wear goggles, masks, etc, which is understandable. But mortality and resilience alone should not make a difference unless their urine somehow comes in contact with an open wound.
 
Let's be clear about something.

Experimentally, Ebola has been transmitted also through the air, but not between primates (whose infection is not primarily in the lungs). Since the number of infected people studied is low, it's still debatable whether there is an aerosolized transmission among humans. If a highly-educated American doctor can get Ebola, anybody can.

Hence the bio-safety level 4 (the highest possible level) classification. Here's how a BSL-4 level facility looks like inside:

 
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Triple AAA said:
http://www.cdc.gov/vhf/ebola/transmission/

According to the CDC:

When an infection does occur in humans, there are several ways in which the virus can be transmitted to others. These include:
  • direct contact with the blood or secretions of an infected person
  • exposure to objects (such as needles) that have been contaminated with infected secretions
This really isn't much different from HIV or Hep C, which most healthcare workers deal with on a daily basis. I won't contract ebola simply by virtue of being in the same room as a patient, so long as I am reasonably far away from any infected fluids and don't have any breaks in my skin.

The reason people are ramping up the precautions here is because Ebola can be transmitted through virtually any bodily fluid (HIV doesn't typically spread through contact with urine, saliva, sweat, etc), the resilience of the virus in said fluids is stronger (hence, more rigorous decontamination protocols), and the mortality is considerably higher without any vaccine/cure.

The first reason is the reason why people wear goggles, masks, etc, which is understandable. But mortality and resilience alone should not make a difference unless their urine somehow comes in contact with an open wound.
Click to expand...

See FFPs picture. Idk what your talking about how it's transmitted via lab studies....but cdc wears level 4 hazmat suits around it....they sure as **** don't wear that around HIV or hep c.....because of 88% of those pts don't die in an outbreak...
 
First case of Ebola in the US
US health officials said on Tuesday the first patient infected with the deadly Ebola virus had been diagnosed in the country after flying from Liberia to Texas, in a new sign of how the outbreak ravaging West Africa can spread globally.

The patient sought treatment six days after arriving in Texas on Sept. 20, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), told reporters on Tuesday. He was admitted two days later to an isolation room at Texas Health Presbyterian Hospital in Dallas.
Click to expand...

In a press conference Tuesday evening, Centers for Disease Control and Prevention (CDC) Director Thomas Frieden provided more information about a patient confirmed to be carrying Ebola—the first to be diagnosed in the United States.

The patient, who has been identified as a male, left Liberia on September 19 and arrived in the United States on September 20. Four days later, the man began showing symptoms. On September 26, he reportedly “sought care,” which Frieden declined to elaborate on. On the evening of September 28, the patient was placed in isolation. By 1:22 p.m. Tuesday, experts in Dallas had confirmed that the patient had Ebola. Frieden said the patient is now “critically ill” and that the CDC is exploring “experimental Ebola treatments.”

Since the patient did not show symptoms of the infection until four days after arriving in the United States, he was not contagious on the plane or in the airport. “At this point, there is zero risk of transmission on the flight.
Click to expand...
http://www.thedailybeast.com/articl...r-first-u-s-ebola-patient-critically-ill.html
 
narcusprince said:
Watching the case of ebola on television has really struck home. The physician was a classmate of mine in medical school.
Click to expand...

Have you seen the new issue of "Time" magazine? He's one of two Americans and three survivors (and the only one where the Venn diagram overlaps) on this week's cover.
 
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