One of the nurses that cared for the Ebola index patient in Dallas has tested positive for Ebola. Why didn't they giving nurses the same suits/PPE that they use at the CDC? Are they doing so now? Why wasn't the CDC on site supervising in Dallas from the start? They are now down there now after the fact. Who knows if they are giving the nurses, doctors, and other allied health people the same PPE as what CDC uses for dealing with Ebola? Right now, they need to start from there until there is a better grasp on Ebola.
Now Nurse That Cared for Index Pt in Dallas Has Ebola
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I just think that the Thomas Duncan with Ebola situation was handled poorly from the get go.
People in allied health are saying to me re: this latest Ebola news--you, know--US has it's own index pt for Ebola and that CDC, it appears, dropped the ball on this thing--well, they are saying, basically, "What does this news have to do with me? What do you want me to do about it?" Someone whom I thought was fairly intelligent replied that to me, and I nearly fell over. Duh! It has to do with awareness...staying alert to this issue. . .understanding that this is supposed to be a nation of "We the people..." and with that comes some level of responsibility of awareness and speaking out. Listen, we pay the CDC's costs and salaries too. There isn't one damn good reason I can think of for them not being there in Dallas when Duncan was admitted and thereafter--supervising, directing, teaching, from jump street. Also, hell no. The nurses and doctors and any involved allied health personnel should have had top of the line gear--not merely a flimsy plastic shield, crappy mask, crappy gown, and crappy gloves.
Shame on them. It's ridiculous. Personally, I am pissed, and no. I don't think it is overreacting at all. Again, it only takes one person to light the fire of a deadly endemic leading to pandemic. Heck it's already a pandemic. Time to get ultra-serious CDC and America--AKA Americans.
Shame on them. It's ridiculous. Personally, I am pissed, and no. I don't think it is overreacting at all. Again, it only takes one person to light the fire of a deadly endemic leading to pandemic. Heck it's already a pandemic. Time to get ultra-serious CDC and America--AKA Americans.
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You're fearmongering for little reason.
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Its very unlikely that this one mishap would cause a pandemic. And the CDC has learned its lesson now (fingers crossed) and if we do have any additional cases, they will probably be more hands on.
Ebola is already a pandemic. Furthermore, how many people does it take to start one? ONE. The nurses in the direct care of Duncan interacted with others. There are at least 50 people or more than have been identified on the CDC watch list just from the caring of Mr. Duncan--and that's AFTER he was admitted into isolation. Each of these 50 people have interacted with others.
I really encourage people to read about the history of Ebola, both recent and past. It's both enlightening and alarming.
We can and should do better, period. Doing right is NEVER fearmongering. I find that a terribly poor choice of words. Your choice, but it's neither fair nor accurate.
"Wisdom is knowing what to do next; virtue is doing it." ~David Star Jordan, The Philosophy of Despair
You're fearmongering for little reason. ridethecliche, Yesterday at 11:21 PM Report - See more at: http://forums.studentdoctor.net/thr...pt-in-dallas-has-ebola.1103086/#post-15779485
^That is absolutely hilarious, and scary at the same time.
I don't think this has anything to do with fearmongering. It has everything with doing the right things, and getting on the ball to get this crap under control.
We are not a third world nation. There is no excuse for the CDC dropping the ball or not giving the people involved in minute-to-minute direct patient care the best protection from a highly infectious illness. And make no mistake, it's highly infectious. It's infected > 8.000 people and killed over 4,000 people, and that is only in recent months--not counting other strains on the other side of Africa and elsewhere. There is no known (published) cure for this disease. This virus is said to have a great ability to mutate. Furthermore, droplet particles do indeed become airborne, b/c they are pushed by heavy breaths, speech, sneezing, or coughing away from the individual to where other people and their PPE has contact with them.
No, this is a serious situation, and we need to get this under control NOW. As it is, the spread of Ebola in East Africa got so far b/c of delays in identifying and effectively dealing with it. We are not Africa. We have the ability to do better. We should have done better, and so we must now going forward. It's that simple
Also, the whole situation did not involve but ONE mishap. Biohaz waste was thrown into regular trash. The CDC should have been there as conductor from jump street in direction supervision. Top of the line PPE should have been issued, and the CDC people should have had their people caring for this patient until all were properly trained and monitored--or Duncan should have been carefully taken to a facility that could have provided the necessary controls.
Yes, this nurse is now the first index patient for Ebola in the US. Let's hope and pray to God that CDC, et, al will be on top of this and not miss a step going forward. Even still, there remains significant risks and the necessity of thorough contact-tracing for those 50+ folks. Sigh
^That is absolutely hilarious, and scary at the same time.
I don't think this has anything to do with fearmongering. It has everything with doing the right things, and getting on the ball to get this crap under control.
We are not a third world nation. There is no excuse for the CDC dropping the ball or not giving the people involved in minute-to-minute direct patient care the best protection from a highly infectious illness. And make no mistake, it's highly infectious. It's infected > 8.000 people and killed over 4,000 people, and that is only in recent months--not counting other strains on the other side of Africa and elsewhere. There is no known (published) cure for this disease. This virus is said to have a great ability to mutate. Furthermore, droplet particles do indeed become airborne, b/c they are pushed by heavy breaths, speech, sneezing, or coughing away from the individual to where other people and their PPE has contact with them.
No, this is a serious situation, and we need to get this under control NOW. As it is, the spread of Ebola in East Africa got so far b/c of delays in identifying and effectively dealing with it. We are not Africa. We have the ability to do better. We should have done better, and so we must now going forward. It's that simple
Also, the whole situation did not involve but ONE mishap. Biohaz waste was thrown into regular trash. The CDC should have been there as conductor from jump street in direction supervision. Top of the line PPE should have been issued, and the CDC people should have had their people caring for this patient until all were properly trained and monitored--or Duncan should have been carefully taken to a facility that could have provided the necessary controls.
Yes, this nurse is now the first index patient for Ebola in the US. Let's hope and pray to God that CDC, et, al will be on top of this and not miss a step going forward. Even still, there remains significant risks and the necessity of thorough contact-tracing for those 50+ folks. Sigh
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The cdc has lost funding over the last decade. It is woefully unprepared for anything and it's not the agencies fault.
Why don't you actually read what's happening instead of freaking out over one infection where everyone dropped the ball. My hospital already has a comprehensive plan for dealing with potential infections and others are following suit.
http://www.huffingtonpost.com/2014/10/12/ebola-vaccine_n_5974148.html?ncid=fcbklnkushpmg00000013
Why don't you actually read what's happening instead of freaking out over one infection where everyone dropped the ball. My hospital already has a comprehensive plan for dealing with potential infections and others are following suit.
http://www.huffingtonpost.com/2014/10/12/ebola-vaccine_n_5974148.html?ncid=fcbklnkushpmg00000013
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To be fair until someone with a Liberian passport who was personally exposed to Ebola patients can't just board a flight to Dallas, we are all chasing our tails. This isn't really a hospital problem -- that's really just the last stop, and the one most able to handle these problems. it's really a TSA/customs problem - it has to be. That's where the ball got dropped and I'm not sure it ever got addressed, nor do we know if others on the flight or in the Dallas airport who this guy potentially coughed on are being monitored. It's silly to focus on whether there's adequate protective gear and training for nurses when for all we know the hospital was the tenth place he went once he got to the U.S.
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TSA/Customs are medical experts now?
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They don't have to be a medical expert. For them it should be more of a hazardous material import/export issue than a Medical problem -- once you let it get all te way to the hospital setting, ie need to diagnose something with vague symptoms, it's already much too late, too many people have been exposed. If someone is coming with a passport from Liberia (or one of the other two places struggling with Ebola), maybe there ought to be a few more hurdles before he gets to board a plane to Dallas. Or maybe we even ought to suspend travel to/from this part of the world for a bit. Trying to deal with this problem after it's imported, and talking about how hospital personnel "dropped the ball" is foolhardy and backwards. They should never have seen this ball to drop.
Well I agree with you Law, and I don't.
It's not foolish, but indeed it's wise to objectively and effectively assess and evaluate the many points where the ball has been dropped. This is a teachable moment right now in healthcare. And it's a serious one at that. Like I said in the ED forum. No one is saying the sky is falling. But it's time to thoughtfully re-group and fix what is broken. It's defeatist IMHO to say that we can't learn and grow. We should. It's not likely, even if travel is suspended for non-medical/humanitarian or military personnel, that Ebola will cease to be a threat to Americans/America. It is a potential threat, and we have to be aware and ready. You can't stop every potential point of entry. You can try to limit it, and I agree with that. But we cannot completely stop it.
Yes, the symptoms are vague--especially early on. And also, there is this: what did "House" often say? "People lie." So Duncan lied, and others probably have and will too. What's more, you cannot stop humanitarian aid. Dear God, Ebola, at least in part, has gotten as far as it has over there b/c the help and support trickled in. When you read about it, you see where doctors were practically begging WHO for support and even to let CDC do there thing over there.
Since the potential will continue to exist to one degree or another, it absolutely behooves us and the CDC to have a well-developed plan in place. One of the most sensible ones to me seems to be to carefully transport any potential or active Ebola patients to a fully CDC-approved facility.
No way they are going to catch everyone coming into this country. In today's world, the big Atlantic is not going to stop the potential of infection.
Let's learn and be bettered prepared. Let's not panic; but let's take this thing very seriously. No one listens to Franklin anymore about "an ounce of prevention?"
It's not foolish, but indeed it's wise to objectively and effectively assess and evaluate the many points where the ball has been dropped. This is a teachable moment right now in healthcare. And it's a serious one at that. Like I said in the ED forum. No one is saying the sky is falling. But it's time to thoughtfully re-group and fix what is broken. It's defeatist IMHO to say that we can't learn and grow. We should. It's not likely, even if travel is suspended for non-medical/humanitarian or military personnel, that Ebola will cease to be a threat to Americans/America. It is a potential threat, and we have to be aware and ready. You can't stop every potential point of entry. You can try to limit it, and I agree with that. But we cannot completely stop it.
Yes, the symptoms are vague--especially early on. And also, there is this: what did "House" often say? "People lie." So Duncan lied, and others probably have and will too. What's more, you cannot stop humanitarian aid. Dear God, Ebola, at least in part, has gotten as far as it has over there b/c the help and support trickled in. When you read about it, you see where doctors were practically begging WHO for support and even to let CDC do there thing over there.
Since the potential will continue to exist to one degree or another, it absolutely behooves us and the CDC to have a well-developed plan in place. One of the most sensible ones to me seems to be to carefully transport any potential or active Ebola patients to a fully CDC-approved facility.
No way they are going to catch everyone coming into this country. In today's world, the big Atlantic is not going to stop the potential of infection.
Let's learn and be bettered prepared. Let's not panic; but let's take this thing very seriously. No one listens to Franklin anymore about "an ounce of prevention?"
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That's the most ridiculous way to handle an ID event like this.
Do you want to test all people traveling from affected regions?
Do you want to test all people traveling from affected regions?
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Um no. I want to suspend travel from that region until they get a handle on this disease.
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That's ludicrous! I can understand quarantining people with symptoms pre flight, but that's nuts!
Wow. Where did he say test all people traveling from affected regions? As far as I know, it's useless to test for it until after symptoms have come into play. I believe the viral load has to be high enough and antigen markers have to be there, and that usually means some degree of symptoms--even subtle ones. But temp checks aren't always effective; b/c some folks have screwy immune symptoms, kind of like neonates, that don't show a typical response, at least not early on. So some people may not pop a fever then. There is no surefire way to know if someone has Ebola early. I mean isn't the "prodromal phase" very brief?
But as I said earlier, only humanitarian, military, and medical people, who can be carefully tracked, should be allowed to move between the US and those previously stated areas of West Africa. Close it off to all others attempting to come in or going there. If a rare, special petition has to be made to officials--some major family crisis--then people can go through those channels.
I understood Law to say stop the going in and out of US to W.Africa and back for now. This is something that should have been done when the Dr. Brantly and the other missionary came to Emory. CDC and the government knew the stats over there then, but it is definitely something we should do now. They KNEW how out of control it was over there. Please, again, read A LOT of different material on the recent development of particular strain of Ebola.
Any official who tells you that limiting passage to W. A. to humanitarian, medical, and military personnel can't be done w/o risking further spread of the disease in Africa is so blowing smoke up your skirt.
So many of us are done with drinking Koolaid from government talking-heads.
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I'll be the first to say that I don't agree with the way everything has been handled, but I also think we need to be careful making assumptions as well.
Knowing how the CDC operates in these types of situations, I would be willing to bet very large amounts of money that members of the CDC were in Dallas quickly after that result turning up positive. Now how much time they spent doing contact tracing vs. on site guidance to the providers is a different issue. Those CDC members were also probably providing guidance issued from down on high as well. And I have to agree that budget cuts are probably an issue here.
They have been issuing guidance to hospitals and state health depts for months. Whether it was enough or the best is something that needs to be evaluated.
Having faith in our PPE is one thing. Having faith in people to remove it 100% successfully 100% of the time when they haven't drilled for something like this, extensively, is more than overly optimistic. So even though the regular PPE is supposed to be enough, why not out of an aboundance of caution, give people the best option with the Tyvek suits? Why not utilize the buddy system like they do in the containment units, why not spray them down when they come out? Let's just cover our bases here.
Also, we've invested the time and money for these containment sites, so let's make the most of them. Just because we can, in theory handle this at any hospital doesn't mean we need to. Once we ID it, transfer them there. Let's give those people the opportunity to do what they trained for, so the rest can learn from them.
My institution has been having protocol planning sessions and running simulations for months and still don't have the kinks worked out.
Good analysis on the problems with the guidance from the CDC
http://www.cnn.com/2014/10/13/health/ebola-cdc/index.html
As for the TSA, yeah, they should be able to screen people, but given what we know about the TSA, I wouldn't want to stake my life on them doing it consistently. Just like anything in healthcare, we need multiple points where we have the opportunity to catch near misses.
I'm on the fence about the air travel quarantine, banning people from those countries issue. It sounds like a nice easy fix, but there are issues that make it problematic. so I'm not sure. It would be nice if they would lay those issues out in detail for people though, for a better discussion about it.
Finally, if you really want to talk about who dropped the ball here, the entire international community did by ignoring the calls for help from groups like MSF who were on the ground and saying they needed backup back six months ago. It wasn't in our backyard so not high on our priority list, but people with extensive experience managing Ebola knew it would explode in this region. Now here we are, and instead of the costs being hundreds of lives and millions of dollars it's going to be 10s of thousands of lives and billions of dollars. Someday we'll learn, but I'm scared of what it's going to take to get us there.
Knowing how the CDC operates in these types of situations, I would be willing to bet very large amounts of money that members of the CDC were in Dallas quickly after that result turning up positive. Now how much time they spent doing contact tracing vs. on site guidance to the providers is a different issue. Those CDC members were also probably providing guidance issued from down on high as well. And I have to agree that budget cuts are probably an issue here.
They have been issuing guidance to hospitals and state health depts for months. Whether it was enough or the best is something that needs to be evaluated.
Having faith in our PPE is one thing. Having faith in people to remove it 100% successfully 100% of the time when they haven't drilled for something like this, extensively, is more than overly optimistic. So even though the regular PPE is supposed to be enough, why not out of an aboundance of caution, give people the best option with the Tyvek suits? Why not utilize the buddy system like they do in the containment units, why not spray them down when they come out? Let's just cover our bases here.
Also, we've invested the time and money for these containment sites, so let's make the most of them. Just because we can, in theory handle this at any hospital doesn't mean we need to. Once we ID it, transfer them there. Let's give those people the opportunity to do what they trained for, so the rest can learn from them.
My institution has been having protocol planning sessions and running simulations for months and still don't have the kinks worked out.
Good analysis on the problems with the guidance from the CDC
http://www.cnn.com/2014/10/13/health/ebola-cdc/index.html
As for the TSA, yeah, they should be able to screen people, but given what we know about the TSA, I wouldn't want to stake my life on them doing it consistently. Just like anything in healthcare, we need multiple points where we have the opportunity to catch near misses.
I'm on the fence about the air travel quarantine, banning people from those countries issue. It sounds like a nice easy fix, but there are issues that make it problematic. so I'm not sure. It would be nice if they would lay those issues out in detail for people though, for a better discussion about it.
Finally, if you really want to talk about who dropped the ball here, the entire international community did by ignoring the calls for help from groups like MSF who were on the ground and saying they needed backup back six months ago. It wasn't in our backyard so not high on our priority list, but people with extensive experience managing Ebola knew it would explode in this region. Now here we are, and instead of the costs being hundreds of lives and millions of dollars it's going to be 10s of thousands of lives and billions of dollars. Someday we'll learn, but I'm scared of what it's going to take to get us there.
I'll be the first to say that I don't agree with the way everything has been handled, but I also think we need to be careful making assumptions as well.
Knowing how the CDC operates in these types of situations, I would be willing to bet very large amounts of money that members of the CDC were in Dallas quickly after that result turning up positive. Now how much time they spent doing contact tracing vs. on site guidance to the providers is a different issue. Those CDC members were also probably providing guidance issued from down on high as well. And I have to agree that budget cuts are probably an issue here.
They have been issuing guidance to hospitals and state health depts for months. Whether it was enough or the best is something that needs to be evaluated.
Having faith in our PPE is one thing. Having faith in people to remove it 100% successfully 100% of the time when they haven't drilled for something like this, extensively, is more than overly optimistic. So even though the regular PPE is supposed to be enough, why not out of an aboundance of caution, give people the best option with the Tyvek suits? Why not utilize the buddy system like they do in the containment units, why not spray them down when they come out? Let's just cover our bases here.
Also, we've invested the time and money for these containment sites, so let's make the most of them. Just because we can, in theory handle this at any hospital doesn't mean we need to. Once we ID it, transfer them there. Let's give those people the opportunity to do what they trained for, so the rest can learn from them.
My institution has been having protocol planning sessions and running simulations for months and still don't have the kinks worked out.
Good analysis on the problems with the guidance from the CDC
http://www.cnn.com/2014/10/13/health/ebola-cdc/index.html
As for the TSA, yeah, they should be able to screen people, but given what we know about the TSA, I wouldn't want to stake my life on them doing it consistently. Just like anything in healthcare, we need multiple points where we have the opportunity to catch near misses.
I'm on the fence about the air travel quarantine, banning people from those countries issue. It sounds like a nice easy fix, but there are issues that make it problematic. so I'm not sure. It would be nice if they would lay those issues out in detail for people though, for a better discussion about it.
Finally, if you really want to talk about who dropped the ball here, the entire international community did by ignoring the calls for help from groups like MSF who were on the ground and saying they needed backup back six months ago. It wasn't in our backyard so not high on our priority list, but people with extensive experience managing Ebola knew it would explode in this region. Now here we are, and instead of the costs being hundreds of lives and millions of dollars it's going to be 10s of thousands of lives and billions of dollars. Someday we'll learn, but I'm scared of what it's going to take to get us there.
I addressed this in the ED thread, so. . .
Point is, popping in and out, as I pointed out in the ED thread, is NOT good enough. If they aren't prepared to be there 24/7 when needed, then they need to ensure that the patient is moved to one of their hospitals. I have absolutely NO problem pointing out the lack of good sense the CDC has exercised; b/c I help pay their salaries. Every American should be watching them and they have more than every right to be VERY concerned. Concern is not Panic; but if the incompetence or avoidance behavior continues, people may also understandably panic.
I am very worried with any skirting around what their role is and how it should be done. Some of this business doesn't not even require a degree in public health or specialization in epidemiology. It's simply good sense.
Guidance is one thing. Taking the bull by the horns when necessary is another.
No one given their amount of funding, budgetary cuts or not, should be afraid to stand and be counted from an accountability standpoint. No way.
And our leadership needs to face the music about not tightening up on movement to and from these areas. Only necessary personnel as previously stated could be sent.
I have read the CNN article, and I pretty much agree.
Again, how the PPE is used from donning until removal is part of direct and repeated teaching, drilling, and supervision.
This is not about kinks not being worked out. This is just plain screwy, and the people have an absolute right and just plain good sense to be concerned. I refuse to tolerate shifting of accountability. No passes for the administration or the CDC here.
Yes, I agreed about the ignoring of the pleas for help. I mentioned that earlier in this very thread.
Finally going back to your earlier point above. I find no issues that make limiting passage to these countries and back impossible or even grossly problematic. As mentioned several times, and as is incredibly avoided by our government and sadly Dr. Frieden, we can limit travel to the noted areas of W. A. to necessary personnel only-->humanitarian and medical aid and military.
If someone has to make a special petition to go there, let it be heard by the appropriate officials and followed-through on a case-by-case basis.
Limiting travel to W.A. to the aforementioned groups also allows for better tracking of infection from our end.
Honestly, there is no oversimplification here. This is not rocket science, and no. Many Americans, thank God, won't swallow the Kool-Aid. And they shouldn't.
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Because it's stupid to ban travel from all affected regions with no real reason. It's ludicrous and reminiscent of some of the BS that went around at the height of the AIDS epidemic albeit for different reasons.
At best case scenario, you're making it harder for aide workers to go back home. If people are symptomatic, then sure check and potentially quarantine them, but complete travel restrictions are hilariously naive.
At best case scenario, you're making it harder for aide workers to go back home. If people are symptomatic, then sure check and potentially quarantine them, but complete travel restrictions are hilariously naive.
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Quarantine's are a great idea!
http://gawker.com/nbc-chief-medical-correspondent-quarantined-for-ebola-1645924287
http://gawker.com/nbc-chief-medical-correspondent-quarantined-for-ebola-1645924287
That is completely false. If anything, you can keep better track of those that are directly involved in the aid. Wow.
Travel restrictions from that area are not stupid at all. It's intelligent and basic common sense to do this. You can get help in and out and monitor them closely. The Dr.-missionary from Samaritan's Purse had not difficulty getting home and into a CDC facility. Private flights makes more sense for these folks coming home anyway.
Whatever. It's just Kool-Aid. Be very glad and thank God above if this things stays limited to the nurse in Texas. And God help her to be well. If it does manage to stop at the nurse; the question them will be, for how long? Why disaster have to come and hit the fan before people use good sense?
Something is not right, at all, with this whole situation and picture.
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What's stupid is importing a deadly disease to another country and only then trying to identify and contain it. Once people are symptomatic it's relatively easy to identify and quarantine. But this thing starts relatively benignly and it kind of wishful thinking that it only becomes contagious once it's symptoms are bad enough to end up in the ER. A lot of us walk around with various colds and flus for days every year, assuming it's just a 24 or 48 or 72 hour bug that will run it's course. Much of the nation is coughing and sniffling during flu season. Guess what -- that's symptomatic enough to be contagious with whatever we've got. The guy would have been (and presumably was) wandering around Dallas shedding virus in supermarkets and drug stores and public transportation, the waiting/triage rooms of the local ER and other public areas for days by the time you seem to want to address it. Hes already symptomatic, its jyst not clear yet whether its something ad or benign. Once someone is MORE "symptomatic" it's really too late -- that's exactly the point on the decision tree you dont want to be. If you dont stop and confine this bug earlier than at that point, its game over. I'm pretty sure I know which one of us us being "hilariously naive" here. As for limiting humanitarian aid by restricting travel, I think you kind of have to do that until you have a much better handle on how this spreads than we or the Liberian medical system obviously does.
AIDS is really the opposite kind of disease -- it is actually EXTREMELY hard to catch via caregiving, it's symptoms are far less subtle, and by the time people in the US had heard of it it already wasn't geographically confined to a specific part of the world. so that is a pretty dissimilar example. Things like SARS is a better example, and I think we saw a pretty good example of why we were already chasing our tail if we let people travel with the illness and didn't try to address it until it became symptomatic.
This is all very scary stuff, but what's naive is to say, after we've already seen a healthcare worker who supposedly used some degree of precautions catch the virus, and who knows how many people were exposed to this guy while he was mildly symptomatic but before he ended up in the ER, that we just need to address it once a guy is in the hospital. What's an early symptom of a flu-like illness really? You don't think the person taking a history and doing a physical exam in the ER before he hears the word Liberia or asks about travel hasnt potentially already exposed himself to symptomatic Ebola patient? Or the others in the waiting room sitting next to this guy?
I think every med student comes to the conclusion after evaluating patients later put on isolation precautions that there really is no protection for the first wave of medical personnel, who will be the potential vectors for the rest of the hospital. At that point it's too late. I know I've personally examined patients and by the next day the patient is on gown and glove or airborne precautions. No one hunts down the med student or nurse or resident to let them know. We all go on to see another dozen patients that day,and every day. We don't call out sick the next week when we have a Mild case of the sniffles. And then share computers, phones, pens, call rooms with countless other healthcare providers daily. When one of the residents gets a cold, very quickly they all get it, every time. Which is why if you let this get to the hospital setting, it's kind of too late. Just my two cents.
What's stupid is importing a deadly disease to another country and only then trying to identify and contain it. Once people are symptomatic it's relatively easy to identify and quarantine. But this thing starts relatively benignly and it kind of wishful thinking that it only becomes contagious once it's symptoms are bad enough to end up in the ER. A lot of us walk around with various colds and flus for days every year, assuming it's just a 24 or 48 or 72 hour bug that will run it's course. Much of the nation is coughing and sniffling during flu season. Guess what -- that's symptomatic enough to be contagious with whatever we've got. The guy would have been (and presumably was) wandering around Dallas shedding virus in supermarkets and drug stores and public transportation, the waiting/triage rooms of the local ER and other public areas for days by the time you seem to want to address it. Hes already symptomatic, its jyst not clear yet whether its something ad or benign. Once someone is MORE "symptomatic" it's really too late -- that's exactly the point on the decision tree you dont want to be. If you dont stop and confine this bug earlier than at that point, its game over. I'm pretty sure I know which one of us us being "hilariously naive" here. As for limiting humanitarian aid by restricting travel, I think you kind of have to do that until you have a much better handle on how this spreads than we or the Liberian medical system obviously does.
AIDS is really the opposite kind of disease -- it is actually EXTREMELY hard to catch via caregiving, it's symptoms are far less subtle, and by the time people in the US had heard of it it already wasn't geographically confined to a specific part of the world. so that is a pretty dissimilar example. Things like SARS is a better example, and I think we saw a pretty good example of why we were already chasing our tail if we let people travel with the illness and didn't try to address it until it became symptomatic.
This is all very scary stuff, but what's naive is to say, after we've already seen a healthcare worker who supposedly used some degree of precautions catch the virus, and who knows how many people were exposed to this guy while he was mildly symptomatic but before he ended up in the ER, that we just need to address it once a guy is in the hospital. What's an early symptom of a flu-like illness really? You don't think the person taking a history and doing a physical exam in the ER before he hears the word Liberia or asks about travel hasnt potentially already exposed himself to symptomatic Ebola patient? Or the others in the waiting room sitting next to this guy?
I think every med student comes to the conclusion after evaluating patients later put on isolation precautions that there really is no protection for the first wave of medical personnel, who will be the potential vectors for the rest of the hospital. At that point it's too late. I know I've personally examined patients and by the next day the patient is on gown and glove or airborne precautions. No one hunts down the med student or nurse or resident to let them know. We all go on to see another dozen patients that day,and every day. We don't call out sick the next week when we have a Mild case of the sniffles. And then share computers, phones, pens, call rooms with countless other healthcare providers daily. When one of the residents gets a cold, very quickly they all get it, every time. Which is why if you let this get to the hospital setting, it's kind of too late. Just my two cents.
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Yes Law2, most of what you say is quite true. I do feel that support can still be given from the US, but I say hold off on everyone else--unless they have one exceptional reason and have gone through the right channels.
Meanwhile, a medical worker who had been working in Liberia has died in a German hospital from Ebola.
"His death further raises questions of just how equipped health officials are in dealing with the disease.
The 56-year-old man was Sudanese, a spokesman for the St. Georg hospital in Leipzig said Tuesday. He was being treated in a secure isolation ward there. And the clinic said last week that its doctors and medical staff were "perfectly prepared" for the task."
http://www.cnn.com/2014/10/14/world/europe/ebola-outbreak/index.html
Well, at least things are looking up Good to know some of us were just being reactionary scaremongers.
Meanwhile, a medical worker who had been working in Liberia has died in a German hospital from Ebola.
"His death further raises questions of just how equipped health officials are in dealing with the disease.
The 56-year-old man was Sudanese, a spokesman for the St. Georg hospital in Leipzig said Tuesday. He was being treated in a secure isolation ward there. And the clinic said last week that its doctors and medical staff were "perfectly prepared" for the task."
http://www.cnn.com/2014/10/14/world/europe/ebola-outbreak/index.html
Well, at least things are looking up
Good to know some of us were just being reactionary scaremongers.
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Yes Law2, most of what you say is quite true. I do feel that support can still be given from the US, but I say hold off on everyone else--unless they have one exceptional reason and have gone through the right channels.(1)
Meanwhile, a medical worker who had been working in Liberia has died in a German hospital from Ebola.
"His death further raises questions of just how equipped health officials are in dealing with the disease.
The 56-year-old man was Sudanese, a spokesman for the St. Georg hospital in Leipzig said Tuesday. He was being treated in a secure isolation ward there. And the clinic said last week that its doctors and medical staff were "perfectly prepared" for the task."
http://www.cnn.com/2014/10/14/world/europe/ebola-outbreak/index.html
Well, at least things are looking up
(1) What are you talking about? This is such a western centric view. Yes, let the others die. We'll hide up here on our cloud.
(2) I'm glad you finally saw the light.
In reply to both comments above: Um, What? Seriously. And who is letting whom die? So, I am unclear of your meaning. I don't think I said or even inferred your above comments. Saw the light about what exactly? The fact that others have died or are ill from Ebola in Germany?
Honestly, I don't mind having civil disagreements. I mean, I embrace people sharing differing views. I just don't see how such communications get anywhere when either of us is unclear. Please feel free to seek clarification from me regarding any of my meanings/messages. What others are dying exactly? I believe you are putting words in my mouth, I mean, quote-box. I don't want dogs to die from Ebola, much less people.
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Tldr: I'm in favor of screening and quarantine, but not in favor of travel bans. I think they're short sighted and do more harm than good.
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You keep making a lot of statements about travel bans being ridiculous, naive, short sighted, etc. yet you offer no reasoning, let along evidence, as to why they WOULDN'T reduce risk......do you have any?
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Sure, here you go:
1) New yorker article with a good quote from Dr. Gawande.
http://www.newyorker.com/news/news-desk/ban-flights-countries-ebola-outbreaks
There are several reasons for this. For one thing, as Gawande points out, travel bans don’t really work: “Even if travel could be reduced by eighty per cent—itself a feat—models predict that new transmissions would be delayed only a few weeks.” For another, they make it even more difficult to address the public-health crisis: “If you try to shut down air travel and sea travel, you risk affecting to a huge extent the economy, people’s livelihoods, and their ability to get around without stopping the virus from traveling,” Gregory Hartl, a W.H.O. spokesman, said, according to the Washington Post. “You can’t ship goods in. Sometimes these goods are basic staples people need to survive.”
2) Opinion piece by Frieden: http://www.foxnews.com/opinion/2014...-support-travel-ban-to-combat-ebola-outbreak/
3) Vox: http://www.vox.com/2014/10/13/6964633/travel-ban-airport-screening-ebola-outbreak-virus
4) National Geo: http://news.nationalgeographic.com/news/2014/10/141007-ebola-travel-ban-restrictions-health-world/
TLDR?
Well, travel bans might delay spread by a few weeks but make things worse in the longer run. By shutting off travel between a few countries and the US, you don't do anything to help as the virus could pretty easily spread to other nearby countries with similar issues as those currently affected. It might buy you a couple of weeks time, but the opportunity cost is far higher than the 'benefit' of time. And by then, there is a real possibility that the spread is too great in the continent to contain effectively and you're going to have to shut down all your borders to stop people from getting sick.
Oh, start shooting migratory birds as well since they might have come into contact with other birds... or something.
Happy?
1) New yorker article with a good quote from Dr. Gawande.
http://www.newyorker.com/news/news-desk/ban-flights-countries-ebola-outbreaks
There are several reasons for this. For one thing, as Gawande points out, travel bans don’t really work: “Even if travel could be reduced by eighty per cent—itself a feat—models predict that new transmissions would be delayed only a few weeks.” For another, they make it even more difficult to address the public-health crisis: “If you try to shut down air travel and sea travel, you risk affecting to a huge extent the economy, people’s livelihoods, and their ability to get around without stopping the virus from traveling,” Gregory Hartl, a W.H.O. spokesman, said, according to the Washington Post. “You can’t ship goods in. Sometimes these goods are basic staples people need to survive.”
2) Opinion piece by Frieden: http://www.foxnews.com/opinion/2014...-support-travel-ban-to-combat-ebola-outbreak/
3) Vox: http://www.vox.com/2014/10/13/6964633/travel-ban-airport-screening-ebola-outbreak-virus
4) National Geo: http://news.nationalgeographic.com/news/2014/10/141007-ebola-travel-ban-restrictions-health-world/
TLDR?
Well, travel bans might delay spread by a few weeks but make things worse in the longer run. By shutting off travel between a few countries and the US, you don't do anything to help as the virus could pretty easily spread to other nearby countries with similar issues as those currently affected. It might buy you a couple of weeks time, but the opportunity cost is far higher than the 'benefit' of time. And by then, there is a real possibility that the spread is too great in the continent to contain effectively and you're going to have to shut down all your borders to stop people from getting sick.
Oh, start shooting migratory birds as well since they might have come into contact with other birds... or something.
Happy?
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The greatest failure here is the disenfranchisement of science in the united states over the last decade plus which has left the CDC and NIH handicapped to handle such outbreaks. Additionally, no one in the west gave a crap when agencies on the ground in west africa were saying that this epidemic had potential to get out of hand as far as 6 months ago (MSF etc). No one heeded the warnings because it was 'over there' and now it's too late to prevent initial spread.
The world is flat, after all.
The world is flat, after all.
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Only now they are saying that healthcare workers should spray their protective gear before removing it. Isn't this obvious and why isn't it normal protocol in hospitals? In the CDC research labs, this is normal procedure with level 4 biohazards like Ebola.
From wikipedia:
From wikipedia:
Rid, those aren't evidence. They are opinions.
At any rate, let's just start putting up billboards and doing some mass advertisements.
These could say: Ebola: Coming to a Hospital Near YOU--or grocery story, mall, pretty much any public place.
And look. Just in time for the holidays!
At any rate, let's just start putting up billboards and doing some mass advertisements.
These could say: Ebola: Coming to a Hospital Near YOU--or grocery story, mall, pretty much any public place.
And look. Just in time for the holidays!
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Rid, those aren't evidence. They are opinions.
At any rate, let's just start putting up billboards and doing some mass advertisements.
These could say: Ebola: Coming to a Hospital Near YOU--or grocery story, mall, pretty much any public place.
And look. Just in time for the holidays!
I'm pretty sure the opinion of the acting head honcho at the CDC takes the cake over whatever you, or even I, have to say.
You're still fear mongering. All evidence, i.e. past infectious epidemics, have led to models that predict that the only thing travel bans do is make the situation abroad worse and delay the spread by a little bit.
My institution is prepared to handle such cases should they show up. I'm willing to trust what you call 'opinions' and I call 'expertise' of the ID doctors that I have worked with in the past that are responsible for the response at my institution.
You have shown no evidence that a travel ban works. Flip the table. Jokes on you.
I don't need to show evidence that a travel ban works, even if this were REASONABLY possible, as far having any substantial or recent pandemics from which to draw. Where is anything that either of us could says as hardcore. long-term evidence along these lines?
It is perfectly reasonable, however, to establish boundaries out of an also reasonable overabundance of caution. Absolutely. This whole thing is really, mostly about priorities. No offense, but your's seem quite political in nature.
It is your opinion and the opinions of those others with the same political bent for which you should present hard, long-term evidence. . .but good luck with that.
BTW, Guinea has closed it's borders to Liberia and Sierra Leone. How cruel and idiotic for them to do so.
BTW, the "joke" is not a joke. And it's sad that you would even jest with that.
It is perfectly reasonable, however, to establish boundaries out of an also reasonable overabundance of caution. Absolutely. This whole thing is really, mostly about priorities. No offense, but your's seem quite political in nature.
It is your opinion and the opinions of those others with the same political bent for which you should present hard, long-term evidence. . .but good luck with that.
BTW, Guinea has closed it's borders to Liberia and Sierra Leone. How cruel and idiotic for them to do so.
BTW, the "joke" is not a joke. And it's sad that you would even jest with that.
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I don't need to show evidence that a travel ban works, even if this were REASONABLY possible, as far having any substantial or recent pandemics from which to draw. Where is anything that either of us could says as hardcore. long-term evidence along these lines?
It is perfectly reasonable, however, to establish boundaries out of an also reasonable overabundance of caution. Absolutely. This whole thing is really, mostly about priorities. No offense, but your's seem quite political in nature.
It is your opinion and the opinions of those others with the same political bent for which you should present hard, long-term evidence. . .but good luck with that.
BTW, Guinea has closed it's borders to Liberia and Sierra Leone. How cruel and idiotic for them to do so.
BTW, the "joke" is not a joke. And it's sad that you would even jest with that.
I'm really glad that you're qualified to disagree with the experts in the ID field.
This has nothing to do with politics. I'd suggest that those most strongly advocating for shutting down borders right now have a strong political bent given that they all belong to the same party whereas those saying that it only buys a few short weeks are those who happen to be medical experts.
I'm glad that you don't need to show any evidence. That's really fabulous. It's also the same line of argument that anti-vaccers use.
Again, from the Vox article:
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "To completely seal off and don't let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can't get supplies in, you can't get help in, you can't get the kinds of things in there that we need to contain the epidemic."
Quote was taken from this article: http://www.washingtontimes.com/news/2014/oct/6/a-top-health-expert-warns-against-closing-borders-/
You are arguing against the wisdom of those that have worked in this field for longer than you've been out of diapers. I still hold to it that you are fear mongering and acting out of an emotional bent due to ZOMG EBOLA vs a logical conclusion. Good job.
What a crock of crap. You have nothing to say so you suggest politics are at play. Do me a favor and actually try to say something of substance next time. If you want to read through the links I've posted, then great. If not, good for you. If you don't agree with the leading experts in the field, then I'm certainly not going to waste my time to correct you. You're clearly overqualified and should contact Fauci et al to let them know the errors of their way.
I'm done here.
PS: You missed the point: you were the joke. Plot. Twist.
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This would be way too costly for hospitals with little return I bet. Well, not sure about the spraying but all the extra suits and barrier rooms... Not gonna happen in many community hospitals imo.
I would be much more comfortable taking care of an ebola patient if I had the training and proper equipment but not many hospitals are going to invest in something like that unless they have the resources and want to make headlines. Pretty much every nurse on my unit is extremely uncomfortable with our flimsy yellow gowns that don't fit and tear easily, gloves, mask and goggles as our only protection. And when we asked the infectious disease doctor about our protective barriers and how little they cover and splashed blood/urine he said when does that ever happen (in reference to splashes/spilling fluids)... Ummmm pretty much every single day.
So freaking typical. I have to say, I have generally been disappointed with a number of ID physicians. See, what happens is that people end up wanting to protect their jobs. As such, the are pressured to cut costs. A good example is the one I posted about my experience in the ED thread on this topic.
And I say as long as these hospitals are not willing/able (?) to employ the top-of-the-line standards, approaches, and PPEs, etc for Ebola patients, they need to send these patients, by way of CDC-controlled transport to CDC centers.
There is absolutely NO end to the amount of spin and BS in HC anymore. Damn, I have been actively and closely involved in it for 20 some years. Each quarter decade, the BS gets worse. *sigh*
I respectfully say to you this: Please stop trying to kid yourself and anyone else. It most definitely IS POLITICS, plain and simple.
BTW this is far from the first time I have seen various types and levels of politics harm or kill others. Many of the mistakes and poor choices that I have seen in healthcare and medicine over many years--mistakes that KNOW have resulted in harm to others--were due to some type and level of politics, bar none.
It's about having the will to do the right and best thing for others. And sadly that good can and has been superseded by some internal political crap or some external political crap--and the inherent association of money, power, and/or prestige.
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But you're not preventing anything you dolt. Merely buying time.
You keep saying that I'm playing politics, but you have yet to support your evidence when I have cited numerous experts. All you talk about is this emotional appeal to 'doing the right thing' and coming up with what is essentially a conspiracy theory because clearly everyone at NIAID and CDC only have monetary and power aspirations and so do their colleagues at WHO.
Your appeal to logic is to refute anything I say using circuitous arguments that all go down to saying that there's something else at play and it's politics and it's not doing the right thing and that you don't have to cite evidence because it's obvious. Science is often not obvious and things are very often not as they appear. Your distrust of the ID establishment is your issue, but yet again I'm glad to hear that you're so qualified to make all these claims.
In a nutshell it's this argument:
You keep saying that I'm playing politics, but you have yet to support your evidence when I have cited numerous experts. All you talk about is this emotional appeal to 'doing the right thing' and coming up with what is essentially a conspiracy theory because clearly everyone at NIAID and CDC only have monetary and power aspirations and so do their colleagues at WHO.
Your appeal to logic is to refute anything I say using circuitous arguments that all go down to saying that there's something else at play and it's politics and it's not doing the right thing and that you don't have to cite evidence because it's obvious. Science is often not obvious and things are very often not as they appear. Your distrust of the ID establishment is your issue, but yet again I'm glad to hear that you're so qualified to make all these claims.
In a nutshell it's this argument:
Listen, no offense, but at this point, it makes as much sense to "discuss" this with you as it does to discuss it with a deaf and blind mule. I can see circular, and it's coming from you and your camp's side of things. But, since you seem to be unable to continue with a balanced and civilized tone [Yes, I am sure most people that strive to have decent discussions with each other are fine with being called a fool (dolt)] I choose to no longer interact w/ you.
As far as your "arguments," you are simply espousing the spin-doctoring BS that the head of the CDC was told to espouse. He's so full of it, and his re-stating of the same lame comments without anything to back them up is self-evident.
What further added to me seeing him stance for what it is is that he said this crappy PPE is just fine, and he would be OK with wearing it in there with a critically ill, multi-system failure, Ebola patient. That's a total joke, and it was very telling.
There is NO WAY in HELL he would go in and provide 12 hours of anything close to what a nurse must in the intimate and frequent care of a critically ill patient w/ Ebola w/ such flimsy attire that was given to the nurses there. He said that he would, but he is full of it. I am sure Dr. Brantly smiled to himself when he heard Frieden say that. LOL, what an absolute joke. It's self-evident that the man is a complete spin-doctor, and anyone with a mg of sense see it.
Skirting the reality by name-calling, however, is a good but childish deflection device--just a sad way to shift the focus off of the glaring issues here. Good job. Stand tall with that.
BTW, I am not choosing to close off discussion with you for any other reason than the fact that you have employed both condescension and incivility in this discussion. A genuine apology and change in approach, however, might influence me to continue with discussion.
Otherwise, just, no thank you.
I will say that I have not seen, as yet, a decline into incivility on the Ebola thread in the ED forum. It would seem there is more of a sense of respectfulness, even when differing. Not saying it could happen there. When and if it does, I will take the same position.
With online discussions like this, it's better to just stop talking with someone that is disrespectful w/ others over a difference of opinion. It gets nowhere, and it's a waste of time and energy.
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Not surprising because you're being relatively reasonable in your demands on the other thread and are claiming for a travel ban on this thread. I think precautions need to be better as well as the tools used, yes. My sticking point is your unfounded belief that a travel ban would magically have spared the US from ebola. That's a dolt-ish line of thinking.
Asking for better precautions for healthcare workers, however, is not. You're confounding your own two arguments and getting all these threads mixed up. We never discussed anything but travel bans here, which I still hold as a stupid idea and which you have yet to refute. So kudos for actually sounded like you're semi educated on the other thread you're involved in with ED.
Asking for better precautions for healthcare workers, however, is not. You're confounding your own two arguments and getting all these threads mixed up. We never discussed anything but travel bans here, which I still hold as a stupid idea and which you have yet to refute. So kudos for actually sounded like you're semi educated on the other thread you're involved in with ED.
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Based on what? All the prior cases of Ebola they've successfully handled? This may be the most naive statement ever uttered on SDN, congrats! You HOPE they are prepared, as do we all. But to be more confident than that is truly foolish.
Those of us who have been in hospital setting for a while and interacted with patients with TB and other contagious diseases know that quite a few healthcare personnel interact with every new patient before a diagnosis is made. And then move on and interact with other personnel and patients before a diagnosis is made. And maybe use the phone, computer terminals, eat in the cafeteria , hug their kids. Things become a bit easier once the patient is diagnosed, but equipment and current teachings of precautions still represent best guesses and almost nobody in this country has any experience handling Ebola patients safely. So no, no hospital is prepared. If your hospital is claiming to be that's probably something that should trouble you -- on what data are they basing this, given that little exists? The few places that have treated Ebola patients have not exactly done a good job of containing it so I'd be pretty skeptical when someone never put to the task claims they are "prepared".
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Can't really say much more without giving away exactly where I've worked. Sorry, but I'm still pretty comfortable.
Additionally, a german hospital has treated a patient successfully without any other infections at that institution, so it can be done. Sure n=1 does not a trend make however proper precautions can be taken even during increased viral shedding.
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It's just getting better and better:
2nd Dallas nurse has Ebola. She flew with 132 passengers day before showing symptoms. Let's hope that since she wasn't symptomatic, those on the flight are safe. Can't be sure of this, and that's why they now have to follow these people.
AND
There might be a third case of Ebola in Texas. Nina Pham's boyfriend has been admitted to Texas-Presby, b/c he reportedly is exhibiting symptoms of the illness.
Law2, really after 20 years in the busiest hospitals in the world, I know for a fact that what you say is completely true.
We are not prepared. The CDC was clearly NOT prepared
And what in the hell is screening in the airport going to do, other than with someone that is febrile and/or showing viral-like symptoms?
Funny, I don't see a lot of docs in the ED thread arguing against closing off flights from the noted areas of W. Africa to the US. And geez. What's wrong with Belgium and France?
Not shutting down influx of people from W. A. is a HUGE mistake. If even 1/16 to q/8th of those coming from W.A daily are infected, that's still way more than we could clearly handle; since we couldn't handle even 1, now 2, and possibly 3 and 4. And the missionaries at Emory cannot count; b/c clearly much better planning and use of protocols were used, and in fact, Samaritan's Purse helped get things rolling to get them to the right place the right way.
2nd Dallas nurse has Ebola. She flew with 132 passengers day before showing symptoms. Let's hope that since she wasn't symptomatic, those on the flight are safe. Can't be sure of this, and that's why they now have to follow these people.
AND
There might be a third case of Ebola in Texas. Nina Pham's boyfriend has been admitted to Texas-Presby, b/c he reportedly is exhibiting symptoms of the illness.
Law2, really after 20 years in the busiest hospitals in the world, I know for a fact that what you say is completely true.
We are not prepared. The CDC was clearly NOT prepared
And what in the hell is screening in the airport going to do, other than with someone that is febrile and/or showing viral-like symptoms?
Funny, I don't see a lot of docs in the ED thread arguing against closing off flights from the noted areas of W. Africa to the US. And geez. What's wrong with Belgium and France?
Not shutting down influx of people from W. A. is a HUGE mistake. If even 1/16 to q/8th of those coming from W.A daily are infected, that's still way more than we could clearly handle; since we couldn't handle even 1, now 2, and possibly 3 and 4. And the missionaries at Emory cannot count; b/c clearly much better planning and use of protocols were used, and in fact, Samaritan's Purse helped get things rolling to get them to the right place the right way.
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