Now Nurse That Cared for Index Pt in Dallas Has Ebola

[Law2Doc]

The bigger problem is that if we manage to "cure" any of our Ebola cases, by plasma transfers and the like, that more or less guarantees that anyone who thinks they might have contracted Ebola is going to try and get here.

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[Law2Doc]

Can't really say much more without giving away exactly where I've worked. Sorry, but I'm still pretty comfortable...

That's fine, you've been more than clear that you work in fantasy land. Don't need to hear more.

 

[ridethecliche]

The bigger problem is that if we manage to "cure" any of our Ebola cases, by plasma transfers and the like, that more or less guarantees that anyone who thinks they might have contracted Ebola is going to try and get here.

Oh my god, sick people will want to get better! Please, tell me more!

 

[ridethecliche]

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.

Actually, she had a fever the day she flew. She was also told not to fly but did so anyway.

 

[ridethecliche]

@jl lin , to be fair... I read what you said on the other thread about contact precautions and hospitals being wildly underprepared and completely agree. I think the only think we actually disagree on is the travel ban.

The US often thinks that it's insular and won't be affected by crises in other parts of the world. We're repeatedly on the wrong side of history and drawn to act only when it's too late. We often make up for it, but it takes a lot to awaken a sleeping giant.

 

[Law2Doc]

Oh my god, sick people will want to get better! Please, tell me more!

I want them to get better. I don't want them getting hundreds of others sick en route to getting better. Which they will potentially do. Your responses are getting progressively more reactionary and less thought out as we go. Maybe you should read up on pandemics because your knee jerk responses and assertions of preparedness are bordering on the bizarre.

 

[ridethecliche]

I want them to get better. I don't want them getting hundreds of others sick en route to getting better. Which they will potentially do. Your responses are getting progressively more reactionary and less thought out as we go. Maybe you should read up on pandemics because your knee jerk responses and assertions of preparedness are bordering on the bizarre.

It won't if people are quarantined and tested appropriately.

Your statements are ridiculously overly simplistic and/or obvious. If the cure can be found quickly and disseminated even more quickly, the end game scenario is not everyone rushing to fly in here.

I also didn't say every location is prepared. The situation in Dallas illustrates that, as does the fact that one of the infected nurses blatantly just didn't follow directions and neither did the TV Doc in NJ.

If you want to talk about pandemics, then I'm sure we can enter someone shooting missiles of ebola ridden bodies into our country ala genghis khan.

 

[Law2Doc]

It won't if people are quarantined and tested appropriately.

Your statements are ridiculously overly simplistic and/or obvious. If the cure can be found quickly and disseminated even more quickly, the end game scenario is not everyone rushing to fly in here.

I also didn't say every location is prepared. The situation in Dallas illustrates that, as does the fact that one of the infected nurses blatantly just didn't follow directions and neither did the TV Doc in NJ.

If you want to talk about pandemics, then I'm sure we can enter someone shooting missiles of ebola ridden bodies into our country ala genghis khan.

What you don't seem to get is that (a) as we learned with SARS we are very unprepared for things like this in hospitals, (b) hospitals are full of immunosuppressed people and the last place you want to introduce a deadly disease, (c) doctors, nurses and med students, because we go room to room daily and don't take sick days often tend to be very effective vectors for spreading disease. So you really don't want a deadly disease to get s foothold in a hospital setting. No place in the US is prepared. If you want to talk simplistic your statement that your facility us takes the cake. Anyhow as I said before, in my schooling and training I've been exposed to TB, shingles, Mrsa and who knows what else BEFORE a patient was diagnosed and moved to isolation. All these patients shared rooms with other patients and saw a lot of trainees, nurses, phlebotomists, etc before a diagnosis was in. I fortunately didn't contract any of these diseases but not from my facility being prepared. And these were some of the better funded and competent centers of excellence. So I know if they aren't prepared, most aren't. And so we want as few vectors in motion until we are prepared. Whether we only buy ourselves weeks or months, it's a pretty good idea. We are already chasing our tails with the sequela of a single person coming to the US. More would very swiftly be beyond anything the CDC has an approach to handle.

 

[ridethecliche]

What do I mean by prepared?

ED: SOP to get travel histories and triage patients based on this even before they're seen.
Staff that have worked with Ebola both abroad and been involved with care of patients at Emory.
Routine drills for using the PPE equipment and proper contact precautions in negative pressure rooms.
Etc.

Like I said, as far as US institutions are concerned, mine is as prepared as one can be. A lot of this goes along with the bioterrorism stuff here. Having a strong global health department helps too as they have first hand knowledge of treatment.

Do I think this is all going to be challenging? Yes.
Am I **** scared about this? Not yet.

I agree that hospitals present a challenge due to having that patient population. I've worked in and with ID both in the US and abroad (albeit not in direct care, but closely with it) to have seen some of those challenges.

Those couple of weeks won't make much of a difference. I just hope that this epidemic serves as a lesson to all the political players that are constantly defunding all these efforts. That part probably makes me the most nervous.

 

[jl lin]

Btw, trying to infer that our reasoning for tightening up travel is similar to the child anti-vaccination movement is honestly idiotic. No credible clinician I know, including those that add some CAM, is NOT OK w kids not getting vaccinated. I mean, really? I work in peds. You have got to be kidding.

All anyone is saying is limit further infux until we get our £}!^ together. That's not unreasonable.

Now they are sending the second nurse by charter flight to Emory.
Hopefully they will do better over there with her.
And we are not so freaked that others were on the plan with the nurse, but that she was not carefully watched, knowing that she was marked for the potential to show seroconversion, yet was able to fly commercial.

OMG, the biggest takingheadjob is now holding a conference.

When people say "not airborne," they fail to also state that droplet particles can fly through the air, and furthermore, Ebola lives for a while on fomites. *scream*

Someone needs to make this clear to the GP, but they won't. They will not highlight these points BC of so called "fear of panic. "

Half-azz information.

 

[jl lin]

CDC: Ebola can live "for a few hours on dry surfaces and in puddles or substances at room temp for days.

 

[ridethecliche]

@jl lin and @Law2Doc

Apparently the nurse that flew and is positive called the CDC and was told that her fever wasn't high enough to put her at risk so she was allowed to fly.

Derpy derp derp.

(Also, thanks for continuing to add to the convo. I appreciate it! As daft as even I might seem at times, I am learning something!)

 

[Law2Doc]

...
Apparently the nurse that flew and is positive called the CDC and was told that her fever wasn't high enough to put her at risk so she was allowed to fly.
...

Riiight. That sounds like something based in evidence... Not.

 

[ridethecliche]

:/

CDC facepalm...

 

[brainnurse]

Hi, guys. Nothing to add, but I just wanted say I'm following this thread for personal reasons. I'm part of a volunteer-only team who will train to receive Ebola patients should they show up. We all know the news isn't giving us accurate information, and it's been difficult to find information elsewhere. I'm not scared yet, but even my physician friends are "not happy with me" for volunteering. They're being funny, of course, but I know there's a hint of truth there. They're actually worried about what would happen to me, which makes me wonder if I should also be afraid.

I feel like we take care of TB, meningitis, and all sorts of contagious diseases every day. This is just another infectious disease (that we don't have a cure for yet), and we'll triumph over it eventually, but that won't happen if nurses and other healthcare workers choose to deny infected patients care. I understand that we don't want to bring this home to our families. I don't have one of those to worry about, so I felt like I had no reason not to volunteer. Plus my facility is adding extra levels of precaution to what the CDC suggests: full jumpsuits, tandem care with three personnel, extra temperature checks, etc. But I know there's no guarantee that this will protect us. Everyone else's fear is causing me to question my lack of it.

 

[jl lin]

Hi, guys. Nothing to add, but I just wanted say I'm following this thread for personal reasons. I'm part of a volunteer-only team who will train to receive Ebola patients should they show up. We all know the news isn't giving us accurate information, and it's been difficult to find information elsewhere. I'm not scared yet, but even my physician friends are "not happy with me" for volunteering. They're being funny, of course, but I know there's a hint of truth there. They're actually worried about what would happen to me, which makes me wonder if I should also be afraid.

I feel like we take care of TB, meningitis, and all sorts of contagious diseases every day. This is just another infectious disease (that we don't have a cure for yet), and we'll triumph over it eventually, but that won't happen if nurses and other healthcare workers choose to deny infected patients care. I understand that we don't want to bring this home to our families. I don't have one of those to worry about, so I felt like I had no reason not to volunteer. Plus my facility is adding extra levels of precaution to what the CDC suggests: full jumpsuits, tandem care with three personnel, extra temperature checks, etc. But I know there's no guarantee that this will protect us. Everyone else's fear is causing me to question my lack of it.

I know. I have no idea how many patients in isolation I have taken care of over the years. Wow. But it's when you have other unit patients, and then you are constantly running to gown up, etc, and the kid in the isolation is choking on his secretions or has pulled apart the end of his PICC line or is hemorrhaging or vomiting for some reason, and you are in a hurry to leave the other patient, wash up, gown up, and get in there before he/she codes. It gets crazy and stressful, and that's what people don't understand about the risks to nurses.

Personally, I would only take an Ebola patient if they give me the same training and HAZMAT gear that the CDC uses--I mean total coverage, etc. I know how fast a patient that is confused and in pain can get out of control--as they are bleeding from every orifice or vomiting everywhere or putting out utter lakes of liquid diarrhea. You could do everything right, and in an instant, you are somehow contaminated. I betcha initially they didn't even give those nurses in Dallas proper headgear. I am pretty sure that they didn't give proper training and a buddy system. And I bet they didn't have bleach or antiseptic cloths to wipe down with before disrobing or bleach spraying, etc.

Droplet particles are a big deal, and plus this virus CAN live on fomites for a while--especially something that is moist and room temp or so. The CDC is giving mixed information, and this is problematic. They said today in Washington that it can't live outside the human body. That is incorrect. I mean we can go into that whole deal about whether or not viruses are somewhere between living and non-living, but they can hang for a while on things. What if you got some on your hair--head wasn't covered. You disrobe, scrub, and then inadvertently touch your hair and then touch your eyes, nose, mouth. It's still in the quasi-existence state, waiting for something in which to grow and divide.

They are also misleading with it not being airborne, b/c most people assume airborne means anything that can float in the air, and that's not it. Can it be aerosolized? Yes. As we know, when it comes to transmission diseases, the main difference is that the droplet is infected through the nose, mouth, mucous membranes and conjunctivae of a person. With airborne transmission, the source of the disease or agents is through the respiratory system. So droplet particles are limited to the direct areas of the source of the droplets--mucous membranes, but respiratory -based infectious diseases pass quickly from someone's respiratory system into the air that other people are breathing.

This seems tricky; but you have to think of what the source of the bug is--mouth, nose, mucous membranes or from the respiratory system. Since pharynx interacts as part of upper resp. system, it gets confusing. Point in this matter that is obvious to us, but not to the GP is that someone could have Ebola, and sneeze a nice juicy sneeze or cough and indeed contaminate another person. It's a more limited transmission than with a respiratory infectious disease, but it certainly is a real threat!

So, I say, thoroughly educate, drill, watch closely, and bubble those healthcare workers up. Give them buddies, and do what they need to do to keep transmission to them down to the greatest known minimum.

I love caring for people; but if you don't train and gear me up right, I am not putting myself and subsequently my family and others at risk. I think hospitals are foolish if they don't see this.

 

[jl lin]

^ Corrected.

 

[Megalomis]

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.

http://www.cnn.com/2014/10/15/health/texas-ebola-outbreak/index.html

So much for the CDC learning their lesson. My question is, how exactly was this SECOND nurse able to get on a flight so soon after coming into contact with the initial US Ebola patient, Duncan? I'm at a loss for words. Apparently this second nurse called the CDC, informed them she had a minor fever, and they gave her the ok to board a flight. Not only is the CDC not keeping a close watch on the folks that came into contact with Duncan, but they are allowing them to travel lol.

SMH

 

[ridethecliche]

She was told to fly by someone she called at the CDC to ask for permission. Her fever was lower than the temperature at which they would have banned her.

 

[wholeheartedly]

No one has been able to confirm that the nurse actually did talk to someone in the CDC. The news reports are only saying that the CDC has confirmed that "she said she talked to someone at the CDC." There are also now reports from people she was with in Ohio who said she had more symptoms maybe a few days earlier than the day she said, which she left out of her original story, which calls her credibility into question. Given the accuracy of our news organizations in recent years I'm really trying to avoid jumping to conclusions on this. It's going to take quite a bit of time to get the facts of all this sorted out.

Overall, there's quite a bit of criticism being launched here about things that supposedly happened that even news reports haven't suggested happened. For instance the suggestion that the cdc wasn't there or just popping in to the hospital. They had 16 people sent to Dallas on sept 30th, the day Duncan was diagnosed, including two in the hospital.

As I've said, I don't agree with how CDC handled all of this and the cnn piece does a good job of this, but this is very much a system wide issue. They sent out recommendations on ebola back at the end of June beginning of July. The institutions I'm affiliated with up here went to work on that right away. Here they've done sims with the protocols and are continuing to make adjustments. It's becomming apparent, from various posts by others here and on news sites, that didn't happen everywhere. That's unfortunate because this isn't something you can plan for at the drop of the hat.

Sure the experts can, and should, come in and take the lead. However, these patients can show up in any hospital and that situation needs to be dealt with until there's a positive test result and the team arrives, because there have been too many suspected/potential cases here to send a team to all of those. Both of the infected nurses had contact with Duncan before the day his results came back positive and the CDCshowed up, so is it reasonable to assume that lack of assistance by the cdc is to blame when they showed up in force with dedicated people at the hospital as soon as the diagnosis was confirmed and the nurses could have been infected before they got there? So what role and how much responsibility lies with the state health departments? With the hospitals?

There's documentation in the nurses notes that people were triple gowned and triple gloved going into the room. It's actually explicitly written in the guidelines NOT to triple up like that because removing the gear is the riskiest part of the process and adding more layers actually increases risk.

All of these other factors seem to largely be left out of the discussion on this thread of the problems in this situation.

Any of us who've worked in crisis situations know that no matter how much planning goes into preparing for these crazy situations, you still need to make changes as you go through it for real the first few times. That sucks and can lead to bad outcomes, but it's impossible to predict every possible nuance. As @Law2Doc indicated, you can plan all you want but you'll never be fully prepared for the reality. So yes, unfortunately, things will happen in this situation that don't work and need to be fixed.

This whole situation sucks, but hindsight is awesome when it comes to critiquing situations. Yeah, in hindsight, it makes sense that scared providers would put on extra protection thinking it would keep them safer. Cant say I blame them. It makes sense that there are hospitals who think this couldn't happen at their shop and didn't plan ahead like they should have. Or that a nurse might try to head out of state to plan her wedding while monitoring herself for symptoms. Or that that some hospitals might not stock up on the necessary PPE because of budget constraints and thinking the risk is low. Some hospitals could be suffering serious staffing shortages. Should all of these things and many more been reasonably predicted before hand?

I guess what I'm saying is:
1) there's plenty of blame to go around, way around
2) some understanding should probably be granted in that no one has ever dealt with anything like this here before
3) there is probably going to be a lot if interesting information that comes to light after the dust settles, and it might be worth taking a step back until then

 

[wholeheartedly]

Just an aside, I have no idea why there's a at the beginning of my earlier post. My emoticons always seem to go to the front when I'm on my iPad. I was actually shooting for an /rant for the end of the post one and couldn't find it. So my apologies if that came across as confrontational or dismissive or anything.

This is rightly an emotional topic.

 

[wholeheartedly]

I'm also going to post some links to some reading on here sometime over the weekend. Nothing that's intended to support or refute any positions in this thread just more educational since the people on this thread are obviously keeping up with this topic and it was interesting to me.

With that, I'm off to bed and won't be posting on here much since i have a three day weekend for my birthday and don't want to think much about ebola. The topic has been coming up in my life everywhere else, including strangely, my trip to the attorney this morning to discuss a fence issue of all things.

 

[Megalomis]

I'm also going to post some links to some reading on here sometime over the weekend. Nothing that's intended to support or refute any positions in this thread just more educational since the people on this thread are obviously keeping up with this topic and it was interesting to me.

With that, I'm off to bed and won't be posting on here much since i have a three day weekend for my birthday and don't want to think much about ebola. The topic has been coming up in my life everywhere else, including strangely, my trip to the attorney this morning to discuss a fence issue of all things.

Yea the media is having quite a field day with this Ebola crisis. I'd like to hope that it's all just unrealistic hype/hysteria that won't amount to anything major in the end.

Side note: something about the way in which the media is reporting on this is slightly reminiscent of the missing malaysia plane--and how for months the media went on a spree of daily articles about how there are pings being heard here, pongs being heard there, LOL. The general public remained hopeful that the black box and items from the plane would eventually be found--but to this day, still nothing. Not a seat cushion, not a piece of luggage,...nothing.

It seems like there is a similar game being played by the government, cdc, etc. Keep the general public feeling hopeful for as long as possible, and pretend that you know more than you really do about the virus, when and how it's spread, etc. Today during a press conference Obama said that the virus is only transmittable when a person is symptomatic. Symptomatic lol. Don't even get me started on that...

Anyway, for what it's worth I hope u have a nice birthday weekend! I'll keep checking this board to see what you (and others) end up posting.

 

[Law2Doc]

What nobody has yet addressed, and maybe cannot be addressed, is what exactly hospitals are supposed to do if someone with flulike or ambiguous symptoms is brought into your local ED and no history is forthcoming, either because the person is being deceptive or not able to communicate (patients "found down" and brought to the ED are commonplace, as are patients with flulike symptoms, ambiguous symptoms, non-communicative patients). Doctors and nurses and trainees worldwide wear gloves while examining patients but usually no other protective gear in such situations. Stethoscopes are reused. People don't change scrubs between patient in the ED. And fluids and droplets get dispersed regularly. Ebola rightly isn't at the top of ones differential in a region with many other more prevalent ailments, and shouldn't be. The CDC don't offer much advice until one actually has reason to suspect Ebola. So hospitals are doing business as usual. And then all the personnel, as mentioned are becoming very effective vectors throughout the hospital and apparently on commercial airlines as well. So anyone who thinks hospitals are "prepared" really doesnt know how hospitals or EDs work or has this unrealistic notion that you can identify a guy with ebola from across the room without a very suggestive history. Plus in the US lots of "sick" people with vague symptoms now get care from NPs at CVS or Walmart, or self medicate with over the counter meds. So we don't have the ability or set up to deal with this even at the healthcare setting -- and by the time someone is identified as a potential ebola case in a hospital, thats really too late to start worrying about protective gear. I see very little constructive or useful advice out there except maybe to limit the moving pieces for a while. What I do know is that saying any facility is "prepared" is naive. Places like Atlanta having a modicum of success compared to Texas partly represents beginners luck -- Every lion tamer is amazing until a lion eats him.

 

[puppylatte]

What nobody has yet addressed, and maybe cannot be addressed, is what exactly hospitals are supposed to do if someone with flulike or ambiguous symptoms is brought into your local ED and no history is forthcoming, either because the person is being deceptive or not able to communicate (patients "found down" and brought to the ED are commonplace, as are patients with flulike symptoms, ambiguous symptoms, non-communicative patients). Doctors and nurses and trainees worldwide wear gloves while examining patients but usually no other protective gear in such situations. Stethoscopes are reused. People don't change scrubs between patient in the ED. And fluids and droplets get dispersed regularly. Ebola rightly isn't at the top of ones differential in a region with many other more prevalent ailments, and shouldn't be. The CDC don't offer much advice until one actually has reason to suspect Ebola. So hospitals are doing business as usual. And then all the personnel, as mentioned are becoming very effective vectors throughout the hospital and apparently on commercial airlines as well. So anyone who thinks hospitals are "prepared" really doesnt know how hospitals or EDs work or has this unrealistic notion that you can identify a guy with ebola from across the room without a very suggestive history. Plus in the US lots of "sick" people with vague symptoms now get care from NPs at CVS or Walmart, or self medicate with over the counter meds. So we don't have the ability or set up to deal with this even at the healthcare setting -- and by the time someone is identified as a potential ebola case in a hospital, thats really too late to start worrying about protective gear. I see very little constructive or useful advice out there except maybe to limit the moving pieces for a while. What I do know is that saying any facility is "prepared" is naive. Places like Atlanta having a modicum of success compared to Texas partly represents beginners luck -- Every lion tamer is amazing until a lion eats him.

Is there any country that could handle it better and what could we learn from them?

The fact the US is huge is both a bane and a boon. It means that there are rural areas where hospitals may not be as well-funded, but they also have isolated populations which buys the feds some time. Then there are huge cities with international travel. If there were an outbreak in NYC I would happily move to Utah or Oregon and feel safe. The internet allows the experts to do the same and manage the situation remotely.

I feel like Norway would best survive an outbreak because they have 1st world hospitals, a smaller, somewhat geographically isolated population and cold winters which keep people indoors.

 

[LupaCupcake]

An ignorant person I know told me Muslims ensured this happened and they are going to run around the U.S infecting people on purpose because all Muslims are violent and are trying to take over the U.S.

I had to take a slow breath as I wanted to slap that person on the back of the head

 

[ridethecliche]

Here's the real crisis!

http://fox2now.com/2014/10/14/ebola-threatens-world-chocolate-supply/

An ignorant person I know told me Muslims ensured this happened and they are going to run around the U.S infecting people on purpose because all Muslims are violent and are trying to take over the U.S.

I had to take a slow breath as I wanted to slap that person on the back of the head

Someone's been listening to too much Bill Maher.

 

[jl lin]

No one has been able to confirm that the nurse actually did talk to someone in the CDC. The news reports are only saying that the CDC has confirmed that "she said she talked to someone at the CDC." There are also now reports from people she was with in Ohio who said she had more symptoms maybe a few days earlier than the day she said, which she left out of her original story, which calls her credibility into question. Given the accuracy of our news organizations in recent years I'm really trying to avoid jumping to conclusions on this. It's going to take quite a bit of time to get the facts of all this sorted out.

Overall, there's quite a bit of criticism being launched here about things that supposedly happened that even news reports haven't suggested happened. For instance the suggestion that the cdc wasn't there or just popping in to the hospital. They had 16 people sent to Dallas on sept 30th, the day Duncan was diagnosed, including two in the hospital.

As I've said, I don't agree with how CDC handled all of this and the cnn piece does a good job of this, but this is very much a system wide issue. They sent out recommendations on ebola back at the end of June beginning of July. The institutions I'm affiliated with up here went to work on that right away. Here they've done sims with the protocols and are continuing to make adjustments. It's becomming apparent, from various posts by others here and on news sites, that didn't happen everywhere. That's unfortunate because this isn't something you can plan for at the drop of the hat.

Sure the experts can, and should, come in and take the lead. However, these patients can show up in any hospital and that situation needs to be dealt with until there's a positive test result and the team arrives, because there have been too many suspected/potential cases here to send a team to all of those. Both of the infected nurses had contact with Duncan before the day his results came back positive and the CDCshowed up, so is it reasonable to assume that lack of assistance by the cdc is to blame when they showed up in force with dedicated people at the hospital as soon as the diagnosis was confirmed and the nurses could have been infected before they got there? So what role and how much responsibility lies with the state health departments? With the hospitals?

There's documentation in the nurses notes that people were triple gowned and triple gloved going into the room. It's actually explicitly written in the guidelines NOT to triple up like that because removing the gear is the riskiest part of the process and adding more layers actually increases risk.

All of these other factors seem to largely be left out of the discussion on this thread of the problems in this situation.

Any of us who've worked in crisis situations know that no matter how much planning goes into preparing for these crazy situations, you still need to make changes as you go through it for real the first few times. That sucks and can lead to bad outcomes, but it's impossible to predict every possible nuance. As @Law2Doc indicated, you can plan all you want but you'll never be fully prepared for the reality. So yes, unfortunately, things will happen in this situation that don't work and need to be fixed.

This whole situation sucks, but hindsight is awesome when it comes to critiquing situations. Yeah, in hindsight, it makes sense that scared providers would put on extra protection thinking it would keep them safer. Cant say I blame them. It makes sense that there are hospitals who think this couldn't happen at their shop and didn't plan ahead like they should have. Or that a nurse might try to head out of state to plan her wedding while monitoring herself for symptoms. Or that that some hospitals might not stock up on the necessary PPE because of budget constraints and thinking the risk is low. Some hospitals could be suffering serious staffing shortages. Should all of these things and many more been reasonably predicted before hand?

I guess what I'm saying is:
1) there's plenty of blame to go around, way around
2) some understanding should probably be granted in that no one has ever dealt with anything like this here before
3) there is probably going to be a lot if interesting information that comes to light after the dust settles, and it might be worth taking a step back until then

First WH, Happy Birthday.

Secondly, if the government and CDC hadn't stated weeks and weeks ago that they were prepared for Ebola, people would probably be a little more tolerant of their foolishness. Not by much though. This damn thing is deadly.

Yes, WH, they sent people there, but they didn't stay and supervise. They didn't stay to instruct. They didn't even stay to ensure that the hospital would be supplying the proper PPE or procedures. They just cared about their stats.

No. The nurses didn't have full covering, and they most definitely should have had. I know what hospitals put out. They will do the bare minimum. See my story about how I became infected b/c of an inconsiderate act of a RT and the fact that ID pulled out the masks in the isolation unit. It's in the ED thread.

With this particular situation, they should have provided full, impervious protection, just like the nurse in at the NIH is wearing in the video with Nurse Pham in Bethesda. Period. No back and forth. No nonsense. And if that means staying to supervise, educate, demonstrate directly, whatever, hell. That is what you do.

The thing is, the CDC has dealt with this, and that is the point. They have now come off like bumbling bureaucrats, like so many in politics and the government. Anyone with an ounce of insight can see this.

They shouldn't have had to triple gown, if they had had the proper suits in the first damn place. If they feel that people are not properly educated and practiced in using them, teach them, supervise, be hands-on. And it the meantime; put people in there from their agency that does--or move them to facilities where this is the case.

I don't care how they do it; but they need to get squadrons from major and even community hospitals in there at NIH or CDC hospitals, and get these people well-prepared with proper oversight.
Is that a huge undertaking? Yes, it is. They need to take a military, disciplined approach here. But that is something this current administration doesn't have a clue about. It's called leadership.

When they stood and stated to the American people that they were prepared, the undertaking of such assessments, action plans, implementations and foll0w-up evals needed to already be in place.

And if someone brings up the CDC cuts one more time, I may vomit. They still got a boatload of money for dealing with this, in spite of other cuts. But of course, for so many in gov't, the answer seems to routinely be to simply throw more money at a problem--without have a sound plan in place.

The CDC must, like other entities, know how to work with health departments and hospitals--and when it comes to a lethal virus that is already a pandemic, there is little room for excuses or not taking the bull by the horns.

Everyone thinks American hospitals are the best. Well, it really depends. I should know. I have worked in enough of them.
Most hospitals will do anything to cut costs, they will. Most of us that have worked in nursing long enough have seen this. In 2008 they stopped hiring and training nurses for positions that they still needed filled. The answer is to make nurses do more with less. Hospitals alone aren't doing this. I have a VP of a major bank that is telling me that they are constantly having to make the branches do more, with less staff, but meet all their ridiculous metrics.
So hospitals are businesses lead now by mere business-focused people, and they will routinely cut costs where they shouldn't--even at the expense of nurse's lives.

And this is why I have my concerns about limiting malpractice rewards or the ability to sue. Why? Here's the simple truth. People and organizations need to have accountability. Unfortunately, accountability seems to have become quite the dirty word.

 

[ridethecliche]

So does rationality apparently.

There are issues early on as there are with many new systems. However you're acting as if everything is lost at this point. The hospital has a responsibility to keep up with CDC briefings that were made available and ensure that it has the resources available or atleast seek them out. This failure here doesn't rest solely with the CDC.

You're saying that the CDC doesn't know how to play well with other health departments. That's not backed by any sort of fact. You're taking an n=1 as a bastion of evidence.

 

[Megalomis]

What nobody has yet addressed, and maybe cannot be addressed, is what exactly hospitals are supposed to do if someone with flulike or ambiguous symptoms is brought into your local ED and no history is forthcoming, either because the person is being deceptive or not able to communicate (patients "found down" and brought to the ED are commonplace, as are patients with flulike symptoms, ambiguous symptoms, non-communicative patients). Doctors and nurses and trainees worldwide wear gloves while examining patients but usually no other protective gear in such situations. Stethoscopes are reused. People don't change scrubs between patient in the ED. And fluids and droplets get dispersed regularly. Ebola rightly isn't at the top of ones differential in a region with many other more prevalent ailments, and shouldn't be. The CDC don't offer much advice until one actually has reason to suspect Ebola. So hospitals are doing business as usual. And then all the personnel, as mentioned are becoming very effective vectors throughout the hospital and apparently on commercial airlines as well. So anyone who thinks hospitals are "prepared" really doesnt know how hospitals or EDs work or has this unrealistic notion that you can identify a guy with ebola from across the room without a very suggestive history. Plus in the US lots of "sick" people with vague symptoms now get care from NPs at CVS or Walmart, or self medicate with over the counter meds. So we don't have the ability or set up to deal with this even at the healthcare setting -- and by the time someone is identified as a potential ebola case in a hospital, thats really too late to start worrying about protective gear. I see very little constructive or useful advice out there except maybe to limit the moving pieces for a while. What I do know is that saying any facility is "prepared" is naive. Atlanta having a modicum of success compared to Texas partly represents beginners luck -- Every lion tamer is amazing until a lion eats him.

Exactly.

But...Obama continues to say that the virus is not transmittable unless symptoms are present. Ha.

Ask him to elaborate on how Ebola initially presents itself in comparison to the standard flu, and he'd either be at a total loss or just lying through his teeth.

 

[jl lin]

Exactly.

But...Obama continues to say that the virus is not transmittable unless symptoms are present. Ha.

Ask him to elaborate on how Ebola initially presents itself in comparison to the standard flu, and he'd either be at a total loss or just lying through his teeth.

Yes.. Maybe he should go hug some more Ebola pt's in West Africa , whilst donned in the same suits the nurses in Dallas nurses were given.

Thoroughly Disgusted

 

[Gauss44]

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".

Lots of good points.

Hopefully someone will tell this* to Ron Klain - or just comment on a news website anonymously so the news media will get it.

Stuff I've wondered about: What disease, if any, would result in travel bans/restrictions? Is the "porous borders" theory** accurate? And, as sort of mentioned, whether or not the people in charge are aware of the information in the above quotation.

**Porous border theory says that a travel ban will result in increased spread of the disease, increased difficulty in tracking the spread of the disease, and roundabout travel to the USA.
*vulnerability of hospitals/front-line medical personnel

 

[Doctor Bob]

Exactly.

But...Obama continues to say that the virus is not transmittable unless symptoms are present. Ha.

Ask him to elaborate on how Ebola initially presents itself in comparison to the standard flu, and he'd either be at a total loss or just lying through his teeth.

He isn't a physician. Why would I ask him about the pathogenesis of a disease?
Anything he says about a disease is recitation of talking points given to him by medical advisors.
So... I'm missing your point.

Yes.. Maybe he should go hug some more Ebola pt's in West Africa , whilst donned in the same suits the nurses in Dallas nurses were given.

Thoroughly Disgusted

Are you suggesting that the POTUS should go hug infected patients in an area of pandemic because of poor precautions taken by a private US entity?
Even if I bought the argument that the poor precautions were as a direct result of CDC mismanagement... and even if I bought that the POTUS is directly responsible for every action taken by every branch and sub-branch of the government... it's a bit of a stretch to then ascribe malicious intent to the actions.
So why then are you directly wishing to infect and cause harm to the POTUS? Or anyone for that matter?
Maybe I'm missing something and you have a good line of thought that I'm just not following...

 

[Gauss44]

...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.

1. I don't think they were expecting ebola.
2. Hospital budget.
3. Hopefully, Ron Klain's newly trained national ebola troupe will bring some extra PPE along to the next case, if or when, it happens.

 

[ridethecliche]

1. I don't think they were expecting ebola.
2. Hospital budget.
3. Hopefully, Ron Klain's newly trained national ebola troupe will bring some extra PPE along to the next case, if or when, it happens.

Doesn't matter what they were expecting or not. CDC has been advocating for preparedness since june/july. If the hospital didn't heed this advice, it's not the fault of the CDC or POTUS. At a certain point that institution has to take responsibility for letting their staff down and essentially putting them in harms way.

 

[jl lin]

He isn't a physician. Why would I ask him about the pathogenesis of a disease?
Anything he says about a disease is recitation of talking points given to him by medical advisors.
So... I'm missing your point.



Are you suggesting that the POTUS should go hug infected patients in an area of pandemic because of poor precautions taken by a private US entity?
Even if I bought the argument that the poor precautions were as a direct result of CDC mismanagement... and even if I bought that the POTUS is directly responsible for every action taken by every branch and sub-branch of the government... it's a bit of a stretch to then ascribe malicious intent to the actions.
So why then are you directly wishing to infect and cause harm to the POTUS? Or anyone for that matter?
Maybe I'm missing something and you have a good line of thought that I'm just not following...

Chill. He said that he hugged people with Ebola. Well, let's see if he would do do, much less give around the clock, intimate/close care to very sick Ebola pts w/o the proper protective gear. I'm making a point, and as far as the PO.tUS is concerned, I fully believe he doesn't really care.

I am beyond disillusioned at the current administration, but really, I am not surprised by it.

 

[ridethecliche]

Chill. He said that he hugged people with Ebola. Well, let's see if he would do do, much less give around the clock, intimate/close care to very sick Ebola pts w/o the proper protective gear. I'm making a point, and as far as the PO.tUS is concerned, I fully believe he doesn't really care.

I am beyond disillusioned at the current administration, but really, I am not surprised by it.

You're potentially more delusional than anything else at this point and honestly regarding the rest of your statements, I don't think this is the proper fora for the line of discussion you seem to want to pursue.

I'm just baffled at how you're continuously blaming the president for what seems to amount to the hospital not paying attention to CDC briefings months ago. It is not the fault of the CDC nor the POTUS that the hospital skimped on PPE, didn't teach staff to use it, and seemingly left the care of that patient to rookie nurses.

I have a lot of respect for all healthcare staff, but this is the kind of thing where experience pays off.

It's unfortunate that this happened, but it's not unsurprising given that it was the first case in the US where someone just showed up to care. I think it's naive to think that there would be no near misses with something like this. It's like everyone expects this to be handled perfectly from the onset when there are too many moving parts. At least it's in consciousness now and people are screening more diligently.

Were you really expecting perfection all the way through? Show me an instance where the public health response occurred without any infections passed through with a pathogen with similar modes of spread.

 

[wholeheartedly]

Yes, WH, they sent people there, but they didn't stay and supervise. They didn't stay to instruct. They didn't even stay to ensure that the hospital would be supplying the proper PPE or procedures. They just cared about their stats.

I don't mind you criticizing the CDC but it's statements like this that bother me in discussions like this. You have no basis to support this claim. The CDC sent 16 people to Dallas the same day they confirmed the positive ebola result. Two of those people were dedicated to assisting the hospital the rest were for contact tracing etc. in the aftermath of sept 11th the CDC staffed the hospitals that way as well with two EIS officers at each major hospital pulling 12 hour shifts. Youre just speculating that they popped in and out because you want to lash out at them.

No. The nurses didn't have full covering, and they most definitely should have had. I know what hospitals put out. They will do the bare minimum. See my story about how I became infected b/c of an inconsiderate act of a RT and the fact that ID pulled out the masks in the isolation unit. It's in the ED thread.

You seem to be projecting a lot of your experiences and frustrations onto this situation. You again don't have facts to back that up. Records that were released indicate that they wore hazmat suits after the diagnosis was made, just probably not adequate protection during the 2 days before.

I get that bureaucratic bs in healthcare sucks. I've got plent of experience to get that. However, when an individual hospital fails to pay attention to multiple communications with recommendations from months before this incident, it's not the fault of those giving the guidelines. It's the hospitals responsibility to take it from there providing training and gear.

[QUOTE/]With this particular situation, they should have provided full, impervious protection, just like the nurse in at the NIH is wearing in the video with Nurse Pham in Bethesda. Period. No back and forth. No nonsense. And if that means staying to supervise, educate, demonstrate directly, whatever, hell. That is what you do.

The thing is, the CDC has dealt with this, and that is the point. They have now come off like bumbling bureaucrats, like so many in politics and the government. Anyone with an ounce of insight can see this.

They shouldn't have had to triple gown, if they had had the proper suits in the first damn place. If they feel that people are not properly educated and practiced in using them, teach them, supervise, be hands-on. And it the meantime; put people in there from their agency that does--or move them to facilities where this is the case.[/QUOTE]

Again, you weren't there and no one knows what happened or what guidance was provided, but I'm guessing those two CDC staffers dedicated to the hospital weren't sitting around on their butts. Records indicate CDC guidelines were followed starting the 30th. Any councidence that that's also the day the showed up?

If the nurses chose to triple glove when CDC guidelines explicitly say not to because it increases risk, that's not the fault of the CDC. They triple gowned because of fear, plain and simple.

Second, an article published by the group at Emory actually talks about how those providers followed CDC guidelines for PPE while working with the patients and only switched to full suits or used leg and shoe covers and full hoods when patients were vomiting and having diarrhea. Otherwise the didnt.


There aren't enough CDC staff to go to every hospital and train everyone. the hospital should be quite capable of accomplishing this if they try given the guidelines. If they're skimping in supplies that isn't anyone's fault but the hospitals.

You're also overlooking the role and responsibility of state and county health departments. The CDC works closely with these groups to spread information and resources. It WOULD be feasible for state health officials to come out and touch base with hospitals, train staff to train their own people and check supplies.

You're always, always going to have to revise plans in crises situations. They will never be perfect the first time. I imagine I'm not the only one surprised that hospital leadership admitted to congress that they received the guidelines but didn't act on them or come up with a plan.

So the CDC saying we're prepared to deal with it doesn't mean it'll go without a hitch. It means we'll shut it down without it spreading rapidly into the community and we'll minimize damage as much as possible.

 

[wholeheartedly]

An ignorant person I know told me Muslims ensured this happened and they are going to run around the U.S infecting people on purpose because all Muslims are violent and are trying to take over the U.S.

I had to take a slow breath as I wanted to slap that person on the back of the head

I don't know Lupa, a lot of the comments on the articles I read show A lot of people saying Americans made this virus to kill off Africans to steal their land and resources. Maybe it was a collaborative effort?

...

 

[wholeheartedly]

@jl lin
Disagreement aside,


Thanks for the birthday wishes. It was nice, peaceful, and ebola free except for work today. We got our medical director a stuffed ebola for a stress relief gift. I though she might throw it at me. She goes, "I hate it! ...but at the same time it's nice, thanks."

 

[jl lin]

In reply WH

No, nurses, the nurse's unions, as well as the two nurses in seclusion (as evidenced by their infection) now back up the fact that they didn't have the things I have the previously stated--i.e., PPE and proper CDC supervision. The fact is, they did NOT provide impervious suiting. They were not hands-on with direction and supervision. And let me tell you right now, a whole host of other hospitals would not even now be either-sadly.

I can tell you as point of fact what hospitals do. They provide the skimpiest crap they can get for the cheapest price, and they don't have any issues with telling people to tape up the rest. No, not until they get bad press or a law suit.

Furthermore, nursing organizations and those nurses in the media will tell you that this not just some Ebola issue. This has generally been the issue when it comes to infectious illnesses. Again, read my aforementioned example. And I can post many more like it from RL experience and the RL experiences of my nurse colleagues.
Truth is, nurses are expendable. A very sad LOL there. WH, it is what it is, and after 20+ years, I pretty much have been there and can tell you the general reality. So yes. It's a hospital thing, and it's also a government agency thing.

How long have you worked with ACTUAL, infectious patients--and I mean in DIRECT AND CLOSE CARE? Were you are in close contact for 12 hours or more shift in and shift out?? Sorry, but yes; I damn well do know what I am talking about here.

Frankly and sadly, I wasn't surprised by the hospital's stupidity, b/c they do the bare minimal very often in order to limit costs. Again, another reason why I have some problems with tort reform and caps. Institutions and individuals NEED added levels of accountability. Yes after over two decades, I can tell you that people and organizations need such things to make them think twice and do the right thing. Do you really think everyone and every organization wholeheartedly embraces what is the ethical, moral, or safest thing to do???? That is not reality, at all. We get endless ethics courses--I lost track of how many I have taken over the years for degrees or for license or work. Yet, amazingly, it is sad to think of how many actually believe, live, and work by high ethical standards. It's not a superiority thing. It's a sad human thing.

I say let's stop making excuses for the CDC and the current leadership. It is a shame that I was only a little bit surprised by their incompetence. Like many government-based organizations, bureaucratic/politic-think has taken over. The days of having people like C. Evertt Koop around, sadly, seem to be over.

 

[jl lin]

@jl lin
Disagreement aside,


Thanks for the birthday wishes. It was nice, peaceful, and ebola free except for work today. We got our medical director a stuffed ebola for a stress relief gift. I though she might throw it at me. She goes, "I hate it! ...but at the same time it's nice, thanks."

Glad you had a nice BD.

Working directly in the fields or the mines so to speak, and having worked in them for quite some time--and not at a few places mind you, it's not likely we will agree with re: to the CDC and hospital handling of Ebola or other infectious diseases. c'est la vie!

 

[wholeheartedly]

Sorry you've had such bad experiences where you've worked. I can't imagine such a blatant disregard for nurses/ other staff. Biggest problem in healthcare is that the people who care the most are furthest from decision making positions. And that the almighty dollar rules over good sense.

I guess I've been pretty lucky at the places where I've worked. They've all had a fairly good safety culture and speak up if you have concerns type culture. Not that I don't have other complaints, but that fortunately isn't one of them.

I don't think we totally disagree, I've lodged my own criticsms of the cdc and especially the hospital elsewhere here. I'm just advocating waiting for the dust to settle and more concrete info to come out before calling for heads. Trying to get accurate info on this subject is damn near impossibe, I swear every other article I read contradicts at least some part of the one before it. Then the next day, something has changed again.

There are a lot of players here with even more agendas at play, everyone from health officials, to hospital officials, to politicians, the nursing union, and the especially the media that can't seem to fact check anything before running with an eye catching sound byte.

I'm on our depts event management team and this reminds me of the stuff that we review at that level. It's usually a chain of screw ups along multiple points: ie doctor screwed this up, confused phlebotomist who screwed this up, sample went to wrong lab who was then confused and messed that up, nurse calls to investigate but gives wrong test, lab repeats wrong test while the missing test turns out to be a critical value that's delayed by two hours due to chain reaction cluster...


The one thing I'm really anxious to see is how much responsibilty the WHO is going to take on this. I suppose it's overly idealistic of me to think anyone else in the international community will admit that thousands of people died because it wasn't in their backyard, yet. Let alone offer viable solutions to prevent it from recurring.... Must be dreaming.

 

[wholeheartedly]

And, @jl lin

At least we agree on the dog!

 

[jl lin]

And, @jl lin

At least we agree on the dog!

Yea. Here's hoping that both nurses and the dog Bentley are doing alright.