Second Case of Ebola in Texas

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pgg said:
Ebola isn't contagious prior to the development of symptoms. It doesn't matter how many patients this nurse came into contact with before developing a fever.

If we get credible reports of some cases transmitted from an asymptomatic patient, at that time I'll be a little concerned.
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According to the CDC's website, nurse #2 was considered to be asymptomatic since she only had a fever of 99.5. To be considered "symptomatic," one must break a fever of 101.5F. My question is..where on earth is the cdc getting these specific temp values anyway? And is 99.5F still considered an asymptomatic temp?

And now that the second nurse is positive w/Ebola, why hasn't the cdc changed the first bullet point on their website? Obviously we now know that a low grade fever could be one of the first symptoms of Ebola.

http://www.cdc.gov/vhf/ebola/symptoms/index.html?mobile=nocontent
 
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Dude... we've been doing it that way since the early 80's...

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I kid, I kid... :)
 
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Yeah that Dallas hospital is taking a major hit. 900 bed hospital. Only 300 beds in use.
IMO, they have ruined their public image.
 
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sevoflurane said:
Yeah that Dallas hospital is taking a major hit. 900 bed hospital. Only 300 beds in use.
IMO, they have ruined their public image.
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Agree, that ER guy who saw Ebola dude first is done and most likely unemployable now. Hospital CEO is done too - trying to save a few bucks on proper PPE while loosing thousands if not millions in the end. *****s all across
 
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Do you guys buy this crap about how stopping flights from africa will somehow make things worse?
 
Random Resident said:
Honestly, I haven't bought any crap at all since 2008 and less and less up til then.
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Ha. For me it began at some point during the bush administration/post 911--when the government/media began their comical fear mongering charade. Red terror alerts, blue terror alerts--orange--yellow--what a joke that was. Terror alerts, terrorism terrorism, the invasion of 3 countries, and the steepest incline in debt that we've seen in decades.

People love to blame Obama for the terrible economy and everything else that goes on...but the truth is it was all going to hell way before he ever took the reigns. Romney, Mccain, Joe Schmoe lol--not even god himself could have cleaned this up:

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/24/george-w-bushs-presidency-in-24-charts/
 
caligas said:
Do you guys buy this crap about how stopping flights from africa will somehow make things worse?
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It won't make things better either. There are very few direct flights from West Africa to the U.S. To go there you pretty much have to transfer in London, Brussels or Paris. If someone wanted to fly from Africa to the U.S. all they'd have to do is buy two separate tickets with different airlines, which is what I always did anyway because it was cheaper. You could try refusing entry to anyone on a Liberian, Guinean or Sierra Leonean passport, but plenty of nationals in those countries also hold foreign passports, since getting a visa for a West African passport was difficult enough before ebola. Realistically to halt all travel between Africa and the U.S. you'd have to shut down all flights between Europe and the U.S. as well. By the time we get to the point of considering that, ebola will already be an epidemic in the U.S. and it'll be too late. It's scary how connected the world has become.
 
47-minute interview with the intensivist who treated all 3 Texas Ebola patients:
 
Megalomis said:
Ha. For me it began at some point during the bush administration/post 911--when the government/media began their comical fear mongering charade. Red terror alerts, blue terror alerts--orange--yellow--what a joke that was. Terror alerts, terrorism terrorism, the invasion of 3 countries, and the steepest incline in debt that we've seen in decades.

People love to blame Obama for the terrible economy and everything else that goes on...but the truth is it was all going to hell way before he ever took the reigns. Romney, Mccain, Joe Schmoe lol--not even god himself could have cleaned this up:

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/24/george-w-bushs-presidency-in-24-charts/
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I'm libertarian. I hate pretty much everything about government. And I'm not giving Obama a pass for anything done before him. I try really hard not to engage in too much political discussion here. Sometimes it comes through though.
 
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That was painful to watch. Sounds like they were inadequately protected initially but then got their act together and started using more appropriate PPE and decontamination procedures.
 
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I'm not sure that Ebola is all that difficult to spread.

I'm not sure people are currently 100% certain how it spreads.

I remember something my professor said during my micro lectures from med school. He said that there are some people who will contract tuberculosis if just a few mycobacterium are hurdling through the air and they breathe it in. Others could literally bathe in a tub of the stuff and not get the disease. I think this is meted out by observation of those who suffered "dropsy" in the late 19th century compared to those who were around them all the time and never did. I surmise that something like this is going on here.

We need to better understand the actual virology of this disease. Do people of African decent, for example, have a higher virulence rate and suffer a worse disease? How exactly does it get into our system? Oral route? Skin? Etc.

Most importantly this is an acid test for our response to more serious, more easily spread, and possibly more deadly diseases in the future. How well we respond to this will set the tone for future deadly epidemics.
 
BuzzPhreed said:
I think this is meted out by observation of those who suffered "dropsy" in the late 19th century compared to those who were around them all the time and never did. I surmise that something like this is going on here.
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"Dropsy" (from "hydrops") is an obsolete term for edema in general, but is most associated with CHF. Andrew Jackson was a noted sufferer of dropsy. There was no associated infectious component (if that is to what you were referring).
 
:bag:

Oops... I meant "consumption". (Thanks for the correction.)
 
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Can people really be expected to quarantine themselves? Obviously not. Not even those that should know better.
 
They can quarantine themselves inside their house arrest. :)
 
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Almost two weeks ago, I said this...

BuzzPhreed said:
Yeah, expect cases like this to trickle in and pop up in various places for the next year (or longer). Worst case scenario is that Ebola smolders on and becomes endemic in certain parts of Africa. Let's just hope the vaccine works. That's our only real chance at getting control of this thing.
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The CDC website has suggested quarantining people for 3 weeks before they come to the U.S.

Then they are supposed to be "quarantined" for another 3 weeks when they get here.

How on earth are they going to accomplish this?
 
IlDestriero said:
Yes. Now in NY.
Another exposed health care worker arrogantly travelling around the city in public transportation. These people need to quarantine themselves.
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I read that when he developed symptoms he was transported from his house by EMS in suits.

Or are you saying because he was in west Africa he should've stayed home for 21 days after returning? That doesn't seem to be necessary, since we know how non-contagious asymptomatic carriers are.



Anyway, to recap the USA Ebola experience so far:

8 cases diagnosed and treated.
7 are alive.
One death after a 3-day delay in diagnosis.
Two cases in healthcare workers in contact with very sick patients.
Zero cases in casual contacts.
Zero cases in close family contacts.

A pause for a breath would seem to be in order.
 
IlDestriero said:
I think he should have quarantined himself for 3 weeks after his last contact with the infected. That seems reasonable to me.
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We're not quarantining everyone else coming from Africa for 3 weeks. I know lots of people think we should. Some people think we should stop the flights entirely. I don't think actual evidence supports those precautions though.


I just can't bring myself to get irritated at this doctor, who volunteered at substantial personal risk to help in Africa, who came home, and as soon as he at a temp of 100.3 sought appropriate treatment. The guy's a saint and we have no reason to believe he put anyone in the US at risk.
 
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pgg said:
We're not quarantining everyone else coming from Africa for 3 weeks. I know lots of people think we should. Some people think we should stop the flights entirely. I don't think actual evidence supports those precautions though.


I just can't bring myself to get irritated at this doctor, who volunteered at substantial personal risk to help in Africa, who came home, and as soon as he at a temp of 100.3 sought appropriate treatment. The guy's a saint and we have no reason to believe he put anyone in the US at risk.
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Seems like anyone who has been potentially exposed should self-quarantine, especially a health-care practitioner. And he's been feeling bad for a couple days before his temp went up.
 
jwk said:
Seems like anyone who has been potentially exposed should self-quarantine, especially a health-care practitioner. And he's been feeling bad for a couple days before his temp went up.
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Again though, asymptomatic people aren't contagious. It's becoming increasingly clear that even people who feel a little bad aren't contagious either.

I'm not sure why there's so much resistance to using data and science on this subject. Knee-jerk, why-not, sounds-like-a-good-idea declarations and policies based on speculative concern are what career nurses at JHACO do.
 
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CDC conference call, Monday, October 20, 2014, audio and transcript: Approaches to Clinical Management for Patients with Ebola Treated in U.S. Hospitals

The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. A small number of patients with Ebola virus disease (EVD) have been medically evacuated from West Africa to receive care in U.S. hospitals. The first imported case of Ebola was diagnosed in the United States in a person who had traveled from West Africa to Dallas, Texas and two secondary Ebola cases in health care workers have been identified as of October 14, 2014. CDC and our partners are taking precautions to prevent the spread of Ebola by sharing information with clinicians who may provide care for patients with EVD. During this COCA Call, clinicians will learn the clinical features and complications associated with Ebola and recommendations from Emory University Hospital and the University of Nebraska Medical Center on clinical management of patients with EVD.
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pgg said:
I'm not sure why there's so much resistance to using data and science on this subject.
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Because there's still a lot we don't know about this disease. The science is not completely understood. The data are still small.
 
^^^ and when someone catches this virus they have a 50% chance of being dead.

We have had good results with early treatment here in the US but if people start spreading the virus like in Africa (unlikely) we will start to see different results.

The seriousness of this virus with a 50% fatality rate is why I don't by the argument that we need to focus more on things like the flu virus. Yes it kills more people but that's because it infects many many more. And it doesn't kill half of those it infects. I would much rather catch the flu than Ebola.
 
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BuzzPhreed said:
Because there's still a lot we don't know about this disease. The science is not completely understood. The data are still small.
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It's Ebola. We've been studying it for 40 years. Granted, circumstances and its rarity until this outbreak have somewhat limited that study, but we know a thing or two about it. In particular, we understand the mechanism and risk of transmission. The CDC has been right about the (low) contagious risk to casual contacts since the very beginning.

The most significant NEW thing that we appear to be learning about Ebola is how survivable it is in a modern hospital.


Noyac said:
^^^ and when someone catches this virus they have a 50% chance of being dead.
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In Africa, it's probably even worse than that. Believe in magic, a corpse-hugging custom, and fear of modern healthcare doesn't help. But the first-world experience with this virus is a LOT less than 50%: one death, after a delay in diagnosis and treatment.

Don't get me wrong, I'm not interested in catching it. I too would rather have the flu.


On a lighter note, I read a headline earlier today that made me laugh: "More Americans Have Married Kim Kardashian Than Have Caught Ebola In The US"
 
pgg said:
It's Ebola. We've been studying it for 40 years. Granted, circumstances and its rarity until this outbreak have somewhat limited that study, but we know a thing or two about it. In particular, we understand the mechanism and risk of transmission. The CDC has been right about the (low) contagious risk to casual contacts since the very beginning.

The most significant NEW thing that we appear to be learning about Ebola is how survivable it is in a modern hospital.
Click to expand...

We don't know the disease penetrance. We don't know the exact route of transmission (i.e. how exactly it gets into the body... skin? fecal-oral route? mucous membrane contact?). We don't know who exactly is susceptible and who isn't. We don't if there is a reservoir of asymptomatic carriers who have subclinical disease but can still transmit. We we have done is made a lot of assumptions.

Yes, modern healthcare helps. But, there's only so much of Dr. Brantley's plasma to go around...
 
pgg said:
It's Ebola. We've been studying it for 40 years. Granted, circumstances and its rarity until this outbreak have somewhat limited that study, but we know a thing or two about it. In particular, we understand the mechanism and risk of transmission. The CDC has been right about the (low) contagious risk to casual contacts since the very beginning.
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Sincere question: Since we've been studying it for so long, do you think we are close to a vaccine (e.g., ZMapp)?
 
I believe ZMapp is a mAB.
 
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bashwell said:
Sincere question: Since we've been studying it for so long, do you think we are close to a vaccine (e.g., ZMapp)?
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I have no idea. But I don't see how the statement is related to the question. We've been studying lots of diseases for a long time, malaria, HIV, herpes, etc ... don't have a vaccine ... and have no reasonable expectation of a vaccine any time soon.


My point in this thread - and in all the other Ebola threads since the very beginning of this circus - has simply been that a virus that
- isn't contagious in asymptomatic patients, and
- produces horrific, incapacitating, travel-stopping symptoms when it does become contagious, and
- results in death (or recovery) in a short period
just isn't the kind of virus that is positioned to cause pandemic mayhem in developed countries. It's 0-for-3 on the most important features a deadly pandemic pathogen needs.

Quarantine and treatment of symptomatic people is all that's needed to stop the outbreak. Nigeria did it. If Captain Tripps ever arrives, it won't be anything like Ebola.
 
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I should also add that mABs are prohibitively expensive and notoriously difficult to scale up. This medication will cost thousands (if not tens of thousands) of dollars per dose.

The only real hope of getting ahead of this thing and potentially eradicating it as a human pathogen is an effective, cheap vaccine.
 
This lady is just rubbing me the wrong way: State of Maine, nurse who went to Africa at odds over Ebola quarantine.

I get the part about constitutional liberties, I get the part about not having been treated nicely by the Garden State, but when one volunteers to go to Ebola country, takes care of Ebola patients, and then comes back home, then the last thing one should do is bang one's chest. Just shut up, stay at home for 3 weeks and accept that people are scared. She was a hero until she got home, now she's just another selfish human being. No difference between her and the millions who'd quarantine her, except that the latter have more political power.
 
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I sure hope she doesn't turn up to have Ebola. If so, she will look like a complete idiot. Worse than imaginable since she is also a nurse and claiming that the quarantine is unnecessary and, God forbid, a violation of her human rights. Are you f'in kidding me? It doesn't matter if you "believe" that you are free of the virus young lady. It's about the greater good. And the greater good includes, "fear". Take the 21 days with a f'in smile.

I understand, at least as well as the average American, how this virus works. That's not the issue here.
 
I don't believe she needs to be quarantined, but I hope she loses her lawsuit. Otherwise we'll have precedent for people being able to ignore quarantine orders. I want the quarantine decision for a disease outbreak to be up to public health officials, not individuals who think they know better.

I was disappointed to see NJ cave and let her go.
 
I don't agree or disagree with you, pgg.

Here are some points to debate tho.
1) she did have an elevated temp of 101 at one time upon arrival.
2) she tested negative for the virus
3) she did have contact with the virus

What are we to do?
 
Noyac said:
1) she did have an elevated temp of 101 at one time upon arrival.
2) she tested negative for the virus
3) she did have contact with the viru
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I think I recall reading that they used a skin temp probe, so I'm not sure what to make of that 101 temp. (We have those devices in our PACU, and they suck. The RNs just keep swiping them again and again until they get a temp they like.) I think that's kind of a red herring though; it's the tool that the public health officials chose, and 101 = a fever. It's dumb to do any test and then second guess it when it gives you an inconvenient result.

I don't know how sensitive the test they did was, or if its sensitivity varies significantly between the asymtompatic and symptomatic periods. Assuming it's highly sensitive (>95%?) at that time, and she was negative, and she actually was afebrile and asymptomatic, quarantine was IMO unnecessary at that point.

But again though, the people whose job it is to make these decisions created a protocol that put her in quarantine. Whether I agree with their thought process or data or the protocol itself is unimportant. A quarantine order shouldn't be an invitation.


Noyac said:
What are we to do?
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NJ had a policy and protocol and they should've adhered to it. Enforce the quarantine. Let her fight it in court if she really wants to. I'm about as libertarian as they come but this isn't a civil rights or freedom issue at all. Enforced quarantines have 1000s of years of history behind them; civilized people accept them the way they accept taxes. I can't believe they just let her drive off to another state.

We should publicly mock and scorn her for being a selfish person. She's free to be a '**** and sue; we're free to publicly shame her in the hopes of discouraging other people from fighting quarantine orders. And we should. I think that's all we really can do.
 
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FFP said:
This lady is just rubbing me the wrong way: State of Maine, nurse who went to Africa at odds over Ebola quarantine.

I get the part about constitutional liberties, I get the part about not having been treated nicely by the Gardener State, but when one volunteers to go to Ebola country, takes care of Ebola patients, and then comes back home, then the last thing one should do is bang one's chest. Just shut TF up, stay at home for 3 weeks and accept that people are scared. She was a hero until she got home, now she's just another selfish human being. No difference between her and the millions who'd quarantine her, except that the latter have more political power.
Click to expand...


I know the nurse in question. Worked with her before medical school. Her behavior is no surprise to me or others that have worked with her. This is all about attention and politics. She is an arrogant know-it-all. Extremely far left politically, which to me is quite ironic now that she's the "victim" of government power. She will use this attention as a springboard for some sort of personal gain, whether it be politically, financially, or attention to whatever her current "cause" might be. In other words, your sixth sense about her rubbing you the wrong way is spot on, and then some.
 
GABAergic said:
I know the nurse in question. Worked with her before medical school. Her behavior is no surprise to me or others that have worked with her. This is all about attention and politics. She is an arrogant know-it-all. Extremely far left politically, which to me is quite ironic now that she's the "victim" of government power. She will use this attention as a springboard for some sort of personal gain, whether it be politically, financially, or attention to whatever her current "cause" might be. In other words, your sixth sense about her rubbing you the wrong way is spot on, and then some.
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This is my shocked face: :lame:
 
One of the very vocal, very opinionated surgeons was talking about this in the OR today. His take on the people volunteering to go over there right now is that they fall into basically two categories... right, wrong, or indifferent... agree or disagree with him:

1) That "God has a plan" people: Like Brantley, they're doing God's work. God has it all mapped out, God wanted me to go there and help these people, God wanted me to get Ebola, if I had died it was all in God's hands, but God saved me from Ebola, God is great. God, God, God, God, GOD!

2) The "K2 Climbers": Mostly looking at stuff to post on their Facebook page about how awesome and humanitarian and risk-taking they are. They do it because it's there and well, you know, because they're just a little bit better than you and, you know, it's their duty to society because I'm just an awesome person and, you know, I can get some terrific pictures and experience and, you know, nothing bad is going to happen to me because I'm frickin' invincible... until something goes wrong. Then it's because someone ELSE did something wrong because, you know, nothing is ever my fault. Just get out of the way of my experience, man. Me, me, me, me, ME!

I suspect this particular nurse falls into Category #2. Both are ultimately self-serving/self-fulfilling. Not that there's anything wrong with that. Provided the ultimate work done is good work.
 
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Bike-riding U.S. nurse defies Ebola quarantine, on collision course with governor

A nurse who treated Ebola patients in Sierra Leone but has tested negative for the virus went for a bike ride on Thursday, defying Maine's order that she be quarantined in her home and setting up a legal collision with Governor Paul LePage.
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Quarantine is not something voluntary or negotiable; you don't let people go take a walk, bike ride or whatever, as long as they keep away from the public. Yeah, sure, because that's exactly what they do, keep away voluntarily. It's either 100% isolation, or it's not effective, which makes one wonder why it was needed in the first place.

LePage's office said he offered to allow her to go for walks, runs or bike rides but prevent her from going into public places or coming within 3 feet (1 meter) of other people.
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Really? I have to deal with way more complicated "contact precautions" with patients who had MRSA before I was born.
 
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I read that the elevated temp was via a temporal artery scanner.

I also read that the test may show negative for Ebola until the person begins to show symptoms.

Don't know the truth to all this but it gives thought.
 
New York (CNN) -- A Doctors Without Borders physician who recently returned to New York from West Africa has tested positive for the Ebola virus, becoming the first diagnosed case in the city, authorities said late Thursday.

The doctor, identified as Craig Spencer, 33, came back from treating Ebola patients in Guinea October 17 and developed a fever, nausea, pain and fatigue Thursday. He is in isolation and being treated at New York's Bellevue Hospital, one of the eight hospitals statewide that Gov. Andrew Cuomo designated earlier this month as part of an Ebola preparedness plan.

Spencer, who is hospitalized in intensive care, went for a jog, may have gone to a restaurant, traveled the city's vast subway system and went bowling before feeling ill, but authorities stressed that the likelihood of him spreading the virus was low.
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http://www.cnn.com/2014/10/23/health/new-york-possible-ebola-case/index.html

That reminds me of the bureaucratic circulator who, to satisfy new hospital requirements, just had to ask a patient about her travel history right before induction today, while lying on the operating table (the admitting nurse had forgotten). There is no common sense left...
 
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