Second Case of Ebola in Texas

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Yangkower

Full Member
10+ Year Member
Joined
Mar 29, 2010
Messages
87
Reaction score
47
So now there is a nurse in Texas who contracted Ebola when she was supposedly in full PPE. During the press conference the hospital hides behind HIPAA and doesn't release much useful information. Why are they doing this? Isn't it time to lay everything out in the open so we as a medical community can learn as much as possible about this disease and get it under control. It seems to me they are more concerned about PR than solving this problem.

Members don't see this ad.
 
  • Like
Reactions: 1 users
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.
 
  • Like
Reactions: 1 user
Lots of questions and I'm just pondering the issues. With every incidence, consider the number of contacts taken out of patient care for 21 days. How many patients did that nurse care for outside of patient zero? How many other healthcare workers are now isolated? Will it be necessary to form teams dedicated to treating ebola patients, and only ebola patients to minimize risk of infecting other patients? Should hospitals, if they believe themselves unable to provide adequate protection for patients and staff, be able to refuse ebola patients. In pigs, they have shown asymptomatic transmission of ebola, should every patient now be treated as if they have ebola? (http://www.ncbi.nlm.nih.gov/pubmed/21987755) What if you're called at 0130 for an emergency intubation in the ED for a possible ebola infix, do you wait until you are fully suited up and protected before approaching the patient? If that person does have ebola, or even suspected to have ebola, then you're isolated for 21 days, who takes care of your scheduled OR cases for the next 3 weeks. Does your ED even have full Tyvek suits with hoods, or just the standard PPE hoods? What about your ICU? Ours (a level-1 TC) can't even find N95 more than half of the time for any patient not already in an isolation room. As examples in New York and Dallas, when workers start refusing to clean the ambulances, ventilators, rooms, etc., how long before we run out of ventilators in service. In 2003, healthcare workers in Canada refused working with SARS patients (http://www.cmaj.ca/content/169/2/141.2.full). Whether ethical or not, this will occur with ebola patients, what's your strategy to manage this shortage of staff? Personally I have little confidence in people being able to adhere to protocols for managing ebola patients, it's like saying that universal guidelines prevent needle sticks in the OR, it's just not reality, do you believe these new protocols will protect from infection if you are on an ebola team? Supposedly the infected nurse in Dallas was wearing full PPE (http://www.cnn.com/2014/10/12/health/ebola/index.html?hpt=hp_t1). Should the screening nurse in the ED be wearing full level-4 bioprotection since they are most likely going to be infected?

Oh, so many more questions.
 
  • Like
Reactions: 5 users
Members don't see this ad :)
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.
 
I agree and wouldn't even have really cared about this case except she was using PPE when she contracted it which means something broke down and that's where the hospital should be more forthcoming. Maybe she was just not careful, maybe the PPE was defective, maybe the decontamination room wasn't cleaned properly. Who know, but this is clearly a case where best practices should be shared, especially since healthcare workers are at high risk.
 
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.

I have absolutely no idea where the premise that asymptomatic ebola patients cannot transmit the disease. Nobody I've talked to can cite a single manuscript that this has been scientifically established. Even in the CDC literature, the statements that ebola is infectious only in symptomatic patients is made without any cited references. This to me has all the scientific credibility of "wishful thinking."

It might be true that ebola becomes contagious if and only if a patient exhibits symptoms, but it makes no sense to me. What would make ebola so significantly different from other viruses? Nobody argues that HIV (an enveloped virus like ebola), or Hep-B,C,D are transmitted from asymptomatic patients. Ebola is a negative sense RNA virus, analogous to orthomyxlvirdae, paramyxoviruses, and rabies. Each of these viruses are established to be transmitted from asymptomatic animals. Logically, to me anyway, as the viral load increases, but at some point before symptoms manifest, there must be a point that viral shedding occurs. In pigs, transmission was established by an oronasal route, so it seems likely, to me anyway, that once some, as yet undefined, critical mass of virions build up, a sneeze is enough to infect.

This is a forum for physicians, not politicians hoping to prevent irrational public reaction, and so I am hoping commenters will have reality in mind, and we can learn how best to protect ourselves, our colleagues, and our patients.

http://jid.oxfordjournals.org/content/204/suppl_3/S804.full.pdf+html
 
  • Like
Reactions: 1 users
Asymptomatic patients aren't projectile-vomit explosive-diarrhea spewing large quantities of bodily fluids all over the place. I don't interpret the CDC's statement that it isn't contagious prior to the development of symptoms as a claim that the viral load of an ordinary pre-symptom sneeze is zero, merely that risk of transmission during that period is so minimal as to be epidemiologically irrelevant.

I don't understand why you think you can compare ebola to similar viruses. Why is chicken pox so readily transmitted by very casual contact, but herpes simplex 1 and 2 aren't? They're all herpesviridae in the alpha subclass. How come there's a vaccine for chickenpox but not herpes? How come most of us (pre-vaccine) as little kids got chickenpox from our little friends but somehow didn't catch herpes from their slutty older siblings? Because they're not the same virus.

If it's reality-based discussion you want, let's back up for a moment and stick to talking about known circumstances of transmission between humans, at least until we see
credible reports of some cases transmitted from an asymptomatic patient

At this point there is no reason to believe we need to do anything other than isolate symptomatic patients and wear basic PPE to protect ourselves, our colleagues, and our patients. Absent data to the contrary, theorizing that asymptomatic patients pose an infectious risk is just as speculative - and useless - as wondering if it's also an airborne-transmissible virus.
 
  • Like
Reactions: 2 users
This is a forum for physicians, not politicians hoping to prevent irrational public reaction, and so I am hoping commenters will have reality in mind, and we can learn how best to protect ourselves, our colleagues, and our patients.

With reality in mind i'll say i'll probably never see a patient with ebola, how is that for a rational reaction?
 
At this point there is no reason to believe we need to do anything other than isolate symptomatic patients and wear basic PPE to protect ourselves, our colleagues, and our patients.
Please go take care of an Ebola patient just with basic PPE. I have the same invitation for the wise CDC people, who have studied Ebola only in BSL-4 suits, but would like mere mortals to use regular PPE. Until I see that, I personally won't get close to an Ebola patient.

The fact that we overreacted in the past to many epidemics, most famously HIV/AIDS, does not mean that we should underreact now.

I have a strong feeling that gtb is right about the virus being contagious before a person realizes she has it. How many of us would detect a low fever?
 
Last edited by a moderator:
  • Like
Reactions: 2 users
These are almost exactly the reactions from people during the initial HIV/AID/GRIDS scare in the late 70s and early 80s. Honestly - I've heard it all before. The sky didn't fall then, it isn't falling now - IMHO.

I'm far more concerned right now about the enterovirus cases in the US which has a significantly higher numbers of actual cases of ebola in the US.
 
  • Like
Reactions: 1 user

Except you didn't actually say anything in that thread. You just posted a pair of odd statements that you implied were what the CDC told us:

We were told that Ebola would not make it to the U.S. We were told that there was no threat to us from Ebola.

... followed by three questions and no further comment:

Do you believe anything they say?
Everyone still happy with CDC?
Are you more concerned about Ebola on our soil than the CDC says you should be?

What is it again that you said, or meant to say? :)
 
I think everyone understands what I'm getting at. I shouldn't have to spell it out.
 
Members don't see this ad :)
At this point there is no reason to believe we need to do anything other than isolate symptomatic patients and wear basic PPE to protect ourselves, our colleagues, and our patients. Absent data to the contrary, theorizing that asymptomatic patients pose an infectious risk is just as speculative - and useless - as wondering if it's also an airborne-transmissible virus.
I have just read that the Ebola-positive Texas nurse wore full protective equipment:
The woman had on a gown, gloves, mask and a shield during her multiple visits with Thomas Eric Duncan
http://www.cnn.com/2014/10/12/health/ebola/index.html

What is very important on that page, is the video with the CDC spokesperson identifying endotracheal intubation as a high risk procedure for contamination.

I personally find that, with regular PPE, it's possible to lose focus and touch a body part by mistake, which is impossible with a BSL-4 or any other type of closed astronaut-type suit. If not the latter, they should use the kind of suit orthopedic surgeons wear in the OR, with the excellent face protection.
Orthopedic_Reflect.png
 
Last edited by a moderator:
Except earlier today you said,
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.

Now you're saying
pgg said:
I don't interpret the CDC's statement that it isn't contagious prior to the development of symptoms as a claim that the viral load of an ordinary pre-symptom sneeze is zero, merely that risk of transmission during that period is so minimal as to be epidemiologically irrelevant.

I still cannot find any evidence supporting your statement that the risk of transmission, in an asymptomatic patient is, "epidemiologically irrelevant." I hope so, but at this point, I'm only completely certain that very little is known about ebola virus epidemiology. Just getting back to scientific argument: If ebola is transmitted only by body fluids, and a sneeze comprises oropharyngeal body fluids, then my conclusion is that a sneeze from an infected patient is potentially infectious. There is no evidence anywhere that only blood and GI fluids are the only body fluids containing virions. There are papers, albeit in animals, that the oronasal route is an established experimental method to transmit the virus. There is nothing known about the minimum number of virions required to infect a human. That's why I consider statements about low communicability risk of this virus to be effectively nothing more than attempts at pacification of the masses.

If anyone has actually read an abstract or manuscript detailing real science regarding the risk of infection from asymptomatic individuals, then please post it here. Does anyone have any history on where the origin of the dogma that either no, or very low transmission risk exists from asymptomatic patients?
 
  • Like
Reactions: 1 user
To be little facetious :), I'm aware that no one has conducted randomized clinical trials concerning the sneeze viral load that will infect 50% of an adult human nonimmunocompromised sneezed-upon population, and when that level appears relative to symptoms. But that doesn't mean we don't know anything about how the disease is transmitted. This isn't HIV, which was surrounded by mystery and confusion when we discovered an in-progress human epidemic; we've been watching ebola for decades and we do know quite a bit about it. And our experience with it thus far has been consistent with the CDC's statement that symptoms must be present for there to be a transmission risk.


The fact that smart, educated people like you and Noyac are worried about this has caused me to re-evaluate my own thoughts on this. I still can't muster significant alarm, however.


I think everyone understands what I'm getting at. I shouldn't have to spell it out.

I think I understand your concern, but implying things in a cryptic one-liner fashion isn't much of a discussion ...
 
  • Like
Reactions: 1 user
Recently, the CDC updated their 'transmission' webpage on Sept 22, 2014 to state, this is, I believe, a very important recent change that needs cemented into the psyche of everyone caring for a suspected or definitive ebola diagnosis.

http://www.cdc.gov/vhf/ebola/transmission/qas.html
Can Ebola spread by coughing? By sneezing?
Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.

The webpage states, "if a symptomatic patient . . .," however, at some point, before the cytokine storm makes an infected patient symptomatic, there's no doubt in my mind that the virus is communicable.

This update seems to be in conflict with the poster that the CDC also published for the general public.
Ebolatransmission.jpg
 
I think I understand your concern, but implying things in a cryptic one-liner fashion isn't much of a discussion ...

Just wait til I start speaking in tongues. That discussion will be detailed. ;)
 
Monty's commentary post is intriguing.
Part of my concerns when I posted the CDC thread were that one, we would let someone into the U.S., And two, that we would not call enough attention to the ways to prevent Ebola from impacting us for fear of causing panic. Well the first part has occurred and the second may be soon. I am typically not an alarmist and I dont mean to be one here. If I saw some sort of progress being made on the Ebola front then I would be less concerned but I havent. The virus isn't slowing down and nobody seems any closer to containing it. Therefore, I would recommend suspending all travel from these areas if I were the government. I am afraid that either the CDC is being told to not cause alarm or that the CDC doesn't have a good grasp of what is going on. I find the latter to be hard to believe. I'm fully convinced that the CDC knows what's going on but is practicing with their hands tied behind their backs.
The fourth plan in the commentary posted by Monty is good but I have issues with it. A 1/1000 false positive rate isn't not that bad but the 4/1000 false negative is unacceptable to me. If I had that find of anesthesia mortality rate then I'd be out of work and be thought of as a completely incompetent physician. It is unacceptable to me. Plus I have little faith that the screening would be foul proof.
Therefore, I would advocate for closing all travel avenues from this area.
 
  • Like
Reactions: 1 user
A 1/1000 false positive rate isn't not that bad but the 4/1000 false negative is unacceptable to me. If I had that find of anesthesia mortality rate then I'd be out of work and be thought of as a completely incompetent physician. It is unacceptable to me.
4/1000 false negative rate means a sensitivity of 99.6%. That's pretty good for a screening test.
 
Monty's commentary post is intriguing.
Part of my concerns when I posted the CDC thread were that one, we would let someone into the U.S., And two, that we would not call enough attention to the ways to prevent Ebola from impacting us for fear of causing panic. Well the first part has occurred and the second may be soon. I am typically not an alarmist and I dont mean to be one here. If I saw some sort of progress being made on the Ebola front then I would be less concerned but I havent. The virus isn't slowing down and nobody seems any closer to containing it. Therefore, I would recommend suspending all travel from these areas if I were the government. I am afraid that either the CDC is being told to not cause alarm or that the CDC doesn't have a good grasp of what is going on. I find the latter to be hard to believe. I'm fully convinced that the CDC knows what's going on but is practicing with their hands tied behind their backs.
The fourth plan in the commentary posted by Monty is good but I have issues with it. A 1/1000 false positive rate isn't not that bad but the 4/1000 false negative is unacceptable to me. If I had that find of anesthesia mortality rate then I'd be out of work and be thought of as a completely incompetent physician. It is unacceptable to me. Plus I have little faith that the screening would be foul proof.
Therefore, I would advocate for closing all travel avenues from this area.

Thanks for being more specific and "on the record".
 
Peter Jahrling, one of the country's top scientists, has dedicated his life to studying some of the most dangerous viruses on the planet. Twenty-five years ago, he cut his teeth on Lassa hemorrhagic fever, hunting for Ebola's viral cousin in Liberia. In 1989, he helped discover Reston, a new Ebola strain, in his Virginia lab.

Jahrling now serves as a chief scientist at the National Institute of Allergy and Infectious Diseases, where he runs the emerging viral pathogens section. He has been watching this Ebola epidemic with a mixture of horror, concern and scientific curiosity.And there's one thing he's found particularly worrisome: the mutations of the virus that are circulating now look to be more contagious than the ones that have turned up in the past.

When his team has run tests on patients in Liberia, they seem to carry a much higher "viral load." In other words, Ebola victims today have more of the virus in their blood — and that could make them more contagious.
http://www.vox.com/2014/10/13/6959087/ebola-outbreak-virus-mutated-airborne
 
Therefore, I would advocate for closing all travel avenues from this area.
I doubt that would really be effective. If I was an American in Liberia and I wanted to come home, and flights to the US were blocked, I'd find a way to get to Algeria or South Africa and book a flight from there. You can't quarantine a continent, especially when 90% of it isn't even affected by the outbreak. And we can't quarantine the affected countries without sending troops over there, where they'd probably be unwelcome, and then I guess they'd be stuck there too.

You'd also cut the amount of aid going to West Africa to just about nothing, because everyone would know it's a one-way trip. The best way to prevent ebola from spreading is to contain it in West Africa. Travel restrictions would just leave Africa to itself, and they sure can't handle it alone.
 
I doubt that would really be effective. If I was an American in Liberia and I wanted to come home, and flights to the US were blocked, I'd find a way to get to Algeria or South Africa and book a flight from there. You can't quarantine a continent, especially when 90% of it isn't even affected by the outbreak. And we can't quarantine the affected countries without sending troops over there, where they'd probably be unwelcome, and then I guess they'd be stuck there too.

You'd also cut the amount of aid going to West Africa to just about nothing, because everyone would know it's a one-way trip. The best way to prevent ebola from spreading is to contain it in West Africa. Travel restrictions would just leave Africa to itself, and they sure can't handle it alone.
I don't think anyone that is calling for travel restrictions is saying that the support door will be shut. We can still provide support whether it is military or medical or social or even volunteer. Once they are ready to return they are monitored and possibly quaranteened for a period. This quaranteened period can't be worse than working in Liberia. Seriously, it isn't that difficult. And then we could use the screening test described. I much prefer a false positive results of 4/100o when testing only a few hundred verses a few 1,000-100,000. I understand that there are obstacles but it isn't impossible or even all that difficult. After all, we may be talking about the worst epidemic/pandemic of the past few centuries. This may make polio look like the common cold.

Here's the problem with Ebola as I see it.
We are just getting started with this virus possibly. We don't know were it is headed. But it kills 70% of its victims give or take, depending on the strain. Nothing I am aware of does that. They tell us that the flu kills more numbers every year. So what, the flu has been around forever ever and we know who it kills, the elderly and the weak. Ebola basically. Just arrived so we have no idea where it will go but 70% dead is seriously concerning. I'D RATHER GET THE FLU THAN EBOLA. We say we know how it is transmitted but I'm not confident we are receiving the most accurate information here. Next, we are not doing enough to contain the spread. We are much different here in the US because we don't handle our dead the same way that they do in Africa therefore, it should be easier to contain. But do we really know?
 
We are just getting started with this virus possibly.

Yes. And this won't be the last such epidemic.

Well I don't want to be an alarmist.

A "healthy" amount of alarm is warranted. This is an acid test for the current surveillance and interdiction plans. As it appears, it is failing woefully.
 
How does an American nurse contract Ebola? With directions like these.

That's why I plead for astronaut suits. Much smaller chance for mistakes.

CNN had a segment with Dr Sanjay Gupta that was an interesting demonstration. He followed the CDC's suiting up and removal procedures exactly, with the exception of putting chocolate syrup on his gloves prior to removal as a marker for contamination. He contaminated himself- you could see the evidence. So clearly "breaches of protocol" shouldn't exactly be surprising.

He had travelled to Guinea and followed Doctors without Borders' protocol there and felt theirs was much more effective. (They used something closer to the orthopod space suit in the clip shown.) Until this year they hadn't had an infection and they've dealt with cases for years. So he took a bit of a jab at the CDC that perhaps we should ask DWB to come to the US to help out.
 
Asymptomatic patients aren't projectile-vomit explosive-diarrhea spewing large quantities of bodily fluids all over the place. I don't interpret the CDC's statement that it isn't contagious prior to the development of symptoms as a claim that the viral load of an ordinary pre-symptom sneeze is zero, merely that risk of transmission during that period is so minimal as to be epidemiologically irrelevant.

I don't understand why you think you can compare ebola to similar viruses. Why is chicken pox so readily transmitted by very casual contact, but herpes simplex 1 and 2 aren't? They're all herpesviridae in the alpha subclass. How come there's a vaccine for chickenpox but not herpes? How come most of us (pre-vaccine) as little kids got chickenpox from our little friends but somehow didn't catch herpes from their slutty older siblings? Because they're not the same virus.

If it's reality-based discussion you want, let's back up for a moment and stick to talking about known circumstances of transmission between humans, at least until we see

At this point there is no reason to believe we need to do anything other than isolate symptomatic patients and wear basic PPE to protect ourselves, our colleagues, and our patients. Absent data to the contrary, theorizing that asymptomatic patients pose an infectious risk is just as speculative - and useless - as wondering if it's also an airborne-transmissible virus.
Thought this was an interesting study - apparently some strains of Ebola are transmissible without direct contact (I.e. airborne) at least in laboratory conditions.

http://www.nature.com/srep/2012/121115/srep00811/full/srep00811.html
 
...and the second domestic transmission of Ebola has occurred.

Alarming, to say the least.
 
She went to Akron to visit her fiance. How much does anyone want to bet against the fact that "bodily fluids" weren't exchanged during that visit?
 
And she got on an airplane after being told not to.
OK. Here comes the unbelievable part. She was told by federal health officials she can board that flight, because her fever was under the CDC definition of fever, 100.4. Let me repeat that: a quarantined person, under observation to rule out Ebola, was told by a US health official that not only can she board a commercial flight during quarantine, but she can do that while she was basically symptomatic. When you look up FUBAR, this is what will come up in the dictionary for the next 20 years.

I think we have reached a level of incompetence where the CDC needs new leadership.
 
Last edited by a moderator:
  • Like
Reactions: 2 users
CNN just said she was told NOT to board the flight.

Someone is either confused, or lying. If she was told NOT to go, why didn't the CDC call the FAA and ground the passenger, or if they had already left by the time the govt right and left hands got together, quarantine the flight in Dallas?

I think some poor, ignorant soul f'd up, just like on Duncan's initial presentation. No matter what, everyone is starting to look incompetent.
 
This is BS. If they were truly concerned these people would fly, why not put them on a federal Do Not Fly list?

This is extremely serious, regardless who f***ed up. The only way to defeat this disease is through quarantine, which means house arrest, period. If you leave the house, you get arrested and shackled to a hospital bed, or even sent to prison. What is so difficult?

One does not have a civil right to put others in harm's way.
 
Last edited by a moderator:
  • Like
Reactions: 1 users
Looks like telling healthcare facilities that hazmat suits were not needed was a crime.

Somehow the cleaning crews need hazmats to decontaminate empty apartments, but the nurses touching the source patient are fine with just a gown. Go figure!
 
  • Like
Reactions: 2 users
CNN just said she was told NOT to board the flight.

Someone is either confused, or lying. If she was told NOT to go, why didn't the CDC call the FAA and ground the passenger, or if they had already left by the time the govt right and left hands got together, quarantine the flight in Dallas?

I think some poor, ignorant soul f'd up, just like on Duncan's initial presentation. No matter what, everyone is starting to look incompetent.
It became clear late Wednesday night that Frieden was mistaken, and a CDC official confirmed the agency had actually cleared Vinson to fly. Dave Daigle, an CDC spokesman, told TIME that as officials widened the net of people who needed to be monitored, Vinson was in Ohio and the CDC told her to come back to Dallas. Her temperature was 99.5 degrees, Daigle said. “Most doctors would call that a slight temperature, not a fever,” he said. “At that point, she was asked by CDC to come back to Dallas so she could be monitored, and she came back.”

Addressing Frieden’s comments that Vinson “should not have flown,” Daigle said the threshold for a fever is 100.4 degrees. “We may end up lowering that threshold,” he said, “but under the current guidance, she was clear to fly.”
http://time.com/3510341/ebola-airplane/
 
CNN.com backtracked ten minutes ago to agree with the Time piece.

What in the actual #@#& are these hackers at CDC doing? It now reads that she told them my temp is elevated to 99.6 and they said get on a plane back to Dallas so we can check you? Really?

I'm just a dumb anesthesiologist like you guys. I don't do ivory tower (or Ivory Coast) ID. But to say hey, you may have Ebola, and you shouldn't have left Texas. But you did, so go down to the airport and take commercial aviation back to Texas.

It's like saying you may have rabies. Go to the bus station and bite everyone you see, on your way to the hospital.

Again, I'm not ID, but wouldn't it make more sense to tell her not to move, and we'll come to you, urgently?

This looks even more incompetent than I thought. :mad:
 
  • Like
Reactions: 1 users
Unbelievable she was cleared to fly. Just defies reason.
 
Anyone want to cast their vote of confidence for the CDC? How about for our remarkably estute(?) government?

This is what happens when politics get in the way of common sense.
 
  • Like
Reactions: 1 users
...and the second domestic transmission of Ebola has occurred.

Alarming, to say the least.
The world is overpopulated and nature has it's ways in self regulation. I do believe pandemics with high mortality rates will occur (my bet is on influenza) but 3 cases of infection of people in close contact with the virus is not surprising nor alarming. Now if your idea of containment is to put infected people on cross country flights, that is alarming.
 
Here in my mind is what needs to occur:

1) Here in the U.S., we need specialty response teams that consist of physicians, nurses, epidemiologists, and law enforcement to be part of an emergency response system to intervene when these cases pop up. You need to provide these people significant hazard pay for the work they do. These people should have advanced bio-containment training and should rapidly identify and work to quarantine all contacts with infected persons.

2) We should set up several specialty treatment centers (modeled after Emory and Nebraska) where equipment, expertise, and (most importantly) isolation of these patients can be undertaken. Who on earth would want to go to Presbyterian Hospital in Dallas right now for anything other than an immediately life threatening condition? This infrastructure should be beefed-up now for future such epidemics. Forget protocols and trying to train the over 2,600 hospitals in this country how to treat these patients. We've already learned that that's not gonna work - and I can tell you firsthand my hospital is not ready to do this. Diagnose them, isolate them, and then get them to a specialty center.

3) We need to ban all passengers from traveling from parts of Africa where the epidemic is currently out of control. We can and should send teams to those areas to help treat and contain the disease. The problem is that this is not PC nor seen as good ambassadorship with those countries. Tough cookies. This **** is serious. It's time to go into commando mode and get this **** under control.
 
  • Like
Reactions: 1 user
Great points. This should've happened from the get go, if not for some pencil pusher trying to make a name for themselves in accepting the pt and believing that it could be contained. One nurse breaking protocol and infecting herself is believable, but two means that more than likely there were flaws in their set up which they are now apologizing for...don't be a hero. Defer to those with the appropriate training/facilities.
 
The two nurses exposed to Duncan in Dallas, despite the PPE and knowing about the Ebola diagnosis, were ICU nurses, per Dallas hospital exec! Wow!
 
Top