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  • 2nd Ebola Case in Dallas Texas

    Posted by Trent Telenko on October 12th, 2014 (All posts by )

    One of the health care workers (HCW) that treated Thomas Eric Duncan on in Dallas during the period of 28th thru 30th of September has tested positive for Ebola after coming down with a fever Friday night. Heath care workers at Texas Health Presbyterian Hospital intubated and placed Duncan on dialysis as a part of his palliative treatment schedule. The HCW were in personal protective equipment (PPE) level two or “droplet level” protection at the time.

    It is notable that in the laboratory environment that Ebola is treated as a full bio-hazard level four or “inhalation” threat. Especially when you see circular thinking in public by CDC .


    “I think the fact that we don’t know of a breach in protocol is concerning because clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients.”

    The statement said the CDC had NO IDEA how the protocol was breached, but protocol must have been breached because there was a an infection.

    There was no mention as to why there was a two tier PPE protection level structure with widely different infection rates by routes other than Ebola virus injection accidents.

    There is a huge no confidence vote in the CDc coming. One that will take the form we are seeing in Spain — HCW no-shows for hospitals caring for Ebola outbreaks.

     

    54 Responses to “2nd Ebola Case in Dallas Texas”

    1. vxxc2014 Says:

      CDC is in Level A suits – positive pressure – their public protocols Level B. Level B is probably the most the rest of us can afford. Tyvek Suit, booties, hood, N95 mask, Goggles, gloves.

      A basic principle of leadership is to do what you say. DO Level A pressure suit while SAY Level B mask/gloves=FAIL.

      It has gone airborne briefly in the lab historically.

      http://www.scientificamerican.com/article/fact-or-fiction-the-ebola-virus-will-go-airborne/

    2. Trent Telenko Says:

      The following was posted on the PANDEMIC FLU INFORMATION FORUM (PFIF) by the site Administrator “Pixie.”

      It makes for scary reading as the CDC seems to have told Texas Health Presbyterian Hospital that they need not keep a list of health care workers who treated Duncan from his 28 Sept isolation to his death as long as all of their contact was in approved PPE-2.

      Neither the CDC nor Presby had a full list of Presby HCW as of the press conference this morning.

      Pixie comments are { inside these }

      See:

      http://www.singtomeohmuse.com/viewtopic.php?t=5725&postdays=0&postorder=asc&start=3405
      —–
      CDC press conference:

      Frieden:

      Confirmatory testing under way at CDC.

      We don’t know what occurred in the care of the index patient, but at some point there was a breach in protocol.

      The HCW developed symptoms on Friday. They were assessed Friday and tested yesterday.

      Test result came in 12 hours ago.

      The individual was self-monitoring and immediately upon developing symptoms contacted healthcare system. Came in and was immediately isolated.

      Symptoms and test suggest level of virus she had was low.

      1. Care for patient.

      2. Assess her contacts. Only one contact who may have had contact with her while she may have been infectious.

      3. Evaluating other HCW exposure. Possible other individuals were exposed. This individual did provide care to the index patient on multiple occasions. Had “extensive contact” with patient.

      4. Will undertake complete investigation as to how this may have occurred.

      Safe & effective care:

      Had already begun to ramp up the education and training of HCWs at this facility. “The care of Ebola can be done safely but it’s hard to do it safely. It requires meticulous and scrupulous attention to infection control.”

      {yes, blood just shot out of my eyes…}

      “And even a single inadvertent innocent slip can result in contamination.”

      {HCWs everywhere are now wondering why Ebola patients are not treated in highly specialized facilities by highly trained workers using the highest level of PPE….because in other words, one “slip” can be fatal.}

      “We are recommending to the facility that the number of health care workers who care for anyone expected of Ebola be kept to an absolute minimum.”

      We recommend that the procedures…be limited solely to essential procedures.

      “We are looking at personal protective equipment. Understanding that there is a balance and putting more on ($$$) isn’t always safer and may make it harder to provide effective care.”

      {Sure, that’s what the guys working in all the BSL-4 labs always sit around and say when they’re shooting the breeze over a beer, that less PPE would just be easier, and when they get back to the lab on Mondays, they suit up in full head-to-tow hazmat gear. Wink }

      Recommend one person be placed in charge of infection control while Ebola patient is being cared for. {This isn’t already being done?!?}

      CDC has sent additional staff to TX.

      We look at what happens before someone goes in, what happens in that space, what happens when they leave. Two areas looking at closely – kidney dialysis and respiratory intubation. Both of those procedures may spread contaminated materials and are considered high-risk procedures. They were undertaken on the index patients a desperate measure to try to save his life.

      {I’m sure that during congressional hearings looking into all of this that MSF doctors, in addition to Drs. Brantley and Saco, will testify that the hospital and CDC were INSANE if they were allowing any HCW to undertake such high-risk procedures while not in head-to-toe PPE, after having trained for such eventuality and having had knowledgeable assistance with its donning and doffing.}

      Two final points.

      We may see additional cases of Ebola. “This is because HCWs who cared for this individual may have had a breach of the same nature of the individual who appears now to have a preliminary positive test.”

      {And, right on schedule, Frieden throws the health care workers UNDER the bus!!! Note that there has been no investigation yet, and no conclusion from any investigation has been reached.}

      I can hear the swearing from Dallas all the way over here on the East Coast, and my bet is that a couple of big screen TV’s in the Dallas metro area just got broken by incoming high velocity objects.

      “The risk is in the 48 people who are being monitored, who have been tested daily — none of them have so far developed symptoms or fever — and in any other health care workers who may have been exposed to this index patient while he was being cared for. We are still determining how many health care workers that will be. Exclamation That is an intensive investigation it takes many hours.” Question

      {Again, this was not done already????}

      “We’ll always cast a net wider.” {um, apparently the “low-risk” meme caused your net to land short this time}

      There is no risk to people outside of that circle of the health care workers who cared for the individual patient and the individual 48 contacts who had definite or possible contact with the patient who we have already identified.

      What we do to stop Ebola is to break the links of transmission, to break the chains of transmission.

      {Well, your PPE guidance has allowed transmission.}

      Boilerplate.

      Dr. Lakey:

      Appreciates support from CDC.

      HCW had extensive contact with our initial patient. Had symptoms, came in to be checked. Test came back at 9:30 last night. It was positive. Amount of virus in blood less than that in index patient’s when he came in.

      Refining plans. 48 original contacts continue to be monitored.

      {Unbelievably, CDC took its own guidance so seriously that, because HCWs were using the recommended PPE, the folks having “extensive contact” with Duncan did not make it onto the “high-risk” monitoring list! Crikey!}

      ?: Why focusing on taking off of PPE?

      A: Frieden: We have spoken to HCW and she doesn’t know why.

      ?: Will this change the way HCWs interact with this patients? Wearing more?

      A: Very concerning. Need to enhance training. Protocols work. Even a single breach can result in infection.

      {Nope, no way he will ever admit his half-assed PPE guidance is what is at fault}

      ?: Besser, ABC: One slip can be so dangerous. Consideration of moving patients to specialized units where they are trained instead of hospitals where they do not have this training?

      A: We cannot let any hospital let its guard down. We do want hospitals to have the ability to rapidly consider diagnose Ebola. Anone who has been in three countries in past 21 days and has symptpoms…. “Safest way to provide that care, that’s something we’ll absolutely be looking at.”

      ?: CNN: Kind of extensive contact, what was the role of this person? Clarify monitoring process? She was self-monitoring?

      A: Lakey: 48 individuals get onsite visit and a fever check later in the day.
      “The HCWs where there was no breach in contact, we’re doing self monitoring.” {CDC hubris} “In light of this case we’re looking at the ongoing monitoring of all the HCWs and going forward having epidemiologists see them, a more active surveillance for these individuals.”

      ?: CNN: This woman was not in those 48 contacts, do you have a sense of how many others this extends to?

      A: Frieden: “This individual was not part of the 48 and defining what that new number is, we’re working on that pretty hard right now”

      {Shockingly unbelievable, even for me, that THEY DON’T EVEN HAVE A LIST OF THOSE HCWs WHO WERE TREATING DUNCAN HANDY!!! Absolutely unbelievable…Such damnable hubris!}

      ?: Grady, NY Times: What did you mean about limiting care to essential procedures? How do you limit procedures and not compromise care?

      A: Try to keep number of HCWs that enter area to minimum. We try to limit procedures to absolute minimum. So for example a blood draw…maybe it only needs to be done once a day instead of multiple times a day.

      ?: Betsy MacKay WSJ: Can you comment on preparedness of hospitals that have treated other Ebola patients who have come to U.S.? What does this say about preparedness generally, is this an outlier? Or are you concerned now about possible preparedness? And an infection control person should be monitoring – is that a recommendation for all hospitals?

      A: In Ebola treatment centers in Africa one of the things contributing to infection there is the lack of an onsite manager who doesn’t have any specific responsibilities other than overseeing and supervising to see that infection control is done correctly. We will ensure that that is being done in Texas at this particular hospital. Very important to distinguish physical layout from procedures and policies, training and staff work. Some special demands in place, an ante room for putting on PPE. Doesn’t spread through the air so doesn’t require some of the most intensive physical infection control procedures. “However, personnel training, supervision, followup, monitoring, it is very clear that the necessity of doing this right, 100% of the time, does require a very intensive training and monitoring process.”

      {So…logic then dictates that Ebola patients should be transferred to highly specialized units located in hospitals which have been specially prepared for this level of caution and care.}

      ?: “How frustrating is this for you after saying we are going to stop Ebola in its tracks to know that a breach of protocol was what caused this.” {wow!} Is it shaking your faith in hospitals around the country to adequately…and prepare their staff?

      A: It’s deeply concerning that this infection occurred. Thoughts are with HCW who became infected in the process of that care. “That doesn’t change the bottom line — we know how to break the chains of transmission. We need to ramp up the infection and control for any patients suspected as having or confirmed of having Ebola. And we need to do what we’ve been doing with contact tracing and monitoring.” She identified symptoms. She was isolated immediately. “It doesn’t change the bottom line. We know how Ebola spreads. We know how to stop it from spreading.”

      But it does reemphasize how meticulous we have to be in every single aspect of the control measures.”

      {Yes, more blood just shot out of my eyes…He did the little “meticulous” hand gesture while he was saying this.}

      A: Lakey: We have to be very careful, we need to closely look at the infection control practices as they are occurring in the hospital, to be meticulous {omg he’s Borg!} to make sure there are no breaches. Is it frustrating or disappointing? Of course it is. Our hearts go out… “The HCW who is infected, she’s going to have a rough time.”

      ?: When will screening begin at additional airports?

      A: Frieden: Began at JFK yesterday. Anticipate it starting on Thursday.

      ?: How a HCW using high precautions caught ebola while people in apartment for several days did not. Do you have plans to transfer patient to Nebraska?

      A: Patients with Ebola become progressively more infectious the sicker they become because the amount of virus in their body and in their secretions increases. The people who had contact with indue patient in Dallas are not yet out of their 21 day exposure period. We’re not out of the woods yet with potential additional cases among contacts who are in isolation. But medical procedures… dealing with things that may have large quantities of virus. And that’s why the PPE and the protocols are so important.

      ?: Clarify this HCW was not in initial group of 48. Varga said there were 19 hospital employees they were tracking. Is this person part of the 19? The hospital by its own track record has not provided the best information, they’ve had to do a lot of walk backs. The hospital this morning said there was low grade fever. Are there any other symptoms? Is there any other information we need to parse further given the hospital’s track record in not providing accurate information initially?

      A: The 48 contacts were individuals who had contact with patient up to Sept. 28 when he was isolated. From the 28th to October 8th, that’s a period of 10/11 days when there may have been additional contact given that this individual was clearly exposed then. Now we’re doing a new investigation given the diagnosis of anyone else who may have been exposed.

      Clinical information on patient showing only mild symptoms and low grade fever.

      ?: Why was she not, you’ve kind of gone around this, initially included in the 48 who were monitored?

      {The media doesn’t understand that CDC in its hubris has believed that any HCW using proper PPE while caring for an Ebola patient is at *NO* risk. They just need to read the CDC risk of exposure chart for clarification on that.}

      ?: When you were in Africa did you take special precautions that you normally wouldn’t have in putting on the protective equipment?

      A: We monitored all the contacts of the patient up to Sept. 28. We will now monitor all contacts who may have had exposure during the hospital stay.

      “In terms of precautions in Africa, yes they are very specific for personal protective equipment in terms of taking off and putting it on and what happens there.”

      A: Lakey: “The HCWs who were in full PPE during their involvement in the care of the initial individual were specified at minimal risk and those individuals had guidance to do self-monitoring but were not in that 48.”

      ?: How common is it for people to be on dialysis or to be intubated during an Ebola infection? Is that something you’ve seen in other patients being treated in other Western countries? How often have HCWs had to deal with that?

      A: Frieden: I don’t know the details of the patients cared for in other parts of the world but “I am not familiar with any other patient who has undergone either intubation or dialysis.”

      Of the 48 — that does include health care workers who had contact with the patient before he was isolated on the 28th, but doesn’t include anyone after Sept. 28th.

      {Because they were, according to your own CDC charts, at NO risk. This idiocy needs to change, and Frieden needs to resign.}

      Frieden now saying they will investigate how this happened, but he’s already come to his own verdict and he has voiced it.

      “Anxiety producing time.”

      {No, it’s you who is “anxiety producing,” Dr. Frieden, by undertaking a giant in vivo experiment in Dallas which has so far seen the death of your first patient and the infection of a health care worker.}
      _________________

    3. vxxc2014 Says:

      @Mr. Trelenko – understand we’re in France 1940 and that bad decisions are being made rather deliberately in our own best interests.

    4. vxxc2014 Says:

      We’re going to need a Rudy. Instead we voted in Obama.

      We’ll continue to elect Pimps holding welfare checks as long as women can vote. Yes, I said the truth.

    5. Robert Schwartz Says:

      The Gods of the Copybook Headings with terror and slaughter return!

    6. MikeK Says:

      The next event, as has happened in Africa, is the HCWs start calling in sick to avoid exposure. Hell, they call in sick to avoid Monday !

      Flu season is coming. How many cases before Obama stops incoming airline flights ?

    7. MikeK Says:

      The New York City left has the answer

      Shut Up !

      Several politicians, like Governor Bobby Jindal, of Louisiana, have turned the epidemic into fodder for their campaign to halt immigration. Jindal, and others, have suggested that we ought to simply close our borders to people coming from West Africa. That would only increase the isolation of countries that have already been devastated and make it harder to deliver essential aid there. As Bruce Aylward, the assistant director general of the W.H.O., has pointed out, travel bans make the world sicker, not safer.

      More brilliance at the link. I wonder if the writer is taking precautions.

    8. newrouter Says:

      the stupid kills

      > we ought to simply close our borders to people coming from West Africa. That would only increase the isolation of countries that have already been devastated and make it harder to deliver essential aid there.<

      thanks to this credentialed stupidity mr duncan was free to bring ebola to america. is west africa banning aid form the rest of the world?

    9. David Foster Says:

      Here’s something interesting: On Oct 2, Texas Health said, re the Ebola patient who was initially released when he shouldn’t have been: “we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows. The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician’s standard workflow. As result of this discovery, Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows.”

      And ONE DAY LATER, they said: “We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.”

      Pretty strange.

      I don’t know a lot about EHR systems, but it seems to me that “documented and available” could mean very different things depending on HOW the information is presented to the physicians or nurse or other individual who needs it….and I have to wonder how much serious human-factors work has been devoted to this and other EHR systems, both in their core design and their configuration for particular hospital, including specifically Texas Health Presbyterian Dallas. (I see that at Mt Sinai in NYC, the combination of “patient has high fever” and “patient recently was in Liberia” will trigger a yellow flashing alert .)

      See also this piece, which says “While some industry participants blame EHR workflow (for patient’s initial release), others suggest that a hospital culture in which physicians ignore nurse notes is to blame.” http://www.slate.com/blogs/future_tense/2014/10/04/ebola_case_reveals_flaws_in_the_new_electronic_health_record_systems_around.html

    10. newrouter Says:

      the stupid kills cont.

      >One commenter on a Huffington Post story about the second case of Ebola in the US argued that the president should begin the air travel ban with a quarantine of Texas.<

      Time Waits For No One

    11. MikeK Says:

      Nurses notes in the new world of hospital records are basically written by risk management and include pages and pages of crap intended to deflect lawyers. When I was in practice and later when I used to review charts for lawyers, I always read nurses notes first. For the last 20 years they have been useless. Kaiser has taken this to a high art. Their charts are pages and pages of patient instructions and nonsense about “You have been given instructions about what to do if… ” Many years ago, nurses notes were a separate section of the chart and included a lot of information about how the patient actually looked. Now, it is all together and sounds like lawyers wrote the whole thing. I’m not surprised if the facts were missed.

    12. Trent Telenko Says:

      The Ebola infected HCW at Texas Presby was a contract employee of the DISD system as a part time nurse.

      DISD robo-called Sunday Night stating that she has no children of her own and treated no children in the DISD system during the time of infection.

      Welcome to the new world of Ebola.

    13. David Foster Says:

      MikeK…surely the situation you describe will lead to litigation against both hospitals and EMR vendors…it should not be too difficult to demonstrate that excessively voluminous report, not organized in a priority-sensitive way, cannot be effectively used by actual human beings in a time-critical situation.

      The aviation analogy that comes to mind would be a system that mixes a stall warning and a pitot-tube icing warning in with messages about an engine oil change being needed in 15 more hours and a burner being out on the galley stove.

    14. Trent Telenko Says:

      Texas Health Presbyterian Hospital opened up for EMS arrivals for 1/2 hour and then shut down again.

      Either they found an area related to case #2 that needed decontamination, or they have another suspected Ebola case.

    15. Ginny Says:

      One of the doctors on Fox’s weekly show argued that the ban should be on those coming out. I’m not sure if it is necessary – the two doctor panel got into a heated argument. But it does make more sense than coming in to one country – especially when the screenings were limited to a small percentage of airports with international flights here.

    16. newrouter Says:

      and fu too

      Ebola Victim’s Nephew: “If He Were a Different Color He Probably Would Have Been Living Today” (Video)

    17. TMLutas Says:

      Travel ban? No. Post arrival quarantine? You bet. If you’re planning to travel to the ebola hotspot, plan on spending 21 days coming out of it under medical supervised isolation. You can do paperwork and telepresence for those three weeks.

      Swineburne and Hoffman islands need a 21st century updating.

    18. Thers Says:

      Surprised none of you dingalings has yet suggested nuking West Africa. Exterminate all the etc.

    19. ErisGuy Says:

      I approve of the Texas Quarantine. As a test, let the governor order the Guard to close the southern border to everything except goods. Since it’s quarantine, shoot anyone who violates. Add sworn vigilantes to help the Guard. After six months of testing, perhaps we can extend the closure to the internal borders.

      One step on the road to independence.

    20. ErisGuy Says:

      “Surprised none of you dingalings has yet suggested nuking West Africa”

      You’ve obviously confused CB with The New Republic, WaPo, and NYT: go there for jaw-dropping stupidity. And nukes wouldn’t work. War is politics by other means. It is not doctoring by other means.

      OTOH, I hear there might be an Ebola case in DC. A test of whether a nuke works might not be out-of-line, provided all important elected and appointed government officials reside in the DC during the test.

    21. ErisGuy Says:

      I agree about the terrible racism in America, Texas, and Dallas. All blacks should immediately vacate all three for Liberia. They’ll live in a racism-free paradise where everyone gets equal treatment for Ebola. Until then, STFU.

    22. ErisGuy Says:

      Is Texas Health Presbyterian closed?

    23. Trent Telenko Says:

      It appears that Texas Health Presbyterian Hospital is on “divert status” due to “personnel shortages.”

      IOW, the lack of proper PPE and PPE training has caused the health care workers not to show up and Presby can’t staff its emergency room as a result.

    24. Trent Telenko Says:

      Insurance companies are refusing to insure airlines in the knowing transport of Ebola patients, so the leading aeromedical evacuation companies are telling International Public Health Authorities “No Insurance, No Evacuations.”

      See:

      Ebola Tests Insurers’ Medical Evacuation Services As Airlines Cut Flights

      By Carolyn Cohn | October 13, 2014

      http://www.insurancejournal.com/news/international/2014/10/13/343322.htm?

      Two leading companies in the field – medical assistance company International SOS and insurance firm Allianz Worldwide Care – have recently said they will not provide medevac services for patients with Ebola symptoms.

      “International evacuation should not be considered as feasible for patients with active clinical symptoms of Ebola,” International SOS said in a statement on its website last updated on Thursday.

      “International evacuation of patients with Ebola or other viral haemorrhagic fevers is highly complex, and may not be achievable,” said the statement, which a spokesman said had first been issued some weeks ago.

    25. Mrs. Davis Says:

      We clearly need to learn more about how to fight Ebola. Unfortunately, the way to learn is by making mistakes. As we proceed down the learning curve we improve our performance. The numbers are small enough that the US will learn quickly enough to prevent an epidemic of ebola in the US from Africans.

      The Central Americans are the ones who haven’t the resources to travel down the learning curve quickly enough. Within weeks of the first case breaking out down south, an uncontrolled mass of sufferers will be at and across our porous southern border seeking treatment. Look at the so far more deadly in the US spread of the enterovirus aided by the Obama dispersion of illegal aliens across the US. That is why it was a mistake to treat patient zero in a hospital. He should have been put in a moon suit and sent back to Liberia where there was an outstanding warrant for lying on a government exit form.

      This is a world wide problem. Isn’t that what the UN is supposed to deal with? The nations with outbreaks should be quarantined. That’s what we have done with the families where an outbreak has occurred. A quarantine does not mean health care workers cannot treat patients, but it does mean that the disease will not spread beyond its current area of infection.

      This disease will spread because people are stupid and don’t follow the tried and tested protocols for dealing with infectious diseases. How stupid? Look at Dr. Nancy Snyderman, now under a State of New Jersey quarantine order after violating a voluntary quarantine. There can be no flexibility, no emotion, and no exceptions.

    26. Grurray Says:

      From physicist Yaneer Bar-Yam who has studied and written about infectious disease outbreaks:

      the case for a travel ban

      and

      the response strategy.

    27. Trent Telenko Says:

      Others are seeing what I am regards Texas Health Presbyterian Hospital’s emergency room staffing and the repercussions of the CDC’s handling of the first Ebola outbreak in Texas.

      From a HCW on the Free Republic forum —
      =========
      …The reason they don’t have staff is a severe case of the blue flu.

      Their staff is refusing to work.

      But.

      That information went down the memory whole.

      After the doc said no staff, so decontaminating while we’re down anyway…

      The media reported: closed for decontamination.

      They (the people that yanked the doc out of the press conf) don’t want you to know that they cannot provide adequate staffing during an outbreak.

      Every hospital. Every unit. Every clinic. Every medical office. Nationwide. They’re discussing this. People are drawing lines about what they will do if Ebola comes to their workplace.

      You’d be surprised what is being said. See. A primarily female work force with young children at home and spouse that also work is a workforce that has employment options. Maybe not all of them.

      But.

      As clearly seen in Dallas. Enough of them

    28. Grurray Says:

      I’m not so sure we’ll see healthcare workers abandoning their hospitals and clinics in droves. Initially, there is sure to be panic, but doctors and nurses have faced occupational risk before treating hepatitis, HIV, tuberculosis, and probably many more I’m not thinking of.
      I think the risk is the opposite happening – most will stay and face getting infected.

    29. MikeK Says:

      “doctors and nurses have faced occupational risk before treating hepatitis, HIV, tuberculosis, and probably many more I’m not thinking of.”

      The problem is that this is new and very ugly. Also politics has changed. We saw the first warning here in California with AIDS. I was still in practice running a trauma service. We were not allowed to test patients for HIV. California law, passed at the insistence of the same people suing wedding cake bakers, stated that an HIV test result COULD NOT BE SENT TO THE ORDERING DOCTOR. It could only be sent to the patient who was then at liberty to inform the treating doctor. Needless to say, many HIV tests went unreported but were done to protect staff members. Some trauma cases were awash in blood. I threw away underwear on occasion it was so blood soaked.

      Now, we something much worse and the politics are worse. There is little confidence in the health care system right now as it has been maneuvering to take advantage of Obamacare. Costs have been cut and staff reduced in the hospital where I used to practice. Last week it lost its Joint Commission accreditation for surgery, labor and delivery and cardiology. There is no mention of this in the local papers. Nurses and doctors know and don’t trust anything administrators say. Administrators are often fairly ignorant of the details of good care and high quality.

      I ran into this 20 years ago when I spent a year at Dartmouth to learn to measure quality and how to do quality improvement. I quickly learned that NO ONE was interested in quality. They all assumed it would be more expensive. All “Peer Review” since 1978 has been about cost not quality. The system is on shaky ground and nurses and doctors know it. The CDC is an arm of the Democratic Party, spending its swollen budget on such things as lesbian obesity research and guns in the home.

    30. vxxc2014 Says:

      “It is not doctoring by other means. ”

      HEH HEH HEH.

      Comrade. Citizen. How quaint.

      @NewRouter – it’s not stupid.

      It’s MALICE.

      Until you understand we are bore MALICE that prefers HARM be indirect for reasons of their own survival, the actions of our Masters are inexplicable.

      Stupid kills one, then is corrected.
      After that it’s something else.

      And at this point, it’s MALICE.

      It’s not Misguided, it’s MALICE.

    31. vxxc2014 Says:

      Whoever noticed the spin on the story, with the first story the truth after that massaged this is nothing new.

    32. MikeK Says:

      The CDC is going into full campaign mode with the allegation that they could have had a vaccine if those nasty Republicans hadn’t cut their budget

      Dr. Francis Collins, the head of the National Institutes of Health, said that a decade of stagnant spending has “slowed down” research on all items, including vaccinations for infectious diseases. As a result, he said, the international community has been left playing catch-up on a potentially avoidable humanitarian catastrophe.

      “NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here,'” Collins told The Huffington Post on Friday. “Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.”

      The “ten year slide” coincided with interest in guns in the home, lesbian obesity and other critical topics.

      Of course, their breach of security with Anthrax should not be taken as evidence of incompetence.

    33. Trent Telenko Says:

      It doesn’t matter what the Democrats say or don’t say.

      Reality is here.

      See:
      —————

      The Ebola Epidemic Is About to Get Worse. Much Worse.

      As in: We need to order 500 million vaccines. Now.

      By MICHAEL T. OSTERHOLM
      September 30, 2014
      http://www.politico.com/magazine/story/2014/09/the-ebola-epidemic-is-about-to-get-worse-111493.html

      Michael T. Osterholm is director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

      Ebola is spreading faster than anyone would like to admit, and the current, slow international response to the deadly disease is morphing into a modern tragedy. On Tuesday, the Centers for Disease Control and Prevention (CDC) in Atlanta confirmed the first case in the United States, in Dallas. If Ebola has already arrived on these shores, imagine how quickly it could be spreading in Africa.

      Ebola’s dispersion on the African continent must be stopped soon. But right now there exists no realistic scheme to do so: Plan A is failing, there is no real Plan B and the best chance for a magic bullet—Plan C—is at best many months away.

      Plan A—smothering the virus where it is currently an epidemic—hinges on having a sufficient number of Ebola treatment-center beds in African countries and necessary health-care providers for every Ebola virus disease (EVD) patient. In this ideal setting, each EVD patient is isolated and is no longer in a position to transmit the virus to family members or others in the community. Once patients are identified, public health workers begin to track down their contacts to ensure that if contacts become sick with EVD-like symptoms they are quickly provided a treatment-center bed, where they, in turn, can be isolated and the process repeats itself. This strategy has worked in containing every previous Ebola outbreak.

      But Plan A is clearly not good enough this time. The truth is that we are failing miserably at containing Ebola, despite daily pledges by governments and philanthropic organizations to provide more health-care workers and additional financial and logistical support. It’s also despite the heroic work of a limited number of national and international volunteer health-care workers and public health professionals who are risking their lives daily so that others may live and the epidemic can be stopped.

      Plan B—stopping any further spread—doesn’t exist, either for quickly stopping the transmission of the virus within Liberia, Sierra Leone and Guinea or for squelching it if it leaps to the slums of other large urban areas across Africa. Nigeria and Senegal, together with the CDC, succeeded in halting the virus’ spread after single introductions of the disease. If an infected person reaches a crowded area where health-care services are limited, however, it could spread exponentially.

      In the end, the only guaranteed solution to ending this Ebola crisis is to develop, manufacture and deliver an effective Ebola vaccine, potentially to most of the people in West Africa, and maybe even to most of the population of the African continent. This is Plan C, and it is still a long way off. While the U.S government has done more than other international players to support the possibility of developing an effective vaccine, current efforts still fall short of what is needed to implement an effective vaccination strategy.

      ***

      How bad is the Ebola epidemic? It’s bad, but the honest answer is we don’t know just how bad.

      So far, the reported number of deaths from Ebola in Africa is 3,044, and the World Health Organization believes the actual death toll could be three times that many. Just last week, the WHO estimated that as many as 20,000 EVD cases would likely occur in the three affected countries by early November. Meanwhile, the CDC projected a worse-case scenario of 1.4 million cases in Liberia and Sierra Leone by the middle of January unless effective interventions are implemented. These widely varying estimates by the world’s two leading public health agencies illustrate how little we know about the future course of this crisis, and demonstrate the need to scrutinize the statistical models used to estimate future case numbers. Any such estimates are only as good as the imprecise assumptions statisticians use to create the models. I don’t even try to predict the number of Ebola cases and deaths over the next few months except to conclude that there will be a lot of them—more than we should ever imagine.

      The optimists tell us the disease is under control. Bill Gates, whose foundation has donated $50 million to respond to the epidemic, said earlier this week, “There’s a pretty clear road map of what needs to be done. … What’s taking place now is quite impressive.” Tony Banbury, the WHO official who oversees the emergency operations center for the Ebola crisis, declared this past week, “The United Nations is moving at lightning speed to bring a response on the ground to meet the challenges posed by this terrible disease.”

      But this kind of rhetoric is not being translated into action, according to Joanne Liu, the international president of the NGO Doctors Without Borders. The promised surge of aid is still largely a promise, with beds and medicine in short supply. Liu said this week. “[E]verybody in their intentions is moving fast, but in the field we are moving at the speed of a turtle.” Tragically, every credible report from the front lines of the Ebola battle supports Liu’s more pessimistic assessment.

      Plan A continues to fail today for one simple reason. Donor countries and organizations are operating on “program or bureaucracy time,” while the epidemic is unfolding on “virus time.” Thirty days of planning to deliver on-the-ground support might be considered lightning speed to a foreign aid officer, but it is an eternity for a virus being transmitted by physical contact between many people living in intensely crowded conditions. Each day of delay is also another day of hell for newly infected Ebola patients and their exhausted health-care providers.

      Think of fighting a forest fire. Imagine waiting days before the necessary resources arrive; it means the blaze has expanded by the hour. And stopping a 100-acre fire is a lot different than containing a 100,000-acre fire. Every day the global response to Ebola falls far short in terms of treatment beds, health-care providers, public health workers and even adequate food and safe water is another day the epidemic grows substantially and becomes that much harder to contain. What might have been an adequate response last month now becomes much less effective.

      We’ve seen increased finger-pointing about who didn’t and still hasn’t provided critical leadership or necessary resources. This debate will play out for years to come. But no one individual or group of individuals is to blame; instead, almost everyone involved is. And, unfortunately, far too many leaders, organizations and agencies still don’t understand the concept of virus time or the desperate need for command and control leadership in the affected countries.

      Imagine if the only plan for Minneapolis to respond to a rapidly spreading fire were to call the New York City fire department for mutual aid. Leaders in both cities would speak proudly of the caravan of fire trucks and firefighters making their way westward. In the meantime, downtown Minneapolis would quickly become an inferno. That’s essentially the international response to the West African Ebola epidemic. World leaders have never prepared themselves or the global community for the public health actions necessary to combat this type of situation.

      Doctors Without Borders and other NGOs on the front lines tried to warn the public health community as early as March that this Ebola outbreak was very different and would require unprecedented response resources. No one listened then, and the virus continued to spread unfettered across the three countries. Once it got a foothold in crowded, poverty-stricken West African cities, it was like igniting gasoline.

      The U.S. government has in recent days taken a leadership role in responding to this international crisis. President Obama has urged a comprehensive, rapid response. His willingness to deploy military troops to support critical transportation, logistics and supply chain needs is an important step. (But again, the president’s promises of a month ago have been slow to become reality, and in many instances have not yet been acted upon.) CDC Director Dr. Tom Frieden has issued clear and compelling warnings over the last six weeks about the dire consequences of our ineffective response. CDC professionals are also providing valuable support in trying to track and stop new cases.

      But the international public health community had never seriously planned for a [color=darkred]“black swan[/color]” event such as this epidemic, so having an alternative to Plan A was never considered. You might call the recent quarantine restrictions employed by the governments of Liberia and Sierra Leone as an attempt at Plan B. But these measures have largely failed to control the disease’s spread, while they have been a humanitarian disaster.

      For the affected countries, sadly, it’s already too late for a Plan B. Regardless of whose case estimates you believe, those put forward by the WHO or the worst-case numbers put forward by the CDC, the number of cases in these countries will increase substantially in the coming months. Everything in my 40 years of experience as a public health official and infectious disease researcher tells me this virus has a high likelihood of spreading to other African countries. And unlike in Nigeria and Senegal, it might not be so easily contained this time. What is our plan to fight this Ebola war on multiple African fronts when we can’t handle the current battles in West Africa?

      We know how the disease will likely spread in the months ahead. Each year, thousands of young West African men and boys are part of a migratory work population not too dissimilar from U.S. migrant farm workers. Crop-friendly rains wash over West Africa from May to October, forming the growing season. These young men typically help with harvesting in their home villages from August to early October, but afterward head off for temporary jobs in artisanal gold mines in Burkina Faso, Mali, Niger and Ghana; cocoa nut and palm oil plantations in Ghana and Cote d’Ivoire; palm date harvesting and fishing in Mauritania and Senegal; and illicit charcoal production in Senegal, Mali, Cote d’Ivoire, Ghana, Burkina Faso and Niger.

      This migration is about to begin, even for young men whose villages have been recently hit by EVD. These workers find daily laborer jobs at $5 per day, half of which they remit to their families back home. Like their ancestors before them, they use little-known routes and layovers through forests to avoid frontier checkpoints. They usually have ECOWAS ID cards, providing free passage to all the member states of the Economic Community of West Africa States. It takes one to three days to travel from the EVD-affected countries to these work destinations. There is no need for Ebola to hop a ride on an airplane to move across Africa: It can travel by foot.

      Densely populated African cities such as Dakar, Abidjan, Lagos and Kinshasa—teeming with jam-packed slums as far as the eye can see—could be most at risk. This is the nightmare scenario. It is all too real, and yet no international, coordinated plan exists for how to respond to what would likely be an even more catastrophic event. Ask the world’s intelligence and security experts what an Ebola epidemic unleashed on Africa’s megacities could mean for the continent’s stability. We need a Plan B, or hundreds of thousands of people may die.

      And what of Plan C? The use of effective, safe vaccines has been a foundation of modern public health. We even eradicated one of the Lion Kings of infectious disease—smallpox—with an effective vaccine. Unfortunately, not all infectious agents can be relegated to the history books through vaccination. We are still searching for effective and safe vaccines for diseases such as AIDS, malaria and TB. But I feel certain that a safe and effective Ebola vaccine is on it way.

      Will it come soon enough? On virus time? And on the scale that the disease demands? Only a month ago, the primary discussion around developing, approving, manufacturing and distributing an effective and safe Ebola vaccine was to protect a few thousand health-care workers and prevent the few remaining community-acquired Ebola cases that continued to occur. But it’s now a different ballgame. This epidemic could grow much, much larger and become what we call an endemic disease—one that doesn’t go away. Science recently published two must-read articles, by Jon Cohen and Kai Kupferschmidt, about the grim reality of trying to find and produce an effective vaccine: Their conclusion was that government bureaucracy, a lack of adequate funding and battles between government and private-sector companies have prevented progress.

      The first critical mistake public-health officials often make amid such outbreaks is failing to consider another black-swan scenario. At the moment, they are focused only on meeting the vaccine need in the three affected countries. If this virus makes it to the slums of other cities, the epidemic to date will just be an opening chapter. Africa contains more than a billion people, and is growing faster than anywhere else in the world. If world leaders don’t make it a priority now to secure up to 500 million doses of an effective Ebola virus vaccine, we may live to regret our inaction. It’s that serious.

      Securing 500 million doses of an effective Ebola virus vaccine is going to require a partnership between government and vaccine manufacturers that puts it on the same footing as our response to an emerging global influenza pandemic. This will require mobilizing people and resources on a massive scale—it has to be the international community’s top priority.

      In the words of Sir Winston Churchill, “It’s no use saying, ‘We’re doing our best.’ You have got to succeed in doing what is necessary.” It’s time to do what is necessary to stop Ebola. Now.

    34. MikeK Says:

      ” Meanwhile, the CDC projected a worse-case scenario of 1.4 million cases in Liberia and Sierra Leone by the middle of January unless effective interventions are implemented.”

      This is only a “worst case scenario” at CDC. The German Tropical Medicine Institute estimates that west Africa is lost.

      The estimates I have seen are 1.4 million deaths by early 2015. That will set off a huge panic.

      What will happen if we see a dozen cases here? The Democrats are already trying to blame budget cuts by Republicans (Who have not been in power since 2006).

    35. Grurray Says:

      Last week the Washington Post showed this simulation comparing Ebola’s spread to other diseases.

      As stated before, it spreads slowly, but it’s deadlier than Smallpox. While smallpox and measles seems to reach a tipping point where more deaths result after a certain number contract it, Ebola’s death rate is fairly uniform.

      If we wait until it really takes hold before an all out mobilization effort, such as the 1947 smallpox campaign, many people will still die.

    36. Grurray Says:

      “The problem is that this is new and very ugly. Also politics has changed.”

      You are an expert and vastly more informed about this issue, but I’m still not sure about this. I know an ER doctor who was pricked by a needle he was injecting into an HIV patient. After a period of frantic concern amongst his friends and family, when he was cleared he went right back to work.
      This is obviously a very small anecdotal sample of one person, but I’ve also met others who would move heaven and earth to save people.
      It’s also possible I’ve only known and seen outliers from good upbringing, communities, and hospitals. My first inclination actually is a hope that they would all run far away from this Ebola mess.

    37. MikeK Says:

      “This is obviously a very small anecdotal sample of one person, but I’ve also met others who would move heaven and earth to save people.”

      I went back to caring for AIDS patents and my partner cut himself on one. This was before the reverse transcriptase inhibitors and the other retrovirals that have kept Magic Johnson alive. My point is that this disease is even worse and the politics have changed. The CDC, for example, is blaming the poor nurse. There is a lot more cynicism among medical and nursing people today. AIDS was not airborne and the transmission was pretty well understood. The CDC is lying when it says it knows how Ebola is spread and everyone knows it.

    38. Trent Telenko Says:

      This is from the PANDEMIC FLU INFORMATION FORUM.

      Clip and send this to as many medical care workers as you can.

      =========
      PPE procedure as used by Ebola workers in the field, step by step.

      Pixie’s post from earlier article

      http://www.singtomeohmuse.com/viewtopic.php?t=5725&postdays=0&postorder=asc&start=3465
      T

      We need to synchronise putting the PPE on with other team members, because if one is slower than the rest we end up waiting and baking in the sun. We have a dresser to make sure we are completely covered, or we work in pairs and check each other.

      First on are gloves and a jumpsuit. Then a second pair of gloves, a thick duckbill mask, a hood, and an apron that is tied by the dresser so we can untie it with one pull. Then on go the goggles with a generous drizzle of antifogging spray, a final check in the mirror and a final check with each other.

      The checking does not stop there, as we must ensure during our time in the high-risk area that we are still covered, that a mask has not slipped, or that a piece of skin has not been exposed. If that happens, we leave the area immediately.

      A minimum of five minutes is needed to undress. We have two tents, where the undressers and sprayers need to be on the ball. The urge to just pull the suit off is strong, but we wait. First, the chlorine spray to the hands. Then, feet apart, arms in the air, we are sprayed from head to toe, first the front, then the back. We wash our hands in 0.5% chlorine. Off come the first set of gloves.

      We wash our hands again. Off comes the apron and hopefully it was tied perfectly, as we have to blindly reach around to release the knot; we pull it over our heads. Into the chlorine soak it goes. We wash our hands.

      Next go the goggles. We bend over, close our eyes and gently remove them, dunk them three times in the strong chlorine-filled bucket, and then place them in water. We wash our hands.

      The hood comes off next. Once again, we bend over, closing our eyes to avoid contamination and dispose of the hood in the garbage. We wash our hands.

      Next, the removal of our heavy PPE. Moving slowly – we do everything slowly here – we carefully expose the zipper, hidden under a taped-down flap. We wash our hands. Blindly, we have to find the zipper, as our undressers and sprayers guide us. We wash our hands.

      As we shimmy out of our PPE, we are soaked to the bone in sweat, but it feels great. This is the hardest part: to ease off the jumpsuit while kicking your legs back, at the same time standing on it so it doesn’t fly away from you. It’s a balancing act. The sprayer sprays the entire jumpsuit with a stronger chlorine solution and we put it in the garbage. We wash our hands.

      Our heavy-duty filtration mask is next. I close my eyes and hope it doesn’t catch in my ponytail. We wash our hands.

      The last pair of gloves comes off. Our boots are sprayed from all angles and we have to balance on one foot to cross the line from high risk to low risk. We wash our hands and we are done, stripped down to our scrubs, soaked with sweat.
      ====
      Pixie’s comment: Just like the PPE and infection control procedures they are using in Dallas, right Dr. Frieden?

      My Comment: The CDC’s Col Blimp (Dr. Frieden) can’t comment due to pending criminal negligence litigation.

    39. TimL Says:

      Radio show on Ebola including Dr. Fauci. If ever there were people in denial, this is it. It’s small wonder we’re in this predicament.

      http://thedianerehmshow.org/topic/science

    40. Trent Telenko Says:

      There are a lot more ways Ebola can become more contagious than becoming airborne.

      One of the experts says this strain has a much higher viral load in humans much earlier.

      =======
      A top scientist worries that Ebola has mutated to become more contagious

      Updated by Julia Belluz on October 13, 2014, 9:00 a.m. ET @juliaoftoronto julia.belluz@voxmedia.com

      http://www.vox.com/2014/10/13/6959087/ebola-outbreak-virus-mutated-airborne

      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.

      We spoke last week about his work studying the disease, how this Ebola virus may be more dangerous than others, and what that means for the epidemic. What follows is a transcript of our conversation, lightly edited for clarity and length.

      Julia Belluz: What concerns you most about the virus circulating now?

      Peter Jahrling: I want to know if this virus is intrinsically different from the one we have seen before, if it is a more virulent strain. We are using tests now that weren’t using in the past, but there seems to be a belief that the virus load is higher in these patients [today] than what we have seen before. If true, that’s a very different bug.

      One of the studies we’re going to do here is to test the virulence of this new strain in experimentally infected primates and compare it with the reference strain, and look at whether it is hotter, extrapolating from monkeys to people. It may be that the virus burns hotter and quicker [meaning it’s more contagious and easily spread].

      JB: Yet everyone is worried about Ebola going airborne…

      PJ: You’re seeing all these patients getting infected, so people think there must be aerosol spread. Certainly, it’s very clear that people who are in close contact with patients are getting a very high incidence of disease and not all of that can be explained by preparation of bodies for burial and all the standard stuff. But if you are to assume that the differences in virus load detected in the blood are reflected by differences in virus load spread by body secretions, then maybe it’s a simple quantitative difference. There’s just more virus.

      JB: A higher viral load means this Ebola virus can spread faster and further?

      PJ: Yes. I have a field team in Monrovia. They are running [tests]. They are telling me that viral loads are coming up very quickly and really high, higher than they are used to seeing. It turns out that in limited studies with the evacuated patients, they continued to express virus in blood and semen. What does that mean? Right now, we just don’t know.

      JB: Can you entertain the air-borne hypothesis. Do you think it’s plausible?

      PJ: You can argue that any time the virus replicates it’s going to mutate. So there is a potential for the thing to acquire an aerogenic property but that would have to be a dramatic change. When scientists have done studies, playing with influenza strains to make them more virulent, when they increase the aerosol potential of a flu strain, they also reduce its virulence. So when you start messing with viruses, you usually make them less virulent.

      JB: There have been worries that Ebola can become a pandemic like HIV and spread around the world. Even Tom Frieden, director of the Centers for Disease Control and Prevention, was recently saying as much. Your thoughts?

      PJ: The mode of transmission is different between the two viruses. Ebola causes an acute infection which you either die from or you’re immune, you don’t carry the virus for long periods of time. Whereas with AIDS, a lot of people transmitting AIDS didn’t know they have it. Before we had a triple cocktail therapy, AIDS was lethal with the exception of a few people who were not susceptible. Long term AIDS was hotter than Ebola. My gut feeling is that Ebola is going to burn out in human populations.

      JB: Why are you optimistic about this epidemic burning out?

      PJ: In this epidemic, it would appear that there have been multiple introductions [of the virus from animals to humans]. It’s not all person to person transmission. It’s coming from animals again and again. [This means people need to be near potential animal hosts — believed to be fruit bats endemic to Africa — to get the virus.] Now there are all these different strains. That could also mean the virus is more mutable. We can’t yet say. I think it’s unlikely that this thing is going to perpetuate in humans.

    41. Grurray Says:

      “My point is that this disease is even worse and the politics have changed. The CDC, for example, is blaming the poor nurse.”

      Absolutely disgraceful.

      Her treatment with the convalescent serum was interesting.
      I’ve been seeing a lot of stories about non-traditional blood transfusion therapies for chronic conditions, inflammation, autoimmune diseases, and even for aging.

    42. MikeK Says:

      THe convalescent serum is the same principle as horse serum for tetanus.

    43. MikeK Says:

      Well, we are getting an update on the struggle. The struggle to control Ebola ? No, the struggle to control the narrative.

      The Obama administration is battling for control of the media narrative about Ebola as conditions worsen in West Africa and fears of an outbreak mount in the United States.

      Health officials insist the virus will be contained and stress the potential for infection is remote. While Ebola is frightening, says Centers for Disease Control and Prevention (CDC) Director Tom Frieden, health officials “know how to stop it.”

      But those assurances are falling flat amid wall-to-wall coverage of the virus on cable networks and growing calls for a ban on air travel to parts of West Africa where the virus is spreading.

      “Ebola is scary. And we understand that people are very concerned. And we’re very concerned,” Frieden said Sunday.

      It can be difficult to gauge the administration’s sense of the Ebola threat, as the language from leaders has shifted at times depending on their audience.
      Frieden this week warned world leaders that Ebola could be “the world’s next AIDS” as he sought to drum up more international funding for the response effort.

      “I’ve been working in public health for 30 years,” Frieden told a World Bank and International Monetary Fund meeting in Washington, D.C.

      “The only thing like this has been AIDS. And we have to work now so that this is not the world’s next AIDS,” Frieden said.

      The remarks — his most urgent to date — came just days after the CDC director touted “encouraging” signs of progress against Ebola during a more upbeat appearance on CBS.

      Not to worry. If there is one thing this administration and its bureaucracies know how to do, it is controlling the “narrative.”

    44. ErisGuy Says:

      “The Ebola Epidemic Is About to Get Worse. Much Worse.”

      Well, that’s cheerful. I live about thirty minutes from THP.

    45. ErisGuy Says:

      “The CDC, for example, is blaming the poor nurse.”

      I hope that a compassionate and humane society, that is, not our feminist-socialist society, would act differently. I don’t think I’ll live to see that society.

      I wonder whose breach in protocol (if there was one) lead to Pham’s infection. It’s wrong to assume the breach was hers. Perhaps someone else left contaminated items about.

    46. MikeK Says:

      I haven’t studied the details but I’ll bet this was airborne and the protocol did not include those risks. This may provide a clue.

      While I agree that we have the knowledge, experience, and resources to be able to control Ebola, most of the experts are academicians or practice in relatively well-heeled ivory towers. I have practiced Infectious Diseases and Infection Control for 30+ years, primarily in a number of community hospitals, and offer a different perspective here, based on these experiences.

      Administrators vs. Practitioners

      Increasingly, decision makers are administrators who are disconnected from the realities of patient care. The latest fad, for example is to design hospitals to look like hotels and be “inviting” to patients, although they are very dysfunctional for delivering patient care, especially problematic in ICUs.

      Also this

      First, the Emergency Room failed to take an adequate history, or to relay important information from the triage nurse to the physician—who is ultimately at fault for not having taken his own history, especially when presented with an accented foreign patient and after warnings about Ebola.

      The Texas Health Presbyterian Hospital in Dallas next blamed the error on their electronic medical record system (EMR). This is entirely plausible, as the many brands of EMR I am familiar with are seemingly designed to maximize billing and minimize liability, by giving the illusion of comprehensiveness. They are, however, extraordinarily poor for patient care, as they are so cluttered with needless, clinically irrelevant detail. Though not at fault in this case, some Emergency Room EMRs are not readily accessible to the hospital inpatient units or clinics.

      I have mentioned this before. The Obama administration is forcing physicians to adopt poorly design EMRs at the risk of loss of revenue by Medicare. They seem to be written by risk managers, not clinicians.

    47. Trent Telenko Says:

      When it comes to the Ebola fomite threat — Ebola inside human liquids — keep the following facts in mind from this NY Times article dated 13 Oct 2014

      Questions Rise on Preparations at Hospitals to Deal With Ebola
      By DENISE GRADY OCT. 13, 2014

      http://www.nytimes.com/2014/10/14/us/questions-rise-on-preparations-at-hospitals-to-deal-with-ebola.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=0

      >>The researchers at Emory tested patients and found high levels of the virus in their body fluids and even on their skin.

      And the following broken out from a single paragraph —

      >>At the peak of illness, an Ebola patient can have 10 billion viral particles in one-fifth of a teaspoon of blood.

      >>That compares with 50,000 to 100,000 particles in an untreated H.I.V. patient,

      >>and five million to 20 million in someone with untreated hepatitis C.

    48. Trent Telenko Says:

      Pixie at PFIF says it all about the cult-like, ignore the reality in front of his face, leadership of Dr Frieden as director at CDC —

      ——————————————————————

      From Frieden’s press conference, Pixie’s notes above:

      Quote:
      >>A: We did send a team. Sent epidemiologists, contact tracers. We did send some expertise in infection control. We
      >>could have sent a more robust hospital infection control team and been more robust. Ebola is unfamiliar. Getting
      >>it right is important. Hospitals may think using additional layers of equipment could make things more unsafe…

      Is he referring to using Level 4 PPE instead of Level 2, or something else? Anyone know?
      ——–

      Yes, Frieden is intimating that having the unwashed rank & file utilize BSL-4 PPE for a BSL-4 pathogen might somehow put them more at risk.

      (You know, he does start to sound more like Margaret Chan every day…).

      Present in Frieden’s assumption is obviously his concept that the rank & file HCWs are too stupid to learn how to do this correctly. Thus, he suggests the more familiar — though of course not as protective — BSL-2 PPE be used when HCWs are caring for a patient with the BSL-4 level pathogen, Ebola.

      Frieden doesn’t want BSL-4 PPE used while treating Ebola patients in a multitude of American community hospitals because:

      1. The cost in dollar terms would be far higher for BSL-4 PPE than it would be for BSL-2 PPE. If you’re going to keep the borders open to all comers, as Frieden insists on doing, then many U.S. hospitals will at some point be caring for Ebola patients and if BSL-4 PPE is required, that will be expensive.

      Of course, that whole conversation is something of a red herring because EVERYTHING about treating an Ebola patient in a local American community hospital is extraordinarily expensive. Most of these hospitals likely cannot afford it, and the BSL-4 level PPE is just the beginning of it.

      2. Frieden believes that U.S. HCWs are not capable of learning how to properly don & doff BSL-4 PPE. Remember, it’s mostly highly trained doctors and nurses which MSF allows into their treatment facilities in the affected countries. Not everyone qualifies. These HCWs are highly skilled, highly trained, and substantial previous experience working in similar surroundings is required by MSF before the HCWs are allowed to work for MSF in an ETU.

      The workers we see wearing the BSL-4 PPE in Africa are, in Frieden’s view, I am certain, very different animals from the average community HCWs here in the States. In his mind, our rank & file HCWs probably are not capable of learning how to use this highly technical equipment. So, like young children who are handed snub-nosed scissors instead of the real thing, Frieden hands our HCWs BSL-2 PPE rather than the required BSL-4 PPE. Frieden’s a damned elitist. His actions on this square with his wider philosophy. And, like all elitists, what is good for him is not necessarily good for the hoi polloi. While in West Africa Frieden used BSL-4 PPE, make no mistake about that. He is also fine with the “experts” at places like Emory and Nebraska using BSL-4 PPE. They’re “experts,” after all. Not part of the great unwashed. I believe that Frieden thinks, really this, that the average HCW in America is incapable of learning how to use BSL-4 PPE. And yet, he is ready to have legions of these HCWs take care of Ebola patients. (Yes, Frieden wants to have it both ways).

      Dr Frieden’s forced resignation as head of the CDC can’t come too soon.

    49. Trent Telenko Says:

      >Double Face Palm<

      —-

      Nurses at Texas hospital: ‘There were no protocols’ about Ebola

      http://fox8.com/2014/10/14/nurses-at-texas-hospital-there-were-no-protocols-about-ebola/

      OCTOBER 14, 2014

      “The guidelines were constantly changing” and “there were no protocols” at Texas Health Presbyterian Hospital Dallas as the hospital treated a patient with Ebola, the president of National Nurses United told reporters Tuesday.

      Protective gear nurses wore at first left their necks exposed, union co-president Deborah Burger said, citing information she said came from nurses at the hospital.

      Union officials declined to specify how many nurses they had spoken with. They said they would not identify the nurses or elaborate on how the nurses learned of the details they are alleging in order to protect them from possible retaliation. The nurses at the hospital are not members of a union, officials said.

      In response to the allegations, a spokesman said patient and employee safety is the hospital’s top priority.

      “We take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting,” hospital spokesman Wendell Watson said. “Our nursing staff is committed to providing quality, compassionate (care), as we have always known, and as the world has seen firsthand in recent days. We will continue to review and respond to any concerns raised by our nurses and all employees.”

      Here are some of the other allegations the nurses made, according to the union:

      – On the day that Thomas Eric Duncan was admitted to the hospital, he was “left for several hours, not in isolation, in an area where other patients were present.” Up to seven other patients were present in that area, the nurses said, according to the union.

      – A nursing supervisor faced resistance from hospital authorities when the supervisor demanded that Duncan be moved to an isolation unit, the nurses said, according to the union.

      – After expressing concerns that their necks were exposed even as they wore protective gear, the nurses were told to wrap their necks with medical tape, the union says. “They were told to use medical tape and had to use four to five pieces of medical tape wound around their neck. The nurses have expressed a lot of concern about how difficult it is to remove the tape from their neck,” Burger said.

      – “Nurses have substantial concern that these conditions may lead to infection of other nurses and patients,” Burger said.

      – At one point during Duncan’s care, “there was no one to pick up hazardous waste as it piled to the ceiling.”

      – “In the end the nurses strongly feel unsupported, unprepared, lied to and deserted,” Burger said.

    50. MikeK Says:

      Médecins Sans Frontières is being devastated by Ebola cases with 16 infected and 9 dead.

      They were the experts in protocols.

    51. Exasperated Says:

      Wow, a second case of ebola in a Texas HCW, clearly magical thinking doesn’t pan out. Despite being scolded and schooled by our betters, shouldn’t we all have learned that “nature will out” from the movie “Jurassic Park”? Nature defies, defeats, and eats “hubris” for breakfast. Wasn’t that the moral of the story?

    52. Joe Wooten Says:

      Torches.Pitchforks.Tar.Feathers.

      I think it may be time folks.

    53. Death 6 Says:

      “I close my eyes and hope it doesn’t catch in my ponytail.”

      Absurd. Cut your pony tail off. You need to be absolutely certain you can get your gear on and off flawlessly as well as operate in protection. Anything that reduces those operations or effectiveness of your protective gear must go, such as long hair, nails, jewelry, etc. Guys lose the facial hair. The masks have to seal.

      Mike

    54. MikeK Says:

      “Anything that reduces those operations or effectiveness of your protective gear must go, such as long hair”

      I am astonished at the number of female medical students and medical residents who have long hair. I haven’t seen one with the hairstyles of the 50s and 60s. I still remember Audrey Hepburn getting her hair cut in Holiday in Rome. Not today.

      Women instructors are far more harsh at criticizing breaks in technique by female students doing exams. If they touch their hair some instructors will fail them.