Health Care

2nd Ebola Case in Dallas Texas

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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.

Treatment of the Ebola contact.

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The early information of the Ebola patients in Dallas seems to suggest that competence has not been high on the list of priorities. First, the patent seems to have known about his illness before he got on the plane to the US. He lied to the authorities in Liberia but that is not that unusual. All it takes is ibuprofen to evade the screening at the airport.

Second the treatment of the relatives Has finally become humane after days of cruel treatment including quarantine in a contaminated apartment.

The initial treatment was not a model of infectious disease protocol. Why he was sent home with a GI illness and a history of travel to Liberia is still not explained. My medical students are all told to take a history of travel with any GI illness symptom. It’s not clear who he saw but many ERs use Nurse practitioners or PAs to see ER patients.

He is not doing well and he seems to be declining. We will see how he does but his relatives are still in serious trouble. We are still in trouble.

The promised treatment program is still inadequate. Tomorrow will bring more bad news.

A CDC official said the agency realized that many hospitals remain confused and unsure about how they are supposed to react when a suspected patient shows up. The agency sent additional guidance to health-care facilities around the country this week, just as it has numerous times in recent months, on everything from training personnel to spot the symptoms of Ebola to using protective gear.

This is only the first case.

UPDATE: More news from Bookworm.

Ebola can transmit through people’s skin. It’s not enough to keep your hands away from your nose and mouth. If someone’s infected blood, vomit, fecal matter, semen, spit, or sweat just touches you, you can become infected. Even picking up a stained sheet can pass the infection. Additionally, scientists do not know how long the virus will survive on a surface once it’s become dehydrated. The current guess is that Ebola, unlike other viruses, can survive for quite a while away from its original host.

Oh oh. This explains the infection of hospital workers in Nigeria from urine.

The good news, if any, is this:

If patients get Western medicine that treats the symptoms — drugs to reduce fever and to control vomiting and diarrhea, proper treatment if the body goes into shock, and blood transfusions — the mortality rate is “only” 25% — which is still high, but is significantly lower than the 70%-90% morality in Africa, where patients get little to no treatment.

I will update this as news becomes available.

UPDATE #2

Now we have a possible case #2

A patient with Ebola-like symptoms is being treated at Howard University Hospital in Washington, D.C., a hospital spokesperson confirmed late Friday morning.

The patient had traveled to Nigeria recently.

That person has been admitted to the hospital in stable condition, and is being isolated. The medical team is working with the CDC and other authorities to monitor the patient’s condition.

“In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient,” said hospital spokesperson Kerry-Ann Hamilton in a statement. “Our medical team continues to evaluate and monitor progress in close collaboration with the CDC and the Department of Health.”

No final word yet. Then, of course, we have the NBC case.

Thursday, news broke that a freelance NBC cameraman covering the outbreak in Monrovia, Liberia had tested positive for Ebola after experiencing symptoms of the disease.

The cameraman, Ashoka Mukpo, had been working with chief medical correspondent Dr. Nancy Snyderman. NBC News is flying Mukpo and the entire team back to the U.S. so Mukpo can be treated and the team can be quarantined for 21 days.

Ebola Case Has Been Confirmed in Dallas, Texas

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A patient who has recently traveled to West Africa at Texas Health Presbyterian Hospital of Dallas has a confirmed case of Ebola. There will be a CDC conference this evening with local Dallas officials.

See:

KERA News @keranews 57m 57 minutes ago Dallas patient tested for possible #Ebola.
“We want to caution Dallas County residents not to overreact.”
http://bit.ly/1rDjBEM @keranews

As my children go to a pediatric clinic across the street from Texas Health Presbyterian Hospital of Dallas, this hits close to home.

The CDC’s “Risk communications” have gone to DefCon-1. The Dallas County Health and Human Services director Zachary Thompson has been on local media this morning with the following message:

“This is not Africa,” DCHHS Director Zach Thompson said. “We have a great public health infrastructure to deal with this type of disease.”

Notably missing was any mention of the Ebola fomite threat (AKA human body fluids with Ebola in them) in an urban environment.

I will try and keep you up to date on the latest local Dallas CDC “Ebola Risk Messaging.” Don’t expect the MSM to be of any use during this outbreak. You need to start reading the PANDEMIC FLU INFORMATION FORUM and the Free Republic EBOLA SURVEILLANCE THREAD for the latest real Ebola news updates, as opposed to MSM delivered “Risk Messaging.”

See:

http://www.singtomeohmuse.com/viewtopic.php?t=5725&postdays=0&postorder=asc&start=2655

and see

http://www.freerepublic.com/focus/chat/3191066/posts?q=1&;page=1#1

Wish all the folks in Dallas good luck. We are going to need it in the days ahead.

Is Ebola airborne ?

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Ebola has become an uncontrolled epidemic in Africa. I have previously posted on Ebola.

UPDATE: A new CDC report has now been provided on precautions. Somebody is worried. The document, itself, is here (pdf)

Now, we are going to send 3,000 military personnel to Africa to help. I sure hope none of these US people are infected. They did not volunteer for this and the training to protect themselves will take time.

Now the German epidemiology community has concluded that Liberia and Sierra Leone are lost.

Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.

“The right time to get this epidemic under control in these countries has been missed,” he said. That time was May and June. “Now it will be much more difficult.”
Schmidt-Chanasit expects the virus will “become endemic” in this part of the world, if no massive assistence arrives.

With other words: It could more or less infect everybody and many people could die.

This, of course, is from a German site and our own CDC is unwilling to say it.

For Sierra Leone and Liberia, though, he thinks “it is very difficult to bring enough help there to get a grip on the epidemic.”

According to the virologist, the most important thing to do now is to prevent the virus from spreading to other countries, “and to help where it is still possible, in Nigeria and Senegal for example.”

Of course, it is already in Nigeria.

In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.

And: This may be a new strain with more virulence.

The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.

Now, we have more news. From 2012, we know transmission in animals may be airborne.

While primates develop systemic infection associated with immune dysregulation resulting in severe hemorrhagic fever, the EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11. The present study was design to evaluate EBOV transmission from experimentally infected piglets to NHPs without direct contact.

The study of this potential explosive development showed:

The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting. Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.

Now we have more articles appearing about this.

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

If the New York Times is publishing this, somebody is worried.

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The revolution we need might be starting in Britain.

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A “Seismic Shock is coming to the British political system.

Douglas Carswell, a prominent Conservative MP has announced he is switching to UKIP. a new political party that has been attacked as “racist” and has been attracting a larger constituency from the British traditional voters.

A new political party has appeared in Britain called UK Independent Party. It has been called racist and a number of other things that might sound familiar to Tea Party members here.

For example:

News reports about the rising primary school population in England fail to mention the ‘elephant in the room’, said MEP Paul Nuttall.

“It is accepted that primary schools have increasing numbers of pupils, which causes all manner of problems, but what is frequently not referred to is why we have such a boom in numbers.

“And the answer is unlimited immigration into this country. It hits some areas harder than others but there cannot be many primary schools in the country which have not been affected at all,” said Mr Nuttall, UKIP Education spokesman.

Why is this controversial ? In the 1990s, the Labour Party opened the floodgates of immigration from Pakistan. The Conservatives have mentioned reducing this but have done little about it.

Steven Woolfe, UKIP Migration spokesman, attacks Conservatives for ‘lying to electorate’ on promises to cut migration, adding that ‘it is no wonder their own MPs are losing faith in them and they are haemorrhaging support to UKIP.’

“These shocking figures today show that the Government does not have a handle on immigration. The Conservative Party promised to cut net migration to tens of thousands and yet it has shot up by a staggering 68,000 in just one year. It is quite simple. They lie to the electorate. They lie to try to keep votes. Well they are being found out.

This is one reason why UKIP is hated. For example, of the 1400 young girls made sex slaves by “Asian” men, several were taken from foster parents because they had voted for UKIP.

A couple had their three foster children taken away by a council on the grounds that their membership of the UK Independence Party meant that they supported “racist” policies. The husband and wife, who have been fostering for nearly seven years, said they were made to feel like criminals when a social worker told them that their views on immigration made them unsuitable carers.

Sounds like the Tea Party to me.

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