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Texas Health Worker Tests Positive For Ebola
Thomas Eric Duncan, the first person to have been diagnosed in the U.S. with Ebola, and who subsequently died of the disease, was treated at Texas Health Presbyterian Hospital in Dallas. Now, in a second diagnosis for the U.S, an unidentified health-care worker from the hospital has tested positive for Ebola as well. According to the linked Reuters story, Texas officials did not identify the worker or give any details about the person, but CNN said it was a woman nurse.
The worker was wearing full protective gear when in contact with Duncan, Texas Health Resources chief clinical officer Dan Varga told a news conference.
"We are very concerned," Varga said. "We don't have a full analysis of all of the care. We are going through that right now."
...
The worker was self-monitoring and has not worked during the last two days, Varga said.
The worker was taking their own temperature twice a day and, as a result of the monitoring, the worker informed the hospital of a fever and was isolated immediately upon their arrival, the hospital said in a statement.
(Also covered by the Associated Press, as carried by the Boston Globe, which notes that "If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S.")
We have robots for ridding explosive ordinance. Considering the humber of healthcare workers that contracted this disease so far, hopefully some remotely controlled robot doctor/nurses would help further quarantine the situation.
We are far from autonomous humanoid robots, but since this isn't a labor saving measure, it should be much easier, as they are rather more like walking drones, how far is current tech from making this possible?
No, there is no need to panic. Get a grip on your fantasies.
I'm sure that there's a protocol you could follow to prevent catching the flu from flu patients, too, but I doubt it would be practical to practice medicine at the same time. I think that as Western medical personnel are beginning to be infected, it becomes less easy to just say "the training/equipment/conditions were the problem". At some point, we need to look at how the containment protocol interacts with the treatment protocol, and see if it actually works.
Remember, correctly executed withdrawl is just as effective a form of birth control as a correctly applied condom, but a greater share of condom users use them correctly than those who attempt pulling out.
"Because Science" is one step from "Because old book". Try "Because of my experiment testing my falsifiable assertion".
You know, I've heard that many times now, yet Ebola continues spreading. And every new case gives it new opportunities to evolve further. So perhaps it would be better to panic and spend some serious dough to crush the outbreak while it's still possible, rather than wait for it to turn into the doomsday scenario a deadly and highly contagious disease has every potential to become?
Forget magic. Any technology distinguishable from divine power is insufficiently advanced.
As someone who lived through the SARS panic in Asia, I would say no, we're not "there" yet. Apparently it has taken a bit longer than it should have for the rank-and-file health workers in the USA to get clued in on this, but I would venture to say that the number of them who remain unaware of this threat today is approximately zero. If anything, I'd expect to see a lot more "false alarms" than actual infections in the next few weeks.
Once the public is aware, the infection rate will plummet. Because of SARS, I still avoid doorknobs and elevator buttons whenever possible (use your keys, lighter, sleeve, etc. to buffer such contact), it just makes sense to do so. Once the protocols for avoiding Ebola become widely known, this so-called "epidemic" will quickly dissipate.
XML is like violence. If it doesn't solve your problem, you're not using enough of it. --AC
The fact that the nurse in Spain, and the one in Dallas both contracted the disease despite wearing full protective gear - and in full knowledge that the patient was infectious - is pretty scarey. You have to imagine that both of those people were fully aware of how dangerous the situation was and were doing their very best to avoid doing anything to compromise their own safety. Clearly we either need better suits or better training, or some kind of a 'buddy system' where two people watch each other to ensure that they don't accidentally do something wrong.
There was a piece on NPR a few days ago that said that the Doctors Without Borders people use a buddy system like this - and despite having hundreds of people on the ground in Africa for a month or more, have only had three staff infections.
Without some improved level of protection, asking doctors and nurses to expose themselves to a disease with a 70% mortality rate (latest WHO estimate...up from 60%), no immunization and no known cure, is asking a lot. Clearly we aren't going to be able to make a vaccine or a cure in any reasonable timescale - so we really need to be working hard to improve protection. The idea of using robots for at least some of the jobs is interesting - but probably impractical for all but the simplest tasks.
We know that this disease can spread exponentially the "base reproduction" figure (the number of people who catch the disease from one infected person) is between 1.7 and 2.3, and it takes 2 to 3 weeks for the infected person to develop symptoms and pass it on. So there is a potential for the disease to double every 3 weeks. We have just a couple of victims in the USA right now, so in a year, we could have a million victims and 700,000 deaths. Clearly, we have to reduce that base reproduction number below 1.0 - but if...with proper protection gear and highly aware workers...both the Spanish and Dallas initial cases were able to spread to one additional victim, we're clearly not going to get anywhere close to a 1.0 rate anytime soon.
We now have two cases of Ebola being contracted by health care workers in developed nations (Spain, USA), plus the many workers who have contracted it while working with patients in the affected African nations. One wonders if the pool of health care workers willing to work with these patients will start to dwindle and whether the CDC call for calm is more direct at those workers than the general public.
But last week it was reported that Sgt. Michael Monning contracted ebola while trying to get the quarantine order signed.
No, it says a possible second Ebola victim. He didn't actually have the symptoms of Ebola, but felt sick, and since he had been in Thomas Duncan's apartment, he went to get checked out just in case. But his test for Ebola was negative.
Does anyone know how the virus can penetrate a hermetically sealed suit?
It cant, but when the health worker does not use care to disinfect and properly remove the gear, he/she may not as well have worn the suit in the first place.
One of the workers infected in africa admitted that that was the cause of their infection; accidentaly touching their bare skin with the outside of the suit.
For those who said "No need to panic" ... are we there yet?
No. Panicking does nothing, except perhaps make you look like an irrational moron. Like all those people panicking about terrorism after 9/11; idiots.
yet Ebola continues spreading.
No, no really. There are more and more victims in Guinea, Sierra Leone, and Liberia. But it was stopped in Senegal and Nigeria. All African nations are not the same. In terms of institutions and infrastructure, Guinea, Sierra Leone, and Liberia are at or near the bottom. While primitive by Western standards, Senegal and Nigeria are far more functional countries. If they were able to control and contain the disease, then more developed countries should not have much difficulty doing the same.
Simplest explanation is always right.
No. Most likely. But in the absence of more information, most certainly NOT "always right".
AIDS doesn't cause contagious blood, spit, diarrhea, and vomit to go everywhere. Ebola does.
AIDS doesn't infect health care workers who are treating patients unless there's a needlestick or sexual contact. Ebola does, with alarming frequency. Even if you DO have sex with someone with AIDS, it's not 100% that you'll get AIDS.
AIDS can't be spread by sneezing or coughing. It's possible Ebola *is*.
In terms of contagiousness, Ebola seems 10x worse. It's like saying "smallpox is no worse than chickenpox". Maybe if you put them both on a logarithmic plot and back up 50 feet!
--PM
No.
We MIGHT (and I stress "might") be getting to time to panic the first time we get an ebola victim who hasn't been to Africa, and hasn't been in contact with any known Ebola victim.
Note that this case is one of the 48 people who are currently being monitored due to contact with that ebola victim who brought it here from Africa.
"I do not agree with what you say, but I will defend to the death your right to say it"
But where is the evidence of a pandemic? It's only a few thousands at this stage.
The evidence is continued exponential growth of Ebola to recent past. It appears that the rate of infection may be slowing down in the worst of the three primary countries of infection, Liberia. If true, fears of pandemic are overstated.
If instead, cases continue to climb exponentially, but patients are staying away from hospitals, then you still have the eventual pandemic problem looming on the horizon.
I know, if "you only follow procedure" this isn't supposed to be a big deal.
But what's scary is that with a very small number of patients (one) and likely a lot of attention to procedure, a healthcare worker got infected. Sure, we can blame sloppy procedure, but it happened anyway.
What would it look like though if we had a dozen patients or a hundred or a thousand? It's real easy to blame bad procedure, but what makes us think a wider outbreak would have *better* procedures and more attention to detail? We might get better at it (lack of practice may be an issue) and we might make incremental improvements to the kinds of procedures we follow but we might also get worse, lack facilities or the inevitible stress of a larger outbreak might impede vigilance, not improve it.
What scares me about Ebola is how apparently difficult it can be to contain even under ideal conditions.
well no, I bet a dollar there was a tear in his suit. Simplest explanation is always right.
Be prepared to lose a dollar. The protocol for donning and removing the protective gear is very complex, and very hard to get perfect. When putting the suit on, it's possible to get gaps between the goggles and suit without even knowing it. And when taking it off, a tiny flap of the contaminated suit brushing against a clean surface is almost impossible to detect.
In contrast, Tyvek suits are very hard to tear unless you're doing hard physical labor in a rough environment. Most hospital settings don't have the infectious care nursing staff crawling through piles of dirty rebar or squeezing along rough mortared brick walls.
John
Dear Texas,
After careful consideration, we do actually think that your secession plans make sense after all!
With Best Regards,
The Other 49 States
sigs are for losers (except to point out that sigs are for losers)
Yup, nothing to worry about. We've had all of about three people in the US with the disease so far with no more than one in any hospital at a time, and yet the workers still manage to get themselves infected. That is under fairly ideal conditions - these patients are actually in specialized isolation wards and they can dedicate personnel to them and generally isolate them from the rest of the hospital.
So, 3 sick patients leads to 1 sick healthcare worker. That isn't a particularly good ratio. If we had 100 people with Ebola then you'd expect 33 sick healthcare workers, and then you'd expect those to go on an infect another 11, then another 4, and then one more for good measure. If you're keeping count that is 50 healthcare workers in total, from treating 100 sick people.
Now, maybe we're just really unlucky or something, but I'd think that if the ERs started filling up with Ebola patients the amount of isolation would go down, not up.
The "nothing to worry about, it is just Ebola" crowd is beginning to sound a bit like the "the space shuttle is designed to not blow up more than once per 100k missions" crowd. All the hand-waving about how hard the disease is to transmit is in complete contrast that in first-world medical centers we already have two infected nurses.
This isn't AIDS. You CAN catch it from a handshake, let a lone a kiss.
The barrier protocols are quite onerous. It doesn't need to be idiocy, fatigue is enough to induce human error. Experts have pointed to this as a factor in the spread of Ebola in West Africa; aside from the fact that most people have access to medieval levels of health care, or facilities that lack things like latex gloves, supplying hospitals with equipment is not enough. The workload of health care workers has to be kept light enough that they can take the extreme precautions needed without making errors.
It is also possible that the barrior protocols have a bug somewhere in them.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
What I don't understand: Wouldn't it be possible to put the wearer through a disinfectant decontamination shower before he or she takes off the suit?
By my logic, if you people start getting ebola with no KNOWN ebola contact, it's time to think about maybe panicking.
Because that would mean an unidentified reservoir of ebola in the country. Which is potentially disastrous.
So long as we have a clear eye on patient zero and everyone in contact with him, we don't need to be terribly worried....
"I do not agree with what you say, but I will defend to the death your right to say it"
Last I saw, that debate wasn't split on party lines. Some of each party said both. Oh, but no, let's just treat every single event that ever happens like one US political party is always right and the other wrong. Because when you get elected in one party you become a god. They're not at all just people with their own opinions and ideas who make mistakes. And when you get elected to the other party, you sit around wringing your hands trying to think about how to screw up. Because they too aren't just people trying to stumble through awesome responsibilities.
Behold the brilliance of American politics. Nothing in the world is more important than choosing which group you'll worship.
For those who said "No need to panic" ... are we there yet?
Nope. And we never will be. Panicked people make stupid decisions that make the situation worse.
One thing these outbreaks in Europe and the US show - we don't know enough about Ebola.
There is no "outbreak" in the US or Europe. And not knowing enough about Ebola is not the same as saying we know nothing about Ebola, and what we know says there is not going to be an outbreak here -- just a few isolated cases of transmission. Thus far there have been one confirmed case of endemic transmission in the US and one in Europe, both nurses. The other "cases" were people with other viral diseases. One transmission does not an "outbreak" make, except to people who are panicky. It's normal in a situation like this for "suspected cases" to pop up all over the place. What do you expect, with the media spreading panic.
The CDC is now saying that the transmission in TX was caused by a "breach of protocol", which is not surprising given that the barrior protocols are exacting and onerous.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
Note that this case is one of the 48 people who are currently being monitored due to contact with that ebola victim who brought it here from Africa.
While I agree We should not panic, this case is not 1 of the 48 according to NPR.
The problem in these African nations is that the virus' main victims have been predominantly among the few trained health care workers they had.
If you live in the developed world, you don't even think about the doctor:patient ratio, which is probably somewhere around 1:400 in your country. In Liberia, the ratio was about 1:100,000 (back in 2008). That means in this entire country of 4 million people, they had about 40 doctors - about the same as one typical urban American hospital. These are the only people capable of "holding back the infection", as you so glibly put it.
This year alone, Ebola has already killed about 10% of their doctors.
As far as money goes, Liberia already spends more of their money on health care than any other country in the world. As they are one of the poorest nations, they have very little money for anything at all, so this has them completely tapped out.
What good is even a hundred liters of zMapp if there aren't enough doctors to identify and treat the infected?
John
You know, I've heard that many times now, yet Ebola continues spreading.
And it is still correct. There is no need to panic. Ebola gets WAY more press than the severity of the actual risk justifies.
Basically stop freaking the hell out. The people that can and will deal with this outbreak are dealing with it. Panic will accomplish nothing productive. Quite the opposite in fact.
So perhaps it would be better to panic and spend some serious dough to crush the outbreak while it's still possible, rather than wait for it to turn into the doomsday scenario a deadly and highly contagious disease has every potential to become?
First off, ebola is NOT "highly contagious". It's actually rather hard to get. Unless you have been in direct contact with the sweat, blood, tears, feces or other bodily fluids of a symptomatic ebola patient then you have nothing to worry about. Medical personnel who are treating such patients directly are at highest risk for obvious reasons. This is nothing shocking though it probably means someone made a mistake.
It is incorrect that "every" pathogen has to potential to become a "deadly and highly contagious disease". Go talk to an infectious disease doctor and they will tell you that the biology of most viruses and bacteria prevents them from ever becoming a threat to humans. It's actually quite hard for that to happen even in a rapidly mutating virus which ebola is not. What you are suggesting is almost as unlikely as all the air in the room suddenly deciding to be on just one side of the room because, hey, it's theoretically possible. The real world probability of most viruses and bacteria mutating into something harmful to humans is actually vanishingly small if not actually zero.
http://www.khou.com/story/news...
"Monnig was transported to Texas Health Presbyterian inside an ambulance protected with plastic on the inside. Once there, his blood was drawn. He was cleared of the Ebola virus the next day."
The evidence is continued exponential growth of Ebola to recent past.
Be careful of extrapolation.
Let's see: total number of Ebola Patients in the U.S. is ... 1. Mssr. Duncan is dead and cremated and no longer spreading the disease. So, the answer is "no".
You didn't bother reading the summary or the article, did you? Not just 1, Mr. Duncan. The next victim is the trained, well-equipped health care professional who - despite having far better protection and awareness than the vast majority of people in the world - just tested positive for having caught the virus from him.
What's your point in ignoring that glaring little dose of reality?
Don't disappoint your bird dog. Go to the range.
So, 3 sick patients leads to 1 sick healthcare worker. That isn't a particularly good ratio. If we had 100 people with Ebola then you'd expect 33 sick healthcare workers, and then you'd expect those to go on an infect another 11, then another 4, and then one more for good measure. If you're keeping count that is 50 healthcare workers in total, from treating 100 sick people.
Extrapolation from small numbers is rarely a sensible idea.
Don't let facts get in the way of your rant.
This latest case arose because of a man who arrived in the US like any normal person would. He was not flown under quarantine for treatment, he developed the disease already in the US.
Considering the record so far, it's far safer to fly people back to the US for treatment than to let them arrive on their own even if they show no signs of the disease. This allows us to reach a single conclusion and no other: that Dallas hospital has some explainin' to do.
If your advice had been followed, that man would still have died in the US, infecting this other person, and those who were successfully treated in the US may have died due to not having access to the same level of care.
I think this just points to the need to really step up our game if we want to stay ahead of this.
What do you suggest doing to 'step up our game?'
I would initially greatly restrict travel (air, land, and sea) out of Africa and limit it to those involved in aid efforts. Those workers would be carefully observed. If a tight quarantine could be imposed at a level of granularity smaller than the entire continent, then I'd be willing to lift travel bans on the entire continent after they were effective for an incubation period with no sign of spread. However, it is hard to contain a disease area as large as the current outbreak, and the entirety of the continent provides geographic barriers to spread.
If somebody does develop Ebola then anybody they had contact with would be quarantined, with police enforcement (either monitoring devices as are commonly used in house arrest, or guards outside the door). Anybody infected would be isolated in dedicated facilities, with the healthcare workers quarantined. Of course, without an endless stream of flights out of Africa there would be few infections outside of Africa so these measures would be very limited.
First world nations should immediately fund rapid development and testing of promising treatments, offering bounties or fee-for-service models where necessary to get around concerns around marketability of the treatments. Nations really need an Ebola treatment in their bag of tricks even if this outbreak goes away before it is developed. There is no reason there can't be ten thousand greenhouses doing a crash course in wmapp production right now, even if it turns out to be a dud (which seems unlikely). Anybody with a biochem degree could be trained to produce it, and they aren't THAT uncommon. By all means use the drug domestically first, but with the travel ban there won't be much demand for that so you can actually give doctors without borders a good supply of the stuff. The fact is that having a pool of a million people with Ebola anywhere on the planet isn't a good thing for anybody, so even if everybody is completely selfish it is in their interest to fund getting that epidemic under control.
In a nutshell I'd treat this more like a war and less like a recession. The US has an insane 10% unemployment rate or something like that - there are plenty of bodies that could be given the necessary training to get ahead of this if we just got off of our collective rear ends and maybe did something with that nice GDP growth besides build private jets for CEOs. Since this could save the CEOs own hides, they probably won't complain too much about it.
How do you know it was stopped in Nigeria? Because the Nigerian government, who have a strong incentive to protect their billions of dollars in trade with the rest of the world say they stopped it? 21 days will tell more than any press releases.
well no, I bet a dollar there was a tear in his suit. Simplest explanation is always right.
My favorite part about this is how it gives the lie to all the xenophobic rationalizations that people in various African nations were contracting Ebola because of $DANGEROUS_TRIBAL_FUNERARY_CEREMONY.
Ebola is transmitted through bodily fluids including sweat and aerosolized saliva (produced by sneezing). Containing bodily fluids in a social context—especially saliva and sweat—is virtually impossible and probably makes Ebola a lot more contagious than the talking heads are letting on.
blog
well no, I bet a dollar there was a tear in his suit. Simplest explanation is always right.
Be prepared to lose a dollar. The protocol for donning and removing the protective gear is very complex, and very hard to get perfect. When putting the suit on, it's possible to get gaps between the goggles and suit without even knowing it.
Goggles?! - Proper biohazard suits are full-body and pressurized, with a full-head hood and absolutely
no openings in the vicinity of the head. Or any place on the front side of the body for that matter.
And when taking it off, a tiny flap of the contaminated suit brushing against a clean surface is almost impossible to detect.
Eh, again? - There's a multi-step decontamination procedure before taking off the suit.
Taking off a still-contaminated suit would be a major fuckup, and a (potentially) contaminated suit should never
be in an environment where any "un-suited" contact can happen.
Have a look at how this works at the BSL-4 level (skip to about minute 13).
What kind of amateurs are running this place?
According to NBC, this is exactly what appears to have happened.
The NBC report is pure speculation. Nobody knows. It's just as likely aerosolized cough droplets, which is another thing the CDC insisted couldn't possibly happen.
Where are all those Slashdot posters who scream "Stop blaming the victim" now? Too scary to stand on principles?
When it comes to a choice if blaming the victim or admitting that their protocol is woefully inadequate, the CDC seems to take the low road.
Sig Battery depleted. Reverting to safe mode.
Which half of the person infected in the united states is dead ?
Nullius in verba
Actually my understanding is that they are not treating patients with the full suits on. The decision to just do face masks, gloves, etc. was pretty common it seems now... I think people have gotten more lax with Ebola simply because wearing the full suits is hot and tough to deal with for a long epidemic like we're seeing. It sounds like the nurse in question wasn't in full protective gear. I agree with the idea this shouldn't be happening... How many of these places really have full training for BL-4 diseases though? Last I knew there were only a few labs in the US capable of fully handling diseases like this in the laboratory. (CDC and USAMRID) How is an average hospital set up for this? Hopefully the Dallas one was, but if this trend continues these will not be the last patients we see coming to the US. My guess is this little incident will get in hand just fine, but I doubt that the ones that are likely to come will be as easy to contain.
The CDC and respective officials around the world train and plan for this stuff. Sure, some political idiocy always exists and sometimes makes problems worse (or blows them out of proportion) but overall the experts are making informed reasonable decisions. Naturally, propagandists twist anything to their own ends and the armchair critics who have way more confidence then competence (which BTW, is a big problem in the USA...go find the studies which prove it.)
Europe isn't banning relations with whole nations. If there was an easier way to screen for it, don't you think they would be doing that already?
You can't realistically quarantine whole nations as if that would actually work. It only takes 1 person sneaking bye -- and instead of thinking of that man who brought it to the USA as a massive failure, you should realize the obvious: they identified the man who brought it in rather quickly... he could have gone around spreading it until his death on some sidewalk somewhere.
It's not highly contagious and we have more deadly diseases in the USA already which don't get this kind of attention; no media reporting on those. Some are born right here as a result of industrial farming... (which is part of the reason it won't be hyped until more than a million die per year... or 1 celebrity.)
Democracy Now! - uncensored, anti-establishment news
Highly trained workers... hmm...
Before you go on a tangent, think about this:
Look at the average person who works with you.
Note his abilities, how he handles himself, how he acts and how he does his work.
Note that this is what we call "a professional"
Now reevaluate that statement about "highly trained workers".
In my experience, 9 out of 10 times "professional" only means getting paid to do it. It's not a statement of quality.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
Ok, then let me rephrase my question that you'll probably find below:
What does being afraid of it accomplish?
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
I had brunch with my friend this morning, who is an MD PhD in infectious disease and works in a BSL-4 laboratory from time to time, so I asked about this.
BSL-4 is a standard that only applies to laboratories, the same standards aren't necessarily applied to clinical environments, and in the case of Ebola are major overkill. Ebola can't travel through the air, so positive pressure suits aren't appropriate, and they still have to be taken on and off, and that's when health workers seem to get infected. People who "test positive" for Ebola are not contagious, only people who have symptoms are, and they can only pass the disease through contact with bodily fluids -- this usually implies touch, since hemorrhagic fevers cause people to give off all kinds of gross effluent, but it's just not like a "virus" one gets from casual contact, like, say, rubella.
The fact is, Ebola isn't that contagious -- HIV is more virulent, and these two are nothing compared to the influenza or SARS. It's bad that health workers can get it, but this is still one person, so on a completely epidemiological basis it's really not a big deal. Characterizing a single case as somehow indicative of the safety of these procedures is sensationalism.
Don't blame me, I voted for Baltar.
Take a deep breath. You are wrong. If you're like me then you really appreciate the times when that's a good thing.
Ebola is spread via bodily fluids, and it needs an opening to the body to be contracted. There's a nurse who caught it because she touched her face after working with a patient. The face has openings to the body. Getting an infected someone's blood, urine, or saliva on a cut is a surefire way to catch it. So, it's not as communicable as Captain Trips from The Stand, but don't let that inspire complacency either.
Medical workers responding to the outbreak in Liberia have been photographed burning the belongings of ebola victims, and sanitizing with pure chlorine anything that can't be burned. Think about your sheets and mattress. You sleep on those, so it's inevitable that bodily fluids will come into contract with them. Now think of the number of people who don't wash their hands after using a public bathroom. How many people use a public bathroom and some time later rub their eyes?
So, there's good news and bad news. The good news is that with careful hygiene and quarantine with appropriate protective equipment used and all procedures properly followed, an outbreak can be prevented. The bad news is that if there is an outbreak, it's almost guaranteed to be an epidemic because people won't do what they have to in order to prevent further infections. They simply won't listen, guaranteed.
I really wish that hospitals would consult with the US Army regarding proper procedures when dealing with NBC contaminants because from what I've read, the current procedures are lacking in proper rigidity or are otherwise not followed properly. They need to start with replacing their ridiculous protective equipment. That flimsy crap is made on the cheap, sold at a stupid markup, and is simply not good enough.
Furthermore Ebola never did reach Nigerian cities. When it does, it will be the same disaster as the other countries.
Unlikely. Nigeria has twice the literacy rate of Sierra Leone, three times the per capita GDP, a much stronger public health system, and working government institutions. It is a democratic country, with leaders answerable to the electorate. Nigeria has plenty of problems, as any country does (well, maybe not Denmark), but compared to Liberia, Sierra Leone, or Guinea, it is not even close to the same level of dysfunction.
Decontamination shower is part of the protocol in Africa, but not in the US. The doctors in the US need to be trained better on this.
One problem is to most healthcare workers, all of their training on blood-borne pathogens is geared primarily toward AIDS, unfortunately HIV is a very labile with a fairly high infectious dose, so basically if you do just about anything you kill it and it remains infectious in the environment for minutes to an hour if you do nothing. Ebola on the other hand is a robust virus with a very low infectious dose (1 -10 virus), anything strong enough to guarantee a 99.999% kill rate is going to also dissolve plastic, peel the paint off the walls and corrode any metals to uselessness.
Apocalypse Cancelled, Sorry, No Ticket Refunds
This is why Africa was finally made barren of human inhabitants in 1980...
Also this is what, two cases in the US, three? Maybe 5 total outside of Africa, and almost all of them among health workers collateral to treating confirmed Ebola-suffering patients?
Don't blame me, I voted for Baltar.
So basically you're just anxious, because none of this "seems right" in complete absence of empirical evidence?
Somebody in a modern clinical environment who supposedly knew what they were doing got infected.
That right there is empirical evidence of something not being right.
And in your sample of 10 (or 20, who knows!) one person became ill, because, we dunno, but it sounds fishy.
It doesn't to you? "Well, they have to take off those contaminated suits, and some will get infected while
doing that. Shit happens." really isn't the right approach here.
What recommendations would you make, if you were, say, a public health official? Everyone who develops illness has to be treated in something akin to a BSL-4 facility?
No, but how about "don't mix clean and unclean environments, and follow proper decontamination
procedures while moving between them, and before undressing"?
Have you any idea how many plane flights that would require, just to cite one small aspect of the logistics?
Huh? Plane flights? Are we still talking about a controlled clinical environment in a big American city?
And all this to protect from a disease vector that's completely unsubstantiated in the literature?
Or do you do like Judge Clay Jenkins, and personally go to the family's house in shirt-sleeves and drive them to a new home? Which approach is more appropriate? Which one balances our available resources against the actual concrete threat of the disease? Which one is actually workable?
You're losing me here.
How do you know it was stopped in Nigeria? Because the Nigerian government, who have a strong incentive to protect their billions of dollars in trade with the rest of the world say they stopped it?
No. We know it because US health authorities and the WHO reported it.
More recent version of the WHO report (which confirms no new cases in Nigeria since 8 September).
What I don't understand: Wouldn't it be possible to put the wearer through a disinfectant decontamination shower before he or she takes off the suit?
There is a strong protocol, and yes, it includes decontamination sprays. As I understand it the protocol includes a disinfectant spray before taking off the suit, a hand spray after removing the first layer of gloves, then another disinfectant spray after stripping. And the gloves and suit are all supposed to come off inside-out, always turning the the hot side to the inside.
Remember that any suit that can protect the wearer against virus is also impermeable to air. That means the suits heat up. They are sweating profusely as soon as they get their suits on, and they can only remain suited up for less than an hour before roasting in their own juices. When every surface is soaked in sweat, it's impossible to recognize when it's the patient's infectious sweat or your own.
We know the best practical approach is to use a buddy system, and have them help each other. Even so, the first buddy to disrobe is still handling the infectious materials while helping the other to strip, so they still have to be vigilant. Repeat that clothing protocol every other hour for a long work day, week after week, and if the wrong piece of fabric ever accidentally brushes on you any time during the process you may get infected with a disease that has a 60% chance of killing you. Or if this is your first time dealing with an Ebola case, how do you know you've followed the protocol perfectly?
Now, cross the ocean. Place all of that in the context of extreme poverty; chronic suit, glove, equipment, and doctor shortages; wailing and shrieking family members; orphaned babies that may be infected; contaminated water supplies; relentless heat; men who tell rumors that Ebola is a disease from the West that is being spread by doctors and is being used to kill Africans, or that Ebola doesn't exist; populations frightened by the presence of workers in "moon suits" coming to collect their dead relatives; a culture that grieves by touching the bodies of the dead; and the dozens of other deadly diseases that still strike Africans constantly, including malaria, dengue fever, AIDS, hepatitis, typhoid fever, and chronic diarrhea caused by rampant bacterial and protozoal infections. Oh, and attacks on clinics by gunmen.
It's almost as if the disease evolved itself to adapt to collapsing health care systems in impoverished nations.
John
To answer your question, if you mean *absolutely* prevent, the answer is nothing. But that's not the right question. The question is whether this will be transmitted at such a rate that it can result in sustained "endemic" transmission. "Endemic" is defined as a situation where each person infected in a location on average infects at least one other person. There may be a handful of transmissions from this index case, but it will fizzle out.
People worried about Ebola becoming endemic based on what's happening in West Africa have no idea how primitive conditions are in West Africa, where hospital workers often lack basic supplies like gloves, and are even reduced to re-using hypodermic needles. And people there who get to one of those horrible hospitals are the lucky ones. The health care and sanitation standards in the effected regions has been described as "medieval".
"Pulling out all the stops" sounds like a good idea, except if you think about it, it gives you absolutely no guidance about what you should do. Some of those "stops" would actually make things worse, and others would be a ridiculous overreaction. For example, should we quarrantine the state of Texas? After all there's been a case of transmission there. That's an overreaction.
Beware the Dunning Kruger effect. Not knowing anything about public health or tropical disease makes it really easy to design a containment program that sounds to you like it ought to work. But there aren't infinite dollars, even to fight Ebola. Every half-baked thing you do comes at the expense of something that would have been more effective. I've worked with the CDC, specifically the Fort Collins DVBID, which does vector borne stuff. The agency is full of PhDs and MDs who've spent their career studying tropical disease outbreaks and what to do about them.
People who think they know better remind me of this quote from Terry Pratchett:
Sergeant Colon had had a broad education. He'd been to the School of My Dad Always Said, the College of It Stands To Reason, and was now a post-graduate student of the University of What Some Bloke In The Pub Told Me.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
Do you even know how this case of infection occurred?
I don't. You, however, speculated about contaminated suits which "still have to
be taken on and off, and that's when health workers seem to get infected."
Which really shouldn't happen.
you're the one who says he knows, or rather knows enough to know there was a systemic problem and not one merely attributable to failure to follow established protocols.
Please tell me where I said that.
Huh? Plane flights? Are we still talking about a controlled clinical environment in a big American city?
There are only about a dozen BSL-4 facilities in the US; if you want to establish the principle that patients must be treated in such a facility, you will be moving A LOT of them.
1.) I don't. My video example above was meant as a "look at how the pros do it".
2.) You do expect "A LOT" of Ebola patients in the US?
you seem to think every metro in the US has a world-class biohazard facility and infrastructure, and has plenty to spare on a wild goose chase of isolating minimally-virulent ebola patients, and you can't seem to understand that your fears are based completely on your own speculation and snap judgement. Your conceptualization of this disease, and the means required to contain it, constitute the textbook definition of cargo cult science.
Hm? What part of "don't mix clean and unclean environments" is cargo cult?
Also: I'm not afraid.
Just to clarify: I'm not talking about the Ebola outbreak as such, and arbitrary
patients. I'm talking about this one specific case of an infected health worker in
a proper clinical environment.
No, the protocol needs to be changed if it's inadequate.
They also weren't putting IVs in him and taking care of him while he was bleeding out the ass and vomiting during his final few days on earth.
No, I was talking about the CDC blaming the victim for breaking protocol, when it is clearly their own protocol that is at fault here.
Doctors without borders uses a much stricter protocol, with a buddy system for donning and doffing, and they have had
a much better record in keeping their people safe in absolutely horrible conditions.
Sig Battery depleted. Reverting to safe mode.
1:10 bleach solution is one of my favorites, but what it lacks is the guarentee, in this case manufacturer's product liability insurance. It doesn't disolve plastic, but repeated and prolonged contact does oxidative damage and embrittlement. It also does a number on latex paint but not immeadiatly and it will corrode metal even stainlees steel and colbalt-chrome alloy.
Apocalypse Cancelled, Sorry, No Ticket Refunds
Remember, correctly executed withdrawl is just as effective a form of birth control as a correctly applied condom, but a greater share of condom users use them correctly than those who attempt pulling out.
Here were some of the problems with the studies you've alluded to:
A noted limitation to these previous studies' findings is that pre-ejaculate samples were analyzed after the critical two-minute point. That is, looking for motile sperm in small amounts of pre-ejaculate via microscope after two minutes – when the sample has most likely dried – makes examination and evaluation "extremely difficult."[4] Thus, in March 2011 a team of researchers assembled 27 male volunteers and analyzed their pre-ejaculate samples within two minutes after producing them.
The researchers found that 11 of the 27 men (41%) produced pre-ejaculatory samples that contained sperm, and 10 of these samples (37%) contained a "fair amount" of motile sperm (i.e. as few as 1 million to as many as 35 million).
Of course, that study as well is not completely definitive either.
However, two things need to be kept in mind. First, the study suggests that some men can leak sperm into their pre-ejaculate (though the authors do not extrapolate on this supposition and the possible causes of such a phenomenon). Second, the authors admit that some of their subjects who submitted sperm-positive pre-ejaculate samples could have actually used their ejaculate – due to failure of producing pre-ejaculate – to avoid the "embarrassment" of not producing pre-ejaculate.
So I'd say, the jury is still out on this question.
We had 0.
Then Mr Duncan arrived. We had 1.
Then Mr Duncan died. We had 0.
Then the nurse tested positive. We have 1.
We've never had more than one case. Unless the guy in Boston who went to renew his prescription and complained about muscle aches tuns out to test positive. In which case there are two cases.
In comparison, every year, between 3,000 (confirmed) and 49,000 (estimated) people in the US die from influenza.
And neither coughing or sneezing are Ebola symptoms.
I don't want to misattribute something to the CDC, but what I read was glaringly clear on this point.
What the unnamed party said, was, "there HAD to be a breach of protocol, because this person is infected. However, we haven't identified what the breach was yet"
Circular reference?
My opinions are my own, and do not necessarily represent those of my employer.