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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.")
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.
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.
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
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)
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.
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