Positive Ebola Test In Second Texas Health Worker

mdsolar tips news that a second healthcare worker at Texas Health Presbyterian Hospital has tested positive for the Ebola virus. Like the nurse who tested positive a few days ago, this worker was involved in providing care to Eric Duncan, the Liberian man who seems to have brought the virus into the country. The CDC is working to identify further exposures to the local community, though the Times says a second infection among the 70+ medical professionals who were around Duncan is not unexpected. The largest U.S. nurses union says a lack of proper protective gear and constantly changing protocols are to blame for exposures. Meanwhile, the World Health Organization says infection rates in West Africa are such that within a few months, they can expect 10,000 new Ebola cases a week. They also say the death rate for the current outbreak has risen to 70 percent.

Comments

their own fault

[slashmydots]

I worked in an IT department in a hospital and even I had to go through biohazard and infection protection training. These workers came into contact with the patient's bodily fluids. That's sort of frowned upon for medical professionals. Forget ebola. Under normal circumstances, they could now have hepatitus, AIDS, or basically anything else. People this careless are a time bomb. Ebola was just the one that got them.

Re:their own fault

[Anonymous Coward]

Please do not simplify such a grave topic.

There are innumerable communicable diseases in the world, including the US. Many of these infectious diseases have very serious health consequences, also including those in the US. As such, there are numerous (and sometimes onerous) regulations put in place by the public and private sectors to educate and prepare those who are at the front line.

The most basic form is something called universal precautions, which should be observed with EVERY patient you come in contact with. Essentially the goal is to treat every patient's bodily fluid as if it is contaminated, thereby protecting yourself from unknown diseases that the patient may have, and preventing spreading of nosocomial diseases to an otherwise healthy patient. If a patient is known to be infected, additional precautions are put in place in accordance with the communicability of the infection. These include everything from gowns and gloves, all the way to pressurized rooms, N95 respirators, and the so called "space suits". Used appropriately, these are excellent barriers to the spread of disease.

I guarantee those involved with Mr. Duncan's care were certified in all of the above, and once diagnosed Mr. Duncan was almost certainly triaged appropriately. Additionally, the hospital should have ample stock of all of the above equipment -- it is used on a daily basis in the hospital with or without ebola. So the question becomes, how did subsequent infections occur. There must have been a breakdown somewhere in the above steps, whether it was the hospital providing faulty facilities, faulty precautionary equipment, or faulty usage of said equipment. YOU nor I can say nothing more -- we do not know where the blame lays. (Also, run through your mental exercises again keeping in mind that there were no infections in Atlanta or Nebraska, other sites that have taken care of ebola patients). Just take a deep breath and stay civil.

Sauce: I am a doctor who has worked with the sickest of the sick here in the US. I have seen hospitals error, gloves break, and an incredible number of health care professionals misuse equipment and ignore precautions.

As an aside, health care professionals are always at the front line of these things and always at risk of the worst. A very sizable number of physicians, if they are being honest, will admit to inadvertently sticking themselves with a dirty needle or scalpel (myself included). The risk of communicable diseases, very serious pathologies, are small but not inconsequential. I personally know doctors who have died form AIDS, and radiologists with myeloproliferative disorders. Do you remember the AIDS epidemic in the 1980's, especially before anyone knew the etiology? Where was the mass exodus in the 80s? With all the fear in society, physicians and health care professionals were still compelled to treat anyone sick. Despite this, from my anecdotal experience, more doctors are leaving medicine because of increasing litigation, oppressive malpractice laws and increasing malpractice insurance, rather than fears of communicable diseases.

And a bit of advice: although the treatment of hepatitis and HIV have improved over the years (and very solid evidence that HIV is innately becoming less virulent, another interesting story in and of itself), I would recommend not sharing needles or playing with infected fluids of others.

Re:Just tell me

[Wycliffe]

You haven't been to a hospital recently have you? Doctors aren't like Dr. House. They aren't looking for
zebras when 99.99% of their patients are horses. If you come in with a rare disease it can sometimes
take years to get a proper diagnosis. Also most hospitals in the US are private and understaffed so
taking time out to train everybody in every hospital to look for ebola and how to treat it is just not going
to happen as that would hurt their bottom line. That's assuming that a hospital even has someone on
staff that is qualified to do the training which I assume most hospitals don't. What really needs to
happen is the CDC needs to train 10 people and have those 10 people train 10 people, etc...
Let's say you are REALLY FAST and can keep doing this on a 3 day schedule, that means that it would
take 9 days to train 1000 people, 12 days to train 10000 people, etc.... IF you can keep up this
extremely tight schedule it would take over 21 days to train all the health care workers in the US.
That's assuming that the person 3 levels deep is actually trained well enough in 3 days to teach it
to the next level. Good luck with that.

Re:Just tell me

[Wycliffe]

It's already a well known fact that many important professions like teachers, police officers, nurses, firefighters, paramedics, etc...
are not paid very well compared to how much they are needed but what's scary is how few there are. We have decent health care
in the USA but it would take very little to overwhelm them. Most cities have only 1 ambulance per 30000 people. It only takes a
very tiny disaster to deplete them. Heck, it doesn't even take a real disaster. Listening to the police scanner in my city, it's fairly
common to hear "status 0" which means that every available ambulance is already on a call. And forget worrying about isolation
rooms, in the USA we only have 3 hospital beds per 1000 people. Isolation rooms are several orders of magnitude smaller than
that as is proper equipment. We are completely unprepared for any type of mass illness.

Re:Just tell me

[fightinfilipino]

simple. because those persons can go to a third country and then travel from there. it creates an impetus for persons from West Africa to simply try to evade such controls. this would of course worsen the situation, not improve it.

the world as a whole needs to be sending more resources to West Africa to fight the epidemic *there*. that is the only thing that will help stop this from becoming an actual pandemic.

Re:NO

[cptdondo]

Oh fer crying out loud. What do you want, Obama personally doing body cavity searches at the border? If he did that people like you (or others) would be screaming about an "irresponsible Administration" destroying businesses or trampling on your rights or whatever.

You CAN'T quarantine this. Those people are coming through Amsterdam or Frankfurt or Paris or London. Are you going to close all the borders?

Re:Just tell me

[fhage]

You can only catch it by ingesting another persons bodily fluids

Let me translate that into real-world terms. Do NOT rub your eyes, nose, or mouth with the hand/s that have come in contact with Ebola infected bodily fluids.

While that's good advice, it's not completely correct. One does not have to "self-contaminate" to catch Ebola. Lab tests show a single droplet landing on your eye can cause an infection. It is well known that standard surgical masks, eye protection, gowns and gloves do not prevent transfer of Ebola from patients to their caregivers. The CDC techs working with Ebola use full containment suits with positive pressure ventilation and high performance respirators. They get 2 days of hand on-training on protocol. Reports in the MSM say the nurses infected in Tx were given a 20 minute training video and only gowns, shoe booties, gloves and a face shield. It's very possible that the infected Tx nurses didn't self-contaminate.

In addition, there's documented evidence of non-contact transmission between animals and primates. See http://healthmap.org/site/dise... The Ebola infection rate was 100% of the monkeys kept in the same room with infected pigs. There were no opportunities for direct contact between animals. There definitely are vectors for transmission of Ebola without any direct contact with bodily fluids.

Re:Just tell me

[MichaelJ]

According to the Times she was not symptomatic at the time of that flight; however, I would consider it nearly criminal for her to have chosen, even lacking symptoms, to fly in a plane or be in any public confined space until well after the maximum possible incubation period after the last moment she could possibly have been exposed to the contagious patient.

Re:Just tell me

[daveschroeder]

No, it didn't. It was "some sort" of droplet transmission by monkeys in adjacent cages.

That is NOT -- repeat, NOT -- "airborne" transmission.

And no, it didn't go through the ventilation system; it was later learned that sick monkeys sneezing while they were being transported past well monkeys did indeed transmit the virus in this case.

It was also a completely different strain than the one we are talking about.

Airborne transmission occurs when an infectious agent is able to cling to particulates in the air and ride air currents for significant amounts of time, over significant distances, through ventilation systems, etc., long after the infected person who expelled the virus is no longer in the area.

Droplet transmission is NOT "airborne" transmission. It is projecting bodily fluids directly onto a well person in close quarters...usually less than 3 feet, but under optimal conditions, perhaps further. That is still not airborne transmission.

Furthermore, coughing/sneezing is probably one of the least effective ways to spread Ebola, even via droplets. Blood, feces, and vomit are the primary ways this will be spread. Yes, virus "could" be in saliva, mucous, semen, etc. But that's not the primary way Ebola spreads.

Airborne transmission would be very bad, but the Ebola virus is too large to spread this way. It would have to shed about 75% of its genome to be small enough for airborne transmission in sub-5um droplet nuclei that could ride on particulates. And if it did that, it wouldn't be "Ebola" anymore -- it would be something very different; perhaps still deadly, perhaps not, and so much different from what we are talking about right now that it is next to meaningless to discuss.

So, in closing: no, Ebola is not airborne.

Re:Just tell me

[Anonymous Coward]

simple. because those persons can go to a third country and then travel from there. it creates an impetus for persons from West Africa to simply try to evade such controls. this would of course worsen the situation, not improve it.

the world as a whole needs to be sending more resources to West Africa to fight the epidemic *there*. that is the only thing that will help stop this from becoming an actual pandemic.

Your (GP) "solution" makes the problem exponentially worse for others and, here's the real kicker, it makes it worse for you too! People flying from country E with Ebola to country F without it and then the U USA are then exposing TWO flights worth of people instead of just one. Or N+1 vs just N since most flights may not be direct anyway. If I need to get back home, back to work or my family, I'll figure out a way. Three intracontinental flights, a bus trip and then another flight to get home? So be it.

You are trying to increase my risk to decrease yours. That's basically war. If you want me to honestly answer those kinds of questions - where have you been, etc - don't make certain answer a death penalty. If I think I am healthy and you want to quarantine me with people suspected of a deadly contagious disease, I'll do what I can to avoid the quarantine if I'm a rational person. Hell, I'll assume I just have a common cold and not Ebola, and shoot myself full of antihistamines or whatever to mask my symptoms and avoid your death penalty. If I'll get a clean top notch medical care in a private room away from other suspected Ebola carriers, then you have a shot at honesty. If I trust you - which, let's be honest, is not a strong point for the USA after Bush's wars and Obama not reining it in.

Re:Just tell me

[WuphonsReach]

Ebola would have to shed about 80% of its mass to get airborne. At which point, it probably would not be Ebola any longer. There's just a huge difference between fluid-borne and air-borne viruses in terms of mass.

Droplets are the big issue, small enough not to be visible to the naked eye, but with a range of 1-2m (3m if the wind blows hard).