First american ebola case diagnosed

[Sabine Grant]

I haven't seen it discussed, but I would like to know at what point the heightened protocol was put into place for Duncan, and if the health care worker had contact with him before that when he came into the ER for the second time.

I cannot tell you what type of rotations ER personnel will do in that particular hospital and whether they are also assigned to ICU type of care. My guess is that this nurse was primary an ICU type of care attending medical personnel. Meaning she most probably would not have been part of the ER attending medical personnel the day Mr Duncan returned for the second time.
I am safely assuming here that in view of Mr Duncan having placed in immediate isolation following his second visit, to be confirmed as an Ebola infected patient, his subsequent care and treatments were NOT provided in an ER. Rather an isolation section in Intensive Care. Therefor my second assumption that she was a nurse specifically assigned to the ICU.

Usually when a hospital suspects a patient has reported with a highly infectious disease yet to be fully diagnosed, they will contact the CDC who will then instruct them as to heightened prevention/control measures as well as the CDC being the body who will test blood samples etc...

 

[RavenSky]

I haven't seen it discussed, but I would like to know at what point the heightened protocol was put into place for Duncan, and if the health care worker had contact with him before that when he came into the ER for the second time.

I cannot tell you what type of rotations ER personnel will do in that particular hospital and whether they are also assigned to ICU type of care. My guess is that this nurse was primary an ICU type of care attending medical personnel. Meaning she most probably would not have been part of the ER attending medical personnel the day Mr Duncan returned for the second time.
I am safely assuming here that in view of Mr Duncan having placed in immediate isolation following his second visit, to be confirmed as an Ebola infected patient, his subsequent care and treatments were NOT provided in an ER. Rather an isolation section in Intensive Care. Therefor my second assumption that she was a nurse specifically assigned to the ICU.

Usually when a hospital suspects a patient has reported with a highly infectious disease yet to be fully diagnosed, they will contact the CDC who will then instruct them as to heightened prevention/control measures as well as the CDC being the body who will test blood samples etc...

Given how lax the ER appears to have been the first time, it looks like they may have dodged a bullet the second time as no one from ER seems to be showing symptoms.

 

[Sabine Grant]

I cannot tell you what type of rotations ER personnel will do in that particular hospital and whether they are also assigned to ICU type of care. My guess is that this nurse was primary an ICU type of care attending medical personnel. Meaning she most probably would not have been part of the ER attending medical personnel the day Mr Duncan returned for the second time.
I am safely assuming here that in view of Mr Duncan having placed in immediate isolation following his second visit, to be confirmed as an Ebola infected patient, his subsequent care and treatments were NOT provided in an ER. Rather an isolation section in Intensive Care. Therefor my second assumption that she was a nurse specifically assigned to the ICU.

Usually when a hospital suspects a patient has reported with a highly infectious disease yet to be fully diagnosed, they will contact the CDC who will then instruct them as to heightened prevention/control measures as well as the CDC being the body who will test blood samples etc...

Given how lax the ER appears to have been the first time, it looks like they may have dodged a bullet the second time as no one from ER seems to be showing symptoms.

Good point. However, from the few details filtered via the media regarding his first time reporting, the symptoms he exhibited did not yet include the presence of bodily secretions resulting from vomiting and diarrhea. From what I understood, he was running a high fever (103) and complained of lower abdominal pain and extreme fatigue. Which means that simple contact while wearing gloves to examine Mr Duncan ,taking his vitals,checking his throat (inside and exterior palpation), palpation of his abdomen, etc...that type of "superficial contact" while wearing gloves and if no exposure to bodily secretions and/or blood, it would mean a lower risk of contamination for any ER personnel relying on standard precautions when examining any patient. If they took a urine or/and blood sample, it would still be handled with protective gloves all the way to the lab tech. As to drawing blood, the use of "butterflies" versus the old style sharp or needle has made it much safer. And again, if observing standard precautions, the RN or LPN drawing blood would be wearing protective gloves.

There are very few details regarding how his second ER visit went. At that point, his symptoms had progressed to where he was having diarrhea and was vomiting. Increasing the risk of contamination.

I am not surprised that it was a nurse who got infected. Nurses tend to spend longer time and have far more contacts with the patient than the attending physician does. The nurse is the one who will provide everything involved with skilled nursing care , to include meds administration and in Mr Duncan's case he had to be on an IV for hydration (at least). Nurses will follow instructions given by the attending physician and are the "hands" who will handle the patient most. Add to skilled nursing care (RNs and LPNs), CNAs who will change the bedding, clean the patient (sponge bath) etc...they are as susceptible to exposure and contamination as full nurses are when it comes to vectors involving urine, feces, bloody fluids, vomit etc...Which is the case for Ebola. So far, I have not found any clinical/medical data confirming that human sweat is a vector.

 

[thief of fire]

CIDRAP released a report

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.
The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

 

[Nice Squirrel]

I used to give CIDRAP grant money.

 

[Valjean]

If droplet transmission weren't a possibility the workers wouldn't be wearing masks, much less N-95 masks, goggles or full filtration hoods.
If droplet transmission weren't a possibility the CDC wouldn't be recommending Standard, contact and droplet precautions.


http://www.americanthinker.com/2014/08/airborne_transmission_of_ebola.html

The public has been misinformed regarding human-to-human transmission of Ebola. Assurances that Ebola can be transmitted only through direct contact with bodily fluids need to be seriously scrutinized in the wake of the West Africa outbreak.

The Canadian Health Department states that airborne transmission of Ebola is strongly suspected and the CDC admits that Ebola can be transmitted in situations where there is no physical contact between people, i.e.: via direct airborne inhalation into the lungs or into the eyes, or via contact with airborne fomites which adhere to nearby surfaces. That helps explain why 81 doctors, nurses and other healthcare workers have died in West Africa to date. These courageous healthcare providers use careful CDC-level barrier precautions such as gowns, gloves, and head cover, but it appears they have inadequate respiratory and eye protection

 

[Rhea]

Talking about a deadly virus being brought to America from overseas just reminded me to wish you all a Happy Columbus Day.

 

[Jimmy Higgins]

If droplet transmission weren't a possibility the workers wouldn't be wearing masks, much less N-95 masks, goggles or full filtration hoods.
If droplet transmission weren't a possibility the CDC wouldn't be recommending Standard, contact and droplet precautions.


http://www.americanthinker.com/2014/08/airborne_transmission_of_ebola.html

The public has been misinformed regarding human-to-human transmission of Ebola. Assurances that Ebola can be transmitted only through direct contact with bodily fluids need to be seriously scrutinized in the wake of the West Africa outbreak.

The Canadian Health Department states that airborne transmission of Ebola is strongly suspected and the CDC admits that Ebola can be transmitted in situations where there is no physical contact between people, i.e.: via direct airborne inhalation into the lungs or into the eyes, or via contact with airborne fomites which adhere to nearby surfaces. That helps explain why 81 doctors, nurses and other healthcare workers have died in West Africa to date. These courageous healthcare providers use careful CDC-level barrier precautions such as gowns, gloves, and head cover, but it appears they have inadequate respiratory and eye protection

This is from the Canadian Health Department.

MODE OF TRANSMISSION: In an outbreak, it is hypothesized that the first patient becomes infected as a result of contact with an infected animal . Person-to-person transmission occurs via close personal contact with an infected individual or their body fluids during the late stages of infection or after death . Nosocomial infections can occur through contact with infected body fluids for example due to the reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids . Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals .


In laboratory settings, non-human primates exposed to aerosolized ebolavirus from pigs have become infected, however, airborne transmission has not been demonstrated between non-human primates . Viral shedding has been observed in nasopharyngeal secretions and rectal swabs of pigs following experimental inoculation.

I do not see where it says that airborne transmission is a transmission method.

 

[rousseau]

It keeps being mentioned in this thread that Ebola isn't much of a risk in more developed nations, but from the news I've been following it looks like the virus is absolutely out of control in Africa. So until the virus actually stops its course, or people aren't allowed to cross borders, I don't see how there's not at least a small risk of an outbreak elsewhere in the world.

We might be great at containing it when more money and resources are available to do so, but this must be one of the riskiest outbreaks since the arrival of HIV.

 

[Loren Pechtel]

It keeps being mentioned in this thread that Ebola isn't much of a risk in more developed nations, but from the news I've been following it looks like the virus is absolutely out of control in Africa. So until the virus actually stops its course, or people aren't allowed to cross borders, I don't see how there's not at least a small risk of an outbreak elsewhere in the world.

We might be great at containing it when more money and resources are available to do so, but this must be one of the riskiest outbreaks since the arrival of HIV.

There probably will be isolated cases in the western world. It's just that the multiplication rate will be well below one, we will have a few people dying, not an epidemic like we have in parts of Africa.

 

[Warpoet]

It keeps being mentioned in this thread that Ebola isn't much of a risk in more developed nations, but from the news I've been following it looks like the virus is absolutely out of control in Africa.

Yes, because many people in the countries affected have no concept or understanding of how diseases spread, and in particular the dangers of physical contact with the deceased; communal funerals in which the entire family washes the dead body with their bare hands, and then proceed to eat, also communally and with their bare hands, are clear and common methods of transmission. The WHO linked 300 cases -- 300 cases to one funeral alone, and almost two thirds of all cases in Guinea to similar circumstances. This is something that simply doesn't occur in the West. And the medical and sanitation infrastructure is either non-existent or worlds apart from any Western country. Note that Nigeria, which is still developing but possesses vastly better infrastructure than the three primary outbreak countries, was able to isolate the few people in the country who were infected and has not seen any new cases in over a month.

We might be great at containing it when more money and resources are available to do so, but this must be one of the riskiest outbreaks since the arrival of HIV.

It is of concern because of the high mortality rate, but it is not at all likely to spread in the U.S. as it does in Africa, just as HIV has not. And unlike HIV, it cannot be transmitted for years or even decades at a time. Yes, Ebola should merit a serious international response, but that was the case months ago, when it was just poor Africans dying from it and the media had a harder time scaring the shit out of people for ratings.

 

[Loren Pechtel]

Yes, because many people in the countries affected have no concept or understanding of how diseases spread, and in particular the dangers of physical contact with the deceased; communal funerals in which the entire family washes the dead body with their bare hands, and then proceed to eat, also communally and with their bare hands, are clear and common methods of transmission. The WHO linked 300 cases -- 300 cases to one funeral alone, and almost two thirds of all cases in Guinea to similar circumstances. This is something that simply doesn't occur in the West. And the medical and sanitation infrastructure is either non-existent or worlds apart from any Western country. Note that Nigeria, which is still developing but possesses vastly better infrastructure than the three primary outbreak countries, was able to isolate the few people in the country who were infected and has not seen any new cases in over a month.

Exactly. To stop it all you need is to get the multiplication rate below 1. That's not that hard, it doesn't take level 4 precautions. You need level 4 precautions to protect the healthcare workers, not to stop the epidemic.

 

[bilby]

Ebola is its own worst enemy. Patients are not infectious until they are symptomatic; and they usually die very quickly once symptoms appear. If few people are exposed to the sick and the dead, outbreaks die out very fast, as the hosts are killed faster than the virus can spread to new ones. Only when large numbers of people are routinely exposed to the corpses of victims is an epidemic likely. Unfortunately, the traditional funeral practices in parts of West Africa make such exposure routine.

 

[Toni]

If droplet transmission weren't a possibility the workers wouldn't be wearing masks, much less N-95 masks, goggles or full filtration hoods.
If droplet transmission weren't a possibility the CDC wouldn't be recommending Standard, contact and droplet precautions.


http://www.americanthinker.com/2014/08/airborne_transmission_of_ebola.html

This is from the Canadian Health Department.

MODE OF TRANSMISSION: In an outbreak, it is hypothesized that the first patient becomes infected as a result of contact with an infected animal . Person-to-person transmission occurs via close personal contact with an infected individual or their body fluids during the late stages of infection or after death . Nosocomial infections can occur through contact with infected body fluids for example due to the reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids . Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals .


In laboratory settings, non-human primates exposed to aerosolized ebolavirus from pigs have become infected, however, airborne transmission has not been demonstrated between non-human primates . Viral shedding has been observed in nasopharyngeal secretions and rectal swabs of pigs following experimental inoculation.

I do not see where it says that airborne transmission is a transmission method.

See the bolded part above. Aerosolized ebola virus from pigs has infected non-human primates in a laboratory setting. It hasn't been demonstrated in non-human primate to non-human primate or between humans but that suggests that it is possible. I have not clicked on the link to the Canadian Health Department but am trusting that the link is genuine and the research is sound.

 

[Toni]

Yes, because many people in the countries affected have no concept or understanding of how diseases spread, and in particular the dangers of physical contact with the deceased; communal funerals in which the entire family washes the dead body with their bare hands, and then proceed to eat, also communally and with their bare hands, are clear and common methods of transmission. The WHO linked 300 cases -- 300 cases to one funeral alone, and almost two thirds of all cases in Guinea to similar circumstances. This is something that simply doesn't occur in the West. And the medical and sanitation infrastructure is either non-existent or worlds apart from any Western country. Note that Nigeria, which is still developing but possesses vastly better infrastructure than the three primary outbreak countries, was able to isolate the few people in the country who were infected and has not seen any new cases in over a month.

Exactly. To stop it all you need is to get the multiplication rate below 1. That's not that hard, it doesn't take level 4 precautions. You need level 4 precautions to protect the healthcare workers, not to stop the epidemic.

What you also need is to educate and train all staff in heightened patient screening and interviewing processes, as well as in much heightened use of personal protection equipment and other precautions in dealing with patients who have suspected or confirmed cases of ebola. AND we must be judicious about lab tests ordered and performed and limit the scope of such testing to strictly as needed to avoid exposing lab workers who routinely use personal protective equipment but not respirators, etc. and who routinely handle MANY specimens every day. AND we must also do a better job of informing the public of the extreme importance of reporting symptoms after possible contact.

I think we would be insane to believe that we will have 100% compliance because people are human. Hubris, ignorance, and misinformation are the enemies.

 

[Loren Pechtel]

Exactly. To stop it all you need is to get the multiplication rate below 1. That's not that hard, it doesn't take level 4 precautions. You need level 4 precautions to protect the healthcare workers, not to stop the epidemic.

What you also need is to educate and train all staff in heightened patient screening and interviewing processes, as well as in much heightened use of personal protection equipment and other precautions in dealing with patients who have suspected or confirmed cases of ebola. AND we must be judicious about lab tests ordered and performed and limit the scope of such testing to strictly as needed to avoid exposing lab workers who routinely use personal protective equipment but not respirators, etc. and who routinely handle MANY specimens every day. AND we must also do a better job of informing the public of the extreme importance of reporting symptoms after possible contact.

I think we would be insane to believe that we will have 100% compliance because people are human. Hubris, ignorance, and misinformation are the enemies.

Of course we won't have 100% compliance. We don't need 100% compliance to stop the epidemic.

 

[RavenSky]

Talking about a deadly virus being brought to America from overseas just reminded me to wish you all a Happy Columbus Day.

 

[Toni]

What you also need is to educate and train all staff in heightened patient screening and interviewing processes, as well as in much heightened use of personal protection equipment and other precautions in dealing with patients who have suspected or confirmed cases of ebola. AND we must be judicious about lab tests ordered and performed and limit the scope of such testing to strictly as needed to avoid exposing lab workers who routinely use personal protective equipment but not respirators, etc. and who routinely handle MANY specimens every day. AND we must also do a better job of informing the public of the extreme importance of reporting symptoms after possible contact.

I think we would be insane to believe that we will have 100% compliance because people are human. Hubris, ignorance, and misinformation are the enemies.

Of course we won't have 100% compliance. We don't need 100% compliance to stop the epidemic.

I don't expect that there will be a widespread outbreak in the U.S. but I do expect that there will be more cases transmitted and diagnosed in the U.S. and in other countries outside of Africa.

 

[barbos]

Second medical worker in Texas tested positive.

 

[Valjean]

Of course we won't have 100% compliance. We don't need 100% compliance to stop the epidemic.

Agreed. The chances of an epidemic in developed countries is vanishing small. On the other hand, I think the risks of transmission to us healthcare workers is being underplayed.