Wednesday, October 15, 2014

Should we be worried about Ebola?

I'm not, yet, but the emerging scene in Dallas isn't particularly reassuring:
A second Texas health care worker who provided care for Ebola victim Thomas Eric Duncan has contracted the virus, according to preliminary test results released early Wednesday. The worker reported a fever Tuesday and was immediately isolated at the Texas Health Presbyterian Hospital in Dallas, state health officials said in a statement. Confirmatory testing will be carried out by the Centers for Disease Control and Prevention in Atlanta. "Health officials have interviewed the latest patient to quickly identify any contacts or potential exposures, and those people will be monitored," the Texas Department of State Health Services said. "The type of monitoring depends on the nature of their interactions and the potential they were exposed to the virus." It is the third case diagnosed in the U.S.
Oh, and do you remember the earlier reporting that the first nurse who contracted Ebola wasn't following protocols? Well, it's hard to follow protocols that aren't really protocols:

Also Tuesday, National Nurses United made troubling allegations about the hospital, claiming "guidelines were constantly changing" and "there were no protocols" about how to deal with the deadly virus."

"The protocols that should have been in place in Dallas were not in place, and that those protocols are not in place anywhere in the United States as far as we can tell," NNU Executive Director RoseAnn DeMoro said. "We're deeply alarmed."

Protective gear nurses initially wore left their necks exposed; they felt unsupported and unprepared, and they received no hands-on training, union co-president Deborah Burger said.

A Texas Health Presbyterian spokesman did not respond to the specific allegations, but said patient and employee safety is the hospital's top priority.
NNU is a labor union, so they have another agenda in making these charges. That doesn't necessarily mean the charges are incorrect, which the CDC folks are now beginning to admit:
The Centers for Disease Control and Prevention says it's moved a team of experienced experts in to help a Dallas hospital where a nurse became infected with Ebola to improve "every step in the process." And they'll send in a special response team to help any hospital in the future that gets an Ebola patient.

The team will help workers there improve their techniques for safely caring for Nina Pham, who was infected while herself caring for Thomas Eric Duncan before he died.

"The first and most important is ensuring that every hour of the day there’s a site manager there who is overseeing aspects of infection control," CDC director Dr. Tom Frieden told a news conference. One thing the site manager will do is make sure someone spots workers as they put on and take off personal protective equipment (PPE).

And he promised any hospital that receives an Ebola patient that CDC will help with a special response team. "We will put a team on the ground within hours with some of the world's leading experts on how to take care of and prevent health workers form Ebola virus infection," Frieden said.

"I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection," Frieden added. "But we are prepared to do this in the future with any case anywhere in the U.S."
So imagine a scenario where you have an Ebola patient in Seattle, Salt Lake City, Topeka, Milwaukee, Louisville, Tallahassee and Providence. Do we have enough people who are trained properly to handle such a scenario? And would we have the right equipment and facilities in place? A lot hinges on the answers to such questions. And thus far, the answers we've been getting aren't particularly reassuring.

6 comments:

Gino said...

so... the Rx pros who took care of the sick african guy are getting infected, but none of the family he lived in close quarters with are?

an aside: State has determined that those who's visas are expired will not be repatriated to their ebola countries of origin, and will be granted humanitarian asylum...
yet, we still accept incoming flights from these countries. if it is too dangerous to send people back, its too dangerous to allow them here, too... so i would think.

all i know: i'm not believing anything this govt tells me... i think they hiding something.

Brian said...

Gino: the health care pros came into regular contact with the patient's blood. The difference between that and mere proximity aren't trivial.

There have been 3 people infected outside of west Africa, two at the same hospital (the other is in Madrid). 8 other hospitals are treating patients in the US, UK, France, Germany, and Norway that all have a transmission rate of zero. We should not over interpret such a small set of anecdata, but the best explanation so far is that TX Presbyterian just wasn't as good at implementing enhanced bio safety protocols.

We'll know for sure in a couple of weeks if this thing is easily contained in the west. I suspect that it will be.

I am more worried about the drain on hospitals a disproportionate panic about Ebola is likely to cause when flu season starts in earnest.

Gino said...

Brian: i hear ya, the blood and all. and i'm also hearing it could be spread with any moist contact: sneezes, vomit, feces...

and then there is the humanitarian non-deportations. its too dangerous/contagious... but not really?

competing agendas maybe?

i suspect its more contagious than some are letting on, but not as contagious as others are claiming.
i dont know what to believe, actually.

i do know one thing for sure: i'm going to avoid travel to west africa (and TX Presbyterian) til this thing blows over...

Gino said...

shephard smith just laid it all out on FNC just a few minutes ago... i fell better about the whole thing now. (he also called out politicians on both sides for creating a climate of fear.)

i hope it gets replayed over and over.

Mr. D said...

I am more worried about the drain on hospitals a disproportionate panic about Ebola is likely to cause when flu season starts in earnest.

That's a good thing to worry about.

Bike Bubba said...

I'm also hopeful that we're going to handle it, but it's worth noting that the Firestone plantation in Liberia managed to control it there with an effective quarantine.

It's also worth noting that nurses at the facility in Texas were more or less saying that not too many protocols were communicated to them. So it would appear that the spread of the disease has a lot to do with someone at the CDC not communicating to them how to handle it.