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Observing Ebola and some thoughts (not fears)

Note: I am not personally afraid of Ebola. I don’t think even this outbreak will reach the level of pandemic. I worry about the people in the west African nations  who ARE personally affected. I admire the people who have gone there to fight for them.  But, I have to admit to being fascinated by the spread of this disease, the details surrounding it and the affect two cases of Ebola have had on our hospitals and health care system. Also, I think it’s fascinating. I do.

So, what do we know?

UPDATE: Here is the full statement from National Nurses United:

 Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United

Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.

Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.

Patients who may have been exposed were one day kept in strict isolation units. On the next day were ordered to be transferred out of strict isolation into areas where there were other patients, even those with low-grade fevers who could potentially be contagious.

Were protocols breached? The nurses say there were no protocols.

 Apparently the nurses who treated Thomas Duncan didn’t where those “Moonsuits” while exposed to him. Monday evening I saw this video of Gupta suits up in Ebola protective gear according to the CDC protocols.  As you will see it’s lucky he was covered in chocolate sauce and not Ebola vomit: http://www.cnn.com/video/data/2.0/video/health/2014/10/14/sgmd-gupta-ebola-suit-demo.cnn.html.I’m glad I saw this before I heard the statement from National Nurses United (discussed below) — it made it MUCH easier to follow the details:

Nurses’ union slams Texas hospital for lack of Ebola protocol, by Catherine E. Shoichet, CNN

Here’s a look at some of the allegations the nurses made, according to the union:

Claim: Duncan wasn’t immediately isolated

On the day that Duncan was admitted to the hospital with possible Ebola symptoms, he was “left for several hours, not in isolation, in an area where other patients were present,” union co-president Deborah Burger said.

Up to seven other patients were present in that area, the nurses said, according to the union.

A nursing supervisor faced resistance from hospital authorities when the supervisor demanded that Duncan be moved to an isolation unit, the nurses said, according to the union.

Claim: The nurses’ protective gear left their necks exposed

After expressing concerns that their necks were exposed even as they wore protective gear, the nurses were told to wrap their necks with medical tape, the union says.

“They were told to use medical tape and had to use four to five pieces of medical tape wound around their neck. The nurses have expressed a lot of concern about how difficult it is to remove the tape from their neck,” Burger said.

Claim: At one point, hazardous waste piled up

“There was no one to pick up hazardous waste as it piled to the ceiling,” Burger said. “They did not have access to proper supplies.”

Claim: Nurses got no “hands-on” training

“There was no mandate for nurses to attend training,” Burger said, though they did receive an e-mail about a hospital seminar on Ebola.

“This was treated like hundreds of other seminars that were routinely offered to staff,” she said.

Another post covering this topic, No hospital ‘protocols’ for Ebola treatment: US nurses’ group by MICHAEL LANGAN (AFP) has a little more information:

Deborah Burger, the NNU’s co-president, said Duncan’s lab samples were sent in the hospital tube system “without being specifically sealed and hand delivered,” Burger added.

“The entire tube system was potentially contaminated,” she said.

“There was a lot of confusion about (gear) protocol, and frequent changing of instructions.”

The nursing staff said that they were directed to wear standard or generic hospital gowns that are flimsy and could be permeated or ripped.

They also complained that they were advised to use surgical masks, not the plastic welder-type shield mask considered a best option.

And while they wore protective gloves, parts of their heads and necks remaine exposed, she explained

DeMoro pointed the finger not just to the Texas hospital where Pham worked, but at the US health care overall.

It “is a chaotic system,” she said.

If I can find the complete transcript, I’ll add it here because it was an extensive and damning list.

It makes complete sense to me that a hospital, any hospital, wouldn’t be prepared for an actual Ebola patient. The chances have been pretty good for several months that some hospital would get an Ebola patient but predicting which one would have been impossible in advance. However, I am pretty shocked to learn that there’s no “infectious disease kit” that could be sent to a hospital faced with an outbreak something like Ebola. How hard would it be for the Centers for Disease Control (CDC) to stock sufficient emergency supplies that could be sent overnight to any hospital — including a couple of experts.

The nurses statement says that Duncan was left in an area with several other patients for hours before he was isolated. That was bad enough but, things went downhill from there. Couldn’t the Centers for Disease Control (CDC) send an expert to Dallas during those hours? I’m not a medical person but, it seems like the CDC should have a contact list of people – maybe from the US hospitals that have already treated Ebola patients who could help local hospitals control outbreaks of diseases.

So what else do we know?

Nurses wrapped tape around their necks to protect them. (I can’t even control tape on a Christmas present! What would I do if I had to work with Ebola drenched tape after a shift in Duncan’s room?)

Duncan’s lab samples were sent through the tube system without being protected! (I didn’t even know they sent lab samples through tubes, much less Ebola samples!! That’s just gross)

These are some thoughts from a non-medical reader. Again, I’m not afraid. And I don’t think the above issues mean we’ll get an epidemic here.

32 Responses

  1. Now CNN is trying to figure out how to decontaminate an airplane.

    • fumigating it with chlorine gas should work. Heck, they probably don’t even have to do that. The virus dies on its own after a few hours. And the nurse wasn’t even that infectious. It’s the human vectors we need to worry about not whether we have to autoclave seats 19a through 31d.

  2. Now, can we be afraid? We are trusting people to use common sense. Why did this health care worker get on a plane?

    Why did Dr. Nancy Snyderman, who was under quarantine, go out to get soup?

    Why did the CDC not send people to that hospital in TX immediately?

    Again, we’re relying on common sense; something that seems to be lacking these days.

    • Ebola seems relatively self-containing. I think we’re still way into interesting – not scary – territory. But, we are learning a lot about how mushy our systems are.

      What I think IS scary is what if something REALLY contagious starts getting momentum. …. How to we contain that?

      Now that I know the nurses weren’t really covered up, I’m not as afraid as I was thinking that maybe I should be. I mean, if things were THAT sloppy at the Dallas hospital, it’s a wonder they don’t have 25 or more Ebola patients.

      I think Riverdaughter had the answer to the question about why the CDC didn’t send someone to Dallas right away. Sequester.

      • I really don’t believe that you can blame the Sequester for members of the CDC not going personally to TX. I’m not following that logic. Are you saying that there wasn’t enough money for them to fly there and give them direct orders on how to contain this? I’m not trying to be argumentative, but I’m being skeptical. Also, the Washington Post gave that story of it being the Republican’s fault, four Pinocchios. It’s time we stop blaming both sides. I just want people to start using some common sense.


        I also cant believe that the CDC is sending out tweets to people on that flight from Ohio. Can’t they get the manifest and notify those people?

        • See my comment below. The CDC already has a lot on its plate. Yeah, flying may have been a budget problem. Sometimes, travel expenses are so restrictive that officials have to drive themselves.
          And I do blame the sequester. But it was only the latest insult. Budget cutting has been reckless for years.
          If you believed the Republican mantra that government needs to be smaller, well, this is a tangible result. Republicans should stop trying to make excuses and own it. This is what happens when you ignore and undermine your research sector,
          If they didn’t mean for this to happen, they shouldn’t have been so viciously ruthless about it. They’ve put all our lives at risk.

        • And, of course, the Democrats voted for the sequester, too. So four pinocchio’s might be appropriate when blaming only Republicans…BUT, blaming the sequester is probably dead right (er, I mean, right).

          • Yeah, Democrats thought they were being clever because who in their right mind would be so determined to cut the budget that they would voluntarily cripple the nation’s disease fighting institutions.
            Democrats completely underestimated just how crazy republicans are.

      • And you would think that with an infection this serious, the hospital would have behaved in a more professional manner. Besides, there are teleconferences, videos, phone calls, Internet. The CDC doesn’t have to be there to be there. On top of that, flying Duncan to Emory would have meant getting a sponsor. Both kent Brantley and nancy writebol were flown out of Liberia on specially equipped planes and those trips were underwritten by Samaritan’s Purse. It’s nice to see them offering their blood to give back. But you can see the problem. Who was going to be Duncan’s sponsor? Even the CDC doesnt pick up the tab and they probably couldn’t even if they wanted to.
        In the end, I think it’s going to be about money. You heard it here first. The “best health care in the world” is no match when it comes to the bean counters and shareholder value.

        • Of course it’s about money.

          The USA is (mis)governed according to the Capitalist Shahada: “There is no god but Mammon, and Ayn Rand is his prophetess.”

  3. But, if you will remember correctly, the President was at a press conference at the CDC in Atlanta, in mid September, saying that it was highly unlikely that it would be coming here.

    Instead, they should have been sending out warnings to the hospitals! It sounds like everyone was caught off-guard.

    Then, we read this:

    “We will from this moment forward ensure that no other individual who is monitored for exposure undergoes travel…” – CDC’s Frieden.

    Again, where is common sense??? Shouldn’t we have banned travel immediately? Why does it always seem like we’re behind the 8 ball?

    I come to this site because I know your background. I’m not coming here to see you blaming sequestration. Common sense doesn’t cost money.

    • I think it’s pretty obvious that common sense didn’t have a role in any of this. For example that whole thing about sending lab samples through a tube system. Even without Ebola in the picture, that’s insane.

      And did you see the get-up that Gupta put on while demonstrating the so-called protocols? It looked like it was made of paper.

      • I just read an article at the Boston globe about nurse number 2. The paper says that the nurses reported that Duncan WAS left in an open area of the emergency room before he was transferred to isolation. I’m sorry, we have to stop blaming the CDC now. This is all on the hospital’s head. The bourses must have been very concerned to go over the head of their management to tell what really happened.
        Just think about that for a moment. A fatally Ill Ebola patient sits in the er experiencing vomiting and diarrhea while other patients are present and it takes the hospital 90 minutes to get around to admitting him. That’s 90 minutes of getting up to use the common toilet, 90 minutes to aerosolize sweat and vomit, 90 minutes to infect sick patients around him and anyone who sat down on the areas where he had been.
        There’s nothing the CDC could have done to prevent such incredible stupidity. I’m surprised there are only two other cases so far. This is inexcusable.

        • Yep, I mentioned in my post – the quoted section – that he was in an area with other patients (7 or more) for HOURS. Hours of that. Long enough for someone who knew what was going on to get there from pretty much anywhere in the country and whip them into shape.

          I don’t get it…. Were the administrators (including floor supervisors) so out of touch they didn’t know what they were dealing with?

          That hospital need a health-audit and a heavy fine.

          I don’t mean to blame the CDC. What I am saying though, is that we keep seeing their Director answering questions — he’s the public face of the Ebola Response in the US. I’ve listened to almost all of his public statements and conferences. He talks and talks. So people like me are assuming he was the go-to guy … or that the CDC was right in the thick of things.

          But (you’re right), it doesn’t sound as if the CDC had anything to do with the Dallas Hospital. They didn’t contribute a thing.

          Is that how it should have been though?

          • Do you know if anyone from the CDC has shown up at the hospital, at any point?

          • Not a hint of it. Have you?

          • no

          • Josephus weeks, Duncan’s nephew called the CDC about his uncle’s treatment. They instructed him to call the Texas board of Heath to get the ball rolling. So, weeks did the right thing, CDC passed it off to Texas board of health, which presumably had local authority and knew how to handle infectious disease. We have to conclude that the hospital fucked up. I’m betting that the hospital did nothing until the Texas board of health told them they had to.
            Money. I’m still thinking it’s all money related.

          • To me, it sounds like the cdc expected the Texas board of health and the hospital to have their act together. I don’t think this was an unreasonable assumption. I’m going to guess that the exposures happened at the beginning of the crisis when the hospital was still in denial.
            Not sure who provided the antibody test for Ebola. Was it Texas or was it the cdc?

          • Nytimes reports that the cdc team arrived in Dallas on or about October 1.

  4. Can I just say that everyone in the world seems to be behind the 8 ball, including the WHO.

    What is also troubling is the number of Drs./health care workers that have caught it and died. Don’t tell me that they didn’t know the protocols.

    Then, there was the nurse in Spain, who said that she wore the proper protection.

    My heart goes out to everyone that has been affected. Think about all those people on the flight from Ohio, and their families. They might not come down with it, but that incubation time will be terrible for them and their families.

  5. Please, RD, tell me, does this make any sense?:

    Dr. Tom Frieden, director for the Center for Disease Control and Prevention (CDC), said during a telephone press briefing Wednesday that you cannot get Ebola by sitting next to someone on a bus, but that infected or exposed persons should not ride public transportation because they could transmit the disease to someone else.

    • Yes.
      You can be infected but not showing symptoms. But you will become contagious the minute your body’s defenses start to become overwhelmed and begin to fight back. There’s no knowing when the infected person will reach that point. It can take up to 21 days. If you’ve ever had food poisoning, you know how quickly that can manifest itself. One minute your fine, the next minute you’ve lost your cookies. So, it’s a good idea to stay away from buses. Because one minute you’re feeling a little under the weather, the next you’re potentially contaminating the whole bus.

  6. Do we believe then, after Obama said this, that the hospitals were prepared. I’m sure, like the nurses union backing their employees, the hospitals will speak up if this wasn’t really the case.

    President Obama, addressing the ebola outbreak September 16, 2014 at the Centers for Disease Control and Prevention in Atlanta:

    First and foremost, I want the American people to know that our experts, here at the CDC and across our government, agree that the chances of an Ebola outbreak here in the United States are extremely low. We’ve been taking the necessary precautions, including working with countries in West Africa to increase screening at airports so that someone with the virus doesn’t get on a plane for the United States. In the unlikely event that someone with Ebola does reach our shores, we’ve taken new measures so that we’re prepared here at home. We’re working to help flight crews identify people who are sick, and more labs across our country now have the capacity to quickly test for the virus. We’re working with hospitals to make sure that they are prepared, and to ensure that our doctors, our nurses and our medical staff are trained, are ready, and are able to deal with a possible case safely.

    • I guess he didn’t count on our unfettered free enterprise system. Just wait. I’m betting there is something the hospital doesn’t want you to know.

  7. I’m heading back to lurking. I enjoy your gardening posts, and thank you for the link to Titli’s Busy Gardening. Sometimes, it’s just nice to get away from politics and the blame game. Life is short. Enjoy PA. (my mother grew up a little South of you, near Uniontown.) Some of my fondest memories are visiting my grandfather there.

    • Funny, shouldn’t you vote for a politician based on the outcome of their policies? If you don’t hold th accountable because you find it distasteful and impolite, what’s the point of voting in the first place? Why not just let the leaders of the respective parties appoint representatives and do away with all the accountability stuff? Why bother making policy at all?
      Hey, I think Congress really screwed up with the sequester. I’ve seen what it does to research with my own eyes. Ignore it at your peril.

      • Yikes, I said I was going to head back to lurking, but here I am responding. I did get very involved in ’09. It wasn’t til after the financial collapse, and my son’s enlisting, that I thought I needed to pay more attention.

        I jumped in with both feet, walked parades, door to door, made phone calls, attended fund raisers, etc. One day, it dawned on me that the system is corrupt. The money and high-powered people are controlling everything.

        I like to read Naked Capitalism and Zero Hedge. The money, lobbyists, etc. control everything. No need to rehash all the promises that were made and broken by the politicians. Sorry to be so cynical.

        I still try to stay informed, but most of my friends hate politics, my husband included. I like to have civil conversations, and understand both points of view. I read, watch, listen to both sides. That’s why I visit your site. I very seldom agree, especially when it comes to your distaste in religion, but I admire your writing, and try to understand where you’re coming from.

        I’m just sorry that we’re leaving this mess to future generations.

  8. There is no american healthcare “system.” It’s all pieces and parts and the patient has to stitch together a plan and a schedule, and the records scattered here and there. I know from more experience than I would have chosen to acquire. And, no one, no piece or part, is responsible for anything, which is the beauty of chaos: you can’t pin down anyone or anything. Works perfectly as designed.

  9. The CDC may or may not be blame-worthy, but they certainly are good at implicitly blaming victims. This morning, the headline was that the 2nd nurse “should never have flown”. But dig a little deeper and you find that the CDC gave her permission to fly!!!


    For not being blameworthy, the CDC is certainly doing an amazing job of attempting to get out in front and pre-shift blame.

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