Patterico's Pontifications

10/12/2014

Nurse Who Treated Ebola Patient Tests Positive for Ebola; CDC Claims Unspecified “Breach of Protocol”

Filed under: General — Patterico @ 10:27 am



A nurse who treated the late Ebola patient Thomas Duncan has tested positive for Ebola — but your friendly federal government hastens to assure you that it’s her own fault:

The director of the Centers for Disease Control and Prevention said a “breach of protocol” caused a health care worker at a Dallas hospital to preliminarily test positive for Ebola.

The health care worker, a female nurse at Texas Health Presbyterian Hospital, had “extensive contact” on multiple occasions with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., who died last week, Dr. Tom Frieden said in a press conference Sunday.

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 particular nature of the “breach of protocol” has not yet been announced. My guess is, they haven’t even identified one yet.

Wait: what is Patterico saying here?

I’m just going to come right out and say it: I don’t believe them. By saying that, I’m not saying it’s impossible they’re wrong. I’m just saying: I believe they would say this whether it’s true or not — because as a political matter they want to avoid panic and/or blame for Ebola. And we have seen many times before that they will say any old thing that benefits them politically, and the truth of the matter be damned.

Maybe someone from the federal government gave her bad advice. It wouldn’t be the first time; Obama just got through contradicting the CDC in an address to West Africans:

“First, Ebola is not spread through the air like the flu,” Obama said in the video released by the White House Thursday. “You cannot get it through casual contact like sitting next to someone on a bus. You cannot get it from another person until they start showing symptoms of the disease, like fever.”

Yet, as CNS News noted, the CDC’s advice to people returning from Liberia includes avoiding sitting next to people on the bus:

Limit your contact with other people when you travel to the doctor; avoid public transportation.

Thanks to daleyrocks for this image:

Screen Shot 2014-10-12 at 10.09.43 AM

It may not be entirely fair, but a lot of what Obama does to us isn’t fair at all — from ObamaCare to the IRS scandal to lying about countless public issues. So in that sense, yeah. It’s perfectly fair.

Prayers for this nurse as we await specifics from your friendly federal government on what she did to deserve this.

P.S. There is no possibility that the protocol is deficient in some way, citizen. The federal government developed the protocol and it is perfect. Logically, therefore, if a nurse was infected, she failed to follow the protocol. Because the protocol is perfect.

175 Responses to “Nurse Who Treated Ebola Patient Tests Positive for Ebola; CDC Claims Unspecified “Breach of Protocol””

  1. Ding.

    Patterico (9c670f)

  2. we’re all gonna die!

    redc1c4 (a6e73d)

  3. P.S. There is no possibility that the protocol is deficient in some way, citizen. The federal government developed the protocol and it is perfect. Logically, therefore, if a nurse was infected, she failed to follow the protocol. Because the protocol is perfect.

    Patterico (9c670f)

  4. Does anybody else sit scratching their heads, wondering why a fully suited up healthcare worker observing absurd levels of “abundance of caution” hits the Ebola jackpot, when relatives, friends, and children around him for more than a week—so far—are symptom free? The same thing happened in Spain. There’s something going on here that nobody seems to have figured out yet. As somebody who’s watched the 4 part mini-series The Stand, like maybe 50 times, I’m not so sanguine about reassurances from the powers that be.

    Jack (ff1ca8)

  5. I’m anxiously awaiting a finkbomb of information considering Sammeh’s well-informed comments were so on target! Winning!!! Tiger’s blood minus ebola!!!!!!!

    hadoop (f7d5ba)

  6. CDC is a little too invested in its protocol’s adequacy, if it resorts immediately to logical fallacy in the absence of facts.

    It may be the protocol is inadequate. It may be that shields need to be destroyed, not disinfected.
    It may be that tyvek or tyvek suit seams are too permeable to afford adequate protection, despite protocols assuming they are adequate.
    It may be that the gear peel-off procedures need new steps.

    It may be that masks were re-used or the filters or seals need new specifications.

    SarahW (267b14)

  7. A former ICU nurse musing on possible transmission…
    Only speculating, but the news reports state that this nurse had a lot of contact with Duncan. If he was on a ventilator and required suctioning then perhaps there was more aerosolization of the virus and it was transmitted more easily. Also, as he got sicker, the viral load rose, thus viral shedding increased and made her risk higher than that of his family members.

    cardio np (de0c0b)

  8. hadoop. “Speak of the devil and he shall appear”.

    felipe (40f0f0)

  9. “It may be that the gear peel-off procedures need new steps”.

    I’d say that this is the best place to start. And then check out all of the rest.

    felipe (40f0f0)

  10. Not to mention gloves with micro-tears.

    PS I needed a TV ultrasound earlier this year. The transponders cannot be put in a sterilizer, and cheats on disinfection are a health-care industry problem. http://abovethelaw.com/2013/01/the-five-second-rule-does-not-apply-to-vajayjays/ The manufacturer-provided sheaths are notorious for breaking. Guess who brought her own latex-free condom, required double sheathing – and insisted that the operator wash her hands before touching the wrapper.

    SarahW (267b14)

  11. I mean obviously, there is room for human error and it doesn’t take much with Eboleee. But some of that error could be the CDC’s.

    SarahW (267b14)

  12. cardio np (de0c0b) — 10/12/2014 @ 11:01 am

    I hadn’t even considered suctioning putting contagion into the air. But she could have been working in a mist, couldn’t she?

    SarahW (267b14)

  13. And why are “we” sending American soldiers to Liberia? Furthermore, why are Liberians still admitted to this country?

    DN (395a7b)

  14. Yes, suctioning can produce a fine contaminated mist – not sure a HEPA filter of any type would help in this situation.

    felipe (40f0f0)

  15. DN, because the President allows commands it.

    felipe (40f0f0)

  16. The CDC is not reliable because, like all other federal agencies, it has been politicized. They spend millions on gun control. The possibility of airborne transmission is an obvious question or why are the workers using space suits ? This is a worrisome development that I was worried about a month ago.

    Allowing continued air travel into the US is an obvious political decision that is a weakness. We already have a retired general who is worried about what will happen if Ebola reaches Central America

    The country is in the best of hands.

    Mike K (90dfdc)

  17. Sorry for the fuzziness of the bumper sticker.

    I’m thinking that treating an ebola patient might be sort of like cooking bacon naked. If you’ve done it once, you may not want to do it again, but that’s just me. YMMV.

    daleyrocks (bf33e9)

  18. #13, DN: It all stems from an early childhood experience of the EarLeader. Thru a series of miscommunications he came to believe that Marines were corpsemen, and so when he learned that the frontline healthcare providers were also corpsemen, he naturally assumed that the military was full of people with deathwishes. The rest follows logically.

    bobathome (2aebbb)

  19. I am reminded of “President” Morgan Freeman in the movie Deep Impact, where he gives a series of addresses to the nation about how we are going to deal with the huge approaching asteroid.

    There’s Plan A. It doesn’t work.
    There’s Plan B. It doesn’t work, either.
    There’s Plan C. It makes everything worse.

    Plan D is “We VIPs have got shelters we’ve been secretly preparing. Good luck to the rest of you.”

    Kevin M (b357ee)

  20. IMHO (briefly, go to go)
    When one hears hoofbeats, think horses when in America. The experience of 40 years of treating Ebola informs us of what to do, and we should focus on doing it, which we aren’t, rather than postulate other things that generally distract us.

    MD in Philly (f9371b)

  21. Only speculating, but the news reports state that this nurse had a lot of contact with Duncan. If he was on a ventilator and required suctioning then perhaps there was more aerosolization of the virus and it was transmitted more easily. Also, as he got sicker, the viral load rose, thus viral shedding increased and made her risk higher than that of his family members.

    Then they should have been using BLS4 protocols if there was any chance of aerosolization. Inexcusable! If she has it because of such an oversight, someone should be fired!

    hadoop (f7d5ba)

  22. The underlying (ha!) theme is that many people no longer trust this fine government of ours.

    I kind of knew this would happen. These people in office are typical academics hybridized with Chicago thug politico types. I have direct experience with both, and fully expected what is happening now.

    So whenever I hear how “the two sides are the same” or “my vote doesn’t matter” or similar things, I come back to our current state of affairs.

    Even some folks on this side of the aisle helped make all this happen. I don’t expect people to admit that outright, but you know—given the past six years—that I’m right.

    So please, please, please don’t let it happen again.

    Even if you think you will lose, vote. It’s better than snark. And despair remains a sin.

    Simon Jester (c8876d)

  23. I’m starting a new job and may not be able to make it to the polls. I’ve already received my mail in ballot. Who knows if they’ll count it though.

    hadoop (f7d5ba)

  24. These people in office are typical academics hybridized with Chicago thug politico types. I have direct experience with both, and fully expected what is happening now.

    Aye. Academics are not typically stand up guys and are commonly shifty and supercilious when they cannot answer a challenge (compare the performance of the North Carolina Bar to that of the faculty of Trinity College at Duke University in that messy ‘rape’ case in 2006, or compare the Bar’s performance with that of the New York Times editorial staff). As for the Obama political apparat, the pundit who said it’s Potemkin villages all the way down with these people had the right idea.

    Art Deco (ee8de5)

  25. It’s beyond not believing the feds. We don’t know if the CDC is PC, nor naive nor following orders for The One to keep him in the best light. We also know Frieden was the NC commissioner who was more worried about soda, salts and transfats than actual diseases that could kill you when he was NYC Health Commissioner; PC nonsense. And worse increasingly don’t think the CDC nor any medical authority is completely sure how ebola is transmitted. The fact they won;t discuss the “protocol” does;t give you any confidence.

    Bugg (f0dbc7)

  26. Hey, maybe if they can scare enough people about ebola transmission in the next couple weeks there will be more absentee ballots cast and a lower turnout of actual voters at the polls on Nov.4. What could possibly go wrong?

    elissa (35f4ae)

  27. I wonder if there is any application of the irradiation methods used commercially to kill pathogens and viruses in/on food and medical instruments in fighting Ebola. If so, it would beat trying to handle or decon a virus spread by fluids with cleaning fluids…

    crazy (cde091)

  28. I think you are on to something, elissa.

    felipe (40f0f0)

  29. I think if you scream real loud, the “tingle” releases a protein sheath stripping substance that eradicates any virus – Vincent Price said so.

    felipe (40f0f0)

  30. oops! “tingler”

    felipe (40f0f0)

  31. OK speaking as someone who was a Hazmat technician, I’m sure they are not following the protocol that we were trained in. First when you exit the contaminated area, which would be the patient’s room in this case, you step into a decon basin. That was usually a plastic kiddie wading pool. Then the second person who is on guard at the door, washes you down with a decon solution. Probably bleach in this case, while you are still wearing your protective gear.

    You make certain that your outside pair of gloves is washed down. The you step into a second basin and while the eagle eyed monitor watches you peel off your protective gear in a definite order. This is designed to keep you from contaminating your body with whatever it was that you were exposed to. There is a chair inside the basin for you to sit in. As you pull a leg out of the suit you put that foot outside the second basin for example. There is a specified way to peel off gloves, and you wear at least two pairs.

    This obviously gets expensive fast, it ties up a second person as a monitor, and anything you were wearing with the exception of a self contained breathing apparatus, or another type of respirator (if you had one) are discarded. As Bio Waste in this circumstance. Respirators are cleaned following their own protocol, straight into a gas autoclave would be my guess in this case.

    There is no way that they are following anything like this, otherwise people would not be getting contaminated. And obviously this cannot be done in Africa for lack of training and lack of supplies.

    agesilaus (73e938)

  32. I’m perfectly willing to say we cannot trust our government spokespeople.

    That said, we are wasting time and effort, I am wasting time and effort, focusing on relative nonsense. (And I will soon apply this to the other health-related thread as well).
    For example, a lot of the fuss so far has been about:
    1) the danger of letting Brantley and others back into the country under the strictest of precautions directly to units specially equipped to handle them
    2) whether or not it is airborne and such

    In the meantime, there are quite a few ^%^$%%*%^&$%^T*%#$#&!!!! things that are a bigger priority and would actually help:
    For example, the very knowledgeable and concrete suggestion that maybe precautions need to be rethought about people on a ventilator, if indeed that is the scenario where the nurse contracted the illness. Perhaps that was the first time somebody with Ebola ever had access to a ventilator in the history of the disease (one reason to treat a person in a developed nation rather than an under-developed part of Africa). This also would have been a real good time to think about the frickin’ experience with the Reston variant and the suggestion that under lab conditions aerosols could spread the disease, rather than having to deal with speculation that people on a plane or bus are going to get it from breathing the same air.

    Another example, unless things have changed in the last few years since I was in such circles, “they” have already established medical centers that are supposed to handle not only exotic diseases like people with Ebola getting off of a plane, but to handle victims of biological warfare, including smallpox. In Philly this is/was Univ. of PA Hospital because it was the major medical center with the shortest and most direct ambulance ride from the airport.
    So, rather than arguing about the extremes of “it could not come here” and to “everyone is gonna’ die!”, perhaps some clear thinking should have said, “If we can’t ASAP transport someone to one of the 4 especially equipped facilities, let’s ASAP send people to the regional centers that are supposed to deal with this stuff already.”

    I’m frustrated by my own inability to think of the obvious while messin’ with the speculative.

    MD in Philly (f9371b)

  33. It’s easy to be paranoid, and who can blame a person for feeling that way.

    But there is a long history of what works and what doesn’t with hot pathogens.

    There is nothing good about another case…other than the fact that folks will now be very very careful about contact with such patients.

    Keep in mind that there are many health care professionals, without money or equipment, working with Ebola patients in Africa who do NOT get the disease.

    I honestly don’t think that the disease is being passed via droplet aerosols. This is the first time in a long time that folks have had to deal with a hot pathogen in this country. Remember SARS in Canada?

    It’s time to tighten up a lot of things in this nation.

    Simon Jester (c8876d)

  34. MD makes good points.

    Simon Jester (c8876d)

  35. agesilaus (73e938) — 10/12/2014 @ 12:44 pm

    Thank you for your educated and experienced insight.
    Actually, before this recent outbreak got out of hand, what you describe is exactly how they did it. In fact, the second American that got it had the job of being in gear herself and washing down people with bleach as they came out of the contaminated area. This is why over the years the medical people who get it are the locals who are exposed before they realize what it is, and NOT the Doctors Without Borders people who come in to deal with the outbreak once recognized. (Recently a DWB/MSF worker did get it, I’m thinking ion part because they must have a bunch of new recruits not fully proficient, unless the worker got it from an unknown exposure outside of the ward, as the other American medical staff are assumed to have contracted it).

    Common sense should have prevailed, “Yes, it is possible for it to come here, in fact, we have had hsopitals designated to respond to such a scenario for years, we’ll send them there. Heck, if they are supposedly trasined to handle smallpox, whnat’s a little Enbola gonna’ do?”

    But no, common sense doesn’t prevail, not in the government, not in the media, not in the public, and sometimes not in my own posts!!!!!!!

    MD in Philly (f9371b)

  36. You’re thinking logically MD, something that is short supply with a CDC that’s busy checking salt content and ammunition clips, the EPIC data collection system that is substandard at best,

    narciso (ee1f88)

  37. Thanks, jester,
    And I said previously to expect additional cases, if history teaches us anything.
    That it was a nurse who should have been taking precautions surprises me, but unfamiliarity with the procedures, or the additional risk of the use of a ventilator not being thought about in hindsight is perfectly logical.

    off to another thread…

    MD in Philly (f9371b)

  38. Well, narciso, I think there is an anti-common sense virus going around, attacking people out of their device screens, because it’s not only the CDC that is affected.

    MD in Philly (f9371b)

  39. Are we sure this is a health care worker who was caring for Duncan after he was admitted? Couldn’t it be an ER nurse who saw him when he first went to the ER?

    DRJ (a83b8b)

  40. By the way, she went to the hospital where she works — Texas Presbyterian, the one that treated Duncan — with a fever, and it still took them 90 minutes to put her in isolation. Meanwhile, my little town’s hospital had an ebola scare and it took the suspected patient to a special hospital entrance with a dedicated isolation room. I have to ask, what’s going on at Texas Presbyterian?

    DRJ (a83b8b)

  41. Correction to my comment 39. Are we sure this is a health care worker who was caring for Duncan after he was admitted? Couldn’t it be a nurse who saw him when he first was admitted, before they used the HazMat suits and special protocols?

    DRJ (a83b8b)

  42. The walking dead is now a reality show in dallas texas thanks to gov. perry turning down obama care medicade funds so hospitals turn out patients with 104 degree temp so they don’t go bankrupt with indigent health care costs!

    black death (b5e7d8)

  43. black death – I’ll wait to read the book.

    daleyrocks (bf33e9)

  44. black death (b5e7d8) — 10/12/2014 @ 1:24 pm

    Please go away and keep that crap to yourself. 10 Zillion dollars of ObamaCare money stolen from the entire universe would not have made a difference.

    MD in Philly (f9371b)

  45. According to this report and contrary to CDC’s Dr. Tom Frieden, the patient was absolutely following protocol:

    Presbyterian chief clinical officer Daniel Varga said the exposure occurred during Duncan’s second visit to the hospital. According to Duncan’s patient records released by the family to The Associated Press, this is what happened at Presbyterian:

    — On Sept. 28, an ambulance with Duncan arrived at the hospital’s emergency bay shortly after 10 a.m.

    — Doctors performed tests on Duncan, who told them he had recently arrived from Africa, and determined he had sinusitis.

    — Now in isolation, Duncan was projectile vomiting, having explosive diarrhea and his temperature was 103.1 degrees.

    — On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper.

    — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.

    Varga at Presbyterian said the worker was wearing protective gear, including a gown, glove, mask and shield, when she came into contact with Duncan. “This individual was following full CDC precautions,” Varga said.

    Dana (4dbf62)

  46. Well, DRJ, anything is possible with any story as we know. She might have been exposed buying skittles.
    What I read seemed to strongly imply that she was someone taking precautions after he was known to have had Ebola, but, hey, polar bears are supposedly dying, so I don’t know what to believe.

    MD in Philly (f9371b)

  47. — Now in isolation, Duncan was projectile vomiting, having explosive diarrhea and his temperature was 103.1 degrees.

    Dana – Sounds like Sunday morning in college before a little hair of the dog.

    daleyrocks (bf33e9)

  48. 25. It’s beyond not believing the feds…

    Bugg (f0dbc7) — 10/12/2014 @ 12:27 pm

    Which reminds me, Obama sent out old reliable to lie about foreign affairs and national security again.

    http://www.powerlineblog.com/archives/2014/10/susan-rice-all-is-well.php

    Dempsey also was on a Sunday talk show today. He didn’t lie quite so reliably for the Obamateur. He admitted this “strategy” that Susan Rice is so cheery about is already failing miserably.

    I’m noticing a pattern. Whether it’s Ebola or ISIS, this administration will come up with a plan that is unbelievably inadequate, ultimately futile, a complete waste of time, already obsolete by the time they hatch it but they’ll bitterly cling to it anyway, and was developed by painstakingly barring anyone who knows what they’re doing from providing input.

    Steve57 (e409e4)

  49. I’m starting a new job and may not be able to make it to the polls. I’ve already received my mail in ballot. Who knows if they’ll count it though.

    There’s some “Go Green” propaganda stamps the Post Office is selling. Put one of those on it and they’ll count it. Probably don’t want to use the Reagan stamp though.

    Kevin M (b357ee)

  50. Thanks, Dana and MD. It sounds like the CDC is saying this was a nurse with full protection, but she got ebola anyway so she must have breached the protocol. This is government gone crazy: They can’t say what her breach was, so she must have done something wrong because the government’s protocol can’t be wrong. What does this mean for our poor troops in Africa?

    DRJ (a83b8b)

  51. — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.

    That is either a misinterpretation of CDC guidelines, or the guidelines are ridiculous.
    IMO, H or not, you had an obviously seriously ill patient at about as high risk for Ebola as can be without getting the test back positive. I would have refused to treat such a patient without a HAZMAT suit.
    I would find a lawyer if I was this nurse and her family,
    if the evidence is as presented.
    Any medical people out there disagree?

    MD in Philly (f9371b)

  52. narciso (ee1f88) — 10/12/2014 @ 1:42 pm

    Oh yeah, happening all of the time, but my time and energy for fuming has expired for the moment.

    MD in Philly (f9371b)

  53. It sounds like the CDC is saying this was a nurse with full protection, but she got ebola anyway so she must have breached the protocol. This is government gone crazy: They can’t say what her breach was, so she must have done something wrong because the government’s protocol can’t be wrong.

    That is exactly what they are saying.

    Patterico (9c670f)

  54. The CDC used to be pretty cool. I’m not so sure today.

    Communicability and exposure. Take for example Cdiff (caused by sporeforming Clostridium difficile). Very communicable. As with MRSA, we have trouble with this in hospitals.

    For all of our carping about Europe, they are pretty good with both. This is because they isolate the patients, the take proper precautions, and they decontaminate correctly.

    We will get there, with what I hope is a minimal loss of life.

    What we need are politicians willing to say two things: (1) they don’t know everything, and (2) they are willing to take advice from people who are actual experts in the area.

    Sigh.

    Simon Jester (c8876d)

  55. For what it’s worth, the rumor I hear is that Clay Jenkins’s wife and kid volunteer at the kid’s school cafeteria, and after Judge Jenkins made his highly publicized visits to Duncan without protection, a sizable segment of the students did not attend that school. That’s a rumor; I can’t confirm it through any news stories, so take it for what it’s worth, which may be nothing. I throw it out there in case anyone who lives in the area can confirm it.

    Patterico (9c670f)

  56. DRJ, re the troops in West Africa, I commented earlier this wee, that my main concern upon hearing our military were being sent there, was that although we were assured they would received very, very intensive training and be wearing protective gear, if you recall, back in 2004 or so, our soldiers in Iraq were desperate for ceramic-plated gear and families were buying it from third-parties for their loved ones to be deployed because the government failed to do so (manufacturers got behind in production or something…). So, don’t give me the bullshit line that our young men and women will be safe because of the protective gear they will wear. Also, I believe the nurse in Spain was very, very highly trained, too, no? And how about this nurse in Dallas? Very, very highly trained personnel contract Ebola, too.

    Further, we were also told that our military would not be handling or exposed to live Ebola virus, and we’ve found out that that is not so.

    Dana (4dbf62)

  57. Well, here is the algorithm:
    http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf

    As I read that, full HAZMAT precautions are not called for until there is a confirmed diagnosis of Ebola by testing.
    I find it hard to believe there is not a high risk scenario where you use full Ebola gear pending test results.
    I wonder what the Doctors Without Borders people do.
    It may be harder to sue the hospital (not that I am one to eagerly suggest litigation, I’m not)
    but, you have a seriously ill patient with projectile vomiting and severe diarrhea with a high clinical suspicion of having Ebola,
    and you’re not taking precautions as if the person does indeed have Ebola?
    “Better safe than sorry” sounds like what was called for.

    MD in Philly (f9371b)

  58. Why wasn’t Judge Jenkins quarantined? He would have been part of the circle of contact (not directly with Duncan, but with his currently quarantined family)?

    Dana (4dbf62)

  59. thanks to gov. perry turning down obama care medicade funds so hospitals turn out patients with 104 degree temp

    That’s a skip and hop in the park compared with what people of your ilk (Friends of Obama, Pelosi, Reid, etc) have done by Nidal-Hasan-izing the southern border, Nidal-Hasan-izing the Dept of Health and Human Services, Nidal-Hasan-izing the US Customs Dept, Nidal-Hasan-izing the NSA, Nidal-Hasan-izing the State Department, Nidal-Hasan-izing the US Military (of course—and now expected to save the poor souls of West Africa), etc, etc, etc. “Nidal Hasan,” by the way is a code word for really idiotic, if not outright dangerous and irresponsible, thinking and policymaking on the part of people in charge of our beautiful, benevolent government, particularly at the federal level.

    — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.

    Varga at Presbyterian said the worker was wearing protective gear, including a gown, glove, mask and shield, when she came into contact with Duncan. “This individual was following full CDC precautions,” Varga said.

    So the assumption is the infected worker was not one of the staffers who originally dealt with Duncan wearing no more than gowns and scrubs. If not, then her catching the virus is hardly surprising. But if so, then why is one group — presumably more vulnerable to infection — somehow managing to avoid getting the virus, while a woman in the other group wasn’t quite so fortunate?

    Mark (c160ec)

  60. here’s how they’re dealing with her apartment…

    i can’t tell you how reassuring this is.

    redc1c4 (b340a6)

  61. for all the health care “experts” posting here ( not MD, etc)

    kindly list all the viral disease we can cure with current medications/technology:

    i’ll wait.

    redc1c4 (b340a6)

  62. She probably disregarded section 13., step 8.3, subsection g per protocol EMG-0010221.14. Worry not, this deviation will result in an OSHA citation over lost work days for the hospital.

    If the hospital doesn’t get their safety record under control, the feds may cease the hospital.

    Don’t worry! You’re Federal Government is on it!

    DejectedHead (13c12c)

  63. 61. Well, there are vaccines that work, so that is a long catalog.

    As far as getting cured of a viral disease, it usually takes cocktails with anti-viral meds. Magic Johnson was effectively cured of HIV through that type of treatment.

    DejectedHead (13c12c)

  64. Magic Johnson was effectively cured of HIV through that type of treatment

    Only true with a very loose definition of “effectively cured”.
    More appropriate terminology would be that his HIV infection was “under control”, likely with an “undetectable viral load”.
    And if he stopped his meds, it would be expected that the virus would soon come back, as it almost always (>99.99999999%) does.

    MD in Philly (f9371b)

  65. Apparently, there is still no concern at our airports for those arriving from countries with Ebola outbreaks:

    The World Health Organization is sending doctors to countries where the virus is most prevalent — Liberia, Guinea, Sierra Leone and Nigeria. Fusion’s Jorge Ramos spoke to one of the doctors, Dr. Aileen Marty, who recently returned home to Miami after spending 31 days in Nigeria. She says she was surprised what happened when she arrived at Miami International Airport.

    “I get to the kiosk…mark the fact that I’ve been in Nigeria and nobody cares, nobody stopped me,” Marty said.

    “Not a single test?” Ramos asked her, surprised.

    “Nothing,” Marty answered.

    It’s as if the powers-that-be are not taking this seriously. Or, I should say that practical and reasonable steps and measures of protection are being overshadowed by politics (& upcoming elections) as well as attempting to keep the lid on things to stop a panic. When does that ever effect the desired outcome of any populace?

    Dana (4dbf62)

  66. vaccines *prevent* the disease from starting in your body… which is NOT a cure.

    ergo, they do not count. as for Magic & the others, take away their ant-viral meds and get back to me with the results.

    IOW, viral suppression isn’t a cure in the accepted sense of the word, any more than vaccines are a “cure”.

    redc1c4 (b340a6)

  67. Seek help, Perry

    JD (bc2e39)

  68. s/he/it would have to admit they have a problem first…

    redc1c4 (b340a6)


  69. Magic Johnson was effectively cured of HIV through that type of treatment

    Does that mean he’s cleared to start having unprotected sex with strangers again?

    daleyrocks (bf33e9)

  70. It’s glaringly obvious to anyone who isn’t an idiot that it’s at least *possible* that the protocol is flawed. This, if they’re claiming otherwise, they’ve yet again proven their incompatible (at best).

    A further issue I’ve been pondering; they’re telling us that Ebola absolutely isn’t contagious unless the person is symptomatic. They are saying this while also placing people who’ve been potentially exposed into voluntary (or otherwise) quarantine. The issue here is that those two facts directly contradict each other. (If there’s no chance of contagion from an asymptomatic person, why quarantine them?).

    Arizona CJ (2b41c6)

  71. Well, a person with Ebola at some point goes from being asymptomatic and noninfectious to symptomatic and infectious, and since you don’t know when that happens until it does, you need to act as if it could be any minute.

    MD in Philly (f9371b)

  72. #71: and we’re back to quarantines, which is the ONLY method proven to stop the spread of diseases like Ebola.

    redc1c4 (b340a6)

  73. yes, red, we should be doing what we know to do.

    MD in Philly (f9371b)

  74. Unfortunately she rode the bus with duncan.

    Jim (84e66d)

  75. “Is the dog gonna be all right, Uncle Lar?”

    “Yes, little Tommy, the dog’s going to be fine.”

    Chicago area readers of a certain age will understand this reference. Otherwise, go to the link.

    http://www.usatoday.com/story/news/2014/10/12/dallas-ebola-health-worker-dog/17159727/

    elissa (35f4ae)

  76. #64. Loose definition of “effectively cured”? The use of the word “effectively” demonstrates that understanding that you just described.

    DejectedHead (13c12c)

  77. #66. Magic Johnson will always test positive for then HIV antibodies. Is he free to have unprotected sex with someone and not pass on the virus? Don’t know, it would be seen as unethical to attempt it, but he may be.

    DejectedHead (13c12c)

  78. What does this mean for our poor troops in Africa?

    God help them. I expect to hear about more cases and that is a high probability.

    Flu season is coming and we will be inundated with scares in ERs.

    Mike K (90dfdc)

  79. This hospital that treated Duncan has been so slow to react, even when they have enough information to act.

    Sinusitis? He got a classis ER contractor physician.

    SarahW (267b14)

  80. it still took them 90 minutes to put her in isolation.

    That’s outrageous. She should have walked in only after the hospital was prepared to isolate her.

    SarahW (267b14)

  81. “Classic” not “Classis”

    SarahW (267b14)

  82. there is no such thing as “effectively cured”…

    either you are cured or you’re not.

    people on AIDS cocktails are simply in remission, which is NOT cured. the disease is just biding its time to either move on or take the patient out.

    or both.

    redc1c4 (b340a6)

  83. Does the military have any ability to demand special protections and assurances of protocol for the guys and gals before they are “sent overseas to help” with ebola response? I know when they enlist they are prepared to go into harm’s way to fight or to assist in disaster relief and clean-up–but who could have possibly known a deployment might involve THIS?

    elissa (35f4ae)

  84. Great thread. Thanks to all, but especially to MD in Philly and agesilaus.

    Well, now I’m off to Costco to buy a few extra cases of non-perishable foodstuffs. I hope there are some left.

    ThOR (130453)

  85. #83. You are using a very strict definition of the word “cured”. Relieving someone of symptoms of a disease is curing them of the disease. I could tell you were asking for a complete cure, hence why I attempted to bridge the gap by using a qualifier prior to the word.

    Magic Johnson and others on anti-viral meds could possibly go about their lives without medication and without transmission of the disease. I don’t know the specifics of their current treatment plans, do you?

    Your definition of “cured” is also a difficult one concerning how viruses are detected. I believe (correct me if I am wrong), that we detect anti-bodies, not the virus itself. Once someone is infected with a virus, those anti-bodies will always be there. Would you not consider someone cured until they no longer test positive?

    DejectedHead (13c12c)

  86. it’s in remission, one wonders if Michael Crichton, who was quite prescient about these things, when he wrote ‘the Andromeda Strain’, would have ever thought that people would take it as a guidebook and not a warning

    narciso (ee1f88)

  87. Some routine testing tests for the virus itself, for example, viral mRNA of HPV.

    SarahW (267b14)

  88. #83: i’m using the term “cured” in the accepted definition of the healthcare industry, and i verified my understanding with my personal clinical pharmacist, who agrees completely with my definition and usage.

    if you’re on an AIDS cocktail, you are in remission, because the infection is suppressed. withdraw the meds, or have your virus mutate so the meds no longer suppress it, and you’re back at square one, or worse.

    as with cancer: you may go into remission, or they may be able to remove the tumor, but you’re still at risk, for the rest of your life, of having it come back, in one form or another.

    either way, you are NOT cured unless the disease is totally gone from your body and you would need to be re-infected in order to suffer from it again. that’s different from remission, which what you’re talking about. to a lay person they may seem like the same thing, but they are worlds apart from a medical POV.

    take the common influenza virus: we can make vaccines, but they have to guess over a year out, what strains will be prevalent the next season, since manufacture & distribution take that long. some years they nail it, some years they don’t, but either way, once you get it, your body has to fight the infection off itself. Tamiflu and the other treatment options can shorten the process, but they don’t “cure” it: your body does.

    until the next time you’re exposed to a different strain, and then you get the flu again.

    redc1c4 (b340a6)

  89. could possibly go about their lives without medication and without transmission of the disease
    It would be expected for the virus to return once off of medications, the only question is how long it would take and how high the virus would rebound. It would be expected that after a prolonged period off of medications they would progress to AIDS, on average it would take maybe 9 years, some sooner.

    There is a common sense reality that the more virus a person has swimming around in their blood, the easier it would be to transmit. Having no virus detectable in the blood would mean a person has a very little chance of transmitting the virus, but no doctor would ever say “little chance” means they couldn’t/wouldn’t.

    we detect anti-bodies, not the virus itself
    For most things these days we can detect both, often by different methods, and the significance of antibodies varies dependent upon the illness.
    Antibodies to measles means you are immune to measles
    antibodies to varicella/chicken pox, means you are highly unlikely to get chicken pox again, but you are at risk of getting shingles (unless you have antibodies from vaccination rather then the disease.
    Antibodies to HIV and Hep C are markers for being infected and NOT immune
    Antibodies to Hep B are complicated and beyond the scope of this mini-course.

    In the mid-90’s we went from measuring only HIV antibodies to being able to measure the HIV virus itself, which was a major breakthrough in the understanding and treatment of HIV.

    Hep C actually appears to be one viral disease we can often actually cure with medication.
    Most others, like HIV, herpes, varicella, we can only control the infection with medication. With herpes and varicella (shingles) medications can be stopped and the illness may not immediately return, but it is still lurking and may return at any moment

    Now, if you will give me an address to send the bill….

    MD in Philly (f9371b)

  90. my understanding is that anti-bodies show the patient was exposed to the disease at one time or another, but is not necessarily proof of active infection.

    for instance, blood tests are routinely conducted to see what titers of anti-bodies you have against certain diseases to determine if you need to get a booster shot for some vaccines.

    it doesn’t mean you have the disease if you show anti-bodies, just that you’ve been vaccinated at one time or another.

    screening patients for anti-bodies is just that, winnowing down the herd to identify those who are either at risk or best protected, depending on the scenario.

    redc1c4 (b340a6)

  91. #90: GMTA!

    redc1c4 (b340a6)

  92. #89. I’m familiar with the concept of remission. It isn’t that I do not understand the difference. It is that your definition of “cured” cannot ever be verified. You go into remission because they cannot guarantee you do not still have the disease. They cannot do this because if even a single strain of the rogue pathogen remains, it has the potential to re-infect. The medical profession cannot test every cell in a person for cancer any more than we can detect a single existence of a virus that is micrometers in size.

    Technically, if you survive the symptoms of a virus, you are generally “cured”. People do not get reinfected from a virus (as you stated concerning vaccines for flu). People gain resistance to a virus from vaccines because it allows the body to suppress the virus. We introduce the weakened strains and allow our bodies to defend against viral infection.

    Per your definition of “cured” are you saying that no one is ever cured of a virus? Or that we have no “cure” for a virus? I would say that “yes” we have a natural cure for viruses with regard to our immune systems and that no, we cannot cure a virus.

    DejectedHead (13c12c)

  93. 84. Does the military have any ability to demand special protections and assurances of protocol for the guys and gals before they are “sent overseas to help” with ebola response? I know when they enlist they are prepared to go into harm’s way to fight or to assist in disaster relief and clean-up–but who could have possibly known a deployment might involve THIS?

    elissa (35f4ae) — 10/12/2014 @ 3:31 pm

    I haven’t seen too much information on this deployment. Reuters is reporting that the Army is sending the 101st Airborne Division to Liberia.

    http://news.yahoo.com/u-military-faces-kind-threat-ebola-055717486–finance.html

    Why on earth anyone would throw the 101st Airborne Division at an Ebola outbreak I have no idea. My impression from what I’ve read and seen is that the Army is just slapping this thing together. It looks like the poor grunts will get maybe a day of training on putting on and taking off a HAZMAT suit, then get sent on their way.

    I don’t see this turning out well.

    Steve57 (e409e4)

  94. #90. Thanks MD in Philly. Great update on the current state of viruses and medicine.

    DejectedHead (13c12c)

  95. last time i looked, we stopped using live virus vaccines long ago, due to increased risk of infection due to QC issues and problems with giving live viruses to immune compromised patients.

    AFAIK, all vaccines used today are made with inactivated viruses, but i’m willing to be proven wrong, because i have other things to do this afternoon besides pharmaceutical research.

    read post #90. Doc explained what i said, but in different language w/ different examples: maybe that will help you see where your use of the term is inappropriate.

    redc1c4 (b340a6)

  96. #94: it’s a given that standard MilSpec MOPP4 will NOT protect against this disease, so they better be doing something, otherwise we’re sending them off to die needlessly.

    redc1c4 (b340a6)

  97. The MMR and the chickenpox vaccines are live virus vaccines.

    DRJ (a83b8b)

  98. A Boston hospital was evacuated this afternoon because of a patient who had recently traveled from Liberia was experiencing muscle aches and headaches.

    ‘Out of an abundance of caution we immediately notified authorities and the patient was securely removed from the building and put into an ambulance now headed to Beth Israel Deaconess Medical Center,’ Ben Kruskal, chief of infectious disease at Harvard Vanguard Medical Associates, said in a statement.

    ‘The building was closed briefly but has now re-opened,’ the statement said. ‘We are working closely with the Department of Public Health who will determine next steps.’

    Ebola protocol is in place,’ said Joe Zanca of Braintree Fire.

    Dana (4dbf62)

  99. I think each State should identify specialized regional hospitals where these patients will be sent. They do this with burn victims. They should do it with highly infectious diseases like ebola. Then hospitals can concentrate on training staff for screening, setting up isolation for short-term care, and working with ambulance and air ambulance services on safe transport.

    DRJ (a83b8b)

  100. “Remission” is one of those words that doctors can use among themselves with a straight face, and normal people should avoid. Like the “n-word”, which among some black people can be a greeting or a term of endearment or a rap song lyric, but is crude and inappropriate in mainstream society. The medical profession has a lot of words like that; it’s part of how they convince us they know things we don’t.

    nk (dbc370)

  101. One of the real benefits of our health care system is the ability to safely move patients to regional care centers where they can get specialized treatment. Why aren’t we doing that here?

    DRJ (a83b8b)

  102. #96. You missed where MD said they can cure Hep C.

    There is your answer to the previous question. Don’t need to discuss terminology anymore.

    DejectedHead (13c12c)

  103. The medical profession has a lot of words like that; it’s part of how they convince us they know things we don’t.

    What?

    Art Deco (ee8de5)

  104. They’ll have to, if they’re serious, quarantine and isolate every soldier for the twenty-one days it takes to tell before sending them home. And I don’t think you can do that in batches, since one sick guy may infect the rest of the ward before they know if anybody’s got it. That means umpteen single-bed facilities where bored, scared adolescents will be spending three mortal weeks with nothing but their Ipad or whatever to pass the time. I suppose they could take an on-line course or something.

    RA (f6d8de)

  105. 100. I think each State should identify specialized regional hospitals where these patients will be sent. They do this with burn victims. They should do it with highly infectious diseases like ebola. Then hospitals can concentrate on training staff for screening, setting up isolation for short-term care, and working with ambulance and air ambulance services on safe transport.

    DRJ (a83b8b) — 10/12/2014 @ 4:55 pm

    What’s going to happen shortly, now that flu season is upon us, is that hospitals will be shutting down in large numbers out of an “abundance of caution” as more and more people start showing up complaining of fever, nausea, diarrhea, and muscle aches.

    Steve57 (e409e4)

  106. thanks for the insight, MD.

    narciso (ee1f88)

  107. What?
    Art Deco (ee8de5) — 10/12/2014 @ 5:20 pm

    Slap mae Fro and call me Bro.
    Fool don dig when he bein jived,
    I ain’t gwine put him wise.

    nk (dbc370)

  108. If that comes to pass, Steve57, then the minor-emergency clinics is where the action will be.

    felipe (40f0f0)

  109. I very much doubt that hospitals will shut down or refuse to treat. Doing so would be their end as hospitals. I do, however, expect regional hospitals to get most or all of these patients transferred to them so that they can be treated with best practices by people who know what they are doing, rather than worry about whether each nurse at Podunk Community Hospital can be trained in time.

    In Los Angeles, I would expect this to be UCLA Medical Center and/or County/USC. Since these are often teaching hospitals, it would also train up the next generation of doctors in treating hemorrhagic fevers.

    They might get it wrong for a while, but they’d figure it out. I have no confidence in the administration, but I have ultimate confidence in the best people Western Medicine has to offer.

    Kevin M (b357ee)

  110. It’s easy enough to see that a guy with a crowbar through his head should get a helicopter ride to a Level I Trauma Center. Ebola will not be like that. And emergency rooms and clinics who let people with flu-like symptoms through their will have to adopt Ebola precautions regardless of where the patient diagnosed with Ebolas is treated, I think. Miserable, shiftless, golf-playing, Hollywood-groupie SCOAMF.

    nk (dbc370)

  111. Actually, DRJ, there should already be in place hospitals that are dedicated to deal with this, and worse:
    http://patterico.com/2014/10/12/nurse-who-treated-ebola-patient-tests-positive-for-ebola-cdc-claims-unspecified-breach-of-protocol/#comment-1695045

    I don’t know if they are following exactly what agesilaus (73e938) — 10/12/2014 @ 12:44 pm described here:
    http://patterico.com/2014/10/12/nurse-who-treated-ebola-patient-tests-positive-for-ebola-cdc-claims-unspecified-breach-of-protocol/#comment-1695039

    but here is a picture reportedly in Boston where they have a suspected Ebola patient:
    http://news.yahoo.com/patient-isolated-massachusetts-clinic-displaying-ebola-symptoms-newspaper-200117720.html
    Whether or not it is the full HAZMAT protocol, it is whole lot better than what the CDC algorithm has for patients not yet diagnosed with Ebola:
    Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves)
    http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf
    Now, that is the algorithm for “evaluating the returning traveler”. By my reading, that does not describe the need for HAZMAT precautions presumably until after the diagnosis has been made. (Anybody disagree?) Unless there is some other CDC info (which I am not going to look up at the moment), that suggestion is far less rigorous then what the Boston people are doing for a presumed case.

    MD in Philly (f9371b)

  112. And, the picture of the set up at Boston resembles what the pictures look like in Africa when they are going in and out of the Ebola wards.

    I agree with nk that likely most major hospitals are going to need to be prepared to evaluate a patient with possible Ebola coming into their ER,
    but I also think any suspected patient should usually be transferred to a regional facility for treatment that has a priority of being able to handle such a case.

    I have to think hospital risk management types are having a hard time going to sleep at night.

    MD in Philly (f9371b)

  113. MD,

    According to the local hospital authorities in my community, the full HAZMAT response is what my local hospital did when responding to a suspected ebola case. They reported all the details in the local newspaper. I believe they did that to reassure people, not to scare them, but I’m fortunate to live in a community where the government officials don’t think we’re stupid.

    That’s what I would hope all hospitals do, but I realized in the Newark case that each community and, in fact, each hospital decides how to respond — based, presumably, on the judgment of the evaluating physician and/or the PR concerns of the local government officials. That’s troublesome to me, especially in cases like Newark where officials weren’t forthcoming about the details of the response. It’s very difficult to gauge whether the response is adequate if you don’t know the details. Of course, it’s possible the hospitals object to releasing the details because of HIPAA concerns. If so, I think that’s a misplaced concern in public health matters like this.

    DRJ (a83b8b)

  114. Thus, MD, I agree with you that it looks like some hospitals, including Texas Presbyterian, are following the guidelines for returning travelers instead of the ebola guidelines, until there is a definitive diagnosis of ebola. It could be that’s what the CDC told them to do. If I were an administrator at Texas Presbyterian and my doctors were treating the first US ebola patient, I’d make sure I did exactly what the CDC people at the hospital told me to do.

    DRJ (a83b8b)

  115. Last night I watched an hour-long episode of “Nova” on Ebola that I’d recorded earlier in the week. I would expect that PBS would hew pretty closely to whatever party line is currently being preached by the White House and by the CDC, and I think that was reflected mostly in the questions they largely dodged (e.g., should there be more international travel restrictions? or should the U.S. military be involved, and if so, with what limits?). They were awfully enthusiastic about ZMapp — while being appropriately Leftish in wondering, guiltily, if American imperialism is the reason that it’s been given preferentially to infected American healthcare professionals rather than Africans. (They were so enthusiastic about it that they convincingly undercut the rote warnings that they repeated, to the effect that this admittedly promising drug still has nothing but the most thin and anecdotal medical evidence to support its efficacy).

    The Obama Administration politicizes everything. That’s actually too weak a statement. It is more accurate to say: Nothing but politics matters to Barack Obama. He is clueless and shameless and venal; the only thing which keeps me from complete despair over his performance as POTUS is that his own selfish political calculations just occasionally, almost by happenstance, manage to coincide briefly and accidentally with the national interest. So like our host, and many of you, I’m intensely skeptical of the “party line” about this Ebola stuff. And I want to explore lots of alternative media, and do anything else I can think of to get more perspective.

    But just as I’m skeptical of the party line from the White House or the CDC — or, for that matter, Doctors Without Borders or the UN or even the Texas Health Department — I’m keenly aware that public opinion is a very poor gauge of what’s wise and unwise. The public, collectively, behave like sheep way too often, viz the entire vaccine nonsense that’s going on with diseases that we’ve known for decades how to suppress. Beware the demagogue. Beware junk science. And beware the advocate who’s too eager to make these decisions political — in either “establishment” or “anti-establishment” directions.

    Beldar (fa637a)

  116. Here’s a link to the PBS Nova program of which I just wrote.

    Beldar (fa637a)

  117. My semi-direct experience with Ebola and Doctors Without Borders is they know what they’re doing because their lives do depend on it,
    I agree that anything touched by Obama is contaminated with political posturing and may not be reliable.
    I would not necessarily trust NOVA anymore than I would trust Obama.

    here is a link to the CDC recommendations for suspected or known Ebola cases in a hospital.
    http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
    The recommendations are the same as previously listed on the “Returning Travelers” algorithm, which is NOT a Hazmat level. What one sees at Boston, what one sees in Africa, is more a Hazmat scenario where they wear things that can be disinfected by bleach before being taken off.
    I tried to find pictures of the unit in Atlanta but was not successful after a brief search.

    MD in Philly (f9371b)

  118. http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

    “COMMENTARY: Health workers need optimal respiratory protection for Ebola”

    SarahW (267b14)

  119. Masks /shields insufficient, they say. Health workers caring for Ebola patients should have respirators.

    SarahW (267b14)

  120. OT – is it me, or is it no possible to comment on Michael Hiltzik’s articles? He has a new one in which he blames the NRA blocking a Ebola czar.

    lee (b2dfc0)

  121. Interesting link, SarahW,
    but I think it too fails in the simple application of what we know to be true from 40 years of experience.
    The level of contact precautions used in Africa is more like the Hazmat protocol discussed above than contact/droplet precautions that the CD apparently recommends.
    The experts in Africa do not use respirators, and they do not get the disease.

    Treat body fluids “like the plague” they are. It is relatively easy to contaminate oneself taking off gowns, etc. While the CDC site has instructions about how to take off protective clothing and the like, that is not what the people in Boston are doing and not what the people in Africa do. They first decontaminate the outside of the suit they are wearing with bleach, including what they were on their feet. there was an article about some woman in Liberia that took care of 4 family members with the illness and she did not get it. She did not use a respirator, she did use heavy rubber gloves, a rubber rain slicker, and rubber boots that could all be decontaminated with bleach before removing them.

    I think the article is fine as a discussion about what we do and don’t know about aerosols, ESPECIALLY in regard to the issue brought up early in the thread by a nurse about the reality of US patients being on a ventilator, something that I presume has not been part of the previous Ebola experience in Africa.

    So, if they want to outfit staff with respirators when taking care of patients on vents, sounds like a great idea.
    But they first have to do what they already should know to do.

    MD in Philly (f9371b)

  122. MD,

    Here are images from the Nebraska hospital that is treating to 2 ebola victims. This is from Emory in Atlanta. And there is a photo here of the airplane containment unit used to transport the patients to Atlanta.

    DRJ (a83b8b)

  123. MD,

    According to this report, some hospitals are choosing to go beyond the CDC recommendations and are adopting the WHO protocols:

    Mount Sinai Health System in New York, which had two more suspected Ebola cases last week, has been going beyond the Centers for Disease Control and Prevention’s recommendations for taking off protective gear and using the World Health Organization protocol, which involves hand washing at more stages.

    “I don’t think [the CDC’s version] is inadequate. We still need to know what happened with the nurse in Texas. Based on our experience, we’ve decided to use the WHO version,” said Brian Koll, executive director of infection prevention for the Mount Sinai system, referring to a Texas health worker who the CDC confirmed has tested positive for the disease after caring for Thomas Eric Duncan, the Ebola patient who died last week in Dallas.

    “What I like about the WHO version is, every time you take off a piece of PPE [personal protective gear], there’s a hand hygiene step built in.”

    Sounds like a good choice.

    DRJ (a83b8b)

  124. Interesting as it is an exceptionally authoritative source arguing the need for those in very close proximity to patients/viral particles.

    SarahW (267b14)

  125. Erring on the side of prudence, seems prudent considering the consequences of infection.

    SarahW (267b14)

  126. It also sounds like they have a suspicion what might have gone wrong in Dallas.

    DRJ (a83b8b)

  127. Drudge is calling the CDC the Center for Disease Confusion.

    DRJ (a83b8b)

  128. After getting the news about the Dallas nurse, Obama played golf:

    Perhaps realizing the incongruity of the president playing golf amid crises, the White House today initially loaded up the press pool to accompany Obama to his golf outing, and then had a better thought. The press was yanked out of the vans and dispatched to the windows of the Oval Office, where reporters instructed to witness the president speaking on the phone with HHS Secretary Sylvia Burwell about the new Ebola case in Texas.

    And then it was on to golf.

    The president today is playing on his usual course at Fort Belvoir, Virginia with his usual group of junior White House aides.

    DRJ (a83b8b)

  129. SarahW- my main issue with the article is that it is focusing on a theoretical problem rather than emphasizing known factors. It makes no sense to me to invoke previously undetected concerns while ignoring established ones. Theoretical concerns should add to the observed experience, not distract from it.
    Very rigorous contact precautions with decontamination has been the standard of care. That should be the basic starting point and appears to be what Boston and others are now doing instead of adhering to the less rigorous CDC protocol.
    If people want to argue that in a resource rich developed world environment, ESPECIALLY with patients on ventilators which is a new issue, one wants to add respirators of some type, well, I’m not going to argue against it. The people in the picture in Boston are clearly wearing more than a “mask” and a face shield that protects only against direct splashes. I do not know how that head gear matches with the recs in the article you link.
    As the nurse said earlier, taking care of a patient on a ventilator is an entirely different and new risk, and more rigorous respiratory measures would be indicated.

    Thanks for the links, DRJ. It is apparent that those facilities are beyond the CDC recommendations, but then they were also designed for hazards worse/more contagious than Ebola, such as smallpox.
    But since we are talking about contracting a disease that is likely 50% fatal with treatment here in the US, extreme measures for prevention are called for.

    I was surprised to realize that the CDC recs for suspected and confirmed cases are what they are. I don’t think they are up to the standards Brantley used in Liberia. If I am wrong, I am happy to be corrected.

    MD in Philly (f9371b)

  130. And most Obama voters don’t care as long as it doesn’t happen to them.

    DN (395a7b)

  131. There is an interesting report on the containment of Ebola in a district in Sierra Leone using quarantine from the get-go:

    It is a remarkable feat, a source of pride for district residents, a source of hope for the entire struggling nation, and a curiosity to epidemiologists tracking the worst Ebola outbreak in history, which has recorded more than 8,000 cases in west Africa with no end in sight.

    The district’s success was no accident. It has been the result of concerted, early efforts to staunch the spread of the disease, sometimes turning to novel measures, tailoring details to fit the region’s unique needs. Most of the planning has fallen to a man named Momoh Konte. He, along with district government and tribal officials, have managed to do what has seemed impossible elsewhere.

    The strictest measure was to draw a ring around the district and restrict who went in or out. The mountains helped. But so did checkpoints, where guards stood armed with thermal thermometers and chlorinated water — and a pass system that prevented most residents from leaving. Visitors needed a local resident to vouch for them. Aid groups such as Doctors Without Borders have criticized such quarantines, which exist in several regions of Sierra Leone, arguing that they only worsen suffering.

    But Konte, relying on his business background, devised some potential solutions. While most small business owners were not allowed to leave Koinadugu to visit Freetown on supply runs, he set up a $45,000 revolving fund to make loans for the importation of food, fuel and medicine, with deliveries coordinated by the task force.

    It’s a fascinating look at basic protocols that have been strictly maintained and thus, no Ebola. It is the last and only district in Sierra Leone to not have an outbreak.

    Smartly, the plan also most specifically addressed local faith healers:

    Konte’s plan also targeted faith healers. The task force dispatched teams to meet with these traditional medicine practitioners, give them cash and beg them not to treat anyone appearing to suffer from Ebola. The disease’s first cases came to Sierra Leone from people infected during a faith healer’s burial in Guinea. Faith healers offer hands-on treatments that can involve blood-letting, all of which carry risks of transmitting Ebola.

    When it comes to traditional African healers, we had to pay extra attention,” Konte says. People trust them. They are popular. A faith healer with Ebola could be disastrous. “It would’ve wiped out our community.”

    Dana (4dbf62)

  132. Ironic that a third-world can successfully implement a quarantine and be met with great success thus far.

    Dana (4dbf62)

  133. MD,

    You noticed the gap in the CDC guidelines as soon as you looked closely at them, and it sounds like some hospitals are noticing, too. I wonder why the CDC deviated from the WHO protocol, since WHO has had significant experience with ebola and the CDC hasn’t?

    DRJ (a83b8b)

  134. Yes, it is ironic, Dana. That community basically established a border and enforced it, something we don’t have the will to do.

    DRJ (a83b8b)

  135. We don’t have the will, and as long as politics is the controlling factor in the crisis, we won’t “find” the will, either.

    Dana (4dbf62)

  136. Nigeria has also had some success, after a time,

    narciso (ee1f88)

  137. ==Ironic that a third-world can successfully implement a quarantine ==

    Dana, it’s not so ironic. What this shows is what can be done when a country is not trying to thread a medical emergency and deadly disease outbreak through a needle of political correctness and accusations of racism.

    elissa (16d100)

  138. Hence the irony.

    And now the horse is already out of the barn.

    Dana (4dbf62)

  139. HIB director blames budget cuts for lack of Ebola vaccine. His budget has doubled since 2000. But origami condoms for rabbits were funded.

    JD (03f68b)

  140. 138. ==Ironic that a third-world can successfully implement a quarantine ==

    Dana, it’s not so ironic. What this shows is what can be done when a country is not trying to thread a medical emergency and deadly disease outbreak through a needle of political correctness and accusations of racism.

    elissa (16d100) — 10/12/2014 @ 8:05 pm

    Also mountains of Western aid money. When all that free cash is available for the taking, it’s difficult to focus on fighting the disease as opposed to maximizing opportunities to get your hands on the loot.

    I read an interesting article by a medical missionary earlier today. He said one of the reasons why this Ebola outbreak is different than in the past is because Western governments and NGOs are making the problem worse, not better. Which is why I found it interesting that Doctors Without Borders were criticizing the measures that have proven so effective in Sierra Leone. According to what the medical missionary wrote, the measures this guy Konte took are in fact very traditional ways to deal with outbreaks of plague. Traditionally, villagers would self-quarantine. Neighboring villagers would deliver food and other provisions without violating the quarantine. Caregivers in the effected village would be meticulous about washing with soap and water. In the past these simple methods proved effective at containing disease including past outbreaks of Ebola.

    But then NGOs such as Doctors Without Borders show up and implement The Golden Rule. He with the gold writes the rules. And when they say that these quarantines only worsen the suffering, as long as they’re writing the checks they get their way.

    Steve57 (e409e4)

  141. Origami condoms for rabbits? That would take pretty nimble fingers. My smallest origami is around one inch in at least one dimension.

    nk (dbc370)

  142. You could focus on fighting the disease in the slums of Monrovia. On the other hand if you play your cards right you could win a new car! If instead you focus on writing up the proposal detailing why you need EU taxpayers to buy you a fully optioned Toyota Land Cruiser.

    Steve57 (e409e4)

  143. Ironic that a third-world can successfully implement a quarantine and be met with great success thus far.

    Well, it does help that their citizens cannot all just up and fly across the continent. Keeping people from traveling is a LOT easier when they can’t.

    Kevin M (b357ee)

  144. HIB director blames budget cuts for lack of Ebola vaccine.

    The only response that should EVER be made to statements like that is “You’re Fired!” Even bureaucrats know it’s BS, and weak BS at that.

    Kevin M (b357ee)

  145. I find that a bit confusing, Steve57. Doctors Without Borders (MSF) are the people who have traditionally been there dealing with Ebola outbreaks in the past. I have assumed that the issue is simply that this time it reached heavily and densely populated areas and rapidly outstripped the resources to handle it. I don’t know if there are different personnel at MSF now or what. Every previous outbreak, with the involvement of MSF, was contained. My correspondence with people (missionaries) involved in the 2007 outbreak in Uganda had nothing but respect for the work they did.

    MD in Philly (f9371b)

  146. Here you go, MD in Philly:

    Astute students of ‘New World Order Conspiracy Theory’ understand the dirty game by which “humanitarian” CIA-Mossad fronts known as NGO’s (Non Governmental Organizations) will often infiltrate a target nation and wreak havoc from within. The “health group” with the high-sounding name “Doctors Without Borders” is in fact one such NGO, with links to George Soros and other shady characters.

    Doctors Without Borders (in French, Médecins Sans Frontières) was founded by French Zionist Jew Bernard Kouchner; a politician and doctor ranked as the “15th most influential Jew in the World” by the Jerusalem Post. The “humanitarian” Kirchner is also a rabid supporter of the UN and the EU. Zionist Kouchner openly supports going to war against Iran (if others measures fail). (here)

    Though the angry villagers may not quite understand the geo-political aspects of this dirty game, they evidently sense that something is very strange about this latest disease outbreak. The fact that their suspicions point to an NGO group, which they would have had no way of knowing was a CIA-Mossad front, is most intriguing. The fear and suspicion (instincts) of the villagers is nothing to be laughed at!

    No, I won’t provide the link. It’s on Google if you like wading through sewers.

    nk (dbc370)

  147. And then there’s this. https://www.lifesitenews.com/?/news/african-archbishop-workers-from-western-ngos-hang-around-with-boys-to-intro

    That’s a Catholic Archbishop. “Just give us your money, no strings need be attached.”

    nk (dbc370)

  148. Is anybody keeping track?

    Ebola cases on US soil:
    1. Brantly (recovered)
    2. Writebol (recovered)
    3. Sacra (recovered)
    4. Aid worker at NIH (research participant) (status unknown)?
    5. unnamed WHO Dr at Emory (according to this article) (status unknown)
    6. Thomas Duncan (Deceased)
    7. Nukpa (freelance journalist)
    8. Dallas Nurse who treated Duncan
    9. ?

    Chris (0ba377)

  149. Well, it looks like you are, Chris. Please keep us posted.

    nk (dbc370)

  150. Only the immigrants have died. Jessie and Chris should sue.

    JD (03f68b)

  151. Only the immigrants have died.

    So Obama is doing one thing right at least.

    nk (dbc370)

  152. so we can reasonable conclude that subterfuge is deadly,

    narciso (ee1f88)

  153. nk (dbc370) — 10/13/2014 @ 5:44 am

    Thank you, nk. I can see it clearly now.
    Who knew that Soros was a Mossad-CIA asset.

    MD in Philly (f9371b)

  154. nk (dbc370) — 10/13/2014 @ 5:55 am

    Well, the Ugandan initiative of “ABC”,
    Abstinence prior to having a life-long partner
    Be faithful to that one partner
    Condoms if you aren’t willing to do A+B
    which is the only intervention shown to decrease AIDS transmission,
    was fought by the “AIDS lobby” and even eventually corrupted in Uganda because of international aid

    MD in Philly (f9371b)

  155. I’m not saying that poor Steve is in that ilk. The media publishes a lot of nonsense, from all kinds of sources, and just because it’s in print does not make it so.

    nk (dbc370)

  156. I looked up the ABC program, MD. The opposition to condoms came from people who oppose all forms of contraception in all circumstances. That’s sad.

    nk (dbc370)

  157. It would probably be appropriate to name the US strain “obola

    Jim (84e66d)

  158. was fought by the “AIDS lobby” and even eventually corrupted in Uganda because of international aid

    Thank you for pointing that out, MD. Everyone should read the book, “Broken Promises” by Edward Green to get the full story. Green’s no conservative, but he shows how the AIDS lobby and other liberal causes pretty much sunk a successful program in Uganda.

    Chuck Bartowski (11fb31)

  159. First the CDC blames the nurse and the hospital for a breach of protocol, and now liberals are blaming the Republicans for budget cuts that they claim made it harder to fight ebola. I see a pattern. No matter what the facts, liberals — like little children — are never to blame.

    DRJ (a83b8b)

  160. In the CDC director’s press conference today, it sounds to me like tried to back off his earlier claim that there was a breach of protocol that led to the nurse’s ebola infection:

    Frieden noted that despite a breach in protocol, that does not mean there was “wrongdoing” by the worker who contracted Ebola.

    “The enemy here is Ebola,” Frieden said. “It’s not a person. It’s not a country. It’s not a hospital. It’s a virus.”

    Frieden added that he does not know yet how the worker contracted Ebola.

    “People on the front lines are protecting us,” Frieden said.

    The enemy may be the ebola virus but the problem is government bureaucrats.

    DRJ (a83b8b)

  161. nk, not sure what you found and where you found it, but AFAIK the definitive history is “Broken Promises” by Edward Green mentioned by Chuck Bartowski above.

    I cannot give that book high enough praise. If I was in charge I would make it required reading for everyone, not so much what it says about AIDS per se, but the illustration of how politically correct thought ignores science for their agenda.
    I first read about Green in the early ’90’s when he was initially studying the Uganda response to AIDS (before “AIDS in Africa” ever made it to our newspapers).
    Yes, not a conservative at all, and by his own admission was voted “most likely to be killed by a jealous husband” in high school, and his (first?) marriage failed for such behavior.

    MD in Philly (f9371b)

  162. CDC has one job, to fend of or manage contagion, but they pretend they have others. There was no shortage of money, just a lot of political intransigence. Not that much money is required to advise the president to block visas from hot zones.

    SarahW (267b14)

  163. The enemy may be the ebola virus but the problem is government bureaucrats.
    DRJ (a83b8b) — 10/13/2014 @ 9:42 am

    Ding, ding, ding, ding!!!!!
    Thread winner!!!!

    MD in Philly (f9371b)

  164. The nurse has been identified as Nina Pham. http://abc7chicago.com/health/nurse-catches-ebola-from-thomas-eric-duncan-1st-us-patient/348131/

    The protocols in place did not protect her.

    SarahW (267b14)

  165. MD in Philly – its already standard protocol for ebola, according to those infectious disease specialists, to employ respirators while undertaking any task known to produce aerosolization. I presume that would include suctioning of a patient on a respirator. They limit the call for use of respirators to caretakers who work in very close proximity because the non-droplet viral particles probably can get into the lungs and GI tract.

    I would refuse to care for an ebola patient in extremis without a respirator.

    SarahW (267b14)

  166. “patient on a ventilator”, rather. Since this is the standard advice, I wonder if it was actually followed.

    SarahW (267b14)

  167. SarahW- I think using respirators when caring for a patient on a ventilator makes wonderful sense, when caring for an Ebola patient not on a ventilator, I do not know if the head gear pictured at Boston which appears similar to what they use in Africa is considered a type of “respirator” or not. When I think of “Respirator” in the patient on a vent scenario I’m thinking they are talking about a completely contained unit, like Brantley and the professional escorting him were wearing going into Emory. I think that 40 years of experience in Africa gives no evidence of a need for that level of respiratory protection in absence of being on a vent.

    My main point in the midst of my rant, was that we should first focus on what we know works, which is not standard US hospital contact and droplet precautions, but rather a process that requires an elaborate decontamination process of the suit before taking it off.
    And then add other additional precautions as circumstances warrant, which would include increased precautions against respiratory spread for a patient on a ventilator.

    Thanks for helping me clarify what I meant in a calmer moment. I am not sure if we still have a disagreement or not.

    MD in Philly (f9371b)

  168. Doc @146, to be fair the medical missionary whose article I read didn’t single out Doctors Without Borders as one of the NGOs that is causing the problems. It is entirely possible, even likely, that Doctors without Borders is doing far more good than harm.

    But the group’s criticism of what turned out be a successful program in Sierra Leone is exactly the sort of interference that the missionary complains of.

    It’s really not very confusing. It’s just human nature. All the relief supplies and aid money pouring in is far to valuable in the third world to actually be lavished on the poor people who are dying of Ebola, for free no less! It’s worth cash on the black market, if it isn’t already gushing into the country in the form of cash. It’s the age old problem of what aid actually does, as opposed to what it’s supposed to do. Why would you waste it on people who can’t pay for it? Why would you let it go to the sick who have a 70% chance of dying anyway?

    No doubt Doctors Without Borders has the experience to avoid the pitfalls of providing aid in the third world. And their off-base criticism of Sierra Leone’s quarantine policy falls under the heading of “nobody’s perfect.” But other groups funneling aid to West Africa aren’t so perfect. The problem is that the people in West Africa who see all this aid as a once-in-a-lifetime windfall will be perfectly happy to do whatever will make them the most money. Which isn’t the same thing as doing what’s most effective against Ebola.

    I wish I could find the article again. It was very interesting. The missionary described one scam in which local official declared an outbreak of Ebola in a particular district. The NGOs delivered medicine and other supplies to the villages. And surprise surprise. No one died of Ebola. The NGO involved considered it a success. But as the missionary points out, he’s never heard of Ebola having a 0% fatality rate. The simplest, most logical explanation is that there never was an outbreak of Ebola. The local officials just wanted to get their hands on those valuable relief supplies and medicines. They couldn’t do it without the cooperation of the villagers and the local headmen, but make no mistake the ringleaders got the lions share of the cut.

    It should come as no surprise; the same thing happens here in the aftermath of a natural disaster such as a hurricane. Scam artists come out to the woodwork to supposedly help people repair their lives. Then disappear as soon as they’re paid. It’s just much more common in the third world where it’s not seen as a bad thing. The common attitude is if you can profit from your official position, and you’re not using whatever power and influence you have to enrich your family and friends along with yourself, you’re immoral.

    Steve57 (4d34f4)

  169. this is certainly good news on the healthcare front

    for various values of “good news”… it might also explain the Dallas case.

    redc1c4 (34e91b)

  170. The UK Daily Mail has a story on Pham. In the text they note “Mr Duncan also underwent two surgical procedures in a bid to keep him alive but which are particularly high-risk for transmitting the virus – kidney dialysis and intubation to help him to breathe – due to the spread of blood and saliva.”

    http://www.dailymail.co.uk/news/article-2791089/first-picture-devoted-texas-nurse-fighting-life-catching-ebola-treating-man-brought-dreaded-virus-america-beloved-dog-s-quarantine.html#ixzz3G37UEdsf

    The article does also mention CDC’s little “walkback” on breaches of protocol, though it didn’t really, just sort of vaguely addresses issues of blame, and also CDC implied that maybe protection for nurses and other care workers was not so robust as it ought to be: “The CDC said on Monday it has launched a wholesale review of the procedures and equipment used by healthcare workers.”

    I’m beginning to think that, as quoted from the article I linked earlier, even though it is the CDC’s “official” recommendation “…Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)” [emphasis added – SW] That the incantation in place in the hospital was limited to ““Gown, glove, mask and shield” and the spell was not sufficient.

    SarahW (267b14)

  171. Wasnt there a CDC doctor by the name of Westphal (if memory serves and increasingly these days it does not)who contracted the disease back it the early 80’s after following all of the WHO and CDC protocols? everyone on his team that was in Africa with him at the time was convinced he got it from an aerosol.

    Rorschach (61bf43)

  172. MD, the World-wide New World Order World-wide Conspiracy To Impose A New World-wide World Order, is more insidious than we could have imagined. From HotAir:

    How did I not already know about the existence of this shadowy, global powerhouse known as the World Cocoa Foundation? It sounds like something straight out of a James Bond movie. Are we trusting the world chocolate supply to an unknown hegemony which could cut off the flow of Reese’s Peanut Butter Cups at any moment? And now they are the only ones standing between the planet’s chief supply of cacao beans and an army of Ebola infected migrant workers.

    nk (dbc370)


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