CDC Changes Their Flawless Ebola Protocol
Guess what? The CDC has now changed their perfect protocol:
Ebola care instructions at a Dallas hospital and across the country were changed by federal officials on Monday — a tacit admission that training and procedures used for America’s first case of the disease had come up short.
The changes were prompted by the discovery that a nurse at Texas Health Presbyterian Hospital Dallas had become infected while treating Thomas Eric Duncan, the Liberian man who died of Ebola in the hospital last Wednesday.
And the CDC director has apologized for making the “breach of protocol” comment — further evidence of the deserved backlash he faced for it:
“‘It is possible that workers will contaminate themselves’ in taking off protective clothing, said Dr. Frieden,” The Wall Street Journal reported. “He said he didn’t mean to be critical of anyone at the Dallas hospital when he spoke Sunday about a ‘breach in protocol.’”
Sure. Y’all breached protocol and got a nurse sick with a deadly virus, but we’re not criticizing!
The “breach of protocol” story was always questionable. ABC News has reported:
“The comments from CDC [the Centers for Disease Control and Prevention] early on that this could be done in any hospital that is used to doing isolation just doesn’t ring true to me,” ABC News chief health and medical editor Dr. Richard Besser said.
“Groups like Doctors Without Borders, they have incredible training in this, and they practice it, and it’s the practicing that ensures that you don’t have a slip-up,” he said. “For our first patient in America to lead already to a health care worker getting sick really raises a concern to me.”
But in the same ABC story, there is a video that asserts the hospital “admits” there was a breach of protocol at some point. Why would the hospital say something like this? They don’t know what any alleged breach of protocol would have been, any more than the federal government does.
What they do know, is that the hospital (like pretty much any business in America) is subject to regulatory reprisals if they step out of line. If they said anything about Duncan’s care that contradicted the federal government, there could be HIPAA fines. So, although a protocol breach looks increasingly unlikely, they can maintain that fiction, so that Obama can pretend to be angry and interested in knowing what happened . . . on his way to the golf course, naturally.
Ding.
Patterico (9c670f) — 10/14/2014 @ 7:22 amSarahW called it early on. Well done.
felipe (b5e0f4) — 10/14/2014 @ 7:34 amI used to work with radioisotopes. It’s the same deal. Easy, easy, easy to overlook something.
Simon Jester (c8876d) — 10/14/2014 @ 7:38 amYou know what? If they only had more money they could have had a hot tub boondoggle to Hawaii with margaritas to discuss the best way to meet these challenges going forward. But nope, the GOP killed this idea with crushing budget cuts.
jb (4da557) — 10/14/2014 @ 8:00 amI think it was Md in Philly who first noticed that the CDC guidelines didn’t match the WHO and Doctors Without Borders protocol. SarahW alertly noted the problems with respirators.well done to both.
DRJ (a83b8b) — 10/14/2014 @ 8:10 amThe CDC has become just another bureaucracy. So has the NIH which is whining about budget problems while implying they have ever created a vaccine.
Mike K (90dfdc) — 10/14/2014 @ 8:17 amAnd it looks like the nursing group/officials that said America’s nurses don’t have the training for Ebola were right.
DRJ (a83b8b) — 10/14/2014 @ 8:17 amThe CDC was checking to see if better protective gear should be used with Ebola patients, gear less cumbersome yet able to block the virus.
“Kidney dialysis and respiratory intubation, two procedures performed on Duncan, are procedures unavailable for patients in West Africa that might that pose unanticipated risks to health-care workers. ” http://www.thedailybeast.com/articles/2014/10/12/2nd-ebola-case-in-dallas-shows-limits-of-protective-gear.html
Except the CDC did “anticipate” this risk in the recommendations it published on its own website before Ebola came to this country. It recommended the use of a respirator. I think its pretty clear that one was not used during the riskiest parts of Duncan’s care.
SarahW (267b14) — 10/14/2014 @ 8:17 amAs SarahW and I think another nurse pointed out previously, Ebola care in the US is different from in Africa because of the availability of high tech interventions, such as mechanical ventilators. New situations call for thinking about new problems, as well as continuing to do what we’ve known what to do for 40 years with Ebola, which is stringent contact precautions with decontamination prior to taking anything off.
As narciso points out elsewhere:
https://patterico.com/2014/10/13/nih-we-could-have-developed-an-ebola-vaccine-but-for-budget-cuts/#comment-1695930
there already is a person who was/is in charge of such things, apparently AWOL.
Start out doing what you know how to do, think carefully about obvious known complications, and save the speculation about the outlier stuff for after #1 and #2 are in place.
Doing that, minus all of the political gesturing and PR, would have us in a much better position.
MD in Philly (f9371b) — 10/14/2014 @ 8:21 amAs SarahW has been diligent (much more than I) in researching and documenting already established recommendations,
MD in Philly (f9371b) — 10/14/2014 @ 8:26 amit seems that in multiple places along the line, people did not simply keep their heads and do what they needed to do.
I am sure I have done that more than once myself in life.
MSF has already had 9 medics come down with the disease.
The Borg is incompetent and their Gay Crack Whore affirmative action mascot is a woeful POS.
Even Jimmah admits as much.
gary gulrud (46ca75) — 10/14/2014 @ 8:34 am11.MSF has already had 9 medics come down with the disease.
Impossible to say how much of that was caused from unknown contacts in an area with an epidemic,
and how much of that was caused in giving care, likely from newly trained staff. Did you see more details about who those people were? How many are docs and nurses from Europe, or aids hired locally?
Every previous outbreak was in an isolated and sparsely populated area. The numbers of trained workers were adequate to the task.
MD in Philly (f9371b) — 10/14/2014 @ 8:44 amThat has not been true of this since June, if not earlier.
I imagine that not all of the people taking positions are the best in their field, but may be desperate to have a job to feed their family.
No one spends money on a problem they don’t have.
For whatever reason, the Borg wants to fight this thing in urban Amerikkka.
QE ends this month, Qbamaneycare price raises are leaking out, the Saudi/Ogabe garroting of Pooter over manufactured oil glut is killing investors, ISIS is preparing to flood the zone with Ebola zombies,…
Wait until the Left gets desperate.
gary gulrud (46ca75) — 10/14/2014 @ 8:45 am12. The good news is Ms. Pham is getting a dose from Dr. Brantly.
The bad news is she was one of 70 Dallas medics not tracked by the CDC following contact with patient zero.
We have entered the ‘wait on pins and needles’ phase, it is too late to gear up.
gary gulrud (46ca75) — 10/14/2014 @ 8:52 amIf we are to overcome the challenges facing us, the biggest obstacles will be the desire of the administration to avoid responsibility and the apparent willingness of their supplicants (the hospital for example) to aid them in their attempt. Clear thinking is not indicated when the hospital admits their mistake before they even know what it is, but it is indicative of the problem.
Nor is it encouraging that the administration keeps repeating that a thorough quarantine would do more harm than good. And our soldiers are being sent into harms way in West Africa with little thought as to their mission and their preparedness. This appears to be viewed as a gigantic PR opportunity with no consideration of the dangers. It’s analogous to the DoD maintaining that climate change is our greatest threat while they stumble piecemeal into a middle east conflict that could engulf us, just as the Democrat’s “best and brightest” inserted us into Vietnam 50 years ago.
bobathome (5ccbd8) — 10/14/2014 @ 9:02 amLiberian health workers are on strike and have abandoned the battlefield.
The death rate has reached 70%. 3500 people are arriving from the outbreak areas per week. The WHO expects 10,000 new cases per week imminently.
BHO has a number of fundraisers scheduled. FLOTUS stumped for Braley in IA this weekend and couldn’t get his name or history in front of her.
gary gulrud (46ca75) — 10/14/2014 @ 9:04 am15. I am relieved that I have plenty of wood to burn our dead.
gary gulrud (46ca75) — 10/14/2014 @ 9:06 amQuestion: How much and how often can Dr. Brantley donate blood?
elissa (8f8a59) — 10/14/2014 @ 9:18 am“I think it was Md in Philly who first noticed that the CDC guidelines didn’t match the WHO and Doctors Without Borders protocol. SarahW alertly noted the problems with respirators.well done to both.”
DRJ – I don’t think the CIA would have unleashed this disease they created without knowing how to prevent catching it themselves. They just need to be more forthcoming in sharing those techniques. 🙂
daleyrocks (bf33e9) — 10/14/2014 @ 9:22 amDid you read the article at Maxed Out Mama?
http://maxedoutmama.blogspot.com/2014/10/ive-about-had-it-with-race-mongers.html
She starts with the race-whining by Jesse Jackson and the Duncan family; then says that the rest of us aren’t going to get the level of care Duncan got. (She’s reacting to the new CDC guidelines which include avoiding AGP’s – Aerosol Generating Procedures. Like ventilation, intubation, dialysis … the things that keep Ebola patients alive while the infection runs its course.)
M-O-M is working on (non-Ebola-related) treatment protocols at a small clinic, and says “a few weeks ago, the clinic started getting calls from the African immigrant families who are patients. They all had relatives who were visiting and just wanted to come in for tests. Unspecified. Needless to say, we did not take them.” She goes on to say that hospitals don’t test for Ebola unless the patient is showing symptoms at the time he goes in. “We’ve referred several regular patients who believed they might have been exposed, but they aren’t getting tested.”
Think of THIS happening all around the country! (Note that Our Big Nanny Government just rescheduled hydrocodone and tramadol –now no refills and no phone or faxed prescriptions; each issuance requires a brand-new hard copy from a doctor– “because of the danger of abuse and addiction”. But this same Dear Nanny Gov’t CAN’T POSSIBLY bring itself to restrict incoming travel from Ebola hotspots, even thought there’s a danger of epidemic and massive civilian casualties. “CDC- 24/7 – Saving Lives. Protecting People” (TM) You betcha.)
A_Nonny_Mouse (650292) — 10/14/2014 @ 9:40 am#19, rocker: They are probably focusing on the ancient remedies: ample stores of ammunition, fuel, water, and food. And a clear field of fire on all sides of their bunkers. Look for large, circular clear-cuts in the forested areas around D. C.
bobathome (5ccbd8) — 10/14/2014 @ 9:45 amelissa,
I think Dr Brantly is donating plasma because that’s the part of the blood that has antibodies. If so, and assuming he’s in good health (as has been reported), he can donate a couple of times a week — but not on consecutive days. The main limitation is whether his blood type and the recipient’s match. I read that Brantly offered to donate to Duncan but, unfortunately, they weren’t a match.
DRJ (a83b8b) — 10/14/2014 @ 9:57 amI should have said they need compatible blood types, not matching.
DRJ (a83b8b) — 10/14/2014 @ 10:03 amThis call for Frieden’s head expresses my sentiments exactly.
Chris (0ba377) — 10/14/2014 @ 10:12 amMy job keeps us at the same hotel in Houston that the airlines use. I’m thinking of switching to staying in Laredo. At least the diseases those illegals bring are curable.
BradnSA (ca1a7e) — 10/14/2014 @ 10:13 am#20 ANM: From MaxedOutMama: “You’ll be lucky to even get an IV. It’s more likely that when you get really sick they’ll tie you to the bed and roll you into the dying ward. They may give you some liquid morphine if you are able to swallow.” This sentence concludes a paragraph outlining the new CDC guidelines.
This will be the true legacy that EarLeader will leave behind. The “Obama Care Pathway”.
One-shot, disposable zip guns designed to fire backwards would be more humane.
bobathome (5ccbd8) — 10/14/2014 @ 10:16 amThere is a positive side to this tragedy: Ebola is serving as a good test of our system’s response to a deadly agent. Better to flub with this sort of disease, which is very unlikely to cause an epidemic in the US than to flub with SARS or with a contagious biological agent terrorist attack.
This stuff is hard. Many organizations train for emergencies, and there are inter-agency training events. But, nothing is like the real thing. Training scenarios cannot be completely realistic. They may miss out on some officials (say, a judge who jumps into the fray) and some officials won’t bother to participate – it’s a low likelihood event and they have “better” things to do.
In the Dallas case, there were many different organizations involved, from the CDC to local health departments, to private hospitals and staff, to private cleaning agencies. Getting the right word out to everyone, and having appropriate inter-agency coordination, never works right. Hopefully this event will cause it to be improved.
I think that there many of the criticisms are misplaced, and are driven by politics – and I say this as a conservative who is not a fan of big government.
John Moore (ac5430) — 10/14/2014 @ 10:17 am20. A-Nonny-Mouse: what part of Georgia is MOM located, do you know?
Chris (0ba377) — 10/14/2014 @ 10:27 amI would like to know if Nurse Pham had a true hazmat suit or just a face mask? The CDC’s pictures show a worker in just a gown and face mask.
If it’s true, it’s absolutely inexcusable.
Frieden needs to resign and a real scientist take his place.
Patricia (5fc097) — 10/14/2014 @ 10:36 amPresident Ebola thinks the problem with America is it’s full of Americans.
He’s working hard on that problem.
papertiger (c2d6da) — 10/14/2014 @ 10:52 amA few thoughts from a medical blog at Scientific American.
First, the Emergency Room failed to take an adequate history, or to relay important information from the triage nurse to the physician—who is ultimately at fault for not having taken his own history, especially when presented with an accented foreign patient and after warnings about Ebola.
The Texas Health Presbyterian Hospital in Dallas next blamed the error on their electronic medical record system (EMR). This is entirely plausible, as the many brands of EMR I am familiar with are seemingly designed to maximize billing and minimize liability, by giving the illusion of comprehensiveness. They are, however, extraordinarily poor for patient care, as they are so cluttered with needless, clinically irrelevant detail. Though not at fault in this case, some Emergency Room EMRs are not readily accessible to the hospital inpatient units or clinics.
Second is the question of protocols and whether community hospitals rate prepared to deal with them.
It’s fine to have policies for isolation and employee health. Administrators love that, and it looks great when JCAHO (Joint Commission on Accreditation) comes around. The problem is that we need training, practice, and the ability to demonstrate our infection control skills. I have made this plea repeatedly for helping to control superbugs, to no avail. I have suggested that each year or two we practice our skills using Glo-Germ, which will readily show if we make an error. For example, I suspect that I contaminate something as I try to balance and take off shoe covers. It’s not easy. Unsurprisingly, now US nurses are saying they are unprepared for caring for Ebola patients.
In previous epidemics, especially during the SARS outbreak in 2003, removing personal protective equipment (PPE) was the most dangerous and health care workers (HCW) reported insufficient training. As Médecins Sans Frontières (MSF, or Doctors Without Borders) has demonstrated, HCW can be much safer by having a second HCW guide them through the removal process.
Do not be alarmed, though. The administration is working furiously to control the media narrative . That seems to be their principle skill.
Mike K (90dfdc) — 10/14/2014 @ 11:04 amWe are having an outbreak, aren’t we?
In about a month, we will have several people dying and lots more in quarantine. That’s an outbreak, and it will be just in time for the election. (That’s the main reason I don’t believe Obama planned this–it would be political suicide for the Dems.)
Patricia (5fc097) — 10/14/2014 @ 11:24 amMs. Pham’s BF has the symptoms.
gary gulrud (46ca75) — 10/14/2014 @ 11:26 amThe CDC recs, prior to any changes, said that precautions for Ebola included the combination of already known “general, contact, and droplet precautions”, which means gown, gloves, face shield (not sure if a mask necessary along with the use of a shield), and maybe/likely shoe covers.
Theoretically, that should be sufficient. “Theoretically” because as Mike K.’s excerpt says, it is easy to contaminate yourself taking the stuff off. This is why WHO/MSF uses coverings that are disinfected prior to taking them off. I do not know if/how ,this varies from a “True Hazmat”, if there is such a thing. The WHO/MSF protection would not need to protect against airborne pathogens/dangerous fumes, just make sure that any virus particles are on the outside of the suit and can be destroyed by chlorine before you take it off. there was a story of a Liberian woman who took care of 4 sick family members in her home and did not get it. She used a combination of a rain slicker, rubber gloves, rubber boots, and a mask, and used bleach water to disinfect herself.
At least that was the story.
Prior to any CDC change, pictures of the Boston hospital with a potential Ebola patient shows people using this kind of get up, including walking through a basin to disinfect their boots.
I think some of the criticisms are well placed, as it is clear that Obama appoints people on the basis of their ideology and slavish devotion, rather than competence. Also, I am sure the decision not to block flights comes down from Obama, whether people in responsible positions agree or not.
MD in Philly (f9371b) — 10/14/2014 @ 11:34 am32. But for the angle that a suspension of personal liberties will be necessary to combat the plague.
gary gulrud (46ca75) — 10/14/2014 @ 11:35 amAn interesting sidelight is the existence of an Ebola “Czar” who directed funding away from the company that has a possible treatment to a big DNC donor. I wonder if Collins has heard about this ?
A company controlled by a longtime political donor gets a no-bid contract to supply an experimental remedy for a threat that may not exist.” This Forbes piece is also interesting.
The donor is billionaire Ron Perelman, who was controlling shareholder of Siga. He’s a huge Democratic donor but he also gets Republicans to play for his team, of course. Siga was under scrutiny even back in October 2010 when The Huffington Post reported that it had named labor leader Andy Stern to its board and “compensated him with stock options that would become dramatically more valuable if the company managed to win the contract it sought with HHS—an agency where Stern has deep connections, having helped lead the year-plus fight for health care reform as then head of the Service Employees International Union.”
The award was controversial from almost every angle—including disputes about need, efficacy, and extremely high costs. There were also complaints about awarding a company of its size and structure a small business award as well as the negotiations involved in granting the award. It was so controversial that even Democrats in tight election races were calling for investigations.
The company that lost the grant makes Chimerix, which argued that its drug had far more promise than Siga’s. And, in fact, Chimerix’s Brincidofovir is an antiviral medication being developed for treatment of smallpox but also Ebola and adenovirus. In animal trials, it’s shown some success against adenoviruses, smallpox, and herpes—and preliminary tests show some promise against Ebola. On Oct. 6, the FDA authorized its use for some Ebola patients.
It was given to Ebola patient Thomas Eric Duncan, who died, and Ashoka Mukpo, who doctors said had improved.
Oh well, who cares ? Oh, and Siga went bankrupt.
Mike K (90dfdc) — 10/14/2014 @ 11:38 amYes as above, Brantley most recently gave plasma, which is the liquid component of blood without any blood cells. More or less, they take his blood as would a blood donation, spin it down to separate all of the white and red blood cells and platelets, and infuse those back into Brantley along with some saline. The plasma, with many proteins including antibodies goes into the recipient. I do not know what Brantley gave before, and I do not know what Brantley received in Liberia from a recovered patient. He may have received a whole blood transfusion as they may not have had the equipment to separate plasma.
MD in Philly (f9371b) — 10/14/2014 @ 11:40 am#27, John: As a true conservative concerned about training and institutional practice opportunities, you must be wondering why we sent the 101st Airborne to West Africa instead of a team from the CDC and their logistics support agency which I presume to be FEMA. We learned that FEMA needed just such opportunities following their massive failure at Katrina, and they will be even more sorely tested when our health care system is flooded with people with flu-like symptoms and there are no nurses and nurse assistants to render care.
As a true conservative, do you find the airing of such concerns just politics?
As a true conservative, do you think good intentions, or at least the appearance of good intentions, outweigh the importance of managing disasters effectively?
bobathome (5ccbd8) — 10/14/2014 @ 11:42 amMaybe this was already said elsewhere. Rushbo says the CDC was given 300 million more dollars by the House than was requested by Obama.
MD in Philly (f9371b) — 10/14/2014 @ 11:43 amThanks DRJ and MD for your responses to my question concerning Dr. Brantley’s blood and antibodies. I guess my reason for asking and my concern is that this one recovered- from -ebola man is not possibly going to be able to safely provide all the plasma that it appears is going to be needed as this continues.
elissa (ff4018) — 10/14/2014 @ 12:02 pmelissa,
I assume that, as other American Ebola victims recover and hopefully return to good health, they will be potential plasma donors. The only problem is that not all blood types are compatible with the American Ebola survivors, which is why Duncan don’t have a compatible donor.
DRJ (a83b8b) — 10/14/2014 @ 12:13 pmDuncan didn’t, not don’t. Grammar is hard.
DRJ (a83b8b) — 10/14/2014 @ 12:13 pmThis reminds me of Dana’s post where she suggested there are intangible benefits from having American doctors travel to Africa to help fight Ebola. Having Brantly’s blood available in the US strikes me as one of those benefits.
DRJ (a83b8b) — 10/14/2014 @ 12:24 pmSome of the compatibility issues are less of a problem with serum. Horse serum can still be used with tetanus. I was thinking, when the Spanish killed the dog that belonged to that nurse who died of Ebola, if dog antibodies could be used. Apparently dogs survive Ebola and develop antibodies. Dogs seem to survive Ebola and develop antibodies Pigs may be able to transmit the virus to humans but there is no evidence thus far of any danger from dogs. Primates seem to be the most susceptible.
Mike K (90dfdc) — 10/14/2014 @ 12:33 pm43. Agree completely. I just hope we don’t put more of a burden and responsibility upon Dr. Brantley than his system (which still must be compromised or weakened to an extent) can reasonably tolerate. Even mildly invasive processes like drawing blood for plasma and re-applying it is not completely risk free to the donor, especially if it is being done frequently.
elissa (ff4018) — 10/14/2014 @ 12:43 pmI hope they take care with Dr. Brantly’s health, too. He’s only donated three times — apparently once in September and twice in the past week — and that doesn’t seem excessive based on what I’ve read. But this ABC report quotes the Red Cross as saying donors should only donate plasma approximately once a month. I’m not sure if that’s a Red Cross policy or medically necessary.
DRJ (a83b8b) — 10/14/2014 @ 2:00 pminteresting article on topic of blood:
http://www.nbcnews.com/storyline/ebola-virus-outbreak/why-cant-we-have-more-magic-blood-ebola-n225536
elissa (ff4018) — 10/14/2014 @ 2:25 pmWell, a gallon of whole blood and a gallon of plasma or serum are significantly different in impact on the donor, with whole blood being a much bigger loss, and in my reading the story I don’t see it made clear.
MD in Philly (f9371b) — 10/14/2014 @ 2:35 pmBut still, it’s wonderful that he has a common enough blood type to give to most of the folks (I’m guessing he is O+, and Duncan was RH-). As others recover, maybe he will not be the only one who can give, and there will not be that many more in the US that need it.
Only 5% of blacks are Rh neg. It was probably an ABO problem. Even if he is Rh+, and Duncan Rh -, the first exposure to Rh for Duncan would probably not be serious.
Mike K (90dfdc) — 10/14/2014 @ 2:45 pmNo it doesn’t. It concludes a paragraph outlining someone called “maxedoutmama” characterizing the CDC guidelines. If you follow her link, the words “liquid” and “morphine” do not appear. In fact, the CDC guidelines give instructions for how to handle IVs and injections.
carlitos (c24ed5) — 10/14/2014 @ 2:51 pmThe above was in response to bobathome (5ccbd8) — 10/14/2014 @ 10:16 am
carlitos (c24ed5) — 10/14/2014 @ 2:52 pmHas anybody tried chicken soup?
nk (dbc370) — 10/14/2014 @ 3:08 pmSnow!!!!
elissa (ff4018) — 10/14/2014 @ 3:11 pmUsed to do phoresis (sp?) where they run a tube from one arm to a centrifuge and separate the, I think, plasma and return the balance to the other arm. I don’t think I lost any red cells, as it was explained to me.
Richard Aubrey (f6d8de) — 10/14/2014 @ 3:11 pmThose instructions go for any patient. Last time I checked we are careful with sharp things, and use them only when necessary.
Being flippant and poking patients for fun is so last millennium.
I think the point she was making was that if you don’t know what precautions will work to keep one safe, not entering the patient’s room at all is a good bet. I once joked with a patient about doing a lumbar puncture from the doorway*, but IV’s require close proximity.
Mike K.- you may be right, I was just thinking what would be the most likely situation where Brantley could donate to many people, but with one there was a problem. I thought being O would make it most likely for him to donate to most people, but I was only guessing.
*I had a friendly guy as a patient when in med school who needed lumbar punctures/spinal taps about every day to inject chemotherapy into his spinal fluid. It had gotten to the point of being “routine”, and I wondered aloud one day if I could do it from the doorway like throwing darts, he chuckled and suggested that I could try and we would find out.
MD in Philly (f9371b) — 10/14/2014 @ 3:15 pmRichard, yep, that’s it and you’re close, pheresis.
MD in Philly (f9371b) — 10/14/2014 @ 3:18 pmApheresis, the Greek word for subtraction.
nk (dbc370) — 10/14/2014 @ 3:20 pmChris #28-
I don’t know where in Georgia M-O-M lives. I’ve been curious myself!
A_Nonny_Mouse (866326) — 10/14/2014 @ 3:23 pma friendly guy as a patient when in med school who needed lumbar punctures/spinal taps about every day to inject chemotherapy into his spinal fluid.
I remember one who had coccioides meningitis who had to have a puncture of his 4th ventricle every day to inject amphotericin B. It was like pithing him every day.
Mike K (90dfdc) — 10/14/2014 @ 3:29 pmI had rabbit bolognese over the weekend.
carlitos (c24ed5) — 10/14/2014 @ 4:04 pmDid it help with your ebola?
nk (dbc370) — 10/14/2014 @ 4:27 pmfeets… Megham McCain just gave you a shout out on O’Reilly!
Colonel Haiku (2601c0) — 10/14/2014 @ 5:23 pm60… did it taste like Snow, carlitos?
Colonel Haiku (2601c0) — 10/14/2014 @ 5:25 pmNovember 4:
“So sorry, but we have to endure that everyone entering this polling place is Ebola-free. Please line up by political party registration.”
Kevin M (b357ee) — 10/14/2014 @ 6:12 pm*enSure
Kevin M (b357ee) — 10/14/2014 @ 6:12 pmMike K (90dfdc) — 10/14/2014 @ 3:29 pm
See, I knew there were good reasons to never visit California…
MD in Philly (f9371b) — 10/14/2014 @ 6:26 pmGood to know we have fluconazole and such these days.
Has this been linked yet? Nurses in Texas hospital say there were no “protocols”…. Guidelines kept changing.
SarahW (267b14) — 10/14/2014 @ 6:42 pmhttp://www.cnn.com/2014/10/14/health/texas-ebola-nurses-union-claims/
Hadn’t seen that yet. Sounds terrible.
MD in Philly (f9371b) — 10/14/2014 @ 6:47 pm67. I’m thinking Dr. Frieden has shot the CDC’s credibility all to hell. They’re as big a joke as NASA, except melting freshwater ice causing freezing seawater is funnier than Ebola.
gary gulrud (46ca75) — 10/14/2014 @ 7:25 pmWell, this isn’t good – via Instapundit. Don’t recognize the cite, but….” http://www.jems.com/article/news/16-members-doctors-without-borders-infec
Walter Cronanty (f48cd5) — 10/14/2014 @ 7:38 pm“16 Members of Doctors Without Borders Infected with Ebola, Nine Dead”
I guess those 16 infections and nine deaths kind of belie ABC’s health guru, Dr. Besser’s statement, that: “Groups like Doctors Without Borders, they have incredible training in this, and they practice it, and it’s the practicing that ensures that you don’t have a slip-up,” he said. “For our first patient in America to lead already to a health care worker getting sick really raises a concern to me.”
Walter Cronanty (f48cd5) — 10/14/2014 @ 7:49 pmAnd then there’s this: http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-bankrupt-my-hospital-director-reacts-to-cdc-prep-call/
Gary had a similar bit of info earlier.
MD in Philly (f9371b) — 10/14/2014 @ 7:52 pmIt would be interesting to know whether these were highly trained folk from Europe, recently trained folk from Europe, locals hired to help, or people who may have contracted it from contact not in the wards, like Brantley and company.
The work has outstripped the workers since June, and is getting worse.
As I said above, the usually highly trained and experienced Doctors Without Borders team has been overstretched and overwhelmed since the end of June. I’m assuming some of their current staff are relatively untrained, and those with training are being overworked, making mistakes more likely.
Those are my guesses, anyway.
For years hospitals have been consolidating, with some closing and the ones remaining running at very high occupancy rates. There is no capacity to increase services unless you cancel normal operations such as elective surgeries.
MD in Philly (f9371b) — 10/14/2014 @ 8:00 pmit’s much like marching into the valley at Balaclava:
http://hotair.com/headlines/archives/2014/10/14/ultimatum-to-nurses-make-a-mistake-and-you-die/
narciso (ee1f88) — 10/14/2014 @ 8:05 pmI recall a documentary on PBS several years ago about the early years of medicine, long before an awareness of the world of germs or micro-sized objects existed or was fully validated. One of the actors in the program depicting a leading doctor of the era portrayed him as becoming very insulted (and even hostile) when an assistant — who apparently had an inkling of the concept of micro contamination — said he should wash his hands before performing surgery.
More than 100 years later, a study during the 2000s indicated that even among many nurses and doctors, the basic proviso that one should always carefully wash his or her hands before and after seeing patients was routinely waived off or ignored, perhaps due to time restraints or simple laziness.
People in general can be very casual about observing basic concepts of hygiene, perceiving their nonchalance as a way of not looking anti-social or obsessively fussy. Whether a fear of Ebola infection will change some or all of this in upcoming months is anyone’s guess.
Mark (c160ec) — 10/14/2014 @ 8:19 pmWhat will Jenny McCarthy’s followers do if someone comes up with an Ebola vaccine? Just asking since I know the answer.
Ag80 (eb6ffa) — 10/14/2014 @ 8:35 pmSo your not supposed to play darts with the used syringes. Helpful pro tip.
papertiger (c2d6da) — 10/14/2014 @ 9:50 pmFrom write up: “Groups like Doctors Without Borders, they have incredible training in this, and they practice it, and it’s the practicing that ensures that you don’t have a slip-up,” he said. “For our first patient in America to lead already to a health care worker getting sick really raises a concern to me.”
Just read elsewhere that Doctors Without Borders has had 17 doctors infected and 9 of them have died. That doesn’t seem too encouraging for the ones that don’t get the incredible training.
zdude (887376) — 10/15/2014 @ 8:55 pmTrue.
MD in Philly (f9371b) — 10/15/2014 @ 9:01 pmAs I mentioned previously, Doctors Without Borders was overwhelmed by the work load back in June. Veterans must be exhausted, and new people pressed into service immediately do not have the training as those in the past.