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And you will act differently truly knowing that someone has some super scary disease vs just suspecting it. Just talking from personal experience there. So it is very likely that she was less stringent in following the protocol before a test came back, which fits the story that we know.

So this new Czar for the Ebola situation in the US....with no medical background does not seem right

 Jihadin wrote:
So this new Czar for the Ebola situation in the US....with no medical background does not seem right

It makes sense for what his role is supposed to be: coordinating the logistics of the response to Ebola. He's not the guy to tread the disease, his job is that of a CEO. How many non-medical people head up the majority of hospitals, insurance companies, or any other operation in the medical field.

But even though I don't think that there is anything wrong with having a non-medical person be the "Ebola Czar", I think we would be better served by finally getting a Surgeon General.

 d-usa wrote:
And you will act differently truly knowing that someone has some super scary disease vs just suspecting it. Just talking from personal experience there. So it is very likely that she was less stringent in following the protocol before a test came back, which fits the story that we know.

While I'm sure that may be true when someone is putting PPE on for a suspected MRSA, I doubt the nurses caring for a possible ebola case, in a symptomatic patient, from Liberia, when donning hazmat suits were anything less than careful. I actually think it's a bit insulting to assume otherwise, as I'm sure like most healthcare related follies, this is a broken process rather than poor nursing.

 AgeOfEgos wrote:

 d-usa wrote:
And you will act differently truly knowing that someone has some super scary disease vs just suspecting it. Just talking from personal experience there. So it is very likely that she was less stringent in following the protocol before a test came back, which fits the story that we know.

While I'm sure that may be true when someone is putting PPE on for a suspected MRSA, I doubt the nurses caring for a possible ebola case, in a symptomatic patient, from Liberia, when donning hazmat suits were anything less than careful. I actually think it's a bit insulting to assume otherwise, as I'm sure like most healthcare related follies, this is a broken process rather than poor nursing.

It is if I were to imply that they went "Ebola, lulz" and didn't care at all, then I would consider it insulting.

But recognizing that people who deal with isolation everyday, who are dealing with people with violent explosive diarrhea every day, who are dealing with GI bleeds and projectile vomiting every day, who "know" that there have been multiple false alarms about Ebola already, might just act a little bit different if they truly KNOW that someone has Ebola versus just suspecting it isn't exactly insulting. It's recognizing some of the institutional issues affecting nurses and that they may become fatigued towards every single disease requiring isolation. The fact that the two people that got sick so far both treated him prior to a positive test for Ebola should make us think.

One thing we (the medical field) have started talking about prior to this while Ebola thing is the concept of "isolation fatigue". If we isolate everyone for everything, do we become complacent and immune to the perceived danger?

I'm not trying to blame the victims here, but it think ignoring the fact they they cared for him pre-diagnosis would be a mistake. It gives us a definite time-frame to compare things. Did isolation practices change pre/post diagnosis? Did policies change pre/post diagnosis? Did personal behaviors change pre/post diagnosis? It's an important clue.




Automatically Appended Next Post:
Edit:

And again, just to clarify: I'm looking at this from a root-cause analysis perspective. Even if the initial investigation ends up pointing to "the nurses were not careful enough", then that would simply be the answer to the first question as well as the starting point for the next question.

I don't think that they would be consciously less careful because of it, but investigating why they might have made the mistake (anybody in any sort of managerial role knows the whole "cause/effect investigation", "5 why's", etc) is worthwhile.

If "they weren't as careful as they should have been and they made a mistake when doffing" is the answer to "how did they get infected", then we should ask "why did they let their guard down" which can lead us to the "is isolation overused and leads to fatigue", "did multiple false alarms give a false sense of security", "does the initial presentation mimic other known diseases (c-diff and GI bleeds are common ICU ailments)".

My position is not "it's the nurses fault". It is "considering the time frame of having them care for him before the diagnosis, did they do something different in the way they provided care for him before having the definitive diagnosis and if so what possible institutional problems might have contributed to a culture where something like this could happen.".

I say close the border keep everyone out til it is over. Keep us clean.... must be clean.

On a side note if someone shares body fluid with me make sure they arn't throwing up vomiting or leaking blood.... this is very different then usual life.

 Jihadin wrote:
So this new Czar for the Ebola situation in the US....with no medical background does not seem right

I see no reason that a politically connected dude with no specific related skillset can't do, shall we say, a heckuva job.

Spanish nurse-aid no longer has Ebola:

http://www.cnn.com/2014/10/19/health/ebola-crisis/index.html?c=homepage-t

Outstanding for the nurse. I kind of wish they waited to see if the dog got it or not

Well, the CDC has confirmed that ebola can be spread by sneezing, coughing, etc....but don't worry because thats not "airborne" (even though its what every normal person considers the term to mean).

Also, just issued today was a CDC statement that "we are not sure if ebola can be passed via pets"....but the implication was that this uncertainty is a good thing.



Bottom line, here's hoping this is a REAL wake up call for a lot of people. Here's hoping that the good voters of America see fit to toss out a lot of political leaders come election time. This gak with assigning an "ebola czar" with no medical or public health background is a slap in the face to the entire nation.

 Peter Wiggin wrote:
Well, the CDC has confirmed that ebola can be spread by sneezing, coughing, etc....but don't worry because thats not "airborne" (even though its what every normal person considers the term to mean).

Well, the average person is pretty ignorant. Source on the CDC claiming that Ebola can be spread via coughing? Because their FAQ makes no such claim.

Also, just issued today was a CDC statement that "we are not sure if ebola can be passed via pets"....but the implication was that this uncertainty is a good thing.

Okay?

Bottom line, here's hoping this is a REAL wake up call for a lot of people. Here's hoping that the good voters of America see fit to toss out a lot of political leaders come election time. This gak with assigning an "ebola czar" with no medical or public health background is a slap in the face to the entire nation.

A wake up call to what, exactly? The fact that a deadly, rare disease is in fact rare and deadly?

Hopefully everyone tosses out the idiotic fear-mongers on Capitol Hill, because they've done more to hurt the country than the two sick nurses.

Droplets was mention

 Peter Wiggin wrote:
Well, the CDC has confirmed that ebola can be spread by sneezing, coughing, etc....

Here we go, even though you don't source what you are typing and it's not like we have not addressed this numerous times in this thread already I will explain it. Again. And will probably explain it, again, in a few days:

 d-usa wrote:
I think that we are currently treating it as "droplet", which is somewhat of an intermediary between airborne (what the medical community truly mean whey they say airborne) and not-airborne.[

Basically, if you have infectious body fluids in your nose/mouth/throat/lungs then a cough or a sneeze can cause those liquids to become aerosolized and travel "through the air" as far as the cough or sneeze will carry it. The droplets will then drop to the ground (or whatever surface), unlike true airborne pathogens which will stay in suspension and actually travel through the air.

So if you are on an airplane with a disease that is airborne then you can get everyone sick, but if it's droplet then you can spread it only to the people within a few feet of you.

I don't think there is concrete proof yet that Ebola is spread via droplets, but it's plausible enough and the extra precautions (eye protection and face mask) are not that cumbersome.

 Peter Wiggin wrote:
but don't worry because thats not "airborne" (even though its what every normal person considers the term to mean).

A) I honestly don't give a care what "normal person" thinks a medical definition should be. Ebola doesn't become "airborne" because people don't know what "airborne" means.
B) "Every normal person" doesn't think that "sneezing = airborne". When a normal person thinks about "airborne" they think "somebody with Ebola sneezed on a plane, this is going to float through the air for the rest of the flight, all 300 people on this plane are going to get Ebola". And that is not what is happening.

Ebola is not a respiratory disease. Ebola does not affect the deep tissues of the lungs. Ebola does not have the ability to stay airborne. The droplets might become forcefully projected under very specific circumstances. But calling it airborne is 100% wrong, It's the equivalent of me taking my airbrush, filling it with Ebola tainted blood, spraying your face down with it, and then claiming that it became "airborne" when you got sick because with enough force you can spray blood a short distance.

IF you are in the stage of Ebola where you are sick enough to start bleeding, and IF your viral count is high enough, and IF you have a bleed in your mouth or nose, and IF you sneeze or cough, and IF you happen to sneeze on someone that is within a few feet from you, and IF those droplets land on a cut or mucous membrane THEN you can become infected via droplets. But you can get infected with HIV or Hepatitis the same way. I took care of a combative guy once who got his butt kicked and had a nose fracture and a couple tooth that were knocked loose. While we were putting him on the backboard he decided to spit on me and I could taste blood in my mouth. He spit blood, that flew through the air, and hit my mouth. Thankfully his tests came back negative, but this could have been a case where I could have gotten a blood-borne disease after it "traveled through the air". But that wouldn't have made it an "airborne" disease, just like Ebola is still not Airborne. No amount of misrepresenting old studies and misquoting the CDC will change that.

Bottom line, here's hoping this is a REAL wake up call for a lot of people. Here's hoping that the good voters of America see fit to toss out a lot of political leaders come election time.

This gak with assigning an "ebola czar" with no medical or public health background is a slap in the face to the entire nation.

Here is your homework assignment for the day:

Wherever you live, take a look and report back with the following:
-Who is the CEO for the 5 biggest hospitals in your area
-Who is on the boards of the 5 biggest hospitals in your area
-Who is in charge of your State Department of Health and your County Health Department
-Who is in charge of your EMS system.

My educated guess will be that you will find out that the vast majority of medical things are run by non-medical people.

The role of the "Ebola Czar", just like any other administrator in a health related environment, is to handle the logistics and to listen to the people about what needs to be done. His job isn't to be the "Ebola Doctor", that role should go to the Surgeon General (which Congress and Obama need to get the feth together on).

I am pretty damn certain that you are trained in ICS, in fact if anything that you have said in this thread is true then I am willing to put some money on you being ICS trained. So take a step back, take a breath, and think about all your training: Who should be on top of the chart. Someone that has the experience and knowledge to handle a complex response. Not the guy who passed medical school and hasn't done all that much (I will admit that from everything I know that would be the nominee for the Surgeon General job). The doctors should be the Operations Section Chief, the person actually implementing everything and making recommendations. That's where everything medical should be focused on. Let the non-medical guy handle the overall response. Let non-medical section-chiefs handle the planning, logistics, and administration sections. Let doctors focus on doctoring.


Automatically Appended Next Post:
And the school district here just announced that no student or teacher that was on the cruise ship with the worker who had zero symptoms and a negative lab test will be allowed to come to school...

The stupid is overwhelming...

 d-usa wrote:

 AgeOfEgos wrote:

 d-usa wrote:
And you will act differently truly knowing that someone has some super scary disease vs just suspecting it. Just talking from personal experience there. So it is very likely that she was less stringent in following the protocol before a test came back, which fits the story that we know.

While I'm sure that may be true when someone is putting PPE on for a suspected MRSA, I doubt the nurses caring for a possible ebola case, in a symptomatic patient, from Liberia, when donning hazmat suits were anything less than careful. I actually think it's a bit insulting to assume otherwise, as I'm sure like most healthcare related follies, this is a broken process rather than poor nursing.

It is if I were to imply that they went "Ebola, lulz" and didn't care at all, then I would consider it insulting.

But recognizing that people who deal with isolation everyday, who are dealing with people with violent explosive diarrhea every day, who are dealing with GI bleeds and projectile vomiting every day, who "know" that there have been multiple false alarms about Ebola already, might just act a little bit different if they truly KNOW that someone has Ebola versus just suspecting it isn't exactly insulting. It's recognizing some of the institutional issues affecting nurses and that they may become fatigued towards every single disease requiring isolation. The fact that the two people that got sick so far both treated him prior to a positive test for Ebola should make us think.

One thing we (the medical field) have started talking about prior to this while Ebola thing is the concept of "isolation fatigue". If we isolate everyone for everything, do we become complacent and immune to the perceived danger?

That's being very disingenuous. If you are stating a nurse, knowing a patient is isolated for a 70% mortality rate exotic disease named ebola, is going to be sloppy with isolation protocol because she's had C-Diff patients on her floor before---I'm sorry d-usa but that is insulting--to her and her family. I'm quite sure the nurses caring for Mr. Duncan were not thinking "Oh well, I've treated MRSA and C-Diff before and they isolate for too much now...so I won't be too careful". I'm sure they were likely frightened when someone explained they needed hazmat suits to enter the room, not to mention when they heard how deadly the disease was. It's something the media responded with, it's something the CDC responded with (then apologized) and it's certainly not fair to the young lady that cared for the patient and is now suffering under the same disease. There were relatively few false alarms at that point in the country and to suggest it was her lapse in judgement/wariness, really is demeaning to the nurse. Sure, there has been times when I worked ER and I thought it was silly that they isolate for a past positive MRSA but at no point would isolation fatigue enter my mind when the word 'Ebola' was being tossed about--and I can't imagine anyone at the hospital thought that either. I think to suggest so is a very large stretch.

The truth is, no one knows at this point how she (and another nurse) contracted ebola. Did someone (Doctor, aide, housekeeping, etc.) bring a device out of the room? Did the doctor's tie brush something when he removed his PPE? Did the nurses have the proper protocol to remove their PPE after treating Mr. Duncan? There is no answer as of yet so no need to jump to conclusions. Since there were two nurses however, that would likely point to a faulty process rather than a faulty nurse--especially considering some of the troubling reports I've read on how they instructed the nurses to don neck gear.


And while it was a one off case, you cannot state with authority that ebola is not a respiratory disease. While that is true for humans, the Reston Strain of 1990 (and of Hot Zone fame) was (and still is) thought to have gone airborne--when the agent was housed in swine--however would only spread to macaques.

Yes, I can state with authority that Ebola is not a respiratory disease because we know how it infects humans and what tissues it infects.

Knowing how it infects pigs, how it presents in pigs, and knowing that pigs can aerosolize anything (none of which makes it airborne) has zero impact on how the disease infects humans, how if presents in humans, and that we are not nearly as efficient to spread droplets as pigs (none of which makes it airborne).

But hey, we should also completely ignore the very significant fact that every person infected so far cared for him pre-diagnosis because we don't want to have hurt feelings and therefore we should not look into the possibility that not knowing for a fact that he had the disease might have contributed to a setting or institutional culture that made it easier for the disease to spread.

d-usa. Best it came from you. The difference between a droplet and a aerosol for those who still do not get it. Just throwing it out there.


Edit

Service both my pro-mask's
Additional 500 rounds for carbines
Service my ammo CLIPS.....for those who call them magazines
Hand painted signs saying "Keep Out" with a red hand print smearing downward

 Jihadin wrote:
d-usa. Best it came from you. The difference between a droplet and a aerosol for those who still do not get it. Just throwing it out there.

I understand why it's scary for the people that don't really know the difference, so all we can do is repeat and explain the difference between a droplet having a maximum range of a couple of feet and the true airborne putting everybody in a confined space in danger. Knowledge is power.





Automatically Appended Next Post:

 d-usa wrote:

But hey, we should also completely ignore the very significant fact that every person infected so far cared for him pre-diagnosis because we don't want to have hurt feelings and therefore we should not look into the possibility that not knowing for a fact that he had the disease might have contributed to a setting or institutional culture that made it easier for the disease to spread.

This came across as more of a jackass reply than I intended, sorry about that.

I think it's just as harmful to the situation to not investigate the possibility that the nurses could have made a mistake before they had a definitive diagnosis as it is to assume that they would be bad nurses if they made a mistake.

That's the point of a root-cause analysis. It's not to find a mistake, blame the person making the mistake, and then punish them. It's to find out what the mistake was, how it was made, what contributed to it, and what changes can be made to prevent it. By the time you are done with a RCA you are looking at institutional changes and cultural changes instead of "these nurses were bad, they need to stop being bad".

Indeed, during the 1989–1990 epizootic of the Reston subtype of Ebola, there was circumstantial evidence of airborne spread of the virus, and supporting observations included suggestive epidemiology in patterns of spread within rooms and between rooms in the quarantine facility, high concentrations of virus in nasal and oropharyngeal secretions, and ultrastructural visualization of abundant virus particles in alveoli

That's from the Oxford Journal of Infectious Diseases. And yes, aerosol particles can certainly be considered airborne---hell even TB, the Godmother of all airborne diseases is transmitted by infectious aerosols;

http://www.ncbi.nlm.nih.gov/pubmed/14656754

A Medscape article, which describes how the CDC defines aerosol particles;

http://www.medscape.com/viewarticle/741245_3

Also, the very definition of airborne transmission is;

The transmission of pathogens (bacteria, viruses, spores) by aerosol, from one vector/host to another. Once inside the vector’s respiratory tract, the “bug” develops, matures, reproduces, becomes contagious, and is transmitted to the next host.

Or, the NIOSH if you prefer;

Aerosol transmission has been defined as person-to-person transmission of pathogens through the air by means of inhalation of infectious particles. Particles up to 100 μm in size are considered inhalable (inspirable). These aerosolized particles are small enough to be inhaled into the oronasopharynx, with the smaller, respirable size ranges (eg, < 10 μm) penetrating deeper into the trachea and lung (Figure).[23,24] Aerosols are emitted not only by "aerosol-generating procedures,"[19] but may also be transmitted whenever an infected person coughs, sneezes, talks, or exhales. Pathogens transmitted by respiratory aerosols can travel short or long range from the source depending on the size and shape of the particles, the initial velocity (eg, cough vs exhalation), and environmental conditions (eg, humidity, airflow).


The question is, how long does the aerosol sustain the bacteria and/or virus? If the aerosols are too 'thick' and cannot float on simple breezes, it's considered droplet (I cough on your mucous membrane). However, the Reston strain was shown to be different in this regard when transmitting from animal to animal. So we cannot say "Ebola cannot and has not ever been airborne" with authority, as circumstantial evidence and studies have shown it very likely was--and this is from the Oxford Study of Infectious Diseases, not some random blog--and that particular strain is quite famous for this very fact.

Lastly (and perhaps lastly period), of course I suggested we study what procedure broke (something did). Stating it was a nurse's lapse in judgement and/or concentration, without waiting until they actually finish their investigation is not fair to anyone--for future nurses that may become infected in the same failing of protocol---or the nurse. I didn't blame the nurse, nor would I suggest its her fault until their investigation is complete. However, suggesting it might be, without waiting until we know--is not something anyone should engage in.

Reston is non-pathogenic in humans, so it's manner of transmission doesn't really affect human-to-human transmission of pathogenic Ebola.

The important question in this case is not "how long can an aerosol support the virus", it's "how long can an aerosol stay suspended in the air. That's the difference between droplet transmission and airborne transmission. And absolutely nothing has given us any indication that Ebola is airborne. It's not a respiratory disease, so humans don't really shed any viruses into their respiratory secretions. Which means that viruses don't really become aerosolized by themselves. It relies on blood and other secretions, which are pretty much the biggest barrier to this ever being an airborne disease.

"Pigs aerosolize stuff" has nothing to do with human-to-human Ebola spread.
"A Non-pathogenic strain may be airborne" doesn't affect how the pathogenic sprains spread.

The definitive answer, as definitive as we can get at this point, is that there is zero reason to suspect an airborne transmission route for human cases of Ebola.

While it is absolutely necessary to treat Ebola with all possible respect- because that is the only way to limit it- I can't help but constantly feel that everyone is panicking about Ebola to a stupid extreme when compared to how little they worry about diseases that already have existed in the US for years and years and injure/kill people with much more regularity. Some of which are completely treatable.

Or how little anyone has worried about Ebola in the last 4 decades, when they could have been doing work towards a vaccine.

Day 21 for his family tomorrow.

http://www.cnn.com/2014/10/19/health/us-ebola/index.html?c=homepage-t&page=0

 d-usa wrote:

Ebola is not a respiratory disease. Ebola does not affect the deep tissues of the lungs. Ebola does not have the ability to stay airborne. The droplets might become forcefully projected under very specific circumstances. But calling it airborne is 100% wrong, It's the equivalent of me taking my airbrush, filling it with Ebola tainted blood, spraying your face down with it, and then claiming that it became "airborne" when you got sick because with enough force you can spray blood a short distance.

Which prompted my reply;

And while it was a one off case, you cannot state with authority that ebola is not a respiratory disease. While that is true for humans, the Reston Strain of 1990 (and of Hot Zone fame) was (and still is) thought to have gone airborne--when the agent was housed in swine--however would only spread to macaques.....The question is, how long does the aerosol sustain the bacteria and/or virus? If the aerosols are too 'thick' and cannot float on simple breezes, it's considered droplet (I cough on your mucous membrane). However, the Reston strain was shown to be different in this regard when transmitting from animal to animal. So we cannot say "Ebola cannot and has not ever been airborne" with authority, as circumstantial evidence and studies have shown it very likely was--and this is from the Oxford Study of Infectious Diseases, not some random blog--and that particular strain is quite famous for this very fact.

Everything since then, you seem to be agreeing with me. I just pointed out that there is a very strong possibility ebola was airborne in the Reston case--which involved interspecies infection--and that aerosols are certainly considered airborne disease, depending on how long those aerosols are carried by the air. And yes, studies on macaque monkeys, including lung tissue staining, has shown that ebola can certainly infect lung tissue in non-human primates. And viral agents, that has shown in the past to have the ability (however remote) to A) Infect lung tissue of primates and B) Cause interspecies infection from pig to primate (seems familiar...), should absolutely be something they should be studying and concerned about. Considering the amount of study the current ebola mutations are absorbing from reputable virologists and infectious institutes--it appears they are.

To the mind of the average American, if it goes into the air and you can catch it....then it is airborne. The semantics are far less important than the perception of the masses, in terms of managing public concern on the matter.

Its also kind of directly contrary to what was repeatedly said about "you can only catch it from direct contact with fluids"....or perhaps simply wasn't communicated clearly ahead of time. Given the way this has gone all FUBAR I'm going to err on the side of "this crap is a LOT more easily transmitted than they want people to believe." Thats why the story keeps changing.

 Peter Wiggin wrote:
To the mind of the average American, if it goes into the air and you can catch it....then it is airborne. The semantics are far less important than the perception of the masses, in terms of managing public concern on the matter.

Its also kind of directly contrary to what was repeatedly said about "you can only catch it from direct contact with fluids"....or perhaps simply wasn't communicated clearly ahead of time. Given the way this has gone all FUBAR I'm going to err on the side of "this crap is a LOT more easily transmitted than they want people to believe." Thats why the story keeps changing.

If you read up about the entire 40 year history of Ebola virus disease, it's pretty easy to see that the story hasn't changed.

The only thing that has changed is what people are willing to listen to.

If you start going into "our government doesn't want us to know how easy it is to catch" territory, then you are heading into crazy conspiracy theory territory.

 d-usa wrote:


The stupid is overwhelming...

I'm waiting for people to start blaming and attacking immigrants, that's when you know the stupid is truly in the ascendant .

 d-usa wrote:
If you start going into "our government doesn't want us to know how easy it is to catch" territory, then you are heading into crazy conspiracy theory territory.

I believe Peter and a few others have already crossed into that territory a few times past.


Just a warning, soapbox imminent

I've said this already, but it real bears repeating: If you want to actually do something about Ebola, give money to the people who are risking their lives to stop it.

You don't have to give a lot and donating is super easy, just go to the Doctors Without Borders (MSF) website and give what you can.

We can sit here and toss around idiotic conspiracies and be scared to death of the invisible African bogeyman coming to kill us all or we can help the people that are risking their lives to do what no one else would. I mentioned this earlier, but I'll say it again: MSF has had at least 25 staff members contract Ebola and have lost another nine to the disease. They could use the support, guys!

 d-usa wrote:
Day 21 for his family tomorrow.

http://www.cnn.com/2014/10/19/health/us-ebola/index.html?c=homepage-t&page=0

And they are...out. This does lend support to statements that its harder to pass along.

Nina BF seems to be going into isolation for he showing "COLD" symptoms that same as Ebola symptoms


Edit

Blood samples being processed

Nigeria cleared of both ebola and E-Bola by the WHO.
http://hosted.ap.org/dynamic/stories/E/EBOLA_NIGERIA?SITE=MYPSP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2014-10-20-07-03-57