Texas health care worker tests positive for Ebola

[cali]

Source: CNN

A health care worker at Texas Health Presbyterian Hospital has tested positive for Ebola after a preliminary test, the hospital said in a statement.

Confirmatory testing will be conducted by the Centers for Disease Control and Prevention in Atlanta.

The employee helped care for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States. Duncan died on Wednesday.

"We knew a second case could be a reality, and we've been preparing for this possibility," Dr. David Lakey, commissioner of the Texas Department of State Health Services, in a statement Sunday morning.

Read more: http://www.cnn.com/2014/10/12/health/ebola/index.html

---

cross posted in GD

[greymattermom]

1. None from Emory or Nebraska so far, right?

If that's true, there will need to be special units with specially trained staff set up in more locations. I think there are only 3 or 4 of these level 4 isolation units in the country. This needs to be done asap.

[Shemp Howard]

6. Yet people keep coming in from the infected region.

The isolation units you speak of are eventually going to be overwelmed.

In cases of mass infection, only one thing works: a complete quarantine of the infected region. Yes, rush supplies to the region, but the region itself must be quarantined.

I cannot understand why the regions in Africa where the outbreak has occurred are not now under quarantine. "Screenings" at the airports are not nearly enough. Infected people can, and will, slip through.

[jwirr]

19. I hate to agree with you BUT the reason they can slip by is because they can be exposed and go for

some days before they start showing signs. So Duncan got on the plane with no symptoms and made it to US before he got sick.

[uppityperson]

40. None of the family who cared for and lived with him for days in infected quarters had gotten it yet.

Yes, infected people will slip through. The problem is not so much how contagious it is, but if you get it you are in big trouble.

Please be patient while they figure out how this woman got infected as first reports are often inaccurate. I do like this part of this article though the "first ever!" "second ever!" "Those stricken with Ebola suffer ghastly symptoms, including vomiting, diarrhea, muscle pain, fever and unexplained bleeding." are rather CNN let's sell air time and ad time crap.

"At some point, there was a breach in protocol, and that breach in protocol resulted in this infection," he said at a news conference Sunday. "The (Ebola treatment) protocols work. ... But we know that even a single lapse or breach can result in infection."

[pnwmom]

49. The problem is that they don't know FOR SURE whether there was a breach in protocol

or whether the protocol they have -- without a respirator, and apparently without having an additional person "spotting" each person who is removing protection gear -- is adequate.

[uppityperson]

50. Please be patient while they figure out how this woman got infected as first reports are often inacc

inaccurate.

[pnwmom]

59. What was impatient about my post? The problem with their initial statements

is that they need to consider the possibility that their protocol might have been followed -- and it might need to be strengthened.

[CullenBohannon]

44. true

This is getting crazy.

[roamer65]

67. I hear you.

We need to shutoff air travel to that region of Africa and anyone coming back is immediately quarantined for 20-30 days. I don't care about businesses and their profits. It is the only way to halt the spread of the disease.
We have to take action and get aggressive.

[LisaL]

20. Emory and Nebraska are 2 of the 4 hospitals especially designed to treat highly infectious

patients. TX is not one of those 4.

[Jawja]

33. Emory Healthcare workers who provided care

For Ebola patients had at least 12 years training and a support staff who monitored them every day. I would hope this patient would be transferred to Emory University Hospital or one of the other specialty units. Same way the healthcare workers were brought home from Africa to be treated.

[Chemisse]

2. How does this even happen?

Unless it was a worker who was exposed to Duncan before he was diagnosed, I don't understand how someone could acquire this disease.

The special unit and protective gear should afford health care workers 100% protection.

His family members didn't get it, and those workers who brought him to the hospital after vomiting all over the sidewalk didn't catch it (it's been 21 days, hasn't it?).

[Turborama]

8. Exactly what I was wondering.

Hopefully there'll be an answer soon.

[Yo_Mama]

10. Not yet, no. Two weeks, not three for the EMT/admitting staff

The CDC was going to follow a 42 day period anyway, that 42 day period has now been extended again. The 42 day period is two incubation periods, so you can catch a secondary case stemming from an exposure you didn't catch.

The family, whose exposure ended on the 28th, are due to end their quarantine next Sunday. I imagine they'll do tests on them before they officially end quarantine.

EMT workers follow body fluid precautions, so they should have some protection.

[krkaufman]

117. Sunday release from quarantine seems premature

The family, whose exposure ended on the 28th, are due to end their quarantine next Sunday. I imagine they'll do tests on them before they officially end quarantine.

Their exposure to Duncan ended on September 28th, but they remained in the contaminated apartment until October 3rd. Putting aside the recent reports that a 21-day quarantine may be insufficient, a release on Sunday would be just 16 days since his fiance et al were finally isolated.

Who's making this decision?

[notadmblnd]

12. It's only been about 15 days

[jwirr]

22. This is probably someone who took care of him the first time he came to the hospital?

[BooScout]

87. Nope....

She took care of him in full protective gear.

[jwirr]

90. Yes, I saw that in DU just a little while ago. There seems to be something we are not doing. I just

read an OP that says 30% of people who died in the last period of the epidemic were health care workers. I remember reading that in the Black Plague in England most of the ministry in the church were wiped out because they were the ones who did much of the health care. It is no surprise that health care workers are in danger they are the front line.

[Chemisse]

26. On Face the Nation just now, the guy said it only could have happened if protocol was broken

Perhaps in the way the nurse removed his/her protective clothing, or maybe related to the dialysis or other procedures.

It will be interesting to find out.

[dixiegrrrrl]

35. "kidney dialysis and respiratory intubation, posed higher risks for transmission of Ebola"

CDC Director Dr. Tom Frieden says.

So not known, but possible.....

[pnwmom]

52. Or if the protocol is insufficient. They don't want to admit that, but the protocol

might not be perfect.

For one thing, when scientists work with much smaller quantities of Ebola than a health care worker could potentially be exposed to, the scientists are required to use respirators -- not face masks.

[kestrel91316]

74. In BSL-4 labs that do ebola research, the scientists are in impermeable

full-body suits hooked up to an external air supply. SPACE SUITS.

And before removing those suits they go through a disinfectant shower of several minutes.

[magical thyme]

100. Agreed. I think they don't want to admit the normal PPEs are not enough. It would cost too much

otherwise. And nobody would volunteer to treat them.

In Spain, several health care workers have quit and others called out sick to avoid treating the infected nurse's aide.

[kestrel91316]

101. I think the space suits are probably the best way to ensure that human error isn't such a problem.

But that isn't feasible. I watched a great video about BSL-4 labs on This Week in Virology. There is NO way to get that level of protection in a hospital. The dollars simply aren't there.

[magical thyme]

103. Agreed again.

I'll be relieved when tourist season ends here in a few weeks. Still more relieved when a safe, effective vaccine is available.

[Chemisse]

122. If the dollars simply aren't there, maybe the nurses shouldn't be either.

It's not right to expect health care workers to take such high risks.

It's a job; it's what puts the food on the table. It shouldn't be treated like it is a religious calling for which they would lay their lives on the line.

[kestrel91316]

123. BSL-4 research lab space suits simply aren't needed for these patients.

Whatever the staff at the Biocontainmant Patient Care Units at Emory and NIH and Nebraska and the other place are JUST FINE. No staff have been infected there. It helps, of course, that they have had TRAINING.

A woman in Liberia treated her family of 6 successfully and avoided infection in her tin hut with nothing more than bleach, trash bags, a few latex gloves, a few surgical masks, and some IV fluids and setups for the patients. She also clearly had a keen sense of where virus could be and how to stay clean.

High tech isn't necessary if you have absolutely impeccable hygiene.

[AverageJoe90]

112. In fact, that IS indeed the only way it could have happened.

I only hope the hospital doesn't try to cover their asses and blame the CDC for all this. They already tried that with the nurse who first talked to Duncan, as many of us know.....

[Baitball Blogger]

28. I understand Duncan had a temp of 103 when he was first admitted.

So he exposed the workers from the very first visit. Why the family members aren't showing symptoms is a real mystery.

[kestrel91316]

75. Sheer dumb luck? Immunity from prior exposure in the fiance's case?

No way we'll ever really know. Stuff happens.

[JimDandy]

77. Duncan's family may be symptomatic

but the county may not have released the info yet.

We learned only early this morning that the nurse reported her Ebola symptoms on Friday. By Saturday night they had confirmed that lab tests revealed she had Ebola. Before they even told the public, hazardous cleaning teams had already arrived at the nurses apartment complex and disinfected all of the public areas, and they then overnight(?) informed every resident in the area of the Ebola case in their neighborhood.

[krkaufman]

116. Release from quarantine?

Anybody know when ebola victim Thomas Eric Duncan's fiance and relatives are scheduled to be released from their quarantine? And who it making that determination?

[hedgehog]

98. How long was he sitting in a crowded ER waiting room before being seen?

[uppityperson]

41. This is in the article, it will be interesting to see what they come up with.

"At some point, there was a breach in protocol, and that breach in protocol resulted in this infection," he said at a news conference Sunday. "The (Ebola treatment) protocols work. ... But we know that even a single lapse or breach can result in infection."

[pnwmom]

53. How do they know that the protocol they SHOULD be following isn't the one

that is followed in Emory and Nebraska, and every science lab that works with Ebola -- the one with respirators, not just face masks?

The fact is that the protocol followed in the special hospitals is quite a bit stricter than the CDC has deemed adequate for other hospitals.

[magical thyme]

108. that has bothered me from the beginning.they assure us that ordinary hospital PPEs are enough

but that's not what I see them using in Africa, in the 4 specialized units in the US, or in research laboratories.

[pnwmom]

110. I think it is what they recommend in Africa, so they're trying to say it is enough here, too.

But the scientists who work with much smaller amounts of the virus in laboratories have given themselves level 4 biosafety protection. So why shouldn't the medical personnel have the same?

[magical thyme]

111. because they aren't available and we aren't trained in them.

I think given the number of Ebola patients at this point, they all should be shipped to one of the four facilities set up for them. But nobody's asking me.

At least she's been caught early.

[pnwmom]

51. The Dallas workers didn't get the same protection as the Emory and Nebraska workers.

And they didn't get the same protection as scientists in the field who work with Ebola virus.

Ebola is a biosafety level 4 virus, so it's technically supposed to warrant respirators when being used, but the CDC is only requiring regular hospitals to use face masks. Either the face masks are not sufficient and/or people are making mistakes when removing their protective gear. The Dallas personnel didn't have the same training in doing that, or the same supervision, that the special hospitals (in Nebraska and Atlanta) had.

[kestrel91316]

70. Removing contaminated PPE is supposedly the most dangerous time.

If they aren't spraying everyone's PPE down with a bleach soak before removal, they should be.

[cannabis_flower]

73. Actually, no..

he was admitted into isolation September 28th. That's 14 days ago.

[magical thyme]

96. Duncan wasn't in a special unit; he was in an ICU ward all to himself

The health care workers had ordinary contact PPEs plus mask/goggles. It is very easy to make a mistake with ordinary PPEs and without extraordinary precautions when removing the PPEs.

He wasn't in one of the 4 special units designed for treating BSL 4 pathogens or treated by people with 12+ years training for it.

[krkaufman]

118. 20 days ... and 15 days

His family members didn't get it, and those workers who brought him to the hospital after vomiting all over the sidewalk didn't catch it (it's been 21 days, hasn't it?).

As of Saturday, Oct 18...

20 days since Duncan was finally admitted to hospital

15 days since his fiance and relatives were rescued/removed from contaminated apartment *


* and it sounds like they're scheduled to be released from quarantine on Sunday, 21 days from when Duncan was taken to the hospital on the 18th, but just 16 days since they were removed from the contaminated apartment on the 3rd; seems like yet another TX/CDC flub in the making

[quadrature]

3. could another city host NFL-Dallas home games? ...nt

[DonCoquixote]

4. In florida, we have a strain of MRSA

called "florida hospital MRSA." It normally happens to nurses, like a relative of mine.

The Medical Care system is run to the bone by a bunch of for profit ceo creeps who will glaldy let as many people die as possible if it means their nbext big paycheck. Of course, a greta place to cut costs is procedures and staff, the very things that get strained when an epidemic comes.

[hedgehog]

99. Thank you for bringing this up -

I strongly suspect that most of the protocols for caring for an Ebola victim apply equally as well to any situation involving care for someone with an infectious disease.

[aceofblades]

5. A key question I think is

whether this worker was exposed to duncan after he was suspected and subsequently diagnosed (during his first visit) or before that? Either way it is very unfortunate...

[OKNancy]

9. agreed

[JimDandy]

31. The article says she was exposed during his second visit. n/t

[calimary]

88. Welcome to DU, aceofblades!

Glad you're here! Hope we get some answers soon. The whole nation is depending on it. A "great" job ( ) has already been done on making sure many Americans don't trust their government anymore. Now, And we have to be able to trust our health care workers!

[WinkyDink]

7. (it's been 21 days, hasn't it?) Not quite; 10/12/14 is Day 19. Duncan timeline:

Sept. 24 — Begins having symptoms.

http://abcnews.go.com/Health/wireStory/timeline-case-ebola-diagnosed-us-26125457

[Yo_Mama]

11. It's three weeks from last exposure.

And the CDC is following a 42 day period (double incubation), to catch anything that slipped through the net.

[WinkyDink]

15. The timeline shows that Duncan's symptoms started on 10/24/14/

[Yo_Mama]

18. Last exposure outside the hospital was 9/28. It is now two weeks later

However, what is being reported about this second case in TX is that the worker who tested positive was in full protective gear at the time of exposure. So this exposure occurred 9/28 or after.

The family will not be cleared until around the 19th, and I think they will do testing to confirm no exposure before releasing them. They should, anyway. It's at least theoretically possible to have a subclinical case. Reports have it that they are supposed to be largely isolating themselves in the house where they are staying.

The CDC had announced that they were going to use a 42 day monitoring protocol for the first case - two incubation periods.

That 42 day period now starts again as of this date, and if this worker has exposed others and there is a tertiary case, it will restart when that case is identified and isolated.

In any case, until any persons exposed to this case (even in the hospital in a treatment setting) are cleared, one can't say much. Because this case was detected early it is highly unlikely that another infection has been transmitted - unless it happens again during the clinical course.

This will transmit a shockwave throughout the US health care system. The situation cannot be described as "controlled" in any way.

This patient should be transferred to one of the special biocontainment facilities. And then the whole process of decontamination, contact tracing and monitoring picks up again with a much larger group of potential exposures.

[krkaufman]

120. Quarantine release on 19th seems premature

The family will not be cleared until around the 19th,

Given the family wasn't rescued/removed from the contaminated apartment until October 3rd, a release from quarantine on the 19th (tomorrow) seems premature -- just 16 days since they were isolated. Seems somewhat risky, and definitely doesn't seem to be erring on the side of caution, which I'd think would be the CDC's approach given the general public panic.

[Yo_Mama]

121. I don't know what they will be doing

They could do testing on the family to confirm no infection. For the family's welfare, I would think that would be a good step, because otherwise they may face public fear and discrimination after the news about the nurses.

But the truth is that the probability of infection from non-intimate exposure during the early stages is not very high.

However, now that the nurse who flew has caused multiple persons exposed to her to be quarantined, the public isn't going to understand that for logical reasons.

The CDC would have to authorize the testing, though. And what if they came up with antibodies? Then the shit would really hit the fan, because it would prove that it is easier to contract (although that low levels of exposure may not cause clinical illness, because the body defeats the pathogen). But the risk to HCW would be much higher, because HCW would be at risk from infection during clinical procedures with patients who might have very low levels of virus in their bodies, no indication of infection, but yet be capable of spreading it to HCWs.

[JTFrog]

34. Can I have next week's lottery numbers please.

That date you posted is in the future, so I just thought I'd ask.

Sorry, couldn't myself.

[pnwmom]

54. For any particular person, the 21 day period would start after THAT person's

last exposure to Duncan, not with the day of the onset of Duncan's symptoms, Sept. 24. It's not that Duncan is only contagious for 21 days; it's that a person who was infected by Duncan could start showing symptoms up to 21 days after that person was exposed.

[uppityperson]

64. Correct. 21 days after the last exposure. You wrote it well.

[LisaL]

21. It's not 3 weeks. It's only 2 weeks.

[Yo_Mama]

38. The incubation period is three weeks - it's only been two

since last community exposure, probably 8-10 days since this second case contracted it.

Outside contact tracing for this contact will last an additional 21 days.

Presumably CDC has a team on the ground trying to figure out what to do about the other workers exposed in the hospital. One can't presume only one infection.

[kestrel91316]

76. Epidemiology FAIL. The longest documented incubation period for

Ebola is in fact 21 days, so that is the length of isolation.

I'm really glad you aren't in charge.

[krkaufman]

119. 42 days?

Not sure the 42-day period is being followed for Duncan's fiance and relatives, given stories that they're scheduled to be released on Sunday, 21 days from when Duncan was taken from the apartment but just 16 days since the family were rescued/removed from the contaminated apartment.

[fbc]

13. Quarantine Texas!

[Vinca]

14. I would be surprised if this is the last contact to come down with it.

I'm especially concerned about the family since they were cooped up with the ebola-laden trash and linens for days on end. Why hasn't this spurred a nationwide conversation about healthcare for everyone? I just read that 1 in 4 people in Dallas can't afford health insurance. Do you think they'll go to the ER if they get sick knowing a giant bill will land in their mailbox?

[peacebird]

16. Had not thought of the hospital costs, they should be waived for any potential ebola case.

In the interest of public safety.

[kestrel91316]

79. When I got exposed to rabies and went down to County-USC for PEP,

nobody had any interest in my insurance status or whether or not it might be a workman's comp thing (it technically wasn't, I was an independent contractor/temp). They had no intention of making the money an issue for any of the 22 people exposed.

But this is California. I suspect Texas is more of a pay-or-die place.

[pnwmom]

55. That's because they rejected Medicaid expansion. n/t

[AverageJoe90]

113. That's the one thing that worries me.

I believe one really good thing that President Obama could do is offer for the government to pay any and ALL health bills of Ebola victims, as a precautionary measure.

[paleotn]

17. That's so sad....

...but not too surprising. One mistake, a screw up, a brain fart, a simple break in protocol. It happens. Every health care professional from MDs to CNAs has done it, but this time the stakes are much higher.

Our success in containing this outbreak is dependent on how draconian we're willing to be. If we have the stomach for it, it can be contained and allowed to burn itself out. We get squeamish and the outbreak WILL expand. Pathogens and really the natural world in general don't give a shit about our concepts of freedom, human rights or compassion. They just want to replicate and if in the process that means your death then welcome to life on earth.

I cannot believe that people are actually able to fly from the affected areas to nearly anywhere with only a temp check and a few questions. It boggles my mind. What the fuck are we thinking? The handling of this entire outbreak has been a colossal cluster fuck, caused by slashed budgets, seeming indifference and global organizations unwilling to do what must be done. It's simple, really. No one leaves the affected countries without a damn good reason. Absolutely NO ONE leaves the affected countries without going through a strict quarantine of at least 21 days. And that includes foreign healthcare workers, US military personnel, everyone, period.

Unless we're willing to cordon of Guinea, Sierra Leon and Liberia and possibly additional west African states, treat the infected as best we can and let this thing burn itself out, there's no way we will control this and it will continue to smolder for years. It won't burn us down in it's current form, but it won't slink back into the bush anytime soon either.

[misterhighwasted]

23. Well stated.

Very sad indeed

[Chemisse]

29. I don't understand why we can't restrict people from coming here from those countries either.

Sure, we still let our own citizens return, and others who have a good reason to come here. But otherwise, why not just shut that whole thing down?

[Rozlee]

106. Lol. "...shut that whole thing down."

I'm sorry. I don't mean to laugh about such a serious subject but that reminds me of Todd Adkins comment on 'legitimate rape' victims not getting pregnant because their bodies can 'shut that whole thing down.' I really look at this whole Ebola epidemic from the view of perspective. My mother was a little girl back in the 1918's in Mexico when the Spanish Flu pandemic struck and she remembers the screams of her relatives and neighbors and in her own home as young bodies were carried out and buried in burlap shrouds. She lost 2 brothers and 2 sisters in that pandemic. 50 to 100 million lives were lost world wide to the flu. It was estimated that the Black Death killed between 30 to 60% of Europe's population in the 1300s. Ebola strikes terror today because it's been so sensationalized and because it produces such a ghastly death. It's kind of like the hysteria over the AIDs epidemic when healthcare workers would leave food outside of the rooms of AIDs patients because they feared contact with them. Sure, AIDs is epidemic in the US, Africa and many other countries, mostly through ignorance and the criminal interference of religious leaders and groups, but Ebola is being hyped in the same way. It isn't very easy to contract and bodies won't be stacking up in morgues. We won't be living with it like AIDs and while it's a horrific disease, it won't be like the Black Death.

[Chemisse]

107. That's actually where I got that phrase - lol.

I love it (it just makes me laugh to recall its original usage), and use it whenever it makes sense to do so.

I've read some about the 1918 flu epidemic and it must have been just horrific.

You are so right. Ebola is a scary disease, but it is unlikely to spread like a plague. Even in the countries in Africa that are so hard hit right now, a pretty small percentage of people there actually have Ebola.

[uppityperson]

42. how do you cordon off those countries? Build impenetrable fences all the way around?

There are roads, paths leading through the forests between those countries and many others. That is how it is spreading, combined with fear of healthcare and cultural norms in how they treat their dead.

Precisely how do you recommend sealing off all the borders there?

[pnwmom]

56. We require passports and sometime VISA's when people go through customs.

So it would be easy enough to restrict entry from people who were Liberian citizens, wouldn't it?

[uppityperson]

57. People are crossing the borders there, moving the disease around to other African countries

How do you propose to stop that, to "cordon off" those countries to stop the spread? Or are you merely concerned with people entering the USA?

[pnwmom]

62. We can't control Africa, but we can limit people coming from Liberia (or another heavily impacted

country) into the US. I'm not ready to say we SHOULD, but it is certainly possible to keep people like Duncan out.

[uppityperson]

63. Ah, so unlike paleotn who wants to cordon off those countries and stop the epidemic, you want only

to keep people from those countries out of the USA.

[pnwmom]

68. Can you read?

I said, "I'm not saying we SHOULD" but that it could be done.

[Thor_MN]

66. There are no direct flights to/from Liberia.

Are you prepared to totally close down air travel to all other countries?

[pnwmom]

69. So? It is easy enough to see where someone's flights originated. They knew that Duncan

was coming from Liberia and he carried a Liberian passport.

And I didn't say we SHOULD close off travel from Liberia; I merely said it could be done.

[Thor_MN]

71. And if they buy two tickets, rather than a connecting flight?

???

[pnwmom]

80. His passport and visas would tell the story. n/t

[kestrel91316]

82. No. But telling people with Liberian, Guinean, or Sierra Leone passports

to undergo 21 days' quarantine prior to entry is beginning to make a hell of a lot of sense.

And yes, have graduate level education in virology and epidemiology.

[Thor_MN]

85. So does your graduate work tell you that only people who are citizens of those countries

can carry the ebola virus? What about people from other countries that happen to be in one of them? Are they somehow magically immune?

I know and respect your medical background, but if one is going to be paranoid, might as well go all in and close down the borders until the outbreak burns out.

[kestrel91316]

86. The vast majority of victims of Ebola are in fact the citizens of Liberia,

Guinea, and Sierra Leone. Do you have factual information to the contrary?

People from other countries need to refrain from going there unless they are part of the medical effort. And they should leave only to go back to their own country, and not go gallivanting around the world.

This won't prevent 100% of spread, but it will make it manageable. An uncontrolled exodus of exposed citizens of those countries will rapidly overwhelm our healthcare system.

[Thor_MN]

89. Closing borders will triger that exodus.

As the vast majority of people in those countries are from those countries, it follows that the majority of victims are natives of those countries. Which also means that there does exist people who are visitors. I'm relatively certain, in the extremely unlikely circumstance that one contracts ebola in the US, the nationality the person that passed it doesn't matter.

A worldwide shutdown, a global quarantine, until the outbreak burns out and for a month+ longer would control it, but is it going to happen?

[CullenBohannon]

47. Its a combination of

Last edited Sun Oct 12, 2014, 01:26 PM - Edit history (1)

incompetence and or being stubborn. This sh*t is only beginning.

[Stardust]

58. But...but...that might inconvenience the Oil and Gas bigwigs!!! All of West Africa's economy will be

devastated!

[kestrel91316]

81. I agree with you except for the medical workers who get ebola and come home

for treatment. That is their right, and nobody is going to catch ebola from THEM (IMHO).

[TwilightGardener]

24. Here we go.

[greymattermom]

25. 4 BSL hospitals in the US

19 in the whole world. This level of containment is required for ebola. None of these hospitals are in Texas. http://undergroundmedic.com/?p=6990

[hedgehog]

97. Given that that blog also suggests that Ebola patients are going to be rounded

up and sent to spare FEMA camps "set up to quell civil dissent", I wouldn't put too much importance to this claim.

[greymattermom]

27. The bottom line

is that Texas has no facilities for ebola.

[kestrel91316]

83. I've been appalled at Frieden's claims that ANY US hospital can safely

handle Ebola patients.

I beg to differ, just by observing the average medical people I know and paying attention to the news. Hell, they can't control the spread of any other infectious diseases in the average hospital. Just look at the mess with nosocomials.

[drray23]

30. unfortunately

It is very easy to slip up. Removing your protective gear correctly is as important as having it on during potential exposure.

A nurse who is not from one of the lvl 4 hospitals probably would not have had enough training to make it second nature. All it takes is removing your gloves the wrong way or touching your face without sanitizing your hands.

[Sancho]

32. I think there must be something they really don't know about ebola...

or at least it's more contagious than they report. If doctors and nurses in full compliance with procedures in Africa get it, and the nurse in Spain who only went in the room with the patient while completely suited up catches it, and someone in Dallas in an isolation unit is sick......well, it seems to me that it must be possible to transmit ebola some way they don't anticipate.

Either it's is sometimes airborne, or it survives on surfaces after disinfection, or SOMETHING is wrong with the protocol.

[dixiegrrrrl]

37. And the head of the CDC is almost immediately blaming the protocol

CDC head Dr. Tom Frieden says there was a clear breach of safety protocol.

How he knows this so early in the game I have no idea.

while the head doc in Texas is saying there was no protocol breach.

New Texas Ebola patient was wearing protective gear, complied with CDC guidelines, Texas Health Dr. Dan Varga says

and yet,,,,,,,,,,,,

,Nurse who has tested positive for Ebola has been unable to identify a breach in protocol that led to contracting the virus, CDC director says

all excerpts from the CDC news video.

Do you remember that the nurse in Spain also said she followed protocol, and could not identify any breach?

[Quixote1818]

92. The nurse in Spain thinks she touched her face with a glove

http://www.washingtonpost.com/news/to-your-health/wp/2014/10/08/spanish-nurse-says-she-has-no-idea-how-she-got-ebola-as-her-family-fights-for-their-dogs-life/


The fact is the disease is still only spreading to about two people each time. This is no more aggressive than Ebola outbreaks in passed years.

[newblewtoo]

36. No system is foolproof

A similar double gloving and suiting procedure occurs in the nuclear industry. Do people screw up the process? Yes they do. Do they get exposed. Yes they do. Difference is, they wear dosimeters and are "wanded" out of secondary containments. At the moment you can't do that with Ebola

The military drills with MOPP Gear ( http://en.wikipedia.org/wiki/MOPP )donning and doffing. (or at least they use to) but again nothing will guarantee against a mistake or accident. You try to minimize the exposure and contain collateral damage when you cannot.

[eilen]

39. CDC protocol for removing contact isolation

has us removing our gloves, face shield (many of these are mask/shield combination units), gown and mask. Then washing our hands. Once you remove your gloves, you can easily unknowingly contaminate your hands and then something else as you remove the rest. You are supposed to wash your hands in between if you accidentally contaminate them but how do you know? Plus any opening in the skin will sink you -- and our hands are dry with fissures from frequent washing. I saw footage of people sealing gloves and gown sleeves with tape and wondered how they were going to remove that.

At our hospital, our contact isolation gowns are open in the back. Sometimes a glove does rip as well. It is not foolproof.

[Drayden]

46. Except we are being told it is just like HIV

Clearly that isn't the case. Doctors do not catch HIV simply tending patients. And they don't even wear bio suits to tend HIV patients. Ebola is more easily transmitted than we are being told. Too many healthcare workers have been infected. Now the exact mechanism of transmission intrigues me because to date, none of Duncan's family had developed ebola.

[magical thyme]

109. not only do gloves tear, I've had gram stain permeate them on at least 2 occasions

in the past 3 years. 2 occasions when I removed my gloves and the stain was just soaking through to the inner surface.

[shanti]

43. not good

not good at all....

[pediatricmedic]

45. The majority of health care workers are not trained to the level required

Most Doctors and Nurses are trained in the use of standard PPE equipment. This is the usual gowns, gloves, face masks, and other pieces used. Training for use of Level 1 or 2 bio/hazmat suits is not given in any medical or nursing program I know of. Those that have received the training are also unlikely to practice with the equipment on a regular basis.

I suspect in both cases(Dallas and Spain), it was improper removal of PPE equipment. The nurse in Spain has already admitted she probably touched her face while removing PPE. A similar lapse will probably be found in Dallas.

One thing you have to remember is that every square centimeter of an Ebola patient is infectious and contagious.

[dixiegrrrrl]

48. Why don't they use ultraviolet light

or some other decontamination procedure BEFORE stripping off the protective gear?
Lots of photos in Africa of spraying down protective gear of health workers before removal.

[kestrel91316]

84. I think they should wipe down the exterior of their PPE with

bleach or other disinfectant before doffing. Or spray them like they are doing in Africa. But that's just the paranoid microbiologist in me.

[Quixote1818]

93. I agree. You can't be too safe.

If there is a chance of getting Ebola by just touching your glove to your face when taking the suit off, then why not spray it down first and kill everything before you take the thing off.

[pnwmom]

61. "admitted she probably"-- probably under some duress, I would think.

They probably came to her with the most likely scenario, that she touched her face, and she acknowledged that it COULD have happened that way. Since no one was supervising her or recording her while she took it off, no one can really say what or even if she did something wrong. But her FIRST statement was that she removed the gear properly.

[uppityperson]

65. The Spanish woman was not a nurse but a volunteer with minimal training and poor iso gear

She was an assistant, not a Professional Nurse.

[LisaL]

94. The one in TX is apparently a professional nurse.

[crim son]

60. Where are the DUers who said this couldn't happen here?

The video at CNN explains exactly why it could and did happen here, even with our modern equipment and alert staff. Is it time to panic yet? No, but maybe it's time to acknowledge that we aren't all experts. Even the experts appear to be somewhat inexpert at this point.

[AngryOldDem]

72. I think now is the time to designate centers and trained staff to handle these cases.

Just like some hospitals are designated as level 1 trauma centers. Centralize and specialize care to ensure safety for everyone. I hope the CDC seriously considers this soon before there are any more confirmed cases. Now is the time to be preparing for this. Hopefully it won't be needed, but as they say, better safe than sorry.

[pnwmom]

91. Good idea. Not every little community hospital is prepared to handle emergencies like this. n/t

[snappyturtle]

102. I agree with you however....but is transporting contagious people to the special

facilities really going to work? Then, all the intermediaries, the transporting staff,etc. will need to have special training and risk even more people. All hospitals need to be prepared....better for the patient too...faster treatment. imho

[pnwmom]

104. It's already happening. The MA (possible) patient turned up at an urgent care center

and he obviously couldn't remain there. So he got transported via an ambulance to a good hospital.

And ambulances in every city will have to be prepared to transport people from their homes -- although it is certainly possible to designate some specially trained medics to have first priority.

[snappyturtle]

114. Thank you. nt

[magical thyme]

105. the CDC has confirmed the positive

http://www.nbcnews.com/storyline/ebola-virus-outbreak/second-u-s-ebola-case-confirmed-caregiver-remains-isolation-n223976

Earlier, Dr. Thomas Frieden, director of the CDC, said officials at the agency are "deeply concerned" about the new Ebola case involving the unidentified female caregiver, because she was infected after Duncan was admitted to Texas Health Presbyterian Hospital on Sept 28, when all workers were taking full precautions against Ebola transmission. He said the employee had been interviewed and could not "identify the specific breach" that allowed the infection to spread.

She was not among the original 48 people identified as having had contact with Duncan, all of whom are being monitored. The original contacts of Duncan have a week to go on their 21-day monitoring period and are not out of the woods yet.

Frieden, speaking at a news conference in Atlanta, said the CDC was working to identify other health care workers who also might have also come in contact with Duncan.

“If this individual was exposed … it is possible that other individual were exposed,” he said. Until the source of the caregiver's exposure is determined, he said, the CDC is recommending that the number of health care workers who treat potential Ebola patients be kept to a minimum.