[Health] The Infectious Diseases Thread

[$iljanus]

Heh, I'm sure Laurie Garrett is getting her next book ready as I type.

I would need to go back and review Betray of Trust (a great book and weapon) to see if she predicted this, but my guess is no. She does cover the other Ebola outbreaks in Africa, so who knows. Regardless, it was written at a different point in time, so yes, she is probably gearing up for an update. She's been very active on Twitter, at least. She's merciless in her accounting, so I do hope she's able to come up with something.

Personally, I'm all for it. I really don't think public health is winning the PR battle - now more so than ever. I don't think the average person truly appreciates all the things we're doing behind the scenes to try and keep society healthy. This is a great opportunity to get that information out there and show people why it's important for us to be proactively monitoring, training and preparing for these types of events.

I'm afraid given the current way we all cooperate across party lines and ideology when faced with adversity, the take home message will be that Big Gov failed yet again and we need tighter border controls to keep out certain people.

[Smoove_B]

From your local CBS News affiliate:

Among the nurses’ allegations was that the Ebola patient’s lab samples were allowed to travel through the hospital’s pneumatic tubes, opening the possibility of contaminating the specimen delivery system. The nurses also alleged that hazardous waste was allowed to pile up to the ceiling.

...

The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to the media or they would be fired. They did not specify whether the nurses making the claims were among Duncan’s caregivers.

The AP has attempted since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have so far been unwilling to speak.

So yeah, it's a mess.

[LawBeefaroni]

Health systems along for the ride just try to focus on profits.

You might be on to something. From Scientific American:

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.

That might be the single-greatest article I've read on the subject so far.

I think they later retracted that statement blaming the EMR but yeah, they are in place to maximize reimbursement and minimize liability (reduction of preventable errors, force doctors through a checklist, etc). Many doctors hate them because they aren't used to using them and they think the EMRs get in the way of actually practicing medicine. However, they will soon be required in order to get paid by Medicare, Medicaid, and private insurers. They have already been paying various incentives. Mostly because they generate a ton of useful data and cut program administration costs.

[paulbaxter]

From your local CBS News affiliate:

Among the nurses’ allegations was that the Ebola patient’s lab samples were allowed to travel through the hospital’s pneumatic tubes, opening the possibility of contaminating the specimen delivery system. The nurses also alleged that hazardous waste was allowed to pile up to the ceiling.

...

The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to the media or they would be fired. They did not specify whether the nurses making the claims were among Duncan’s caregivers.

The AP has attempted since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have so far been unwilling to speak.

So yeah, it's a mess.

I'm pretty sure it would be a violation of the law for the caregivers to talk to the media about these things. Unions don't get to bypass that sort of thing. They could just make firing someone more complicated.

[$iljanus]

From your local CBS News affiliate:

Among the nurses’ allegations was that the Ebola patient’s lab samples were allowed to travel through the hospital’s pneumatic tubes, opening the possibility of contaminating the specimen delivery system. The nurses also alleged that hazardous waste was allowed to pile up to the ceiling.

...

The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to the media or they would be fired. They did not specify whether the nurses making the claims were among Duncan’s caregivers.

The AP has attempted since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have so far been unwilling to speak.

So yeah, it's a mess.

I hope they offered doughnuts as an added incentive to get people to attend:

— Preparation for Ebola at the hospital amounted to little more than an optional seminar for staff;

[LawBeefaroni]

I'm pretty sure it would be a violation of the law for the caregivers to talk to the media about these things. Unions don't get to bypass that sort of thing. They could just make firing someone more complicated.

It's not a violation of the law to speak in general terms about hospital conditions and practices. It may be a violation of your terms of employment, but not the law.

Also, we have to be careful to believe just the soundbites. What is hazardous waste piled "up to the ceiling?" Is that a few sealed SHARPS dispoals stacked on top of a large pile of regular waste? Or is it piles of soiled linen laying out in the open?

Is pneumatic tube delivery really a problem? Even ones designed specifically for lab sample delivery?

[Smoove_B]

Also, we have to be careful to believe just the soundbites. What is hazardous waste piled "up to the ceiling?" Is that a few sealed SHARPS dispoals stacked on top of a large pile of regular waste? Or is it piles of soiled linen laying out in the open?

In light of how the cleanup at Duncan's apartment was ultimately handled, I'm inclined to believe the latter.

[Smoove_B]

...and just as I'm getting ready to leave for work, I see that the nurse with Ebola reported air travel the day before her symptoms started. Hopefully she's correct in her recollection of timing.

And with that - HELLO CLEVELAND!

[paulbaxter]

It's not a violation of the law to speak in general terms about hospital conditions and practices. It may be a violation of your terms of employment, but not the law.

Right. I'm still learning this stuff in school.

One of the things that makes me generally uncomfortable is the policy that anything which happens in a hospital which might look bad has to go into a separate report for "internal use only." Incident reports. I understand the reasoning, but I don't like the fact that that sort of policy could quite often hide bad practices and conditions from any outside observation.

[Blackhawk]

...and just as I'm getting ready to leave for work, I see that the nurse with Ebola reported air travel the day before her symptoms started. Hopefully she's correct in her recollection of timing.

And with that - HELLO CLEVELAND!

[Captain Caveman]

...and just as I'm getting ready to leave for work, I see that the nurse with Ebola reported air travel the day before her symptoms started. Hopefully she's correct in her recollection of timing.

And with that - HELLO CLEVELAND!

Man, this becomes exponentially difficult to track once the cat has even just a toenail out of the bag. How every effort was not made to lock this shit down immediately upon admittance of the first patient is baffling. It definitely exposes some big flaws in the system, as you guys have been saying.

[J.D.]

I'm travelling to Florida in less than two weeks. I'm officially worried now. Even though I probably shouldn't be, I am.

[J.D.]

One big difference between West Africa and North America that I think is being overlooked is that while West Africa lacks the proper hygiene/health care system/etc, they don't travel very far. Most people stay around their villages because they don't have the means to travel. In North American we're always zipping from city to city on planes and cars. Which means if this thing isn't locked down soon it could spread geographically very quickly. Not so much in terms of overall numbers, but just in scope of geography (2 cases in Texas, 1 in Ohio, a few more somewhere else, etc).

[Jeff V]

I'm travelling to Florida in less than two weeks. I'm officially worried now. Even though I probably shouldn't be, I am.

?

The problem is in Dallas, Texas. Not Florida, which has it's own thousand ways to kill you. Geezers in Cadillacs are a much more present danger.

[J.D.]

I'm travelling to Florida in less than two weeks. I'm officially worried now. Even though I probably shouldn't be, I am.

?

The problem is in Dallas, Texas. Not Florida, which has it's own thousand ways to kill you. Geezers in Cadillacs are a much more present danger.

I just mean who knows who's on my flight with me. I'm sure people in Cleveland were also saying "it's in Dallas, not Cleveland".

I'm being irrational, I know. But I am a bit of a germaphobe so this stuff scares the hell out of me at the silliest of times. I remember being all crazy about swine flu. Then I caught it and realized it was really no biggie.

[LordMortis]

One big difference between West Africa and North America that I think is being overlooked is that while West Africa lacks the proper hygiene/health care system/etc, they don't travel very far. Most people stay around their villages because they don't have the means to travel. In North American we're always zipping from city to city on planes and cars. Which means if this thing isn't locked down soon it could spread geographically very quickly. Not so much in terms of overall numbers, but just in scope of geography (2 cases in Texas, 1 in Ohio, a few more somewhere else, etc).

That's what's scary to me. And Cleveland is less than two hours from here. Keep that shit south of the Mason Dixon. Damn you, easy air travel! Actually what scares me is that I'm going to the hospital sometimes twice a week right now, so naturally I'm getting sick all of the time. I need to start wearing masks every time I go. It's like all these hospitals do is collect sick people... and then stick me in an incubation room with them for hours on end. Bastards.

[Octavious]

...and just as I'm getting ready to leave for work, I see that the nurse with Ebola reported air travel the day before her symptoms started. Hopefully she's correct in her recollection of timing.

And with that - HELLO CLEVELAND!

Man, this becomes exponentially difficult to track once the cat has even just a toenail out of the bag. How every effort was not made to lock this shit down immediately upon admittance of the first patient is baffling. It definitely exposes some big flaws in the system, as you guys have been saying.

I just don't get how we're letting people treating people with Ebola fly around willy nilly. They should lock the whole darn team down until it clears up. Sucks for them, but it make a heck of a lot of sense.

[Jeff V]

...and just as I'm getting ready to leave for work, I see that the nurse with Ebola reported air travel the day before her symptoms started. Hopefully she's correct in her recollection of timing.

And with that - HELLO CLEVELAND!

Man, this becomes exponentially difficult to track once the cat has even just a toenail out of the bag. How every effort was not made to lock this shit down immediately upon admittance of the first patient is baffling. It definitely exposes some big flaws in the system, as you guys have been saying.

I just don't get how we're letting people treating people with Ebola fly around willy nilly. They should lock the whole darn team down until it clears up. Sucks for them, but it make a heck of a lot of sense.

I don't know why African countries affected aren't sealed by a military-backed quarantine, either.

[LordMortis]

I don't know why African countries affected aren't sealed by a military-backed quarantine, either.

Nuke 'em from orbit. It's the only way to be sure.

[Rip]

I wasn't worried but I just heard Obama cancelled a fundraiser to have an Ebola meeting. Now I am terrified. he didn't even cancel any fundraisers for Benghazi, so this is a catastrophic sign.

[LawBeefaroni]

No, Seriously, How Contagious Is Ebola?


*We're talking the "basic" R0 here, for all you epidemiologists. So, the R0 that you get when everyone in the population is susceptible to the disease.
**The R0 is integrated over the time that a person is infectious to others. For HIV, this could be years. But for Ebola, that time is only about a week. So even though they have similar R0s, Ebola's infections per unit of time is much higher than HIV's.

I wasn't worried but I just heard Obama cancelled a fund raisers to have an Ebola meeting. Now I am terrified. he didn't even cancel any fundraisers for Benghazi, so this is a catastrophic sign.

Yeah, maybe the spread of the disease is not progressing as quickly as he had planned.

[A nonny mouse]

Isn't this how the whole Zombie apocalypse starts? World war Z (the book) anyone? Hell, even 12 monkeys.

scary shit.

[Rip]

No, Seriously, How Contagious Is Ebola?


*We're talking the "basic" R0 here, for all you epidemiologists. So, the R0 that you get when everyone in the population is susceptible to the disease.
**The R0 is integrated over the time that a person is infectious to others. For HIV, this could be years. But for Ebola, that time is only about a week. So even though they have similar R0s, Ebola's infections per unit of time is much higher than HIV's.

I wasn't worried but I just heard Obama cancelled a fund raisers to have an Ebola meeting. Now I am terrified. he didn't even cancel any fundraisers for Benghazi, so this is a catastrophic sign.

Yeah, maybe the spread of the disease is not progressing as quickly as he had planned.

Exactly.

That will teach those gun toting, bible thumping Texas rednecks who they should really be a scared of.

[Jeff V]

That will teach those gun toting, bible thumping Texas rednecks who they should really be a scared of.

Nurses?

[Carpet_pissr]

Damn, I thought the answer was "Spanish dogs". I'm failing.

[Captain Caveman]

I just saw a tweet from the Dallas Morning News that this second nurse already had a low grade fever while traveling from Cleveland. Lovely.

99.5 they say. I assume this is based upon her own self-monitoring and report.

Edit: I assume her risk of transmission is still extremely low in that circumstance, but even my rationale brain is a tad perturbed by the thought of those 100+ passengers on that flight now out and about town.

I have a feeling there's going to be a lot less sympathy for this nurse than the first.

[J.D.]

From CNN:

Because she had helped care for Dallas Ebola patient Thomas Eric Duncan, this health care worker should not have traveled on a commercial airplane, CDC Director Tom Frieden said.

At that point, health care workers were undergoing self-monitoring. They were allowed to travel but not on a commercial plane with other people, he said.

Moving forward, the CDC will ensure that no one else in such a situation travels outside of a closed environment, he said.

What a gong show.

[J.D.]

I have a feeling there's going to be a lot less sympathy for this nurse than the first.

No kidding. She spent days elbow deep in fluids of a man infected with Ebola, she gets a fever and says "screw it, I'm flying anyway". From an ordinary person I might understand, but from a trained health care worker? Inexcusable.

EDIT: Low risk or not, can you imagine how the person who sat in the seat after her feels right about now? "Hello sir/madam, this is the CDC. You know that flight you took a couple of days ago? Well, a couple of hours before you boarded someone with ebola was feverish and sweating in the chair you sat in. Please take your temperature every day for 21 days and let us know if you start showing symptoms of this disease that may kill you. Have a good day."

Awful.

[Blackhawk]

From what I've read, she didn't develop the symptoms until the day after the flight.

She still said, "screw it, I'm flying anyway" after apparently being told not to travel by air, though.

[Rip]

I have a feeling there's going to be a lot less sympathy for this nurse than the first.

No kidding. She spent days elbow deep in fluids of a man infected with Ebola, she gets a fever and says "screw it, I'm flying anyway". From an ordinary person I might understand, but from a trained health care worker? Inexcusable.

EDIT: Low risk or not, can you imagine how the person who sat in the seat after her feels right about now? "Hello sir/madam, this is the CDC. You know that flight you took a couple of days ago? Well, a couple of hours before you boarded someone with ebola was feverish and sweating in the chair you sat in. Please take your temperature every day for 21 days and let us know if you start showing symptoms of this disease that may kill you. Have a good day."

Awful.

Don't forget to keep track of flights you take in that 21 days so we can go back and send this letter to the tens of thousands of people you could infect in the meantime.

[Blackhawk]

From CNN:

Because she had helped care for Dallas Ebola patient Thomas Eric Duncan, this health care worker should not have traveled on a commercial airplane, CDC Director Tom Frieden said.

At that point, health care workers were undergoing self-monitoring. They were allowed to travel but not on a commercial plane with other people, he said.

Moving forward, the CDC will ensure that no one else in such a situation travels outside of a closed environment, he said.

What a gong show.

I'm not sure what the solution is, other than a legally enforced quarantine with officers standing outside the door. There is always going to be someone who should be trustworthy, who is told what has to happen to protect people, who will nonetheless choose their own interests.

Short of some sort of CDC-equivalent of martial law, individuals will always slip the bit and be stupid.

[LawBeefaroni]

From CNN:

Because she had helped care for Dallas Ebola patient Thomas Eric Duncan, this health care worker should not have traveled on a commercial airplane, CDC Director Tom Frieden said.

At that point, health care workers were undergoing self-monitoring. They were allowed to travel but not on a commercial plane with other people, he said.

Moving forward, the CDC will ensure that no one else in such a situation travels outside of a closed environment, he said.

What a gong show.

I'm not sure what the solution is, other than a legally enforced quarantine with officers standing outside the door. There is always going to be someone who should be trustworthy, who is told what has to happen to protect people, who will nonetheless choose their own interests.

Short of some sort of CDC-equivalent of martial law, individuals will always slip the bit and be stupid.

This ties in with the asshole thread(s). It's simple; don't be an asshole. Don't put your personal comfort and convenience above the health and welfare of others. People tend to only care about themselves. There is no committment to the better of society.

Being a bit more generous to her, though, there's also the psychological act of denial. If she cancelled her flight, she'd be admitting to herself that there's a chance she had ebola.

[Captain Caveman]

From what I've read, she didn't develop the symptoms until the day after the flight.

She still said, "screw it, I'm flying anyway" after apparently being told not to travel by air, though.

The new information is that she knowingly flew with a fever 99.5. It's being reported on major news sights now.

Edit: I say "knowingly" on the assumption that she was self-monitoring and this is why we now know she had this fever during the flight.

[J.D.]

Apparently the first case in Nigeria back in August involved a man vomiting uncontrollably on the plane ride in and none of those passengers got sick. So I'd say the risk to these passengers is pretty close to zero. But still, c'mon now.

[Captain Caveman]

The clusterfuck grows: apparently the healthcare workers wore no protective gear for the first few days until Ebola was confirmed for Duncan.

Jeebus.

[Blackhawk]

From what I've read, she didn't develop the symptoms until the day after the flight.

She still said, "screw it, I'm flying anyway" after apparently being told not to travel by air, though.

The new information is that she knowingly flew with a fever 99.5. It's being reported on major news sights now.

Edit: I say "knowingly" on the assumption that she was self-monitoring and this is why we now know she had this fever during the flight.

Ah. Well, then. Ebola Mary needs a good smack.

[Captain Caveman]

She was in Cleveland planning her wedding, which helps explain a bit why she wouldn't want to back out of the trip.

But still.

[RMC]

Man, I work in healthcare in Cleveland... Holy crap... I am not a clinician, but I am getting calls from people I went to high school with and asking if they need to rush to the ER because they drove by the airport on the day the nurse was there.

If this continues to grow, I can only imagine what is going to happen. Hell, I am worried about this as well, but information is the best way to calm people. And not have people ignoring what they were told to do, or not do.

<sigh>

[J.D.]

The clusterfuck grows: apparently the healthcare workers wore no protective gear for the first few days until Ebola was confirmed for Duncan.

Jeebus.

September 28-30. So we should either see a bunch of cases pop up within the next week, or luckily it'll be disaster avoided.

[LawBeefaroni]

Man, I work in healthcare in Cleveland... Holy crap... I am not a clinician, but I am getting calls from people I went to high school with and asking if they need to rush to the ER because they drove by the airport on the day the nurse was there.

If this continues to grow, I can only imagine what is going to happen. Hell, I am worried about this as well, but information is the best way to calm people. And not have people ignoring what they were told to do, or not do.

<sigh>

If this stretches into flu-season, it's going to be a triage nightmare.