[Health] The Infectious Diseases Thread

[RMC]

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.

No excuse. Sorry, maybe I am a jerk, but she was around a patient and one of the other clinicians came down with the disease, postpone your life plans and ensure that you are virus free before going out. Especially traveling by plane.

I hope that no more positives come out of this, the physician that was with the cameraman that was positive for Ebola violated the self imposed quarantine. However, I think as long as she was being monitored, she was fine in doing so because she was being monitored and was not showing any signs. CNN Linky

But the public is going to go into a panic if they are not given the correct information or one thing is said, IE - It will not spread we are trained, and then it spreads keeps happening.

If this nurse really knew she had a fever and traveled anyway, then she is to blame, because she knows when this virus is transmittable. I still hope that no more new cases spring up, and that we contain it now before anything else bad happens.

[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.

They've corrected the original report to say they they were using protective gear over those I itial two days, just not Hazmat suits. Still, they think it's likely the nurses contracted Ebola during these few days.

[Rip]

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>

Well while you are taking questions. I have an aunt who is best friends with a lady whose daughter lives in Cleveland. Well her daughter send her some baked cookies and she gave my mom one but she didn't eat it. She did post a pic on facebook though. I should be safe right? Probably have to steer clear of my mom for a few weeks. I'll make it a month just to be safe.

[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>

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

Yeah, I am not looking forward to the impact this will have on the overreactions in the ER. I can just imagine a parent with a child and thinking that the child has Ebola. Dear god, they will become impossible to deal with. And as a parent, I can understand what I would do for my child, and if someone thinks that they are being lied too.... Ugh...

But let's hope that the cases stop appearing, and that the CDC can help really contain this and get the best gear/training out to healthcare professionals so that we can cure this and go on worrying about other things.

[Zarathud]

The most disturbing part of this is that we couldn't impress upon this nurse the importance of self-quarantine and risk to the public from travel by plane.

But I'm sure Texas will blame the CDC and Obama.

[paulbaxter]

The most disturbing part of this is that we couldn't impress upon this nurse the importance of self-quarantine and risk to the public from travel by plane.

But I'm sure Texas will blame the CDC and Obama.

I've already seen people on facebook blaming Obama. Look, if you're a republican, wouldn't you want LESS involvement by the gvt.?

[LawBeefaroni]

The most disturbing part of this is that we couldn't impress upon this nurse the importance of self-quarantine and risk to the public from travel by plane.

As a nurse, she knew.

[Isgrimnur]

I've met plenty of nurses and nursing students. I lived in a city that was responsible for training a great number of them. They were unremarkable in any other way in being distinguished from the population at large. There were some that I wouldn't trust to figure out the pointy end of a sharp. I have issues granting anyone an additional benefit of the doubt just because they are a nurse.

[RMC]

I've met plenty of nurses and nursing students. I lived in a city that was responsible for training a great number of them. They were unremarkable in any other way in being distinguished from the population at large. There were some that I wouldn't trust to figure out the pointy end of a sharp. I have issues granting anyone an additional benefit of the doubt just because they are a nurse.

I work with nurses, and while some of them are idiots about computers, and life, and other things when it comes to patients and illness, they all know what is going on.

Unless she was a very bad nurse, and ICU nurses are usually some of the best overall nurses, then she would know all about the signs and symptoms. If she was an OB nurse, then sure she might not know about it, but an ICU nurse that was just treating the one patient in the her hospital with this virus, then she had to know.

[malchior]

You have to hope that with multiple instances of medical professionals ignoring monitoring/quarantine orders in very few cases is just chance and not some indication that the controls are not going to be effective in general.

[Rip]

The most disturbing part of this is that we couldn't impress upon this nurse the importance of self-quarantine and risk to the public from travel by plane.

But I'm sure Texas will blame the CDC and Obama.

I've already seen people on facebook blaming Obama. Look, if you're a republican, wouldn't you want LESS involvement by the gvt.?

I would certainly want less lying to us and telling us about how it can't get here and that any ol hospital can "stop it in its tracks" with standard isolation.

When you make proclamations about things you can't possibly know for sure, don't be surprised with the resulting vitriol.

[naednek]

[Brian]

Don't Dead Open Inside.

[Zarathud]

When you make proclamations about things you can't possibly know for sure, don't be surprised with the resulting vitriol.

That's priceless, RIP.

[Isgrimnur]

If you like your health care plan, you'll be able to keep your health care plan.

[xwraith]

CBS News reporting that nurse Amber Vinson called #CDC BEFORE boarding the plane and was told she was OK to get on the plane with 99.5 temp

[Captain Caveman]

CBS News reporting that nurse Amber Vinson called #CDC BEFORE boarding the plane and was told she was OK to get on the plane with 99.5 temp

Holy moly mother of guacamole.

[Rip]

CBS News reporting that nurse Amber Vinson called #CDC BEFORE boarding the plane and was told she was OK to get on the plane with 99.5 temp

Yea, now lets see if the same contempt that was had for her gets translated to the CDC. I doubt it but I wouldn't mind being pleasantly surprised.

[Captain Caveman]

CBS News reporting that nurse Amber Vinson called #CDC BEFORE boarding the plane and was told she was OK to get on the plane with 99.5 temp

Yea, now lets see if the same contempt that was had for her gets translated to the CDC. I doubt it but I wouldn't mind being pleasantly surprised.

Here's the quote from the full article.

CBS News Medical Correspondent Dr. John LaPook reports that Vinson called the CDC several times before boarding the plane concerned about her fever.

“This nurse, Nurse Vinson, did in fact call the CDC several times before taking that flight and said she has a temperature, a fever of 99.5, and the person at the CDC looked at a chart and because her temperature wasn’t 100.4 or higher she didn’t officially fall into the category of high risk.”

[Smoove_B]

Christ. This is Andrew Speaker all over again.

"We gave the patient the benefit of the doubt, and in retrospect we made a mistake," said Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention. "We failed to take the aggressive actions we could have."

[RMC]

Wow... the CDC is not doing us any favors are they?

If the nurse was worried about the flight, and the CDC said go ahead, then she is clear and the CDC is on the hook for this...

[malchior]

I like to think that while disease might be the mechanism, the root cause of the end of humanity is probably going to be typical big organizational incompetence. So you say you had exposure to a virulent infestation that we are trying to contain and have a slightly elevated temperature - hmm - well the handbook says you're in range so no problems! FFS.

I also don't think the CDC is only on the hook - this is akin to someone asking permission to do something stupid probably knowing it was stupid and wanting to do just it anyway (i.e. ass covering).

[RMC]

I like to think that while disease might be the mechanism, the root cause of the end of humanity is probably going to be typical big organizational incompetence. So you say you had exposure to a virulent infestation that we are trying to contain and have a slightly elevated temperature - hmm - well the handbook says you're in range so no problems! FFS.

I also don't think the CDC is only on the hook - this is akin to someone asking permission to do something stupid probably knowing it was stupid and wanting to do just it anyway (i.e. ass covering).

Agree. But when you can punt and make someone else make the decision, and they say Okay, then passing the buck works..

She should have known not to go, but she wanted to go and the people who could allow her, or not allow her to go said okay do it.

Also, we now are asking all patients that come into the ER if they were on that flight if they have a fever. <sigh>

[LawBeefaroni]

O'hare begins screening today.

CHICAGO (AP) - Screening for the Ebola virus is to begin at Chicago's O'Hare International Airport.

Customs and health officials at O'Hare will take the temperatures of passengers from three West African countries starting Thursday.

Federal health officials say the entry screenings add another layer of protection to halt the spread of the Ebola virus that has killed thousands. Screeners will use no-touch thermometers to try to find passengers with fevers.

Also starting today at Hartsfield (Atlanta), Liberty International (Newark), and Dulles.

Dulles is one of four U.S. Airports scheduled to begin the screening process Thursday, along with airports in Chicago, Atlanta, and Newark, New Jersey.

[Smoove_B]

I predict this lasts a week before they're overwhelmed with false-positives that end up delaying flights or causing traveler strife. Though maybe if they catch people with influenza...

Also, this plan is hinged on catching someone in a very tight window and assuming they don't hop themselves up on antipyretics before travel. I mean, I get that they need to do something, but I can't help but think this is the public health equivalent of taking off your shoes for the scanner at the airport.

[Carpet_pissr]

Every time I fly into Narita (and I think Beijing and HK as well), right after you get off the flight, you pass through a little checkpoint that has a thermometer pointed at the incoming passengers, I assume to check temp levels (I know only because I was curious the first time, and turned around to look at what was on the monitors, which looked something like this:



They have been doing that for as many years back as I can remember. Interesting that we are just now implementing this. OTOH you also see a LOT more people wearing face masks there, so it's probably a cultural thing as well.

[ColdSteel]

I have very little confidence that the CDC (or any other government agency) can handle a real pandemic type of situation. Maybe 30 years ago they could but I don't think the public in general has any real idea of how badly government agencies and their workforces have eroded over those 30 years (and funding is just one of the reasons). Believe me, I personally know this to be true. Political appointees like this clown at CDC are running the show and all they want to do is look good and do damage control as far as fingers pointing at their agency goes.

Apparently the CDC person the nurse called looked up information on the Internet and then told her she was okay to fly with a fever after Ebola exposure when a blind chimpanzee has enough common sense to know better. At worst they should have deferred the decision to an Ebola expert within CDC. Staggering incompetence.

The fact that the hospital staff had no clue about proper protocol and allowed workers to treat Duncan for 2.5 days before adopting proper gear speaks volumes about how prepared the average hospital is for this. This is a giant wakeup call for the US and it will turn out to be a good thing if we can not make any additional mistakes and stop it at this point. There will eventually be a lot of lessons learned. If it spreads further though, they really should call in the WHO which, unlike CDC, actually has experience in dealing with things like this. Hubris on the part of the government will likely prevent that from happening though (unless things get really bad).

[Captain Caveman]

At Target yesterday here in North Dallas, my wife reports seeing not one, not two, but three separate people in various degrees of protective gear-- all had breathing masks, two had gloves, and one had some sort of protective gown. Absolute craziness. I can only hope this gets nipped in the bud soon or this town may lose its collective mind.

This morning my kid is getting a flu shot (well, nasal spray) right across the street from Presbyterian hospital. He'll be fine.

[RMC]

I have very little confidence that the CDC (or any other government agency) can handle a real pandemic type of situation. Maybe 30 years ago they could but I don't think the public in general has any real idea of how badly government agencies and their workforces have eroded over those 30 years (and funding is just one of the reasons). Believe me, I personally know this to be true. Political appointees like this clown at CDC are running the show and all they want to do is look good and do damage control as far as fingers pointing at their agency goes.

Apparently the CDC person the nurse called looked up information on the Internet and then told her she was okay to fly with a fever after Ebola exposure when a blind chimpanzee has enough common sense to know better. At worst they should have deferred the decision to an Ebola expert within CDC. Staggering incompetence.

The fact that the hospital staff had no clue about proper protocol and allowed workers to treat Duncan for 2.5 days before adopting proper gear speaks volumes about how prepared the average hospital is for this. This is a giant wakeup call for the US and it will turn out to be a good thing if we can not make any additional mistakes and stop it at this point. There will eventually be a lot of lessons learned. If it spreads further though, they really should call in the WHO which, unlike CDC, actually has experience in dealing with things like this. Hubris on the part of the government will likely prevent that from happening though (unless things get really bad).

I can say that the hospitals in Cleveland are ready, now that we had the person here. Hell, I have family that live down the road from where the nurse was staying, which is now cordoned off <sigh>. There are several schools that closed today, because someone flew on the same plane(not with the person infected, just on the plane after she did) that the nurse flew on. They are decontaminating the schools/airport/house/everywhere else around Cleveland, which I guess is okay.

But the hospitals are all educating ER staff, and paying OT to get all of the staff trained. There are also protocols in place now to ask the questions and they are flagged in the electronic medical record to alert everyone in the world if there is any positive responses with certain diagnosis or symptoms(high fever, bleeding, etc..).

So I think that the medium sized to larger hospitals will be able to handle this stuff. And most likely the smaller ones have plans in place to get these people out of dodge and to the larger places to handle them. But what about the urgent care or nurse practitioner working at Drug Mart at night? Those places are not always run with the same staff, and things get missed. <sigh> So we shall see over the next 3 weeks or so.

[Smoove_B]

At Target yesterday here in North Dallas, my wife reports seeing not one, not two, but three separate people in various degrees of protective gear-- all had breathing masks, two had gloves, and one had some sort of protective gown. Absolute craziness. I can only hope this gets nipped in the bud soon or this town may lose its collective mind.

It's no fun unless you're taking pictures and sharing them.

This morning my kid is getting a flu shot (well, nasal spray) right across the street from Presbyterian hospital. He'll be fine.

The spray is quite effective. Produces a quicker and stronger immune response. A wise choice sir because you'll soon learn that kids are little bags of disease and they want nothing more than to give you everything.

[J.D.]

I read somewhere online (I wish I remembered where, sorry) that this year's flu shot may be practically ineffective as the strain circulating right now is different than what they predicted back in February and thus what the vaccines were made for. I'm still getting it since I have two young kids but that info was kind of disappointing to read. They're expecting a brutal flu season this year too. Something about it being H3N2 which is bad for old people.

[$iljanus]

I have very little confidence that the CDC (or any other government agency) can handle a real pandemic type of situation. Maybe 30 years ago they could but I don't think the public in general has any real idea of how badly government agencies and their workforces have eroded over those 30 years (and funding is just one of the reasons). Believe me, I personally know this to be true. Political appointees like this clown at CDC are running the show and all they want to do is look good and do damage control as far as fingers pointing at their agency goes.

Apparently the CDC person the nurse called looked up information on the Internet and then told her she was okay to fly with a fever after Ebola exposure when a blind chimpanzee has enough common sense to know better. At worst they should have deferred the decision to an Ebola expert within CDC. Staggering incompetence.

The fact that the hospital staff had no clue about proper protocol and allowed workers to treat Duncan for 2.5 days before adopting proper gear speaks volumes about how prepared the average hospital is for this. This is a giant wakeup call for the US and it will turn out to be a good thing if we can not make any additional mistakes and stop it at this point. There will eventually be a lot of lessons learned. If it spreads further though, they really should call in the WHO which, unlike CDC, actually has experience in dealing with things like this. Hubris on the part of the government will likely prevent that from happening though (unless things get really bad).

Then this article will validate your concerns. Don't know if that's a good thing unfortunately:

Lax U.S. Guidelines on Ebola Led to Poor Hospital Training, Experts Say

Some choice quotes from the NYT article:

Sean G. Kaufman, who oversaw infection control at Emory University Hospital while it treated Dr. Kent Brantly and Nancy Writebol, the first two American Ebola patients, called the earlier C.D.C. guidelines “absolutely irresponsible and dead wrong.” Speaking by phone from Liberia, where he was training workers for Samaritan’s Purse, the medical charity that Dr. Brantly and Ms. Writebol worked for, Mr. Kaufman said he had warned the agency as recently as a week ago that its guidelines were lax.

“They kind of blew me off,” he said. “I’m happy to see they’re changing them, but it’s late.”

And...

The Doctors Without Borders guidelines are even stricter than the new C.D.C. directives in that they require full coverage of the torso, head and legs with fabrics that blood or vomit cannot soak through, along with rubber aprons, goggles or face shields, sealed wrists and rubber boots. Doctors and nurses wear two sets of gloves, including long outer ones that strap or are taped to the gown; janitors wear three sets.

As they undress in choreographed steps, Doctors Without Borders workers wash their hands with chlorine solution eight times and are sprayed with a chlorine mist. Most important, all personnel disrobe only under the eyes of a supervisor whose job is to prevent even a single misstep.

Risky procedures like blood sampling are kept to a minimum.

“I’ve seen the C.D.C. poster,” said a Doctors Without Borders representative who spoke on the condition of anonymity because she did not want to be named criticizing the agency, and who was referring to C.D.C. guidelines before they were changed on Tuesday. “It doesn’t say anywhere that it’s for Ebola. I was surprised that it was only one set of gloves, and the rest bare hands. It seems to be for general cases of infectious disease.”

Fascinating though to read about the infection control that the NGOs are following in Africa.

[RMC]

I have very little confidence that the CDC (or any other government agency) can handle a real pandemic type of situation. Maybe 30 years ago they could but I don't think the public in general has any real idea of how badly government agencies and their workforces have eroded over those 30 years (and funding is just one of the reasons). Believe me, I personally know this to be true. Political appointees like this clown at CDC are running the show and all they want to do is look good and do damage control as far as fingers pointing at their agency goes.

Apparently the CDC person the nurse called looked up information on the Internet and then told her she was okay to fly with a fever after Ebola exposure when a blind chimpanzee has enough common sense to know better. At worst they should have deferred the decision to an Ebola expert within CDC. Staggering incompetence.

The fact that the hospital staff had no clue about proper protocol and allowed workers to treat Duncan for 2.5 days before adopting proper gear speaks volumes about how prepared the average hospital is for this. This is a giant wakeup call for the US and it will turn out to be a good thing if we can not make any additional mistakes and stop it at this point. There will eventually be a lot of lessons learned. If it spreads further though, they really should call in the WHO which, unlike CDC, actually has experience in dealing with things like this. Hubris on the part of the government will likely prevent that from happening though (unless things get really bad).

Then this article will validate your concerns. Don't know if that's a good thing unfortunately:

Lax U.S. Guidelines on Ebola Led to Poor Hospital Training, Experts Say

Some choice quotes from the NYT article:

Sean G. Kaufman, who oversaw infection control at Emory University Hospital while it treated Dr. Kent Brantly and Nancy Writebol, the first two American Ebola patients, called the earlier C.D.C. guidelines “absolutely irresponsible and dead wrong.” Speaking by phone from Liberia, where he was training workers for Samaritan’s Purse, the medical charity that Dr. Brantly and Ms. Writebol worked for, Mr. Kaufman said he had warned the agency as recently as a week ago that its guidelines were lax.

“They kind of blew me off,” he said. “I’m happy to see they’re changing them, but it’s late.”

And...

The Doctors Without Borders guidelines are even stricter than the new C.D.C. directives in that they require full coverage of the torso, head and legs with fabrics that blood or vomit cannot soak through, along with rubber aprons, goggles or face shields, sealed wrists and rubber boots. Doctors and nurses wear two sets of gloves, including long outer ones that strap or are taped to the gown; janitors wear three sets.

As they undress in choreographed steps, Doctors Without Borders workers wash their hands with chlorine solution eight times and are sprayed with a chlorine mist. Most important, all personnel disrobe only under the eyes of a supervisor whose job is to prevent even a single misstep.

Risky procedures like blood sampling are kept to a minimum.

“I’ve seen the C.D.C. poster,” said a Doctors Without Borders representative who spoke on the condition of anonymity because she did not want to be named criticizing the agency, and who was referring to C.D.C. guidelines before they were changed on Tuesday. “It doesn’t say anywhere that it’s for Ebola. I was surprised that it was only one set of gloves, and the rest bare hands. It seems to be for general cases of infectious disease.”

Fascinating though to read about the infection control that the NGOs are following in Africa.

And with all that a Doctor and Nurse from that program still contracted the virus? Wow, that does not bode well for this outbreak at all..

[Blackhawk]

I think that nurses on the front page of every national news outlet contracting a likely-fatal disease from not being careful enough is going to prove a strong motivator to the rest of the medical community to not take their precautions lightly.

[silverjon]

And with all that a Doctor and Nurse from that program still contracted the virus? Wow, that does not bode well for this outbreak at all..

Internet says MSF has had 16 infections among staff, 9 fatal.

[Carpet_pissr]

The spray is quite effective. Produces a quicker and stronger immune response.

Interesting - can adults get the spray form as well? I have only ever gotten the shot (and kids get spray).

[Smoove_B]

And with all that a Doctor and Nurse from that program still contracted the virus? Wow, that does not bode well for this outbreak at all..

While I don't have any experience with training for hospital and/or clinician PPE, the thing that stands out for me is the use of a partner or buddy. I don't know how common it is in a hospital setting to don PPE and then have someone check you out or having someone help you remove the gear safely after you've finished, but my gut feeling is that it's not something typically seen. As opposed to people wearing PPE for environmental cleanup where that's the norm.

A vocal NJ nursing group came out yesterday and said our state should not be treating any Ebola patients; they should be sent to facilities prepared to handle them. I really can't disagree. This really reminds me of the post-Anthrax training I went through after October of 2001 where I was told it was now part of my job to wear a respirator and respond to "suspicious mail". I had to be fit tested and trained, all of which was wasted time and money. While I would expect nurses to be able to deal with infectious diseases in general, I think the stakes are just too high at this point to expect the average person to be able to handle this as routine.

[Smoove_B]

The spray is quite effective. Produces a quicker and stronger immune response.

Interesting - can adults get the spray form as well? I have only ever gotten the shot (and kids get spray).

Yes. There was even an approval granted earlier this year for a vaccine that doesn't contain egg allergens so people that were previously unable to be vaccinated now can do so. Info on the Live Attenuated ("Flu Mist") vaccine is here. Note, that because you're exposed to a living organism (as opposed the inactivated vaccine traditionally offered), the risk for some type of illness is higher (though still really, really low and not the flu regardless). In other words, the potential side effects will likely be more significant and systemic (though still rather limited). However, because it's a live organism, your immune system has a much stronger response to it.

Can the nasal spray flu vaccine give you the flu?

No. While the nasal spray flu vaccine does contain live viruses (unlike the flu shot), the viruses are attenuated (weakened) and cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.

Science, bitches!

[$iljanus]

And with all that a Doctor and Nurse from that program still contracted the virus? Wow, that does not bode well for this outbreak at all..

Internet says MSF has had 16 infections among staff, 9 fatal.

Keep in mind that the working conditions are much more primitive than the average US hospital and the hot and humid climate is an additional challenge so I'm not surprised that there are staff that still get infected in Africa.

[stessier]

The spray is quite effective. Produces a quicker and stronger immune response.

Interesting - can adults get the spray form as well? I have only ever gotten the shot (and kids get spray).

Yes. There was even an approval granted earlier this year for a vaccine that doesn't contain egg allergens so people that were previously unable to be vaccinated now can do so. Info on the Live Attenuated ("Flu Mist") vaccine is here. Note, that because you're exposed to a living organism (as opposed the inactivated vaccine traditionally offered), the risk for some type of illness is higher (though still really, really low and not the flu regardless). In other words, the potential side effects will likely be more significant and systemic (though still rather limited). However, because it's a live organism, your immune system has a much stronger response to it.

Can the nasal spray flu vaccine give you the flu?

No. While the nasal spray flu vaccine does contain live viruses (unlike the flu shot), the viruses are attenuated (weakened) and cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.

Science, bitches!

The stuff is on back order in our area with no info on when they will get some. Been that way since Sept 1 (my kids prefer it so my wife always inquires early). It's good if you can get it but you might as well get the shot if you have to wait into December for FluMist .