So, let’s review the chart here, shall we?
- Patient presents at Dallas hospital with symptoms consistent with Ebola. He tells ER staff that he’s been in a country affected by the outbreak. They send him home.
- He comes back to the hospital days later, is finally diagnosed and treated, but dies — which of course is going to happen in far too many cases with this horrific disease.
- It takes DAYS for anyone to take it upon themselves to put on hazmat suits and go clean out the apartment where this guy was sick before going into the hospital. Human beings are living in that apartment during that time.
- We learn that a nurse at the hospital that treated the deceased has contracted the disease. This shatters our hubris about how, here in the U.S. we know how to treat infectious diseases safely.
- Today, we learn that a second nurse who treated this patient is sick with Ebola. Which makes us wonder what in the world kinds of procedures were in place at that hospital. And whether Ebola transmits a LOT more easily than we had been told.
- Between being infected and showing symptoms, the second nurse flew to Cleveland and back, the return trip on the day before coming down with the disease. Authorities are now trying to reach the 132 people who were on board Frontier Airlines flight 1143 from Cleveland to Dallas with her on Monday. She was supposedly being monitored for signs of Ebola during the period in which she took this trip.
OK, so maybe the proper, professional reaction to these developments isn’t “WTF?,” but a more dignified, “Really?”
But a great deal of incredulity is a natural reaction, along with more than a little alarm.
As we speak, all over the country, hospitals and government health officials are (one hopes) reviewing plans and procedures. Which is good, because Ebola is horrible enough, and enough people are going to suffer and die, without committing boneheaded errors that help it along…
Before the last few weeks, everything I knew about Ebola came from Tom Clancy novels — specifically, Executive Orders (in which a fictional Iranian regime launches a deliberate germ-warfare attack on the United States using the virus, infecting thousands) and Rainbow Six (in which a super-radical environmental group, backed by a billionaire businessman, attempts to wipe out the rest of the human race using the disease).
Ever read a Tom Clancy novel? He was a great respecter of expertise, of whatever type — military, medical, what have you, his tales were filled with calm, super-competent professionals who always knew exactly what to do in a dangerous situation, and usually did it flawlessly. He was a great admirer not only of technology, but of procedure. When a patient came in with a high fever, nausea and petechiae, the staff swept into action sealing off the area and instituting ironclad safety procedures, making sure none of the medical professionals contracts the disease, and even if they do, that they don’t take it out into the world with them.
Apparently, it doesn’t always work that way in the real world. To say the least…
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What can I say but thanks, guys!
This is shaping up to be a a very interesting set of holidays. With the roughly three week incubation period for the virus:
By Halloween we should know about how many people Duncan infected.
By Thanksgiving we should know how many people THEY infected.
By Christmas we will know if Ebola is out of control in the US.
This sequence of events not bad enough for you? How about this: The nurse was running a fever when she was on the plane…
Did she use a restroom in the plane or the airport? Did she eat a meal somewhere along the way? What/who did she touch? This could get exponential real fast.
Oh, and don’t give me that about it being a “low-grade” fever. My normal temperature is about 97 degrees Fahrenheit. If my temp in 99.5, I am SICK…
Remember year before last, just before Christmas, when I had the flu? Well, maybe you don’t, but I was so sick for a week and a half that I couldn’t even blog. Just making the phone call each morning to work to say I wasn’t coming in would exhaust me, making me breakout in a soaking sweat and start a coughing fit. I wasn’t able to put a coherent thought together much less type one (and yes, wise guys, that is a departure from the norm for me).
All that time, my temp seldom went above 100. Didn’t keep me from being majorly sick.
The fact is that people, on average, are average. Exceptional people who are diligent, focused, knowledgeable, and proactive are exceptions. Any large organization (hospital, airline, Center For Disease Control) is full of people who are not world class. The fact that screwups like this will happen is the rule, not the exception.
It will be interesting to see if the spread of the virus can be contained now that it may have moved to other parts of the country via the trip to Cleveland.
That’s actually been one of the pleasures of reading a Tom Clancy novel — his characters swept you along with their dedication and competence. No matter how bad the situation — and a bunch of nuts having the capability and intent to use Ebola to wipe out the human race is, let’s face it, pretty doggone bad — there were always experts ready to sweep into action and counter it, just in the nick of time.
Sometimes bad things happened anyway — a mad pilot DID fly an airliner into the U.S. Capitol (years before 9/11) and succeed in wiping out most of the U.S. government; the bad guys DID manage to kill a lot of Americans with Ebola before swift and sure action contained it (and, because it petered out, with the third or fourth person to contract it tending to survive more often than the initial victims, apparently due to mutations in the virus over generations — a reassurance that as far as I know is still fiction).
But that was always because the baddies struck in a way that reasonable people could not anticipate — as did the 9/11 hijackers. Once forearmed, Clancy’s good guys would head them off at the pass.
But yeah, it’s fiction…
Denial is an unbelievable thing.
The very idea that a nurse who had directly cared for an Ebola patient would get on a plane immediately after his death to go visit HER FAMILY is just staggering. That she would then reboard the plane with a fever was, at that point, sadly predictable.
The same goes for NBC’s Nancy Snyderman. The only thing that will stop the spread of this disease is isolation of the potential infectees. That’s the program.
I’ve seen one report that said that nurses at that hospital had complained (anonymously, for fear of losing their jobs) that they had not originally had appropriate protective gear (for example, they had regular gloves and face shields, but not the full body suits), that the isolation protocol changed several times over several days (for example, they were not initially instructed to use disposable booties until a few days after they had begun caring for this person (a person who had projectile vomiting and explosive diarrhea–I don’t want to think what may have been tracked out on their shoes), and that they were not given training in how to use the protective gear.
My second thought is that yes, viruses indeed mutate quickly. It might become milder, or it might develop a more effective means of transmission (like airborne). Wouldn’t that make you feel good when you hear someone repeatedly coughing on a plane?
The only really scary thing I’ve read is that the virus could become contagious when airborne. All the other reports stress that you have to touch bodily fluids contaminated with it and then touch one of your mucus membranes. For almost all of us, we are far more likely to die of the flu than Ebola. Everyone got their flu shots yet?
So for the first time in history Ebola comes to the U.S. and CDC doesn’t immediately send a team of specialists.
Why does the CDC exist again?
The CDC did not know there was Ebola–heck the Dallas hospital didn’t know. Ebola is not a huge danger in developed countries with plenty of clean water, soap, and flush toilets.
Experts on NPR point out that someone presenting with a fever now is way way more likely to have the flu, even if he came from Africa.
Everybody calm down!
“The CDC did not know there was Ebola–heck the Dallas hospital didn’t know.”
I’m not talking about before they knew. I’m talking about after. After they knew they should have (immediately) sent in the CDC specialists to take over the treatment from the local Dallas folks.
But they’re just bureaucrats. SO they send a memo out to remind folks to follow protocols, and feel like “Hey, I’ve done my job. I sent a memo.”
WTF IS absolutely the correct response to how we’ve responded so far.
We keep telling ourselves that this does not transmit easily, but as long as people behave irresponsibly it will transmit easily. It’s only marginally more difficult to become infected by Ebola than by the flu. A flu patient is contagious prior to developing symptoms, and can infect you with a sneeze from across the room, but other than that, there’s not much difference. And while the flu is likely going to kill more people this year than Ebola will, the mortality rate for Ebola can be 60 or 70%, meaning if you become infected, you are LIKELY to die from it (at least in Africa, anyways).
Much of the American public has never lived in a time period in which infectious diseases are real threats. Previous generations had to deal with polio, smallpox, typhoid, tuberculosis, and measles. They understood how their personal behaviors had an impact on those around them. We don’t seem to have that communitarian trait anymore. Coupled with our increased mobility and population density , an infectious disease that gets a real foothold in this country could be difficult to contain.
Gaia theory, anyone?
You cannot catch Ebola from a sneeze across the room, according to all responsible sources.
I was saying that’s how the flu is spread, and that’s one difference between the two.
Currently Ebola is not transmitted by infection. The only thing that really scares me is if it gets into our homeless population. They tend not to be highly aware of the news, so may well not understand what’s going on. Nor are they, as a rule, tremendously cleanly. That could become a real problem for all of us.
Indeed. I would guess that the homeless are not likely to intersect with infected people, as it now stands, though.
A homeless man did ride in the ambulance that had earlier transported Mr. Duncan to the hospital. He was eventually located and, so far, is asymptomatic. There was some speculation about how (may have required a court order) and where (homeless shelter not an option) to quarantine him. Read this last week so I trust that by now they’ve worked those details out.
You are pretty much correct, Kathryn. But if people who are at risk keep refusing to isolate themselves, it becomes much easier. A scenario: An ‘at risk’ person goes to a restaurant for lunch. While there he get sick. He goes to the bathroom and throws up. He attempts cleanup of himself, then comes back in and leaves immediately. A homeless person walks up to him as he is leaving and asks for money. He gives him some to get the homeless person or touches him in some way. He then goes to the hospital. The homeless person is at risk, not to mention everyone who uses that bathroom before it is cleaned. That is, I hope, an unlikely scenario, although if enough people who have been exposed remain as thoughtless as that nurse and Ms. Snyderman it might.
Sequestration and other mandated federal budget cuts over the past decade have seriously hit the CDC.
Yeah, it’s pretty bad. As I saw in a thought-provoking program on television, the CDC only had one employee left. And then, the whole place blew up.
So I’m not a bit surprised at the CDC’s ineffectiveness in this crisis…
Yeah, I’m sure the CDC is running just a bare bones operation now. Too bad there wasn’t a large pot of money available in other areas of the government to shift to priority items. But that’s not how government works. It’s never about priorities, it’s about expanding to do more and more. I’m guessing most of us would prefer better disease protection than another jet fighter.
There’s plenty of money in the system to do all the important stuff. According to reports yesterday, federal government revenues are at a record high.
Sequestration didn’t cause the CDC’s incompetence. It’s a function of government.
Yeah, the budget cuts at the CDC have been absolutely brutal. Here’s something funny I found from The Washington Post:
“In the specific case of the NIH branch that deals with infectious diseases, funding jumped from $1.8 billion in 2000 to $4.3 billion in 2004 — but funding has been flat since then. Funding in 2014 was again $4.3 billion. So that’s effectively a cut over time.”
I love it. Only in Washington DC is not giving out MORE money each year “effectively a cut”. I guess $4.3 Billion doesn’t go as far as it used to way back in the olden days of 2004.
Folks, wash your hands thoroughly, frequently. Get a flu shot. The most deadly virus you’re likely to catch is the enterovirus that’s going around, not Ebola.
Exactly.This paranoid hysteria over a disease that’s very hard to catch,reminds me of the early days of AIDS/HIV,although AIDS was/is a serious threat.In the early days,nurses/caretakers of AIDS’ patients,were some of the first to contract the disease.Unless you’re working in healthcare with Ebola patients,you have very little to worry about.You’d have to want the disease to get it…(I’m not a doctor,but my BF is)
“You’d have to want the disease to get it.” That’s oldthink. I’m beginning to think that it spreads a lot more easily than conventional wisdom would have it.
Else how did two nurses get it, treating a patient they KNEW had Ebola?
I sincerely doubted that they “wanted” to get it.
And yeah, I know you said “unless you’re working in healthcare,” but I would think a nurse who is totally aware of a patient’s condition would be better protected than, say, someone who was living in the apartment with the guy before he went back into the hospital…
Poison Ivy/Oak is a good analogy. It’s generally easy to avoid, but once one comes into contact with the toxin, it is very difficult to keep it from spreading.
The problem would seem to me to be the place one would want the space suit approach is in the healthcare system when dealing with a known infected person – instead we are treated to photos of cleaning crews and airplane boarding teams wearing these suits.
If only two nurses become infected with Ebola in Dallas, then we will know it was a breakdown in proper procedures. If more become sick, it is the procedures which must be revisited.
Yes, Brad, but the nurse has much more contact with highly contagious bodily fluids.
Doug, the reason revenue is at an all time high is because the population is at an all time high. The truth is, the government is not funding all it needs to fund, and we’re seeing it in our infrastructure, at the CDC, and in education to name a few places.
I fault the hospital administrators. We pay them huge salaries to manage tough situations. These people let us down. They should be fired at the least. I wonder if prosecutors can charge them with criminal neglect. Nurses are at their mercy for decisions on what patients the hospital treats, what equipment is available, how medical personnel are trained to put on and take off equipment, and how much time is allocated for dressing and undressing in this suits.
This situation is a train wreck, with many failures in “the system.” The hospital claims they followed procedures established by the CDC, and as nurses reported concerns about the CDC procedures, the hospital notified the CDC and procedures were changed. It is a certainty there will be a lawsuit, but “reasonable care” is the legal standard. Attorneys following this situation say it will be hard to establish a threshold for reasonable care since this was the first case, and there is no precedent for what reasonable care should be.
edit “these suits.”not “this suits.”
Might help if Congress would actually approve a Surgeon General.