Ebola in The USA

Four days.
They are estimating that the Ebola patient was in contact and infectious for four days before entering isolation.
That's a lot of time amongst a lot of people.

Joe(good luck everyone)Nation

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And he, apparently, came into contact with some children who are now under observation.

Heard a doctor on TV assuring everyone that this isn't a crisis, but that there's a good chance that one or two more people will come down with ebola because of this fellow.

In the general scheme of things, I guess 2 or 3 people dying a horrible death can't be considered a "crisis," but the doc wasn't very reassuring.

The poor guy who came down with it in Liberia can't be blamed and, in fact, the story is that he caught it helping a pregnant women, who was infected, get to a hospital. I hope he recovers, and I hope no one else comes down with it, but based on what this doctor says both of those things may not be very likely.

Panic mode is a very long way off, but this sure has heightened my sense of vulnerability. Different strain or different bug and maybe Captain Tripps isn't so far fetched.

When I read about the 1918 flu pandemic, I'm amazed that it doesn't figure a whole lot more prominently in history.(I guess that was bound to happen what with a World War going on at the same time) 500 million people came down with it and 50 to 100 million died from it - 3% - 5% of the world's population. 500 to 650 thousand Americans died. Arguably a greater plague than the Black Death but no where near as "infamous." If something like that happened today just imagine what it would be like.

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@Joe Nation,

I've read that he only had close contact with 12-18 people including a number of children and they're all being closely monitored.

I think part of the general concern is that Ebola is a new virus to *us*, but it's not a new virus. It's been well studied, there are already diagnostic tests available (unlike HIV in the early 1980s), and people can/do recover from it (unlike HIV, the diagnosis of which was an eventual death sentence at one time).

There are a lot of "what if" scenarios out there - such as what if someone spikes a fever while on an airplane - that we simply don't know the answers to. At this point we can trust those who have years of experience studying this virus, we can somewhat trust them and hope for the best while being cautious in our own dealings with someone who is sick (which is where I'm at right now), or we can go the conspiracy route I'm seeing online.

I'm cautiously optimistic that these cases (there will be others, including a potential unrelated case in Hawaii) can be controlled within the public health arena by following infectious disease guidelines and recommendations.

It would, however, be a good thing if health care providers actually read the medical histories that patients provide. Doctors blaming nurses and nurses blaming doctors does nothing to mitigate the fact that this man told them he'd recently arrived from Liberia and was sent home with antibiotics.

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I like this perspective

Quote:

... the guidelines have been out for months,” said Dr. Susan McLellan, a professor at Tulane University’s School of Public Health and Tropical Medicine who recently returned from a trip to West Africa, where she was treating victims of the current outbreak. “It was inevitable that someone was going to come to the United States and get sick while they were here.”

snip - goes on to explain about treatment precautions

McLellan said there is little cause for the average person to fear Ebola and that with proper precautions it can be prevented from spreading. And, she said, there are other health concerns that far outweigh the threat from Ebola in the United States.

“If you are worried about dying a horrible death, buckle your seat belt, stop smoking, wear a helmet on your bicycle and take all the guns out of your house,” McLellan said. “Then you can worry about Ebola.”

source

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Here's a link to the possible case in Hawaii.

http://khon2.com/2014/10/01/patient-in-isolation-in-honolulu-hospital-officials-say-ebola-a-possibility/

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@JPB,

I agree with you on that - the only time I was in the hospital in years (I'm fine) was last year when I fainted and spent 5 days being worked up for this and that. The intake people wrote me up at length, and I eventually got a copy of that from the hospitaller (doctor). Far as I could tell, my caregivers had read that - some no doubt skimming, and the last guy, the cardiologist, read it twice, at the beginning of my care and again at the later part. That was a Presbyterian hospital, so similar system as the one in Dallas, I assume.

One thing you may have a view on - Reuters has posted for a while now that when Mr. Duncan was going back to the hospital two days after the first admission, he was seen vomiting outside the apartment; I'm not sure if it was at Reuters or some link, one of his friends said he vomited "all over the place" outside the apartment.

I haven't seen that remarked about elsewhere - as in, was there a clean up? Vomit from an ebola patient would worry me. Might have gotten on some shoes..
I don't know, that vomit might not be a worry, air drying and all.
I read elsewhere that they're keeping looky loos out of the building..

Anyway, I said early in this thread that human error will happen in the medical world, and so it has in Dallas, but since I said that I'm also somewhat less worried than I was at first re the potential for massive spread of ebola everywhere, at least with the virus not mutating.
But - I can still see medical waste being a quandary.

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@ossobuco,

More on the subject of ebola waste material in the U.S.

http://in.reuters.com/article/2014/10/02/health-ebola-waste-idINKCN0HR07X20141002

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@ossobuco,

ossobuco wrote:

One thing you may have a view on - Reuters has posted for a while now that when Mr. Duncan was going back to the hospital two days after the first admission, he was seen vomiting outside the apartment; I'm not sure if it was at Reuters or some link, one of his friends said he vomited "all over the place" outside the apartment.

I haven't seen that remarked about elsewhere - as in, was there a clean up? Vomit from an ebola patient would worry me. Might have gotten on some shoes..
I don't know, that vomit might not be a worry, air drying and all.
I read elsewhere that they're keeping looky loos out of the building..

Anyway, I said early in this thread that human error will happen in the medical world, and so it has in Dallas, but since I said that I'm also somewhat less worried than I was at first re the potential for massive spread of ebola everywhere, at least with the virus not mutating.
But - I can still see medical waste being a quandary.

I agree with you about medical waste being a problem. According to your link the CDC and DOT are working to draft a guidance document for safe handling/hauling.

Re vomitus in a public or private setting, there would have to be open sore or mucus membrane contact. It would quickly die on a shoe, but perhaps not on a shoelace that stays moist. I'd be tossing any shoes I might be wearing out just in case.

CDC transmission routes

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@Finn dAbuzz,

no I wouldn't, but the nture of this discussion I kina fatalistic and that's not warranted
an ebola victim is, apparently, only infectious after he's symptomatic.
Watch how quickly this Duncan guy is followed up, and his contacts (before and after symptoms developed). Whether he lives or dies, Ill bet there will be limited new cases, unlike those in AFrica.

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From the NYT (behind a pay wall after 10 articles per month)

This is insane.

Quote:

On Thursday, Mr. Duncan’s nephew said that even after his uncle was rushed to the hospital three days after his initial visit, vomiting and gravely ill, he did not feel they were acting with enough urgency and called federal authorities himself to alert them to the situation.

“I called C.D.C. to get some actions taken because I was concerned for his life and he was not getting the appropriate care,” the nephew, Josephus Weeks, told the NBC program “Today.” “And I feared that other people might get infected if he was not taken care of.”

More

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@JPB,

The latest is that he came into contact with as many as 80-100 people, and the 4 kids he came in contact with all go to different schools.

Not saying it will happen this time, but this is the way a pandemic starts.

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@JPB,

Finally someone is bringing some sense to this thread beside those looneys that talk about conspiracies.

I was commenting in the other Ebola thread that when the swine flu started here in my country (Mexico) the first case concidentally happened during a visit that Obama made to our former president Calderon. The media tweeter and facebook where flooded by conspiracy theories about Obama bringing the virus, and of US domination, and anexation of territories, and of a apocaliptic setting. All nonsense.

I agree that carefull hygene procedures could help a lot in controlling the viruz spread here in America. Even with the lmited resources here in Mexic o we were able to contain the Flu, mostly with hard work and hygiene. And of course a lot of help of the CDC guidelines.

I iwas just checking some fact about Liberia (hence the case of Mr Duncan occurred there)

Youth (15-24) literacy rate 49.1%

Elderly (65+) literacy rate 32.8%

2006 National Human Development Report said before the war 45 per cent of the country's population had access to piped, clean water

22 Jun 2012 Only 0.58 per cent of Monrovia residents have access to public electricity

Mr Duncan caught the disease while transporting a woman that was having seizures to a local Hospital. He was inside a cab with no more than 2 or 3 cubic meters of space with a patient having seizures, spitting, probably vomiting and bleeding. He should had been isolated there in Liberia, but htere is no infrastructure for isolating every contact. There was a failure in the protocols in that hospital in Dallas if he stated to the Doctor that he just came from Liberia.

There is no comparision between the heath services in US and in Monrovia. No hospital in my own city can even closely compare to the heath facilties in any small town of the US.

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@luismtzzz,

Regarding the botched hospital protocols and training, I have a suggestion that will limit the training and learning curve for medical workers at all levels.

Via personal experience with my mom, whether you enter a hospital via an emergency room or a walk in elective surgery patient, the first thing they are already trained to do at the admission/triage desk is ask if you have any allergies. At the first mention of any allergy, they slap a bright red ID bracelet on your wrist that says ALLERGIES. From that point on, any worker you come in contact with knows to look at your wrists for that red bracelet to see if you are allergic to something and they are already trained to ask you about it. Even at lower level doctor offices and medical clinics, the first thing they ask about are any allergies.

Once the patient enters the system and is wearing that red bracelet, it doesn't require any further self reporting from the patient or chain of communication between medical staff to make note of a check mark on a long form.

Why can't that same system that everyone is already trained to look for be used to identify people entering the health system with possible ebola exposure and or symptoms?

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@Butrflynet,

Quote:

Via personal experience with my mom, whether you enter a hospital via an emergency room or a walk in elective surgery patient, the first thing they are already trained to do at the admission/triage desk is ask if you have any allergies.

Which they self report because they dont want to get sick or die, and this band helps with that. There is zero incentive to self report possible ebola infection.

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@hawkeye10,

You don't think someone who suspects they might have ebola will want to tell the medical people so they can get treatment for it, especially if silence means you get sent home to get worse rather than receive immediate treatment and a strong chance of surviving?

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@Butrflynet,

Butrflynet wrote:

... whether you enter a hospital via an emergency room or a walk in elective surgery patient, the first thing they are already trained to do at the admission/triage desk is ask if you have any allergies.

I'm a bit confused about your comments. Is the above comment your suggestion for how things should be done, or is this the manner in which your mother has been treated in New Mexico?

I've never found that the first question asked in the ER, the urgent care clinic, or any aspect of ambulatory care is "Do you have allergies"? First question is your name and other relevant data,followed by the reason for your "visit", and then, "Are you in pain"? Any question about allergies ( at least in most Boston Hospitals) is usually asked after the patient is asked about their medications.

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Re JPB's post to me re vomitus, and her other posts, this is very useful to be clear about -

there would have to be open sore or mucus membrane contact

Thanks for that clarity.

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@Butrflynet,

Butrflynet wrote:

someone who suspects they might have ebola will want to tell the medical people so they can get treatment for it..

What medication is now being used as a form of treatment? Or is the treatment merely fluids , bed rest, isolation?

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@Miller,

Read up. There is treatment, not easily produced.

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If there is going to be a major out break of this disease in the US, it will probably be in New York City, a very ethnically diverse and congested part of the US (think subway cars!).

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Ebola in The USA

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