Mistake blamed for US Ebola spread

[webfact]

Ebola: Hospital mistakes blamed for US transmission

(BBC) A US health chief has said a mistake was "clearly" made by hospital staff treating an Ebola victim in Texas, resulting in one member being infected.

The US Centers for Disease Control and Prevention (CDC) has confirmed that a female health worker tested positive for the deadly virus in Dallas.

CDC chief Dr Tom Frieden has promised a full inquiry into how the transmission could have occurred.

He said 48 other people who may also have had contact were being observed.

The health worker at Texas Health Presbyterian Hospital is now on an isolation ward and is said to be in a stable condition.

She had been treating Ebola victim Thomas Eric Duncan, who caught the virus in his native Liberia and died on Wednesday.

The current Ebola outbreak, concentrated in Liberia, Guinea and Sierra Leone, has resulted in more than 8,300 confirmed and suspected cases, and at least 4,033 deaths.

Full story: http://www.bbc.com/news/world-us-canada-29590832

-- BBC 2014-10-13

[ClutchClark]

Dr Daniel Varga, of the Texas Health Resource, said she had worn a gown, gloves, mask and shield when providing care to Duncan during his second and final hospital admission.

Now compare the PPE identified above against the drawing of proper PPE and there is quite a discrepancy.

Poor reporting or fact?

[bkkcanuck8]

According to the CDC it was likely after he was dead, she let her guard down while disconnecting the equipment and cleaning up.

Of course none of us were there, but it is interesting to note that although the incubation period is not over... the LAST person to come in contact was the only one showing symptoms yet (including co-passengers on the flight; family members that were living with him when he was barfing, etc.).

Edited October 13, 2014 by bkkcanuck8

[Aussieroaming]

It makes me wonder what will happen if someone inadvertently carries ebola into Bangkok. With the population here it would be incredibly hard to contain I imagine.

I can only imagine how ostracised African people that travel are feeling as people try to avoid contact through fear.

[cloudhopper]

I think that the chief is trying to instill more confidence than he privately has with his assertion that the current barrier techniques are invulnerable if properly used. There have been too many instances of trained people in space suits getting infected and this latest instance is very alarming.

[NeverSure]

This is going to get expensive for the hospital. Most large US hospitals self insure (as they call it) by establishing a fund rather than paying the very expensive malpractice premiums.

They actually just have a massive deductible which is an amount above which the insurance company doesn't believe any claims will exceed. Then the premiums for the excess are very affordable.

This could cause those med malpractice ins. co's. to rethink that. Imagine what it would cost if members of the public were infected because the hospital sent this guy home.

[kotsak]

Time for those who haven't watched it to grab a copy

[arjunadawn]

I think that the chief is trying to instill more confidence than he privately has with his assertion that the current barrier techniques are invulnerable if properly used. There have been too many instances of trained people in space suits getting infected and this latest instance is very alarming.

I have snipping photos from Africa, Texas, etc., of Ebola responders in full gear. I packed a few various photos in an email to send family and friends with my concerns. Here's the two problems- I am certain prime problems:

1- when doctors de-glove after surgery or contact with infected product our fingers never go inside the glove, on either hand, to begin de-gloving- rolling the gloves off with contaminated side down. Then, the opposing glove is pulled into the first, unrolled, and the doc or nurse has a little ball of latex and waste, with the contaiminents inside. When you wear a cheap ass paper tyvko white suit, that's not a step-in step-out, you cannot properly "de-glove" your clothes- your duct taped at the wrist. (If you can withdraw your hands inside to emerge and step out of the zipper, your now in contact with everything your avoiding. These cant really be decontaminated. Not really). As any provider knows, even when double gloved, when your taped to the sleeve attempts at removing the tape "snap" the elastic latex gloves. This is bio level 4 crap. This is The Stand, Captain Tripps virus.

2- the photos I've mentioned nearly always show the disposable paper masks used by lil girls on bts, dentists, nurses, etc. it hardly meets the CDC recommended N95 standards. In fact, if it's wet, perspires, droplets, etc., it's a pablum- it breeds disease. The recommended is N95. Here's the further issue.

N95 will not likely protect you from this disease. The CDC is either intentionally lying or tragically wrong. The micron mesh is potentially small enough to catch larger viruses, and variably Ebola viruses, but the virons are known to be much smaller (indeed, after a virus hijacks your dna to make its own copies its virons that rupture from the cell repeating the process/infection- these are even smaller than the actual virus). N100 masks are what is required. (I elected P100 masks as they also stop oil aerosol delivery).

Conclusion: CDC recommends N95. Hardly anyone uses this. I think N95 too large and hardly effective. I have N100/P100 masks and filters. The white jumpsuits will likely contribute to infection rather than not. Face shield that doesn't fog is a must. I wouldn't by too many masks. If you need more than 20-30 your going to die anyway (they're disposable-3M).

Edited October 13, 2014 by arjunadawn

[RichinThailand]

It seems really strange that someone who knew he had Ebola would be infected with all the protection, and yet the IDIOT that treated and released the Ebola case without testing is OK??? Like was mentioned above...this hospital will go out of business with bankruptcy with all the screw ups they have made!!!

[ClutchClark]

I think that the chief is trying to instill more confidence than he privately has with his assertion that the current barrier techniques are invulnerable if properly used. There have been too many instances of trained people in space suits getting infected and this latest instance is very alarming.

And we have a winner!!

There is no way that a scientist would claim anything was 100% likely without substantial proof.

This guy is trying to stop Americans from becoming concerned that our current preventive methods of transmission are inadequate.

So instead he expects us to believe that an intelligent and highly trained healthcare professional was careless and negligent while performing her duties with a highly infectious disease known to kill 70% of its victims.

[Chicog]

"US Ebola spread"?

What?

[zydeco]

Yes, it's the nurse's fault, screams the lunkhead at CDC. Violation of protocol, he shouts! It couldn't possibly be a flaw in the magical, mystical never go wrong protocols, could it? The arrogance of these people at the head of these agencies is astounding.

[Thai at Heart]

According to the CDC it was likely after he was dead, she let her guard down while disconnecting the equipment and cleaning up.

Of course none of us were there, but it is interesting to note that although the incubation period is not over... the LAST person to come in contact was the only one showing symptoms yet (including co-passengers on the flight; family members that were living with him when he was barfing, etc.).

I just saw a video on CNN that the virus can survive in dry form for several hours and days in wet excretions.

Days.

[Chicog]

Fortunately there is always a politician along to provide us with some comedy relief.

A ** Senator Objects to Emergency Ebola Funding Because It 'Focuses on Africa'

No prizes for guessing which party.....

Edited October 13, 2014 by Chicog

[wackybacky]

Fortunately there is always a politician along to provide us with some comedy relief.

A ** Senator Objects to Emergency Ebola Funding Because It 'Focuses on Africa'

No prizes for guessing which party.....

The most disturbing thing is that Obama actually has plans to fight Ebola on the African continent. That scares me a lot.

I have no faith in his abilities. Just throw some cash at it, but don't get involved.

Ebola is very worrying. At the moment it is generally (loosely) contained in a small area of western Africa, but can burst out across the continent without warning and is expected to do so. It is already starting to pop up in western countries. If it gets say, out of control in somewhere like Lagos, Nigeria... that will be it.

in the current rate in spread, the Telegraph have built a chart on how bad it can get (or expected to get) the estimation for October and Jan 2015 is alarming to say the least. Up to 1.4 million by January???

Nigeria will have a big influence if it follows the trends of Liberia and Sierra Leone.

http://www.telegraph.co.uk/news/worldnews/ebola/11121045/Graphic-how-Ebola-cases-have-grown-since-March.html

[bkkcanuck8]

Fortunately there is always a politician along to provide us with some comedy relief.

A ** Senator Objects to Emergency Ebola Funding Because It 'Focuses on Africa'

No prizes for guessing which party.....

The most disturbing thing is that Obama actually has plans to fight Ebola on the African continent. That scares me a lot.

I have no faith in his abilities. Just throw some cash at it, but don't get involved.

Ebola is very worrying. At the moment it is generally (loosely) contained in a small area of western Africa, but can burst out across the continent without warning and is expected to do so. It is already starting to pop up in western countries. If it gets say, out of control in somewhere like Lagos, Nigeria... that will be it.

in the current rate in spread, the Telegraph have built a chart on how bad it can get (or expected to get) the estimation for October and Jan 2015 is alarming to say the least. Up to 1.4 million by January???

Nigeria will have a big influence if it follows the trends of Liberia and Sierra Leone.

http://www.telegraph.co.uk/news/worldnews/ebola/11121045/Graphic-how-Ebola-cases-have-grown-since-March.html

I actually do find it a little frightening that they are sending in military troops to help with it (though I gather they would be cheaper than medical specialists) that will come into contact with it ... potentially without proper training. Of course he might just be doing it to get of people that would more likely vote Republican

Edited October 13, 2014 by bkkcanuck8

[Chicog]

I've said it before. US soldiers are trained in dealing with Nuclear, Biological and Chemical agents, and are equipped to deal with them.

They've also sent (I think at the last count) 3,000 servicemen who will probably be used to build modern medical facilities to help deal with the outbreak in a secure manner.

Why anyone is disturbed about Obama fighting it on the African continent is beyond my comprehension.

If it isn't stopped now, the chances of it spreading globally increase exponentially, and if it spreads globally, blocking flights from Guinea, Sierra Leone and Liberia is not going to protect you.

I thought the honourable Senator was the only idiot that can't see that.

Edited October 13, 2014 by Chicog

[bkkcanuck8]

I've said it before. US soldiers are trained in dealing with Nuclear, Biological and Chemical agents, and are equipped to deal with them.

They've also sent (I think at the last count) 3,000 servicemen who will probably be used to build modern medical facilities to help deal with the outbreak in a secure manner.

Why anyone is disturbed about Obama fighting it on the African continent is beyond my comprehension.

If it isn't stopped now, the chances of it spreading globally increase exponentially, and if it spreads globally, blocking flights from Guinea, Sierra Leone and Liberia is not going to protect you.

I thought the honourable Senator was the only idiot that can't see that.

I would not be so sure about that - this is the same president that has beefed up border to deal with ebola using "Customs agents" (who say they aren't qualified for it).... but then it is a taxing situation

[Chicog]

I've said it before. US soldiers are trained in dealing with Nuclear, Biological and Chemical agents, and are equipped to deal with them.

They've also sent (I think at the last count) 3,000 servicemen who will probably be used to build modern medical facilities to help deal with the outbreak in a secure manner.

Why anyone is disturbed about Obama fighting it on the African continent is beyond my comprehension.

If it isn't stopped now, the chances of it spreading globally increase exponentially, and if it spreads globally, blocking flights from Guinea, Sierra Leone and Liberia is not going to protect you.

I thought the honourable Senator was the only idiot that can't see that.

I would not be so sure about that - this is the same president that has beefed up border to deal with ebola using "Customs agents" (who say they aren't qualified for it).... but then it is a taxing situation

Could you provide a link, because it isn't absolutely clear to which border you are alluding.

[bkkcanuck8]

I've said it before. US soldiers are trained in dealing with Nuclear, Biological and Chemical agents, and are equipped to deal with them.

They've also sent (I think at the last count) 3,000 servicemen who will probably be used to build modern medical facilities to help deal with the outbreak in a secure manner.

Why anyone is disturbed about Obama fighting it on the African continent is beyond my comprehension.

If it isn't stopped now, the chances of it spreading globally increase exponentially, and if it spreads globally, blocking flights from Guinea, Sierra Leone and Liberia is not going to protect you.

I thought the honourable Senator was the only idiot that can't see that.

I would not be so sure about that - this is the same president that has beefed up border to deal with ebola using "Customs agents" (who say they aren't qualified for it).... but then it is a taxing situation

Could you provide a link, because it isn't absolutely clear to which border you are alluding.

The search is now swamped so it is harder to find the original stories in regards to the original order, but I found one UK story:

http://www.dailymail.co.uk/news/article-2781703/Americans-set-face-increased-screening-airports-amid-Ebola-crisis-CDC-FINALLY-considers-giving-passenger-arriving-Liberia-medical-check-arrival.html

The timeline AFTER the first suspected US case was to first say that the current monitoring at the airports was sufficient, then within a day or so they backtracked a little and said they would add more customs agents (the number was 2 digits above 50 and lower than 90 -- I think it was 83 but not sure) to monitor incoming passengers for signs of ebola

Customs agents are likely cheaper than adding medically trained personnel to do the job (they already have them on hand, they just move a few more up to the front line).

Here is the report containing the customs agents complaining that they are not properly trained:

http://www.nbcnewyork.com/news/local/Ebola-Screening-Newark-Airport-Patient-Death-West-Africa-Dallas-New-York-Screening-278582511.html

[Chicog]

It seems most of that article refers to what happened after the interview.

Apart from

A spokesman for U.S. Customs and Border Protection said agents and officers are trained to look for overt signs of illness, and protocols are in place to try to prevent the spread of Ebola. The spokesman said customs officials are working closely with the CDC to improve screening at the five major hubs for people from West Africa traveling to the U.S.

It also talks about new measures being implemented at the (last) weekend.

The biggest problem from that is that they are not separating "hot zone" passengers from other passengers until everyone is cleared.

More to the point, with an incubation period of up to 21 days, I'm not even sure it will do that much good.

And imagine landing in the US with a slight fever from a cold or something?

Might make your journey home a bit longer than planned (as well as your fellow passengers).

[bkkcanuck8]

All people lie, and many (if not most) will lie about having a fever. All airports should have infrared thermal scanning equipment (which although not perfect would be wise) which should be in regular use. In Singapore I believe you walk through these without even knowing it... but then they have had to deal with multiple viral incursions (including SARS). The US still seems to be attacking it as a feel good measure than a professional manner (similar to US airport security - which if tested will miss more real threats than they would catch). The speed of travel at which people can move in this modern age with air traffic -- makes it more of a necessity than back in history because a "real viral" threat would move quicker than anything that we have had yet to deal with.

Although ebola has an incubation period of up to 21 days, the actual risk of transmission from a contact** (assuming the same behaviour - which would be an incorrect assumption) would be represented as a bell curve. Once a person becomes symptomatic -- that is when the person is going to likely transmit the virus. Of course once the symptoms take hold, the person's behaviour changes and they tend on average to stay home and try to recover from this virus (just like all others). The likelihood of transmission is greatest for family members that are looking after the sick person before quarantine or medical help.

**Note: Bell curve in that a contact most likely will not contract the virus, and thus as the incubation period nears 21 days they are less and less likely to be diagnosed with ebola.

Nigeria will likely be declared an ebola free-zone now - their original incursion has been contained (of course being closer to the hotspot they still have to be at full alert). So far they have shown themselves to be fairly competent and professional in their response.

http://www.motherjones.com/politics/2014/10/nigeria-ebola-cdc

Edited October 13, 2014 by bkkcanuck8

[bkkcanuck8]

The biggest problem from that is that they are not separating "hot zone" passengers from other passengers until everyone is cleared.

By the very nature of the air industry, the whole system works on a hub and spoke system. Unless you have a direct flight from the hot-spot (not very likely), the majority of those from hot-spots would be mixed with those not from hot-spots. They have been on the plane with non-hot-zone passengers in an enclosed space that is notorious for spreading cold and flu viruses..... Separating them at the immigration queue would be a feel good measure and not actually do as much as you think.

[Chicog]

The biggest problem from that is that they are not separating "hot zone" passengers from other passengers until everyone is cleared.

By the very nature of the air industry, the whole system works on a hub and spoke system. Unless you have a direct flight from the hot-spot (not very likely), the majority of those from hot-spots would be mixed with those not from hot-spots. They have been on the plane with non-hot-zone passengers in an enclosed space that is notorious for spreading cold and flu viruses..... Separating them at the immigration queue would be a feel good measure and not actually do as much as you think.

Well you could screen them at the arrival gate, but since infection doesn't necessarily show for nigh on three weeks, you could still be sending a hatful of infected people out to get infectious later on.

If it does become a global problem then I fear that hours of extra delays are going to become part of the travellers norm.

Maybe I should buy some shares in one of those Sars mask companies.

[Chicog]

I spoke too soon ( or too late ).

The British government has rushed through an order for 500,000 Ebola suits for British forces and health workers as the extent of the global Ebola crisis becomes clear.

Hull-based Arco is to deliver 100,000 Microgard suits, which offer protection from viral infections every month.

Managing director Thomas Martin said: ‘Our original contract was for 50,000, but that was doubled this morning. Within three minutes of getting that order, we were on to manufacturers to work out how to meet the production schedule.’

The suits will be used to protect British soldiers and health workers in war-torn Sierra Leone, one of the countries where the current epidemic is thriving.

http://metro.co.uk/2014/10/13/british-government-orders-half-a-million-ebola-suits-4903517/

[Chicog]

EU ministers to hold anti-Ebola talks
2014-10-13 14:44 Brussels - The European Union has called a meeting of health ministers on Thursday to discuss the possible screening of travellers from Ebola-hit West African countries, officials said.

The talks are designed "to co-ordinate the actions of member states" in the absence of any agreement on whether to monitor travellers to Europe, the officials said. Britain is the only European nation so far to introduce such measures, with screening at Heathrow and Gatwick airports and on Eurostar trains from France and Belgium. The United States and Canada had also announced new screening measures at major airport hubs to check travellers for symptoms of the deadly disease, and pressure has grown for other nations to follow their lead.

http://www.news24.com/World/News/EU-ministers-to-hold-anti-Ebola-talks-20141013?

[Chicog]

This is the British version, but I am a bit concerned that nowhere does it mention keeping a stiff upper lip.

Ebola: How To Protect Yourself From Virus

Monday, 13th October 2014 10:27

Here are a number of ways people can help protect themselves from contracting the virus.

:: Hygiene is extremely important. Wash your hands frequently or use an alcohol-based sanitiser

:: Keep hands away from the face

:: Avoid contact with the blood and body fluids of anyone, especially someone who is sick, as it is through these fluids, such as vomit, blood and saliva that ebola is passed on

:: Avoid handling items that have been touched by that person or any of their body fluids

:: Do not touch the body of someone who has died from ebola.

:: The World Health Organisation says any areas that person may have had contact with, such as bed linen, should be disinfected

:: Do not touch bats and non-human primates or their blood and fluids, and do not eat raw meat prepared from these animals

:: Avoid travelling to countries where ebola is rife, such as Liberia and Sierra Leone

- Seek medical care immediately if you develop a fever (a temperature of 101.5F or 38.6C) or a headache, muscle pain, diarrhoea, vomiting, stomach pain or unexplained bruising or bleeding

- Limit your contact with other people until and when you go to the doctor and do not travel anywhere else besides a healthcare facility

http://www.lbc.co.uk/ebola-how-to-protect-yourself-from-virus-98605

I certainly won't be eating any bat or baboon in the near future.

Edited October 13, 2014 by Chicog

[bkkcanuck8]

The biggest problem from that is that they are not separating "hot zone" passengers from other passengers until everyone is cleared.

By the very nature of the air industry, the whole system works on a hub and spoke system. Unless you have a direct flight from the hot-spot (not very likely), the majority of those from hot-spots would be mixed with those not from hot-spots. They have been on the plane with non-hot-zone passengers in an enclosed space that is notorious for spreading cold and flu viruses..... Separating them at the immigration queue would be a feel good measure and not actually do as much as you think.

Well you could screen them at the arrival gate, but since infection doesn't necessarily show for nigh on three weeks, you could still be sending a hatful of infected people out to get infectious later on.

If it does become a global problem then I fear that hours of extra delays are going to become part of the travellers norm.

Maybe I should buy some shares in one of those Sars mask companies.

You spread the virus after you become symptomatic, before then the likelihood of transmission is extremely low -- since it is transmitted in bodily fluids. Yes, there will be some that board the plane that will become contagious later on, and for diseases like ebola - fast contact tracing is a necessity in controlling an outbreak. You cannot stop outbreaks, only really control them by slowing them down and tracking down those infected and placing them in quarantine treatment.

Incompetence of airport services/management is not mandatory - just sort of the norm these days. Flying in and out of the Singapore airport is like a breath of fresh air compared to most in the world, therefore it is possible to be competent. Singapore is better at pretty well everything to do with security and health as well as just being plain amazing. The average for me flying in to exiting the airport in a cab or MRT is around 17 minutes.... most of that is walking from the discount airport landing slots to immigration. By that time, I have been scanned, I have walked past several plainclothes security agents, gone through thermal imaging sensors, my luggage has been screened by security.... yet you rarely notice it.

For actually the worst pathogens (which we have not had to deal with in centuries), the goal has to be to slow down the spread (which might require shutting down the air travel in that case) until some sort of treatment is found. It likely won't work, but we can only try. Sooner or later something like ebola -- but much more dangerous will happen... and wipe out 50%+ of the population.... and there are shelters (for select people - need at least 50,000 to survive) that can/will be used if it is worse than that....

[F430murci]

I spoke too soon ( or too late ).

The British government has rushed through an order for 500,000 Ebola suits for British forces and health workers as the extent of the global Ebola crisis becomes clear.

Hull-based Arco is to deliver 100,000 Microgard suits, which offer protection from viral infections every month.

Managing director Thomas Martin said: Our original contract was for 50,000, but that was doubled this morning. Within three minutes of getting that order, we were on to manufacturers to work out how to meet the production schedule.

The suits will be used to protect British soldiers and health workers in war-torn Sierra Leone, one of the countries where the current epidemic is thriving.

http://metro.co.uk/2014/10/13/british-government-orders-half-a-million-ebola-suits-4903517/

Just curious, but the article itself says 100,000 and that 50,000 were initially ordered, but the order was doubled to 100,000. So is it 100,000 or 500,000 suits.

[F430murci]

No one has a crystal ball, but how many people had direct contact with Duncan and the apartment where he puked everywhere? How many of those have contracted Ebola from him? If airborne and so easily transmitted, I would expect at least half of those in direct contact with him while he was sick to have contracted the illness. These numbers suggest a transmission rate much lower than flu or common cold.

Edited October 13, 2014 by F430murci