Ace has up a handful of new posts about the steady trickle of disquieting Ebola reports. HotAir has others. For instance, are you thrilled to hear that high-risk tissue samples were sent through the Dallas hospital's pneumatic tube delivery system? Or that nurses who treated Patient Zero also went on to treat other patients at the hospital rather than working in strict isolation?
I'm inclined to cut the bumbling expert bureaucrats some slack on certain issues, such as the continuing confusion over when and how intensely contagious Ebola sufferers are. The answer seems to be that they're not noticeably infectious at all early on, then they become moderately infectious when they develop symptoms, though only if there is considerable direct contact with body fluids. Finally, they become crazily off-the-charts infectious when they reach the crisis stage: so infectious, at that point, that Level 2 biocontainment protocols apparently are ridiculously inadequate and only Level 4 protocols (such as those used at Emory Hospital in Atlanta) will do. This means that the CDC probably is not nuts to advise us that there is quite limited risk to riding on an aircraft with someone who is infected but not yet showing symptoms, perhaps even someone, like Dallas nurse No. 2, who's knows she's been exposed and is running a low-grade fever but for some reason nevertheless decides to hop on a plane, because, hey, it's not like she's a health professional who should know better. But it also means that the CDC's "we got this" attitude is less than reassuring when it comes to the likelihood that your regular corner hospital is prepared to deal safely with a full-on blowout crisis-stage Ebola case. On that subject, the record is not looking so great so far.
For every news article that tempts us to think everyone's getting hysterical, there's another that suggests we're not taking some risks seriously enough. Ebola is a manageable disease in very small numbers in highly qualified clinical settings. If we adopt slapdash procedures in enough hospitals, we may quickly find that the outbreak becomes very, very difficult to contain.
Meantime, all is well: the President has cancelled a fundraising trip so he can get all over this.
Well, if the U of Minnesota bunch is correct, the Incompetentos-in-Gummint MUST close off travel from West Africa, period.
ReplyDeleteI suspect we are all safer when ∅ is playing golf.
ReplyDeleteSo stay out of a big city and don't fly for awhile.
ReplyDeleteSo the caretakers have to be in MOPP4 when treating the sick. Sounds about right.
Somebody could get rich making those suits.
True enough. In fact, if it stops the disease from getting out of hand, who would even mind that they got rich?
ReplyDelete"For every news article that tempts us to think everyone's getting hysterical, there's another that suggests we're not taking some risks seriously enough."
ReplyDeleteI think both are true. In some sense we're (as a society) both too hysterical about this and at the same time not taking it seriously enough. The average person, who takes normal hand washing precautions as if during flu season should be fine (unless things really blow up). That said, where it does occur, we need to treat it like the quite literally deadly serious disease that it is- and enough so that normally high level precautions aren't enough (one nurse could be a breach in protocol- two, and I'm thinking you'd better look at the protocols again). We should have already closed off accepting travelers from the hot spots, but it's not P.C.
As for sending sample through the pnumatic tubes- wow! My first job was working in a hospital lab, and I can't tell you how many times specimens broke when the tube landed if things weren't packed carefully. If it was tissue samples (is that correct Tex?) then I'm less concerned as those are dropped into formalin by the doctor, then sent to the lab, but I hadn't heard that, I've only heard 'samples'.
Here's a tip for the CDC- if you want people to relax and stop worrying about something that will most likely never affect almost everyone in the country, drop on it like a ton of bricks, and get it fully under control using more aggressive means than you think are necessary, and guess what- people will be more relaxed as they can then safely assume that things are under control.
The problem with saying "we have this under control" is that the reports coming from Dallas are directly contradicting that. You do not have the disease under control when it is currently spreading at the same rate as it does in West Africa. Patient 0 has now infected two others directly. That is the expected infection rate for ebola. They HAD this under control when they brought the two patients to Atlanta. No further infections. But clearly, they currently do not. And with the discovery that patient 2 was symptomatic when they got on that flight from Cincinnati, I think it's a matter of time before we find more cases. As a coworker who flew over last weekend said, "you literally cannot help but touch stuff in a plane". Try and convince me that a person running a fever is not sweating at some point on a commercial flight. Do you think they burned that seat following their arrival in Dallas?
ReplyDeleteBarack Ob[ola] will require you to work. He is going to demand that you shed your cynicism. That you put down your divisions. That you come out of your isolation, that you move out of your comfort zones. That you push yourselves to be better. And that you engage. [Obola] will never allow you to go back to your lives as usual, uninvolved, uninformed.
ReplyDeleteRemember who said that and when?
The reports about the tissue samples are fuzzy. Here's ABC News with the hospital's increasingly desperate attempts to respond to stories about inept protocols:
ReplyDelete'According to the hospital’s statement in response to a release from National Nurses United, the patient’s samples were handled with sensitivity to avoid a potential contamination.
'“All specimens were placed into closed specimens bags and placed inside a plastic carrier that travel through a pneumatic system. At no time did Mr. Duncan’s specimens leak or spill – either from their bag or their carrier – into the tube system,” the statement reads.'
http://abcnews.go.com/Health/dallas-hospital-slams-unions-allegations-ebola-procedures/story?id=26234367
Who knows what kind of samples or how they were treated, or how careful anyone was, after touching them, not to contaminate the outside of whatever they were sealed in. If we're talking about samples taken during the crazy out-of-control contagious stage, with a bazillion virus particles in every drop of fluid, I'd be worried about touching other things that came popping out of those tubes.
They're going to be very lucky if they didn't manage to infect some other patients.
Clearly there's a pretty safe way to do all these things--Emory has a spotless record--but I doubt the folks in Dallas have got their heads wrapped around it yet. I was pleased to hear they're transferring the second nurse to Emory. This is not a learning-on-the-job situation.
Honestly, I can't even imagine handling those specimens to run lab tests- but I'd certainly not put them in the pneumatic tubes! Sure, they didn't leak - but they sure could have, and dramatically at that. The fact that just handling things that someone who has had patient contact close enough to get a specimen is a major risk says that those specimens should only have been handled by specific personnel and hand delivered to the lab, triple sealed. I have no idea what the protocol would be to introduce those specimens to the testing machines. I'll have to ask my mother, the retired lab tech about that.
ReplyDeleteIt also occurs to me that if they were doing blood tests (and I'm sure they were doing frequent lytes and glucose tests, to monitor the effects of the fluid loss) the normal procedure is to spin the tubes in a centrifuge to separate red cells from plasma/serum for testing. When tubes break in the centrifuge, it can be a mess, and there's the chance of fluid vapors (I won't refer to it as aerosolization) being present. I'd think you'd really need specialized centrifuges in safe enclosures and protocols for clean up in the event of a break (transport to a 'cleaning room' before opening the centrifuge) which you could usually do as you would often know of a break by the imbalance of the load- but not always. It's like defusing a bomb- there's risk at every step, and it gets to the point where it seems almost impossible not to make a mistake...
ReplyDeleteI'm just glad I'm not doing that anymore.