Ebola outbreak - general thread #5

[okiedokietoo]

http://www.reuters.com/article/2014/10/13/us-health-ebola-usa-nurse-idUSKCN0I206820141013
BY JULIE STEENHUYSEN
CHICAGO Mon Oct 13, 2014 12:04am EDT

At least Dr. Gavin Macgregor-Skinner disagreed, sort of

Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, also disagreed with the talk of a breach of protocol, saying it just puts the onus on the nurse.
"I think that is just wrong," said Macgregor-Skinner, who helped the Nigerian government train healthcare workers when a traveler from Liberia touched off an outbreak of Ebola this past summer.
“We haven't provided them with a national training program. We haven't provided them with the necessary experts that have actually worked in hospitals with Ebola," he added in reference to U.S. hospital staff.

 

[chipmunk]

It's most likely part of a post I wrote in the closed thread #4 that said once Duncan had entered the hemorrhagic phase of Ebola, hemodialysis and mechanical ventilation were last- gasp measures.
I stand behind my post and my words, if this is the post you are referring to. He was actively dying of an infectious process called the Ebola virus.
When someone has successfully restored normal GFR in the hemorrhagic stage of Ebola, I hope they are published in JAMA, NE Journal Of Medicine, etc. and so forth.
I don't think there is a documented case of hemodialysis or intubation saving an Ebola- infected person's life when it was initiated as late as Mr. Duncan's was.
He was intubated and started on hemodialysis on Oct. 7 as " last ditch" efforts. He was pronounced deceased on the AM of Oct. 8. My sources are CBS- Dallas, Dallas Morning News,WFAA.com and every other local DFW news outlet, and national news outlet as far as the U.K. Daily Mail. Timelines are available for his treatment and deterioration. The treatments didn't harm him, but they were too late to help him.

This is my last comment for a while, as things are being taken out of context now.

I can agree that when an ebola patient is very close to the end it is certainly too late. But if someone speaks about ebola patients in general which I thought someone did I don't think that's the case. I think it was a different poster who didn't give any case example.

 

[gngr~snap]

It's most likely part of a post I wrote in the closed thread #4 that said once Duncan had entered the hemorrhagic phase of Ebola, hemodialysis and mechanical ventilation were last- gasp measures.
I stand behind my post and my words, if this is the post you are referring to. He was actively dying of an infectious process called the Ebola virus.
When someone has successfully restored normal GFR in the hemorrhagic stage of Ebola, I hope they are published in JAMA, NE Journal Of Medicine, etc. and so forth.
I don't think there is a documented case of hemodialysis or intubation saving an Ebola- infected person's life when it was initiated as late as Mr. Duncan's was.
He was intubated and started on hemodialysis on Oct. 7 as " last ditch" efforts. He was pronounced deceased on the AM of Oct. 8. My sources are CBS- Dallas, Dallas Morning News,WFAA.com and every other local DFW news outlet, and national news outlet as far as the U.K. Daily Mail. Timelines are available for his treatment and deterioration. The treatments didn't harm him, but they were too late to help him.

This is my last comment for a while, as things are being taken out of context now.

http://www.columbiamissourian.com/a/179768/little-to-fear-from-ebola-in-us-mu-physician-says/

What sort of treatment would an Ebola virus patient receive?

"They would receive what we call supportive therapy. ... It would be making sure that they have adequate hydration, that they have adequate electrolytes, they have adequate nutrition. ... We would protect them from the next infection as best we can from people coming in with colds. If they went into organ failures, we would do things like dialysis and mechanical ventilation and things like that to support their organs until they begin to heal."

I thought it was standard practice in previous Ebola cases.
I am wrong. CDC doesn't support this it seems.

Curious!


All posts are MOO

 

[SeekingJana]

Noah built an ark because God spoke to him and told him what to build, how to build it and what to put in the ark. The people who say God tells them the end of the world is near end up dead by their own delusions- Heaven's Gate cult, Jim Jones cult... and so forth.
How, exactly, do you " prep" for a thing like an infectious disease with no known recommended treatment and no cure? I'm seriously asking.
Where I live, there's not exactly space to " Head for them there hills" and live in a cave until the danger passes, as my ancestors did when the Spanish Flu hit in 1918.
And if you found a cave, how would you get 6-8 weeks' worth of H2O and food there? By mule?

And when you came out of the cave in 6-8 weeks, what exactly would your quality of life be at that point if so many people had become sickened that there were no functioning power grids, thus no gasoline, no further food supplies, etc? And if all those people were sick, then who buried the dead but still infectious corpses???

 

[chipmunk]

Well, we cut budgets to CDC, to NIH.
So I guess it's not surprising there is lack of preparedness.

Thank you.

:takeabow: :gaah:

 

[SeekingJana]

http://www.columbiamissourian.com/a/179768/little-to-fear-from-ebola-in-us-mu-physician-says/

What sort of treatment would an Ebola virus patient receive?

"They would receive what we call supportive therapy. ... It would be making sure that they have adequate hydration, that they have adequate electrolytes, they have adequate nutrition. ... We would protect them from the next infection as best we can from people coming in with colds. If they went into organ failures, we would do things like dialysis and mechanical ventilation and things like that to support their organs until they begin to heal."

I thought it was standard practice in previous Ebola cases.
I am wrong. CDC doesn't support this it seems.

Curious!


All posts are MOO

You are a nurse. You know about how Ebola has different stages and how the dialysis and mech. vent. were started far too late on Mr. Duncan. He was DYING when they stepped up and gave him the experimental anti-viral med. It was later than that when they started him on dialysis. A CNP had noted hematuria 3 days earlier and questioned in the progress notes whether or not he had impending renal failure. This is when they should have started dialysis and so forth. They didn't.

Presby. messed up from the get- go with Duncan's case, partly because he lied, but mostly because there was an information gap between nurse and doctor that they openly admitted. I think they were extremely desperate to save him... despite the delayed diagnosis, the generally high death rate from Ebola, and the fact that he was not a match for recovered Ebola donor blood products like Dr. Brantley was.

Once he was flagged at risk for Ebola, he should at least have been transferred to Parkland, a Level One trauma center in Dallas, and ideally, to one of the designated Ebola- prepared hospitals in the US.. Presby. is NOT known for clinical excellence in the area, if you KWIM.
Nurses know, and it definitely is not somewhere I would go for any type of treatment. I don't know HOW or WHY he went back there instead of going to Parkland ( large percentage of indigent patient care at Parkland) for the second ER visit.. I've always wondered..

 

[SeekingJana]

I can agree that when an ebola patient is very close to the end it is certainly too late. But if someone speaks about ebola patients in general which I thought someone did I don't think that's the case. I think it was a different poster who didn't give any case example.

OK, thank you. I don't believe that treatment should be withheld from Ebola patients or any other patients with renal failure. I am extremely pro- treatment. Up until the point where it's clear that the person is dying right there before your eyes, and then we still CONTINUE to do the procedures if they have been started, but no one I know would start dialysis on someone in the hemorrhagic stages of Ebola except Presby. Dallas docs.

 

[chipmunk]

I can agree that when an ebola patient is very close to the end it is certainly too late. But if someone speaks about ebola patients in general which I thought someone did I don't think that's the case. I think it was a different poster who didn't give any case example.

It had to have been a layman. It was not you! No worries. I Love nurses. The post was entered around the time posters topics were favoring concentration camps and never hearing of certain types of loose stools.

 

[SeekingJana]

It had to have been a layman. It was not you! No worries. I Love nurses. The post was entered around the time posters topics were favoring concentration camps and never hearing of certain types of loose stools.

And I think Chipmunks are adorable. Thank you for understanding what I was trying to say.

 

[chipmunk]

How do they know it was human error? It's just speculation that nurse breached the protocol. She doesn't say she breached protocol. Yet they are assuming it anyway.

It does happen but agree we have to look at all angles, not assume. I know what you're saying. We do know CDC is trying to notch down fear, PR figures in. Plus don't CDC guidelines omit some important protective items. Following their protocol is not necessarily fool proof.

 

[chipmunk]

Translators will be needed. How to have one locally when needed? Phone won't work for unless one is dedicated to the patient. Guess that can work. While many W Africans speak English those that don't come from tribes with many different languages. Terminology varies from country to country. This reminds me of my brother's hospital stay, telling an African nurse he had to have a bm. He needed help to the bathrm. She didn't understand. Sorry for the example but it's real life.

 

[gngr~snap]

Noah built an ark because God spoke to him and told him what to build, how to build it and what to put in the ark. The people who say God tells them the end of the world is near end up dead by their own delusions- Heaven's Gate cult, Jim Jones cult... and so forth.
How, exactly, do you " prep" for a thing like an infectious disease with no known recommended treatment and no cure? I'm seriously asking.
Where I live, there's not exactly space to " Head for them there hills" and live in a cave until the danger passes, as my ancestors did when the Spanish Flu hit in 1918.
And if you found a cave, how would you get 6-8 weeks' worth of H2O and food there? By mule?

And when you came out of the cave in 6-8 weeks, what exactly would your quality of life be at that point if so many people had become sickened that there were no functioning power grids, thus no gasoline, no further food supplies, etc? And if all those people were sick, then who buried the dead but still infectious corpses???

Touche' I have no answers, no plan, no stash.
No real worries either...
Whatever will be, will be. IMO

All posts are MOO

 

[Sigh Sister]

So, the infected nurse and her family have requested privacy, but her name is now out there (no MSM sources). The site that originally published it stated that public health concerns trump her privacy. Someone that tweeted her name stated that everyone in her community has the right to know. I'm wondering what others think of this? I have mixed feelings. If the health officials in Dallas are doing their jobs, contact tracing should identify those with potential exposure, and they will be notified. If they aren't thorough with contact tracing, however, people with potential exposure would have no idea.

 

[Elley Mae]

I found his statement to be incredibly arrogant. Because a nurse was infected, protocol was breached. ????? How about, we may not know all the ways this virus is transmitted? How about a little humility in the face of the reality that we DON'T know why this old virus has suddenly become so virulent.

You and me both. From the first time I read it I could see a clock and it is counting down to when he will be leaving that job/post. Just my opinion but I see him leaving/being fired. jmo

 

[Elley Mae]

Texas and CDC officials say that the nurse was wearing the recommended personal protective gear for handling an Ebola patient, including a gown, gloves, mask, and eye shield. However, one expert told Reuters that gear only offers a minimum amount of protection, especially when the disease enters its final phases.

http://www.foxnews.com/health/2014/...ing-nurse-ebola-infection-on-protocol-breach/

"You don't scapegoat and blame when you have a disease outbreak," Bonnie Castillo of National Nurses United told Reuters Sunday. "We have a system failure. That is what we have to correct."

 

[Elley Mae]

Ebola: UK cancels resumption of direct flights to Sierra Leone

http://www.theguardian.com/world/20...ption-direct-flights-sierra-leone-gambia-bird

The first direct flights to resume from the UK to Sierra Leone have been cancelled after the British government revoked Gambia Bird’s recently granted permit because of fears over Ebola.

 

[bettybaby00]

Don't know if this was linked already

Liberia health workers' strike on Monday could hurt Ebola efforts

(Reuters) - Thousands of Liberian healthcare workers are set to begin an indefinite strike at midnight on Monday which could undermine the country's effort to stop the spread of the deadly Ebola virus and leave several hundred patients without care.
http://www.reuters.com/article/2014/10/12/us-health-ebola-liberia-idUSKCN0I10SX20141012?feedType=RSS

More at the link

 

[Elley Mae]

Some nurses turning up at hospitals in Liberia

http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2014-10-13-07-29-33

Some nurses turned up for work at hospitals in Liberia on Monday despite calls for a strike to demand better hazard pay amid an Ebola epidemic.

..................................

— On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics.

— His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m.

— Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees.

— On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper.

— On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.

— On Oct. 8, Duncan died.

http://www.latimes.com/nation/la-na-ebola-positive-20141012-story.html#navtype=outfit

bbm

 

[hockeymom]

As others have said there is human error, it is real. Still, we need to determine what protocol does work if CDC guidelines aren't sufficient. There are many medical personnel who care for these patients without getting infected. So what are they doing right? Adding layers plus higher level, more protective gear would seem to be the answer.
Then do follow any improved protocols.

I posted this yesterday, but with so much going on, I'm not sure if it got read. CDC guy and some other expert explained why adding more layers is sometimes detrimental . For example, triple gloving is against protocol because its harder to get them off and you have a greater chance of coming in contact with contaminate.
So I guess more layers isn't always the answer.

 

[Sigh Sister]

Here's a video I came across showing how to doff Level C PPE. The man wipes himself down with a bleach wipe before he starts to remove his gear.

https://www.youtube.com/watch?v=ls69Tib1PjU

Personally, I think more layers is the way to go, but there has to be rigorous training as well. The nurses and doctors at Emory had that training and were well prepared. I bet they wore multiple layers. None of their healthcare workers became infected.