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Are we approaching the “Tipping Point” for Ebola?

Are we approaching the “Tipping Point” for Ebola?

Let’s hope not.

I was talking with biologists yesterday, as part of a work project, and we all were becoming increasingly alarmed at the bureaucratic response to the reports that nurses in Dallas and Spain were stricken with Ebola.

I stated that the “tipping point” would be reached if one of the nurses spread the disease to someone else outside of the hospital setting. Presently, 76 Texas Health Presbyterian Hospital workers being monitored for potential infection with Ebola. Once someone outside the healthcare setting was infected, then the chances of this being a more serious health threat to the nation escalate.

We are coming perilously close to the tipping point, as it looks like an Alcon employee who is “closely associated” with the Dallas nurse, Nina Pham, is in isolation and under observation to determine if he displays “Ebola symptoms”.

The CBS Dallas-Fort Worth affiliate offers a video report and post.

Dallas nurse Nina Pham tested positive for the Ebola virus over the weekend. Pham was one of the medical workers who administered treatment to Ebola patient Thomas Duncan, who died from the virus last week. Pham first noticed that she had some of the symptoms on Friday, and her diagnosis was confirmed on Sunday.

The Centers for Disease Control and Prevention confirmed on Sunday morning that one other person was in close contact with the nurse after her symptoms began to show. That person is now known to be an employee at the Fort Worth company Alcon. The company sent a message to all staff members, letting them know that one of their own was in isolation at Texas Health Presbyterian Hospital in Dallas.

According to the emailed note, the Alcon employee was admitted to the hospital on Sunday and is being monitored for Ebola symptoms. However, the man has not shown any signs of being sick. The name of the Alcon worker was not released.

Here is a screen shot of the note, as offered by the CBS affiliate.

Ebola Note possible exposure Texas Presbyterian

As the incubation period is potentially 21 days, the associate is going to be under observation for quite some time.

One of the benefits of having the infected American missionary doctor brought to Emory Hospital, a facility equipped to handle a pathogen as dangerous as Ebola, is that his antibody rich blood has been used to help Pham recover. Her current condition is reported as stable after she was given a transfusion yesterday.

Questions still remain about how Pham contracted the disease.

On Monday morning, an official with direct knowledge of the Texas nurse’s case told CNN that CDC disease detectives interviewed the nurse several times and thought there were “inconsistencies” in the type of personal protective gear she wore and with the process used to put the gear on and remove it.

[Director of Disease Control and Prevention Dr. Tom] Frieden has spoken of possible ways she became infected. It could have happened when the nurse removed her protective gear — a bit of infected bodily fluid somehow touching her — or it she could have come into contact with infected fluid as Duncan received kidney dialysis or respiratory intubation.

Those procedures were “a desperate measure to try to save his life,” Frieden said. “Both of those procedures may spread contaminated materials and are considered high-risk procedures.”

He said, “When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material … touching you and being then on your clothes or face or skin … is not easy to do right.”

However, all of this is currently speculation. Finding out exactly how Pham became ill will be critical to all the healthcare professionals, so that other nurses and their associates do not become more victims.

It does look like Frieden regrets the less-than-robust response to the first Dallas infection, and seems to be making adjustments. The CDC is sending out a response to to the Dallas hospital where Pham and her “close associate” are located.

“I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection,” Frieden added. “But we are prepared to do this in the future with any case anywhere in the U.S.”

…Emory University, which successfully treated Ebola patients Dr. Kent Brantly and Nancy Writebol, said it would send two experienced nurses to help Texas Health Presbyterian Hospital in Dallas.

“By sending two of our nurses who have been directly involved in the care of Emory patients infected with the Ebola virus, we hope to provide on the ground standard operating procedures for PPE usage, based on CDC guidelines,” Nancye Feistritzer, chief nursing officer at Emory University Hospital, said in a statement.

“We also want to be a resource to other organizations who are facing the need to train direct care providers and to ensure adherence to protocols designed to keep the care team safe.”

Here’s to hoping that Pham and her associate recover and that the agency begins focusing on the “disease prevention” aspect of their responsibilities, instead of downplaying these incidents.

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Comments

All I can think is I told you so, Leslie that Frieden, Obola, and many others should be brought up on charges of NEGLIGENT HOMICIDE if this poor girl dies.

HELLO MEDIA! WAR ON WOMEN!! This was entirely PREVENTABLE! This is OBAMA’S FAULT!!

(Sorry for the caps, but I’m really yorfed over this.)

    “Told you so Leslie?” The transport of the doctor and nurse to Emory actually worked out quite well.

    That has absolutely nothing to do with the failure to screen passengers or train hospital staff.

And another thing, that creep Jesse Jackson basically said this dying girl is a racist. Will anyone make him eat his words?

Hello GOP! Americans are dying for Obola. Stop looking in the mirror and start screaming.

    walls in reply to JerryB. | October 14, 2014 at 8:46 pm

    Well, John Boehner is crying, … I’m just not sure if it is for Nina Pham, or some other cause.

    Abu Nudnik in reply to JerryB. | October 15, 2014 at 4:12 pm

    Jesse Jackson? I’ve heard that name before. Isn’t he the black guy leader who said that, when walking at night in Washington DC he felt relieved when, if he heard footsteps behind him, he found it was a white man behind him? Oh yeah.

In 1981-82, being medical residents at a VA hosptial, we were told that the newly appreciated HIV infections were not serious since NO MEDICAL WORKER had been infected from treating a HIV positive patient. I strongly disagreed saying that it was only a matter of time and to not make such broad assumptions in order to defend “patient rights”… well.. the next week after that… the first reported case happened. Fast forward to the 21st century and it is a blast from the past. HIV turned into a political disease and I wonder how many more people died because it wasn’t treated as a lethal communicable disease. A great many dangerous diseases are in Africa that have nothing to do with one’s race, religion or whatever. We have so much to catch up on with Ebola and no spare room for political posturing.

Midwest Rhino | October 14, 2014 at 7:59 pm

Another tipping point (or insidious asymmetric assault), would be Ebola in Central America. It would spread more easily in third world countries. Desperate people there are already well informed by President Open Borders, that health care and a life of promise is free in America, and he will protect them from the “racists” (otherwise known as taxpaying citizens).

Illegals would make no declarations, just show up coughing and be given a bus or plane ticket courtesy of Obama, to dribble Ebola to parts unknown. After infecting a hundred, they show up in the ER and infect another fifty, before they are even identified as spreaders.

If the kids with lice and EV-D68 get escorted around our laws, why not Ebola victims?

“Treating one Ebola patient requires, full time, 20 medical staff. Mostly ICU (intensive care unit) people. So that would wipe out an ICU in an average-sized hospital.”

http://pjmedia.com/tatler/2014/10/14/ebola-preparation-will-bankrupt-my-hospital-director-reacts-to-cdc-prep-call/

    You know damn well this will happen … and no, I’m not wearing a tin foil hat. Just give this some time. I’m a betting man, and I like my odds.

Freddie Sykes | October 14, 2014 at 8:03 pm

RE: Dallas nurse Nina Pham tested positive for the Ebola virus over the weekend.

Why are so many being quarantined if there is a test?

    ebartley in reply to Freddie Sykes. | October 14, 2014 at 8:28 pm

    The Mayo clinic’s website says the CDC has tests which can detect the virus in your blood. The CDC’s website lists diagnostic tests beginning “within a few days after symptoms begin” (with more types of tests available later in the infection.) Presumably the blood tests are impossible or at least unreliable until there’s enough virus in the bloodstream.

    http://www.cdc.gov/vhf/ebola/diagnosis/

    So, the tests are useful for “does this feverish and projectile vomiting patient have the stomach flu or ebola” but not useful for “did this exposure result in an ebola case in an asymptomatic person?”

On the local scene, a college in Davenport has sent an employee home after he came in contact with a family member who was recently in Liberia.

At least someone is taking this seriously.

http://www.kwqc.com/story/26784446/augustana-employee-sent-home-due-to-contact-with-family-member-from-liberia

Duncan’s family is threatening to sue the hospital over his death. The hospital should underwrite a suit by Pham against Duncan’s heirs for entering the country illegally, concealing his status, and eventually infecting Ms. Pham.

Can someone tell me why the “clean hands” doctrine would not apply against the Duncan family? His illegal conduct (entering the country illegally) put him in the situation in which he found himself at Emory Hospital. Without said conduct he would not have died at that facility.

    Let’s be clear. An attorney (and the reverend JACK—sun) are pushing some kind of suit.

    We haven’t seen hide nor hair of the family, nor any health updates either, since they were transported away from their apartment.

Noblesse Oblige | October 14, 2014 at 10:04 pm

It is clear that this disease is easy to get when the source is sick, indeed easier than we have been fed. What we don’t yet know is how easy — or hard — it is to get from an infected person who is not yet sick. From what I have read it is simply not known but is THOUGHT to be very difficult. On that will hang how fast it spreads in the US. Clearly the administration is betting that one cannot get it from an asymptotic person; in this respect they are gambling with the health and welfare of the country.

I hope the CDC director can find a face-saving way to resign and bring in a leader that people can believe. In a crisis like this, credibility is the coin of the realm, and his credibility is spent. It doesn’t need to be a punitive action – I’m just hoping he can see that CDC needs a credibility transfusion and that’s the only way it can happen.

    Seriously, do you have anyone in mind that the currect administration would nominate that the country, as a whole, would accept as credible?

    I don’t either.

    The current tenant at 1600 Penn. Ave., and all his cronies, have shot their wad in the credibility department, and that’s the main problem. Since no one trusts one word out of their collective mouths, the problem isn’t so much the Ebola virus itself, as the reaction to it is.

      billdyszel in reply to Miles. | October 15, 2014 at 7:18 am

      You’re probably right, Miles, I may be too optimistic. The “all politics all the time” administration has cultivated a unique degree of credibility blindness. I hold a faint hope that they’ll realize how deadly that can be in this case. Or at least that the CDC director, a physician, will value his own credibility enough to recognize the problem and step aside. But as you say, there’s too little evidence to support that hope.

      Voyager in reply to Miles. | October 15, 2014 at 10:02 pm

      The problem is less that we don’t trust them, and more that they have been so consistently wrong.

      If they knew what they were doing it would not matter so much that we didn’t trust them fully, but no amount of trust in them will make them actually competent if they are not already.

How many millions will die BEFORE this evil administration gets deposed?

Worse case scenario would be an asymptomatic carrier arriving in the USA and interacting with a lot of people.

I stated that the “tipping point” would be reached if one of the nurses spread the disease to someone else outside of the hospital setting.

I’d have said that the tipping point was when someone became infected without having to go to Africa.

The lack of response overnight to this thread may indicate a resistance, a reactance, has developed to hearing more bad news on Ebola. Yet Ebola is just getting started, and is incredibly — hundreds of millions of human lives at NEAR risk — dangerous.

The trouble is that the current administration and the elite in many needed establishments are so corrupted by political philosophies and concomitant bad habits of reacting to REALITY WHAN IT BECOMES DANGEROUS, can no longer be suffered in their current positions, and in near whole must be deposed to allow (hopefully) he competent to step forward, and this must happen in the near future, weeks.

Yes, there could be a miracle cure, but the likelihood of that event is in aggregate under 1 in a hundred in the necessary time frame, in my opinion.

And the likelihood of a massive change-over in the leadership roles of major establishments seems equally unlikely, yet without it many manes are going to die, and yet that massive death toll is appearing unavoidable without such change.

In the news this morning a woman from the nurses union claimed that Mr. Duncan’s blood was sent through the usual hospital channels for testing, with no extra safety measures. Huh?…
Also, why not have video cameras running during the removal of PPE? Not to cause trouble, but to help improve those procedures after an exposure. Hindsight is 20/20, but only if it is identified and shared. Just saying.
My thoughts are with nurse Pham, and I hope she continues to improve.

Also in the news this morning is that a second health care worker has the virus and is in isolation. The article about the nurses’ association says that the hospital was NOT ready for an ebola patient and serious errors were made in the early days of his hospitalization, leading to these infections, most likely.

I don’t wish this on anyone, but really, it’s frustrating that Duncan’s family are not reported to be ill, whereas two hospital employees who worked to save him have the disease and face possible death.

Empress Trudy | October 15, 2014 at 9:34 am

In what is a beautiful irony, the basic science that drives the production of a vaccine is the work at two Israeli companies that have been experimenting with the industrialization of genetic engineering which uses the tobacco plant as a medium for growing plant-human antigen hybrids. Now HERE is something the BDStards need to boycott. And for good measure, let’s criminalize it because it involved the dreaded tobacco leaf.

The 2nd nurse flew from Dallas to Cleveland and back after exposure. 132 passengers, plus flight crew, landing crews, and whomever she visited in Cleveland, wherever she went.

The CDC is “on it”, but how long does it take to do that sort of investigation when you can’t know everyone she exposed?

If any of those hundreds she exposed are now carriers, how much farther will they have spread the virus while CDC is investigating?

I know little of medicine, but I know math and the exponentials and infection vectors are frightening.

We may be screwed. This thing may already be loose in America, while the CDC lags far behind.

Great post Leslie and as the cool light of day shows there is yet another healthcare worker diagnosed with Ebola. I think we have a better chance of helping these folks with the original doctor who went to Emory. We should bring our folks back to treat, this is the only place they will receive top notch care. The bigger question is why in 30 years of Ebola decimating Africa we haven’t seen anyone in the West do a good job to treat this.

It does not seem logical to blame the CDC. Guidelines from the CDC are clear, what is not clear is how hospitals implement the guidelines. What about the doctor who initially sent the Ebola patient home? Many hospitals have lax hygiene procedures as evidenced by the data showing the number of hospital acquired infections. Anecdotally I have been astounded by seeing nurses in hospitals who have long fingernails and fingernails with nail polish, a very rudimentary hygiene precautionary measure for health care professionals. Handwashing prior to touching patients, long hair not tied up etc., these precautionary measures are not rigorously enforced in a great many hospitals and medical facilities creating many loopholes that a virus like Ebola can take advantage of and where drug-resistant bacteria can flourish.

    bvw in reply to RuthC. | October 15, 2014 at 8:37 pm

    You have to work with what is real, and the practical realities of operating a hospital. The CDC guidelines fail in that regard, and thus in the case of ebola on the ground in the US, is not going to catch up under current management fast enough. Or rather, given the progression of the wildfire in high wind conditions and no firebreaks … a few more cases undiscovered until late stage are likely to overwhelm all. But who am I? Just a citizen who has been to hospitals way too much over the years and especially in the last decade. And I’m way smart in some ways, but that ain’t exactly an asset in a society of the much less smarter. See Jules Verne “In the Country of the Blind”.

    What used to happen with ebola was the poor man’s adaptation to epidemic. It was effective. Travel gets shut down, villages are isolated. But today with NGOs and high-contact transportation systems, including jets, far more available in the third world … this is a perfect storm event. In addition it seems that easy modern money is drawing the once remote infection carriers into commerce and personal contact in urban areas. The first pandemic of the cell-phone, Facebook and jet age.

    As money is easy and money flows pumped up, so is human contact. With Facebook-liek social media world-wide everyone feels isolated, and so seeks real contact. The old five acres of your home village just isn’t enough.

If a domestic airline passenger develops ebola we’ll definitely be past the tipping point.

    Henry Hawkins in reply to billdyszel. | October 15, 2014 at 6:19 pm

    I hope I’m wrong, but I’m thinking the second infected nurse will go down as the tipping point, a modern Typhoid Mary.

OTOH, Thomas Duncan flew from Monrovia to Brussels to DC to Dallas in mid-September and there have been no reports of infections among other passengers of those flights. That offers some consolation.

    We may get lucky in that people in the very early stages of being ill, shed so little virus for an unknown, but probably short period, that contagion is less likely as opposed to when they get to the point that their insides start coming out of every available orifice.

    We will find out in the near future.

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