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Catching Ebola

Catching Ebola

What the first cases transmitted in the west might be telling us

So far – and admittedly, it’s very early – the pattern of transmission of Ebola in the United States has roughly matched the pattern of transmission in Spain.

These are the only two Western countries where transmission has occurred, and both cases happened to staff in hospitals under conditions that were supposedly in accord with recommended ebola-treatment protocol. In each case, authorities also have almost immediately assumed there was a breach, and that this is what accounts for the transmission.

In Spain, a nurse’s assistant who caught the disease had treated a Spanish priest who’d been transferred to the hospital from Africa in the later stages of the illness, with authorities knowing full well from the start that he was an ebola patient. She had contact with him very briefly towards the end of his life, and then helped clean up his room after death. She is reported to have perhaps breached protocol in the removal of her gloves, by touching her face.

The Dallas transmission is also being blamed by authorities on a breach, this time an assumed one:

…[Dr. Daniel Varga,] a top federal health official said the health care worker’s Ebola diagnosis shows there was a clear breach of safety protocol and all those who treated Thomas Eric Duncan are now considered to be potentially exposed.

In addition [emphasis mine]:

…Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, on Sunday raised concerns about a possible breach of safety protocol and told CBS’ “Face the Nation” that among the things CDC will investigate is how the workers took off that gear — because removing it incorrectly can lead to a contamination.

“I think the fact that we don’t know of a breach in protocol is concerning, because clearly there was a breach in protocol,” Frieden said. “We have the ability to prevent the spread of Ebola by caring safely for patients … We’ll conduct a full investigation of what happens before health workers go in, what happens when they’re there, and what happens in the taking out, taking off their protective equipment because infections only occur when there’s a breach in protocol.”

Maybe yes. Maybe no. Maybe we just like to think that “infections only occur when there’s a breach in protocol,” because it’s even more frightening to consider that the current protocol may be inadequate.

But one of the hallmarks of this particular outbreak has been that transmission to health care workers has been more frequent than in previous ones, and that sometimes the people who have been infected in this manner swear they’ve followed the rules.

Officials have previously assumed that in all cases in which health care workers have contacted ebola from patients, the workers have breached protocol without realizing it, especially in Africa where conditions include heat and overwork, and sometimes poorly-trained personnel. But it has been a puzzlement that some of those who were infected in Africa have been the top doctors working on the disease; wouldn’t they, of all people, be expected to know how to be extra-careful?

There have been only a few ebola cases brought to the West for treatment, and only one (Duncan) who came here after exposure in Africa but first exhibited symmptoms here. And yet there have already been two transmissions to medical staff. That is a very high ratio, and is extremely troubling—and unacceptable.

It is also very troubling (although not very surprising) that officials don’t seem to be taking into consideration the fact that they may have to go back to the drawing board not only on training of staff, but on the design of the protective gear as well.

And what are the chances of a ban in this country on commercial travel from East Africa? Perhaps it would not prevent all ebola cases from arriving on our shores, but at least it could give us more time to prepare, since we clearly were not ready to deal with ebola. Unfortunately, the chances of a ban appear to be very small.

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]

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Without a surgeon general with vast knowledge of medicine and public policy, who will make the decision of having a more inclusive protocol, and thereby increasing the false positives and the costs associated with false positives as opposed to the current policy where, until proven, a false sense of security and creating costly errors by falsely excluding possibly infected invdividuals who may be in the very early stages of infection, i.e. temps less than the current 101.5 F?

    Not A Member of Any Organized Political in reply to mrtomsr. | October 13, 2014 at 11:25 am

    We have “President Barrack Ebola” to thank for that.

    TexasRanger in reply to mrtomsr. | October 14, 2014 at 1:03 am

    Ebola – You Can Help! You, Your Family and Co-Workers are at Unnecessary Risk! Here’s What You Can Do to Help – Listen to Judge Jeanine Pirro!

    https://www.youtube.com/watch?v=A0Gkzm7O0ew

    Help Do Something – Sign the Petition Now! And Spread the Word Not The Virus!

    https://petitions.whitehouse.gov/petition/have-faa-ban-all-incoming-and-outgoing-flights-ebola-stricken-countries-until-ebola-outbreak/FFJHH9yX

    The 1918 Flu Virus Pandemic infected over 500 million people across the world, including the USA, remote Pacific islands and the Arctic, and killed 50 to 100 million of them, that’s a 10 to 20 percent death rate.

    A large factor in the worldwide occurrence of this flu was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease.

    Now we have Jumbo Jets and the Ebola Virus….. With a 70 to 90 percent death rate!

    Help Do Something – Sign the Petition Now! And Spread the Word Not The Virus!

    You Can Help – Facebook it, Tweet it, Pin it, Instagram it and ask your family, friends and co-workers to sign the Petition!

    Obama is Wrong – People are dying! – Help Stop Ebola University of Kansas Hospital Dallas Nurse Duncan Patient Zero!

“And what are the chances of a ban in this country on commercial travel from East Africa? Perhaps it would not prevent all ebola cases from arriving on our shores, but at least it could give us more time to prepare, since we clearly were not ready to deal with ebola. Unfortunately, the chances of a ban appear to be very small.”

But they’re getting better every day as public pressure for such no-brainer measures increases.

Other too-obvious measures include a quarantine on either end of a journey from West Africa. NOT too much to ask a traveler, and certainly consistent with simple, time-honored disease control.

Here’s the scary part – maybe they’re looking in the wrong place. Maybe the infection came from some contact the nurse had *outside* of the hospital setting, and even though the protocols work, and aren’t broken, it’s already out in the “wild” general population.

Ugh not here too.

Being a top doctor by African standards doesn’t mean you were working with a hazmat suit. Firestone, the tire company, stopped an outbreak cold by using people trained in hazmat suits used at its rubber production plants in Africa; the suits worked fine against Ebola. Viruses don’t teleport. That’s why it’s a pretty good guess there was a protocol breach. I’m not sure if how the CDC defines that includes a wardrobe malfunction (tear/ rip/ puncture).

Also, how to explain that in each case (Spain and Dallas) only one nurse got it? Why not all the others plus the doctors? I know the unions want to say otherwise, but people screw up and it’s not beating on them to say so, because these infections do not “just happen”, not when unlike in Africa, only one person of a group got infected in a patient care context.

    Ragspierre in reply to JBourque. | October 13, 2014 at 12:41 pm

    I think you kind of miss the point.

    When you have a “protocol” that proves this failure-prone (delicate), and you have a tremendous cost for a failure, you work at making a NEW, more robust, protocol.

    To my global-thinking mind, this is a matter of simple game theory.

    Observer in reply to JBourque. | October 13, 2014 at 1:16 pm

    Only one nurse got it . . . so far.

    It takes weeks for symptoms to show up after an exposure. This nurse was the first, but we don’t know how many more may start showing symptoms in the coming weeks. Hopefully none, but at this point we just don’t know.

    snopercod in reply to JBourque. | October 13, 2014 at 6:40 pm

    The protocol breach most likely occurred when the woman was removing her gloves. She probably removed one glove, and then used her bare hand to remove the other. Bad thing…

    JBourque, the problem with your analysis is that it starts with the premise that current protocols are 100% effective if correctly followed. Ergo, an infection must be the result of something other than imperfect protocols.

    We have experts insisting with certainty things they don’t really know. We also have experts who insist they followed protocols and still got infected.

    If you are going to entertain the notion that one group of experts is wrong, it only follows that the other group could likewise be wrong.

Here’s a report from a doctor in Liberia

Quote: “Liberia is losing the fight against Ebola because they are depending on NGOs and an influx of Western money instead of traditional ways of dealing with epidemics. The first few Ebola epidemics were in remote villages where the villages touched by Ebola were self-quarantined according to ancient traditions of dealing with plagues. No one went in and out, and the surrounding communities brought them food. The caregivers washed themselves and their clothes rapidly and frequently after each contact with the patient, just using simple soap and water. Very few ever got sick, and the disease was controlled in a few months.

Here in Liberia, everyone is excited about the millions of US dollars being poured in to “fight Ebola,” and everyone wants a piece of the pie. A certain NGO out in rural Liberia quarantined a village, claiming they’d tested and found three cases. They applied for and received US$ 250,000 to fight Ebola in this village. They brought in a few sacks of rice and some chlorine. The villagers mobbed the trucks and carried off the plunder. And, miracle of miracles, not a single person died in the village.

Great effort at treating and controlling Ebola? Or pretending there’s Ebola in order to pocket some easy cash? I’ve never heard of a 0% fatality rate for Ebola, but you make the call.

NGO’s spending hundreds of thousands of dollars to level earth with heavy equipment over a month in order to build tent cities capable of isolating and treating Ebola, but then not even giving them IV fluids or food, so that the Ebola patients sneak out of the tents and cross the street looking for food.

Dozens if not hundreds of US$70,000 Land Cruisers are taking foreigners around town to hotels, bars, clubs, and fancy guest houses so they can feel comfortable while they fight Ebola, and yet they can’t even collect the dead bodies that could expose so many more!

We’ve had bodies left for up to three days. Others have stayed in the open for up to five days before being collected. Patients are often turned away from the Ebola centers, and some have even refused to take anyone who doesn’t come in an ambulance. How many of the poor in West Point slum can afford an ambulance, even if there were enough available to take them?” UnQuote

I’m concerned for the 3,000 US troops who are being deployed to the Ebola “hot zone.” What are the odds of a protocol breach among the troops, and will we bring troopers home if they get infected? If so, how will that play out?

I’d guess that some of the old biological warfare precautions could come into play, but we never had to test those procedures.

Has it been proven beyond a doubt that Ebola is NOT transmitted through the air?

Remember, in “The Hot Zone”, several strains of Ebola went through groups of research monkeys like wildfire not only in Africa, but also in a lab here in the US. Most of those monkeys were in individual cages, and all of the workers followed Level IV protocols.

The number of health care workers who have contracted/died from Ebola in Africa so far this year certainly seems to indicate that perhaps this strain of Ebola can be transmitted in more than one way.

The first rule of science is (or should be) “Never say never”.

TrooperJohnSmith | October 13, 2014 at 12:54 pm

As long as Dr. Friedan crosses his political T’s and dots his political I’s, The Most Transparent Administration In The History of the World® will have his back.

Sadly, I think Ebola will step across any of 0’s red lines and, unlike the milquetoast GOP, will not be deterred by 0’s invective, bluster or taunts. Perhaps 0bama could “suit up” and go reason with the virus, apologizing for the terrible way in which America battled the Spanish Flu virus in 1919 or the merciless way in which America went after the poor little AIDS virus in the 1980s. That should help, you think?

Henry Hawkins | October 13, 2014 at 1:34 pm

The CDC, as regards the TX nurse transmission case, has leaped to the conclusion that she must have violated protocols in some way and are investigating how that may have occurred.

This is pseudoscience at its worst – starting with the conclusion and then seeking out evidence to support it.

The nurse cannot recall any such breach of protocols, and unless she’s as evil as a serial killer, it is difficult to believe she’d lie about something so important. She may have done so and doesn’t recall it. Or…. she may have followed protocols exactly with no breach, meaning the problem might be in the protocols, no?

But bad protocols would reflect badly on the CDC and Obama, so that can’t possibly be the case, right?

Here’s the problem – when you seek an answer for some mystery and believe you’ve found it, you quit looking.

The CDC needs to review the entire set of prophylactic protocols protecting against the transmission of the Ebola virus until they have it nailed down. Choosing the least politically damaging possibility – that the RN screwed up – is the most mindnumbingly stupid and irresponsible course of action I’ve ever seen in response to something so deadly as the Ebola virus.

I want to return to the days when to say one’s political opponents are ‘killing people’ was readily seen as hyperbole, an exaggeration to indicate how important an issue was to the utterer. This Obama administration is actually, literally killing people: Fast & Furious, Benghazi, gun-free zones, Ebola, etc.

George Soros is killing thousands of innocent Africans because he didn’t pay to find a vaccine.

Howie Carr just had a good one: Rename Air Force One the “Ebola Gay.”

Each new infection is seen as a “black swan” event by our government experts. Dr. obama says take a blue pill or a red pill. When they say we are in good hands, why do i feel like they are checking my prostate??

    Henry Hawkins in reply to dunce1239. | October 14, 2014 at 11:05 am

    The judges have deemed you a racist for associating the color black with a negative event. The accepted term since 2008 is ‘white crow’.

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