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Online Discussion: Tracking new emerging diseases and the next pandemic

2nd person in U.S. tests positive for Ebola

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Jen147 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 12:17pm
Originally posted by Germ Nerdier Germ Nerdier wrote:

Oneflu..

Right! If she can remember touching her face, then it was a conscious act... otherwise it would be impossible to remember. No one would consciously touch an Ebola laden glove to their face.
 
One other option might be as soon as she realized she'd done it she stopped cold & thought oh my gosh what did I just do.  Then pulled a Duncan... went on about her life praying that that one touch wouldn't matter but knowing in the back of her mind that any day now she might show symptoms.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 12:21pm
Originally posted by Hazelpad Hazelpad wrote:

Still not convinced about chlorine spray, you need to let the stuff have time to work before it inactivates the virus. Different bacteria and virus need different exposure times to the sterilisating agent ( see CDC guidelines below).   Importantly the process is not instantaneous, I.e. spray hits, virus presumed immediately dead, that's totally wrong.
 
...
 

Free chlorine kills many pathogens such as E. coli 0157: H7 in less than a minute if it is maintained at proper disinfection levels (1-3 parts per million [ppm] free chlorine) and under ideal water conditions (pH at 7.5 or less ).
 
Really good points Hazel, I had not considered this.  I just assumed watching them spray each other down & spraying paths on the ground that it was instant.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CoderOne Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 12:27pm
That's a pretty big hospital to be shutting down an ER. This whole Dallas outbreak is starting to smell like a dead fish.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debg Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 12:40pm
Remember when we were first discussing MERS on here and all of the those first patients were getting dialysis? This is making think the same thing with the Dallas case....although since it is obviously extremely easy to catch, (sorry CDC), there are probably multiple ways she could have gotten infected. Whatever the transmission was, this is terrifying and if those flights don't get stopped, I'm afraid we are going to be seeing many, many more.....Angry

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Phylica1 Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 12:42pm
The nurse was at work till two days ago , I believe that's what they said. Friday was when the hospital knew the nurse had a fever. Therefore, they made no announcement of another possible case till today. Who was the nurse around at work?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 1:17pm
I personally believe a larger part of this cluster will emerge this next week in upwards of 3 + new cases.   "Clusters" usually always involve healthcare AND family.  

I'm not ruling out the GF Louise Troh and/or family being symptomatic right now.   If i was a betting man, I would probably put a small wager on it that they are in fact now showing signs.   Get ready for another announcement, is my personal opinion.   As long as they handle/contain these new ones correctly, then they can minimize the contact tracing and contain it.  If we get a rogue case completely outside the contact watch list, well then they better call in Doctors without Borders (lol) and prepare for a large one -  defcon 5
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 1:59pm
Yeah and I'm not so sure I believe the Mexican report as being bogus. Neither side of that is confirmed to my satisfaction. And if that Mexican guy caught it in Dallas as stated then from whom? Of course this is only speculation but I'm holding my breath for now.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 2:10pm
Meanwhile the Hazmat team clean the first infected healthcare worker's home.
http://washingtonexaminer.com/hazmat-team-arrives-to-clean-ebola-patients-home/article/feed/2172427
Absence of proof is not proof of absence.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote waterboy Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 2:49pm
Relax albert.Your right though
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Schrödinger's Cat Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 2:52pm
Originally posted by onefluover onefluover wrote:

Yeah and I'm not so sure I believe the Mexican report as being bogus. Neither side of that is confirmed to my satisfaction. And if that Mexican guy caught it in Dallas as stated then from whom? Of course this is only speculation but I'm holding my breath for now.


I'm with you Onefluover, seems one to keep an eye on.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 3:05pm
Originally posted by Phylica1 Phylica1 wrote:

The nurse was at work till two days ago , I believe that's what they said. Friday was when the hospital knew the nurse had a fever. Therefore, they made no announcement of another possible case till today. Who was the nurse around at work?
 
I read she was self checking herself for fever.  When she showed one she self quarantined herself at home then went to the hospital where she was isolated.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Hazelpad Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 3:39pm
So sorry if some have you have read the full question and answer interview posted on the CDC website ( link at bottom of post).   However for those who havent I picked out 4 questions TOM FRIEDEN answered below.

Firstly about why the HCW and not family have caught it. Second has the HCW any idea when she got exposed. Next a bit about dialysis in Ebola patients, and last about contact tracing of this new case:

Press Briefing Transcript
CDC update on Dallas Ebola Response, 10-12-2014

We will now take questions. We will start in the room and then go to the phone.


1: JEFFREY WISE: Yes. Can you speak to how a health care worker using high precautions apparently caught the Ebola when people who had close contact in that apartment several days did not, and do you have any plans to transfer this new case to one of the specialty hospitals in Atlanta or Nebraska, someplace like that.


TOM FRIEDEN: With regard to the first question, when patients have Ebola, they become progressively infectious the sicker they become, because the amount of virus in their body and in their secretions increases, and people who had contact with this individual, the index patient, in Dallas prior to his isolation are not yet out of their 21 day exposure period, so we're not out of the woods yet with potential additional cases among contacts before isolation. But medical procedures involve dealing with blood, dealing with body fluids, diarrhea, vomit, other things that may have very large quantities of virus, and that's why the personal protective equipment and protocols are so important because as someone gets sicker, they get more infectious also. We will look at all possibilities to ensure the safe care of patients to the greatest extent possible. Next question.


2: STEVE GEHLBACH: Steve Gelbach with WSB TV in Atlanta. This health care worker had multiple contacts with the original patient. In your interviews with her, has she been specifically isolated, a chance where this may have occurred where this breach you say in those interviews with her, talking about why you're investigating, where she's taking off the equipment or anything, why you're focusing on that part in your investigation?

TOM FRIEDEN: We have spoken with the health care worker and that individual has not been able to identify a specific breach. We look at every single interaction, what was the nature of the interaction, look at any information we can gather. I was not mentioning taking on or off or procedures related to the investigation but as a general rule. These are the two areas where we see the greatest risk.

3: OPERATOR: Next question comes from Lisa Schnirring with CIDRAP.

LISA SCHNIRRING: Hi, thanks for making such great information available today. I'm wondering how common is it for people to be on dialysis or to be intubated during an Ebola infection, is that something you've seen in other patients treated in western countries? Just wondering how common that is and how often health care workers have had to deal with those situations. Thanks so much.

TOM FRIEDEN: Thank you. I don't know the details of the other patients cared for in other parts of the world, but I’m not familiar with any prior patient with Ebola who has undergone either intubation or dialysis. Certainly it would be very unusual if it has happened before. I do


So he also went on to say this case is the start of a whole new chain of contacts....I.e. The first chain was those with contact before he went into isolation on September 28th. This new chain was for those in contact with him after isolation, I.e. within the ICU.


TOM FRIEDEN: Thank you. So the 48 contacts identified were individual who had contact up to September 28th, the day he was isolated. This person was not exposed in that period of time. Those 48 as per everything we know are the only people he may have had contact with before he became isolated. In terms of the care in the hospital from the 28th to October 8th, the date he passed away, that's a period of 10, 11 days when there may have been additional contacts, given the fact this individual clearly was exposed then. That's what's being investigated now. So that first contact tracing period identified what we still believe is all 48 who were exposed, up to the time he was isolated. Now we're doing a new investigation given the diagnosis late last night of this individual of anyone else who may have been exposed once he was on what should have been effective isolation. In terms of the clinical status of the patient, i can say that our information is that as of at least some time back, she was showing only mild symptoms and low grade fever. Our team lead did interview her directly and will continue to monitor closely to ensure she gets the best possible care. We will take two more questions on the phone.

Full questions and answers at

http://www.cdc.gov/media/releases/2014/t1012-ebola-reponse-update.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Hazelpad Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 4:06pm
Oneflu .......We also autoclave everything before use. Nothing gets used unless the black lines on the tape turn black. Organic variables, bugs viruses can contaminate and influence results and bacteria medium, clinical waste get the treatment also. Autoclave waste stinks. Despite this, and using sterile techniques we still get contamination in our work, usually fungal, so nothing is fail safe.

What will you do if someone walks into your shop saying they want a tattoo of their beloved homeland which they were forced to leave the week before, then whip out national flag of Liberia.

You never know, fortune favours the prepared.

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Post Options Post Options   Thanks (1) Thanks(1)   Quote Elver Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 4:51pm
The CDC is pointing the finger at a "breach of protocol", but they don't know for sure.

Why wouldn't the nurse know how the protocol was breached? Perhaps there is something else going on here.

CDC News conference:
http://www.foxnews.com/health/2014/10/12/health-care-worker-at-dallas-hospital-tests-positive-for-ebola/

What if they're wrong about airborne transmissibility?


WHY SHOULD ANY NURSE OR DOCTOR PUT THEIR LIVES AT RISK IN THIS COUNTRY SIMPLY BECAUSE OUR PRESIDENT REFUSES TO SHUT DOWN FLIGHTS OUT OF W. AFRICA? THEY SHOULD USE MILITARY TRANPORT PLANES FOR MEDICAL WORKERS AND SUPPLIES, NOT PASSENGER JETS!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 6:59pm
Originally posted by Hazelpad Hazelpad wrote:

Oneflu .......We also autoclave everything before use. Nothing gets used unless the black lines on the tape turn black. Organic variables, bugs viruses can contaminate and influence results and bacteria medium, clinical waste get the treatment also. Autoclave waste stinks. Despite this, and using sterile techniques we still get contamination in our work, usually fungal, so nothing is fail safe.

What will you do if someone walks into your shop saying they want a tattoo of their beloved homeland which they were forced to leave the week before, then whip out national flag of Liberia.

You never know, fortune favours the prepared.



Good question Hazel. There are actually quite extensive rules and regulations governing tattooing in place in many states in the US, Oregon being the sixth State to regulate at the state level and the toughest of which I sat on the advisory committee that drew up those regulations that most of the other states reference in creating their own set of regs. This is of course past-tence as I sold my businesses in June of 012 but any prospective client must be free of any known or perceived infectious disease or bloodborne pathogen to receive work and that is not optional. Perceived is of course rather vague. Being from Liberia alone is not a disqualifier. I would take the persons temperature. If it was normal then I would proceeded. However, my contractors are self employed and in my view would have the right to decline based on the circumstances. I could neither legally order them to proceed nor would I ask them to and I will say that most would not. Whether they would be setting themselves up for a discrimination claim or not is not known by me. But at this point in the situation I personally would do it. At some point along in the future though, yes, I would decline.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote KiwiMum Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 7:23pm
Originally posted by Elver Elver wrote:

The CDC is pointing the finger at a "breach of protocol", but they don't know for sure.

WHY SHOULD ANY NURSE OR DOCTOR PUT THEIR LIVES AT RISK IN THIS COUNTRY SIMPLY BECAUSE OUR PRESIDENT REFUSES TO SHUT DOWN FLIGHTS OUT OF W. AFRICA? THEY SHOULD USE MILITARY TRANPORT PLANES FOR MEDICAL WORKERS AND SUPPLIES, NOT PASSENGER JETS!

Elver, your president doesn't have any authority to shut down flights out of W. Africa. He can close his borders and prevent flights from W. Africa - and anywhere else - landing in America but he can't stop them leaving Africa. He has no authority on anyone elses borders.

He has no power to prevent a whole plane load of Ebola victims flying straight into Paris for example, but he can stop them coming directly to America. The question is how far do you take it? Ban all direct flights coming from Africa, but what about the flights coming from London or Paris where a passenger could transit through?
If it is to be, it is up to me.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote miker Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 7:44pm
Originally posted by KiwiMum KiwiMum wrote:

Ban all direct flights coming from Africa, but what about the flights coming from London or Paris where a passenger could transit through?


Passports or other accepted forms of ID are required to enter the US, right ? How do you think they enforce the no fly lists ?

Yes, they can be faked, but same for terrorists, and I imagine they're at least reasonably good at keeping terrorists out through secret methods, and to the point of banning many people who should never be on no fly lists in the first place.


I think it's a reasonable assumption that many Ebola infected "runners" might not have the time or financial resources to find a way to sneak through the security checks. Yes, maybe a few percent might get through, but that's a great deal better than 25% or 100%.
:)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote FluMom Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 7:51pm
Ok so how long will it take to discover what protocol was breached? Has anyone asked this nurse? Hope they come up with answers soon the American people are really watching this one!
Always Be Prepared
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Post Options Post Options   Thanks (1) Thanks(1)   Quote miker Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 8:02pm
Originally posted by onefluover onefluover wrote:

"In Spain, a nursing assistant diagnosed with the virus after caring for an Ebola patient recalled touching her gloved hand to her face while removing equipment and health authorities there are looking at that as a possible cause of infection."
.....

I don't believe that. Inadvertent my patooty! If she remembered the contact to her face enough to later report it she one, would of remembered to NEVER do such a thing and two, if it did happen she would of remembered to immediately wash her face with a medical grade virucidal. Whether the report is true or not we've got problems Houston.


In the earliest news releases about the Spanish nurse/assistant, she said that she had no idea how she got infected. Those stories continued for 4-5 days, IIRC, then suddenly she claimed to remember touching her face with glove.

I think it's very unusual for someone to not remember something for several days, and then suddenly remember a lapse.

A theory was floated on another site that her employer or the authorities there may have asked her to report this bogus "memory" in the name of "panic" reduction, business as usual for the economy, and/or to save money on PPE purchases; motives that have been alleged for the CDC as well.


So far the trend has been to blame the nurses first, rather than doctors, public health officials, lax immigration or the use of BSL 2 PPE when BSL 4 is called for.

(1) Texas hospital/CDC first blamed admissions nurse for 1st visit screwup, then later changed the story at least twice, LOL.
(2) Blame the Spanish nurse.
(3) Blame this latest nurse. CDC's Frieden said "...there was a breach in protocol," confidently, before any investigation.

Frieden does not want to admit that the CDC protocol of BSL 2 is insufficient.
:)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote miker Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2014 at 8:07pm
Originally posted by FluMom FluMom wrote:

Ok so how long will it take to discover what protocol was breached? Has anyone asked this nurse? Hope they come up with answers soon the American people are really watching this one!


I have doubts that they will let this nurse talk publicly about protocol.

I'd bet everybody is filling out paperwork trying to cover their own asses of any blame.

Chances of a "tell all" document coming out might be higher if she dies, Of course a lawsuit or a movie deal might loosen lips of someone otherwise worried about losing their job, or being sued herself for breaching employer confidentiality.
:)
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