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

The only time in my life I wrecked a motorcycle was the only time in my life I wore a helmet. (Just outside the I 5 tunnel at sharp curve near China Town going towards Burbank for those of you who know the curve. 50 mph right into the cement dividing wall/fence. Took out 20 feet of the fence with my chest and throat but miraculously without a drop of blood or broken bone.) The helmet protected my head but caused me to crash. It is possible the PPE suits are giving a false sence of protection and or are causing exposure at the disrobe point. That or this virus is being aerosolized during decontam and a few particles are making it past the filters.

Jesse the Rev Jackson and that Judge should be arrested and jailed for gross reckless endangerment. Whether they get Ebola or not. Exposing themselves to make a point risks exposing others. These type people are my biggest fear of it getting loose here and elsewhere.

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.

I wonder at the way Frieden talked about the dialysis and intubation.  I personally think that's where the breakdown happened along with using a face shield and not a fully contained air supply.  I'm thinking that the hookup/disconnection process for the two procedures allows for the virus or some of it anyway to become airborne enough to be breathed in by those only with the face shields.

BTW, now they are saying this hospital is ill prepared and needs training but when they first got Duncan they had bragged about just having finished ebola training and being ebola certified.  Wonder what that training was and what it means to be 'ebola certified' considering all the blunders?

Sorry GN I put the link to the edited version which I was using to demonstrate point I was making at the time. Whole Press Conference on youtube. Watched it on live TV today in UK, kids were like " oh mum not something about emolia....as they call it...they are young.

Pestilence : Press Conference of Second Confirmed…: http://youtu.be/hpZEhUMHO2AhpZEhUMHO2A


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. Despite this in the videos I have seen they start the spraying immediatley as the workers begin disrobing. Without giving it time to exert its antimicrobial properties, this fluid could simply be mechanically washing any virus downward concentrating it to glove region.

Quickly looked on CDC website they are very vague saying quote:
One study reported that 25 different viruses were inactivated in 10 minutes with 200 ppm available chlorine.

Also found the following there.

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 ). However, a few germs are moderately chlorine-tolerant. The table below shows the approximate disinfection times for these germs in chlorinated water.

Chlorine Disinfection Timetable

E. coli 0157:H7 (Bacterium) less than 1 minute.

Hepatitis A (Virus)     approximately 16 minutes.

Giardia (Parasite)     approximately 45 minutes


Notes:
1 mg/L (1ppm) free chlorine at pH 7.5 and 25° C (77° F)
Disinfection times would be expected to be longer in the presence of a chlorine stabilizer such as cyanuric acid.


Anyway will post link as it shows all the antimicrobial disinfectants and what they are and aren't effective against.

http://www.cdc.gov/hicpac/disinfection_sterilization/6_0disinfection.html

Anyway just thinking.

" free ticket for ebola"....  who doesnt want such.. i also thought what can one do with the equipment after doing dialysis to one patient with ebola.... it is pretty hard to cremate it i presume... 

Don't they have CCTV in isolation units? They always do in the movies. Perhaps they could look back and see where a possible contamination occurred. 

kiwimum.. i really do not think it was a very obvious thing  ... so that you can see it on camera.... i do think it had something to do with the sterilisation procedure afterwards... a small mistake there and it is done...

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 ).

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.....

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

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

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.

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

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!

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!

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!

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.

Thanks Miker from the beautiful country of Canada! And welcome to avianflutalk.com You have some interesting points.

DALLAS — The health care worker who tested positive for Ebola has a dog, but the mayor of Dallas says unlike in a recent Spanish case, the dog will be kept safe for eventual reunion with its owner.

Mayor Mike Rawlings told USA TODAY that the dog remained in the health care worker's apartment when she was hospitalized and will soon be sent to a new location to await its owner's recovery.

There are no plans to euthanize the dog, he said.

"This was a new twist," Rawlings said. "The dog's very important to the patient and we want it to be safe."

There were no immediate details on the name or type of dog.

More:

http://www.google.com/gwt/x?u=http://www.usatoday.com/story/news/2014/10/12/dallas-ebola-health-worker-dog/17159727/&ei=oFQ7VNf4F6SUsQfp_ICYCA&wsc=yh

Me too, Yay for dogs!

Albert wrote: If protocol was breached while taking off the suit, that only supports that the virus can survive outside the host on various surfaces/suits for awhile and perhaps an hour or so.  That's a pretty good secondary mode.

I just posted the other day that Ebola can survive on surfaces for up to 6 days under perfect conditions. They didn't define "perfect conditions".