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#271958 - 10/01/14 08:08 PM Re: EBOV versus Pandemic Flu Preparedness [Re: AKSAR]
MartinFocazio Offline

Pooh-Bah

Registered: 01/21/03
Posts: 2153
Loc: Bucks County PA
Thanks, excellent information.

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#271960 - 10/01/14 09:11 PM Re: EBOV versus Pandemic Flu Preparedness [Re: Meadowlark]
desolation Offline
Journeyman

Registered: 01/21/10
Posts: 60
Loc: Sonoma County, CA
Quote:
Several weeks ago, National Nurses United began surveying registered nurses across the U.S. about emergency preparedness. In preliminary results from more than 400 RNs in more than two dozen states released today:

More than 60 percent of RNs say their hospital is not prepared for the Ebola virus.
80 percent say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
85 percent say their hospital has not provided education on Ebola
30 percent say their hospital has insufficient supplies of eye protection (face shields or side shields with goggles) and fluid resistant gowns
65 percent say their hospital fails to reduce the number of patients they must care for to accommodate caring for an “isolation” patient


Source

Looks like we've got some work to do.

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#271962 - 10/02/14 03:04 AM Re: EBOV versus Pandemic Flu Preparedness [Re: bws48]
bws48 Offline
Old Hand

Registered: 08/18/07
Posts: 831
Loc: Anne Arundel County, Maryland
I've felt that I might have been a bit paranoid about my fears of the mixing bowl at immigration at JFK Terminal 1(see earlier posts). But the travel odyssey through major airports of our first US case (see: http://www.wtop.com/41/3713787/Man-with-Ebola-flew-through-DC-airport) makes me feel justified.

In this his case, the wisdom is that "no symptoms, no contagion." Assuming that to be true, it was by pure, dumb luck.

The number of potential exposures if he had been "contagious" and made the same trip through the same airports, with the wait times describe in the article, is astounding. The numbers of people exposed, and then exposed by them simply "blow up" as my mathematically inclined friends say.

IMO, the idea, as is being implemented now, of tracing all contacts and isolating them, would have been both mathematically and practically impossible to implement had this, quite possibly, been the case.

I think that the boarding of international airlines need to be our first line of defense: I don't think we can afford to wait until a passenger has passed through the system of several airports and catch them at the end of the journey and find they are (possibly) contagious. Passengers need to be screened at the start, and if there is any possibility of exposure, denied boarding until medically cleared: even if it takes the 21 days incubation period to be sure.
_________________________
"Better is the enemy of good enough."

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#271964 - 10/02/14 01:19 PM Re: EBOV versus Pandemic Flu Preparedness [Re: bws48]
JerryFountain Offline
Addict

Registered: 12/06/07
Posts: 418
Loc: St. Petersburg, Florida
Originally Posted By: bws48
Assuming that to be true, it was by pure, dumb luck.

The number of potential exposures if he had been "contagious" and made the same trip through the same airports, with the wait times describe in the article, is astounding. The numbers of people exposed, and then exposed by them simply "blow up" as my mathematically inclined friends say.

*******
I think that the boarding of international airlines need to be our first line of defense: I don't think we can afford to wait until a passenger has passed through the system of several airports and catch them at the end of the journey and find they are (possibly) contagious. Passengers need to be screened at the start, and if there is any possibility of exposure, denied boarding until medically cleared: even if it takes the 21 days incubation period to be sure.


Dumb luck is always important, but boarding precautions have already been instituted. Please see the Exit Screening Protocol at http://wwwnc.cdc.gov/travel/page/ebola-outbreak-communication-resources that has been sent to (and according to several sources implemented by) the governments and airlines involved.

Temperatures are being taken before boarding and passengers are refused boarding. Luck has nothing to do with it. There is no evidence reported that the virus is airborne, so even if there were contagion, the number of possible contacts is still manageable.

Respectfully,

Jerry


Edited by JerryFountain (10/02/14 01:20 PM)
Edit Reason: clarity

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#271965 - 10/02/14 03:26 PM Re: EBOV versus Pandemic Flu Preparedness [Re: JerryFountain]
bws48 Offline
Old Hand

Registered: 08/18/07
Posts: 831
Loc: Anne Arundel County, Maryland
Good information---thank you!

In theory, the procedures are there, or at least available to be put into operation.

So, as I understand it, the Texas patient should have been given a "conditional release card" which should then have been given to the Doctor in the ER that he saw when symptoms arose. I wonder if that is what happened?
_________________________
"Better is the enemy of good enough."

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#271966 - 10/02/14 04:11 PM Re: EBOV versus Pandemic Flu Preparedness [Re: bws48]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: bws48
So, as I understand it, the Texas patient should have been given a "conditional release card" ...

It's hard to be sure without knowing his exact status when he was at the hospital the first time, but I don't think that is correct here.

The doctor examining him apparently was not told by the screening staff that Mr Duncan had just come from West Africa. If that info had been passed along, the doctor should have gotten a more detailed history. Mr Duncan had recently helped take the gravely ill daughter of his landlord in Monrovia to the hospital (a sad story in itself). The daughter died soon after.

With that history and the onset of his own symptoms, based on the CDC's protocol, I think immediate isolation would have been the prudent course of action. Severe disease comes on quickly once symptoms appear, and he was already starting to show symptoms and people become infectious when symptoms show, so I think a conditional release to send him home at that point would not be justifiable. Especially since he was staying with a family with children (not in the protocol, but we always try to protect children, right?)


Edited by Arney (10/02/14 05:27 PM)

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#271967 - 10/02/14 04:21 PM Re: EBOV versus Pandemic Flu Preparedness [Re: bws48]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: bws48
The number of potential exposures if he had been "contagious" and made the same trip through the same airports...is astounding.

It's true that it is "dumb luck" that Mr Duncan didn't become symptomatic during his long trip to Texas, but even if he did, I think we need to be more careful about how we define "exposures".

I would agree with your point if Ebola were a truly airborne disease like measles, where sitting on the same plane or walking through the same airport terminal could expose you to the disease, but Ebola requires contact with bodily fluids, which dramatically reduces the number of people directly at risk.

If Mr Duncan became feverish and had body aches on the plane and I was sitting in the row behind him, say, the risk appears very low. If he was vomiting or coughing on the plane and possibly creating infected aerosols, that changes the risk profile.

That said, out of prudence, I'm sure the authorities are reaching out to lower risk or contacts-of-contacts to alert them to self-monitor for a few weeks, just in case. That's what the Texas authorities seem to be doing. I'm not sure what the airlines are doing at this point.

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#271968 - 10/02/14 04:26 PM Re: EBOV versus Pandemic Flu Preparedness [Re: Arney]
Russ Offline
Geezer

Registered: 06/02/06
Posts: 5297
Loc: SOCAL
It would also have helped if he had been direct and unambiguous on his first hospital visit. Something like, "I was recently in Liberia and came in direct contact with an Ebola victim who died." That may have gotten a different response from the hospital staff. Woulda, shoulda, dint...

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#271969 - 10/02/14 04:33 PM Re: EBOV versus Pandemic Flu Preparedness [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
The thought just occurred to me--Mr Duncan was quite ill when the ambulance was called and he was vomiting. What happened to their garbage? I assume there was Ebola-infected items in their trash.

Edit: Just saw this article. Apparently nothing has happened because of the risk of the waste and no waste disposal company wants to deal with it. But an appropriate contractor is supposed to be out this afternoon.

So, just like with hospitals, dealing with infected or even just potentially infected materials will be a challenge whenever Ebola makes an appearance here. I wonder if potential contacts are also facing a similar problem with garbage removal, even if they are all symptom-free?


Edited by Arney (10/02/14 10:08 PM)
Edit Reason: Found new info

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#271973 - 10/02/14 05:44 PM Re: EBOV versus Pandemic Flu Preparedness [Re: Meadowlark]
JerryFountain Offline
Addict

Registered: 12/06/07
Posts: 418
Loc: St. Petersburg, Florida
Arney,
"It's true that it is "dumb luck" that Mr Duncan didn't become symptomatic during his long trip to Texas, but even if he did, I think we need to be more careful about how we define "exposures"."

On the same CDC page shown above are the instructions given to the worlds airlines for responding to the age of Ebola. All the airline pilots I know (and therefore probably their flight crews as well) have been given this information. The response would greatly reduce the risk to both crew and passengers.

Respectfully,

Jerry

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