Ebola

[deuce]

What I don't get is why are they moving these patients around the country? Last I read they are being moved to MD & ATL? To me that seems to make this worse with potential to spread this disease to other states unnecessarily. I would believe we can treat these infections here just as well as they can in these other places. I might be missing some key details, but seems crazy to move these patients and potentially expose others.

The CDC is moving them in a jet designed to carry infectious passengers. Emory University, and the hospital that is associated with it, is in ATL is nearby to the CDC.

 

[Rhyno]

They're all going to great hospitals though, most (I believe) with research ties.

So they're trying to cure the people, and research it at the same time.

It makes sense.

 

[mikeg_74]

The CDC is moving them in a jet designed to carry infectious passengers. Emory University, and the hospital that is associated with it, is in ATL is nearby to the CDC.

I understand that, but why move them? seems treatment can be obtained where they are without the risk of infecting others pre and post transports. I get the CDC has a special jet, but up until now the CDC has not exactly inspired confidence with what they can prevent with this disease.

 

[HBirdman80]

What I don't get is why are they moving these patients around the country? Last I read they are being moved to MD & ATL? To me that seems to make this worse with potential to spread this disease to other states unnecessarily. I would believe we can treat these infections here just as well as they can in these other places. I might be missing some key details, but seems crazy to move these patients and potentially expose others.

There are four hospitals in the country that have specialized isolation units designed for this very purpose (in GA, MD, KS, and MT). The patients are being moved because TX has shown it is not capable of handling this properly. Also, those four special hospitals also have the best doctors for treatment and ergo best chance of survivability.

 

[HBirdman80]

I see it differently. We have tremendous capacity to know where planes and people originate from and where they have been. We should be able to exclude all of the above from entry with relative ease.

The harder question is the gray areas - places that have had incidents (eg, Spain) but aren't in full fledge outbreak mode and people who may have been on flights with other people from banned areas (ie. passenger A sits next to a passenger B say Germany to US and person B had just flown from west Africa to Germany). So a flight ban (and other measures) would reduce the risk tremendously but not be full proof. And who knows, maybe that's good enough for now, maybe we just need to buy the CDC some time to take a breath and get their act together.

There is no risk of transmission in the scenario you posed because that's not how the virus spreads.

CDC is doing a fine job and pretty clearly has their act together. What they are doing is underestimating the lack of scientific knowledge in the general public. They are acting like genius scientists, not Joe the Plumber. What they need is a publicist stat.

 

[deuce]

I understand that, but why move them? seems treatment can be obtained where they are without the risk of infecting others pre and post transports. I get the CDC has a special jet, but up until now the CDC has not exactly inspired confidence with what they can prevent with this disease.

Why move them? Because the risk of infecting more people is greater by leaving them in Texas than by moving them. That's why they're moving them. The CDC has been transporting infected individuals to the US for treatment, and there have been zero problems. I think they more than have their act together. Not sure why people think the CDC has failed to do its job and hasn't inspired confidence. From where I sit, I think they're doing a good job. Do they have to step up their game because others have dropped the ball? Yep, looks that way ... but that doesn't mean the CDC has failed.

It's amazing what people take for granted as long as things are running smoothly. An agency works at 99.999% proficiency and nary a peep, but that 0.001% occurs and suddenly the agency is full of deadbeats (yes, this is hyperbole, but dang if that isn't the sentiment seemingly spreading across the internet along with this unjustified panic that Ebola is hiding behind every bush and tree).

 

[Rhyno]

There is no risk of transmission in the scenario you posed because that's not how the virus spreads.

CDC is doing a fine job and pretty clearly has their act together. What they are doing is underestimating the lack of scientific knowledge in the general public. They are acting like genius scientists, not Joe the Plumber. What they need is a publicist stat.

Hard to argue with that, though the latest case is a bit of a head scratcher.

 

[Rhyno]

The CDC director is getting the blame right now in a house hearing.

It's A scapegoat. And may cause more harm than good. Hosting a hearing during the middle of a crisis.... Hmmm

 

[HBirdman80]

Hard to argue with that, though the latest case is a bit of a head scratcher.

Not really, it's the CDC again forgetting the general level of lack of understanding in the public.

100.5 fever is the lowest of the low for Ebola. We quote normal body temp as 98.6 but few people actually have 98.6 temp (check yourself, I'm usually around 98 or 97.8). So looking for someone with a 100.5 fever is going to return some false positives (people who just have high body temp and are fighting off some other infection which we do all the time) but should not return any false negatives.

Scientifically the CDC was dead on. What they forgot was the mass hysteria it would cause which is why they shouldn't have done it. The risk of people reacting crazily is far higher than risk of transmission.

(Note also there are questions about federal authority, states rights, and the scope of the CDC that I'm skipping here.)

 

[mikeg_74]

The CDC director is getting the blame right now in a house hearing.

It's A scapegoat. And may cause more harm than good. Hosting a hearing during the middle of a crisis.... Hmmm

I agree and disagree. From the very start it's evident that the CDC was less than forthcoming regarding information and subsequent training so nurses and hospitals were able to deal infected patients via the correct protocols. Nurses unions are going on record that they were ill equipped to diagnose and treat.

on the other hand there does seem to be a better time and place to have a high level finger pointing session.

 

[tequila4kapp]

There is no risk of transmission in the scenario you posed because that's not how the virus spreads.

CDC is doing a fine job and pretty clearly has their act together. What they are doing is underestimating the lack of scientific knowledge in the general public. They are acting like genius scientists, not Joe the Plumber. What they need is a publicist stat.

Obviously, other elements to the hypothetical were assumed. I didn't want to write a novel.

Is the disease transmittable with an "elevated body temperature" of 99.5? Do you trust the science enough that you would have unprotected physical contact with that person because a fever starts at 100.4? Do you think everyone else should? This is not an abstract science experiment in a lab. There are many other considerations at play and they are just as legitimate as the underlying science.

 

[HBirdman80]

I agree and disagree. From the very start it's evident that the CDC was less than forthcoming regarding information and subsequent training so nurses and hospitals were able to deal infected patients via the correct protocols. Nurses unions are going on record that they were ill equipped to diagnose and treat.

on the other hand there does seem to be a better time and place to have a high level finger pointing session.

Whose job is it to ensure hospitals (run by charities and private companies) are properly equipped, staffed, trained, and supplied?

Not the CDC. It's state by state.

 

[mikeg_74]

Whose job is it to ensure hospitals (run by charities and private companies) are properly equipped, staffed, trained, and supplied?

Not the CDC. It's state by state.

yes the CDC isn't in the "train the hospitals of the nation business" but they are the highest authority in our country when it comes to infectious diseases, diagnosis, & treatments. They at the very least failed with timely notification and supporting any questions/training needed to make sure all of the hospitals could deal with this properly. They failed to elevate the level of concern/awareness the hospitals should have been under.

 

[tequila4kapp]

Whose job is it to ensure hospitals (run by charities and private companies) are properly equipped, staffed, trained, and supplied?

Not the CDC. It's state by state.

This is a fair point and I'll say that I personally have probably been a little loose using "CDC" as a catch all. Unfortunately, blame goes to the top. We saw this with Katrina also - local and state agency flub-ups got lumped together with Fed mistakes and it all morphed into a Fed govt failure.

 

[deuce]

yes the CDC isn't in the "train the hospitals of the nation business" but they are the highest authority in our country when it comes to infectious diseases, diagnosis, & treatments. They at the very least failed with timely notification and supporting any questions/training needed to make sure all of the hospitals could deal with this properly. They failed to elevate the level of concern/awareness the hospitals should have been under.

Untrue. The CDC is pretty much an open book in regards to protocols, procedures, and guidelines most of which can be found on their webpage.

 

[mikeg_74]

Untrue. The CDC is pretty much an open book in regards to protocols, procedures, and guidelines most of which can be found on their webpage.

I know that, but this doesn't strike me as an instance where there is an outbreak or potential for an outbreak and the CDC's stance is "refer to our website on how to treat"

 

[deuce]

I know that, but this doesn't strike me as an instance where there is an outbreak or potential for an outbreak and the CDC's stance is "refer to our website on how to treat"

No, the CDC has provided resources indefinitely for hospitals to ensure that they have proper protocols in place BEFORE the need arises. Hospitals can't be in the business of being reactionary. Trying to throw together infectious disease protocols a month or two ahead of time won't work. It's not possible. The scenario has always existed that someone could come into the US infected with a viral hemorrhagic disease, and hospitals should have had protocols in place already. Especially in cities that serve as major hubs for international traffic.

Asking the CDC to monitor each and every hospital to ensure that they are competent, is unreasonable. Also, asking the CDC to beat the warning drum constantly, is also unreasonable IMO. Eventually the drum gets tuned out. The CDC reports weekly (MMWR) on relevant issues, and they have published several times on Ebola this year. Any infectious disease doc worth his/her weight in salt should be able to figure out if their hospital has proper protocols in place. I'm guessing the ID docs at Texas Presbyterian are not worth their weight in salt.

ETA: I would not be surprised if we see states finally get on point and designate a hospital within the state as capable of battling exotic diseases, and then sending the resources to accomplish that. A handful of states already have this in place, and I'm sure a hospital such as Baylor University Medical Center could easily serve in that capacity if so tasked. This way, you don't bankrupt each and every hospital, and you limit the amount of oversight that may be necessary to ensure that the hospitals are capable of doing what they are tasked to do.

 

[mikeg_74]

No, the CDC has provided resources indefinitely for hospitals to ensure that they have proper protocols in place BEFORE the need arises. Hospitals can't be in the business of being reactionary. Trying to throw together infectious disease protocols a month or two ahead of time won't work. It's not possible. The scenario has always existed that someone could come into the US infected with a viral hemorrhagic disease, and hospitals should have had protocols in place already. Especially in cities that serve as major hubs for international traffic.

Asking the CDC to monitor each and every hospital to ensure that they are competent, is unreasonable. Also, asking the CDC to beat the warning drum constantly, is also unreasonable IMO. Eventually the drum gets tuned out. The CDC reports weekly (MMWR) on relevant issues, and they have published several times on Ebola this year. Any infectious disease doc worth his/her weight in salt should be able to figure out if their hospital has proper protocols in place. I'm guessing the ID docs at Texas Presbyterian are not worth their weight in salt.

Again i'm not saying the CDC should go around and make sure people are up to speed or trained. My point is that in this instance based on all the information that has come out, the nurses were not given the proper information on how to treat based on the nurses unions comments & others. The CDC simply gave broad instructions and "you can find more on our website" doesn't strike me as the right way to help a hospital that is clearly dealing with a deadly case.

as far as Texas Presbyterian ID docs not worth their weight in salt, that is purely conjecture on your part bc I doubt you were there when the patient was admitted. The patient originally came in bc of a high fever & Ebola was not on the "radar" as a potential reason. He was treated by a regular physician in the ER and released. It was not until his subsequent visit that the ID docs were involved & by that time it was too late.

 

[Rhyno]

The two nurses in question didn't know until after they treated him.

We can't assume everyone that comes in has an infectious disease, that's expensive.

After that they should have been monitored, and they were.

 

[deuce]

Again i'm not saying the CDC should go around and make sure people are up to speed or trained. My point is that in this instance based on all the information that has come out, the nurses were not given the proper information on how to treat based on the nurses unions comments & others. The CDC simply gave broad instructions and "you can find more on our website" doesn't strike me as the right way to help a hospital that is clearly dealing with a deadly case.

as far as Texas Presbyterian ID docs not worth their weight in salt, that is purely conjecture on your part bc I doubt you were there when the patient was admitted. The patient originally came in bc of a high fever & Ebola was not on the "radar" as a potential reason. He was treated by a regular physician in the ER and released. It was not until his subsequent visit that the ID docs were involved & by that time it was too late.

Ebola should definitely have been on the radar at that ER visit. From all accounts I've read, Duncan went into the ER and said "I'm running a fever and I have been to Liberia." that is all the patient history that was needed to start a diagnosis for Ebola. It wasn't done. The hospital failed.

If the nurses feel they have been improperly trained, I'm not sure how that is the CDC's fault. Again, the CDC provides the information, it's up to the respective hospitals to use it and implement it. It's also a bit more accessible than the website. They are a phone call away, and I'm sure available for hands-on instruction, but again shouldn't be necessary. For example, the NY State Department is now going around and working with NY hospitals on the proper training in the use of hazmat gear. If it's any consolation, the CDC is indeed now putting together teams to be immediately dispatched when a case of Ebola has been confirmed. It shouldn't be necessary (what's the point of State Health Departments otherwise), but obviously there is a need for it.

 

[Rhyno]

On a side note, I know someone in the peace core that is currently in Zambia, her parents are understandably very scared.

 

[HBirdman80]

Ebola should definitely have been on the radar at that ER visit. From all accounts I've read, Duncan went into the ER and said "I'm running a fever and I have been to Liberia." that is all the patient history that was needed to start a diagnosis for Ebola. It wasn't done. The hospital failed.

If the nurses feel they have been improperly trained, I'm not sure how that is the CDC's fault. Again, the CDC provides the information, it's up to the respective hospitals to use it and implement it. If it's any consolation, the CDC is indeed now putting together teams to be immediately dispatched when a case of Ebola has been confirmed. It shouldn't be necessary, but obviously there is a need for it.

This. Ebola was on the radar. The hospital f-ed it up.

Another thing I find really interesting about this is it has revealed a general misunderstanding of how our systems work, where the separation of powers between federal and state occurs, and how the healthcare system fits in.

Im curious now as to whether Texas will finally break down, declare emergency, and ask for federal help. Also whether the PHSCC will be mobilized and forcibly take some control (most people don't realize that the Surgeon General is actually a vice admiral in rank and commands the sixth of the seven uniformed services of the United States).

 

[wadesworld]

whether the PHSCC will be mobilized and forcibly take some control (most people don't realize that the Surgeon General is actually a vice admiral in rank and commands the sixth of the seven uniformed services of the United States).

We don't have a surgeon general, as far as I know. The current nominee is a 36-year-old and congress is understandably questioning whether he's qualified.

 

[adwillingham]

We don't have a surgeon general, as far as I know. The current nominee is a 36-year-old and congress is understandably questioning whether he's qualified.[/COLOR]

The current Acting Surgeon General is Rear Admiral Boris Lushniak, who was named to the position following Regina Benjamin's resignation on July 16, 2013.

In doing a quick search, it appears that it is quite common to have an Acting Surgeon General for period of a year plus between having confirmed nominees...regardless, someone is doing the job.

 

[deuce]

We don't have a surgeon general, as far as I know. The current nominee is a 36-year-old and congress is understandably questioning whether he's qualified.[/COLOR]

The current Acting Surgeon General is Rear Admiral Boris Lushniak, who was named to the position following Regina Benjamin's resignation on July 16, 2013.

I think we take the Surgeon General for granted and predominantly see it as a figurehead. I think Congress and the President do as well. However, if a bioterrorism plot ever happens on our doorstep, he is more than likely going to be a critical figure. Nominating, and approving, a good candidate should be a priority at this juncture. Will be interesting to see what happens on this front.