१३ ऑक्टोबर, २०१४
Nina Pham...
... only 26, is the nurse who caught ebola in Dallas and is — as I hear it — getting blamed for not following the protocol.
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८५ टिप्पण्या:
Of course they're going to blame her for not following the protocol. If officials were to remotely suggest that their Ebola containment protocol might not work 100%, there would be public uproar and a well-founded demand to do something more than post-hoc quarantine. Far and away the biggest reason that there has not been such a demand so far is that US health officials have insisted that our health protocols are so much better than those in (most of) Africa that an outbreak could never happen here.
Protocal? No wonder it didn't work!
She must have swallowed some Ebola juice when no one was looking.
It takes 21 days for this plague to incubate. A perfect strategy, a genius strategy, is to take the temperature of visitors, harmless visitors, from West African countries who are here to do no harm and not to go to western hospitals in the event they get flu-like symptoms after they arrive. This will help contain the virus in West Africa.
Nina Pham must be a conservative Republican jackass to have caused this to happen when it is impossible for it to happen.
Yeah, I do know how to spell "protocol." I don't know how that happened….
Michael's right. If people lose faith in the protocols the rubes might start getting restless.
"I don't know how that happened…."
I see what you did there.
CDC head backing away from "breach in protocol":
"I want to clarify something I said yesterday. I spoke about a breach in protocol, and that's what we speak about in public health when we're talking about what needs to happen. And our focus is to say would this protocol have prevented the infection, and we believe it would have. But some interpreted that as finding fault with the hospital or the health care worker. I'm sorry if that was the impression given. That was certainly not my intention. People on the front lines are really protecting all of us. People on the front lines are fighting Ebola. The enemy here is a virus, Ebola. It's not a person, it's not a country, it's not a place, it's not a hospital, it's a virus. It's a virus that's tough to fight. But together I’m confident that we will stop it. What we need to do is all take responsibility for improving the safety of those on the front lines. I feel awful that a health care worker became infected in the care of an Ebola patient. She was there trying to help the first patient survive, and now she has become infected. All of us have to work together to do whatever is possible to reduce the risk that any other health care worker becomes infected. "
http://www.cdc.gov/media/releases/2014/t1013-ebola-reponse-update.html
(elsewhere in the briefing, they talked about changes they were considering to procedures).
Sending American military to Africa to fight Ebola was for political show.
The CDC pronouncements on how to contain Ebola by allowing airline traffic with West Africa was for political purposes.
The minimalist airstrikes against ISIS in the ME are for political show.
All three acts will likely result in American deaths. ...Not that Obama much cares. Such is the price of fundamental change.
It occurred to me, after reading one too many mystery novels (Just finished the latest Agatha Raisin): If you wanted to get rid of a co-worker and an Ebola patient was around...would that be the perfect crime?
Shame on the CDC head for speaking in such a way as to blame the nurse. And note that it's almost a non-apology, tho he does admit to feeling awful that the nurse is infected...but not that he spoke in a misinterpretable way.
People who do research using the most hazardous biologicals are given extensive training prior to letting them loose in the lab. Occasionally, even after years of experience, they screw up. Not really an issue of "blame" as much as "explanation." She may have been given training on how to use the gear, but it sounds like she went straight from boot camp to the front lines.
We NEED to know how she got it. Not like deep in our hearts there is a yearning to know, but rather it is pretty important for us to understand how it is moving between people. Just because the most common strains behave a certain way doesn't mean that any given individual isn't shedding virus that has changed in a critical way. They insist you can't get it this way or you can't get it that way, but they may be fighting the last war ("last" as in "previous").
The head of the CDC is not an intellectually honest man. You cannot conclude that protocol was violated in advance of the investigation of the incident. For all we know, the protocol is utterly inadequate for the situation. Also very interesting about the situation is that NONE of the man's relatives are showing symptoms and NONE of the first responders are showing symptoms. Only the one nurse who was wearing full protective gear as prescribed by the CDC and claims she was following protocol.
The level of trust on government institutions are at al all time low. Thanks Obama, and Lois Lerner, and Susan Rice and Frieden.
It's ALL for show.
Blaming nurses will work well.
I know a doctor from Dallas whose name is Pham. I hope she is not related to him.
Further, if a trained medical professional in full protective gear becomes infected, how is it possible to justify sending troops to Liberia? This is perhaps the single most egregious action Obama has taken with our troops. His daughters should deploy with them.
"would that be the perfect crime?"
Somebody dies of liver cancer. You "gave" it to them years earlier.
She has a cavalier king charles too!
The beautiful well educated front line nurse is the opposite of the slimey REMF liars with pretend Protocols and a podium.
She is a TCU Horned Frog that has more actual education, intelligence and class than the entire coven of Democrat super liars imitating Obama's Liar Protocol.
CDC director Frieden is a slimy, disingenuous tool of the Obama regime. I didn't trust him the first time I heard him speak about Ebola a couple of weeks ago. He has lived up to my expectations. Is there anyone in this administration with any honor or honesty?
traditionalguy,
Good to know I'm not the only one who has "slimy" come to mind when hearing the Obama officials opine to the public.
This woman apparently tried to help her patient at grave risk to herself. That's courage and sacrifice.
Does this count as "victim blaming"? The administration wouldn't do that, would they?
This woman apparently tried to help her patient at grave risk to herself. That's courage and sacrifice.
Which doesn't impress the likes of Ann Coulter.
CNN has an article, "Five Ways The CDC Got It Wrong" which says that, basically, the protocol was wrong, because the steps needed to truly protect onesself are so complex that you need a "buddy system" with a co-worker whose job it is to make sure you get the protocol right.
And what happens when one of our soldiers gets ebola?
The military is meant for fighting wars, not to be the president's personal labor force, to be used for any special project as desired.
Ideally, the agency deciding how a protocol didn't work should not be the agency that makes the protocol. E.g., if the FAA investigated plane crashes, they probably would be hesitant to find flaws in their regulations, while the NTSB would be more willing.
It should be noted that she could have been infected due to somebody else breaching protocol.
sane_voter said, "Is there anyone in this administration with any honor or honesty?"
No.
We shouldn't forget this debacle from July of this year....
Federal officials found more than just long-forgotten smallpox samples recently in a storage room on the National Institutes for Health campus in Bethesda, Md. The discovery included 12 boxes and 327 vials holding an array of pathogens, including the virus behind the tropical disease dengue and the bacteria that can cause spotted fever, according to the Food and Drug Administration, which oversees the lab in question.
--The Washington Post, July 16, 2014
The Boston area was very proud that we were the largest "Katrina dogs" adopters, and we are open and excited about being the Texas Ebola adopters too.
Do you know the gay marriage map today is identical to the map in the country years ago that was for and against slavery?
tits.
Whoa...
Now I've been on a ERT team for over 4 years. There are protocols for donning and doffing.
Yes you can get a bit of blood or whatever if you don't exactly follow the procedures. BUT, the CDC does not douse you with bleach before you doff the HAZMAT gear.
And to me that is the real problem. Their procedures were faulty.
I wanna give that clown from the CDC some skin in the game. How about if he's wrong we burn him alive on th Capitol Mall?
Sarc/Off
As I read it, it was a guess by teh head of the CDC, that is, he surmised that she didn't follow protocol.
There was a protocol the way there was this great Website just like amazon or tavelocity where you could easily shop for healthcare amongst dozens of vendors eager for your business.
The reality is Talk is Cheap.
The execution by CDC is similar to the website. We turned it on and it immediately crashed.
And like the website, it will quickly become clear that despite having years of lead time, they never tested it nor thought too hard about contingency plans.
And it will cost billions to fix and make Obama look completely incompetent. The guy who overspent by $8 Trillion and had nothing to show for it.
Soon Obama will announce he just learned about all this on TV and he's putting Top Men on this but he'll still be taking his 3 weeks in Hawaii in December, thank you very much.
Messing with 1/6 the economy….blowing off a global pandemic…It's just how Obama rolls.
The fact that two nurses, working in Western hospitals, with perfect equipment, at least one with fifteen years of experience with infectus diseases, have caught Ebola scares the shit out of me.
We've gotten lucky so far because the outbreaks have always carried off the carriers before it reached the cities. It has reached the cities this time, in several countries.
"The military is meant for fighting wars, not to be the president's personal labor force, to be used for any special project as desired."
He does refer to it as "my" military.
Many nurses, technicians, and doctors have served me when they did not know what was wrong. These people deserve our respect.
@Crimso (7:44pm) is right. It's not a matter of "blame". We need to find out how it happened.
Once again. This is why the best result for normal people is to never be noticed, and why as a common citizen I continue to be demoralized.
Whether you're Joe the Plumber, any number of people offered up as examples of whatever the powerful want to illustrate, even Sandra Fluke and Cindy Sheehan, you will be analyzed attacked and discarded as soon as you become inconvenient.
Now it's this poor woman's turn. Blame, mistakes, and error are for the little people. And if you're quintuply unlucky you get Ebola as a bonus to being used as someone else's toilet paper to cover their ass.
It is more likely that the protocols themselves, as developed by the CDC, are defective.
Unless you fully decontaminate the outside of the gear before you take it off, these health care workers are not going to be protected.
But that really requires different protective gear.
Before this happened, people were questioning CDC guidelines, because they were less intense than being used in African hospitals. Now we see the result.
Darwin award.
Dr. Nancy Snyderman of NBC with entourage letting themselves be seen and photographed breaking quarantine to visit soup kitchen.
Hagar,
That's not a Darwin award move. She is going for the Typhoid Mary Award. Maybe she will become known as Ebola Nancy
If Ebola spreads, watch how fast or secular nation turns to God.
Yeah, I do know how to spell "protocol."
Ironically, the nurse was infected due to a spelling error in the protocol itself.
It said: "Always wear an appropriate musk."
I learned decades ago, when doing probabilistic risk assessments, that humans, when performing the simplest task, will err once out of a thousand times. Do the CDC protocols take human frailty into account?
They insist you can't get it this way or you can't get it that way, but they may be fighting the last war ("last" as in "previous").
With dingbats like Frieden in charge of the CDC, "last" might have its other meaning for us, too.
It's great that she was the same blood type as Dr. Brantly; hope those antibodies can make the difference.
@Bill Sommerfeld, I hope you were able to cut and paste because typing that much government double-talk would have turned an ordinary man's stomach.
Is there a point where the CDC realizes that a protocol requiring extensive training is by itself a guarantee of failure?
This is not a "we have to work together" moment. It's the CDC's job to keep the rest of us safe from Ebola, not to mention Hantavirus, VEE, Marburg, and a whole lot more. Frieden was supposedly hired to provide leadership, not to make some vague appeals to the rest of us to "work together" with the CDC. Are there behaviors we should avoid (like not traveling to West Africa)? He won't say. Is there anything we can do ourselves as non-medically trained personnel to support the healthcare workers on the front lines? He doesn't say. Is there any reason not to sack him?
The reason Nina Pham found herself on the "front lines" of the ebola war is that Frieden and the criminal he works for believe her death is an acceptable price to pay in the pursuit of some goal they would prefer not to discuss publicly.
The reason Nina Pham found herself on the "front lines" of the ebola war is that Frieden and the criminal he works for believe her death is an acceptable price to pay in the pursuit of some goal they would prefer not to discuss publicly.
Let's not start planning her funeral yet, shall we?
The SARS virus infected and killed several of the staff treating them in Hong Kong--if I remember right. I think the breach was that the air conditioner in one of the patent's rooms was leaking water to the pavement below, and some of the staff stepped in the water. Or some such thing. Anyway it wasn't an ethical or negligent lapse. Shit happens........The CDC doesn't inspire confidence, but they're the only CDC we have......The President of Liberia said that Duncan knew that he had been exposed to Ebola and took a plane to America to improve his odds. What are the chances some other Ebola exposed patient won't adopt the same stratagem?
Of course she screwed up. When 70-odd doctors, nurses, techs and whatnot take care of an Ebola patient and only one comes down with the disease -- and she happens to be one of the youngest and least experienced, just barely qualified to work in critical care -- what else would it reasonably be, hmm? Magical breakdown in just her equipment? 69 of the 70 were just amazingly lucky, even though they followed the same faulty procedures? That beggars common sense -- I mean, if people had common sense when it comes to infectious deadly disease (illusions about which no one who lived through the SARS, H1N1, "mad cow" disease, or AIDS hysterias should harbor).
The fact that she made a mistake has no bearing on her personal heroism, which is obvious and real. Nurses are always on the front line of infectious disease, because they are the "point" men who clean up the blood, barf, stool, pus, and assorted nasties left by patients carrying God knows what. Nurses died in the 80s from accidental needle sticks from HIV+ patients, too. Keep that in mind next time you visit an ER because your kid has a 102 fever and don't be an asshole when the nurse has to ask you for the fifth time what his symptoms are because it's the 11th hour of her shift and she's had one (1) 10-minute break so far and is internally freaking out because she might've touched her eye after cleaning up some horrible mess left by an obviously dying patient an hour ago.
But to reason backward from someone's youth and innocence and heroism to the impossibility of her having made a mistake -- in the face of the obvious facts suggesting she did -- is not just brainless, but dangerously brainless. You do not defeat viral diseases by sentimentality and warm humane thoughts, but by cold rationality. Viruses are just molecules. Molecules don't care about human values. Not the tiniest shred.
Speaking of Snyderman, the story of the pet plague patient she and NBC chose to import just gets stranger and stranger. First, looking at his online CV, he wasn't a "cameraman" -- he'd been in Liberia playing community organizer for 3 years, running Al Sharpton moves on the local "extractive industries", supposedly on behalf of "the people", but as with most community organizers, well, who knows?
So, Snyderman and her 42-man army show up on a Monday, hire him on Tuesday to be a "cameraman"(due to his mad skillz? No one seems to be saying how convincing his resume was... but Wednesday he announces, Oops, I have some bad news ... and suddenly Thursday, all 42 of Nancy's army are back in the air on charter planes, including Typhoid Mary, (did he travel in a plastic plague bubble, I wonder? Did they tell the crew of the charter plane they were carrying an Ebola patient? How did they justify exposing everyone on his plane to him? So many questions...) Such an amazing gesture for a pack of scumbags like NBC, especially for a guy who'd been in their employ, what, 18 hours? Hardly enough time to shake hands with all 42 of the other crew members. And wow, cancelling the entire expedition like that -- like somebody finally figured out that maybe there was some authentic risk involved, and they all got wee-wee'd up and decided to beat feet for home...
So now Typhoid Mary is in an isolation ward in Nebraska, already working his Mad Extractive Industry Skillz to persuade the Great American Public to cough up the money for his treatment ($500,000 give or take--though a prudent bettor would be estimating perhaps 3 times that figure--) since the Great Hearts at NBC seem suddenly to have lost their zeal for good works, at least on his behalf. And, obviously, he was one of those Young Invincibles who chose not to heed the siren song of Obamacare's Gold coverage, such a pity.
Google the guy -- it's an interesting read. And then wonder why NBC did what it did. ALL the things it did.
All the CDC knows of Ebola it learned in African villages. They have been able to isolate the villages and keep the people quarantined. But it's only because the villages are so remote and isolated. Once it got into the larger population areas it became more difficult to control. Hence the thousands that are dying. The CDC is trying to treat it here like a remote African village, but there are too many people and we move around too much. They are just winging it now. Making it up as they go along. And since they haven't been truthful with us, no one is believing them now. We are probably screwed.
Finally, a villain. Now we know who to blame.
@ Carl Pham... Nice pure fictional slander job of the worker who had intense training in the latest medical knowledge because you presume she is merely an intelligent 26 year old highly dedicated to her nursing career that she was educated for at a top program at the best University in Texas.
Are you insane or just jealous of young people who excel?
Why don't we ask Barack Obama himself to postpone one of his golf outings and fundraisings, and instead put on the proper protective clothing and treat an Ebola patient according to the CDC protocol. That would inspire confidence in me. I call this "social justice". He is a civil servant after all.
The Party imbecile heading the CDC, Frieden, first said that they had no idea how the nurse contracted Ebola, and then said that she must not have followed "the protocols." where did he fail Logic 101? Harvard, Madison, or Berkeley? when you start by saying that YOU DON'T KNOW WHAT HAPPENED, that cancels any "explanation" that follows, no?
It's very easy to imagine schools being shut down quickly over Ebola.
Man goes on business trip to distant land. Returns. Time passes. He gets sick at home, vomits. Wife, children, dog--all potentially infected.
If you were the school superintendent, would you want any of those children in school? Would you send your children to those schools?
When 70-odd doctors, nurses, techs and whatnot take care of an Ebola patient and only one comes down with the disease -- and she happens to be one of the youngest and least experienced, just barely qualified to work in critical care
Has the 21-day incubation period passed already? Is is possible that the incubation period could be longer than 21 days? Are we secure in the knowledge that she is the only one or not the first one of the 70-odd doctors, etc.
Were there really 70-odd medical personnel taking care of Duncan (having physical contact with him?) If so, that itself is one part of the protocol that should be revised.
Hey, thanks! - you idiot fuckers who voted for Obama.
You wanna start on the road to redemption? Stop voting at all. Your judgment has been shown to be highly questionable, has it not?
The blame falls on the federal government for not restricting flights from ebola scourged West African nations.
Too busy with donor parties and golf.
"Is is possible that the incubation period could be longer than 21 days?"
While I doubt the virus could pick up the ability to, e.g., teleport itself, all bets are off with normal characteristics such as incubation period. As Osterholm so aptly noted, every single person infected represents a trillion throws of the genetic dice.
I would defend sending US Army troops to Africa to help against Ebola if I thought we were sending the right troops.
The Army and the Navy, I would presume the AF as well, have strong biowarfare defense programs. These folks are trained to prevent harm to troops and civilians from biowarefare agents.
Ebola is not, probably, biowarfare but getting our specialists up close and personal would be good training and experience. This would come in handy in the event of biowarfare or if ebola breaks out in the US. It is risky but the best training always is.
I would support that kind of response.
Unfortunately I can't find anything to indicate that these are the folks who are going. And, I don't trust Obie and company not to screw it up.
John Henry
I don't often agree with TradGuy, but I agree that Carl Pham is being an ass.
You have no knowledge of how the nurse acquired her infection. Conceive of the possibility that she followed all protocols set forth by the CDC...and still became infected. That she is the only one *yet* means very little IMO.
Christy said...
I learned decades ago, when doing probabilistic risk assessments, that humans, when performing the simplest task, will err once out of a thousand times.
My experience is more like one out of 10 times. A lot of the errors will be simple and perhaps not really significant but they are still errors.
The person not washing their hands twice, for a full 60 seconds each time, when entering a class 100 clean room, may not cause a problem 99 times out of 100. But there is a reason for the procedure and it must be followed because that 100th time, someone could, potentially, die.
Never trust anyone to do anything correctly. That is why checklists, used every single time are a must.
Who knows if the nurse followed protocol? As I understand it, the protocol is very complex. Is there a written checklist? Is there a 2nd person observing that each step is followed, from the written checklist?
If not, it is the system and protocols that are to blame for her catching ebola. Not her.
John Henry
If anyone is interested in checklists, I highly recommend Dr Atul Gawunde's book "The Checklist Manifesto".
There are also several documentaries on YouTube on this that are excellent. Search "Gawunde" and "checklist"
I particularly like the story of Jeffrey Stiles. He was the co-pilot of filght 1549 that landed in the Hudson.
When the engines failed he did not try to restart them as a first step. His first step was to pull out the paper checklist for emergency restart. Only then did he try to restart the engines.
The more critical it is, the more important it is to have a paper checklist. And follow it to the letter Skill, experience and memory are never enough.
I wonder if the Texas hospital had one? And if Nurse Pham followed it?
John Henry
We NEED to know how she got it. Not like deep in our hearts there is a yearning to know, but rather it is pretty important for us to understand how it is moving between people.
Of course the chances are we'll never know exactly how or when she contracted the virus. A nurse has a lot of physical contact with a patient, especially if the patient is severely impaired in the ability to get around. If she helped another nurse out of protective gear that wasn't thoroughly decontaminated prior to getting out of it her contact could have been entirely secondary.
At least the CDC is monitoring how the nursing staff is taking care of Pham.
Meanwhile, every hour without a new reported case is a good hour.
"..I would defend sending US Army troops to Africa to help against Ebola if I thought we were sending the right troops. ..."
And after a number of them come down with the disease, then what?
Fly them home?
CDC Guy opines that the nurse didn't follow protocol, then won't say what the protocol was, then backs away from the original statement.
He's.pulling it out of his *ss and now everyone knows it.
I repeat myself...the bubonic plague was originally spread by flea bite...after a short period it mutated into a pneumonic strain i.e. spread through the respiratory system.
The CDC needs to get a history of Europe for the year 1347 AD.
Lars,
read my note. I said it has to be the right (specialist) troops.
If they are the ones who are sent, I would trust them to be trained to take all special precautions.
I would expect them to be be closely monitored for any symptoms.
I would expect them to be isolated if appropriate.
And so on.
As I also said:
"Unfortunately I can't find anything to indicate that these are the folks who are going. And, I don't trust Obie and company not to screw it up. "
I stand by my original post.
John Henry
@Carl Pham, reread what I posted at 10:19. A protocol that requires extensive training to execute properly is a protocol that is guaranteed to fail.
And as for Nancy Snyderman, the penalty for breaking quarantine with something as virulent as Ebola ought to be a quick, fair trial followed by a high hanging.
And, Althouse, that's not meant as a laugh line.
It's just our luck that Ebola shows up at the time when the worst president since Buchanan is in charge.
Of course she screwed up
Its likely she did. But you don't really know that.
Granted, there are many scenarios where that kind of speculation is very reasonable.
Some aren't - like holding a gun to your head and saying "of course its not loaded!".
Smart people check the chamber first, even if they "know" its not loaded.
"...I would expect them to be be closely monitored for any symptoms.
I would expect them to be isolated if appropriate. "
Isolated where? In Liberia? You don't think their families will be clamoring for their return to the US?
P.S. I am somewhat familiar with CBR/NBC troops. You are right that I don't see them being deployed. Only regular med MOS types.
CStanley said...
"Were there really 70-odd medical personnel taking care of Duncan (having physical contact with him?)"
If this country weren't so racist, there would have been 150. Ain't that so, Rev. Jackson?
Of course she screwed up
If we are having people get sick with only one patient in the first time we're treating them in a regular hospital (not the specialized one), then the protocols need to be tightened up so it doesn't happen again. However, it was highly inappropriate for Friedan to blame her for slipping up without any facts and he rightly got called on it. The CDC has done a terrible job on this whole thing in general.
How much specific ebola training did these people get?
I'd normally enjoy unqualified Obama nominees backing and filling and blowing smoke to cover their incompetence except that, as with Benghazi and the VA, people are dying because of this one.
"PuertoRicoSpaceport.com said...
If anyone is interested in checklists, I highly recommend Dr Atul Gawunde's book "The Checklist Manifesto"."
AGREED.
It's one of the best books I've read over the last few years. I've been encouraging people to read it. It's changed the way I do my job and I believe it could save lives - especially now.
Friedan just announced that a CDC rep will now be watching the donning and removal of protective gear.
John Henry, by simple I meant the turning on or off of a switch, nothing as complex as washing hands. Easy to see how that could have a one in ten failure rate.
You can have a specific disease protocol only when you fully understand that disease. At the same time, you must acknowledge that perfection is impossible.
The CDC needs to get a history of Europe for the year 1347 AD.
What about the year 541? (See: Justinian plague.)
Ace is saying that San Jay Gupta demoed how to take off the protective gear on CNN. The link he gave is not working for me and I am having trouble getting CNN to load at all so you will have to search it.
He used chocolate syrup to simulate contamination. Then he followed the CDC ungowning protocol to the letter and wound up with chocolate sauce on his skin.
I've a fair amount of experience with gowning with no skin touching the outside of the gear. None with ungowning like needed here. I can tell you that gowning properly is much harder than it might seem.
I can imagine ungowning is harder still.
My gowning experience is going into aseptic (sterile) manufacturing rooms. There we worried about the human contaminating the room. With ebola, the criticality is reversed.
John Henry
I'm just glad that this kind of virus could not spread to Central America or Mexico.
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