Althouse: "'The guidelines were constantly changing' and 'there were no protocols' at Texas Health Presbyterian Hospital Dallas as the hospital treated a patient with Ebola..."

October 14, 2014

"'The guidelines were constantly changing' and 'there were no protocols' at Texas Health Presbyterian Hospital Dallas as the hospital treated a patient with Ebola..."

"... the president of National Nurses United said in a statement on Tuesday. Protective gear nurses wore at first left their necks exposed, union co-president Deborah Burger said, citing information she said came from nurses at the hospital."

113 comments:

MadisonMan said...: Quote from the head of the CDC:

"I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection," Frieden said. "But we will do that from this day onward with any case anywhere in the U.S."

Gee. I wonder who could have been on the ball at work and ensured that something like that could have been in place? It's not like Ebola came out of nowhere.

Why has this man not resigned in disgrace?; 10/14/14, 7:52 PM
Michael K said...: THis will be huge scandal. Hospitals cannot afford to do this.

According to her, after the CDC outlined its preparation strategy, one hospital administrator responded, “What you’re telling us would bankrupt my hospital!” She said that that administrator represents a Southern California hospital.

McCaughey noted that there was no word on the call of who would pay for hospitals to get themselves ready for Ebola patients.

And then she added: “Treating one Ebola patient requires, full time, 20 medical staff. Mostly ICU (intensive care unit) people. So that would wipe out an ICU in an average-sized hospital.”

In the case of Texas Presbyterian, McCaughey says that the hospital cordoned off its ICU to care for Thomas Eric Duncan and sent the rest of its ICU patients to other area hospitals. She added that many communities will not have multiple hospitals to choose from, so one Ebola case could cripple ICUs in small towns.

It's not going to be small towns, at least at first, but Obama has opened the door to disaster. One of many he has opened the door to.; 10/14/14, 7:54 PM
Patrick said...: "Why has this man not resigned in disgrace? "

What a quaint notion, this "disgrace."

Don't worry though, I'm sure he'll "accept full 'responsibility."; 10/14/14, 8:02 PM
Bob Boyd said...: The men and women who are suiting up and going in are amazingly courageous.; 10/14/14, 8:08 PM
Humperdink said...: Why the uproar? President Obola said it was unlikely an outbreak would occur in the US.; 10/14/14, 8:13 PM
Sebastian said...: "This will be huge scandal."

It already is a scandal.

Ebola can be prevented from spreading in the U.S. by simple travel restrictions. That even one American got infected here is on Barry.

Quite apart from the health consequences of current government irresponsibility, the financial implications of the feds' approach are potentially enormous. No official has discussed them honestly.

Current policy already is a scandal.; 10/14/14, 8:15 PM
Bob Boyd said...: If hospitals aren't going to have the staff to deal with a growing problem, maybe they should start screening and training volunteers now while there's still time. Better to have them and not need them than the other way around.; 10/14/14, 8:15 PM
FullMoon said...: Won't take much for the average hospital worker to quit rather than face ebola when it gets local. I wonder how many workers called in sick in Texas,or took vacation days.; 10/14/14, 8:17 PM
Anonymous said...: 'The guidelines were constantly changing' and 'there were no protocols': EbolaCare.; 10/14/14, 8:22 PM
David said...: ""I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection," Frieden said. "But we will do that from this day onward with any case anywhere in the U.S."

How's that going to work with 100 cases? 500? 5000?

Now maybe it won't come to that. But if it doesn't it won't be a result of anything the federal government is doing. Not yet anyway.; 10/14/14, 8:24 PM
SteveR said...: Nothing to see here, move along.; 10/14/14, 8:27 PM
Barry Dauphin said...: A Texas hospital... I blame Bush.; 10/14/14, 8:27 PM
Phil 314 said...: National Nurses United is a unionization campaign.; 10/14/14, 8:30 PM
Jaq said...: Remember Rich Little's impression of Nixon? "I accept full responsibility... responsibility.. but not the blame."; 10/14/14, 8:30 PM
Jaq said...: Plagues happen when people start moving around the planet freely. Hopefully this is not one.

I just want somebody at the CDC who will level with the American people, not treat us as a collection of children.; 10/14/14, 8:34 PM
madAsHell said...: The Ebola Presidency.

FORE!!; 10/14/14, 8:36 PM
RecChief said...: huh so was it a Frieden bone headed musing out loud? Now that a union is speaking up for a member, I'm curious as to what this administration will say.

hold on, my popcorn is almost done; 10/14/14, 8:37 PM
Humperdink said...: It is fairly clear that our beloved President has his finger on the pulse of US healthcare.

And with Michelle O's healthcare experience with the University of Chicago Hospitals as a Community Affairs executive, who can doubt we are in the best of hands.; 10/14/14, 8:38 PM
Jaq said...: Supposedly, this stuff can live on in a corpse (not a marine, Mr Obama) for four days. I am betting that you can catch it from a toilet seat.; 10/14/14, 8:46 PM
The Godfather said...: This morning on ABC, they showed a photo of a healthcare worker in the protective gear supposedly used in handling Ebola cases, and it looked as though there was a gap at the neck, between the head covering and the body covering; I thought I saw bare skin. I assumed that what looked like skin was probably some protective undergarment. If the nurses union is correct, and if this design flaw in the protective equipment causes the death of Nurse Pham, or others, it sounds like a case of negligent homicide (or worse).; 10/14/14, 9:04 PM
William said...: He was the first Ebola patient. Perhaps with experience the medical teams will have a more proficient response. But I hope to God we don't become proficient at treating Ebola patients......I think it's a harebrained idea to send several thousand American servicemen into an Ebla zone. Use that money to give the aid workers in Liberia the raise that they're asking for and deserve......Duncan knew he had been exposed to Ebola. He lied about it and came here to seek treatment. You have to be mad to think that he's he's only person in Liberia evil enough to adapt such a stratagem......The NBC doctor broke quarantine. I certainly hope she didn't infect any of the other worthy correspondents at NBC. It would indeed be upsetting to see Chris Matthews bleeding out of his eyes while telling us not to panic and that Obama has everything under control.; 10/14/14, 9:18 PM
Anonymous said...: Have them take the Kleenex test.

You have them blow their nose into a Kleenex: if in the act of doing so they blow blood out of their ass you put them into quarantine.; 10/14/14, 9:23 PM
David said...: In other news, attention is starting to focus on Nicole Lurie, Lurie is Assistant Secretary, Preparedness and Response, at HHS. Here is how she describes her job.

Beginning with development of a strategy, my role can be defined as helping our country to be ready for any kind of adverse public health event, including a response to any challenges the future may bring.

She has been in this role since July 2009. A look at her resume will show that she has reasonably impressive scientific and clinical credentials, but virtually no management experience. She had never been managed a health institution, a health bureaucracy, set budgeting or operating priorities for any significant complex organization, or dealt with the political cross currents of any complex private or governmental organization.

In short, she is a researcher, writer,sometime medical practitioner and social policy wonk not a leader or even an administrator.

It is being pointed out that her name has barely surfaced in the recent crisis or before. There is a reason for that, and the reason is that she does not know how to do what she describes as her own job.; 10/14/14, 9:37 PM
David said...: ".I think it's a harebrained idea to send several thousand American servicemen into an Ebla zone. Use that money to give the aid workers in Liberia the raise that they're asking for and deserve......"

But if you do that, you will simply had an ill disciplined and untrained force trying to cope with this in Africa. It's damned dangerous and requires courage and discipline. There is a story out that 16 physicians from Doctors without Borders have contracted Ebola, and nine have died. Some of those soldiers in Africa could be exposed and could die, though they are apparently not going to be exposed to the same extent the medical professionals are. God Bless all of these people. What bravery and dedication.; 10/14/14, 9:42 PM
pm317 said...: On Kelly, I heard the CDC guy agree that the feet remained exposed (how can that be!) -- he was saying if you cover too much with too many layers, that is a problem by itself -- he has a nice way of talking but what he says is quite scary. Kelly asked about the feet being exposed but did not pursue it.; 10/14/14, 9:46 PM
pm317 said...: I thought the CDC guy had a curious response to why not travel ban.. among the things he said.. we will isolate the patients (as in the patients who come from those countries, like Duncan?) -- need transcript to see exactly what he said.; 10/14/14, 9:59 PM
Mark O said...: It is malpractice for a doctor to oppose a quarantine on all persons entering this country who have been in the infected countries during the most recent 60 days.

Study the Spanish Flu, 1918-19 and you will read the same palaver from the ancestors of same smarmy officials.

Of course, if we were to prohibit entry from those countries, we would have to police the Mexican border. That has to be the real reason.; 10/14/14, 10:08 PM
Sydney said...: The CDC has absolutely dropped the ball on this. They used to be the go-to source for outbreak preparedness, but they have been useless in this situation. The World Health Organization recommends heavy duty body protection (rubber boots, impermeable gowns, heavy rubber gloves, face shields, head covering) for healthcare workers, as well as restricting the number of people caring for them to the minimum. In contrast, the CDC recommends our run of the mill paper gowns and face masks and shoe covers. I don't know what has gone wrong over there at the CDC, but I've switched to WHO as my preparedness source.; 10/14/14, 10:13 PM
Anonymous said...: My immediate and extended family has needed plenty of expensive health care in my lifetime--stroke, cancer, heart bypass surgery--things like that. So I am familiar with the layout of emergency rooms and ICU units in several hospitals. I can't remember any of them had a style I would call "isolated." They are designed so doctors and nurses can quickly move from patient to patient, especially if some monitor starts beeping. I think the rule will be "one Ebola patient--one hospital."; 10/14/14, 10:15 PM
Anonymous said...: Besides the inconvenience of illness, death, and lots of people grieving instead of working I think a pandemic would bankrupt our life insurance industry. Will that lead to another financial crisis?; 10/14/14, 10:18 PM
Ellen said...: Thank God for The Patient Protection and Affordable Care Act. PPACA. Obamacare to the rescue.; 10/14/14, 10:51 PM
Jupiter said...: The federal government, with the concurrence of the Centers for Disease control, has decided, for reasons it cannot explain, let alone defend, to refrain from taking obvious steps that would, without any doubt, reduce the likelihood of Americans contracting a disease for which there is no cure, and a very high death rate.

If there is an upside to this, it is that no one will ever again suggest that the CDC is anything but a collection of half-bright failed optometrists.; 10/14/14, 10:54 PM
Fen said...: I'm curious about mutation of the virus. How will it replicate when it comes into contact with American troops who have all kinds of immunizations? Any different than normal?; 10/14/14, 10:59 PM
Anonymous said...: I think this is a good lesson in hubris.

So far, Ebola hasn't gotten out of hand. Which is a good thing. But suppose it does?

It shows the hubris of mankind. We have spent decades trying to prevent global warming, and we all will get killed off by something completely unrelated. We have warned against over population and the world running out of resources, and we get killed by Ebola.

If it isn't Ebola, it'll be some other unforseen tragic event. Like the core of the earth exploding or something like that.

What it won't be? Whatever some moron on cable news is predicting as the next big crises. Give money now!; 10/14/14, 11:45 PM
Michael K said...: Medicins sans Frontieres have 16 cases and 9 deaths and they are the experts.; 10/14/14, 11:54 PM
Annie said...: David, regarding the ebola czar, Lurie, she was involved in a scandal 3 years ago for funneling streams of money meant for ebola research, to a democrat croney instead of to the company developing ebola drugs which are now being used to treat ebola patients.

Even democrats denounced what she did. But yet, she still works there...somewhere, as noone has heard from her.

The federalist has the story. (this device doesn't allow me to link).; 10/15/14, 1:19 AM
virgil xenophon said...: "...she was involved in a scandal three years ago..."

Gee, hasn't everyone in the Obama Administration been involved in some sort of scandal? Nobody here but us chickens!; 10/15/14, 1:42 AM
Carl Pham said...: What a profoundly stupid article. Had the guidelines not been "constantly changing" there would have been bitter complaints about the hospital being "inflexible" and "not learning from experience" and of suggestions from the front line being ignored.

If they'd been constantly randomly changing, that would be one thing -- an indication of chaos and disaster. But there's no such suggestion. And if they were "constantly changing" in a sequence of positive steps, you know what that's called? Constantly getting better.

You know what else "constantly changes?" The response of soldiers under fire, or first-responders trying to dig someone out of a weird crash, or someone gifted learning to play the piano.

And then we have the protective gear exposing their necks. OMG! So, yeah, if you've got a trach installed, so your neck contains an open wound, that would clearly be a problem. Otherwise...the virus can't tunnel through the skin, you know. I bet the protective gear left their ankles exposed, too. Maybe even elbows! Aieeee!

NNU are union shills, of course, much of their base coming from the famously activist and confrontational CNA. They can be relied upon 100% of the time to savage hospital administration that doesn't equip each and every nurse with a full-on NASA space suit, $250,000 of intense full simulation training (and 3 months a year off to do it), and in short everything money can buy to make the working conditions impeccable.

And, I mean, fair enough. That's their job, to press as hard as possible for the best for their members. If there were a USMC Lance Corporal union, it, too, would complain that protocols were "constantly changing" when units were under fire, that officers sometimes changed their minds or made mistakes, and that each and every soldier wasn't given his personal A-10 to supply personal close air support.

There are, without question, lessons to be learned from patient zero here. But they'll never be learned. Because to learn lessons you need (1) humility -- a little of that ol' "there but for the grace of God go I" -- so the preconceptions and purely theoretical ideas of people far from events have any chance of being challenged by actual facts, and (2) a constructive atmosphere in which people who have made mistakes share painful lessons with those who have yet to make them. A hysterical witch-hunting approach -- which son of a bitch let the bugs in? Who's carrying the mark of the Devil? Burn him before he infects the rest of us! -- pretty much guarantees that any real lessons will remain safely unlearned, and the air will be filled with useless fantasy and ill-informed rationalization instead.

That is, pretty much how the Middle Ages responded to The Black Death. And to think, they had decades to notice, if they'd used a smidge of cold rationality and careful observation, that if you got rid of the rats the plague went away. How blind people can be to something so easily imagined, readily tested, and of immense value if proved. But tens of millions died instead, while confident angry theories of miasmas, moral contagion, poisons in the food and wine, conspiracies of the Jews, and whatnot filled the air to capacity. No room for any small whisper of truth, nor ears undeafened by the din that could hear it.

If we've learned anything (from the social, not the scientific, point of view) in the last 600 years about coping with the Universe of Surprises, Some Good And Some Quite Bad, it's not apparent today.; 10/15/14, 1:47 AM
Lewis Wetzel said...: You ever get the feeling that Obama is much more interested in things like telling the American people who is allowed to marry who, than he is about protecting Americans from foreign plagues or foreign terrorists?
I do.; 10/15/14, 3:27 AM
Achilles said...: If the CDC did it's job, I.e. disease control, instead of running an anti gun campaign and obesity bullshit it would be prepared for this. Instead they are off on progressive campaigns. Almost as if getting dems elected is more important than our safety.; 10/15/14, 3:44 AM
rcommal said...: Zero-surprise + 100%-prediction rates here. Hey, man, so it goes.

--

There's nothing to do when nothing one can do can make pay attention people who just do not want to pay attention. Seriously, folks.

As we all say, nowadays, "it is what is" or something like that. I just hope, in terms of Ebola, that it ***ain't***; 10/15/14, 4:02 AM
Anonymous said...: They now have a second case at the Dallas hospital. another HC worker.

I'd feel a lot better at this point if the Army Commander at U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) were telling us that Obama had implemented a limited quarantine under Plan Xray.; 10/15/14, 4:39 AM
Bruce Hayden said...: Won't take much for the average hospital worker to quit rather than face ebola when it gets local. I wonder how many workers called in sick in Texas,or took vacation days.

I think that this may ultimately be a major problem. And it is likely worse in situations where the bureaucracy tries to blame the nurses. There already is plenty of this in the medical profession, and is one of the reasons that nursing is hard. The other part of it though is that it is a part of the medical field where it is relatively easy to move around, and in and out, esp traditionally compared to physicians who have practices. So, I wouldn't be surprised if the Ebola goes pandemic, if a lot of nurses just drop out for awhile. Many may not see it being worth it to risk there lives, esp if they will be left hanging if there are any screw ups in the system (which there inevitably will be, given its bureaucratic nature).; 10/15/14, 5:58 AM
Bruce Hayden said...: If the CDC did it's job, I.e. disease control, instead of running an anti gun campaign and obesity bullshit it would be prepared for this. Instead they are off on progressive campaigns. Almost as if getting dems elected is more important than our safety.

The Dems are apparently already running ads blaming any CDC problems on Republicans because of funding. The problem is that funding rose significantly under Bush(43) but has been flat under Obama, with so many other demands for federal spending. But, instead of spending the money they got where it should have been spent (according to their mandate), much of it was squandered on other progressive projects. Thus, the Dem theory seems to be that it is the Reps fault that they didn't accommodate all this off-mandate spending with even more borrowed money. And, yes, you see this throughout the Obama Administration, with, for example NASA spending money on Muslim outreach, when it should be spent on space, etc.; 10/15/14, 6:07 AM
Jaq said...: Since we didn't give little prince Fauntelroy five trillion in credit with Chinese bankers for the stimulus, everything is Republican's fault.; 10/15/14, 6:25 AM
Lydia said...: Following up on what Bruce Hayden said above: 'Origami' condoms, Michelle Obama gardening games and poop-throwing chimps: NIH spent millions on wacky projects but now complains cuts killed off Ebola vaccine research; 10/15/14, 6:26 AM
Jaq said...: So, the family of this guy who broke laws to bring ebola to the US in order to get treatment is looking for "justice." This is why people hate lawyers.; 10/15/14, 6:29 AM
Quaestor said...: If the CDC did it's job, I.e. disease control, instead of running an anti gun campaign and obesity bullshit

Thomas Frieden was appointed to do just that. Check his background: Frieden was head of the New York City Department of Health and Mental Health under Bloomberg, and was instrumental in Bloomberg's anti-jumbo soda policy.

The head of CDC ought be an epidemiologist, which Frieden is not. Frieden is unqualified for the post.

Given his background I wonder if Michelle was consulted about his appointment.; 10/15/14, 6:50 AM
ron winkleheimer said...: @Carl Pham

1) Pretty sure those nurses didn't sign up to be experimental subject to determine the proper protocols.

2) Sometimes "constantly changing" means "we have no idea what we are doing" not "we are trying to improve the process."

3) We already know what the proper protocols are, but the hospital was apparently not prepared.

4) Some outbreaks of Plague in the Middle Ages may not have been Bubonic but a virus similar to Ebola.

http://abcnews.go.com/Health/story?id=117310&page=1

5) Healthcare workers aren't soldiers. Pretty soon they'll stop reporting to work rather than risk death.

http://www.bing.com/videos/search?q=all+is+well+animal+house&qs=HS&form=QBVR&pq=all+is+well+anim&sc=3-16&sp=1&sk=#view=detail&mid=84A2B03B885D9D2DF8AD84A2B03B885D9D2DF8AD; 10/15/14, 6:50 AM
sinz52 said...: Carl Pham sez: "so your neck contains an open wound, that would clearly be a problem."

You never nicked yourself while shaving in the morning?; 10/15/14, 7:01 AM
CStanley said...: By Carl Pham's logic, no protective gowns would be necessary at all; just make sure you out a bandaid on any cut you might have.

If the virus lands on skin that is uncovered but unbroken, it's true that it can't enter the body and infect you that way. But it does not immediately die, and in the hours afterward you can easily touch the area and then infect yourself by touching your eyes or mouth. This is the whole point of suiting up...you don't want to walk out of the isolation area with the possibility of virus on you, anywhere.; 10/15/14, 7:11 AM
Unknown said...: The head of the CDC is an anti-big-softdrink expert? Terrific.; 10/15/14, 7:12 AM
rhhardin said...: A major part of the protocol is covering your ass.; 10/15/14, 7:20 AM
Paco Wové said...: "The federalist has the story. (this device doesn't allow me to link)."

Here you go:

http://thefederalist.com/2014/10/14/president-obama-already-has-an-ebola-czar-where-is-she/; 10/15/14, 7:31 AM
Quaestor said...: Fen wrote: I'm curious about mutation of the virus. How will it replicate when it comes into contact with American troops who have all kinds of immunizations? Any different than normal?

It appears EBOV has already mutated since it was first characterized 35 years ago. Tom Frieden's CDC has been telling us the incubation period is 21 days, but WHO has evidence that the disease can be dormant for as long as 42 days after contact.

Ebola is a zoonotic virus, i.e. a pathogen that can be transmitted from one species to another. A pathogen that can infect species are widely separated phylogenetically is typically very prone to spontaneous mutation. New flu vaccines are introduced every year because the flu virus is zoonotic between birds (typically ducks) and humans. The virus has this ability because it mutates so readily. Ebola transmits between bats and humans, so we can expect rapid mutation.; 10/15/14, 7:45 AM
Quaestor said...: typo: A pathogen that can infect species are widely separated phylogenetically is typically very prone to spontaneous mutation.

Should read:A pathogen that can infect species that are widely separated phylogenetically is typically very prone to spontaneous mutation.; 10/15/14, 7:49 AM
Shanna said...: Quote from the head of the CDC:

"I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection," Frieden said. "But we will do that from this day onward with any case anywhere in the U.S."

This is maddening. They had months to prepare for this eventuality. They should have had everything ready to go the second a patient tested positive, and been on the ground, training the staff extensively. They completely dropped the ball on this outbreak and as far as I'm concerned, heads should roll. Not at Texas Pres, at the CDC. Those are the experts.; 10/15/14, 8:07 AM
traditionalguy said...: This comment has been removed by the author.; 10/15/14, 8:12 AM
traditionalguy said...: The CDC's fuck-up may have been from assuming that Texas Presbyterian had the same Isolation set up, training and and equiptment that Emory University Hospital had for use in Brantly's case after 14 days warning to get it set up.

Emory U. Hospital is 100 feet from the Emory U. School of Medicine buildings which are two blocks from the CDC's campus.; 10/15/14, 8:12 AM
Fernandinande said...: Paco Wové said...
Here you go: [federalist link]

Thanks.

I liked this part:

++
"Of course, between the fiscal years 2000 and 2004, NIH’s budget jumped a whopping 58 percent. HHS’s 70,000 workers will spend a total of $958 billion this year, or about $7,789 for every U.S. household. A 2012 report on federal spending including the following nuggets about how NIH spends its supposedly tight funds:
- a $702,558 grant for the study of the impact of televisions and gas generators on villages in Vietnam.
- $175,587 to the University of Kentucky to study the impact of cocaine on the sex drive of Japanese quail.
- $55,382 to study hookah smoking in Jordan.
- $592,527 to study why chimpanzees throw objects.
Last year there were news reports about a $509,840 grant from NIH to pay for a study that will send text messages in “gay lingo” to meth-heads. There are many other shake-your-head examples of misguided spending that are easy to find."
++

The fools! I'd only charge $400K to write stories in gay lingo about coke-snorting chimps throwing generators at hookah smoking quail in Vietnam.; 10/15/14, 8:26 AM
CWJ said...: rhhardin wrote -

"A major part of the protocol is covering your ass."

I listened to a lady on GMA today go on about a serious breach in protocol while simultaneously saying they didn't know exactly how the nurse got infected. I turned to my wife and said serious breach in protocol must really mean reality exposing the bullshit of the people trying to control the message.

Look, you could substitute "banana" for every time a person says "protocol" and it would make as much sense. The only reason they use protocol instead is because most Americans don't know what it means, they can change what it represents to fit events as they unfold, and most of all, it makes it sound like they have a plan and everything's under control.; 10/15/14, 8:27 AM
pm317 said...: From the Federalist article, Dr. Nicole Lurie, remember that name. She is the ebola czar, apparently, but looks more like a pay to play character funneling moneys to a Dem donor. What disgusting group of people.; 10/15/14, 8:30 AM
lgv said...: To recap, Frieden said she broke protocol. We got not facts. We don't know if she accidentally broke protocol, purposely broke protocol, or was unaware of the protocol she broke. People, especially other health care workers, should know.

Now, we have a claim that there were no protocols, from a biased source, yet I would be unsurprised by this fact. She broke a protocol that CDS failed to provide, or came up with after the fact.

We are right to have little faith in these people to do a good job. Oh, and the fatality isn't the 50% we have been told. They re-did the math. It's 70%.

I'm sure 60 minutes will be on Dr. Lurie's case right away, LOL.; 10/15/14, 8:32 AM
CWJ said...: Having worked in and with corporate marketing departments, it would not surprise me if they had spent more time choosing "protocol" as their all purpose talking point word than they did actually planning for this eventuality.; 10/15/14, 8:44 AM
sakredkow said...: Ebola can be prevented from spreading in the U.S. by simple travel restrictions.

Wake up.; 10/15/14, 8:45 AM
Fen said...: Thanks Quaestor, but maybe I didn't make my question clear. Or maybe you answered it and I am not understanding.

Lets say I deployed to Somolia 6 months ago and got a shot to ward off Bubonic Plague.

If I get infected with Ebola Dallas, will the virus replication (and therefore mutation) be in any way affected by the Bubonic Plague immunization already in my system?

I may have some terminology wrong here, but do you get what I'm saying?; 10/15/14, 8:47 AM
pm317 said...: 2nd health worker from Dallas hospital..; 10/15/14, 8:50 AM
viator said...: "We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks."

University of Minnesota, the Center for Infectious Disease Research and Policy CIDRAP; 10/15/14, 9:00 AM
Shanna said...: The CDC's fuck-up may have been from assuming that Texas Presbyterian had the same Isolation set up, training and and equiptment that Emory University Hospital had for use in Brantly's case after 14 days warning to get it set up.

The CDC knows this is not the case. There are only four of those facilities in the country. Their problem was hubris, and apparently abject incompetence.

Should read:A pathogen that can infect species that are widely separated phylogenetically is typically very prone to spontaneous mutation.

It’s more that it’s an RNA virus, and they replicate sloppily. However, I’ve been listening to TwiV and it seems unlikely it would mutate to be spread through airborne transmission, rather than droplets (sometimes through the air but still considered contact) and other fluids. It could mutate in other ways, though, like increased/decreased incubation, lethality, etc...; 10/15/14, 9:09 AM
Anonymous said...: Carl Pham: A hysterical witch-hunting approach...

You mean, the highly proactive manner in which the witch-hunters have been deployed to denounce any peep of skepticism or bewilderment about current policy as panic, hysteria, ignorance, and, yep, even racism? Yes, it is crazy.

That is, pretty much how the Middle Ages responded to The Black Death. And to think, they had decades to notice, if they'd used a smidge of cold rationality and careful observation, that if you got rid of the rats the plague went away. How blind people can be to something so easily imagined, readily tested, and of immense value if proved.

Stupid medievals. Too bad you weren't there to point out the obvious.

But tens of millions died instead, while confident angry theories of miasmas, moral contagion, poisons in the food and wine, conspiracies of the Jews, and whatnot filled the air to capacity. No room for any small whisper of truth, nor ears undeafened by the din that could hear it.

You're losing it, Carl.; 10/15/14, 9:09 AM
Shanna said...: We are right to have little faith in these people to do a good job. Oh, and the fatality isn't the 50% we have been told. They re-did the math. It's 70%.

Previous outbreaks were between 50 and 90, so that's pretty much in the ballpark.

I think most are aware that this outbreak has been so large, and so many haven't made it to the hospital that they don't have good numbers, or they are getting them late. So we won't really know until the end.; 10/15/14, 9:11 AM
Shanna said...: If I get infected with Ebola Dallas, will the virus replication (and therefore mutation) be in any way affected by the Bubonic Plague immunization already in my system?

Bubonic plague is bacteria and Ebola is a virus. You treat it with antibiotics. I don't think they have anything to do with each other.; 10/15/14, 9:14 AM
Anonymous said...: If y'all want to put your minds at ease and restore your confidence in our public health authorities, just google "cdc & global warming". You'll be reassured to know that they're on top of the important stuff that's much more relevant to their core mission.; 10/15/14, 9:16 AM
pm317 said...: why no travel ban? because it would be racist in an election season.; 10/15/14, 9:19 AM
PuertoRicoSpaceport.com said...: I mentioned this yesterday but could not find the link. The link Ace posted still doesn't work but this one does:

http://sanjayguptamd.blogs.cnn.com/

Scroll down to the video "Gupta suits up in Ebola protective gear"

He follows the CDC protocols for ungowning and still contaminates himself. (About halfway in)

The CDC gowning/ungowning protocols can be seen here:

http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf

Doesn't look like it provides much protection, to me. I'd want to see one piece coveralls, with booties and hood. Tyvek works well, though it can tear.

As I mentioned, my experience is using this to keep human contamination in. I would think it would work just as well to keep Ebola contamination away from the person.

It is not a quick process. Gowning for a Class 100 cleanroom takes an experienced person 3-5 minutes. It would take less time for ebola.

However ungowning from a clean room takes 30-50 seconds. Ungowning from Ebola contact might take 3-5 minutes to do it properly.

John Henry; 10/15/14, 9:28 AM
Quaestor said...: Fen wrote: I may have some terminology wrong here, but do you get what I'm saying?

Bubonic plague is caused by a bacterium called Yersinia pestis. An immunization against plague would be of no avail against Ebola. Vaccines are very specific to the organism because our immune systems are similarly specific.

Conceivably a vaccine prepared with a closely related yet less pathogenic virus could provide immunity again Ebola -- that's how the smallpox vaccine works, or more correctly did work in the 19th century -- but I don't know if such a close relative exists. The Marburg virus is related to EBOV, but it is deadly as well.; 10/15/14, 9:41 AM
Brando said...: Considering how botched our response is when (a) there's only a handful of Ebola cases popping up in this country and (b) Ebola is not easy to transmit compared to say the flu, this doesn't give me a lot of confidence for how we might handle a far more infectious disease hitting the country at several points. Particularly if some terrorist group were to use that disease as a weapon to sow death and panic.

How many years of new Cabinet departments, issue czars, and making us take our shoes off at the airport only for us to belatedly realize that nurses weren't properly covered when handling Ebola cases and we rely on the honesty of desperate Ebola patients in letting them into the country? If this were written into a movie, the script doctor would have to change it because audiences wouldn't believe the authorities could be so incompetent.; 10/15/14, 9:43 AM
Quaestor said...: phx wrote: Wake up.

Thanks to Obama that option is a non-starter.; 10/15/14, 9:44 AM
Curious George said...: Why are we the ones heading to Africa to fight this virus...and why are patients coming here?

I mean we are 24th in the World in health services. Shouldn't they be going to Cuba or something?; 10/15/14, 9:45 AM
ron winkleheimer said...: @Carl

That is, pretty much how the Middle Ages responded to The Black Death. And to think, they had decades to notice, if they'd used a smidge of cold rationality and careful observation, that if you got rid of the rats the plague went away. How blind people can be to something so easily imagined, readily tested, and of immense value if proved.

Assuming that they had figured out that rats where a vector for the plaque, just how do you propose they get rid of the rats?

Guess which city has the largest rat population in the world, New York, New York.

Estimates are that there is one rat for every human in the city, perhaps even more. And this is despite the fact that the city has an ongoing program to control the rat population in an era with access to knowledge and technology far beyond anything available in medieval times.; 10/15/14, 9:48 AM
MisterBuddwing said...: I'm sure there are much more learned people out there who will shoot down this suggestion in two seconds flat. but how about a short-term medical quarantine for anyone - and I mean anyone - who comes to the USA from the Ebola hot zones?

By "short-term," I mean maybe a month. (The incubation period for Ebola is believed to be three weeks, no?)

Before anyone starts talking about internment camps (and believe me, I would be one of the first to do so), we would make it clear that undergoing temporary quarantine would be a pre-condition for entering this country - nobody would be marched into quarantine at the point of a gun.

Well, Britain for many years kept rabies at bay with a six-month quarantine for incoming dogs - how about something less draconian for people?; 10/15/14, 9:52 AM
ron winkleheimer said...: @Carl

In any event, I don't see how pointing out that the government seems to be mishandling the current crisis is anything like "how the Middle Ages responded to the Black Death."

We know what causes Ebola, we know that so far 3 nurses who treated Ebola patients have caught it (two in the US, one in Spain), and we know that there are limited resources for treating Ebola patients.

e don't know how many Ebola patients will be in the; 10/15/14, 9:57 AM
Quaestor said...: The incubation period for Ebola is believed to be three weeks, no?
No.; 10/15/14, 10:03 AM
Beloved Commenter AReasonableMan said...: The NIH budget is 3.1 billion annually. There are 318,901,000 US citizens. That is $94.4 per person. Not exactly extravagant, given its critical importance in protecting public health.

Some seem shocked, shocked about complaints that the NIH budget has not gone up. It is relevant that research gets harder over time. The easy problems get solved and the hard ones remain.; 10/15/14, 10:11 AM
ron winkleheimer said...: What we don't know is how many Ebola patients we will see in the US and how many patients it will take to overwhelm the healthcare system.

My guess at 40-70 healthcare workers per Ebola patient is not that many, especially if healthcare workers stop coming to work because they are afraid they will catch Ebola because they have the impression that the CDC doesn't know what it is doing.

In addition to healthcare workers there are facilities issues such as, for example, medical waste. The report you deride states that waste was left to pile up. This is most likely true since it took seven days or so to arrange for a hazardous waste disposal company to clean up the first patient's apartment. You can't just throw the sheets of an Ebola patient who is suffering from explosive diarrhea into a laundry cart and send it down to the laundry. So, lets take a second to imagine the environment the nurses where working in.

My point is that concern over these matters is in no way irrational. We have no reason to believe that the US government can contain this other than there assurances that they can.

You appear to feel that you are on the side of rationality but it would appear that I and the other commentators are the ones choosing the path of skepticism, not you.; 10/15/14, 10:12 AM
CStanley said...: Fen, the answer to your question is no, and not only in the specific case you posited as an example. There is no reason to think that the person's immune status from other vaccinations would have any effect on the likelihood or rate or type of potential mutations of the virus.

The main factor that does effect that, though, is the rate of infection. Since this outbreak has infected far more people than previous ones, and is continuing to do so, there is a real potential for the virus to begin showing alterations in its genome. SOE. Of that is just random- the virus is replicating, or making copies of itself, at such a high rate that the odds of alterations in that genome will rise. And then there is the evolutionary shift, where the mutations that make it easier for the virus to survive or spread by infecting new patients will be the new genomes that tend to persist because of these survival advantages.

But none of that relates at all to the potentially infected people having received other vaccinations,; 10/15/14, 10:16 AM
damikesc said...: The men and women who are suiting up and going in are amazingly courageous.

I respect them as I respect the Chernobyl cleanup crew. They're taking psychotic risks but their actions can save many. It takes guts that I cannot fathom to do this.; 10/15/14, 10:24 AM
Shanna said...: The incubation period for Ebola is believed to be three weeks, no?
No.

Actually, I think the '42' days mentioned in your link is the incubation period of 21 X 2, which is when they figure the epidemic is actually over. This was mentioned on a podcast I listened to recently.; 10/15/14, 10:26 AM
Quaestor said...: This comment has been removed by the author.; 10/15/14, 10:36 AM
Quaestor said...: Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval.

3% of confirmed cases in the study incubated Ebola longer than 21 days. That's small but significant, especially given the 70% mortality rate.

Three weeks is an inadequate quarantine period.; 10/15/14, 10:42 AM
Fen said...: Bubonic plague is caused by a bacterium called Yersinia pestis. An immunization against plague would be of no avail against Ebola. Vaccines are very specific to the organism because our immune systems are similarly specific.

Gah. I am not communicating this effectively and don't know the terminology well enough to do so.

Drop the Bubonic, it was a hypothetical.

What I am trying to ask is: if I have immunizations/antibodies from Virus A already in my system, do they figure into Ebola's mutations?

Can ebola "grab" parts of them to make itself more/less resistant or lethal.

Maybe an airborne flu vaccine is a better example? We immunize ourselves by injecting a "lesser" strain to create anti-bodies (and my science may be all borked up here). What does ebola do when it encounters them? Is it possible for it to say "oh lookie an airborne virus, I think I'll grab some of that when I replicate/mutate"

[and apologies if my ignorance in framing the question has frustrated you]; 10/15/14, 10:43 AM
Fen said...: Oh great - 2nd case flew Dallas to Cleveland day before she recognized symptoms; 10/15/14, 11:01 AM
CStanley said...: Fen, see my 10:16 comment.

It's a no.

To further answer the part you just posited about "grabbing"- after you are vaccinated, the viral parts don't persist in your system. Instead, you have immune cells that have a memory of what they encountered, which could then be activated if or when the real virus is encountered. So basically, there is nothing there for the Ebola virus to "grab".; 10/15/14, 11:03 AM
Shanna said...: 3% of confirmed cases in the study incubated Ebola longer than 21 days.

Hmm, I scanned it and didn't see that, but I think I've seen mentioned as long as 25 days. I would love to see the background data on that. I suspect it is all epidemiological (which is where this 'you are not contagious until sick) comes from.

But 2X21 is how long they wait until determining a country is free from infection.; 10/15/14, 11:06 AM
Quaestor said...: What I am trying to ask is: if I have immunizations/antibodies from Virus A already in my system, do they figure into Ebola's mutations?

No model of mutation that I've ever heard of would support that idea. Viruses mutate spontaneously.

Perhaps if we discuss viral reproduction you'll see this more clearly. A virus can be thought of as a free-roaming genome, i.e. a packet of genetic material that exists outside of a living organism. In fact viruses may not be "alive" in the strict sense of the term, since they neither consume energy or reproduce. A virus is typically a protein capsule enclosing a strand of DNA or, as in the case of Ebola, RNA. That's it. There's no molecular mechanism for DNA transcription or replication, nor any mechanisms for protein synthesis -- they're entirely dependent on living cells to do those jobs for them. Basically a virus hijacks a living cell and compels it produce replica viruses at the expense of its normal functions. In the process of replication changes to the DNA sometimes occur. (This is normal. DNA replication is not perfect, if it were we'd all be bacteria.) There are also substance and environments which are know as mutagenic, i.e. promoting mutation, such as 2-Amino-6-chloro-3-nitropyridine and ionizing radiation, but these are not as important as normal replication errors.; 10/15/14, 11:15 AM
traditionalguy said...: A rational response to the failure of political speeches given at CDC would be real leader of a Task Force with power to enforce quarantine areas for travelers and run by an honest MD that has good communications skills.

I nominate Sanjay Gupta, if CNN lets him go. He is the real thing.; 10/15/14, 11:19 AM
Fen said...: Quaestor & CStanley - thanks! That makes sense to me.; 10/15/14, 11:26 AM
Quaestor said...: Perhaps I should add that mutation is also a random process. While some sequences are more prone to mutation than others, there's nothing to suggest that viruses appropriate the characteristics of their hosts or other organisms.

This is not true of certain bacteria, however. Some bacteria engage in a kind of pseudo-sex which entails exchange of genetic material. For example it has been shown that S. aureus can share immunity with other strains of staph.; 10/15/14, 11:32 AM
Julie C said...: Well, it must be serious now. Drudge reports that Obama just cancelled a fundraiser!

P.S. If you haven't watched the Gupta demonstration mentioned by John Henry, go do so now. The head of the CDC should be tarred and feathered, figuratively speaking of course.; 10/15/14, 11:33 AM
Bruce Hayden said...: The NIH budget is 3.1 billion annually. There are 318,901,000 US citizens. That is $94.4 per person. Not exactly extravagant, given its critical importance in protecting public health.

Some seem shocked, shocked about complaints that the NIH budget has not gone up. It is relevant that research gets harder over time. The easy problems get solved and the hard ones remain.

Not surprising from ARM. NIH budget increased significantly under GW Bush, but has been flat under Obama. What seems to have happened though is that an ever increasing portion of that budget gets flushed down politically correct toilets and like. And then, the Republicans are tarred because they refused to increase funding enough to cover both the base objectives, and the politically correct wastage, and ignore the reality that if the agencies had remained targeted as they were designed, there would have been plenty of money.

And, yes, lesbian obesity, chimps throwing excrement, etc is much easier to research than dealing with Ebola, SARS, etc. But that doesn't mean that they shouldn't have remained focused on their official core missions.; 10/15/14, 11:34 AM
Quaestor said...: Well, it must be serious now. Drudge reports that Obama just cancelled a fundraiser!

Insignificant. Now if he'd cancelled a golf date...; 10/15/14, 11:36 AM
ron winkleheimer said...: @Carl

Oh, one other thing. Turns out Medieval society did try to keep rat populations under control. Thus the profession of rat catcher.; 10/15/14, 11:37 AM
Julie C said...: Did you hear about the actual "Czar" that's supposed to be responsible for this kind of outbreak? She's been laying low because a few years ago, she was the center of a scandal involving funneling government money to a Democratic donor's company AWAY from the company that's developing the Ebola treatment. She's still got the job, still getting paid, and hasn't made one public appearance since the Ebola outbreak.

Hope and change!; 10/15/14, 11:37 AM
Shanna said...: P.S. If you haven't watched the Gupta demonstration mentioned by John Henry, go do so now. The head of the CDC should be tarred and feathered, figuratively speaking of course.

Look at what they are recommending versus what they are using in Africa. Sheer madness. They aren't even recommending head covering or double gloves. Those were some of the things Texas added, if I understand correctly, as time passed.

The CDC should have been on top of it. They weren't. This is on them.; 10/15/14, 11:40 AM
viator said...: The Dallas nurses speak:

CNN; 10/15/14, 11:50 AM
Beloved Commenter AReasonableMan said...: Bruce Hayden said...
NIH budget increased significantly under GW Bush, but has been flat under Obama. What seems to have happened though is that an ever increasing portion of that budget gets flushed down politically correct toilets and like. And then, the Republicans are tarred because they refused to increase funding enough to cover both the base objectives, and the politically correct wastage, and ignore the reality that if the agencies had remained targeted as they were designed, there would have been plenty of money.

The budget has fallen under Obama because of the failed austerity policies of the house Republicans.

With basic research programs it is usually possible to find some odd or apparently trivial one. Proxmire did it for years. It is even easier with the military budget. Yet, medical research moves forward at a remarkably rapid pace largely thanks to the efforts of NIH. If a vaccine for Ebola is possible it will be found largely thanks to the efforts of NIH.; 10/15/14, 11:53 AM
Anonymous said...: Curious George: Why are we the ones heading to Africa to fight this virus...and why are patients coming here?

I mean we are 24th in the World in health services. Shouldn't they be going to Cuba or something?

Touché.; 10/15/14, 12:49 PM
Fen said...: AReasonableMan: The budget has fallen under Obama because of the failed austerity policies of the house Republicans.

Ha! You have no shame. Are you really that stupid? Or is it just desperation?; 10/15/14, 3:09 PM
Skeptical Voter said...: But Cap'n Clusterfark assured us that everything was in place and all the hospitals were "shovel ready".

As in shoveling new graves.; 10/15/14, 5:04 PM
HoodlumDoodlum said...: ARM said...The budget has fallen under Obama because of the failed austerity policies of the house Republicans.
I don't think that's a reasonable conclusion, there, ARM. The President's budget represents his (or her!) priorities.

The 2013 federal budget total is $3.8T. 2012's was $3.7T, 2011's $3.8T, 2010 $3.6T, 2009's $3.1T 2008's $2.9T, 2007's $2.8T 2006's was $2.7T, 2005's was $2.4T, 2004's was $2.3T, and 2003's was $2.2T.

In 10 years the budget has grown from $2.2T to $3.8T. Do you notice any large decreases in the totals for the last few years? I don't. I understand that people want to use the word austerity to mean "an increase smaller than I want" but that is not what the word means. If this President and his Adminstration didn't set aside adequate funds in his $3+ Trillion budget (or fight for additional funds, make the case for moving money from another funding priority, etc) surely they deserve most of the blame for that, right?; 10/15/14, 5:13 PM
Brent said...: ". . .but, instead of spending the money they got where it should have been spent (according to their mandate), much of it was squandered on other progressive projects."

You think? Like the NIH spending 250K on a website game for the First Lady's garden. Or 500K to prove that chimps who fling their feces are better communicators? I'm not making this up.

http://www.100percentfedup.com/news/2494-poop-throwing-chimps-and-other-crazy-studies-spend-money-now-needed-for-ebola-research; 10/15/14, 5:36 PM
Beloved Commenter AReasonableMan said...: HoodlumDoodlum said..
In 10 years the budget has grown from $2.2T to $3.8T.

Discretionary spending is typically set by the House and Senate Appropriations Committees and their various subcommittees. Most of that increase is in non-discretionary or mandatory spending.; 10/15/14, 8:51 PM
Achilles said...: AReasonableMan said...
HoodlumDoodlum said..
In 10 years the budget has grown from $2.2T to $3.8T.

"Discretionary spending is typically set by the House and Senate Appropriations Committees and their various subcommittees. Most of that increase is in non-discretionary or mandatory spending."

Obama, the democrat majority in the senate, and the progressives in the bureaucracy of the NIH have at least some culpability in the failure of the Center for Disease Control to actually control diseases. The appointee running the CDC is a political hack that worked for nanny Bloomberg banning soda's.

You progressives are not even trying to hide it now. The CDC has plenty of resources to do its job. You guys just want it to use those resources to take away my guns instead of controlling diseases.

Disgusting people. Boring too.; 10/16/14, 2:45 AM