Dallas hospital isolates possible Ebola patient | Page 7 | Emergency Preparedness | Forums

John Hopkins had a ebola symposium the other day, can re watch it here

http://www.jhsph.edu.....eo-archive

Someone wrote down some hi-lights

“I know a hell of a lot less about Ebola than I did 6 months ago.”

“I am of the notion that we have a lot of unexpecteds ahead of us…Do not expect that anything carved in stone today will not be blown up by some scientific or intellectual piece of dynamite; it might be.”

“One of the things that I find very concerning today is the amount of hubris we have about what we know about ebola from the standpoint of what our history has been with Ebola virus.”

“We’ve had roughly 2400 cases of illness; that’s in 40 years…this virus has hardly pinged the human species until now and yet we have this sense that we know so much about it…and maybe we do; but something has changed.”

“Is this the same Ebola outbreak as the past? No it’s not. Is it the same virus in a different setting? It could be.”

“Let’s acknowledge one thing: we are making this up as we go…and in doing that we have to become more comfortable with uncertainty. I categorically reject the idea that you can’t tell people you don’t know because you’re afraid you’ll scare them.”

“One of the worst enemies we can have today is dogma. Dogma should be, at the first instance, the thing we jettison immediately…do not fall into the trap of dogma. I see far too many today doing that for the fact that they want to reassure the public about A,B or C and that is a dangerous path.”

“In the piece I wrote in Politico…I laid out three plans: plan A, plan B and plan C. And I started out by saying that we’re failing miserably with plan A, and plan A was trying to stop Ebola dead in its tracks in the three affected countries using the techniques we had used so well for so many years.”

“Imagine you have this incredible distance swimmer who can go 4 mph, hour after hour after hour, but you put him in a river where the current is going 6 mph downstream and you say ‘swim upstream;’ every hour he or she is 2 miles farther downstream than where they started.”

“In terms of plan A we have to accept the unpredictability of the epidemic. We’re in uncharted waters over there; we don’t know what we’re really working with. We don’t. We just have to acknowledge that.”

“[Forecasting] is another one of those areas where hubris could get us in trouble. My answer, which is really simple, is there’s just going to be lots and lots and lots of cases and lots and lots and lots of deaths but we don’t know what that number is going to be and we just have to accept that fact.”

“Progress is painfully slow…the virus [is] operating on virus time and all the rest of us [are] operating on bureaucracy time. And the virus [is] winning hands down.”

“I commend the US Government’s response. No other country in the world has put forward the same response that the US has, [and yet] the US response has been woefully inadequate, because it’s up against virus time.”

“We have to understand the health system in these three countries has collapsed completely.”

“I am ready to acknowledge, you know, I’m swimming four miles per hour but the current’s six miles per hour; it’s not going to be enough. Let’s not fool ourselves and let’s not tell the world it’s going to be enough.”

“We have to understand what is very likely to happen [in West Africa]…If we’re worried about this infectious disease forest fire in Africa burning away and the sparks firing occasionally into Dallas or wherever, imagine that wind is drifting to the east right now. I don’t know how it won’t get into those other countries…if West Africa was a can of gas waiting for a match to hit it, the rest of central Africa is a tanker truck waiting for a match to hit it, and we don’t quite get that yet. And there is no plan B; there is no plan B. How would we fight this, if in fact, this were to suddenly flare up in one of these cities along the belt in equatorial Africa, what would we do? Would we fight it on two fronts? We can’t fight it on one front.”

“So what’s plan C? Plan C for me is the only hope we really have, and that’s Vaccine. I’m convinced of it. I believe this will be an endemic disease.”

“One of the things that we really have to understand here is that we don’t understand what’s going on…and that’s why I think this is going to be an endemic situation and vaccine will be the answer. Having said that, I’ve got great concerns about the vaccine situation right now. I think we’ve got great candidate vaccines…I do believe we can have an effective Ebola vaccine; I am convinced of that, I really believe we can, but there is a big disconnect between the time it takes to get us there and then getting it into somebody in Africa.”

“We urgently need an international research agenda; we have none. I understand in a time of dire humanitarian straits, it’s hard to do research, but we’re not doing research for research sake, we’re doing research for prevention, because we have lots of major questions that we’ve got to get answered…I think it is a travesty we’re this far into this outbreak and we have a single set of viral isolates with genomic data from one location in Sierra Leone from May and we’ve got people making pronouncements about what this virus is doing; they don’t know what the hell they’re talking about. We don’t know what’s going on. We need to have that kind of agenda right now. We need to understand transmission better. What is happening there? Why is this different? Is it just the population or are there other things going on? And I don’t know that there is and I surely don’t people to walk away saying, ‘well, that’s scary,’ but we have an obligation as scientists not to have another black swan event.”

“We need much more data and clinical virology. I see evolutionary biologists and bioinformatics people commenting all the time about what’s happening there [in West Africa] and we don’t have a clue.”

“Finally, the issue on risk communication: I just have to say right now, we have to do a better job…we have a problem with the fact that we think we’re going to scare people and so we’re always couching things in certainty for which certainty does not exist, and we have to start being honest about that. That is different than being scary. We don’t really understand [these] issues.”

“I have personally heard from clinicians with a whole series of cases, where people did not ever present [with a fever] for the entire time, from the admission at the treatment center until they died. There was never any documented 101.5 fever. They never did [have one]. Well now we have focused so heavily on fever for screening, in our clinics and so forth, [that] what if somebody presents that doesn’t have a fever? What happens then, when the media gets all over that and says ‘you told us there would be a fever but now this patient has been found to have Ebola but didn’t have a fever, you didn’t know what you were talking about…’ Now is the time to anticipate that and say, ‘you know, most patients are going to have a fever…but we don’t know about this group and we’re trying to learn more about it…’ Tell them what might happen…then when it happens, and I believe it will happen, you don’t have to feel like you didn’t tell [the public] the complete truth.”

“Airborne in the immediate patient space…we really have never been in a position to judge whether airborne transmission could happen because it’s always been overwhelmed by the close contact transmission that’s there. But aerosols are created, I’ve worked on too many outbreaks of Norovirus infection, where somebody like me up at the podium vomited, and I nailed the first seven rows here [infecting them] over the next 48 rows with norovirus, even though no one ever touched the vomit. We’ve seen far too many things like that; we don’t completely understand.”

“We never could quite study it [airborne transmission of Ebola].”

“[Separate from close-proximity transmission just discussed] I raised the issue about the potential for airborne transmission [of Ebola] being a respiratory-transmitted agent…I raise that because I’ve been talking to a number of Ebola virologists who are very concerned about it; they were concerned about it so that made me concerned about it. Some of them have spoken out and been cited in the media recently…and it’s not this great evolutionary mutation…Carl Zimmer, who most people would say is a noted science writer, [wrote] in the NY Times this week that, ‘the chances of an American getting Ebola are tiny. While viruses are known for mutating, Ebola itself is very unlikely to change so much that it could go from being fluid-borne to airborne. That’s just fear. That’s like saying you’re afraid of wolves and you’re really worried that one day wolves are going to be born with wings and are going to fly around and attack people and they’ll fly from Montana to New York. That’s just not a realistic worry. Evolution doesn’t work that way.’ Well you know what, I was one of those people early on explaining why HIV was never going to be a respiratory pathogen: because we understood the physiology of the lungs, we understood which cells the virus was in and we understood that was not going to be an issue; that’s different than this [Ebola]. Number one, we’ve had examples with sub-human primates where transmission of Ebola virus has occurred via the respiratory tract. We had one where pigs transmitted to sub-human primates…I think the point being here is that some people are concerned because we don’t know or understand why that virus passed the first time in those sub-human primates.”

“Today I’ve been given permission [to share] something I’ve known about for a few weeks that has concerned me greatly. Gary Kobinger and colleagues at Winnipeg Canadian National lab actually took one of the strains from Guinea and put it into Macaques a little over a month and a half ago. What they saw was remarkable. It was unlike any of the Ebola viruses they’ve seen in monkeys. It was much, much more severe; the pathology in the lungs was remarkable. As Gary [Kobinger] said, [and he] is one of the most prominent Ebola virologists in the world, ‘[what I saw] was very worrisome to me.’ Maybe this is a different virus. Maybe there is that possibility that if you have that much virus in the lungs [then airborne transmission is possible]. Maybe somebody might cough it up and maybe you might get a cycle. Now I’m’ not saying that to scare people. Plan B; what the hell are we going to do if we suddenly see the potential for transmission that might be respiratory in nature. Do we have a plan?”

“What if we had another black swan event, where now we really had a reason to be concerned about airplanes? I don’t know what that chance is, but I want somebody to be thinking about it and I want a plan. And it’s not based on just idle speculation.”

“Let me just conclude by saying: we all want certainty in this situation, I guarantee you we will not get it. Mother Nature will not allow us that. We’ve got to stop providing certainty. We can still provide good science, we can still provide very effective public health messages and we can still be in control of our destiny as it relates to how we respond. But the virus is in control right now; we have to understand that.”

can't listen to the video at work, but if they are talking about the dude in plain clothes, I saw this earlier

Updated at 3:04 p.m. ET: The mystery man has been identified as a medical safety coordinator with Phoenix Air, the U.S. transportation company that has provided air ambulance services for several Ebola patients.

Dallas nurse Amber Vinson was transferred to Atlanta's Emory University Hospital Wednesday for ongoing treatment after being diagnosed with Ebola. She was helped from an ambulance onto a waiting plane by four medical workers in the now-familiar white hazmat suits, but there was one other person on the tarmac.

According to CBS 11 News in Dallas, questions about who the man wearing plain clothes and carrying a clipboard might be poured in.

"On social media, and on the CBS 11 News phone lines, the biggest question became -- who was the guy not wearing protective hazmat gear?" said CBS Dallas.

Later Thursday, the mystery man, who boarded the plane after all the others and reemerged on the tarmac in Atlanta, was identified as a medical safety coordinator with Phoenix Air, the U.S. transportation company that has provided air ambulance services for several Ebola patients.

A company executive told CBS News the safety coordinator doesn't wear gear so he can act as the team's eyes and ears on the tarmac. They're trained to keep a safe distance from patients. Phoenix Air says it has transported 11 Ebola patients and no crew members have contracted the virus.

Contacted by CBS Dallas, a CDC official said earlier that it appeared the man had maintained a safe distance from Vinson while working on the tarmacs at both ends.

The CDC official stressed to CBS Dallas that only the workers in protective clothing were coming into direct contact with Vinson, and that the man didn't appear to breach any of the protocols put in place for the handling of patients with the highly infectious disease.

Still, the incident prompted questions.

CLARIFICATION: In his "CBS This Morning" report on Thursday, Dr. Jon LaPook commented on video from Dallas that showed a man dressed in civilian clothes while two workers in hazmat clothing helped Ebola patient Amber Vinson, also in hazmat gear, on to a plane. Here is an update:

"The video of nurse Amber Vinson boarding the plane to transport her to Emory shows a man with a clipboard on the tarmac. He was not wearing protective gear, raising the question of whether proper protocol was followed. However, today I spoke to the man with the clipboard. He is a physician and he was following protocol. He is a medical safety coordinator and his purpose is to be the eyes and ears on the ramp to make sure things are being done correctly. The protective gear worn by the other two members of his team impedes their peripheral vision, so the man with the clipboard actually had the best "big picture" view. The company, Phoenix Air, has transported eleven patients with Ebola over the past two months and no healthcare worker on its team has become infected - evidence that when protocol is properly followed, healthcare workers can be protected from being infected with the Ebola virus."

http://www.cbsnews.c.....YHF4eb9d17