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Dallas hospital isolates possible Ebola patient
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spotted-horses
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17 Oct ’14 - 5:07 pm
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Does anybody know why the "F" they are flying these patients to different places?

Be RADICAL Grow Food

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17 Oct ’14 - 5:11 pm
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from my understanding, better medical care

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18 Oct ’14 - 9:02 am
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this is kind of disturbing if you think about it

The state-of-the-art infectious disease centers now treating Ebola patients in the U.S. have world-class doctors and nurses with years of training, hot pressure chambers that can sterilize more than a ton of contaminated waste, and a record of success handling some of the world’s most demonic pestilence.

What they don’t have is a lot of room for patients.

Only four hospitals in the country have high-level containment units specially designed for treating exotic infectious diseases such as Ebola, according to the U.S. Centers for Disease Control and Prevention. Each has the capacity to treat only a handful of Ebola patients at once.

“If there are any more mishaps we’re going to need more beds,” said Robert Glatter, an emergency room doctor at Lenox Hill Hospital in New York. “We need to significantly increase” the number of sophisticated containment units.

The debacle at Texas Health Presbyterian Hospital Dallas, where two health workers were infected with Ebola while treating Thomas Eric Duncan before he died, exposed the lack of preparedness for treating Ebola at many hospitals. While various major hospitals are now gearing up to treat Ebola, for now patients are being treated at just these handful of centers.

Atlanta Hospital

Emory University Hospital in Atlanta, which is treating Amber Vinson, the second Dallas health-care worker to be infected by Ebola, has capacity for three patients in its biocontainment unit, which was created in 2002, said Holly Korschun, an Emory spokeswoman, in an e-mail.

 

Over the years, its workers “were trained in the use of personal protective equipment like full-body suits, and they ran drills for a dozen different scenarios,” she said.

The National Institutes of Health Clinical Center, which is treating Nina Pham, the first Dallas health-care worker to be infected with Ebola, has capacity to take two patients, an NIH official told Congress on Thursday. The unit, in Bethesda, Maryland, is designed to provide high-level isolation capabilities, the NIH said in a statement.

The biocontainment facility at the Nebraska Medical Center, which is treating NBC cameraman Ashoka Mukpo, would most likely be able to handle two to three patients at a time, depending on the severity of the cases, said Christopher Kratochvil, associate vice-chancellor for clinical research at the University of Nebraska Medical Center, in a telephone interview.

Montana Facility

A fourth biocontainment facility in Montana, designed to treat workers from the NIH’s Rocky Mountain Laboratories in cases of accidental infection, has three patient rooms, according to a 2010 article in Emerging Infectious Diseases.

The high-level containment units weren’t necessarily designed with Ebola in mind, said Rick Davey, deputy clinical director of the National Institute of Allergy and Infectious Diseases division of clinical research, on a conference call with reporters. Instead, they were developed to safely treat workers from various national facilities who became infected with pathogens in accidents, he said. Among other features, the units have state-of-the-art air handling capabilities so microbes can’t get out.

“The staff training and drilling and re-training and re-drilling that all of these units have undertaken over a process of years has prepared them thoroughly for this current outbreak,” Davey said.

Ebola is challenging to treat safely because patients release large amounts of vomit, diarrhea or blood as the disease becomes more advanced, and the fluids can contain large amounts of infectious virus. Patients can lose as much as 5 to 10 liters of bodily fluids a day, according to a presentation by an Emory University infectious disease specialist, Bruce Ribner, at a medical conference in early October.

350 Boxes

At Emory, in just a three-week period after its first Ebola patient arrived, the hospital had to sterilize 350 boxes of medical waste weighing more than 3,000 pounds using a device called an autoclave, according to a webcast of Ribner’s presentation at idweek.org.

They filled several trailers sent off for incineration, according to the presentation.

Dealing with fluids “is a huge problem,” in treating Ebola patients, according to Sean Kaufman, a biosafety expert who was involved in infection control when the first two Ebola patients were treated at Emory in August. “The challenge of cleaning up large spills is substantial,” he said.

Kaufman has since left Emory and is now training doctors in Liberia.

‘Engineered Properly’

Emory “did a lot of things right,” Kaufman said. “They had a beautiful facility that was engineered properly. They had the best personal protective equipment. They had outstanding standard operating procedures. And they had great administrative control.”

For example, Emory used full-body suits and head gear, going beyond the minimum recommendations of the Atlanta-based CDC at the time, because nurses were more comfortable in them, according to Kaufman.

It also was important to have someone not involved in care watching over the caregivers to make sure they don’t inadvertently slip up and infect themselves, Kaufman said. At Emory, he said, “I sat in there with them for 15 hours a day for close to two weeks to make sure they did what they were supposed to do.”

The first two Ebola patients Emory treated -- aid worker Nancy Writebol and doctor Kent Brantly -- recovered and were released. A third patient who arrived at Emory on September 9 is recovering and expects to be released soon, according to a statement from the patient released by Emory on October 15.

Prior Training

The biocontainment facility at the Nebraska Medical Center, which successfully treated doctor Rick Sacra, has 40 employees from a variety of backgrounds. They include surgical nurses, respiratory therapists, nursing assistants and infectious disease doctors.

Five to seven staff members work on the unit at any one time treating a given Ebola patient, said Kratochvil, associate vice-chancellor for clinical research at the University of Nebraska Medical Center.

“To be able to perform at this level will really be based on the prior training of the hospital,” Kratochvil said by telephone. “The level of care required for the personal protective equipment with Ebola is higher than what most hospitals are used to.”

Nebraska’s unit has a dedicated individual who monitors the application and removal of protective equipment.

Less Time

Since receiving a second Ebola patient, the hospital has established a lab within the biocontainment unit to test blood and biological samples on site. That cuts down on the time it would take to sterilize the outside of a sample package before shipping it out for testing.

While the Nebraska facility has 10 beds distributed in five double rooms, Kratochvil said it would be difficult to put two Ebola patients in any one room given the equipment needed to treat them, and that the facility would most likely be able to handle two to three Ebola patients at a time, he said.

At the NIH Clinical Center in Maryland, Nina Pham is overseen by two nurses in her room at any one time, with other nurses outside watching to make sure procedures are followed.

Both Emory University and Nebraska had the advantage of knowing in advance that Ebola patients were coming, giving them time to prepare.

‘Advance Notification’

“They were fortunate that they had advance notification of that these patients were coming, versus the hospital in Texas where the patient just showed up,” said Mark Jarrett, chief quality officer at the North Shore-LIJ Health System, which has 17 hospitals in Long Island and New York. “It gave them a chance to make sure everything was put into place.”

Nurses and doctors need “ample training” in how to isolate and treat Ebola patients safely, including detailed training on how to take protective equipment off and observers who can help nurses and doctors do this, said Glatter, the emergency physician at Lenox Hill Hospital. Holding frequent drills or simulations is crucial for hospitals to be prepared for treating an Ebola patient in case one walks in the door.

Being able to treat an Ebola patient without spreading the disease “is direct proof of how well you are doing” in infection control, said Glatter.

http://www.bloomberg.....rooms.html

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18 Oct ’14 - 2:47 pm
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Wanted: Ebola screeners at JFK for $19 an hour

 

They’re looking for the few, the proud — and the really desperate.

For a measly $19 an hour, a government contractor is offering applicants the opportunity to get up close and personal with potential Ebola patients at JFK Airport — including taking their temperatures.

Angel Staffing Inc. is hiring brave souls with basic EMT or paramedic training to assist Customs and Border Protection officers and the Centers for Disease Control and Prevention in identifying possible victims at Terminal 4, where amped-up Ebola screening started on Saturday.

EMTs will earn just $19 an hour, while paramedics will pocket $29. Everyone must be registered with the National Registry of Emergency Medical Technicians.

The medical staffing agency is also selecting screeners to work at Washington Dulles, Newark Liberty, Chicago O’Hare and Hartsfield-Jackson Atlanta international airports.

“Wow, that’s really scary . . . Be safe everybody,” Facebook user Jaclyn Namer wrote under a posting for the job.

Others were a little more eager to lend a hand.

“I can help on weekends in Chicago,” Jeremy Voris volunteered on Facebook.

As part of the new screening process, travelers arriving from Sierra Leone, Guinea and Liberia must answer questions upon arrival, then have their temperatures taken with no-touch thermometers, CDC Director Thomas Frieden announced last week.

http://nypost.com/20.....screening/

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20 Oct ’14 - 8:39 am
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Some good news

ABUJA (AFP) - Nigeria - Africa's most populous country - was declared Ebola-free on Monday as European Union foreign ministers thrashed out measures to help halt the spread of the deadly disease.

The World Health Organisation said Nigeria's was a "spectacular success story that shows to the world that Ebola can be contained" as the country, where eight people died from the outbreak, defeated the disease.

In another piece of good news in the battle against Ebola, test results show that a Spanish nurse who was the first to have contracted the virus outside Africa has been apparently cleared of her infection.

But the fight was far from over against the outbreak which has claimed more than 4,500 lives, most of them in Liberia, Sierra Leone and Guinea.

- See more at: http://www.straitsti.....NhvdG.dpuf

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ashleigh11
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21 Oct ’14 - 5:09 am
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I thought I would post in this thread and offer my 2 cents to the Ebola discussion as a health care worker and someone who is trained in epidemiology.  At my night job, I  work as a paramedic in a large, busy inner city emergency room.  My much less exciting day job is in IT.   In addition to my paramedic training, I have a Bachelor's in biology and chemistry, a Masters of Public Health in epidemiology, and a certificate in molecular biology. My favorite job, though, is being a dad.  I have 5 kids, and if I could figure out a way to get paid to be a dad, I wouldn't do anything else.
 
As a health care worker who knows a little about infectious diseases, Ebola is a little scary.  It's scary because infection control at a hospital is tenuous at best, and adding a deadly disease agent will expose any shortcomings.  Shortcomings=health care workers getting sick and maybe dying. 
 
As an epidemiologist, the thought of Ebola in America doesn't scare me all that much, right now.
 
I'll go on to explain those two main sentences  above, but what it all boils down to is that when I go to work at my night job, I know that there are dangers of infectious diseases, but when I go to church, go to the grocery store, or go to mixed martial arts training, I don't worry too much. 
 
The reason the Ebola scares me, as a healthcare worker, is that hospitals (at least the one I work for-one of the top hospitals in the region) are unprepared for REAL infection control from the top down.  Case in point, the medical director of our emergency room was featured on the local news and said that we (as a department I assume) were prepared, and that we had been "working on this for months".  Everyone that works in our ER knows he told a boldfaced lie.  That afternoon, the first email about Ebola was sent to all of us from the hospital's infection control officer, probably as an oops, we better get on record.  That email was a FAQ about Ebola and contained nothing about donning and doffing personal protection equipment (PPE), which is the most basic and important infection control procedure for a health care worker, and nothing about the department's action plan for caring for a potential Ebola patient. You see, behind the flowery hospital mission statement, the most important thing we do is maintain market share and patient satisfaction.  Proper infection control is slow, methodical, and doesn't generate income or increase reimbursement.  (patient satisfaction is another rant)  I'm sure that department heads across the health system-ER, lab, respiratory therapy, radiology, phlebotomy, lab, inpatient care-are all scurrying to try to figure out policy and procedure.  At least I hope they are.
 
Fast forward a week later, and we come into out pre shift meeting and there is a bath basin filled with PPE in the middle of the table with a laminated card about donning and doffing procedures.  I looked through it and it was missing some key items such as a full face shield and a hood that would cover the head and overlap with the full face shield, protecting our most vulnerable parts.  (eyes, nose, mouth are the most vulnerable infection routes-I assume we won't be having sex with our Ebola patients)  Our actual donning and doffing training consists of  practicing late in our shift, patient load allowing, under the watchful eye of another untrained nurse or paramedic.  None of the doctors  participated.  Watching, as a person who has worked in a Level III biolab, only a couple of hazmat trained firefighter/paramedics correctly donned and doffed the PPE correctly.  There were a lot of laughs and "oops, I'm dead".  I had to walk out.  You see, donning and doffing PPE is just one of the procedures you do in biocontainment.  It is slow and methodical for a reason.  One misstep and you are exposed, and worse, you may take the agent home to someone you love.  Add patient care of a sometimes violently ill patient and you can see where two nurses, like in Dallas, can get infected.  Then I see my coworkers not being fastidious with something as simple as handwashing and I just have to shake my head.
 
The actual action plan of the department on the procedures surrounding the intake of a suspected Ebola patient is largely rumor,  there hasn't yet been a dry run of how this will all work, and none of this is written down, which makes it gospel.  The only people who really seem to know what their role and specific procedure is, is security.  They question everyone who enters about their chief complaints and travel history.  If the patient gives key answers, they remove the patient to a small consult room and their role in the process is done.  From there, the whole process poorly thought out and has not actually been practiced. We truly will be winging it, but "we are prepared".
 
As an epidemiologist, though, an Ebola outbreak doesn't really scare me.  The US may have some isolated clusters of cases, but probably won't have an outbreak and certainly not an epidemic.  The words in the last sentence are concise and mean something to an epidemiologist.  There may be a few infected people (cases) that make it to the US who infect a couple of close contacts such as family or caregivers (a cluster) but there will be very few, if any, tertiary cases or linked clusters (outbreak) or any sick populations (epidemic).
 
The factors that are driving the epidemic in Africa just aren't  major problems in the Western world.   First, our civilization doesn't constantly intrude on the reservoir of the virus.  Each time there is an outbreak of Ebola in Africa, humans have crossed the border into the territory of the population harboring the virus.  The closest thing we have had in the US is the 1993 Four Corners hantavirus outbreak.   Second, we don't have the degree of mistrust in our government that exists in post-colonial west Africa.  You think preppers distrust the government, in Africa people won't go to the hospital if they're infected simply because the government suggests they should.  Because of this people get sick and die at home which brings us to the third and fourth factors, close family members caring for infected patients without a basic understanding of universal precautions, and handling deceased family members.  In the west, we take our sick to the hospital even if we don't trust the government and if they die in the hospital, we have funeral directors who take care of funeral arrangements. 
 
 Ebola is scary.  If you are exposed to the Ebola virus and actually contract the Ebola Viral Disease, there is a 7 in 10 chance you will die.  Here is some information to put the Ebola outbreak in Africa into perspective. I'm not saying Ebola isn't dangerous, but I was told one time the most important medical procedure in a time of crisis is to take your own pulse.  Stop what you're doing, get some perspective, and then do what you need to do.
 
The Top Ten Causes of Death in the World.   http://www.who.int/m...../fs310/en/   
 
Six Diseases You Should Actually Worry About http://www.pbs.org/n.....lly-worry/
 
My next shift in the ER is Wednesday from 7p-7a.  I'll go to work wary of the next patient that coughs in my face, the next code brown that I'll be elbow deep in, or the next drunk assault victim who is spitting blood while i dodge their swinging arms and legs.  I might look twice at the obviously African patient (we have a large refugee population from EAST Africa) and wonder what "he's got", but I'll try to concentrate more on calming an agitated elderly patient , allaying a worried  family member's fears, or helping out a stressed out coworker.
 
Peace, 
 
Ashleigh11

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21 Oct ’14 - 5:58 am
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thanks for that awesome post Ash!

Would be interesting to see what the medical directors response would be if there was really a case, a similar situation happened with the possible person at the pentagon last week

Virginia Hospital Center refused to admit thepotential Ebola patient from the Pentagonon Friday, according to county officials, despite the hospital saying two weeks earlier that it was ready to handle such patients.

Responding to an inquiry from ARLnow.com today, the Arlington County Fire Department confirmed reports that VHC refused the woman — who at the time was thought to potentially have the deadly Ebola virus — when medics brought her to the hospital. She never left the ambulance.

“We were turned away,” said ACFD spokeswoman Lt. Sarah Marchegiani. “We followed our protocol and brought the patient to the closest hospital (VHC), at which point we were rerouted to Fairfax Inova.”

VHC has not responded to multiple requests for comment from ARLnow.com. Marchegiani said the hospital claimed not to be prepared for such a patient, even though the department had previously been told VHC could accept suspected Ebola patients.

“The reason told to our medical director was that they couldn’t handle the patient,” said Marchegiani. Earlier this month, however, VHC told TV station WUSA 9 that it was ready to deal with potential Ebola patients.

“Virginia Hospital Center wants to reassure our community that the Hospital has the infrastructure and procedures already in place to screen, and if necessary, isolate, test and treat all high-risk patients. We drill and prepare for just such situations; therefore, our staff is highly trained to take appropriate precautions for a suspected and/or confirmed Ebola case.

A multi-disciplinary taskforce has reviewed our infection control guidelines and reinforced education of the Hospital staff to ensure it can detect a patient with Ebola Virus Disease, protect all healthcare workers so they can safely care for the patient, and respond to the patient in a timely manner.”

An ARLnow.com tipster indicates emergency responders called the VHC emergency room from the scene at the Pentagon, and were told to bring the patient over. The tipster claims hospital administration refused to allow the patient inside once she arrived at the hospital. The person tells ARLnow.com there was a “heated exchange” between the emergency physician and hospital administration inside the emergency room while the patient waited in the ambulance. The tipster also claims hospital administration worried it would lose business if it came to be seen as an “Ebola hospital.”

The county’s emergency officials reportedly have had talks with officials at VHC since the incident. ACFD confirms VHC has agreed to accept potential Ebola patients in the future.

Arlington County officials also have confirmed that the patient had not traveled to West Africa, as she allegedly first told authorities. In fact, she had not left the country at all, the county said, and had no contact with other potentially infected people.

“She had stated that she had traveled to Sierra Leone at the scene and did exhibit symptoms consistent with Ebola, so responders took all appropriate steps,” said Diana Sun, Arlington County’s Director of Communications. “There was an investigative process that went beyond Arlington. During the course of this, people close to the patient were interviewed and stated that she had not left the country. The patient herself, later in the afternoon, recanted her story and said that she had not left the country. When that last piece came in, public health officials felt confident in not pursuing” further testing for the Ebola virus.

There’s no word yet on whether the woman will face any charges.

http://www.arlnow.co.....a-patient/

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21 Oct ’14 - 6:31 am
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interesting, wonder why it was never identified until the 70's

Ebola Is 50 Times Older Than Mankind. And That Could Be the Key to Stopping It.

 

By studying hair from a wallaby, scientists in Buffalo confirmed Ebola and other filoviruses are tens of millions of years old. How the finding may show us how to defend against them.
 
The tiger and the elephant and the polar bear may be stars at the Buffalo Zoo, but it was a humble wallaby that helped scientists prove Ebola is tens of millions of years old, not a mere 10 millennia, as was previously supposed.

Jurassic Ebola.

The determination was made in recent years by scientists at the University of Buffalo who tested wallaby hair from the zoo along with a brown bat snared on campus to confirm what they had identified in existing databases for the first time: The genetic material of various small animals contains “fossil” fragments of filoviruses, the family that includes Ebola and Marburg.

“Who knew that the bats in the attic as well as modern marsupials harbored fossil gene copies of the group of viruses that is most lethal to humans?” co-author Dr. Derek Taylor said when the paper was published in BMC Evolutionary Biology in 2010. “Our findings demonstrate that filoviruses are, at a minimum, between 10 million and 24 million years old, and probably much older.”

Unlike other viruses such as HIV, the filoviruses lack the capacity to create their own DNA and were therefore assumed to be incapable of inserting themselves into a host’s genetic makeup.

Taylor and his co-authors, Dr. Jeremy Bruenn and Dr. Robert Leach, came upon the fossils by chance during a more general database search.  

“It was a fortuitous discovery,” Bruenn told The Daily Beast last week. “I was looking for all viral genomes, and that’s what I found.”

The mammal profiles in the genetic databases included the wallaby, and the scientists decided to verify their finding by looking directly at the animal’s DNA. They asked the director of the Buffalo Zoo for some wallaby hair.

“We didn’t want to hurt the wallaby,” Bruenn says. “They shed hair.”

The zoo is blessed with multiple wallabies and was happy to oblige. The scientists were able to extract sufficient DNA from the roots, and they did indeed find the virus fossils. They got the same result from the campus bat.

 

141018-daly-wallaby-embed
University of Buffalo

Among the other small mammals studied in the databases were two rodents, the house mouse and the Norway rat, that diverged evolutionarily some 12 million years ago. And yet they proved to have the same virus fossils in the exact same chromosome amid billions of possibilities.

The finding suggested that Ebola and its cousins predated the divergence, giving the filoviruses an absolute minimum age far older than the prior estimate, which had been made via mutation rates. The previous guess had been 10,000 years, around the time agriculture emerged. (The earliest fossils of anatomically modern humans are from about 200,000 years ago.)

“Instead of having evolved during the rise of agriculture, they more likely evolved during the rise of mammals,” Taylor said in 2010.

One remaining question was how those fossils got there when these particular viruses had been presumed to lack the capacity to insinuate themselves into an animal’s genetic makeup.

One possible answer was that the animal integrated fragments of the virus into its genes as a result of persistent infection.

This, in turn, raised the possibility that in the course of continued evolution, the mammals had incorporated the fossil as a genetic defense against the viruses—a kind of vaccine generated by natural selection.

And that could now help us in developing our own defenses against a virus for which there is presently no proven treatment.

The results also may accord insight into which animals might serve as hosts for Ebola, carrying the virus with no manifest ill effects.

“The reservoir for filovirus has remained a huge mystery,” Bruenn said in 2010. “We need to identify it because once a filovirus hits humans, it can be deadly.”

Bruenn’s words are now proving all too prescient.

But he and his colleagues are true scientists who prize knowing over being known, and they are not seeking public acclaim now that Ebola is in the headlines.

Bruenn suggested that he spoke to The Daily Beast only because he happened to pick up the phone. He is no lover of attention, and Taylor is said to be even less so, though one photo suggests he does like wallabies.

http://www.thedailyb.....ng-it.html

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