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Dallas health worker who tested positive for Ebola wore ‘full’ protective gear
- deleted 12y ago[deleted]
- chimeracoder 12y agoThe WaPo headline is rather sensationalist. Of course he was wearing protective gear (it would have been news if he hadn't). He may have worn it, but what procedures did he follow for removing it? That's where infections are likely to occur - the article even notes at the very end that the nurse in Spain who was infected was probably infected this way.
- carbocation 12y agoThis is the critical question. She probably dons and doffs protective gear a few dozen times per day, as do most of us who work in a hospital, but we rarely practice doing so correctly. The topological distinction between in and out becomes totally blurred when most people remove their gowns. Therefore, it is probable that many people would think they are correctly removing full protective gear, but have never or rarely correctly removed such gear and therefore got themselves contaminated in the process. Less likely, we don't understand the transmission vector and some fomite is at play. Ideally, in an unusual situation such as this, there should be observers closely eying all contact including de-gowning.
- tripzilch 12y ago> The topological distinction between in and out becomes totally blurred when most people remove their gowns. Make them a different colour on the inside.
- hga 12y agoIt's a bit late for that to be a solution for the current epidemic. And that'll cost more ... calls for a hack, putting tape on the insides or outsides where you need to distinguish between the two. Or a magic marker ... after you determine ones that won't break down the plastic too quickly.
- hga 12y agoSomewhere I read that if you're really serious about this, you get yourself sprayed with something that glows in ultraviolet light, remove the protective gear, and then look for spots where the agent made its way onto you.
- JshWright 12y agoThat's a common training technique (a lower tech method is simply to spread some sticky liquid (like maple syrup) on your PPE).
- ape4 12y agoVideo recording of that room would be interesting. Might be able to find mistakes.
- k-mcgrady 12y agoI'm not sure if that's standard practice but if not it seems like a very good idea. They could use it to find errors or potential errors, refine the protocols and make the information available to all medical workers worldwide.
- wfjackson 12y agoBtw, it's a she, not a he.
- spikels 12y agoSo far this hospital has completely screwed up both in providing medical services and explaining what happened. Does it really make sense that an apparent emergency room worker would be wearing full protective gear including a face shield before they had even diagnosed Ebola? And if so how did the virus get through? Magic? No somebody, most likely the infected person, screwed up. All it takes is a touch of your comtaminated gloved hand to your unprotected face. Like when they blamed the computer system then later denied it was a problem or when they said the initial patient's fever was 101 and it later turned out to be 104 we may have to wait for the truth to come out, if it ever does.
- JosephHatfield 12y agoDo you recall if the original alleged computer system problem mentioned a particular EHR? Not sure I read anything except vague references to software error.
- spikels 12y agoAccording to National Review it was Epic. This makes sense given their market share but keep in mind that National Review have an axe to grind as Epic is a big Obama/Obamacare supporter. Best to find additional confirmation. http://www.nationalreview.com/article/389817/ebola-electronic-medical-records-and-epic-systems-michelle-malkin http://www.nationalreview.com/article/389817/ebola-electroni... BTW - Epic has my local hospital chain by the balls after a few failed attempts to build alternatives. It looks like something from the 1990s - super modal interface in a remote desktop.
- Shivetya 12y agoLets be honest here, the only facilities which did screw it up, Emory being one, are specifically setup and trained for this type of containment. They also knew they had patients coming. This is why Ebola is such a threat. It takes time to incubate, it looks like other less harmful health problems early on, and it spreads. Yet air travel goes on impeded and borders are open. SARS led to more restrictions that Ebola. Honestly it really seems we are trying to rationalize away the problem. We are coming up with excuses for cases that go against what people were told to expect. This is not how you contain a problem, its how you create a bigger one. So what is the threshold before people should be concerned? five more cases? twenty? A hundred? If it gets to a dozen I am pretty sure people will expect travel to locked down and more.
- oskarth 12y agoI posted the following in the now killed thread (https://news.ycombinator.com/item?id=8444976 https://news.ycombinator.com/item?id=8444976): As many commentators undoubtedly will say, additional cases are to be expected. However, it's a problem that both in Texas and Spain, the people infected have been health workers. Health workers that are supposedly well-protected and well-informed about Ebola specifically (at least the spanish nurse was, it's not clear in this case yet). Now it's true that there are more bodily fluids in a hospital than outside, but given all the protection and procedures, is the difference so big that a health worker is at a much bigger risk than a person who happen to sit next to someone infected on a bus? There are two cases as I see it. Either it's likely that other people, non-health workers, have been infected. We just don't know about it yet, or it has been decided that it's not in the public's interest to know. Or the protective measures are so bad, the disease so misunderstood or hard to protect against, that health workers effectively can't protect themselves against the risk. Either case, it's a big problem. In the west too. In that thread people were saying the health worker was infected before they knew Duncan had Ebola. In this thread, when it turns out that the health worker did know Duncan had Ebola, people are saying that it's obvious. Funny how these things work. No one except mainstream US media is advocating panic. That doesn't mean it's not a serious issue that requires our attention. Saying "Ebola is overrated, more people die of X every year, don't panic ffs" doesn't add anything to the debate - it's neither controversial nor insightful. To guide the discussion, here's a suggestion for people who disagree with me. Either argue why there are more than the two cases that I outlined, or argue for why either of the two cases aren't a problem in the coming weeks and months.
- maxerickson 12y agoAt the time you posted this, there were 1 or 3 other comments. Yet you still summarize, In this thread, when it turns out that the health worker did know Duncan had Ebola, people are saying that it's obvious. Going one step further, none of the comments that were posted at the time you made that summary really said much about whether the worker knew that Duncan had Ebola.
- deleted 12y ago[deleted]
- thewarrior 12y agoMaybe we need to create Robot nurses to treat Ebola patients.
- arbuge 12y agoCan be hacked. Still vulnerable to viruses.
- JshWright 12y agoPPE is hard... Every time you take it off is an opportunity for infection. It's very easy to get complacent and not be as careful as you should be (yes, even when dealing with something like Ebola). When you're donning and doffing dozens of times a day, mistakes happen. It's very likely she wasn't the only one to be exposed, but hopefully she's the only one that was infected.
- konstruktor 12y agoThe prevalent culture in medicine still assumes that people can do things correctly all the time. Contrast that to aviation where every interaction has been designed around the fallibility of human beings for decades. You can't change a culture on a moment's notice, just because the threat is more significant.
- toomuchtodo 12y agoDo they do a decontamination shower before you remove your PPE?
- JshWright 12y agoMaybe? I'm a firefighter/paramedic (with training and experience in hazmat operations). I don't know anything about the specific procedures used in this case. I doubt they do in this case though. Probably at the end of the shift, but when you are in and out of a patient's room a dozen times a day, it's not likely they do a full decon each time. EDIT: Just reread your post after seeing frankydp's reply. I thought you were asking about decon showers _after_ removing PPE. frankydp is absolutely correct that showering while wearing most styles of PPE is a bad idea.
- frankydp 12y agoShowers can actually do more harm than good if the equipment is permeable, or the individual did not follow protocol when donning. Meaning even little things like not cuffing your gloves. The can cause overconfidence in regards to contamination.
- ChuckMcM 12y ago
- sidcool 12y agoI wonder what makes this virus so much more contagious that other strains.
- JshWright 12y agoWhat makes you think it is?
- giarc 12y agoIt's actually not that contagious. There is a unit of measurement for this called the Ro number (high #=more contagious). Ebola is about 1.8 currently, pandemic flu was 1.9, measles is 15-20.
- hga 12y agoI gather that a number of 3 is much more likely than 1.8. Still low compare to what's medically "airborne", especially if you factor in that pandemic flu is probably undercounted.
- philwelch 12y agoOnly 0.1 less than pandemic flu seems enough to be worried about given Ebola's mortality rate, if pandemic flu is any precedent.
- giarc 12y ago
- deleted 12y ago[deleted]
- JshWright 12y ago> Or, maybe, this strain is considerably more infectious than initially assumed, and the protocol is inadequate. It's not magic. There's no amount of 'infectiousness' that will penetrate several millimeters of plastic. The simplest explanation is that the nurse simply made a mistake. Either touching exposed skin while still in PPE, or screwing up while taking PPE off.
- powertower 12y agohttp://www.washingtonsblog.com/2014/10/screening-ebola-taking-temperature-cant-work.html http://www.washingtonsblog.com/2014/10/screening-ebola-takin... "Some Ebola experts worry that the virus may spread more easily than thought -- through the air in small spaces, for example." Aerosol transmission is a very real possibility and has been demonstrated in the field and in some experiments, including working its way through the air ducts of a building, from one part to the another, infecting monkeys, and not just through one room. Though some strains are not as effective in that mode of transmission as others. edit: To the down-voters, at least make your case. The people that worked with the virus, and in the hot-zones, made theirs.
- JshWright 12y ago> including working its way through the air ducts of a building It's _far_ more likely that those transmissions were due to cross contact from the folks working with the animals. The researchers themselves suggested that was an equally likely vector.
- pmontra 12y agoContact is far more likely cause of infection, agreed. But when sneezing we spray a tiny amount of fluids. Are they not enough to get infected even with a low probability? Given an high number of occurrences any low probability yields an event.
- powertower 12y agoThat's the definition of "aerosol transmission" here. Depending on the drop size and the viral load in those drops, depends on how far it will travel in air, how long it will be suspended in air, what potency it has, and how likely someone other can get infected when it's inhaled. It's how the most common virus is transmitted... http://en.wikipedia.org/wiki/Common_cold#Transmission http://en.wikipedia.org/wiki/Common_cold#Transmission "The common cold virus is typically transmitted via airborne droplets (aerosols), direct contact with infected nasal secretions, or fomites (contaminated objects)." A person with Ebola going through a crowded airport and sneezing could infect dozens of other people under the right circumstances (virus strain, load, etc).
- Bud 12y agoAt some point, we're going to have to talk about how this black, uninsured man walked into a Dallas hospital, which discharged him and then later lied about his condition when he first went to a hospital. And we're going to need to talk about Republicans slashing CDC funding and every other type of public health funding they could get their hands on. And we're going to need to talk about how the two white Christian missionaries got flown directly to a specialized hospital in Nebraska immediately upon diagnosis, and survived. (edit: very predictable downvoting on this. But it's simply a fact that politics and race have played a part here. I don't like posting it any more than you like admitting it to yourselves.)
- defen 12y agoWhen would you like to talk about the fact that an unmarried unemployed man traveling from the Ebola hot-zone of Liberia (also 5th highest rate of visa overstay) but with Ghanaian citizenship, who had a sister living in the United States, was even allowed into the country to begin with?
- deleted 12y ago[deleted]
- chernevik 12y agoThe WHO cut its infectious disease budge 50% in 2013, shifting the funds to various chronic disease programs. http://www.scientificamerican.com/article/world-health-agency-gets-a-grip-on-its-budget/ http://www.scientificamerican.com/article/world-health-agenc... Its overall budget was flat -- WHO decided to reduce infectious disease activities to fund other priorities. In complete fairness, the article suggests that WHO intended to shift some detection and emergency response responsibilities to member countries, and put some resources in that new paradigm. But even if so, the management of that transition now seems suspect. I've seen various press references that the WHO had its budget cut after the financial crisis. But as near as I can tell (its budget transparency is almost zero), its budget in 2006 was $3.3bn, vs $4.0bn in 2014. The CDC, by the way, has an ample budget, much of it dedicated to non-infectious disease activities like tobacco and chronic disease. A bit goes to gun control. These activities may be worthy, but it isn't clear that they protect public health in the same sense that epidemic control does.
- zippie 12y agoEntering panic mode too fast, according to the chief of the CDC "there was a breach in protocol"[1] Frankly, this hospital mismanaged the index patient from the beginning and though the woman infected now wasn't on the initial list...the list itself wasn't complete because they didn't properly diagnose the index patient ebola to begin with. [1] http://www.cbsnews.com/news/cdc-chief-on-second-ebola-case-there-was-a-breach-in-protocol/ http://www.cbsnews.com/news/cdc-chief-on-second-ebola-case-t...
- 001sky 12y agoIsn't the breach in protocol using anything under BSL 4? The problem is there is no way to ensure BSL 4 outside of a couple specialist labs. So the protocols are basically dumbed down to the lowest common denominator. "Only 15 BSL-4 facilities were identified in the U.S. in 2007, including nine at federal labs."
- hga 12y agoThose are labs, and there's some surge capability, that count of 15 either includes some that can move to BSL4, or there are a few that can do that. There are 4 hospitals in the nation that have a total of less than 20 beds that are set up for diseases like this. Emory (CDC), the NIH in Bethesda, the biggest with 10 beds is in Omaha, Nebraska, and there's one in Missoula, Montana, not far from one of those BSL4 labs.
- hga 12y agoAh, it turns out we have a grand total of 23 hospital beds nation wide in theory qualified for Ebola: 3 at Emory: http://www.emory.edu/EMORY_REPORT/erarchive/2005/July/July%205/isolationunit.htm http://www.emory.edu/EMORY_REPORT/erarchive/2005/July/July%2... 3 in Montana, and they've never used them or put their protocols to the test: http://missoulian.com/news/local/st-patrick-hospital-of-sites-in-u-s-ready-for/article_da521772-4839-11e4-b266-4342d105e33f.html http://missoulian.com/news/local/st-patrick-hospital-of-site... 7 at the NIH, and it sounds like they've gotten some use: http://clinicalcenter.nih.gov/translational-research-resources/resources/special_clinical_studies.html http://clinicalcenter.nih.gov/translational-research-resourc... As mentioned before, 10 in Nebraska, and they don't have a BSL-4 lab handy; hopefully they have, or are setting up, a mini-lab there, for as Emory realized, it's not practical to send samples from Ebola patients to the hospital's main lab: http://www.nebraskamed.com/biocontainment-unit http://www.nebraskamed.com/biocontainment-unit
- tokenadult 12y agoAs reported in this news story, "'Clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients,' [Thomas Frieden, head of the Centers for Disease Control and Prevention] said in an interview Sunday on CBS’s Face the Nation. "Frieden also promised that protocols at the hospital would be reexamined to find out how the disease was apparently transmitted." Other patients with quite advanced cases of ebola, who were on the brink of death, have been successfully treated in United States hospitals without any health care workers in those hospitals being infected so far. The Dallas hospital where this latest incident happened will definitely have to review its infection control protocols, but we know already that other United States hospitals are doing things right. Terrifying news like this came out when SARS was first spreading around the world in 2003. SARS is especially easy to transmit from one person to another because it is an airborne virus. No doubt there will be other cases of ebola infection spreading in the developed world, even in hospital settings, now that the first few cases have been discovered. But SARS transmission decreased a lot once people in China started taking precautions like self-isolation and masks to cover coughs. West Africa has a lower availability of equipment, supplies, trained personnel, and even information today than rural China had in 2003, but with sufficient outside help the transmission of ebola can also decrease a lot, until numbers of new cases start falling instead of rising.
- fourstar 12y agoYou can't compare this thing to SARS at all. Not only does it have a longer incubation period, but SARS lives outside the host for up to 6 hours (4 days in poop). Filoviruses can live up to weeks outside of the host. Not to mention SARS is spread from respiratory droplets. This thing is spread by: A) vomit B) saliva C) sweat and if you are running a high grade fever you are going to be sweating and transmitting this thing from every pore in your body. So no, this is not going to be as easy to contain as SARS especially once it hits somewhere like India.
- kenjackson 12y agoThere was an Ebola documentary on PBS a few nights ago and one of the people noted that he touched a need and that's how he contracted Ebola. People have likened Ebola to HIV, but HIV does not transmit this easily. Even during seroconversion (which is when you might get vomiting and such with heightened viral load) I've never heard of anyone contracting HIV in a hospital. I feel like the information on transmission has been poor. For example, is skin a barrier for the virus?
- hga 12y ago"is skin a barrier for the virus" We don't know. It's strongly suspected broken skin is not a barrier.
- kenjackson 12y agoI'd expect broken skin isn't, but what about intact skin? With HIV we can answer a bunch of questions about transmission. With Ebola I can answer very few. I think this increases the anxiety.
- angersock 12y agoWell, we're about to learn a lot more, if that's any consolation.
- dpcan 12y agoIt absolutely does. I think the problem is that the virus can live on a surface in bodily fluids for a long time, or a dead body for days. So you touch the surface with the virus then you wipe your nose, rub your eyes, eat with your hands.... and you could get infected.
- frankzinger 12y agois skin a barrier for the virus? On Sky News earlier today an expert was saying that intact 'regular' skin is indeed a barrier, but that thinner types of skin such as that found inside the mouth, the eyes, and the nose is definitely not a barrier.
- kyro 12y agoMore people should understand that hospitals are messy. Really messy. From wiping vomit to feces to rolling over patients to changing chucks to wiping down monitor cables to handling bottles of saline that you may inadvertently leave out in the open for others to touch to not disposing spare gauze that may be contaminated to forgetting to wipe down your stethoscope to tearing your gown off as you rush to see another patient, etc etc etc. There are any number of people going in and out of a patient's room, performing a wide array of tasks, handling an even wider array of objects. Add to that the often hurried nature of hospitals and you get an environment prone to breaches of protocol. I say this not to incite panic, but to provide insight that many might not have. It is more likely that during the thousands of interactions that this patient saw, the messiness led to a breach, instead of the virus infecting via a vector we've not yet realized.
- clumsysmurf 12y ago> More people should understand that hospitals are messy. Thats why its nice to live in a place that requires HAI (Healthcare Acquired Infections) to be reported. In the state I live in (US/AZ), this is only voluntary for the hospitals. As a patient, it makes it almost impossible to make an educated decision on what facilities to avoid.
- jeffdavis 12y agoFirst, everyone was saying that only backwards people doing backwards things in backwards places could possibly get Ebola (paraphrasing; and I am not condoning the message, just repeating it). Now, we see that Western medical workers with education, resources, and the focus of single patients in Western hospitals are catching it. And now I feel like the message is shifting toward something like: "It's impossible for doctors to do their job without a high risk of transmitting Ebola, and even if the protocols work, it's impossible to follow them. But still: Ebola is nothing to worry about, and any significant response is counterproductive panic." I don't know whether that's what you're saying or not. But I am done hearing about how Ebola is not really a problem[1][2]. We just don't know anywhere near enough to be confident that it won't spread. Even if you grant that modern rich areas can control it, that still leaves an awful lot of people exposed. [1] https://news.ycombinator.com/item?id=8161937 https://news.ycombinator.com/item?id=8161937 [2] https://news.ycombinator.com/item?id=8429867 https://news.ycombinator.com/item?id=8429867
- taivare 12y agoPlease, share this Ebola awareness poster ! http://bit.ly/1vF1COO http://bit.ly/1vF1COO
- nathannecro 12y agoA lot of this thread is speculation. Let me interject by actually citing some research which may answer some questions. @kenjackson: "Is skin a barrier for Ebola?" Yes. According to Bausch et al. "Taken together, our results support the conventional assumptions and field observations that most EBOV transmission comes from direct contact with blood or bodily fluids of an infected patient during the acute phase of illness. The risk of casual contacts with the skin, such as shaking hands, is likely to be low." In the same paper, they note that: "We found [Ebola] to be shed in a wide variety of bodily fluids during the acute phase of illness, including saliva, breast milk, stool, and tears. In most cases, the infected bodily fluid was not visibly contaminated by blood." This lends credence to Kyro and JshWright's assertions that hospital and PPE protocol are hard to exactly follow, every time (I'm certainly guilty sometimes). Even if the equipment or chucks aren't stained with blood, there is a possibility that the patient's tears have leaked onto the material and remain unseen. http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full.pdf+html http://jid.oxfordjournals.org/content/196/Supplement_2/S142....
- samstave 12y agoWould UV lights kill the virus, if, for example, it were to be sneezed out from a patient. Assuming the patient room was awash in UV light, would that kill the virus if it found airborne/aerosol method of transport from an infected patient?
- nathannecro 12y agoYes. In a sense. According to several sources, it may take up to an hour for the virus to be invalidated by UV light. That makes it not really practical for the patient or the HCP involved. Not only that, but I suspect at the energies required, the amount of UV radiation would be quite harmful to the patient as well. "Inactivation of virus stocks.Virus stocks were inactivated by exposure to UV light for 1 h. Proper inactivation was controlled by the incubation of Vero E6 cells with the inactivated virus particles and subsequent screening for the presence of viral proteins (immunofluorescence) and viral RNA (reverse transcription [RT]-PCR targeting virus-specific transcripts). The UV-inactivated stocks were used at the same dilutions as the noninactivated stocks." http://jvi.asm.org/content/75/22/11025.full http://jvi.asm.org/content/75/22/11025.full http://link.springer.com/article/10.1007%2Fs00705-010-0847-1 http://link.springer.com/article/10.1007%2Fs00705-010-0847-1
- godgod 12y agoEbola is airborne. Let's stop denying the obvious.