Ebola
 

I searched and didn't see a thread on this.

The first US transmitted case of Ebola has been confirmed at Presbyterian Hospital in Dallas. The 26 year old nurse contracted the virus while caring for Thomas Eric Duncan.

Are you satisfied with how the CDC is handling this? Are you concerned that this will be a much larger epidemic than they are indicating?

I have not been happy with Presbyterian's handling of this from the get-go. They initially blamed the ER nurse for not communicating that Duncan had come from West Africa. When she pulled up her patient documentation she had clearly indicated such. Then the hospital blamed the EMR for not communicating that info to the physician. That, too, has been refuted by the IT staff. Yet, even though it is the MD who writes discharge orders, at no time has Presby laid blame there.

I have no idea what to think about the types of PPE (personal protective equipment) that the staff caring for Duncan was required to wear. Was it just the standard yellow isolation gown, a blue gown, or more of the "hazmat" type gear? The CDC was QUICK to blame this nurse for a lapse in protocol in catching the disease.

Finally, on a personal note, the nurse has been identified by family as Nina Pham. She is a Sigma Kappa, according TCU's online alumni database.

Lapses in protocol happen daily, when the stakes are much lower--how often have you been prepped for an injection with a sterile alcohol wipe, but then the nurse wipes the excess off with an open cotton ball? Or how often are you prepped for an IV by a nurse wearing gloves? In these cases, the stakes are fairly low--it's unlikely the nurse will be infected by anything, even though protocol states that those things aren't the right thing to do.

In this case, a 'lapse' in protocol can be as simple as taking gloves off improperly (contaminating the hands) followed by a subconscious touch of the face. How many times do you touch your face daily without thinking? When the stakes are high, the penalty for even a relatively minor lapse can be infection, simply because the viral load of the patient is so high. Also, all the protocol in the world doesn't always account for the fact that humans are imperfect, even when they KNOW what the impact of error/failure is.

Many people are quick to say that because the CDC is blaming lapse in protocol, that means it's a coverup that the virus is actually airborne, when that's simply not true. Earlier this year, a team at the Broad Institute in Cambridge, Mass published their data looking at the number of mutations in this current form of Ebola versus previous strains of Ebola Zaire (EZ). In 10 years, this specific strain of EZ has accumulated roughly 400 mutations--relatively high, but not outrageous. EZ is a type of virus that has a highly error prone replication, so this actually makes sense. None of them have been in regions of the genome that might make it airborne, nor do they currently look to be contributing to the size of this specific outbreak.

^^^I want to learn more from you IUHoosiergirl88!

I am not in medicine, but am captivated (might not be the right word) by the Ebola and Enterovirus outbreaks. Outbreaks scare me, but I also find them interesting. My latest question is - if Ebola can only be spread by contact with the fluids of an infected person, how is it whem a person with Ebola sneezes, and creates a mist, that is not contagious?

I also find the blame shifting on the nurse as a knee-jerk, cya, attempt on the part of the CDC mouthpieces. The hospital failed and that is where the blame should be. We also should not be blaming the first person in the US to contract Ebola on US soil, instead we should thank her for doing her job and praying that she gets better!

Now what are everyone's thoughts about individuals coming into our country from countries who have a high rate of Ebola infections right now?

The answer to your first para is kind of complicated, as the definition of an 'airborne' virus/bacteria/fungi seemingly would include aerosols generated by an Ebola patient sneezing or coughing. But unlike influenza, measles, or other truly airborne viruses, Ebola doesn't stay airborne a particularly long period of time because the aerosol particles are too large. Influenza, for example, can float through the air in teeny tiny (think 1-10 picometers) for up to almost 3 hours, some studies show. That's why you can catch the flu or the common cold just by being near someone who has it.

Honestly, even if you stop flights from Ebola-stricken countries, it's not going to do much good for a few reasons. First, there aren't a lot of direct flights from those nations to the USA--most transit European hubs. Second, if you do stop entry of anyone originating from West Africa, that is going to induce immigration officials in those countries to just not stamp passports to keep travel flowing. Visitors/tourists have money, and money is important in that area. Third, corruption is rampant.

You'd have to screen travelers from ALL international flights, regardless of country of origin...and even that's not going to help, as you won't catch passengers who are currently asymptomatic or still incubating.

I also wanted to add a little bit on the 2012 pig/monkey aerosol study that's currently floating around and being misinterpreted by people who aren't familiar with virology/aerosols.

The tl;dr version is that monkeys being housed in cages next to pigs infected with Ebola got Ebola. Since correlation always =s causation, therefore this means the monkeys were infected by an airborne (see the definition of airborne above) Ebola virus, right?

Not so fast. First, piggies catch Ebola in a way different than humans do. It's actually a respiratory infection that resides in the lungs (vice the liver in primates), so Miss Piggy coughs/sneezes much more than a human or primate infected by Ebola does. Think more like bronchitis. The study also couldn't determine if the virus was transmitted via giant globs of spit (like it is in human -> human transmission) or via teeny tiny aerosolized particles. So one can't draw the conclusion that the virus is airborne because the study wasn't designed to determine that, nor are the animal models (pig + primate) realistic for true human to human or primate to human infection.

Just as a side note, she isn't listed in the database as a member of Sigma Kappa (under that name).

That doesn't mean I feel less for her and what she must be going through.

Thanks for the update. From what I gather, the TCU alumni directly takes the names based on initiation lists submitted to the Greek Life Office at the time of initiation, and if members resign that is not always reflected in the alumni database. Based on several social media posts that I have seen I do think at one time she was a Sigma Kappa at TCU, but perhaps that is no longer the case.

It is sad all the way around. All our health care workers put themselves at risk for many illnesses day in and day out. This young woman was no different. May she be granted comfort, peace and healing in the days/weeks to come.

I am not in the fields of medicine/health care/bio research. I've seen several articles stating that Louisiana is refusing to take Texas Ebola patient-related waste (ashes). Biohazard materials (incinerated or not) must be disposed of in a special disposal site (extra linings against leaching) and not in one that takes municipal/standard waste. I am not at this point seeing how Louisiana can legally bar the waste, but, as a practical matter, are there no biohazard disposal sites in Texas?

I am, so far, satisfied with the CDC and the medical responses. I am not satisfied by how sensationalized the media has made this medical case. Yes, we should be hearing about the thousands infected in Africa, and we should be aware that there are cases here in the US.

Last Friday, a local news station went nuts over a "Ebola scare". An individual was being monitored at a local hospital for "Ebola-like" symptoms, but was cleared within an hour or two of that first report being released. That didn't stop them from talking about it all weekend and whipping scared members of the public into a frenzy. Awareness is good. Sensationalization is not.

I just can't understand why this disease was allowed into this country! Before we know it, there's going to be all kinds of folks sick with it. Mark my words.

no. no. no. I mean I'm personally surprised it took this long for Ebola to enter the US, because this isn't the first outbreak. It's just the first major outbreak that has resulted in so many deaths.

As a public health major, this REALLY interests me, and also finally gets me closer to thinking what I want to do for grad school down the road. IUhoosiergirl I love all the information you provided!

As for what the CDC has been doing, I personally think they're doing fine! I feel like lapse like this were bound to happen.

I also did hear that Texas Presbyterian did NOT have the hazmat like suits, it was like they were covered, but like not as covered compared to wearing a hazmat suit.

Just to clarify. It was announced on the Dallas Panhellenic Facebook page that Nina Pham is indeed a member of Sigma Kappa and was an initiate of their chapter at TCU. It asked for prayers for Nina and her family.

Actually, Sigma Kappa posted on multiple social media outlets today that Nina was a member for a short time, but no longer is. However, that still doesn't change that we all hope she recovers fully and soon. Affiliation has little to do with the situation at hand. Thinking of her and everyone involved during this hard time.

I am working on a family group for fall 2015 going to Berlin, Barcelona, a Med cruise and then a few days in Athens. Nice trip. I got an email today asking if they need to be worried about ebola or beheadings.

You will be glad to know I did not say LADY, have you looked at a map? And who in the history of EVER went to Saudi Arabia for vacation? And yes, I suppose it is POSSIBLE that a person could contract ebola, go to Berlin, come into close personal contact with one of these travelers and give it to them. But do you cancel a vacation based on that microscopically minute possibility? I also haven't found the polite, professional way to tell them to turn off the friggin TV. All the world's problems will magically disappear.

I'm heading to Italy Friday. I have bigger worries about the Mafia and the Roma than Ebola and ISIS. Heck, Ebola is closer to my house in Ohio than in Rome and Florence.

I think everyone by now has heard of the 2nd patient. She flew from Dallas to Cleveland and back over last weekend to visit relatives in Akron. She visited 3 relatives in Ohio that are employed by Kent State.
The Plain Dealer and all of the TV stations have been running news non-stop on this.

http://www.cleveland.com/healthfit/i...rt_maj-story-1

I wonder whether our for-profit hospital system is really equipped to handle a national outbreak like this. It would seem they have every incentive to not diagnose or treat ebola patients. While that may be illegal, it doesn't mean that it's not going to happen.

Can we get a definition of a person being "isolated" and "monitored", because I'm pretty sure someone who is isolated and monitored isn't going to be allowed to fly!

My understanding is monitored =/= isolated.

Monitored basically means checking your temperature 2x a day and reporting the results to the person who is keeping track of such things. You are free to go and do as you please, so long as you are self-monitoring.

Isolated is what they are doing after there is a suspected case. And it's pretty much what you think it means.

I do think it odd that the 2nd patient went off on a plane flight, but I don't believe she was given any restrictions where she should not have been doing so.

This is hitting EXTREMELY close to home for me right now. I can't concentrate. I went to college with the patient, and she is a really sweet girl. And I am very close friends with some of her family members. Please send your prayers to them as they really need them. Thank you in advance.

Ugh. I am so sorry. Heard they were sending her to Emory hospital in Atlanta, yes? I think she'll be in a much more suited place to deal with her needs there. Hopefully she's a blood type match for one of the survivors like Nurse #1 (Pham) is.

The Dallas part is hitting pretty close to home for me & the reason why I'm watching so closely. I know a ton of people that live right around where both nurses live.

Yes, she is going to go to Emory. The good thing is that she is holding up. Praying it continues.

I agree that for profit hospitals are not the best place to be dealing with this, and I was saying the exact same thing the day Duncan got admitted. Dallas has two large regional hospital systems (Baylor and UT Southwestern). Both are going to have medical faculty that are on cutting edge of everything because they are teaching hospitals. UT Southwestern, especially, is accustomed to seeing rare and difficult cases.

We are in the stages of any big stories where "details" are coming out rapidly. Some will prove true, others will be discounted. One report earlier today is that the staff taking care of Duncan did not have gowns for 2 days. I find that hard to believe, but if that is the case, then wow. I am also very troubled that anyone who had contact with him was allowed to fly. This is straight out of a sci-fi movie, for crying out loud.

And now for a rant:
If one more idiotic person in my social media feed declares that we need to close our borders then I may punch my computer. Let's use logic:

1. Okay, borders are closed. No flights into US from West Africa
2. Guess what? No flights would be going TO West Africa
3. Guess who is on the flights going to that regions? Aid Workers. Guess who would need to be able to get home? Aid Workers.

We need scores of aid workers (both medical hands and others with supplies) to solve the sad state going on in West Africa. People are reacting because this is on our soil now, but thousands of individuals have already died, and the prediction is that those numbers will grow exponentially. We have a responsibility to help those who have a great need, whether they are Americans or citizens of another country.

Close the border and this could wipe out entire countries. And guess what? It would still be able to travel to the US. People in Africa travel by foot and car. They can get to nearby countries, and then get to Europe. Last I check there were plenty of planes coming to the US (or Canada or Mexico) from Europe.

Praying for your friend - she is a very beautiful woman. So sad that she's in the midst of planning her wedding amidst all of this.

Had to come to Presby for a doctor appointment. The media are swarming at another entrance. Going no where near that.

You are very very welcome! I have a grad degree in bio and work in the field, although not in a lab. As strange as it sounds, Ebola has always been one of my 'favorites; because it's close to the perfect virus--but it's not.

For anyone who cares, norovirus is probably the most 'perfect' virus.

Keeping your friend in my thoughts. I'll be flying out on Friday but will follow her progress while I'm on vacation.

After complaining about being sick of hearing about Ebola, I was really intrigued by your background and interest in it. I have to ask as I am no expert in biology, why is it considered the most 'perfect' virus? Is that because it's hard to detect or something?

So the 'perfect' virus is one that's highly contagious so it's easily transferred from host to host, is shed/released very rapidly by the host (via sneezing, coughing, sweat, pus, whatever), evolves quickly to get around both the immune system and medical countermeasures, evokes limited immunity so you can get the same virus over and over, and is only moderately virulent so it doesn't kill off all potential hosts. Ideally, they're also pretty environmentally stable, but that's able to be bypassed--just look at influenza's seasonal outbreaks. You may also want a virus that lays 'dormant' in the host while still remaining infective, so you can pass it on to others even if you yourself are not showing any ill effects.

Ebola fits a lot of those criteria, but not all of them. It's highly contagious because it requires a low viral load (i.e. the amount of virus you come in contact with) to infect, but it's not airborne so it's not transferred as easily. Patients do shed high viral loads--check. It doesn't mutate THAT rapidly when compared to other viruses--but there's not a good treatment for it at this point. It does invoke limited immunity, but it's appearing like that immunity may be stronger than we think. Finally, it's pretty virulent and obviously kills off a high percentage of its hosts, so eventually it 'burns out.'

Norovirus, on the other hand, is INCREDIBLY contagious, you shed high viral counts (some studies have shown 10^5 to 10^11 viral copies per gram of poo or vomit), it mutates extremely fast, immunity is pretty much nonexistent, and fits that moderate virulence category. It's also extraordinarily stable.

Interestingly enough, when it comes to viruses, you actually don't want high virulence because oftentimes, with that comes decreased infectivity or contagiousness.

This was all really informative. Thanks for sharing, IUHoosiergirl88.

Wow. According to CNN, the nurse contacted the CDC prior to boarding the Frontier Airlines plane to Dallas. They gave her the ok.

Could we keep dropping the ball on this?? I'm baffled by all of the screw ups!

What happened to common sense? Does one really have to be told not to board a flight if one is being monitored after a patient death? Why would one even think of traveling until the monitoring period expires, particularly if one is a nurse?

If she was asymptomatic at the time, she was not contagious so they would give her the OK to fly, right?

She shouldn't have to have someone tell her. Symptoms or not, she should have been able to reach the common sense conclusion that travel is out of the question until her monitoring period ends. Common sense.

So.. Is this really as bad as some people are making it out to be? Serious question.

Duncan (his first name escapes me right now) flew into the country with Ebola and visited relatives, and no one on the flight, nor his relatives, contracted the virus.

Of course, there are nurses who are sick, but the CDC is now taking extra precautions to make sure that no other healthare workers are infected.

I guess I just don't see any reason to panic right now. But maybe I'm wrong..?

Sorry to double post, but I just saw this. Thinking of your friend and hoping for the best! I have a few friends who are nurses in Dallas, so I can only hope that my above assessment is correct, and that this won't get much worse.

I'm not a huge fan of Faux News, but this is good.
http://www.huffingtonpost.com/2014/1...n_5992510.html

Unfortunately, we have some school systems which, ironically are NOT near where the nurse was staying in Akron, that have closed today.

I agree with your analysis that there is something to handling bodily fluids of those infected vs. being near those infected. Also, why have so many healthcare workers in Liberia NOT been infected? Could there be a resistance:confused: that they have built up?

If we get even a couple of more cases in the U.S. stemming from this outbreak, I could see it becoming increasingly difficult to keep all these folks quarantined. The average incubation period is 2-21 days, and three weeks is a long quarantine period.

This Forbes article discusses a researcher's study that suggests that 21 days might not even be long enough:
http://www.forbes.com/sites/jonforte...-to-new-study/

Our news said one of those schools closed because a teacher was on the flight with the nurse. But that doesn't make sense to me- unless they had a very quick turn around. The nurse was on the flight going to Dallas from Cleveland. If that teacher went to Dallas and went right back to Cleveland that seems odd.

ETA: The news report I just read said that a teacher was on the same airplane, for a later flight. It also said there were two students who were in contact with the nurse while she was there and that's why their schools are closed.