Ok, I’ve been at work all day.
But I”ve been getting pieces and bits on the newest Ebola case.
So I am a Microbiologist. I have worked in hospital labs for the past 10 years and I currently work here in NOLA. I lived in Dallas for 7 years. I worked in the big public hospital for 5-6 years then I worked for a sister hospital to Presby Dallas, and all I’m gonna say is Presby D has a reputation. I have a former coworker who had a job there PRN and he left within a month because of some issues he found with personnel and the limited experience of the techs working there.
So when the first case came, I always figured from jump that Presby dropped the ball the first time he came to hospital. the entire team that day, including nurses, PA, MDs etc failed arm Duncan that day and now that failure ended with his death and chickens are now coming home to roost.
The problem I had with this latest case was that the nurse knowingly travelled even after she absolutely came in contact with the Ebola patient , but now we find out that she actually called the CDC and they told her it was ok to fly??
What I now wonder if she was a buddy to the other nurse? A friend in DFW tells me the protocol at Presby is a buddy system. It should be the same as my current hospital protocol whis is also a buddy system. For the laboratory purposes, this means that there is a “clean” tech and a “dirty” tech.
the buddy system is supposed to work where one helps the other when it comes to taking off PPE and also the buddy tech is supposed to be paying attention as the “dirty” tech manipulates the specimen…ie they are supposed to be eye balling you and making sure that u aren’t scratching, rubbing head or mopping sweat.
And as you see they are taking the latest case to Emory instead of Presby Dallas and I’m pretty sure I know why.
I honestly am beginning to think the problem is that this is all voluntary. Soon as this guy came through the 2nd time, the CDC probably should have quarantined the whole staff who was gonna be working on him and just as they did the family, quarantine them right at the hospital and do not let them leave until a complete negative cycle of 21 days!
I think though that what needs to be understood is that this IS NOT considered to be an outbreak. Because so far the only people who have become infected so far are the two who were in close contact and caring for Patient 0, in this case Mr Duncan
The thing to do now is CONTAIN the virus so that it doesn’t spread outside of the zero zone in this case presby dallas. hopefully the nurse who travelled didn’t was in the contagious stage and no others become infected, but we won’t know until we know
As to who should be contained? I think they should contain any and everyone who came in contact with Mr Duncan, particularly the care givers at Presby Dallas. If it means they don’t let them leave the hospital, so be it. the family of Mr Duncan is still being monitored and will continue doing so. the same should be done for any staff at Presby Dallas.
the problem you have is the free-will of the people quarantined. in other words, you have a case like the MSNBC physician, Nancy Synderman, who left her quarantined cause she was tired of the food they were giving and she wanted some soup! that is a breach of protocol that should not have happened, but how to you stop someone from exercising their free rights?
Cause let’s be clear, the same ones who are outraged now, would be the same one outraged if they were told that they were being monitored and quarantined. How many among us would be happy with that, particurlarly if we feel fine and don’t think there is a chance that we contracted
Lots of “blame” to go around. To be fair, we do have to allow for a learning curve. While the CDC may be able to rationalize telling Vinson to go ahead with her plane trip back to Dallas, it was a highly questionable instruction. The alternatives weren’t great either. “Get to the nearest hospital for Ebola testing” would have meant entering a hospital that had no experience or expertise in Ebola. Dispatch a plane to transport a possible Ebola patient from Ohio to Emory? As a high risk contact with Duncan, Vinson should never have left the immediate Dallas area.
I’ve gone back and forth in my mind on the need to quarantine anyone that had been in close contact with an Ebola victim. While enclosed spaces with the general public — schools, airplanes, airports, and public transit — should be off limits, it may depend on the quality of monitoring an individual during the possible incubation phase, the official and likely conservative 21 days from the last contact. That, of course, is subject to change if any evidence surfaces of an asymptomatic transmission or even transmission within the first 24 hours of symptoms. So far all the known first order infections have been transmitted from seriously ill EVD victims.
Decontaminating Pham’s and Vinson’s apartments was likely overkill.
Boston com update
Recall that several of those 48 people were in close contact with Duncan until he was admitted to hospital on Sept 28th when he was very ill. Four continued living the apartment for a few days after Duncan left.
Bullshit!!! The entire medical establishment and its corporate insurance owners/controllers has no “learning curve” other than the one that makes them the most money. The chickens come home to roost on this level when something truly dangerous to a large population occurs. This “Ebola” thing and its role in illuminating the CDC’s and U.S. medical system’s total incompetence is no different than was Hurricane Katrina’s role in spotlighting FEMA’s incompetence or the economic crash of 2007’s function as a sign that the SEC is a toothless front for corporate greed. There will be no real “learning curve” here, Marie2, just more reflexive ass-covering and legal tapdancing as we bumble our way through yet another tragicomedy of errors. If the feared epidemic doesn’t happen Doctor Big Brother will say “I TOL ya it was gonna be alright!!!” and if it does happen the entire federal system…nuts right on through bolts…will collapse and we will be living in a military dictatorship. Either way, Big Med is full of shit.
I posted here recently about my contact with a group of well-meaning medical workers and patients in rural New England who had nothing but complaints about the hospital in that area. This microbiologist poster’s view of Dallas Presbyterian resonates the same way as did their complaints. All front but total chaos behind the scenes.
Disgusting.
AG
so far what I’ve read is that she didn’t call CDC until after she arrived in Cleveland and was on her way back to DFW. I agree she should have never left DFW in the first place.
Presby def has a lot of blame for Mr Duncan’s case and if their protocols were/are insufficient then they also have a lot to answe pr for in regards it the health care workers who assisted in Mr Duncan’s care
Don’t know if any of the Dallas health workers were instructed not to leave the area during the monitoring. Or if the CDC had all those workers in their contact and monitoring database. It’s my understanding that Vinson called CDC the day she developed a very low-grade fever which was the day before or day of her scheduled return flight.
“… and all I’m gonna say is Presby D has a reputation.”
That was my conclusion observing from afar and listening to yesterday’s press conference of the head of ebola response team County Judge Jenkins.
It appears PresbyD had a massive failure and breach of protocol. Plenty of criticism from nurses’ union about readiness and qualification to receive and treat an ebola patient in isolation. Does PresbyD have a fully equipped isolation chamber hazardous to biosafety level 4? Yesterday it appeared there was a competency battle between Texas State officials, Dallas officials and the CDC feds.
To transfer Amber Joy Vinson to the Emory Hospital unit in Atlanta says it all!
In the US there are 4 Hospitals geared up to handle Ebola:
As I wrote in my diary yesterday, Germany has seven hospitals fully equipped to handle ebola and marburg viruses with BSL-4 facilities, including its laboratory.
○ ‘In 1976 I discovered Ebola – now I fear an unimaginable tragedy’ | The Guardian |
○ U.S. Patent 20120251502 A1: Human Ebola Virus Species and Compositions and Methods Thereof
Perfect.
Big Med strikes again.
The Petraeus Syndrome up and down the system. Cheap hustlers in suits and uniforms doing as little as possible and getting away with it.
However…always and forever, the chickens eventually come home to roost.
Maybe this is The Big One we have all feared.
Or maybe it’s just another comedy of errors.
We shall see, soon enough.
Let us pray.
AG
○ CDC examines protective gear protocols amid U.S. Ebola cases
○ A look at sick nurses contact with Ebola patient | AP |
US News Texas Health Presbyterian Hospital.
#15 in Texas and #5 in Dallas. That’s out of 135 in the Dallas-Ft. Worth area. So, above middling in the area — but maybe TX hospitals scrape bottom nationally.
Here’s a question that’s been bugging me today and you might have some insight into it as a hospital microbiologist.
Thirteen years ago two Democratic Senators were recipients of an anthrax attack and everyone panicked over the possibility of biological terrorism.
Thirteen years later are there intake protocols that quickly identify exotic diseases like anthrax and ebola on a routine basis down some triage tree or another?
Or have hospitals become more interested in walletectomy screening instead of the appearance of some anomalous public health threat?
Does ability to pay overshadow public health and national security in the minds of hospital administrators?
When the CDC or the state public health office issues a notice letting labs know that there has been multiple occurrences of a particular “bug” (ie. virus, bacteria, parasites, etc) then all hospitals are aware some times even before MSM to be on the look out for signs and symptoms for the particular pathogen that has infected people.
In the case of bioterrorism, there are really only 5 or so pathogens that are on the bioterror list than can be safely testing in routine hospital labs, but usually the hospital lab is NOT equipped for identification, isolation or culturing of this bioterrorism organisms. The majority of them are too infectious even for routine hospitals to handle or want to handle within the clinical lab.
All such specimens are handled with care and shipped with extreme particular parameters and protocols to either the local or main state laboratory and are handled from there.
So I guess to answer your question, if it is a known outbreak of an non bioterrorism organism, then yes, hospitals should be routinely equipped to handle them. This is all regulated and protocols have been in place for years especially after 9/11.
As for regular routine organisms, that aren’t hard to culture or that will not be too hazardous for routine laboratory techs to handle, can be done in the lab.
Examples of bacterial bioterrorism organisms that we in the Micro lab are routinely trained to recognize: Bacillus anthracis, Franciscella tularemia, and Yersinia pestis.
Viral bioterroism organisms are not routinely handled in the Micro lab. That requires culture of the viruses and have to been done under very precise circumstances.
Examples of routine organisms, that are considered really bad organisms, but that are routinely handled and identified in the Micro lab are buzzworth bugs like: Mycobacterium tuberculosis, MRSA, Cryptococcus, Histoplasm, Neisserria meningitis, Influenza, Bordetella pertusis, …and other routine pathogen.
It sounds like DHS has not thought this through well or has not figured out how to deal with the sort of threats that the media was frightening people with in 2001 (ebola was one).
It also sounds like the threats more likely will come from governments with sophisticated labs to weaponize the organisms.
For the fears of terrorists sending sick people to create havoc, the routine operation of hospitals and public health authorities should deal with that.
Both the anthrax attack and the ebola case seem to indicate that that biological warfare, despite its fictional portrayals is finally pretty useless in places in which there is even a modicum of a health care infrastructure.
And that DHS knew it was overhyped in its founding legislation to begin with.
I wish that the US had not continued its biological weapons program, even pitched as defensive. Open research could have provided the same information much more rapidly, and there wouldn’t have been the temptation to build the offensive weapon on the assumption that the US would face such a weapon. And then build the defense.