See, they shouldn't be allowed back or should go through quarantine.

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"In the world I see you are stalking elk through the damp canyon forests around the ruins of Rockefeller Center. You'll wear leather clothes that will last you the rest of your life. You'll climb the wrist-thick kudzu vines that wrap the Sears Towers. And when you look down, you'll see tiny figures pounding corn, laying stripes of venison on the empty car pool lane of some abandoned superhighway." T Durden

that image and text has already been posted here - - I don't remember who posted it though

Duffy.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Yeah, good times. I just cancelled all my other meetings for tomorrow plus a seminar I really wanted to go to. Sucks.

Why?

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

I direct one of the clinical labs at a hospital here in NYC. With this finally arriving in the city, pretty much everyone wants to reconfirm our plans.

uote JSA]And went bowling and took Uber and ...


A doctor in New York City who recently returned from treating Ebola patients in Guinea tested positive for the Ebola virus Thursday, becoming the city�s first diagnosed case.
The doctor, Craig Spencer, was rushed to Bellevue Hospital on Thursday and placed in isolation while health care workers spread out across the city to trace anyone he might have come into contact with in recent days. A further test will be conducted by the federal Centers for Disease Control to confirm the initial test.
While officials have said they expected isolated cases of the disease to arrive in New York eventually, and had been preparing for this moment for months, the first case highlighted the challenges surrounding containment of the virus, especially in a crowded metropolis.
Even as the authorities worked to confirm that Mr. Spencer was infected with Ebola, it emerged that he traveled from Manhattan to Brooklyn on the subway on Wednesday night, when he went to a bowling alley and then took a taxi home.

http://www.nytimes.com/...-york-city.html?_r=0[/quote]
Why would this be allowed? If he was treating them he should go into quarantine until he clears as safe.

I agree. I struggle to figure out how this happened.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Right. Cuz every healthcare worker who interacts with an Ebola patient needs to immediately go into 21 day quarantine. That seems practical. I'm sure that will encourage lots of people to offer care.

No good ranting on this board but seriously what the fuck was he thinking. Isn't he supposed to "Do No Harm" as a Doctor?

I agree with you - it is practical to do that to stop the spread of the disease.

More American's have been married to Kim Kardashian than have died from Ebola

Is that Tom Cruise or Adam Sandler?

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To defy the laws of tradition is a crusade only of the brave.

Reach high, think big, work hard, have fun.

Haha. Then no one will care for the patients. Does that stop the spread of the disease?

What is wrong with a doctor returning from treating ebola patients in Africa going in to quarantine before coming home? Go over, do your stint to help people, wait a couple weeks without treating people then come home. Seems like this was easily avoidable.

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Long Chile was a silly place.

Wait a minute. This dude just spent months in Africa treating ebola patients. I do not think it is asking too much to expect some type of quarantine.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

geeeze, that's so much of a pain. Let's see how many people have to go into quarantine because this one guy did not...

Both are likely to kll you.

Investigators took the case seriously from the outset because it appeared the doctor didn't quarantine himself following his return, the law enforcement official said. The doctor traveled to Brooklyn and then back to Manhattan on Wednesday night, the official said.

In a statement Thursday, Doctors Without Borders confirmed that the physician recently returned from West Africa and was "engaged in regular health monitoring." The doctor contacted Doctors Without Borders Thursday to report a fever, the statement said.

The law enforcement official said the doctor was out in public. Authorities also quarantined his girlfriend, with whom he was spending time since his return from Africa.

http://www.nytimes.com/...n-new-york-city.html


Yeah, this makes much more sense than requiring a quarantine of doctors returning from treating Ebola ...

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Just picked up one of these. I'm good to go�

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Civilize the mind, but make savage the body.

- Chinese proverb

Maybe you missed it but the President has assured us all that its nothing to worry about and even went so far as to say he was smooching on the nurses that treated an ebolaite. We are safe and big government has us covered with their infinite wisdom.

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~
"You lie!" The Prophet Joe Wilson

How many Americans have gone over to help and healthily returned without a quarantine? Just playing devil's advocate here. Hundreds of health care workers have treated the 9 Ebola patients here. How do we quarantine them? Lock them in the hospital for months?

put the lotion on the skin...you know the rest.

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ΜΟΛΩΝ-ΛΑΒΕ
we're doomed

Are you kidding me? It's 21 days. Keep them isolated not treating patients for 3 weeks. We are talking about docs treating patients in 3rd world shitholes.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

I'm not kidding. You're talking several weeks of treatment and then 21 days of possible incubation. That's almost 2 months. Are you advocating an isolation like that for every healthcare worker who treats a patient in the US, or just for those returning from West Africa?

And its not the first time that Americans have gone to 3rd world shitholes and treated Ebola patients. Were we calling for quarantines of healthcare workers before?

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Gnothi Seauton.

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Civilize the mind, but make savage the body.

- Chinese proverb

Here's what's fucked up, I'll bet any amount of money that the soldiers that have been deployed to Liberia will be quarantined upon their return.

Returning from Africa.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

From other articles, yes, we have quarantined them.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Count on it. Shit, back when I was enlisted, we were quarantined for less risk than this. My (really) old Army unit is the latest to deploy to Liberia. Hoo-ah Engineers!

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

If the country is going to continue to use Ebola scare tactics, then it's high time that they put some research money into developing a more efficient screening than 'wait for 3 weeks to see if it shows up'. Invent a blood test and start testing people who return from high risk areas. Or, give them the 3-week quarantine option.

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Take a short break from ST and read my blog:
http://tri-banter.blogspot.com/

I was thinking about that earlier when I commented. It'd just about guaranteed.

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~
"You lie!" The Prophet Joe Wilson

Think of where we would be if Obama had his way and research was squashed because there was no insentive as we spread the wealth. Thankfully what you suggest could eventually happen because he and his type haven't quite killed capitalism.

Thank Ebolabama

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~
"You lie!" The Prophet Joe Wilson

Should be those returning from West Africa. Recall just a week or two ago when Dr. Nancy Snyderman of NBC was raked over the coals for being seen out in public when she was supposed to be self-quarantined. Surprised there's no outrage with this doctor. Seems like common courtesy to your fellow mankind to simply lay low if you've been in a high-risk area.

Seems to me the critical question is what is the infection rate? E.g., if it's 1 in 2 vs. 1 in a 1000 then different measures should be taken. Not to mention so far it seems like by the time some one can infect someone they're pretty bad off and likely to have been identified and isolated.

Yes, but one death sounds like a lot more fun:



I'd let that smother me to death.

C'mon you pussies. We've got a Czar in charge now. He's an expert doctor having been the spin doctor for Al Gore and Joe Biden.

Kim has been getting married since 2000. Give this virus the same amount of time and get back to us.

My understanding is that contrary to all scientific evidence and, you know, logic - they have decided to keep him in the nations most densely populated city to be cared for by people who have exactly zero experience caring for an ebola patient. I mean, what could possibly go wrong?

Questions: Unlike the nurses in Dallas, these ladies will not walk from work to their self-contained cars, to go to their own personal residences. They will come off the unit and, most likely, get on a bus or subway coming into contact with, who knows, thousands of people before arriving home. So - will they still be wearing their same uniforms that they have worn while taking care of the ebola patient? Will they change and/or shower? Or do they just hop off shift and head out the door? Will they self- quarantine? It is obviously not possible for a nurse who has no experience caring for an ebola patient to inadvertently get virus on herself while taking off the protective gear - right? and then sit with that contaminated clothing on busses, subways taxis... yah. this is a great idea.

This whole ebola thing would not be such a big deal if people used just a tiny bit of logic and common sense. But - sigh, this is not possible.

You mean like by fretting over people going about their business when the probability of infecting someone else appears to be very low?

The probability that the doctor infected others before coming to the hospital is low. The possibility that he will infect the nurses taking care of him? I'm not sure what that probability is.....at Emory the probability seems closer to zero - in Dallas it seems closer to 100% so.....

You have to measure both the chances of transmission and the results of infection.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Don't worry, New Yorkers are the smartest people living on the planet and living in the greatest city on Earth. All will be well.

Well presumably if those nurses get infected by the time they become infectious they would know it and could be isolated. Quarantining the Dr. wouldn't have prevented the risk of someone treating him getting infected, unless people are advocating not treating these folks too?

Good point but I'll say what I said earlier if there is no transmission there is no result of the infection. At least so far it appears that casual even intimate contact with a person doesn't transmit the virus very easily, it takes the person being pretty sick.

I'm sure it's no walk in the park and I would imagine there could be long term consequences, but we seem to be doing a pretty good job of keeping infected people alive. I'm not sure how many have been treated so far, but I think the only one who has died is the Liberian and there was even some suggestion if he had been treated more competently he may have lived. I would think the mortality rates here are going to be drastically lower than they are in west Africa.

Nah, let's just send them on a cruise....

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Pink? Maybe. Maybe not. You decide.

At what point if it continues to be the case that no one gets infected from these lack of quarantines do we conclude that quarantines aren't necessary?

If you wore that, people would be able to see you're nuts.

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Civilize the mind, but make savage the body.

- Chinese proverb

I think we will need to quarantine until we understand how the virus is being transmitted. With the exception of Duncan, none of the other patients had direct contact with bodily fluids. One of the patients had no known contact with any ebola patients- so I think we need to be cautious until the modes of transmission are more well understood.

which patient had no contact?

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

Nancy writebol.

Oh you mean the woman that didn't wear a mask (leaving eyes, mucosa and skin exposed) while helping folks who were working with late stage ebola de-gown? Gee - wonder how she could have been exposed?

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

My understanding is that, even if you live, your body is wrecked from Ebola. It isn't like the flu, where you just go back to normal. Again, my understanding is that Ebola permanent wrecks your organs, the degree to which varies. In addition, sustaining a 103+ fever for long periods of time does permanent damage to your organs. So, it isn't just about living or dying. You get it and you will never be the same.

Again, I am not asking for a quarantine of everyone who treats Ebola patients. But, I firmly believe it is reasonable to take the position that anyone who actually goes over to Africa to treat Ebola patients must be assumed to be infected. The safeguards over there are like the ones we have over here (and, hell, it doesn't appear our higher level safeguards are perfectly effective). Thus, a 21 day quarantine of those individuals is quite reasonable.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

My understanding is that she never came in direct contact with any of those items. Correct me if I am wrong.


Writebol had been recruited from SIM�s main offices where she�d welcomed new missionaries and helped their families get settled in. David was running the facility, ensuring lights and plumbing worked.
�My responsibility originally was I was going to mix the bleach solutions,� Writebol said. She ended up helping doctors and nurses suit up before they entered the isolation unit, and then helped them remove the suits correctly when they came out.
It�s a vital job � the layers of gloves, the goggles, the boots, the body suits all protect workers from the virus-laden bodily fluids that spread infection. But all that protection does no good if the doctors and nurses get even a few drops of that contaminated mess on their hands or skin, or in their eyes, as they pull the gear off.
Nancy helped spray everyone down, get the layers off in the right order and then made sure everything got either burned or disinfected.
�I was considered to be in a low-risk zone,� she said. �There was a line, an actual line on the floor that I didn�t cross. When they came out and I decontaminated them, I never touched them. I was wearing a gown, I was wearing gloves, and sometimes I was wearing a mask, but not all the time.� But she always had a gown and gloves on. �There was never a fear that I would be contaminated.�
http://www.nbcnews.com/...d-say-was-we-n194361

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Gosh, why didn't they think of practicing their protocols beforehand? Perhaps you should email the hospital and give your advice on how they should handle ebola cases; I'm sure they haven't thought it through nearly enough.

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"Go yell at an M&M"

I'm not entirely sure why you are bagging on her, so, perhaps you can explain. I mentioned earlier in this thread, and in another thread, that my old Army unit (very old, going back to my enlisted days prior to the JAG Corps) was recently sent over to Liberia. They trained for weeks before deploying. When I was in that unit, during Desert Storm, we assumed bio and chem attacks and, as the pointing end of the spear, we were expected to be the first to encounter and/or have to remove same. We rehearsed that shit day in and day out. Do you really think civilian hospitals have done anything like this? I do not believe the medical community in generally fully understands Ebola yet.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Yes - she had no known direct contact with any symptomatic ebola patients or their bodily fluids. She was exposed to the asymptomatic healthcare workers caring for these patients. A mask should not be necessary to observe a worker de-gown if the disease is not airborne - but again - I really feel we don't have a great understanding about what is going on with transmission. Could she have touched an infected surface? Could it have somehow gotten from a contaminated gown and into her mouth or eyeball with no direct contact? If so, how? The notion that her main exposure was only to asymptomatic healthcare workers treating to symptomatic ebola patients is concerning given that we are about to have a whole bunch of healthcare workers treating a symptomatic ebola patient exiting Bellevue- onto the streets of New York city - at the end of their shifts. I have heard nothing about how these nurses will be decontaminated before exiting the hospital.

NYC hospitals aren't run by newbie healthcare providers. "running mom" said "to be cared for by people who have exactly zero experience caring for an ebola patient". Nonsense.



This whole thread betrays such fear and ignorance. How many non-healthcare providers have become infected in the US? Exactly zero. You are far more likely to catch the gay than Ebola.

An interesting factoid that might help keep things in perspective:

"Africa is full of overcrowded public transport � buses, minivans and some trains. There are no known instances of transmission in those environments. On July 20, a dying Liberian-American flew to Nigeria and was vomiting on the plane. All 200 people aboard were monitored; none fell ill."

The physician infected in NYC had only a low grade fever: 100.3, not 103 as earlier reported. (I'm sure someone here will say that the CDC is just lying about that). He was not out and about with any of the typical symptoms that would indicate he was anywhere near being contagious.


As for "wrecking your organs": if you are treated reasonably early, as have everyone in this country except patient zero, you won't have anything like that:



If you aren't treated early, you typically die.

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"Go yell at an M&M"

I'm just saying - we have centers (Emory/NIH etc.) for this- Experienced nurses with proven track records. People who have been specifically trained on units specifically designed for this. Why would we not use them?

"running mom" said "to be cared for by people who have exactly zero experience caring for an ebola patient". Nonsense.

Well considering this is the very first Ebola patient in NYC the odds are, that unless they ship people in WITH experience that in fact it makes complete logical sense that indeed the patient is being cared for by people that have zero experience caring for an Ebola Patient. In fact not nonsense, but completely sensible and logical. Now you might make the argument that a person doesn't need such experience...but then again we had not one, but two nurses without such experience end up getting infected in Dallas.

~Matt

So you think the clusterfuck going on in NYC right now is better than just isolating for a couple weeks people who have been bathing in Ebola in Africa?

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Civilize the mind, but make savage the body.

- Chinese proverb

How many logical fallacies can you cram into one question?

Tell me how having one physician who came down with Ebola, notified authorities as soon as he became slightly symptomatic and before he became contagious, and was isolated promptly by professionals who have been training for this for quite a while, qualifies as a clusterfuck. They aren't overreacting by cleaning the bowling alley, they haven't shut down the subways, they haven't quarantined the Uber driver and the everyone who might have ridden in the care...

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"Go yell at an M&M"

I think it's reasonable to isolate once they start showing symptoms, which I believe is basically what we've been doing.

So you think the clusterfuck going on in NYC right now is better than just isolating for a couple weeks people who have been bathing in Ebola in Africa?

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Civilize the mind, but make savage the body.

- Chinese proverb

Which is too late.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

How many cases of Ebola have been treated in the US? Prior to this, how many cases in NYC?

UNMC is the highest level contagious disease center in the US and even they had not treated Ebola before. You really believe a "regular" hospital anywhere in the US know how to handle this? Shit, the "experts" in the area still have incidents of infection and they, supposedly, know what they are doing.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

For what?

MSF says the nurse was the first case they have ever had of Ebola infection in their ranks, and they've been doing this for decades. "Dr. Spencer is the first worker out of more than 700 expatriate staff members deployed so far to West Africa to develop symptoms after returning home."

I know that orgs like the WHO have protocols that work. Follow those protocols and people don't get infected. There isn't any guesswork involved in these protocols: "gosh, what do we do after step 6b?".

Why do people think no knowledge transfer is possible here? You really believe that there isn't a hospital in NYC that is capable of handling this? Really? You think maybe they took this guy to Bellevue because it was closest or something?

How many non-healthcare workers have gotten ill from any of the cases in the US? Zero. Why is that? We just lucky?

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"Go yell at an M&M"

NO - WHO policy is that anyone assisting in disinfecting/de-gowning wear mask and goggles because of the chance of contact from spatter. Viral titres in the blood will be at their peak in late stage victims, so any potential contact should be minimized. So there are protocols and they do understand the transmission of this particular strain. These asymptomatic victims could and probably would have any amount of bodily fluids on their gear.


And CDC issued new standards vis a vis gowning and decontamination, more in line with the WHO and various EU protocols. Just because you haven't heard doesn't mean they don't exist.


Seriously go look up the pathophysiology of this ebola strain and come back to me with the viral concentrations in various parts of the body at various phases. The information is all out there.

---

Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

It's pretty obvious that the lack of these practical measures has lead to an uncontrollable outbreak here in the United States.

How many non-healthcare workers have gotten ill from any of the cases in the US? Zero. Why is that? We just lucky?

We did have two healthcare workers contract the disease IN the US which was supposedly impossible because "We follow protocols". There may or may not be a NYC hospital capable of handling this, that isn't the question. The question is why not send these people to places we KNOW can handle this? We sent one to Dallas and ended up with two workers infected. Why take the chance?

Most hospitals ARE NOT equiped with the same type of equipment that CDC and other facilities built specifically for such infectious diseases do have. Maybe some in NYC have all of this equipment and training, most don't.

AS to "why no Civilian infection?", I think to some degree, yes, we got lucky. So far every case has been caught relatively early and with relatively low contact rates.

~Matt

http://www.zerohedge.com/...s-sidewalk-trash-can

Un-Fucking-Believable....

Actually isn't probability of nurses getting infected in Dallas closer to 1.5% not 100%? Wasn't it 70 odd nursing folks that had some interaction with the patient and only 2 have gotten sick?

So if they limit the number of medical folks working with the patient in NYC, than the odds drop to less than 1%

So far the odds outside of medical personal seem pretty close to 0%

That would explain the lack of duct tape and plastic sheeting at my local Home Depot!

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"Go yell at an M&M"

Our office manager must have bought them all up. She also posted an ebola fact sheet in the lunchroom along with the Disneyland and Knotts Berry Farm discount ticket announcements.

For crying out loud: health care workers are people. Unlike you, perhaps, people make mistakes. When a healthcare worker who is exposed to highly concentrated virus-containing fluids like vomit or feces and then makes a mistake, infections can occur. Compare that to a non-contagious person riding the subway.

Nobody said it is impossible for someone to get infected. Seriously?

That's why this physician was taken to Bellevue: it was prepared.

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"Go yell at an M&M"

Because the hospitals that specialize in this have had infections. So, no, I do not believe a "regular" hospital in NYC, or anywhere, is really capable of handling this.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

I saw that. Unreal.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

What's unbelievable is that anyone would be outraged that material that has no f'ing chance of containing Ebola virus was not isolated, incinerated and buried in concrete.

Why do you get your science reporting from zero hedge?

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"Go yell at an M&M"

This is just simple common sense here. I forget how many tens of millions of dollars were spent on UNMC to get it to a CDC-approved highly infectious disease center. Then, they receive millions more in government subsidies. If any hospital can handle diseases like Ebola, when why the fuck are we spending so much taxpayer money on places like UNMC???

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

That's why this physician was taken to Bellevue: it was prepared.

That may be the case, I don't know. What I DO know is that if you take in one patient and end up with twice as many infected health care workers you have a problem. That is what happened in Dallas and it's really hard to say that they were "Prepared". That also means that not every hospital is prepared. In fact I suspect that if a hospital that was supposedly "Prepared" ended up with what happened in Dallas this means there's a group that we know is not prepared and another group that we *think* is prepared when in fact they are not. Whether Bellevue is actually prepared or not we won't know until there is or is not further infection. We DO however KNOW that there are several other facilities that ARE prepared. So, again, why not send them there?

~Matt

Who said any hospital can handle Ebola? Why are you asking that? Please answer: do you think that Bellevue can handle this case of Ebola? Yes or no, please.

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"Go yell at an M&M"

a) OK - "more in line" - now that two nurses have already been infected - at least we are moving in the right direction - excellent - so we are now going to decontaminate prior to de-gowning in a way that is backed by research and/or clinical experience? (or should we just grab an antiviral wipe?) - I guess we need to wait until more nurses are infected until protocols are not "more in line" but actually "in line". Don't get me wrong. The new protocols are very good, and changing every day as we learn more (as they very well should) - but they are probably not the final iteration. Things will change as we learn more, but unfortunately, the nurses are the guinea pigs.

b) there is some wiggle room in the protocol. For example, "facilities should consider making showers available" - really? No, nurses should be removing their scrubs and showering prior to leaving the hospital if they are caring for a seriously ill ebola patient. Why would we not have them do this?

c) "nurses should consider using a respirator if there is a possibility that fluids could become aerosolized." - yes - finally. This is what I was asking for last week. Does the CDC read slowtwitch? Honestly ladies (and men) go for the respirator. Once I was caring for a terminally ill AIDS patient who bit her tongue, which started to bleed heavily- then she coughed right in my face. Blood spatter all over my face shield. Normally, I would not have been wearing a face shield to care for an AIDS patient, but since I just happened to be going in to suction her I happened to have it on. Good luck that day.

d) waste can be an issue. Again, back in the early days when I was working on a dedicated AIDS unit, it was nearly impossible to get environmental services to simply remove full (completely enclosed) sharps containers and replace them with new ones. A nurse on my unit got stuck trying to shove a needle into a full sharps box.

Caring for an ebola patient is not just about putting on and taking off protective gear. While a bunch of egg head administrators may have " thought through" protocols up in the 8th floor conference room, life is very different out on the units. There is a large body of research that shows that patients with diseases requiring specialized knowledge do better on specialized, dedicated units.



Yes. I did. That is what scares me. Right now the protocols do not call for respiratory isolation, although some hospitals are doing this. I am concerned that, at the end of life, when a patient goes into heart failure and their lungs fill with fluid - and they have labored breathing over this potentially infectious pulmonary fluid - that the disease could be airborne- at least for the nurses who are just standing inches to feet away. While I think the general public may not need to be concerned about this mode of transmission - I think it is a real concern for nurses.

So now they have quarantined the doctors two friends and are "reaching out" to those who used the bowling alley, the Uber car, the subway and "anyone else he may have come in contact with". In New York City!

Yeah, that's better than just isolating one doctor who just got back from his African Ebola tour.

Btw, I don't think is MUCH risk in allowing this guy to walk around, but look at what is happening (despite the oft told lack of risk). Like I said, giant clusterfuck instead of just isolating this guy for a couple weeks.

Help me out here. Why is what is being done better?

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Civilize the mind, but make savage the body.

- Chinese proverb

I never said it was better. All this quarantining and searching is due to the requisite "out of an overabundance of caution." You can bet that there are a number of epidemiological experts rolling their eyes about this. But, if the opinions on this thread are any indication, they are trying to forestall mass hysteria. In this particular case, it is security theater.

If you enact your three week quarantine on everyone who goes to West Africa to help with the Ebola epidemic, you'll just make things worse: fewer people will be able to volunteer, the epidemic will get worse, and it'll get here more potently than otherwise.

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"Go yell at an M&M"

I guess we are about to find out. Sounds like a fun experiment for the people of NYC.

" Contact with bodily fluids includes unprotected sexual contact with patients up to three months after they have recovered" from link

and the plot thickens now, no?

You did. This is what you said:



My response was:

jsa wrote:

Because the hospitals that specialize in this have had infections. So, no, I do not believe a "regular" hospital in NYC, or anywhere, is really capable of handling this.

So, if you want to change your own statement, change it and we can move forward from there.

In anticipation of you "clarifying" (i.e., changing) your statement, Bellevue is NYC's marquee trauma center. There have a division for infectious diseases, but, do not specialize in it. HHC tagged Bellevue as the primary Ebola treatment facility in NYC b/c of its size, location, and facilities; because, there is no CDC-certified facility in NYC. But, it is not a CDC-certified infectious disease center. IF Bellevue was perfectly capable of handling diseases like Ebola, why the fuck is the government pouring millions into places like UNMC???

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

English is a great language. However, saying "NYC hospitals aren't run by newbie healthcare providers" does not mean "any hospital can handle Ebola."

And "You really believe that there isn't a hospital in NYC" means "You don't believe that there is a single hospital," not "You believe that all hospitals�"

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"Go yell at an M&M"

Yeah, that one got me as well. The costs associated with making sure providers have on a proper mask (not just a surgical mask, but one fitted to them personally that filters aerosolized particles) is not going to go unnoticed by administration either, so I wonder how much of that played into what happened in Dallas (typically most facilities have a small # of negative pressure isolation rooms to care for patients like this and only providers trained to work in that are fitted).

I can also recall taking care of patients in isolation and while the PPE is helpful, you still stomp around the unit in scrubs and shoes that are worn out in public and have God knows what on them. Hospitals don't furnish scrubs anymore and launder them like they used to, but would that also cut down on public exposure to disease? I know the ORs might still do this, but the units and general med/surg floors do not. Is there even enough viral load that will live on the surfaces to cause concern?

Interesting thread. I wish people would get up in arms about influenza and Measles like the do Ebola.

do you think that Bellevue can handle this case of Ebola? Yes or no, please.

Again "Can they" is not the question. Obviously "They can" as could the hospital at Dallas. The question is whether or not someone else can do a better job handling the case and the answer is a resounding yes.

~Matt

If you enact your three week quarantine on everyone who goes to West Africa to help with the Ebola epidemic, you'll just make things worse: fewer people will be able to volunteer, the epidemic will get worse, and it'll get here more potently than otherwise.

While there have been actual studies on the subject of whether a travel ban is effective or not I'd be curious as to what you have to back up the above claim. Any "Volunteer" going to help with this epidemic is going to be able to deal with a three week quarantine as well. "Less volunteers", sure maybe but I would say that's a good thing by weeding out those that aren't taking the issue seriously enough to understand that in order to protect everyone you need to make sure you're not infected before heading back out into the general public.

You go spend a month or a week or a year working with Ebola patients, plan on spending three weeks when you get back in quarantine.

~Matt

and the plot thickens now, no?

I heard that a while back. Not looked at the link yet but heard the virus can live up to 90 days post being declared "Virus free" in sperm.

~Matt

I got that from an interview with an administrator of a major hospital in Mass. who indicated that the extra time would make them reconsider their policy of supporting people who wished to volunteer.

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"Go yell at an M&M"

Don't blame me for your poor writing skills. Of course, I didn't go to no fancy private grade school ...

More importantly, you completely dodged the real issue.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Did they develop an Ebola vaccine when I wasn't looking???

FWIW, the wifie works in a long term care facility and they quarantine suspected flu infected patients and will actually fire a staff member who refuses to get a flu shot and/or shows up to work with the flu.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

I got that from an interview with an administrator of a major hospital in Mass. who indicated that the extra time would make them reconsider their policy of supporting people who wished to volunteer.

Yes, but isn't this like a company saying "We will reconsider whether we pay for insurance or not because of the ACA?" Hardly factual evidence.

Furthermore, as I stated, if a major hospital would rather take the chance of one of their people running around infecting others...well then maybe they aren't the best people for the job in the first place. "We may reconsider whether or not we want our people to follow ALL the protocols necessary to prevent spread of the disease"

~Matt

Why, yes. Yes, they did.
http://www.healthcentral.com/..._comes_off_the_shelf

The point is that there are viruses already out there that do have vaccines available, yet there are also still morons that refuse to get them. So if they had a vaccine for Ebola that was ready for production people would bitch about how unsafe it is and not use it, then whine about getting Ebola.

If that were the case, then I would have as little sympathy for them as I do for those who do not get current vaccinations and get sick.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

With no human trials. So, in other words, no, not yet.

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If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR

Fairly hard lefty senior editor at The New Republic, Noam Scheiber explains why it was best that the authorities were not really truthful in letting the story of the good doctor. Interesting that he ends suggesting there is a quarantine that is to take place (I think this is the self-quarantine). I'm guessing that Ken thinks this is stupid, as Dr Spencer apparantly did.


"In this context, publicly calling out Dr. Spencer for his failure to self-quarantine could have turned into its own minor disaster. Cuomo, de Blasio, and Bassett were generally pretty effective: They correctly assured people that it�s very difficult to contract Ebola, that all the relevant protocols were followed once Dr. Spencer came forward with his symptoms, that the city had thoroughly war-gamed this scenario. Had they taken the additional step of criticizing Spencer for not isolating himself beforehand, you can imagine that dominating the headlines, drowning out most of what they said, and generally contributing to the very panic they were trying to defuse. Everyone who�d ridden a subway or used Uber to get around New York on Wednesday would be asking themselves, Well, if he should have been quarantined but wasn�t, how much danger was I exposed to? (The answer, again, is almost certainly none.) Far better to play it cool while, behind the scenes, making sure any health worker who�s recently returned from the affected African countries has a month�s supply of Stouffer�s in his freezer and a complimentary Netflix subscription.

So one cheer for lying, Mr. and Mrs. Public Official. As a general rule, there�s no better way to get on my shit-list. But in this case, I think it�s your only move. "

http://www.newrepublic.com/...ncers-ebola-thats-ok

Agreed, and before someone goes off on a tangent, yes not all people mount a great response to vaccines and will still get sick with flu (depending on the strain, etc).

Don't get me wrong, I think that it is disturbing that we are seeing Ebola here; but at the same time, I see so many other illnesses that are so much worse that I guess I just have to wonder aloud if this deserves the amount of press we are seeing it get with flu season around the corner, HIV still being transmitted and falling vaccination rates causing a surge in Pertussis and Measles.

I tend to harp on influenza because it is a virus that has killed many in this country and it still does not get the respect it deserves. Like any other illness that is in our country, not falling victim to scare tactics and using some common sense and washing your hands will keep the general public safer. Vaccinating when you can will also help. Healthcare workers are always going to be on the front lines and the ones at highest risk for infection. We know this going into this profession and assume the risk of exposure (granted our employer needs to not be stupid about this either).

Somebody made a good point today. I fear them quarantining everybody now within the US.

Legitimate point, so wouldn't it make more sense to quarantine anybody who has been over there or flat out banning them from coming in? Quarantining them upon entry doesn't prevent if they spread it to people on the plane.

Funny how our country is in such a reactive mindset. We will quarantine the masses here already, but not high risk individuals before they come in.

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"In the world I see you are stalking elk through the damp canyon forests around the ruins of Rockefeller Center. You'll wear leather clothes that will last you the rest of your life. You'll climb the wrist-thick kudzu vines that wrap the Sears Towers. And when you look down, you'll see tiny figures pounding corn, laying stripes of venison on the empty car pool lane of some abandoned superhighway." T Durden

NY and NJ decide to do their own mandatory quarantine:
________

The federal government already stipulates that passengers arriving from Ebola-affected areas self-monitor their temperature every day for three weeks.

Under the new policy in the two states, all travelers from high-risk areas will be interviewed about any contact with Ebola patients. If they have been exposed to the virus, they will be quarantined, and possibly medically monitored, until the incubation period has ended.

"There is no more �voluntary quarantine� in New Jersey because you can't count on people to do it," said Christie, a possible presidential contender in 2016. Cuomo agreed, adding that a voluntary quarantine is "almost an oxymoron to me."

"This is not the time to take chances," Cuomo said.


http://thehill.com/policy/healthcare/221835-ny-nj-to-quarantine-those-high-risk-for-ebola

A fine piece of political theatre.
So NJ has already quarantined a nurse, except officials don't know where to quarantine her.
Yeah, that is prepared.
So tell me, just where did the MSF protocol fail in NY?
Be specific. Try for something that approximates fact and not what is.

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

I don't think he did break protocol (as it exists), but I'll bet the protocol is being reevaluated. Your anger sounds like that of those who defended CDC early on...until CDC came out and admitted weaknesses in their preparations and protocols.

No anger. I worked in labs that cultured class 3 pathogens and have an excellent understanding of risks and protocols. What the doctor did was follow protocols that have worked for decades. I'm just not panicking.
So still, tell me at what point in time the public was at risk.
Oh and frankly I thought the cdc protocols initially were weak. We followed higher precautions in our lab than what they had for caregivers. That said, I have no issue with the self monitoring by a medical professional like this
Look up his background. He was well trained with this disease and did not put the public at risk.
.

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

So you'd be ok with wearing his bowling shoes?

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Civilize the mind, but make savage the body.

- Chinese proverb

Yup

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

It looks like he was infected just at the end of his stay, and his girlfriend might think that protocol needs to change if she comes up positive. OTOH, if he was doing intimate things with his GF up till symptoms appeared, and she does not test positive, they could (and should) trumpet that to good effect.

That makes me feel better.

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Civilize the mind, but make savage the body.

- Chinese proverb

And my point is that all his running around N.Y was pre symptomatic and as such pre contagious.
You do raise an interesting point however that if he and his woman were intimate and she becomes infected, that would be new information. Generally ebola in semen is considered a much later pathology. If that turns out to not be the case then certain models of infection need to be changed.
But viruses are not that sophisticated. They follow the same old infection route and don't change those easily. That would be a game changer in viroligy models.

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

Seriously Duffy, what would you'd get from an early stage person. Sweat. And to date they have never found a complete virus in sweat. They have found partial RNA fragments in sweat in late stage disease, but that is probably from epidermal contamination.
So really, guy pre symptomatic. I will share shoes.

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

No seriously, you're willingness to share shoes with an ebolator makes me feel better.

As for what can happen with feet in shoes, well blisters is one thing.

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Civilize the mind, but make savage the body.

- Chinese proverb

Ok. I know you don't use pink. Thought you were being sarcastic or something.
Yeah I am not worried about pre symptomatic our even early symptom folks.
If you are bleeding, puking, our crapping, whole new ball game.

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Jim
"In dog beers, I've only had one"
http://www.shakercolonial.com/
Creating custom made furnishing to your requirements

Well, so here's my thing with the shoes. Looking at my own as I type this, on the right heel I have a blister (no blood) and on the bottom of my left foot I have a few decent cuts from surfing a reef break the other day (no booties yet, water still warm). So if I put the ebowling shoes that were worn by a sweaty, blistered, cut foot ebolanating doctor there's no risk?

I mean those bowling shoes are nasty enough without Ebolas swimming around in 'em, right?

I'm seriously asking because you seem to be the only one here with experience with pathogens of this caliber.

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Civilize the mind, but make savage the body.

- Chinese proverb

You would probably be at higher risk for getting a foot fungus or MRSA to be honest.

http://www.nytimes.com/...r-to-volunteers.html

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"Go yell at an M&M"

And it worked.
http://newyork.cbslocal.com/...rica-develops-fever/

If it turns out she has Ebola and of course there is the other big if, so far no one has been infected by these people with early stage symptoms so quarantining them may be entirely unnecessary at least from the perspective of preventing spread of the disease.

I think many, even some who advocate for the quarantine, would admit that it's largely to quell the public panic. Is that a good enough reason to do it?

I would say no given that public panic has basically been people whining.

CNN is reporting the woman has tested negative for Ebola.

No, it didn't:


http://www.nytimes.com/...e-craig-spencer.html

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"Go yell at an M&M"

Yup I would wear his bowling shoes and bowl with his bowling ball.

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Just Triing
Triathlete since 9:56:39 AM EST Aug 20, 2006.
Be kind English is my 2nd language. My primary language is Dave it's a unique evolution of English.

 
>No, it didn't:


What didn't work? I think it's perfectly reasonable to quarantine someone who worked with Ebola patients then develops a fever. A quarantine doesn't mean that you eliminate "false positives." The goal is to eliminate self-reported false negatives.

I agree that the NY/NJ policies are largely political theatre, though.

Merely gainsaying the poster's contention that quarantine caught an Ebola-infected traveler.

Also, this traveler didn't develop a fever until after being quarantined.

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"Go yell at an M&M"

Yeah, we just had a coach show up at the High school and at some point informed people she had MRSA. So they cleaned the school that night, but no concern or out cry, I would guess most people in the gym the next night for the games had no clue.

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Just Triing
Triathlete since 9:56:39 AM EST Aug 20, 2006.
Be kind English is my 2nd language. My primary language is Dave it's a unique evolution of English.

I would say no. Public panic for unnecessary reasons should be handled by trying to calm the panic, not kowtowing to whatever the masses want. I'm not saying I expect everyone in the US to know about Ebola or infectious diseases, but the media isn't helping much by increasing the hype instead of reporting facts and statistics and EDUCATING the public on the real risks, especially in relation to the risks of other diseases. What happens when we set a precedent based on panic versus based on actual risk? Why even have experts if we don't want to listen to what they recommend?

None of the panic really surprises me, though. Risk communication is incredibly difficult, especially when it comes to risks that people aren't familiar with or already have misconceptions about (like droplet vs. airborne precautions). Most Americans won't even be bothered to read an article before commenting on it online, let alone look up the real information before panicking about something.

A good summary for the public: https://www.wnyc.org/radio/#/ondemand/409400

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"Go yell at an M&M"

Not only did she not have Ebola, she didn't even have a fever. When she got to the hospital, her temp was 98.6. She registered 101 at the airport after her total mistreatment and four hours of questioning.

And she's still being quarantined. Welcome back to America!

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"Go yell at an M&M"

I agree it's reasonable once they show symptoms, this woman was quarantined before, just for working with Ebola patients in Africa.

http://www.zerohedge.com/...raders-ignored-today

And this is why quarantines need to be put in place.

I don't care about short term panic fluctuations in the market. As far as I see it there are two options:

A) quarantine everyone who has been in west Africa. Result, no western care in Ebola countries, increased likelihood of virus getting more out of hand, increased risk to world population.

B) monitor people who have visited west Africa. Result, no increased risk to general public as people are not contagious until symptomatic.

My wife works in a hospital. MRSA is present in hospital. She takes a shower every time she comes home from work. We haven't quarantined her yet.

And she's getting about 14 Ebola emails a day if she's like my wife. The point is an Ebola outbreak, even small, in the wild aka not a medical care worker will implode the economy. (Do you remember the smallpox scare after 9/11?) People will stop going to work, stop eating out, stop shopping.

As for your supposition in point A) please cite to a source that says that would occur? If you're willing to go to Africa and treat Ebola you should be willing to hang out in isolation for a month.

Costume idea for your/ Torrey's wife:

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Take a short break from ST and read my blog:
http://tri-banter.blogspot.com/

Quickest way to get punched in the nuts is to call my wife "nurse."

Try 'sexy nurse' and see if that's better

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Take a short break from ST and read my blog:
http://tri-banter.blogspot.com/

It's the word nurse since she's a doc.

How does she feel about, ' healer wench'?

What if all countries quarantine those who go to west Africa or stop sending aid. Perhaps a worldwide epidemic cod be prevented. Do you think the virus could the. it magic in west Africa over time leaving only those immune. Maybe we'll get lucky and some of those genocidal pricks and their army of savages will die to. Winner winner, chicken dinner.

Seriously I'm mixed when it comes to this. I support quarantining those who come here under stricter framework. But these are political decisions And what I fear most. It is fitting it is coming from progressive thinking authoritarians.

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"In the world I see you are stalking elk through the damp canyon forests around the ruins of Rockefeller Center. You'll wear leather clothes that will last you the rest of your life. You'll climb the wrist-thick kudzu vines that wrap the Sears Towers. And when you look down, you'll see tiny figures pounding corn, laying stripes of venison on the empty car pool lane of some abandoned superhighway." T Durden