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US - Texas: Mr. Duncan - Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased
The handling of the first person found to have Ebola in the United States has raised questions over whether the country is prepared for an outbreak. Nearly a dozen federal, state and local government agencies, as well as several private entities, were involved in responding to the case in Dallas.
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased
I did not know this- Nancy Writebol also was not diagnosed with Ebola and was sent home the first time she was seen for Ebola symptoms. And she worked in the Ebola treatment center! Ebola Survivor Originally Sent Home With Malaria Diagnosis.I'm feeling quite a bit more charitable toward the ER doctors at Texas Presbyterian, and their misdiagnosis of Thomas Duncan. The early signs must be very nonspecific, and they were blindsided by the first case, ever, diagnosed outside of Africa. Must remember that everything looks different through the retrospectoscope.
I did not know this- Nancy Writebol also was not diagnosed with Ebola and was sent home the first time she was seen for Ebola symptoms. And she worked in the Ebola treatment center!
Which is what makes me cranky about the low-information media stream repeating the talking points about how our modern medical system will protect us from an African-scale outbreak. I know chances are that won't happen here, but not because of some magical power of first worldism.
Our health care system isn't really a system at all. It's a mosaic of people, infrstructure, funding, education, staffing, all dependent on local variables for effectiveness. Too many places for error to creep in.
Our health care system isn't really a system at all. It's a mosaic of people, infrstructure, funding, education, staffing, all dependent on local variables for effectiveness. Too many places for error to creep in.
Some people would say that's not a bug, it's a feature. This is a really huge country with a great deal of geographical, socioeconomic and cultural variation. I had a professor friend who teaches rural public health, and she had a Mary Engelbreit poster on the wall that said, We Don't Care How They Do It In New York." There's a lot of truth in that, when half of the state is not just considered rural but frontier. Which is also true of Texas, BTW- and yet they also have three of the country's ten largest cities and Texas alone is bigger than most foreign nations.
What works in a smaller, more homogenous nation may not work here. Which is not to say that we shouldn't try to streamline things, we sure should, but it is what it is for reasons that go way past just health care. It's always like herding cats when it comes to getting the US to do anything as a unified entity. And it will always be that way.
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased
foxp3, Thank you for your very informative post. If I may ask, what is the other forum you post on? And may I use your post on another forum?
FWIW, the government is scrambling to find a "cocktail" that will control the cytokine storm. One company that may become a player is hemispherix, a company I follow (and invest in). Their drugs are now being tested in 6 bsl4 labs. Here is an abstract that was presented last week at 4th Congress on Virology. the last sentence being the most relevant.
---
William Mitchell
Vanderbilt University School of Medicine
USA.
Title: The Unique Role of TLR3 Agonists and Its Induced Products of Innate Immunity as Pharmaceutical Agents Efficacious Against Highly Lethal Emerging Viruses
Abstract:
The Toll-Like Receptors (TLRs) represent a family of class I transmembrane receptors that are elements of an ancient system of immune response to pathogen associated molecular patterns (PAMPs). TLR3 uses a unique non-MyD88 intracellular signaling pathway to induce innate immune responses including Type 1 interferons (IFN) with reduced inflammatory responses compared to the MyD88 pathway used by the other nine TLRs. The PAMP for TLR3 is dsRNA. Mis-matched base pairing configuration of the two RNA strands (rintatolimod) restricted binding to TLR3. Homologous dsRNA strand base pairing activates TLR3 and cytosolic helicases using the pro-inflammatory MyD88 pathway. Emerging human viral pathogens represent major potential hazards to human populations in which innate immune defenses of the host are compromised. Recent emerging viruses with high lethality in humans include the avian influenza viruses and the human coronoviruses. As example there are six known human coronoviruses (Hu-CoV), four of which are responsible for mild ?cold-like? symptoms. Two (MERS-CoV and SARS-CoV), however, have evolved an infectious advantage over the four mildly pathogenic human coronoviral species by inhibition of innate immune responses. Multiple components of MERS-CoV (M, ORF 4a/b, and ORF 5) inhibit the de novo production of a key component of innate immunity, interferon (IFN),that is an induction product of TLR3 activation. Data demonstrate that natural IFN (Alferon) as well as restricted activation of TLR3 by rintatolimod protect cells and/or animals from infection by emerging viral pathogens or cytokine storm associated pathology.
Some people would say that's not a bug, it's a feature. This is a really huge country with a great deal of geographical, socioeconomic and cultural variation. I had a professor friend who teaches rural public health, and she had a Mary Engelbreit poster on the wall that said, We Don't Care How They Do It In New York." There's a lot of truth in that, when half of the state is not just considered rural but frontier. Which is also true of Texas, BTW- and yet they also have three of the country's ten largest cities and Texas alone is bigger than most foreign nations.
What works in a smaller, more homogenous nation may not work here. Which is not to say that we shouldn't try to streamline things, we sure should, but it is what it is for reasons that go way past just health care. It's always like herding cats when it comes to getting the US to do anything as a unified entity. And it will always be that way.
I agree. One problem with a strongly centralized system is that if there is a vulnerability that no one has noticed yet, all members of the system are equally at risk. Plus, the US has such geographical diversity that things which work in one place simply aren't feasible in another. I have friends in Texas who have to drive 20 miles to pick up their mail because the postal service refuses to deliver that far out. And friends in Idaho who can't get grid power or landline telephone service no matter how much they might be willing to pay, because the the utilities simply won't go to their pproperty. Thank God for solar power, and satellite phones and internet, in other words. They drive 100 miles once a month to do their grocedy shopping. These severe differences from one place to another dictate substantial differences in health care structure and delivery.
..... These severe differences from one place to another dictate substantial differences in health care structure and delivery.
WE have those same issues here, except add that our most remote communities use telemedicine where there is NO doctor.
.
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased
The variability isn't necessarily a bad thing, but it makes the Cracked.com/Buzzfeed type 'top 5 reasons not to worry about ebola' headlines misleading because there isn't some universal protocol being flawlessly carried out across the country.
If EVD were to start popping up in my area, some people would have access to facilities in the nearest big city, some would count on our smallish regional hospital, but many would wait until later stages of distress because they have no insurance and/or are undocumented immigrants, of which there are plenty since we are an agricultural area. And that's assuming the messaging even got to most people.
But from a population management standpoint, and at this level of EVD spread, it is better to have people remaining calm. I suppose uneven medical services is a bridge to cross if we get to that point.
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased
Undocumented immigrants are my biggest concern as well, given their fear of being identified as such. The situation is uncomfortably similar to that of tribal folk in West Africa who fear western medicine and governmental authority. I worry that it could result in families hiding sick relatives for fear of their own undocumented status being discovered.
Ebola Victim?s Family Blames Hospital and State
By MANNY FERNANDEZ and JULIE BOSMANOCT. 11, 2014
Dr. Amesh A. Adalja, an infectious-diseases specialist and emergency-medicine expert at the University of Pittsburgh Medical Center who reviewed some of Mr. Duncan?s medical records at the request of The A.P., said that Mr. Duncan had not had a fever when he first arrived at the emergency room, but that he had complained of abdominal pain and a headache. About three and a half hours into his stay, his temperature reached 103 degrees, the highest reading during his four-hour visit.
...
?You have a person who arrived from Liberia in the last 21 days, who has abdominal pain and a headache and eventually exhibits a fever in the emergency department,? Dr. Adalja said. ?That?s clearly a constellation of findings that meets the criteria for Ebola. From the very start, Ebola should have been in the minds of all the health care providers.?
Based on his review of the medical records, Dr. Adalja said the diagnosis given to Mr. Duncan before his discharge included sinusitis, a sinus infection. But Dr. Adalja said that sinusitis rarely caused a fever as high as Mr. Duncan?s and did not cause abdominal pain, and that a CT scan of Mr. Duncan?s head showed no evidence of sinusitis...
They may have given him a CT scan since severe headache and vomiting can be a sign of a brain tumor. Then when that was not found and he developed the temperature, the sinusitis diagnosis was made.
"...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party
(My posts are not intended as advice or professional assessments of any kind.) Never forget Excalibur.
A health care worker at Texas Health Presbyterian Hospital who provided care for the Ebola patient hospitalized there has tested positive for Ebola in a preliminary test at the state public health laboratory in Austin. Confirmatory testing will be conducted by the Centers for Disease Control and Prevention in Atlanta.
The health care worker reported a low grade fever Friday night and was isolated and referred for testing. The preliminary test result was received late Saturday.
"We knew a second case could be a reality, and we've been preparing for this possibility," said Dr. David Lakey, commissioner of the Texas Department of State Health Services. "We are broadening our team in Dallas and working with extreme diligence to prevent further spread."
Health officials have interviewed the patient and are identifying any contacts or potential exposures. People who had contact with the health care worker after symptoms emerged will be monitored based on the nature of their interactions and the potential they were exposed to the virus.
Ebola is spread through direct contact with bodily fluids of a sick person or exposure to contaminated objects such as needles. People are not contagious before symptoms such as fever develop.
All medical discussions are for educational purposes. I am not a doctor, just a retired paramedic. Nothing I post should be construed as specific medical advice. If you have a medical problem, see your physician.
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased
Louisiana attorney general to try and stop Ebola waste from ending up in state landfill
Advocate staff report
Oct. 12, 2014
The Louisiana attorney general said Sunday he will take legal action to stop the incinerated personal belongings of a Dallas Ebola victim from being disposed of in a landfill in Calcasieu Parish.
Buddy Caldwell said he plans to ask for a temporary restraining order on Monday morning preventing any of the wastes from entering Louisiana, the Attorney General?s Office said in a release.
?The health and safety of our Louisiana citizens is our top priority,? Caldwell said in a news release. ?There are too many unknowns at this point, and it is absurd to transport potentially hazardous Ebola waste across state lines.?
The waste will not consist of the belongings themselves, but rather the incinerated remains of six truckloads of items that could have been contaminated by Thomas Duncan when he fell sick, according to the release.
...
NEW ORLEANS - A Louisiana waste disposal facility said Monday it would not accept the ash from the incineration of a Texas Ebola victim's belongings, at least not until state officials agree that doing so would pose no threat to the public.
"We are in contact and working with all the appropriate Louisiana state officials and certainly want these officials to agree that any acceptance of this ash at our Lake Charles facility is safe prior to its acceptance," Chemical Waste Management Inc.-Lake Charles said in news release about the Calcasieu Parish facility.
The company said it is permitted by the state and federal government to accept such material and that the decontaminated and incinerated material poses no threat to the environment or human health.
But, the company said, "we do not want to make an already complicated situation, more complicated."
...
Environmental Leader Facility
CHEMICAL WASTE MANAGEMENT
Lake Charles Facility
Sulphur, LA
The Chemical Waste Management (CWM) Lake Charles Facility is a wholly-owned subsidiary of Waste Management, Inc., the largest waste treatment and disposal company in the United States. The CWM
Facility, located in Carlyss, Louisiana, treats and disposes hazardous and non-hazardous waste from industrial clients in secure double-lined landfills.
With 80 employees, the CWM Facility has maintained strict environmental controls since its inception more than 20 years ago. These controls include rigorous personnel training, daily inspections of the disposal
areas, leachate management, groundwater monitoring, surface water sampling and analysis, and ambient air sampling. Through these programs the CWM Lake Charles Facility has maintained the quality of air,
surface water, ground water, and soil in and around the site...
"...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party
(My posts are not intended as advice or professional assessments of any kind.) Never forget Excalibur.
Correcting the Record: Facts about Protocols and Equipment at Texas Health Presbyterian Hospital Dallas
National Nurses United recently made allegations regarding the protocols and equipment in place during Thomas Eric Duncan?s treatment at Texas Health Presbyterian Hospital Dallas.
The assertions do not reflect actual facts learned from the medical record and interactions with clinical caregivers. Our hospital followed the Centers for Disease Control (CDC) guidelines and sought additional guidance and clarity.
The following are facts about procedures and protocols in place during Mr. Duncan?s treatment:
When Mr. Duncan returned to the Emergency Department (ED), he arrived via EMS. He was moved directly to a private room and placed in isolation. THD staff wore the appropriate personal protective equipment (PPE) as recommended by the CDC at the time.
Regarding the ED tube delivery system utilized during Mr. Duncan?s initial visit, all specimens were placed into closed specimens bags and placed inside a plastic carrier that travel through a pneumatic system. At no time did Mr. Duncan?s specimens leak or spill ? either from their bag or their carrier ? into the tube system.
During Mr. Duncan?s second visit, the tube system was not used at all. His specimens were triple-bagged, placed in a container, and placed into a closed transport container and hand-carried to the lab utilizing the buddy system.
Additionally, while Mr. Duncan was in the MICU, all lab specimens were hand-carried and sealed per protocol. Routine labs were done in his room via wireless equipment.
Nurses who interacted with Mr. Duncan wore PPE consistent with the CDC guidelines. Staff had shoe covers, face shields were required, and an N-95 mask was optional ? again, consistent with the CDC guidelines at the time.
When the CDC issued updates, as they did with leg covers, we followed their guidelines.
When the CDC recommended that nurses wear isolation suits, the nurses
raised questions and concerns about the fact that the skin on their neck was exposed. The CDC recommended that they pinch and tape the necks of the gown. Because our nurses continued to be concerned, particularly about removing the tape, we ordered hoods.
Protective gear followed governing CDC guidelines at the time.
The CDC classified risk/exposure levels. Nurses who were classified as ?no known exposure? or ?no risk? were allowed to treat other patients per the CDC guidance.
Per the CDC guidelines, patients who may have been exposed were always housed or isolated per the CDC guidance.
Regarding hazardous waste, the hospital went above and beyond the CDC recommendations. Waste was well-contained in accordance with standards, and it was located in safe and containable locations.
Admittedly, when we received Tyvek suits, some were too large. We have since received smaller sizes, but it is possible that nurses used tape to cinch the suits for a better fit.
According to an employee satisfaction survey by Press Ganey, Texas Health Dallas is in the top one percent in the country when it comes to employee engagement and partnership. We support the tireless and selfless dedication of our nurses and physicians, and we hope these facts clarify inaccuracies recently reported in the media.
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