Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas - Died

[hawkeye]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Sawyer did just about as badly as possible. He urinated on doctors, and attempted to break out of the hospital. This man is unlikely to do either thing, both because of the superior health care setting, and because he is now likely unconscious (that's why they can't ask him about his exposure history in Liberia). Nigeria ultimately had 4 generations of cases.

I think Dallas will do better than Lagos, but I think there may be some secondary transmission.

I agree Alert - I'm certainly not comparing this individual to Sawyer at all. But even without trying this individual unknowingly has likely spread the virus.

I think it's shady that the CDC is claiming only 4 days and those on the plane have nothing to worry about. If nothing else they should error on the side of caution and contact each person on those flight manifests (I certainly hope they are doing this).

 

[foxp3]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

At the risk of being lynched I would take with a pinch of salt the testomy of the patient that he was asymptomatic on flight.

Think about this. If someone had known they had been in contact with an Ebola case in West Africa and they had the opportunity to get out to relatives in US, there may be a temptation to run, either presymptomatic or at start of feeling ill. They may put their own health above others safety.

Now you are ill ,surrounded by CDC officials asking when symptoms started......are you going to own up that you ran because you were sick....risk becoming a hate figure.....risk your family knowing the reason you came to visit was because you had been in contact with someone who had Ebola. The temptation would be there to lie. I am not saying this patient is, but there is a motive if they did. It is well documented in Liberia and Sierra Leone that patients often walked into routine hospitals and lied about their symptoms, hoping to get treatment there instead of going to Ebola holding centres. Many HCW got infected this way, as they didn't suspect Ebola based on the symptoms the patient was relaying, and only after admission did they begin to suspect the patient hadn' t been telling the whole truth.


One way to check is see when flight was booked, was it a long planned journey to see relatives, flights booked over 3 weeks ago etc. However if it was recent or last minute booking, then I would er on side of contact and trace passengers that used toilet, and in seats close by. By just taking word of patient they may leave a possible contamination train to speed away.

Anyway who am I to tell CDC how to do their job.

One thing for sure.....THEY CANT GET THIS WRONG.

Fp

 

[mixin]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Racism, fearmongering, etc. is not needed or even relevant. As far as I know the Ebola virus doesn't distinguish its victims by the color of his or her skin or the nationality of the sickened individual.

Speculation about the motives of this individual is uncalled for until we have more information.

OK, so let's talk about the ways we can be exposed and have no idea of it.

 

[AnnaLisa]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Hopefully he wasn't ill at the airport or in flight :/ I wonder what hub he was at? No flights are direct. Given how sick Sawyer was, it appears that no one on his flights caught it...but still. It makes me a bit nervous.

 

[hawkeye]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Quote:
Originally Posted by Laidback Al
Racism, fearmongering, etc. is not needed or even relevant. As far as I know the Ebola virus doesn't distinguish its victims by the color of his or her skin or the nationality of the sickened individual.

Speculation about the motives of this individual is uncalled for until we have more information.

OK, so let's talk about the ways we can be exposed and have no idea of it.

If the individual was just visiting then at least we do not have to include workspace exposure - except potentially for those that he was visiting.

 

[Gemineye]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

The identity of this person should be disclosed. People in the Dallas area have a right to know if they came in contact with this person. This should be done ASAP if complete contact tracing is to be done. This urgent need trumps patient confidentiality.

 

[Nika]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Notice that he signaled in the call (as seen in this reporting) that there may well be additional secondary ebola cases here in the US from this imported case. Im guessing this is deliberate - helping ease future news re a family member or contact who tests positive.

Its best to keep a stiff upper lip regarding this news. Remind yourself and those who ask you that the reason ebola is so bad in Liberia is that it has been in total and violent collapse w essentially no functioning state wide medical welfare for more than a decade now. It would be hard to find a more different place compared to anywhere in the US than Liberia (places like Gaza, Donesk Ukraine, Somalia might also qualify).

 

[MHSC]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

After arriving in the U.S. on Sept. 20, the patient began to develop symptoms on Sept. 24

Again following this timeline of most patients, with symptoms appearing on day four. We would have four days being 23rd, 22nd, 21st and the 20th would be exposure day, is it possible there was an asymptomatic carrier on the plane??

 

[Sollydog]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

If we assume that the patient was from one of the 3 countries with the current outbreak and we know that he had family in this country perhaps he had visited before and therefore had a passport. Wouldn't he still need a visa? How long does it take to get one, in any of those countries? A day, a week? Would it be most likely in those countries that one had to visit the American consulate in person to obtain one, as opposed to being able to do so on line? (I've never done any international travel so don't know what the process is like).

I assume that the ER would be more likely to release someone without insurance since they are only required to "stabilize" someone and they did not feel that the individual was so ill that they had to admit him, insurance or not. It took another 2 days before they did so.

I'm inclined to think that he did not know he had been exposed prior to his departure but had a planned visit to see his family. If you knew you'd been exposed would you wait 6 days after arriving before you sought medical care?

 

[Shannon Bennett]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

The man/woman sought medical attention a few days before being admitted to the hospital. Evidently the first medical person the patient talked to didn't think our victim was sick enough to warrant further medical treatment by another physician. For that reason I doubt the victim deliberately tried to return to the US knowing he/she had Ebola. Sadly, at the outset of this disease it mimics several far more common African maladies. I mean who doesn't often get diarrhea when visiting another country? A small fever can mean anything from a cold to polio. Since she/he didn't leave the airport with obvious symptoms I would give the patient the benefit of the doubt. The downturn in Ebola patients happens fast. One minute they feel only slightly sick the next they are at deaths door. For our victim to spend hours on a plane after she/he was really sick, he/she probably would have been unable to walk off the plane.

 

[Shannon Bennett]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

There are HIPA laws in place that prevent any medical personnel from sharing any information regarding patients. Discosing the name of the victim is a bad idea in any case. Lynch mobs have been started with less provocation then possible Ebola transmission. I can just imagine what his/her family is going through at this moment. Absolute terror comes to mind.

 

[mixin]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

If he had no idea that he had been exposed, then I'm seriously questioning the current thoughts on transmission.

I wonder if he told the medical personnel at his first doctor visit that he had just returned from wherever he had been?

I'm reading now

The Dallas Fire-Rescue ambulance crew who transported the infected man to the hospital is being quarantined and monitored for Ebola symptoms, Dallas Mayor Mike Rawlings told NBC 5, and the ambulance used to transport the man has been pulled from service.

http://www.nbcdfw.com/news/health/Case-of-Ebola-Confirmed-in-the-US-CDC-277648611.html

Now I've seen 3 conflicting statements regarding his visit here. One says he was a Texan returning from Africa, CDC says he was here visiting his relatives and this article I linked to said

A person who moved from Liberia to Dallas a week ago has tested positive for Ebola, becoming the first person diagnosed in the U.S. with the potentially deadly virus, the City of Dallas confirmed Tuesday.

 

[MHSC]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Dallas Mayor: EMS Crew And Ambulance Used In Ebola Case Isolated

September 30, 2014 7:13 PM

DALLAS, TX (CBSDFW.COM) - Dallas Mayor Mike Rawlings confirmed an EMS crew and ambulance that was used to transport a patient now confirmed to have the Ebola virus in Dallas has been isolated. ?We have quarantined both them and the unit itself to make sure that nothing was there that can be spread and we?re going about our protocol about how to do that,? said the mayor. ?We?ve created an emergency center at Dallas City Hall that are going through those procedures right now. So we?re taking all precautions to make sure everybody?s safe. ?

The Mayor expressed his concerns for all involved as well. ?First and foremost we have got to have our thoughts and prayers for this man who is very sick; who hopefully will get well? but we?re going to make sure everybody else is safe at the same time.

Dallas Fire and Rescue Officials say the ambulance has been ?decontaminated.?
...
http://abcnews.go.com/US/wireStory/officials-confirm-ebola-case-diagnosed-us-25874421

Dallas is obviously a large metropolitan are, how many people rode in that ambulance on that stretcher touching the rails in the days following his transport? There's a transmission chain I hope they follow.

 

[AnnaLisa]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

I hope the BP cuffs were disposable. :/

 

[Sollydog]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Dallas is obviously a large metropolitan are, how many people rode in that ambulance on that stretcher touching the rails in the days following his transport? There's a transmission chain I hope they follow.

Isn't it most likely that it was his second visit to the ER that was via ambulance, not the first time? If so then once the hospital personnel suspected ebola the EMT's and their rig would have been dealt with asap and the unit taken out of commission while they waited for test results.

 

[jeffrey]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

The identity of this person should be disclosed. People in the Dallas area have a right to know if they came in contact with this person. This should be done ASAP if complete contact tracing is to be done. This urgent need trumps patient confidentiality.

I agree. Not even a US citizen. All of the US needs to know. Please this is crazy.

 

[Chicagogal]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Does anyone know if this guy went from the ambulance into isolation, or went through intake in the ED first? Wondering how far the contact tracing is going to have to go.

 

[MedStudent_18]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Unless these healthcare workers had reason to suspect Ebola, I can't imagine them taking the necessary precautions. Given that he wasn't tested on the 26th, it's likely the patient's travel history wasn't known until a few days ago.

 

[AnnaLisa]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

I would feel more secure if the CDC just came out and said they were going to have to trace a significant number of contacts. This 'handful' of contacts just doesn't hold water. They lose credibility when they are not honest and then have to back track. People would feel better if they knew what airline and flight etc. I totally disagree that his identity should be divulged. That isn't ethical. This person is a human being. That said, I would feel better if the additional information they have was released.

 

[blacknail]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Again following this timeline of most patients, with symptoms appearing on day four. We would have four days being 23rd, 22nd, 21st and the 20th would be exposure day, is it possible there was an asymptomatic carrier on the plane??

This is pure speculation, he departed on the 19th and symptoms began on the 24th. It is possible that he was exposed before during or after his flight, it is most likely to have occurred before his flight, but you do bring up a valid point that he could have been infected on arrival in the US.