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

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

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

The flight left Liberia on the 19th and all passengers were being temperature checked by that time. Elevated temperature is one of the most reliable of the symptom set. Therefore the patient is very unlikely to have been symptomatic until after they reached the US.....

I think it is rather naive to assume that such a temperature check would be an efficient way of screening travellers.

Here's why and how it can happen when you travel around Africa's less-developed countries:

In the Ebola case, if the patient did not think to have been contaminated, and surmised he only suffered from a case of flu, with a small fever, headaches and fatigue, he might well have taken loads of paracetamol or ibuprofen prior to flying.

In fact, if he believed he suffered from a flu, he might even have taken such fever-lowering drugs right through 4 to 7 days prior to his health worsening a lot and seeing the first doctor in the US. After all, that's what we all do when we catch the flu.

It may be that he only realized he might have contracted Ebola when he worsened after the first medical visit. Then wouldn't it be tempting to say that one only very recently had symptoms - and not mention the first days on arrival in the US?

Also, it's a distinct possibility that this patient may have thought that having felt rundown may have exposed him to some Ebola suffering patient on the plane itself - such being the level of ignorance about the illness.

I would venture to say that any one of us who may feel unwell just before a plane trip will simply swallow one or two tablets of painkillers and be able to pass through temperature detectors at an airport without being given a second glance - that is even assuming these detectors are properly manned, which is not a given.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

2) Apparently whatever the health care workers at Emory University Hospital wore for PPE provided enough protection that no one became sick.

True. However, they also produced up to 40 bags of biohazard waste per day. For just one patient.

http://www.cnbc.com/id/102027557
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Sharky said:
I've been following the outbreak in West Africa since the very early days, and I've come to believe that the above statement about the mode of transmission is unlikely to be correct. There have been quite a few stories of infection of "unknown origin," among other things.

There was also a virologist in Nigeria who explicitly said he thought transmission was possible via droplets and surfaces.

My understanding is that there are only a half-dozen or so facilities in the US that are capable of correctly testing for airborne or more complex modes of transmission, and that this has not in fact been done for the Liberian strain (apparently closely related to Ebola Zaire, but not identical).

Does anyone else here have similar concerns?
I am not concerned. It is not that I believe there has never been a case of droplet transmission it is just that it must be very rare. There are bound to be many cases 'of unknown origin' that is the case for almost all diseases and the relatively small number in the cases of Ebola is one of the pieces of evidence that droplet transmission is not an important transmission route. In the case of Flu, which is thought to be a primarily droplet transmission disease, the origin of an individual's infection is almost never know.

Ebola is technically a Genus and Zaire Ebola (ZEBOV) is a species within this Genus. This outbreak, and the one in the DRC, are both definitely strains of ZEBOV although there are small differences in the Nucleotide sequences between them - as there are between your DNA and mine.

Sharky said:
On a related subject, does anyone know if Ebola transmission via mosquitoes or other insect vectors has been investigated? I realize they aren't a long-term repository, but I'm wondering about short-term transmission. As I understand it, West Africa is starting to enter malaria season, which means mosquitoes.
I would be amazed if mosquito transmission was a factor. Firstly all the diseases transmitted by mosquito's do so because they are vector borne disease and the mosquito is an integral part of their life cycle with replication in their mosquito host.
The second reason is epidemiological. While the current outbreak has so overwhelmed transmission chain tracing it has effectively now broken down within hot spots but there have been many smaller outbreaks in the past that have been well studied and the transmission patterns, and successful containment, are not compatible with airborne transmission - with or without the aid of mosquitoes.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

I think it is rather naive to assume that such a temperature check would be an efficient way of screening travellers.

Here's why and how it can happen when you travel around Africa's less-developed countries:

In the Ebola case, if the patient did not think to have been contaminated, and surmised he only suffered from a case of flu, with a small fever, headaches and fatigue, he might well have taken loads of paracetamol or ibuprofen prior to flying.

In fact, if he believed he suffered from a flu, he might even have taken such fever-lowering drugs right through 4 to 7 days prior to his health worsening a lot and seeing the first doctor in the US. After all, that's what we all do when we catch the flu.

It may be that he only realized he might have contracted Ebola when he worsened after the first medical visit. Then wouldn't it be tempting to say that one only very recently had symptoms - and not mention the first days on arrival in the US?

Also, it's a distinct possibility that this patient may have thought that having felt rundown may have exposed him to some Ebola suffering patient on the plane itself - such being the level of ignorance about the illness.

I would venture to say that any one of us who may feel unwell just before a plane trip will simply swallow one or two tablets of painkillers and be able to pass through temperature detectors at an airport without being given a second glance - that is even assuming these detectors are properly manned, which is not a given.
I take your point and I think it is fair criticism.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Just to clarify my position on airport temperature screening.
In general I think it is primarily a PR exercise. It can not help identify infected individuals who are asymptomatic and is therefore not a barrier to spread. I am also not very confident it is always correctly done.

In my earlier post in this thread I was think about this particular case and this particular disease. Ebola is characterised by rapid symptom onset and particularly high fever, in this case he was well enough to be sent home on Friday but was seriously ill on Sunday. The Dallas patient would have been checked on the 19th but did not seek medical help until the 26th. My thinking was if he was even slightly symptomatic on the 19th then he would have presented much earlier. I should have made this clearer, if I gave anyone false hope in screening in general then please accept my apologies.
Edited date - see post below :tiphat: Sollydog
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Just to clarify my position on airport temperature screening.
In general I think it is primarily a PR exercise. It can not help identify infected individuals who are asymptomatic and is therefore not a barrier to spread. I am also not very confident it is always correctly done.

In my earlier post in this thread I was think about this particular case and this particular disease. Ebola is characterised by rapid symptom onset and particularly high fever, in this case he was well enough to be sent home on Friday but was seriously ill on Sunday. The Dallas patient would have been checked on the 19th but did not seek medical help until the 24th. My thinking was if he was even slightly symptomatic on the 19th then he would have presented much earlier.

Correction: patient stated that he first felt ill on Wednesday, Sept 24 and sought help on Friday, Sept 26. Was seen, treated and released. Had he been symptomatic on Friday Sept 19, when he left Liberia I think he would have been extremely ill by the following Friday when he first went to the hospital.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Possible second patient.

Thompson: Associate of Dallas Ebola patient under close monitoring
Marjorie Owens, WFAA 8:16 a.m. CDT October 1, 2014


DALLAS — Due to close contact with a patient diagnosed with the Ebola virus, a second person is under the close monitoring of health officials as a possible second patient, said the director of Dallas County's health department Wednesday morning in an interview with WFAA.

Zachary Thompson, the director of Dallas County Health and Human Services, says all those who've been in close contact with the diagnosed patient are being monitored as a precaution. However, Thompson pointed to one person in particular as a potential second case.

"Let me be real frank to the Dallas County residents, the fact that we have one confirmed case, there may be another case that is a close associate with this particular patient," he said in a Wednesday interview with WFAA. "... So this is real. There should be a concern, but it's contained to the specific family members and close friends at this moment."

The director continued to assure residents that the public isn't at risk as health officials have the virus contained.

Tuesday, the Center for Disease Control confirmed a patient at Texas Health Presbyterian Hospital Dallas was the first person to be diagnosed with the Ebola virus in the United States.

The patient left Liberia on September 19 and arrived in Dallas the following day. On September 26, he sought treatment at the hospital after becoming ill but was sent home with a prescription for antibiotics. Two days later, he was admitted with more critical symptoms, after requiring an ambulance ride to the hospital.

Local health officials say the patient was in contact with several children before he was hospitalized. Thompson says each of those children have been kept home and are under precautionary monitoring.

The Dallas County school district says they're working closely with health officials.

"DISD is in contact with Dallas County Health Department regarding the Ebola investigation," read a statement from Jon Dahlander, a spokesman with the district. "They are consulting with the County on any additional action that may need to be taken during the course of investigation. This is part of routine emergency operations during a health incident in the county. This is same protocol taken during things like flu and Tuberculosis cases."

http://www.wfaa.com/story/news/heal...n-dallas-county-ebola-patient-cases/16524303/
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Thanks Sollydog. Looked at the Oct. calendar to check the date for Friday - my bad.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Just a quick note.

At this time FluTrackers is NOT recommending any traditional treatments for ebola. We simply don't know what works or has any impact. In addition, there are no proven effective pharma drugs, vaccines, and/or therapies.

We do not want to promote anything unless we think there is a reasonable chance it will be effective against ebola. The CFR is simply too high (50-90%) for guessing. When, or if, there are traditional treatments that are proven to be effective against ebola, we will publish those studies.

If anyone, anywhere, has a high fever, trouble breathing, and/or bleeding get off the computer and contact your medical practitioner.

What you can do to protect yourself against ebola is to stay informed. Use at least 2 news sources. Frankly, there is a lot of bad reporting going on. Also, there are people/entities trying to sell stuff and they are shamelessly promoting to take advantage of this emerging tragedy.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

In addition, any emails complaining that we are not promoting natural products, vaccines, pharma drugs, therapies, masks, etc. etc. are considered spam and not read. They are deleted.

Again, if you feel sick, contact your medical practitioner. Do not buy stuff off the internet that claims to treat or cure ebola unless approved by your medical practitioner.

There are no proven effective ebola treatments, drugs, cures, vaccines. If you have any questions about this, contact your medical practitioner.

At this time it appears that the most effective treatment for ebola is a combination of supportive therapies that are only available in hospital settings. It does not appear that any one thing, alone, "cures" ebola.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Possible second patient.

Thompson: Associate of Dallas Ebola patient under close monitoring
Marjorie Owens, WFAA 8:16 a.m. CDT October 1, 2014


DALLAS ? Due to close contact with a patient diagnosed with the Ebola virus, a second person is under the close monitoring of health officials as a possible second patient, said the director of Dallas County's health department Wednesday morning in an interview with WFAA.

Zachary Thompson, the director of Dallas County Health and Human Services, says all those who've been in close contact with the diagnosed patient are being monitored as a precaution. However, Thompson pointed to one person in particular as a potential second case.

"Let me be real frank to the Dallas County residents, the fact that we have one confirmed case, there may be another case that is a close associate with this particular patient," he said in a Wednesday interview with WFAA. "... So this is real. There should be a concern, but it's contained to the specific family members and close friends at this moment."

The director continued to assure residents that the public isn't at risk as health officials have the virus contained.

Tuesday, the Center for Disease Control confirmed a patient at Texas Health Presbyterian Hospital Dallas was the first person to be diagnosed with the Ebola virus in the United States.

The patient left Liberia on September 19 and arrived in Dallas the following day. On September 26, he sought treatment at the hospital after becoming ill but was sent home with a prescription for antibiotics. Two days later, he was admitted with more critical symptoms, after requiring an ambulance ride to the hospital.

Local health officials say the patient was in contact with several children before he was hospitalized. Thompson says each of those children have been kept home and are under precautionary monitoring.

The Dallas County school district says they're working closely with health officials.

"DISD is in contact with Dallas County Health Department regarding the Ebola investigation," read a statement from Jon Dahlander, a spokesman with the district. "They are consulting with the County on any additional action that may need to be taken during the course of investigation. This is part of routine emergency operations during a health incident in the county. This is same protocol taken during things like flu and Tuberculosis cases."

http://www.wfaa.com/story/news/heal...n-dallas-county-ebola-patient-cases/16524303/

Today is October 1st. If there's a second man ill now, as a result of the first case, that's a very short incubation period, at most 3-7 days for that case.

Unless the second case had the same exposure as the first (and also flew from Liberia) and was actually exposed sometime around September 17, taking ill in the past few days.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

The incubation period is anything from 2 - 21 days, with an average of 10 days so it is quite feasible for secondary cases to emerge at this point, having been infected in the US.
 
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia

Wow. And based on this negative result, they were released from quarantine, and sent home for 21 days monitoring:

http://time.com/3452612/dallas-ems-crew-ebola-ambulance/

[snip]

City of Dallas @1500Marilla
Follow
All 3 DFR EMS crew members tested negative for Ebola. Sent home. Will be closely monitored for the next 21 days.

You have to be kidding me! Yet, Liberia's chief medial officer quarantined herself and staff after her assistant died of Ebola. Of particular note - 5 days had passed since the assistant was in the office and she still quarantined herself.

Lberia's chief medical officer has quarantined herself for three weeks and ordered her entire office to do the same after an assistant died of Ebola....

..."Of course we made the rule, so I am home for 21 days. I did it on my own. I told my office staff to stay at home for the 21 days. That's what we need to do," Dahn told the Associated Press in an interview Saturday....

http://www.latimes.com/world/africa/la-fg-ebola-liberia-medical-chief-quarantine-20140927-story.html


Rev. Brathwaite’s last day in office at the Ministry of Health and Social Welfare, according to Dr. Dahn, was Monday, September 15, when he fell ill. She visited him at his Barnersville Estate residence on September 20, where she saw him but did not touch him, anyone or anything in the house. It was at that point that she decided to quarantine herself, remaining home, isolating herself from her husband, children and anyone else in the house. The Health Ministry has since, of course, been out of the question.

http://www.liberianobserver.com/obi...day-self-imposed-quarantine-dr-dahn’s-special
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Obviously there is some confusion regarding transmission methods. Maybe I can help clear this up. Some methods of transmission are airborne, droplet, aerosol, direct contact and indirect contact.

Direct Contact - Ebola is most often and best transmitted by direct contact as in touching the patient then touching your face. This one gets the most press.

Indirect contact - when the patient leaves virus somewhere and you touch it and pick it up transferring it to your body, remember WHO warned about taxis.


Droplet - As you can see in the graphic at the bottom of the page, droplet precaution PPE is recommended for contact within one meter of Ebola Zaire. Ebola droplets are large and do not stay airborne unless they are projected which is then defined as aerosol transmission. Airborne is entirely different and ebola is not airborne that we are aware of.
Droplet is obviously a concern, this from the CDC:
Patient-care surfaces (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces) are likely to become contaminated and should be cleaned and disinfected after transport.

http://www.cdc.gov/vhf/ebola/hcp/in...t-patients-known-suspected-united-states.html




Aerosol - vomit, diarrhea, blood during procedures, saliva during a cough. Anything that has projectile qualities can be aerosolized, even flushing the toilet. That is why toothbrushes kept out in the open in the bathroom have fecal matter on them. This is from the CDC recommendations for infection prevention in HCW as to aerosols from procedures. (Intubation, suctioning, cpr, defibrillation, BIPAP, CPAP, mechanical ventilation, etc)

Avoid AGPs (aerosol generating procedures) for Ebola HF patients.
If performing AGPs, use a combination of measures to reduce exposures from aerosol-generating procedures when performed on Ebola HF patients.
Visitors should not be present during aerosol-generating procedures.
Limiting the number of HCP present during the procedure to only those essential for patient-care and support.
Conduct the procedures in a private room and ideally in an Airborne Infection Isolation Room (AIIR) when feasible. (So there is obviously some question there). Room doors should be kept closed during the procedure except when entering or leaving the room, and entry and exit should be minimized during and shortly after the procedure.
HCP should wear gloves, a gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit-tested N95 filtering facepiece respirator or higher (e.g., powered air purifying respiratory or elastomeric respirator) during aerosol generating procedures.
Conduct environmental surface cleaning following procedures (see section below on environmental infection control).

More CDC recommendations
* Isolate the patient: Patients should be isolated in a single patient room (containing a private bathroom) with the door closed.
*Avoid aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 or higher filtering facepiece respirator) and the procedure should be performed in an airborne infection isolation room.


To summarize:
Direct contact - direct touching of an infected patient - most dangerous
Indirect contact - touching virus shed onto a surface by patient
Droplet - Ebola droplets shed by patient within one meter of patient
Aerosol - Projected droplets from vomit, diarrhea, toilet flushing, etc.
Airborne - Tiny droplets that stay airborne for an extended period - like the flu

Other transmission methods - not all apply to ebola
Sexual - Ebola is transmitted up to three months after recovery.
Fecal-oral - ingesting fecal matter (the cook doesn't wash their hands, as in hep A) does not apply to ebola that we know of
Iatrogenic (injection via medical procedure, needlestick) - does apply to ebola
Vector is an organism that doesn't cause disease but transmits it like mosquitos and malaria or ticks and lyme disease. - does not apply to ebola
 

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

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

As you can see if you take the time to read the above post, when they say it's not airborne, they aren't lying. But most people don't know the difference between airborne, aerosol and droplet.


Link for the graphic that isn't showing.

http://virologydownunder.blogspot.com/2014/08/ebola-virus-may-be-spread-by-droplets.html
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

USA Today is now citing the WFAA report that a second case is under investigation:

http://www.usatoday.com/story/news/nation/2014/10/01/texas-ebola-patient/16525649/

DALLAS ? Health officials are closely monitoring a possible second Ebola patient who had close contact with the first person to be diagnosed in the U.S., the director of Dallas County's health department said Wednesday.
 
Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia

You have to be kidding me! Yet, Liberia's chief medial officer quarantined herself and staff after her assistant died of Ebola. Of particular note - 13 days has passed since her her last contact with the dead assistant and SHE STILL QUARANTINED HERSELF!


1) No yelling on a news thread.

2) It is the same thing. HOME QUARANTINE for 21 days.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

Clearly this first US imported Ebola case in Dallas, TX was a failure of awareness, public health and our health care system on several levels. Despite multiple warning from scientists, journalists, international organizations, the President, the head of the Centers for Disease Control and public health officials a basic diagnostic tool --travel history --was not obtained or not recognized as significant by a number of health care workers/clinicians in contact with the patient.

Was it because the individual arrived in Dallas, TX rather than NY or DC or LA? If so, why? One of the places discussed as a likely entry point for Ebola has been Texas, given the numbers of oil and gas company workers who travel between the US and affected parts of Africa.

Can only hope this is a wake-up call for health care systems globally. These EMS providers, Urgent Care's and ER's are our first line of defense with this infectious disease. They have to do a better job.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

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

As you can see if you take the time to read the above post, when they say it's not airborne, they aren't lying. But most people don't know the difference between airborne, aerosol and droplet.


Link for the graphic that isn't showing.

http://virologydownunder.blogspot.com/2014/08/ebola-virus-may-be-spread-by-droplets.html

Thank you MHSC. This is one of the many benefits flutrackers provides to the viewer - an opportunity to learn more about the 'scary' unknowns in disease (and many other subjects.)

By recognizing that many people don't understand, you provided an excellent post for educating the public - :tiphat:
 
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