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

Dani · Oct 2, 2014

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

Thank you, Pathfinder.

I thought the mistake at the hospital might have something to do with the electronic medical record (in this case they call it electronic health record or EHR) and so it did:

Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows.

The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician’s standard workflow.

As I mentioned in the other thread: http://www.flutrackers.com/forum/showpost.php?p=548618&postcount=7
EMRs are required by the Affordable Care Act, but have been a huge problem for practitioners as they don't incorporate narrative data well. It's a good idea, but it has been hard for people to adjust to.

Nika · Oct 3, 2014

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

Ummmm. How about a conversation face to face? Or is that too old fashioned?

Vibrant62 · Oct 3, 2014

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 really think that when you strip away the veneer of modern western civilisation, people are not so very different, no matter where they reside on the planet.

The only differences are that developed nations have greater command, control and infrastructure and media communications for easy mass communication, but not everyone can/ will be taught. In a country like the US the command, control and infrastructure is quite fragmented at a local level - I do not envy the CDCs task.

Ebola IS a terrifying disease - no amount of risk communications can or should try to play that down, because those communications will fail.

I hope that the errors in support services, lack of precautions etc do not result in 'unexpected' secondary infections e.g. people visiting the flat, cleaners etc because the 'panic' reaction will be severe. The local govt / health department needs to be seen to be exercising an abundance of caution in all its actions. It hasnt so far.

A good step now would be to include all of these individuals in monitoring and follow up, so that if there is a problem, it is caught early - and that the lessons are learned by planners.

If there are no secondary problems, we can all take great reassurance from this over ebola transmissibility... but until the incubation periods are over, I hope communications are measured and that statements allow for secondary transmission possibilities, otherwise all credibility of officialdom will be lost as soon as a case crops up where they dont expect it, and then there really will be a problem with fear and panic amongst the population. Furthermore, people will outright refuse to carry out tasks of food delivery to people who are quarantined, environmental disinfection and more.

With a disease this severe the precautionary principle should apply at every step IMHO.

Laidback Al · Oct 3, 2014

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

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AlaskaDenise · Oct 3, 2014

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

Vibrant62 said:
...........If there are no secondary problems, we can all take great reassurance from this over ebola transmissibility... but until the incubation periods are over, I hope communications are measured and that statements allow for secondary transmission possibilities, otherwise all credibility of officialdom will be lost as soon as a case crops up where they dont expect it, and then there really will be a problem with fear and panic amongst the population. ...........

If there are no secondary cases, people might come away with the idea that there is nothing to worry about and use less caution around future cases, producing far more infections. However, if just one of his close contacts contracts the disease (and hopefully recovers), then the public will understand that caution is necessary with every case. While some may panic, hopefully most will respond to the teachable moment and modify their behavior.

.

Vibrant62 · Oct 3, 2014

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 more details are emerging of the source outbreak in Liberia, it seems quite plausible that Mr Duncan did not know with any certainty that he had been exposed to Ebola

Read http://www.frontpageafricaonline.co...mer-neighborhood-panic-more-deaths-infections

G.Verkerk · Oct 3, 2014

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

Vibrant62 said:
As more details are emerging of the source outbreak in Liberia, it seems quite plausible that Mr Duncan did not know with any certainty that he had been exposed to Ebola

Read http://www.frontpageafricaonline.co...mer-neighborhood-panic-more-deaths-infections

Mr. Duncan's Passenger Health Screening Form as attachment.

From http://www.frontpageafricaonline.co...porter-to-u-s-duncan-lied-about-virus-contact

alert · Oct 3, 2014

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 gotta ask one unusual question:

Why are they having so much difficulty getting food into the apartment?

Latest reports indicate that a charity delivered three days worth of packaged food (canned, boxed, etc.) last night, temporarily solving the immediate issue. But they are going to need more food, and with the large number of children compared to adults in that apartment, preparing food will be a substantial task.

But this is Dallas in 2014. Why aren't the local pizza joints and hamburger chains and takeout restaurants delivering? If I owned a local pizza shop, I would be dropping food off on a regular basis, figuring that, when it's all over, who else would make a better spokesperson for your advertising than these survivors? I can see the commercials now...

The attitude should be similar to those sequestered for jury duty. These individuals are doing their civic duty by serving out their quarantine, and just as the convention is (at least around here) that the state pays to feed sequestered jurors, these people should be fed well. It would also make them less likely to try and flee.

Or is the stigma and fear so high that they can't even get a delivery person to drop food off at the (disinfected) door?

hawkeye · Oct 3, 2014

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

alert said:
I gotta ask one unusual question:

Why are they having so much difficulty getting food into the apartment?

Latest reports indicate that a charity delivered three days worth of packaged food (canned, boxed, etc.) last night, temporarily solving the immediate issue. But they are going to need more food, and with the large number of children compared to adults in that apartment, preparing food will be a substantial task.

But this is Dallas in 2014. Why aren't the local pizza joints and hamburger chains and takeout restaurants delivering? If I owned a local pizza shop, I would be dropping food off on a regular basis, figuring that, when it's all over, who else would make a better spokesperson for your advertising than these survivors? I can see the commercials now...

The attitude should be similar to those sequestered for jury duty. These individuals are doing their civic duty by serving out their quarantine, and just as the convention is (at least around here) that the state pays to feed sequestered jurors, these people should be fed well. It would also make them less likely to try and flee.

Or is the stigma and fear so high that they can't even get a delivery person to drop food off at the (disinfected) door?

I think the stigma is too high. Look at what is happening in West Africa, orphaned children have no where to go - the stigma is too strong.

Vibrant62 · Oct 3, 2014

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

AlaskaDenise said:
If there are no secondary cases, people might come away with the idea that there is nothing to worry about and use less caution around future cases, producing far more infections.
.

I think that the chances of getting away with NO secondary cases in this instance is going to be very small; I am simply hoping that the count is not too high...

We can learn a great deal from this case I think, on many levels - which will help to ensure that the next introduction does not come up against the same brick walls that this one has, so far...

TMI · Oct 3, 2014

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

According to reports, the cleaning crew is coming today to sanitize the apartment the family members are being quarantined in. The CDC study found that under ideal conditions the virus could survive for 6 days on some surfaces.

It has been a week since Duncan left that apartment and was hospitalized with Ebola. The girlfriends daughter stated that Louise was still sleeping in the same bed. with the same sheets that Duncan had been sleeping on while ill for at least two days after he was hospitalized. Louise herself stated that she had bagged some of his clothing and used towels.

What I'm getting at is, though highly unlikely, the remaining family members in that apartment could have come into contact with and been infected by the virus up to 6 days after he was gone, yes?

So when does the count down for the 21 day incubation/quarantine period begin? The day they were no longer physically in contact with Duncan or the day all possible contaminants were removed?

MHSC · Oct 3, 2014

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

alert said:
I gotta ask one unusual question:

Why are they having so much difficulty getting food into the apartment?

Latest reports indicate that a charity delivered three days worth of packaged food (canned, boxed, etc.) last night, temporarily solving the immediate issue. But they are going to need more food, and with the large number of children compared to adults in that apartment, preparing food will be a substantial task.

This looks like more than three days to me, if you look close you will notice a few boxes are visible behind as well.

http://assets.nydailynews.com/polopoly_fs/1.1961419.1412283724!/img/httpImage/image.jpg_gen/derivatives/article_970/health-ebola-usa.jpg

JimO · Oct 3, 2014

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

alert said:
I gotta ask one unusual question:

Why are they having so much difficulty getting food into the apartment?

Latest reports indicate that a charity delivered three days worth of packaged food (canned, boxed, etc.) last night, temporarily solving the immediate issue. But they are going to need more food, and with the large number of children compared to adults in that apartment, preparing food will be a substantial task.

But this is Dallas in 2014. Why aren't the local pizza joints and hamburger chains and takeout restaurants delivering? If I owned a local pizza shop, I would be dropping food off on a regular basis, figuring that, when it's all over, who else would make a better spokesperson for your advertising than these survivors? I can see the commercials now...

The attitude should be similar to those sequestered for jury duty. These individuals are doing their civic duty by serving out their quarantine, and just as the convention is (at least around here) that the state pays to feed sequestered jurors, these people should be fed well. It would also make them less likely to try and flee.

Or is the stigma and fear so high that they can't even get a delivery person to drop food off at the (disinfected) door?

I agree. There are plenty of resources to feed anyone in quarantine. I think the public health agencies hadn't planned for this particular scenario, where quarantine would be such an integral part of limiting spread of a disease. Working out the logistics of where and how to conduct quarantine, how to identify cases in the first place, and where and how to transport individuals who test positive are critical elements to fighting ebola. Even though we've been anticipating this for some months, I think people still got caught off guard. I hope this incident forces public health agencies across the country to modify their emergency response plans to account for logistics of managing more than the immediate treatment of sick individuals.

MHSC · Oct 3, 2014

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

Jim Oliveros said:
I agree. There are plenty of resources to feed anyone in quarantine. I think the public health agencies hadn't planned for this particular scenario, where quarantine would be such an integral part of limiting spread of a disease. Working out the logistics of where and how to conduct quarantine, how to identify cases in the first place, and where and how to transport individuals who test positive are critical elements to fighting ebola. Even though we've been anticipating this for some months, I think people still got caught off guard. I hope this incident forces public health agencies across the country to modify their emergency response plans to account for logistics of managing more than the immediate treatment of sick individuals.

Here are more pictures of the food.
http://ww1.hdnux.com/photos/32/37/47/6945272/3/628x471.jpg
http://sandrarose.com/wp-content/uploads/2014/10/Red-Cross-food-SPL.jpg
https://pbs.twimg.com/media/By98ognIIAAWxeh.jpg:large
http://www.dallasnews.com/incoming/...jpg.ece/ALTERNATES/w320/1002apartmentfood.JPG

hawkeye · Oct 3, 2014

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

MHSC said:
Here are more pictures of the food.
http://ww1.hdnux.com/photos/32/37/47/6945272/3/628x471.jpg
http://sandrarose.com/wp-content/uploads/2014/10/Red-Cross-food-SPL.jpg
https://pbs.twimg.com/media/By98ognIIAAWxeh.jpg:large
http://www.dallasnews.com/incoming/...jpg.ece/ALTERNATES/w320/1002apartmentfood.JPG

Looks like investigators have visited too:
Oct. 2, 2014 Zachary Thompson, director of Dallas County Health and Human Services, and Christopher Perkins, the DCHHS medical director and health authority.

edited out photo

Why even bother cleaning the apartment? Looks like there is little concern.

Lynda · Oct 3, 2014

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'm laughing right now that the words, "looking ugly', were taken so literally.

This is Texan for "really bad".

Anyway, as far as skin transmission, that is not relevant when the subject is the patients' girlfriend (one of those children is theirs), and they slept together when he got here, having presumed semen and saliva contact. She says he didn't tell her he'd been exposed, and there is no reason to doubt her. If she has been infected, he should be prosecuted to the full extent of the law.

Some of the other family members had contact with him; not just fomite contact. It's clear from Africa that transmission between neighbors is common. In fact, the situation in Duncans' home village right now is absolutely wrenching.

As for Zach Thompson marching into that apartment; in Liberia, they at least attempt to sanitize their shoes. I'm going to say that the casual attitude is part of the CDC PR team saying, "nothing to see here, people, move along...".

Vibrant62 · Oct 3, 2014

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

Re: Photo above - well I hope it got sanitised before these two officials visited.

Why do we suppose that in Liberia, Guinea and Sierra Leone people wear hazmat suits when doing this?

The girlfriend may not or may not be infectious, but there is still potential for fomite transmission in a dark environment.

I really hope that the lessons learned here do not prove to be exceptionally painful.

Lynda · Oct 3, 2014

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

Vibrant62 said:
Re: Photo above - well I hope it got sanitised before these two officials visited.

Why do we suppose that in Liberia, Guinea and Sierra Leone people wear hazmat suits when doing this?

The girlfriend may not or may not be infectious, but there is still potential for fomite transmission in a dark environment.

I really hope that the lessons learned here do not prove to be exceptionally painful.

No, the apartment was hot when they went in. This is all so weird.

hawkeye · Oct 3, 2014

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

Lynda said:
No, the apartment was hot when they went in. This is all so weird.

I don't believe the whole thing about a CDC photo op. However, the girlfriend says she sprayed some disinfectant and sprinkled some cleaner on the furniture. So that counts for something. She also says that she wouldn't let the paramedics in when they first showed up until they put on masks and gloves. Honestly she seems to have a better understanding on situation than anyone else.

Here the photo source and the info on disinfecting. Remember though - when the cleaning crew arrived Thursday night (last night) they were not permitted entry because they did not have the correct permits

http://www.washingtonpost.com/natio...d51488-4a5f-11e4-891d-713f052086a0_story.html

Lynda · Oct 3, 2014

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

There are no small kids in that apartment. The apartment contained (until a bit ago) Louise, 2 men in their early 20's, (one of them Duncans' nephew, whose Dad lives in Arizona), and the 13 YO son of Louise and Duncan.

The daughter of Louise was with Duncan when he was transported by ambulance. She has the kids who were in Dallas schools. Where is she? Where are the exposed kids? Louises' ex-husband was also in the apartment when he was transported. Where is he?

Two Dallas deputies have been taken off-duty, and a couple of court employees. A county judge was in that apartment, CNN has a photo of him leaving there!

I'm getting tempted to use the word, 'ugly', again.

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