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

[Drexl]

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

curiousity is correct about the attention and fear stemming from the case in Dallas. However I would argue that we will start to see significant economic impacts when domestic cases number in the tens. Air travel, for example, will take a heavy hit if more cases appear in the coming weeks.

The CDC appears very confident in saying they have the tools and protocols to prevent the spread of Ebola in the U.S.. If we get more cases domestically and, especially if it involves people who hadn't traveled to West Africa (e.g. healthcare workers or first responders), people will begin distrusting the authorities very quickly and changing behaviors.

 

[JimO]

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

Are they saying that no errors were made? Do they believe that relatively minor symptoms recorded on the first visit combined with travel from Liberia did not suggest ebola? I guess I don't understand what they are saying.

 

[Redcass]

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

Evidently, the new home was provided by a member of Louise's church, (as were the initial meals to the family if I recall correctly):

I hope that every public health agency is watching how this is transpiring and lining up their resources for cleanup, waste disposal, quarantine and the needs of people in quarantine. It is fortunate that the family had community support, but not everyone will.

Although, churches have long been known to be of great help to their congregants in time of need, and it would be great if there were a liaison between public health and faith communities to help fill in the gaps in times of crisis when the needs are great.

I fear that this is going to become a serious issue going forward, as I'm sure this will not be the last imported case here. Duncan's step-daughter (who was the 911 caller), her husband, and 4 children have voluntarily quarantined themselves while under observation. Although the children were told not to return to school, and the adults not to go to work:

The couple decided they would keep the family inside until the time period for risk of developing Ebola symptoms passed: 21 days. They're doing so out of caution ? and because they're not sure what health officials want them to do. They now worry how they'll make ends meet.

"We don't know if we're going to get paid," she said. There are bills to pay, including $725 rent to the apartment manager, a stickler who called the previous day after hearing a rumor that one of them had Ebola."

http://www.latimes.com/nation/la-na-ebola-quarantine-20141004-story.html#page=1

So what happens when the apartment manager evicts them for non payment or from Ebola stigma? Jallah cared for her sick step-father, personally covering him with a blanket when he had the "cold sweats". Where are they supposed to go while still in the (potential) incubation period? It saddens me that they are trying to do the right thing and are being left to fend for themselves. Provisions for quarantined individuals should be factored into the response effort.

 

[AlaskaDenise]

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

Welcome Redcass.

In many/most states the eviction process involves a court hearing. Can you imagine any judge would find them guilty and order law enforcement to kick them out?

I'd also think the planning should have included better provisions for quarantined people. Hopefully that plan is being written as they exercise 20-20 hindsignt.

.

 

[Dani]

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

Are they saying that no errors were made? Do they believe that relatively minor symptoms recorded on the first visit combined with travel from Liberia did not suggest ebola? I guess I don't understand what they are saying.

They are stating the EHR had the information in there somewhere. Thus they throwing the doctors under the bus.

 

[spit]

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

I hope they don't throw any doctors under any buses, people get tired and ER's are chaotic places. But I also think that it's really important to figure out what went on here. I know that I have personally been to any number of regular doc visits where they clearly didn't read a word the nurse put in, I had to repeat everything. That's ok when I'm in for something noncontagious, even if it's annoying, but in this case, the lesson probably is: make sure you all talk or somehow otherwise communicate important details, if there's any travel history worth note.

That's not even just about Ebola, that's about any number of diseases that a doctor might not think about if they don't realize that the patient traveled to (place X.)

If that communication didn't happen, that's hardly unusual, but it does need to change somewhere in the line. I don't work this job, I don't know where that change might best be made.

Apart from that, a question: does anybody know what authority is responsible here for the details of the quarantine/isolation, including things like food or housing or cleanup? Is that generally county, state, federal? I've been assuming here, from who shows up to press conferences, that it's county -- there are some counties, I grew up in one and mean no insult in normal situations, where that's a really stupid idea for something like Ebola. But I don't know how the lines of authority here work, so if anybody does, I'd hugely appreciate the clarification.

 

[bwilde]

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

I have family in Dallas (some with kids in one of the schools where they took another 3 kids out off, not the first 5 but the next 3). Is there any advice I can give them outside of the feel good crap about world class medical care available in Dallas?

Appreciate any replies.

 

[AlaskaDenise]

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

While they're probably safe (unless more cases show up), it wouldn't hurt to do what they're doing in Africa - frequent hand washing, no shaking hands or hugs, etc. Hopefully the current case might not have more than 2 or 3 contacts becoming ill - and they're being monitored. God bless them all.

.

 

[spit]

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

I have family in Dallas (some with kids in one of the schools where they took another 3 kids out off, not the first 5 but the next 3). Is there any advice I can give them outside of the feel good crap about world class medical care available in Dallas?

Appreciate any replies.

bwilde, what I would personally tell anybody in that situation is to just keep an eye on their kids, and to otherwise not worry too much unless there is transmission that is unexpected. In other words, if it doesn't spread at all, or doesn't beyond this first patient's very close and immediate contacts, it's probably ok.

For me, personally, the line for "oh hell" would be the unexpected transmission. If the guy's immediate family, after they've been isolated, winds up with it -- that sucks, and I wish them the best care we can do, but that's not unexpected, and they have been monitored. If it shows up in somebody else in the apartment complex or something, somebody we wouldn't expect immediately from contact and haven't isolated or monitored, then it's time for much greater worry.

Right now, we still have a whole lot of room to hope this is contained, and that's true so long as any secondary case from this patient is somebody we already planned for and were monitoring carefully.

IMO the thing to worry about with this disease are any cases we don't expect or can't see coming. We're pretty good at isolation/quarantine once they're identified. It's that window when we don't know that somebody might have it that is tricky, from a containment point of view.

 

[AlaskaDenise]

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

As flu season ramps up, it will soon be harder for providers to distinguish early Ebola from flu. So everyone - let's all get our flu shot - to minimize our impact on the system.

.

 

[curiosity]

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

bwilde, what I would personally tell anybody in that situation is to just keep an eye on their kids, and to otherwise not worry too much unless there is transmission that is unexpected. In other words, if it doesn't spread at all, or doesn't beyond this first patient's very close and immediate contacts, it's probably ok.

For me, personally, the line for "oh hell" would be the unexpected transmission. If the guy's immediate family, after they've been isolated, winds up with it -- that sucks, and I wish them the best care we can do, but that's not unexpected, and they have been monitored. If it shows up in somebody else in the apartment complex or something, somebody we wouldn't expect immediately from contact and haven't isolated or monitored, then it's time for much greater worry.

Right now, we still have a whole lot of room to hope this is contained, and that's true so long as any secondary case from this patient is somebody we already planned for and were monitoring carefully.

IMO the thing to worry about with this disease are any cases we don't expect or can't see coming. We're pretty good at isolation/quarantine once they're identified. It's that window when we don't know that somebody might have it that is tricky, from a containment point of view.

I agree totally.

 

[TMI]

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

bwilde, what I would personally tell anybody in that situation is to just keep an eye on their kids, and to otherwise not worry too much unless there is transmission that is unexpected. In other words, if it doesn't spread at all, or doesn't beyond this first patient's very close and immediate contacts, it's probably ok.

For me, personally, the line for "oh hell" would be the unexpected transmission. If the guy's immediate family, after they've been isolated, winds up with it -- that sucks, and I wish them the best care we can do, but that's not unexpected, and they have been monitored. If it shows up in somebody else in the apartment complex or something, somebody we wouldn't expect immediately from contact and haven't isolated or monitored, then it's time for much greater worry.

Right now, we still have a whole lot of room to hope this is contained, and that's true so long as any secondary case from this patient is somebody we already planned for and were monitoring carefully.

IMO the thing to worry about with this disease are any cases we don't expect or can't see coming. We're pretty good at isolation/quarantine once they're identified. It's that window when we don't know that somebody might have it that is tricky, from a containment point of view.

I hope the CDC takes into account that they are dealing with a community of immigrants/refugees. There may be those who had direct contact with the patient who will not come forward, and the community will help conceal, simply because they are in this country illegally. The fear of being sent back to an Ebola outbreak in Liberia would be a powerful motivator to hide.

 

[Lizw]

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

I hope the CDC takes into account that they are dealing with a community of immigrants/refugees. There may be those who had direct contact with the patient who will not come forward, and the community will help conceal, simply because they are in this country illegally. The fear of being sent back to an Ebola outbreak in Liberia would be a powerful motivator to hide.

This isn't the same kind of illegal immigrant situation that Texas has with people coming in over the borders, though--people who have no documentation at all. If there are illegals in this population, it's more likely to be people who overstayed a visa, came on a tourist visa and stayed to work, etc. There almost certainly will be some of those, but probably not whole families as you might see in the Hispanic community.

 

[Graupel]

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

For me, personally, the line for "oh hell" would be the unexpected transmission. If the guy's immediate family, after they've been isolated, winds up with it -- that sucks, and I wish them the best care we can do, but that's not unexpected, and they have been monitored. If it shows up in somebody else in the apartment complex or something, somebody we wouldn't expect immediately from contact and haven't isolated or monitored, then it's time for much greater worry.

Agree 100%. If Dallas makes it ~2 weeks past the first ER visit without any 'how the hell did they get exposed?!" cases things will be looking pretty OK for this importation event. Obviously, the real date is 42 days (2* 21 day limit) but given that *most* people present earlier, it'll be increasingly unlikely further out.

 

[TMI]

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

This isn't the same kind of illegal immigrant situation that Texas has with people coming in over the borders, though--people who have no documentation at all. If there are illegals in this population, it's more likely to be people who overstayed a visa, came on a tourist visa and stayed to work, etc. There almost certainly will be some of those, but probably not whole families as you might see in the Hispanic community.

I should have been clearer, like you I was thinking along the lines of an expired visa, not someone who came in illegally through a border crossing. I suppose that is always a possibility though.

If they did not go through the proper channels to extend their visa, they might be reluctant to identify themselves to authorities. I just hope the CDC considered the possibility and questioned accordingly.

 

[Vibrant62]

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

This isn't the same kind of illegal immigrant situation that Texas has with people coming in over the borders, though--people who have no documentation at all. If there are illegals in this population, it's more likely to be people who overstayed a visa, came on a tourist visa and stayed to work, etc. There almost certainly will be some of those, but probably not whole families as you might see in the Hispanic community.

I think the concern here would be if there was a similar introduction to the Duncan case, individuals details would not (always) be included in contact tracing. That would be where the problem lies e.g. if a newly arrived individual has gone to stay with a family who have overstayed their visas. That said, I think the incentive to come forward to get treatment would prompt such individuals to reveal themselves, if they too start to show signs of sickness.

Even in the outbreak countries people often dont tell the truth about contacts to protect loved ones from the stigma associated with infection. I doubt it would be that much different in the US. For this reason it is actually very important to maintain patient confidentiality.. Whilst people want to know names, if there is too much of a stigma attatched and real problems for families, all it will do is drive contacts underground, or help ensure that they are not named for follow up. That would be the worst of all worlds

 

[MHSC]

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

This doesn't really apply to the children in the schools, but more to the situation overall.

Something else to consider is the "Other than Mexicans" category that US Border Patrol apprehends illegally crossing the border.


The last page (5) at this link has chart that shows years 2000-2013, last year the count is somewhere between 140,000-150,000.
http://fas.org/sgp/crs/homesec/R43523.pdf


For example, it's a 33 hour flight from Roberts International Airport in Liberia just south of Monrovia through Brussels to Tijuana, Mexico.

Here is a map of airports in Mexico, the pink are international. There are nine that are very close to the border and a few more that aren't that much further. Mexico still requires a visa, but it is likely much easier to get than an American one.

http://mapasdemexico.org/images/aeror2.gif

 

[bwilde]

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

Thank you. One of the family members is involved in working with immigrants in Texas through his church and this is just so concerning to me. I have to say it is so very easy to go into a punitive mode and want to punish this guy for bringing it over here but I can see that if too much of that happens, it will backfire on us.

 

[Pathfinder]

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

I have family in Dallas (some with kids in one of the schools where they took another 3 kids out off, not the first 5 but the next 3). Is there any advice I can give them outside of the feel good crap about world class medical care available in Dallas?

Appreciate any replies.

DCHHS Activates a Phone Line for Ebola Questions: 972-692-2783

 

[bwilde]

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

also thanks but boy the fear in me just racheted up with a panhandler that was in the ambulance still not found? Seriously, how can they ever get a handle on this now?