Nurses warn U.S. not ready for Ebola outbreak

[MHSC]

LAS VEGAS -- Dire warnings came in Wednesday about the deadly Ebola virus.

According to the Centers for Disease Control, the worst-case scenario would be up to 1.4 million cases in Africa within the next four months.

Meantime, nursing unions used Las Vegas to get their message out to the country that American hospitals would not be ready for an Ebola outbreak.

...

"Which we know is not just a matter of ?if', it is ?when,'" Bonnie Castillo with the Registered Nurse Response Network said.

Within minutes, more than 1,000 unionized nurses, some wearing mock hazardous material suits, made their way outside to pound the pavement; saying hospitals aren't ready for Ebola.

?I think it's very, very scary. I think we need to be more aware, educated," ICU nurse Valerie Loza said.

Loza is a local ICU nurse. She worries Las Vegas is vulnerable to the virus.

...

"I'm not worried about this epidemic making it to the United States. Could it? Absolutely. Do I think it will? Probably not," Chief Health Officer with the Southern Nevada Health District Dr. Joe Iser said.

Dr. Iser had meetings with hospitals and emergency medical services providers on Ebola preparedness this month.

"They are feeling fairly comfortable they can manage a case of Ebola," Dr. Iser said.

But for the nurses unions, they're convinced pure pandemonium could come in real life, if the U.S. saw an Ebola emergency.


Dr. Iser with the health district says he is more concerned about threats posed by tuberculosis and sexually transmitted diseases in Las Vegas over Ebola.

http://www.8newsnow.com/story/26621166/nurses-warn-us-not-ready-for-ebola-outbreak

 

[blacknail]

Re: Nurses warn U.S. not ready for Ebola outbreak

"They are feeling fairly comfortable they can manage a case of Ebola," Dr. Iser said.

I don't think anyone doubts that the first World can manage A case of Ebola. The issue is how well can we identify that one case and trace their contacts before there are dozens of cases. As we saw with SARS, I think the answer is not very well.

 

[Dallas]

Re: Nurses warn U.S. not ready for Ebola outbreak

Most of us are too young to remember Small Pox. We did pretty well with isolate and track back then. We have the infratstructure (even better now) and an educated populace for the most part. This on top of the fact that we have different cultural practices would all combine to make this non threatening in the west. SARS was a differnt animal with the potential to spread rapidly, this is not the case with Ebola.

 

[curiosity]

Re: Nurses warn U.S. not ready for Ebola outbreak

Most of us are too young to remember Small Pox. We did pretty well with isolate and track back then. We have the infratstructure (even better now) and an educated populace for the most part. This on top of the fact that we have different cultural practices would all combine to make this non threatening in the west. SARS was a differnt animal with the potential to spread rapidly, this is not the case with Ebola.

I agree completely.
Public Health investigates contacts for all types of diseases ALL THE TIME.
While some areas may be more equipped, have more staff, have smaller populations, etc... A disease like Ebola - once detected - in any country with capable infrastructure - will have an unlimited number of investigators dedicated to halting the disease.

Unfortunately, stopping the disease does not mean people will not already be infected and/or die from the disease before it is detected.

 

[Laidback Al]

Re: Nurses warn U.S. not ready for Ebola outbreak

An unquantifiable variable is fear and panic. As long as early identification of cases and comprehensive contact tracing can contain outbreaks to the very limited geographic areas, the USA might fare well. Unexpected spreading, even if contained, will raise the fear factor. The media, of course, will pick up on it which will then snowball into more irrational fear and panic.

 

[Vibrant62]

Re: Nurses warn U.S. not ready for Ebola outbreak

Every country has large immigrant populations, areas of high population density and low academic achievement etc.

It is these populations where fear and irrational behaviour could happen, even in the UK and US or other developed countries; i.e there is potential for behaviours that would not be too dissimilar to those seen in West Africa.

And there is the 'human factor' where denial is the paramount issue we have to overcome - denialism is not a factor of education, as seen in the case of Patrick Sawyer and some leading doctors in the current outbreak, and it was these individuals 'denials' that precipitated further spread. We will not be immune to this sort of behaviour either, amongst HCWs and our most educated.

These are the issues developed societies will have to overcome, and I am not sure how we will do this.

All of our preparedness also depends on the ebola virus not changing significantly in its transmissibility, something we cannot guarantee; I personally feel that the development of an airborne virus is very unlikely. However - one of the primary reasons why pandemic flu cannot be contained is not so much its airborne transmissibility, but the fact that people who are infected are infectious before symptoms start to show. A similar change in ebola could change the playing field significantly. I think the world needs a 'Plan B' to determine how societies manage an outbreak in such circumstances, and especially in healthcare settings.

We need to think through everything - from critical actions, supplies, supply lines and plan for different scenarios. The stakes are too high to just take comfort in the idea that our contact tracing will be sufficient. If the numbers get too large, even we couldnt do it effectively.

 

[Graupel]

Re: Nurses warn U.S. not ready for Ebola outbreak

"The stakes are too high to just take comfort in the idea that our contact tracing will be sufficient. If the numbers get too large, even we couldnt do it effectively."

I agree 100%- IF there are only a small number of cases, then the US, Canada, EU, Brazil, etc etcetc will have no problems. BUT there are are limits for any country's ability to triage, followup, and/or quarantine.

Thousands of contacts, panic-filled ERs, massive waste disposal issues, health care workers needing to protect their own families.... I fear there's too much reliance on assuming that that couldn't possibly happen *here* (wherever here is).

 

[Ray]

Re: Nurses warn U.S. not ready for Ebola outbreak

Every country has large immigrant populations, areas of high population density and low academic achievement etc.

It is these populations where fear and irrational behaviour could happen, even in the UK and US or other developed countries; i.e there is potential for behaviours that would not be too dissimilar to those seen in West Africa.

And there is the 'human factor' where denial is the paramount issue we have to overcome - denialism is not a factor of education, as seen in the case of Patrick Sawyer and some leading doctors in the current outbreak, and it was these individuals 'denials' that precipitated further spread. We will not be immune to this sort of behaviour either, amongst HCWs and our most educated.

These are the issues developed societies will have to overcome, and I am not sure how we will do this.
The stakes are too high to just take comfort in the idea that our contact tracing will be sufficient. If the numbers get too large, even we couldnt do it effectively.

Plus the US has a large numbers people who are of anti-science/anti-vaccine/anti-government, pro-gun, and isolationist. Irrational behavior in the event of a pandemic will not be limited to less developed parts of the world.

From what I've seen online and being involved in the Civilian Medical Reserve Corp in the US, most of our pandemic planning is flu related. I hope FEMA and CDC ramp up the public health system/community/volunteer preparedness and awareness on Ebola. It's not just health care workers and hospitals who need education, it is law enforcement, schools and community groups. Why not combine Ebola awareness with flu awareness?

 

[Vibrant62]

Re: Nurses warn U.S. not ready for Ebola outbreak

Good idea, but there is a 'propoganda' issue for the CDC etc here. For as long as the messaging is 'it couldnt happen here', how can such planning be justified as it contradicts that message.

I hope we see a migration to 'plan for the worst, but hope for/ expect the best' way of thinking, otherwise if ebola does break out of Africa in any significant way, our populations will be unprepared to respond, which in turn may relatively easily make a situation that could/ should be manageable into an unmanageable one, or at least one that delops far farther than it should before it is brought under control.

Many people I have spoken to at the moment only consider spread from the current outbreak countries.

However, we need to remember (just for example) that if there were a significant outbreak e.g. in nigeria at Port Harcourt, there are many international oil workers there. It would not take much to disseminate this to all the oil production and refinery centers of the world including e.g. mexico, Brazil etc in south america, the middle east and that from there, Indian and Phillipino expat workers (who reside in the middle east in significant numbers) could in turn export the disease to thier home countries.

If this were to happen then the likelihood of export to the US and Europe increases in line with case numbers and affected countries. This is one reason why it is so important to contain ebola where it is now...

 

[Ray]

Re: Nurses warn U.S. not ready for Ebola outbreak

Good idea, but there is a 'propoganda' issue for the CDC etc here. For as long as the messaging is 'it couldnt happen here', how can such planning be justified as it contradicts that message.

Looks like the messaging is switching to preparedness:

http://www.cdc.gov/vhf/ebola/outbreaks/preparedness/planning-tips-top10.html

 

[Graupel]

Re: Nurses warn U.S. not ready for Ebola outbreak

That's a stunning admission of how dire this has become....

 

[curiosity]

Re: Nurses warn U.S. not ready for Ebola outbreak

All of our preparedness also depends on the ebola virus not changing significantly in its transmissibility, ...

We need to think through everything - from critical actions, supplies, supply lines and plan for different scenarios.

The current Ebola virus transmission, signs and symptoms, and incubation period is EXACTLY why the contact tracing would work.

Influenza is a completely different disease in transmissibility, susceptibility, and incubation period. The virus survives on surfaces for long periods of time, floats in the air very easily, and knows exactly how to get into the host. The incubation period can be as low as 2 days - many people are asymptomatic carriers. Influenza has adapted well to many animals. It would be a catastrophe if the world had to deal with an Ebola virus that adapted as well as Influenza.

We can't forget that in many African countries, before this event in West Africa, where resources are limited - when the disease was recognized and contact tracing provided - Ebola was stopped.

Thus, barring an unforeseen and radical change in the virus or an intentional, multi-population seeded, bio-terrorism event - an Ebola case is a manageable event in the US. Even in the latter, I have confidence in our infrastructure that the event would still be limited and would not create an uncontrolled outbreak like we are witness to in West Africa.

 

[MHSC]

Re: Nurses warn U.S. not ready for Ebola outbreak

I work in healthcare & I approached my employer about creating a short 15 minute refresher course on Ebola. I asked for this because an alarming number of my coworkers seem to think a course of antibiotics will handle Ebola. We have all kinds of continuing ed courses on our computer systems that can be done anywhere at anytime. I volunteered to put it together for free, and after their approval put it online. I was laughed out of the room, because that's silly, it's not coming to the US! Keep in mind the board members I specifically chose to approach also run a hospital that's a level one trauma center and often listed as being in the top ten in the world.

 

[curiosity]

Re: Nurses warn U.S. not ready for Ebola outbreak

I agree there are many healthcare environments that do not see the need to prepare for an Ebola Case - which is especially unfortunate for the employee.

The overall moral and productivity is affected when the employee is fearful and their concern is disregarded.

While the concerns and fears will not help the situation any if an Ebola case appears, once the disease is officially suspected and detected - regardless of the preparation at the healthcare level, the amount of expertise that will descend upon that location will be PHENOMENAL.

There are hospitals in California that are not fearful of receiving a case, but WANT to receive the first case. They WANT to be the hospital that takes care of and preferably "cures" the Ebola Case. There are Public Health Departments that WANT to do contact tracing on the first case because they have prepared and planned to do just that.

It is unfortunate that mismanagement and poor management happen, but it should not be mistaken for the US overall ability to contain an Ebola event.

 

[JJackson]

Re: Nurses warn U.S. not ready for Ebola outbreak

For advanced health care systems the problem is not dealing with one or two isolated cases at a time it is if there are many concurrent introductions.
The math is such that no one is expecting an instant stop to this outbreak, regardless of how much effort is applied today, it will get much worse before it begins to subside.

The problem then becomes geographic containment. Given the inevitable increase in numbers the priorities are to apply effort to contain the scale in the already affected region while not allowing it to get into the billions of people who do not have the luxury of advanced HC and epidemiological systems.
The 'we can contain it' scenario is based on the odd West African imports not the scenario that would ensue if it gets out of the box in rural India/Pakistan/Bangladesh, China, Indonesia or Nigeria. They do not have the capacities we do and their populations are such that we do not have the capacity to help them much.

At present we are dealing with, of the order of, 10,000 cases in one area which has very limited international contacts. I would be very surprised if this does not reach 100,000 per month before it is contained and that will be difficult to contain geographically. The Sawyer, and friend, Nigerian outbreak took a team of 1000 to stop this happening, and it seems to have worked. We are going to be pushed to reproduce this if it keeps occurring around the globe.
If every patient had been allocated a 500 man team to round up his/her contacts this would have been over long ago.

The economic impacts of loss of containment on another continent would make the 2008 financial collapse look like a 1% drop in the Dow.

 

[Shannon Bennett]

Re: Nurses warn U.S. not ready for Ebola outbreak

MHSC, perhaps you can put the program together so when/if it arrives in the US you can hit the ground running. Visionaries are often laughed out of a room so bear that in mind when you feel beleagured. I, on the other hand, applaud your action.

 

[JimO]

Re: Nurses warn U.S. not ready for Ebola outbreak

I hope you are right, but I fear you aren't.

First, I saw how thin the veneer of civility was after hurricane Katrina. People are people and we in developed nations are just as subject to panic and irrational fear as anyone in the world.

Second, smallpox had been around for thousands of years. Though a terrible disease, it was familiar. Also, by the 1950s cases were rare. I imagine it was more like TB is today in the US than what ebola would be like.

Third, one other major difference that curbed fear of smallpox was that we had an effective vaccine readily available.

Fourth, no other disease that has threatened the modern world has has a CFR so high. Even variola major (the more deadly strain of smallpox) had a CFR of less than half that of ebola, at 30%. Variola minor had a CFR of around 1%, so when someone contracted smallpox, they had a reasonable chance of survival. Remember the fear that was present in many places with pH1N1 in 2009-10? Some medical personnel were so concerned that they threatened not to work with flu patients. That's with a CFR of 0.2%.

I believe that if an outbreak spreads beyond a few primary contacts here in the US, there will be significant panic. I do believe that we will contain cases if they arrive sporadically and are detected early. My concern is if multiple cases arrive over a short period of time and/or if secondary contacts are infected before a widely available vaccine or treatment are developed. I don't believe that a catastrophic outbreak in a developed nation is inevitable, but I fear there are reasonable likely scenarios under which it could happen. We need to take this seriously and have a plan in place to deal with it rather than just assuming that our healthcare systems are sufficient.

Most of us are too young to remember Small Pox. We did pretty well with isolate and track back then. We have the infratstructure (even better now) and an educated populace for the most part. This on top of the fact that we have different cultural practices would all combine to make this non threatening in the west. SARS was a differnt animal with the potential to spread rapidly, this is not the case with Ebola.

 

[MHSC]

Re: Nurses warn U.S. not ready for Ebola outbreak

MHSC, perhaps you can put the program together so when/if it arrives in the US you can hit the ground running. Visionaries are often laughed out of a room so bear that in mind when you feel beleagured. I, on the other hand, applaud your action.

Thank you Shannon!

Jim Oliveros, I too worry about the thin veil of civilization. I see it almost everyday. We have a significant portion of our patients that do not have the knowledge or decision making skills to handle everyday illnesses, even when they have written instructions. We also have the homeless population with a significant percentage with mental illness. They are prone to violent outbursts and drug & alcohol abuse. Every week I can guarantee at some point myself or a coworker will be hit, kicked, bit, spit on, threatened with physical violence, etc, because a patient is having a bad day. I don't work in the psychiatric ward, I work with the general public in the nice part of a fairly well off town. When people are under stress they don't behave in a civilized manner.

 

[blacknail]

Re: Nurses warn U.S. not ready for Ebola outbreak

Unfortunately, this is no longer a hypothetical question. Although resources are being deployed to deal with the Ebola case in Dallas, the patient was initially sent away from the ER and then brought by ambulance 2 days later and that ambulance wasn't taken out of service for decontamination until Ebola was confirmed. We need to stay ahead of the virus and it has a 6 day head start.

 

[curiosity]

Re: Nurses warn U.S. not ready for Ebola outbreak

Fortunately, it has a longer incubation period. One of the pieces that help contain the virus. Imagine if the incubation were two days - like flu can be - the outbreak would have circled the globe by now.

Question:
Is this the first detected unintentional importation to another continent?