CDC personnel didn't even follow their own guidelines when in the quarantine area of the hospital. The whole freaking thing was a clusterfuck. Actually, I won't say the whole thing - I believe the CDC and hospital officials risked these nurses lives given them inaccurate information as they treated Mr. Duncan. From what I can tell, they went the extra mile in caring for him.

Hospital. How can these nurses knew about Duncan having Ebola when he didn't say anything? He never mentioned he was ever in contact with infected people. Soo those poor HCW didn't know!!

Mr. Duncan had to apply for that visa long before he came in contact with that pregnant woman. I'm positive this was a planned trip based on several reports, although I'm not sure if the date had been changed at the last minute.

He helped this pregnant woman knowing he she had Ebola. She was turned away from hospital because there were no beds to treat her condition- besides everyone in Liberia is prompt to know someone or be close to someone with Ebola

I think it is over the top to claim he was a terrorist. If he was a terrorist, why did he expose his own family to the virus first? That's an awful claim.

About anyone only to purse the mission set to complete. Their heaven and virgins waiting for them are far more important. Besides, where and when was he ablet to obtain a visa that is so difficult to obtain especially from a country such as Liberia- poor and infested with diseases.

His other actions are to be considered as well, like LYING at the airport that he was never exposed to anyone with the disease and hiding from the nurses the FIRST TIME He went to the hospital that he was exposed to it.

Terrorist?

jeesh?

You the truth.. That's just how it is. Explain then how he got that tourist visa.

who made an attempt to save his own life while endangering others.

I have read conflicting reports on whether or not he knew the woman he helped actually had ebola.
I just don't know for sure either way.

Politically correct?

Huh!
What in the world are you talking about?

It sound like you meant to go to home economics class but ended up in math by mistake.

I admit I'm mystified.

From local government on up, there is no management accountability. If something doesn't get done today, well, just do it next week. If something doesn't get done at all, hide that fact. Or find some low-level employee to blame.

With rare exceptions, government managers are never held accountable. In other words, they never feel any pain for mistakes made on their watch.

And that makes people lazy and complacent. It's a natural reflex.

The same thing occurs in many corporations. However, this is usually not true in the military. An officer who blunders is usually not fired, but his/her career is over. Done. No more promotions. Just a transfer to a humiliating desk job. No more prestigious commands. And that keeps officers motivated, motivated to stay on top of every situation.

The trick here is how to get that philosophy into civilian government, without causing undo stress on everyone involved.

What's the accountability there? And they'll charge you through the nose for it.

As I mentioned earlier, many corporations are just like the government. No management accountability.

And as you alluded to, the private sector is profit-driven. That's not necessarily a bad thing, unless it interferes with doing what's right. And sadly, way too often that's exactly what happens.

You rarely see government mismanagement rise to the criminal level. But it's not uncommon to see that in the private sector.

And as I also mentioned earlier, the solution is to apply military-style accountability to government agencies. But don't ask me exactly how to do that. I'm just the big-ideas guy, not the details guy.

I am so sick and tired of the bean-counters running everything. And running it into the ground. Unrestrained! I see it happening in my former industry (radio) - the bean-counters have just utterly ruined it. Penny-wise/Pound-OBSCENELY-foolish. And Oh God, we CAN'T impose regulations or restrictions or oversight upon these people. Free-market! Free-market! When that's exactly what we need. The runaway vultures HAVE to be contained. Penned in. Restricted. You CANNOT just do whatever the hell you want in the so-called "free market" when it starts to hurt other people. When it starts to impact people adversely and cause harm, or greater risk of illness, or direct threats of exposure to potential DEATH.

Health care services MUST NOT be a FOR-PROFIT OPERATION!!!! Not EVER!!!!!!!

Dammit! Does EVERYTHING have to be something you can make money off of? Is that REALLY all we care about? All that makes the world go round? Our entire reason for being? Seriously? Does it really have to be that way?

THAT is something I wish we could do something about. This is our "National Ebola Affliction." The Ebola virus of the Almighty Money-Grab. It infects and sickens and kills.

I'm watching the report about the Carnival cruise ship. Well, THAT's gonna impact the bean-counters. They couldn't stop in Mexico. Had to turn around and head back out to sea. Clean the ship thoroughly (we hope). That took more unplanned, unscheduled time out of the routine. Unhappy inconvenienced passengers (and, I'm sure, quite unnerved and some maybe downright scared). Probably gonna impact cruise travel, too, because paranoia is stronger and faster-spreading than even the Ebola virus.

The bean-counters are just gonna have to bite the bullet and take it in the shorts here. Maybe you're gonna lose some money. TOUGH. As far as the hospitals go, maybe you need to go the extra mile(s) and spend the money and do it right and make sure everybody's well-trained and well-supervised and well-supplied and well-informed, and well-covered, staffing-wise. And YEAH, that's gonna COST. Tough shit. That's just how it is. Maybe you shouldn't be in this particular venture just for the money anyway! Maybe this particular venture shouldn't be just about making money in the first place.

Hmmmm... are we talking about single-payer?

And what really burns me up is - we had some ALLEGED change-of-heart after Hurricane Katrina, too. We had SOME people begrudgingly admitting that well, yeah, you do need a central command. You do need to spend more on this stuff. You do have to do preventive stuff and things that might cost more. And that's just how it is. But the backslide from that after the danger was perceived to have passed. And people forgot. And people stopped caring.

Sadly, Hurricane Katrina's other short-attention-span lesson, that was taught and then quickly forgotten - was the demonstration of a VERY GRAVE need for a smart and effective central command. The organized big government involvement especially as the crisis crossed state lines and individual states were overwhelmed by the need and couldn't keep up or adequately respond. And here, of course, in THIS case, we have a freakin' Keystone Kops situation - where the "big government" has been crippled by savage funding cuts, they've had to make do with less (ALL KINDS of less - staffing, research, supplies). And instead of going on all-out offense from the get-go, they nickel-and-dimed it. Did the minimums, as far as precautions, recommendations, as little as they could get away with - that still might be sufficient. As little to inconvenience, as little to generate costs, as little as possible so as to keep expenses down. And look where that's gotten us. If we'd gone full-tilt-boogie, spent the money, done the training, aggressively spread the information - AS SOON AS THAT GUY, our unfortunate "Index Patient" Mr. Duncan, was hospitalized - the nation's entire hospital system should have been placed on Red Alert.

This mentality we've gotten into as a nation over the last 30-35 years - this stupid, reckless, short-sighted, cheapskate Penny-wise/Pound-EXTREMELY-foolish, just-do-the-minimums, playing catch-up, waking up only after the horse is out of the barn, day-late/dollar-short, cut-cut-cut-cut-cut-cut-cut, it's just horribly horribly screwed. And it's just gonna wind up screwing us.

underlies how everything is run. We need single payer.

Not that I am against single payer at all...

infiltrated with Liberty U grads as well. Their task is to be incompetent ( which seems to come natural) and make the agency incompetent. The GOP of course is after top managements blood to get rid of any competence.

they can no longer do any harm.

Don't think I need to name names. Abu Ghraib: Blame weekend warrior Janet Karpinski but let Ricardo Sanchez skate. "That's some catch," Yossarian might say.

I should have qualified my earlier post a bit. Military-style management accountability seems to work up to maybe brigadier general (one star) level. Then politics takes over.

they can only suggest. Turf wars will happen.

Unfortunately I think we are kinda learning as we go. I'm just glad this is happening in Texas and not where we live.

I hope the CDC starts to rethink some of their policies. If a country like Nigeria (which btw has also never had an outbreak of Ebola until this recent one and their case started just like ours - one person flying back into the country with Ebola) can somehow manage to stop the outbreak then I can't see why the United States can't do the same thing.

And this is Nigeria. This is the country that can't figure out where terrorists are hiding hundreds of underage school girls kidnapped from their homes yet were able to track down hundreds of people who may have come in contact with the one person who flew home with Ebola into Lagos, the 7th largest city in the world, and stop the spread of the Ebola virus to just 20 infected, 9 dead.

So if a government like Nigeria can do it, I'm hoping the United States can.

And, let's face it. We're a crisis-oriented nation. If there's no money to be made in being pro-active, no one thinks ahead. Even though we had a forty year headstart with another nation's experiences to work from, I think we were hamstrung with a mix of arrogance combined with prejudice. Arrogance because many felt that it could never happen over here since we're such an advanced nation, and prejudice because, well, getting money from Republicans to proactively tackle a virus that was ravaging African people--it just wasn't going to happen.

Add to that what Shemp Howard, the post above yours, says about management accountability, I think we have the answer to my question.

Sometimes I think the reason I was sidelined was to see the world through unfiltered eyes. So many people who are chained to their desks can only operate within a framework that is defined for them by the policy makers of their companies.

We hear all the time about how we have the "best health care in the world", and I think that the CDC believed the hype.

Another think is probably the attitude of dealing with things at the last minute, which seems to pervade our culture. Everything from terrorist attacks in this country to climate change---we put off dealing with it until the danger bites us in the ass, then we scramble.

See my post to LynneSin, above yours.

Arrogance and cavalier attitude.
And they allowed woman with Ebola to get on the plane because her fever hasn't reached some magic number of 101.5 somebody somehow come up with.

at the CDC, or any of the other alphabet-soup government health agencies, you're really pretty removed from the practice of medicine. You're not so much a "doctor" as you are a bureaucrat with an expensive formal education.

These nurses and the cruise nurse did nothing irresponsible because they were told they had no exposure. The HCW were continuing to treat other persons per CDC guidelines.

Until Jenkins stepped in, they were NOT removed from patient care, were NOT told to isolate themselves, and were NOT told not to use public transportation. How anyone can be more afraid of using public transport next to one of these people than of being treated by one of them astounds me. What really blows my mind is those who are posting here who claim to be medical professionals who are upset about the cruise or the flight but not about treating patients. That's a really unique theory of disease containment.

Thank you for posting this.

capitalism's norms that they can't see reality when it is staring them in the face: you are way more likely to get Ebola being treated by a HCW who treated Ebola-infected patients than you ever were from sitting next to one of them on public transportation.

Because, see, workers gotta work, else capitalism fails.

I don't think the CDC has anything to do with patient acuity or nurse staff ratios. I always thought that was a hospital decision.

I do find it very disturbing that the hospital did not require 1:1 care for Mr. Duncan.

It was always about the bottom line and not about patient safety, patient care or the nurses ability to provide both without danger to her or the patient. I left hospital based nursing in 1998, and it's sad to see that things haven't changed that much.

They've got a business to run, don't you know? What, you want them to put people's health first?! They're not some freaking charity!

That does NOT mean that it isn't run with a business mentality. But, technically, it is a non-profit.

http://www.faqs.org/tax-exempt/TX/Texas-Health-Presbyterian-Hospital-Dallas.html

Texas Health Resources is a HUGE operation, with many affiliated or joint operated facilties,
but it is non-profit. http://www.texashealth.org/

From their website: Texas Health is one of the nation's largest faith-based,
nonprofit health care delivery systems.

That doesn't mean it isn't managed to make a profit, it just means the profit
is not distributed to owners nor are dividends paid to anyone. Surplus revenue is retained by the
organization and put back into providing services or otherwise accomplishing its mission.

Even in non-profits, the bottom line is paramount. Until we have single payer, balancing their books will matter more to them than poor people's health. Profit can be a desirable thing, if it is tied to healthy outcomes for their patients. I seem to recall some single payer systems offering bonuses for providers with better than average outcomes.

We've both been proponents of single payer--universal coverage NOT offered through insurance companies--
for many years.

That being said, organizations like CommonDreams ought to get their facts and descriptions straight.
Before the for profit companies like HCA started buying up hospitals, to become one big
organization, it was the Catholic hospitals--and a few other religious ones--that were grouped together
and managed by a single entity. They were more about charity.

The non-profits still have a legal obligation to provide a certain percentage of their services as charity
in order to maintain their non-profit status.
The problem has been not enough people being insured to provide any reimbursement for the cost of
services, and there are only so many ways to bill for services. That's how $10. aspirins gained attention.
There are a lot of fixed costs--for which it can't bill--in a hospital, so the cost gets shifted
into a service where it can bill.

Healthcare workers are the toughest jobs out there. Thank goodness there's folks like you and your husband out there. I know I could never do it. I get woozy looking at a cut on my kid's leg.

whether or not they are being paid. And will somebody deliver groceries and supplies to their door, as was done for the Duncan family, since they are unable to go shopping?

in preventing the spread is to make sure people are financially secure if they have to isolate.

If that doesn't happen, people will not follow the guidelines.

can decide if they want to provide Workers Compensation Insurance, other insurance or no insurance. The two nurses were moved off of hospital pay when they entered the hospital. Whether or not the two moved to Medicare or Medicare temporarily is not known.

Texas is also a Right To Work (for very little pay) RedState with lots of low pay jobs and no Medicaid Expansion. Texas has terrible flu epidemics. Many people cannot afford the flu shot. In winter of this year, every hospital bed in Tarrant County was full and the County Hospital-JPS issued a Code Yellow-A flu related illness-report to a clinic after 5 PM to 8PM.

Texas Taxpayers footed the bills for all indigent persons. There are a lot of poor people in Texas.

http://www.democraticunderground.com/10023891331
Code Red: The Critical Condition Of Health In Texas
(See dates.)

And in any big city major grocery chains do deliver. Though I can't imagine they don't have family or friends or a nearby church to help with that.

supposed to take action. It is my understanding that CDC sent the rules to follow to the hospital administration and they did not take action by training their staff. Technically the title is correct - Health officials did do something but the question is which health officials.

CDC is a research and info agency and in the past did not take over hospitals - that was left to the states and local officials to follow the info that the CDC provided.

The hospital decided to let the nurses work with other patients. The CDC let the nurse fly. Plenty of blame to go around.

especially in Texas which is fueled by Extremists Tea Party member Legislators and thinkers. I believe that Texas extremist policy by Conservative Texans and the Republican Platform is the real reason behind this whole bad episode. It is a learning experience alright.

Who ever heard of providing an antibiotic to a patient without doing a lab work first. No bacteria but a high fever and was known to be in West Africa=a virus.

That is why Governor Perry has called for several Virus/Ebola/Marburg testing facilities through the state.

http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/definition/con-20031241

By Mayo Clinic Staff

Ebola virus and Marburg virus are related viruses that cause hemorrhagic fevers — illnesses marked by severe bleeding (hemorrhage), organ failure and, in many cases, death. Both viruses are native to Africa, where sporadic outbreaks have occurred for decades.

Ebola virus and Marburg virus live in animal hosts, and humans can contract the viruses from infected animals. After the initial transmission, the viruses can spread from person to person through contact with body fluids or contaminated needles.

No drug has been approved to treat either virus. People diagnosed with Ebola or Marburg virus receive supportive care and treatment for complications. Scientists are coming closer to developing vaccines for these deadly diseases.

The Centers for Disease Control and Prevention monitors the United States for conditions such as Ebola infection, and its labs can test for the Ebola virus. Mayo Clinic does not test for the Ebola and Marburg viruses.


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Aug. 06, 2014


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Which is these guidelines have been changed.

guidelines at all.

because the guidelines SUCKED. The guidelines didn't call for head to toe protection nor disinfection before removal. They didn't call for using the buddy system to make sure that everything was covered that needed to be nor any supervision from someone with the right experience. They didn't call for any training or practice either.

Frieden went to West Africa to just TALK to Ebola patients at a physical distance while properly suited from head to toe yet he approves guidelines for CAREGIVERS that didn't even come in the same universe as that which he used his own SELF.

Many other hospitals did notice what was wrong with the CDC's PPE guidelines, threw them in the trash and used the guidelines from Emory and NIH instead.

and, being asymptomatic, couldn't shed the virus,

then you probably wouldn't see the nurses experience as a threat to other patients.

My guess is that nurses working in isolation wards move among some number of patients, that part of it may not have seemed terribly unusual,

Of course, in hindsight, it doesn't seem that way at all.

that the NRA approved of we wouldn't be in this mess.

Thanks Obama!

... and you should denote it with a "/s" after your comment.

If it was Mr. Duncan would have infected everyone on the plane ride to America.

As soon as pham got a fever she followed procedure. More Americans are going to die because of Heart Diesease, Diabetes, The Flu, and Gunshot wounds just like always.

NOT EBOLA

Please turn you angry panic switch to the off position now

Which is how two (and counting?) nurses were infected.
So you are posing on the wrong thread.

The health care worker who got a fever follwed the procedure of taking herself to the hospital as soon as a symptom appeared. The CDC did nothing wrong in allowing workers to continue working who had zero symptoms.

They were given instruction to report to the hospital at the first sign of Ebola.

Notice no one has contracted Ebola that was around Mr. Duncan before his second hospital stay.

Again 2 people with illness after his death is not panic time.

Whatever pull your hair out

on the same day, same shift. Listen to the video.

http://www.usatoday.com/story/news/nation/2014/10/15/nurses-protest-ebola/17302987/

You don't think that is at the very least a bit questionable??

Even if they caught something it would have taken at least 10 days for them to become a typhoid Mary

allowed.

This is how things are prevented in the future. Identifying risks and doing everything possible to be sure they aren't repeated.

How would you like to have been put at such risk due to such incompetence.

If the hospital was filled with newly infected Ebola patients, then you would have a reason to be freaking out.

Pardon me for not jumping on the mass hysteria ebola bandwagon

That is what "didn't happen"

But carry on

And how inexplicably stupid it was to have been allowed.

Too much taking on and off of PPE. Too much rushing around.
His care should have been 1:1.

Many years ago, I worked with RSV and the isolation was almost a joke. Sure we followed CDC guidelines, but we ran like chickens with our heads cut off from RSV patients to non-RSV patients. Eventually, we got so many RSV patients that they created an RSV ward.

(RSV is a lot like enterovirus. Very common, but can be problematic in at-risk children)

The nurses were probably rushed taking on and off the PPE. They were probably preoccupied with their other patients etc.

... our own Supreme Court just screwed 600,000 Texans and is therefore far more toxic to the health of our nation?

Oh that's right, ZERO.

Calm the fuck down about Ebola.

And that's because she was consciencious enough to put those around her at the absolute minimum risk when she suspected she had something. The only thing that she did that I've heard criticized is that she drove herself to the hospital after running a fever, which risked the chance of an auto accident and subsequent exposure of other people through trying to rescue her.

I don't blame her for that, because I have no doubt that the bean counters at the hospital never considered what would happen if one of their employees got Ebola from Duncan, and didn't put in place something to transport workers from home after running a fever.

Of course, at this point, if there is a breach of protocol, or some other inadequacy of how we deal with this particular strain of Ebola, it is indeed possible that her infection will lead to someone else getting infected. I imagine that she would be greatly saddened at such a situation. She seems like a truly caring individual, and I wish her a full and speedy recovery.

And it's spread.
Now people are dying there on the streets.
Ever thought about that?

Maybe they need to take a chill pill and relax.

long.

This deal could have been fairly easily contained back in late spring/early summer... and it's not like no one knew about it, I remember reading about it in April or so--- but foot dragging, denial, and minimizing/underestimating the risk caused the clusterfuck we're seeing today.

at least to some degree. The good news is that (so far) only 2 have actually contracted Ebola.

I think we can thank the very low level of communicability in the early stages. Maybe we can stop worrying so much about things like 'this person was in the same room with someone who was on the same airplane that an Ebola nurse was on, albeit on a different flight.'

infected others by her continuing care for others right after treating Mr. Duncan..

That it "appears" she did not is luck. Nothing else.

to get sick, and these high numbers are just not present until late in the course of the disease.

If it was just luck, why aren't there hundreds of people sick right now? They were all lucky?

which she did in order to become infected. She could have transferred those highly contagious virons to others in her care.

The virons from Mr. Duncan.

That seems pretty unwise.

If she began treating other patients AFTER he died, she would presumably have taken a shower since her neck was exposed to Duncan's ebola virus particles, and would not be producing her own until she began having symptoms.

But again if she was treating numerous patients at the same time as Duncan, then those patients would be vulnerable.

That is my point.

unless they have survived it. Ebola virus is present in semen and breast milk for up to three months after a person has survived the disease.

Ebola is spread through contact with vomit, diarrhea and blood. Unless you are telling us the nurses in question were barfing, shitting and bleeding on their patients, your bile is unwarranted.

Duncan's family were isolated because they were in much closer proximity to him and were wearing absolutely no protective gear. Their situation was completely different. None of them has shown symptoms yet and that should tell you something about how hard it is to transmit.

The disease is not easy to catch if you are not dealing with infectious body fluids. That means anyone trying to keep a person down with it clean and comfortable is at highest risk and that means direct caregivers, especially spouses, parents and nurses.

So far, the most dangerous part of this disease in the US is the hysteria.

Was his fluid contagious? Yes
Did Ms. Pham have contact with his contagious body fluid? YES
Did the nurses who were treating Mr. Duncan, also on the same day, treat other patients? YES
Could whatever contagious fluid that got on those nurses during that day be transferred to other patients they treated the same day, infecting other patients? YES

This isn't rocket science.

they should all be fired. Every last suit should go.

That hospital is so poorly run it needs to be closed until people who know what they're doing can be found to run it.

It is disgraceful.

I thought most knew this.

Of all the boneheaded suits I've had to work around, that hospital takes the prize for the most ignorant, boneheaded suits on the planet.

I suppose even doctors couldn't get through all the corporate gobbledegook to convince them that Ebola is different and nurses can't go room to room when they're caring for a patient down with it.

stripping it and using flamethrowers to disinfect.

And i was only HALF kidding.

Shhhhhhhhhhhhhhhhhhhhhhhhh!

I'm freaking out!

Get a fucking grip, people.

#1, nurses who were treating Duncan with flawed precautions were on the same day on their shift treating other patients.

#2 Since two nurses have gotten ebola, they could have easily infected their other patients.

#3 They didn't have to be shedding a god damned thing. All they had to do was transfer Duncans virons that they obviously were exposed to, to other patients they were caring for.

You think nurses were carrying Duncan's bodily fluids to other patients? Seriously?

I think it's entirely possible for the fluids to be passed from one person to another. How the hell do you think the nurses got ebola?

It is how infection spreads. Whether you think it silly or not.

You don't give a crap about it. Pointing it out is the worse offense.

If no patient gets it, it was lucky. They put patients at risk. And by they, I mean people in positions of power.

That's really all you have to ask yourself.

for a few hours after drying on, say, SKIN.

Please don't ever go into any aspect of healthcare. You truly don't comprehend infectious disease transmission.

They are hunkered down, waiting for the next round of cases. A lot of this will be luck.

There's no possible way for them to get infected without having the virus on the outside of their bodies, and it is wildly unlikely that they got all of it off before exiting the area.

The nurses family when they got home? Their husband/wife?

It's insane aghast going on!

at the same time. Their hands probably wound up covered with virus due to the complete lack of training and all the PPE issues.

They were ALL walking fomites.

During the days he was sick & after the hospital send home he 'self monitored'. No physical contact with the others in the apartment, he stayed alone in one bedroom /w bath.

A couple days left in the exposure from when Mr. Duncan was outside the apartment waiting for ambulance & vomited on the ground. Couple more days left on the first clean-up crews 'work', the person pressure washing the vomit outside with no protective gear.