that people don't need to make gigantic mistakes to get exposed.

They get all defensive and in denial that maybe, just maybe, their attention to detail wavered and they touched something to something else. That's all it takes.

I think it's dangerous to say, "I'm perfect. I can't possibly have made a miniscule error." Hubris kills when Ebola is involved.

because they were lax.

That's how they got infected.

The mind boggles.

No one in Ohio should be panicky but they all are.

What we know now is that vomit, diarrhea, and blood are the major transmission media. If you are not directly exposed to those, your likelihood of getting the disease is close to zero.

I say close to zero instead of zero because this is an emerging disease and a lot of things are likely to change as it is studied more and protocols change, not because I think breathing on somebody is going to make them sick. At this point, no one but people in full panic think it will because people in full panic are incapable of going with the science.

Remember, Mr. Duncan's family have all passed the critical 21 day mark and their chances of getting the disease are close to zero unless they are exposed to the blood and body fluids of someone else down with it.

This is not that easy a disease to catch at this point. Again, that might change, but that is the information we have now.

.... 497 health care workers in Africa have ebola because they are too stupid to isolate themselves from blood, vomit and diarrhea. And of course so are Ms Pham and Ms Vinson.

Conditions in Africa have been and are very different from conditions here.

Health care workers at bush hospitals had little protective gear beyond gloves and face masks that had to be used until they fell apart.

... neither do you.

I saw it before but had a problem finding it again. Thanks for posting.

In many cases they don't have anything resembling modern laundry facilities, let alone gigantic autoclaves for sterilizing bedding. They're letting infectious materials dry in the sun and then reusing them. They're burying the bodies using shovel crews of survivor volunteers because they don't have the facilities for cremations. In the worst cases infectious materials are being stolen from the facilities.

Of course health care workers there are getting infected. They often don't have the resources to protect themselves. What they're doing is enormously brave.

.... the two nurses over here?

The FACT is that saying its "blood, vomit and diarrhea" is a deadly simplification.

It's still only spread by blood shit and puke. I know half of DU wants a movie of the week scenario just to prove themselves right but it's not happening.

We don't know if she has any of these symptoms even now.
You can't assume everybody is going to have the exact same symptoms.

Upper respiratory illnesses can be contagious before symptoms appear.

This is not an upper respiratory illness. Infectious fluids are vomit, diarrhea and blood.

It is not easy for anyone to catch. Family, health care workers, and possibly undertakers are most at risk. You are not, nor was any passenger on any of the airplanes.

you are very polite and made me smile at that.

What I have said, and will continue to say, is that regardless of what anyone else tells you - if you have had medical training, know you have been exposed to Ebola, and are experiencing flu-like symptoms (malaise, fatigue, and a low grade fever - and, according to one report from an unnamed Federal official - also muscle aches), you should presume it is Ebola until proven otherwise. Anyone with medical training should know you don't get on a plane with Ebola.

As a general matter - the CDC screwed up (which they have admitted), Texas Presbyterian screwed up (which they have admitted). The fact that they screwed up does not excuse Ms. Vinson, who also screwed up. I don't care what the CDC told her - she should have paid attention to her training and stayed off the plane.

I think it is likely that the chances that she infected anyone in Ohio or on the planes is pretty small - BUT - when you are dealing with a fatal illness like Ebola, for which there is no cure, you don't take small chances with others' lives.

I think she was calling the authorities and asking them what to do, not that she herself was reckless about her own concerns.

There's still not a recognition that if she had gone to a local hospital, no permission for a test would have been given (the same risk assessment governing the flying controls testing permission). It seems to me that she was in a Catch 22. She was not going to go back to her family home where she was staying, because she knew there was a chance she could get overtly sick and she didn't want them to be exposed when she did. She was the one asking for isolation from the public. She wasn't going to get it at an hospital.

It seems to me that she was just about the most realistic person involved that day, and I don't see why she should be blamed for not being able to get those in charge to act appropriately - a very common experience in most nurse's lives, I would think.

You have to call for permission at an ER to test someone for Ebola. If I were to walk in today with a fever of 99 degrees and tell them that I was exposed to a sick Liberian, I wouldn't get tested. It's the same folks who told her to get on the plane who would be in charge of authorizing the test.

The virus really isn't very contagious at all in the early stages, and she knew that. Duncan's contacts are all cleared. She was concerned about exposing the public and other HCW if she GOT really sick, and that was a valid concern. She wanted to be isolated from the public. She called her contact points, and she was told to return to Dallas on that plane and go home (not to the hospital).

She was away from home when she saw the first very mild clinical signs; she was trying to get somewhere isolated from the public, and she didn't want to go home and expose her family members by getting ill there. Totally rational.

I don't think there will be any cases from the plane trip. I think everything about her clinical judgment and risk assessment was good, including her theory that she shouldn't be on the plane, and I don't understand why we are blaming her for the failure of others to offer her an option that protected the public.

When she called in, they should have told her to go to a local hospital, called the hospital, and arranged isolation and a test there. They were unwilling to do that, so?

What do you think she should have done. Gone back to the family home? Would you do that if you believed you might have Ebola? Gone to a hotel and waited to get sick there? That would have likely been a more serious public exposure!

The real issue was not, IMO, her contagion factor then. The real issue was what her contagion factor would become and when.

But the reason this went so wrong was that CDC's risk assessments changed the next day, and now we are blaming her for that. She didn't make them in the first place and she didn't change them.

What do you think she SHouLD have done?

and warned them that I was someone who treated Thomas Duncan and that I was experiencing vague symptoms consistent with the early stages of Ebola and I was still in the incubation stages. If the ER did not respond, I would have called their infectious disease department.

On the off chance that they did not take me seriously, I would have gone home to my parents house and locked my self in my room until there were either further developments or the symptoms passed. I would not have gotten on a plane and exposed 132 new people when I could safely confine myself to a single room in my parents' house - parents who had already had at least minimal exposure. I would have been concerned for my family, but not concerned enough carry what I would - by that time - have been assuming was Ebola to everyone I would come in contact with on the plane.

She did not need permission to go to the emergency room, or to stay off the plane. She has medical training, and was experiencing symptoms beyond the fever, which should have been the final nail in the stay-at-home-and-stop-exposing-others coffin. The fact that others were irresponsible does not excuse her for also being irresponsible. I am not blaming her for not anticipating the CDC's wake-up call. I am blaming her for not being awake herself, as anyone with medical training (including the CDC and Dallas Presbyterian) should have been.

But she was assured that it was fine for her to fly because her temperature wasn't high enough.

If her own symptoms did not flash great big warning signs, a trivial amount of research (no more than 5 minutes) would have told her that 13% of Ebola patients don't run fevers at all, and that the other symptoms she was experiencing were consistent with Ebola.

My approach to medicine, of always questioning medical authorities, has been earned through the years by experiencing care providers who got it wrong when my medical intuition proved to be right. Amber Vinson has more medical training than I do, and at least as much (probably more) exposure to how inept institutional medicine often is.

The ineptitude and outright incompetence of the CDC are only minor matters that should be forgotten while we concentrate on the real villain in the piece, the person who exposed the incompetence of the CDC by doing something you would have known better than to do.

I have consistently also blamed the CDC and Dallas Presbyterian. I am responding to people who repeatedly insist that Ms. Vinson acted responsibly. She did not.

I virtually always include blame for the CDC and Dallas Presbyterian - even when it is not the subject of the post. And I have also made several posts blasting the CDC. So no, the CDC's role is not a "minor matter," nor is Vinson the "real villain." She did behave irresponsibly, and I am not going to excuse that - any more than I excuse the CDC for its irresponsibility.

My standard is what a reasonable person with medical training, exposed to Ebola, still in the incubation period, with symptoms consistent with the early stages of Ebola should do. For starters, someone in that situation would not get on a plane.

This particular subthread, I was challenged to explain what *I* would have done differently, since the poster believes she did the most responsible thing in the world. That is the only reason my response was couched as a personal explanation of what I would have done. But no, my assessment of what Ms. Vinson should have done is not based on what I, personally, would do - it is an objective standard of what a prudent person with her training and experience should have done. Had she not had medical training, my standards for judging her behavior would be different.

It's difficult enough to get people to listen to those who supposedly know better, getting all Biblical on some nurse for believing the experts when they told her what to is not a good way to promote public health IMO.

Because it acknowledges her real choices, and the need to get some outside doctors agitating to take the potential exposure seriously.

But I don't think requiring people to go expose their families is appropriate or realistic.

That's all. It would have been the safest, most responsible decision she could have made. She cared for a patient with Ebola and she was still within the incubation period and had no idea if or when she would experience a sudden onset of symptoms.

If she could go back in time, I imagine she would listen to her intuition, which was telling her to be safe rather than sorry. But this can't be undone, so it's now a learning opportunity and fortunately, protocol has been changed as a result.

And we wouldn't know just how incompetent the authorities are.

Up until nurse Pham exhibited Ebola symptoms those nurses were still working and taking care of other patients, was that irresponsible too?

For some time during the care of Mr Duncan the nurses were caring for Duncan and other patients on the same shift.

Was that also irresponsible?

And no, the nurse doing her job in a controlled environment was not irresponsible and since I've commented on this in another post, I'll just add it here--

Within the hospital setting, she wore gloves and other protective gear, not only for her protection, but for her patients as well. Should she have experienced the sudden onset of symptoms while at work or even at home, she could have easily and quickly been placed in isolation.

On a plane, she isn't wearing any protective gear and should she experience the sudden onset of symptoms, she's not in a controlled hospital environment and cannot easily be isolated from the other passengers. Also, unlike the hospital setting, no one on the plane was aware of her exposure to Ebola or trained in its care. Had she become injured or incapacitated while symptomatic, those coming to her aid would not have donned protective gear as they would in a hospital setting.

The problem is the plane itself. It's not a hospital where you can just walk into the ER, or a car where you can just pull over and call for an ambulance and have medical personnel render aid and transport you to a hospital in a short amount of time. It's a plane that needs to make an unscheduled landing at an airport. And during the time when the pilot contacts the nearest airport, flies to it, descends and is cleared to land, the patient cannot be quickly and appropriately isolated from 100+ passengers and an untrained crew.

But it's a moot point because she cannot undo her decision and now those who have been exposed to Ebola cannot travel. Let's just hope that going forward, everyone is now more educated because of this incident and makes better common-sense decisions that benefit the greater good, whether another person tells them to or not.

and in Vinson's particular case I have a hunch they very well might be a weak link that hasn't been probed very much.

Reading the article the Dallas HD is mentioned several times. In passing, as if there are no actual people involved performing tasks.

CDC already confirmed they approved Amber getting on the plane, because her temperature wasn't high enough for whatever point they set as a risk for Ebola.
It was a major screw up, but not on Amber's part.

Last edited Mon Oct 20, 2014, 10:20 AM - Edit history (2)

for the actions of others, the livelihoods of some important, well-off people will be jeopardized.

Someone needs to help her to understand that.

Regards,

TWM

That's exactly it. There is no current option for someone who suspects that he/she has been exposed to Ebola and feels the very early signs of illness who does not live alone to safely isolate themselves.

Maybe we should be thinking about this issue. I don't think advising a plane charter is all that realistic, and driving a car hundreds of miles is CLEARLY not an option that increases public safety.

perfect.

I really and truly hope she recovers.

an idea of where one of the weak links in Vinson's situation really were.

Maybe I'm wrong. But if I were an investigator with journalist credentials behind me, that's where I'd dig for more information.

Reviewing what went wrong means exploring all agents.

Dallas County Health Department should also be put under a microscope.

So what do you think putting Dallas County Health Department under a microscope going to accomplish?
CDC told them it was o'key for Amber to fly because her temperature wasn't high enough.

Edit- but I will say this… when something goes wrong ALL parties involved get investigate. ALL actions get scrutinized.

To just gloss over the Dallas County Health Department when they were IN THE MIDDLE of what transpired is ridiculous.

I have seen no actual reporting of exactly who did what there.

CDC confirmed they allowed Amber to get on that plane.

you do not see the entire situation.

The reason for this post is because you not only focus solely on the CDC, you have posted quite a lot… enough for me to notice that.

would suggest an agenda.

BTW > Texas Hospital Apologizes for 'Mistakes' in Ebola Treatment in Full-Page Ad

The CDC accepted responsibility and didn't pass the buck. But that doesn't mean they were the sole cause or even the MAIN cause of the situation that arose.

MRSA, pneumonia, strep--The protections aren't perfect and neither are humans. Unfortunately, the virus is perfect--for finding a host.

This is just one of the several risks a person accepts when they become a nurse, god bless them. But blaming the nurse is out of line. Hundreds of caregivers have gotten infected while wearing protection.