Which is, like so much of everything else, a sign of incompetence or criminality.

with highly infectious incurable disease should have limited number of employees that had contact with this patient.
But it seems common sense went out of the window in this case.

Last edited Sat Oct 18, 2014, 02:35 PM - Edit history (1)

just another disposable commodity.

Another way to think about it: nurses and other front-line health care workers are just as disposable to American capitalism as are young black males in Ferguson, MO (or Anytown, USA).

But we'll ride the U.S.S. Capitalism Titanic right to the bottom of the rising oceans.

USA! USA! USA!

Not without a much more lengthy argument. Capitalism is a rotten system, but it's not the cause of all ills.

had treated Duncan to treat other non-infected patients.

That's a system that places exploiting labor over and above any other value like, say, for example, protecting lives.

As for the 'inaction' of the CDC (I prefer 'incoherent mad scrambling'), I would merely point out that the CDC is a government agency in the service of a capitalist economic system. We don't know how healthcare workers and governmental agencies in a socialist system might have responded, because we don't have a socialist system, more's the pity.

Not sure I'm addressing your concerns exactly and I may be talking right past you without intending to.

This passage especially: "The CDC is a government agency in the service of a capitalist economic system." But more needs to be said to flesh this out for those who are not already convinced, e.g., ties between CDC management and US corporations, etc.

Well said.

Last I read he's going to Iowa or some other state to launch his presidential bid. Heck, if he can't handle the Eloba issue in his home state he can't handled the rest of America. Say what you will about Pres O but he's a strong sob against all the outrageous obstruction and down right mean spirited bashing day in and day out.

fucking coward

not that he wasn't already but this is a new low

a man of courage would be in dallas right now

Deprivatize all hospitals and turn them into a public utility. That is all.

The CDC is a problem too.

trumps all. This is a not-for-profit.

in protocol?

Maybe Dr. Frieden wasn't really at liberty to specifically say some person failed to put it in place until long after it should have been.

That would essentially stand as a public accusation. When I worked in foodborne epi, statements by state staff that pointed at liability were avoided. We had to be very circumspect about saying anything.

While there were initially no protocols, and then the protocols that they made up as they went along were inadequate at best and dangerous at worst (telling the nurses to wrap tape around their exposed necks -- thereby increasing potential for exposure to abraded skin while removing the tape was unpardonably stupid), the fact is that CDC guidelines were *also* inadequate and as a result of that, they have been changed.

CDC guidelines were far below WHO guidelines, MSF practices, and the practices at our own BSL-4 hospitals. They should be following best, safest practices, not cheapest/easiest.

He was trying to assuage fears with his statement, but it was heavy-handed, inaccurate, based on incorrect assumptions, looked like defensive finger-pointing at a hero...and ignited a lot of well-deserved criticism.

He would have been better off simply stating that there would be a thorough investigation to learn how the nurse had been infected and changes made to ensure it didn't happen again. And left it at that.

Infections could have occurred even if the guidelines were followed perfectly. Guidelines were not adequate, evidenced by the fact that they have been changed.

with other hospitals, urgent care centers, clinics, etc. screening, isolating, providing initial testing (almost entirely point of care at my hospital) and then shipping them off to the centers.

Urgent care places shouldn't even let a suspect in the door. Even the hospital-associated ones don't have the equipment and the facilities - or if they do it's something I've never seen.

my point was only that what was said in 'administrative speak' is what can be said within the degrees of freedom he worked under.

I did work in state epidemiology, where I know that people weren't at liberty to talk freely to relatives of the sick, to industry, but especially to the media...for many reasons, the best of which were probably about corrupting legal action that could possibly emerge between the parties affected

His repeated use of the phrase with no reference to a breach or departure was obviously not an accident. It purposefully held to ambiguity.

It was a phrase that communicated something went not according to CDC or other defined procedures, which I agree is easily, and perhaps properly interpreted as intending to indicate reassurance that the 'plan' was good, the experts who did the planning (i.e. the staff/advisors) did their job, but that the implementation did not go according to plan.

I totally agree that within the context of unfolding reality, he looked not a little bit stubborn and even closed-minded. Descriptors which might or might not actually reflect how he was working outside statements to the press.

It's absolutely true that in many cases, saying nothing is better than saying a little. Yet, it was an historic "Aw, SHIT" moment in American Public Health concerns, it would have been hard to stick to saying nothing.

for health care.

I think the way it was received and heard by both people within the healthcare community and outsiders makes it clear it was a PR failure. Simply a very poor choice of words. Your longer statement would have been far more clear to bystanders that he wasn't immediately blaming.

Of course, the fact is that the CDC guidelines were not sufficient, which is why they have significantly changed them. I read the other day that in his testimony, the Dr. that oversaw treatment of Brantly and Writebol ripped them a good one.

this other than putting money ahead of people.

Surprise!

Oh, not.

p.s...OS, know there are tons of us that loves ya man!

You can figure that out from the name. It's owned by Texas Health Resources.

Understand that this term is used to define a certain tax status, but often has little to no correlation with reality.

In 2012, Texas Health Resources recorded operating income was $288.7 million on revenue of $3.7 billion.

Now "revenue" generally refers to all the money a company takes in from doing what it does, and "income” refers to how much money the company has left over after paying off the costs of doing business, so that hospital was flush. They certainly didn't have as any qualms about paying their last CEO a compensation package reported worth $5,716,724, but when it came to shelling out money for training and proper equipment to protect their staff or the public... well, they were on their own.

Non profits often pay their execs high salaries. Charities do it. So what? The point is that you can't blame the profit system for the failures at Dallas Pres.

Incidentally, I am opposed to the profit system. I just don't blame everything on it.

came from ONLY one hospital, Texas Health Presbyterian Hospital in Dallas. Yet Ebola patients have transported, checked into several other hospitals across the country, treated successfully and released to go about their daily lives without a single death or new case of infection in those faculties.

So, yes, let's put the blame where it belongs; Texas Health Presbyterian Hospital in Dallas, because a patient died and his care providers has become infected under their management. Their chief clinical officer, Dr. Daniel Varga, who testified at the recent House committee hearing, even admitted, "we made mistakes" and said they are "deeply sorry".

Only 4 biosafety level 4 hospitals are in the country. They have people specifically trained to take care of these patients. You can't compare them to a regular hospital.

and you understand that, but why didn't Texas Health Presbyterian Hospital? Even after they knew they had Ebola they continued to treat the first patient, and later the two nurses, only transferring them to a proper facility later.

it is still confusing to me why people wear hazmat suits with breathing gear for a disease that the CDC and other officials continue to say is not airborne. I can understand the need to wear gloves if you actually touch the patient, and a mask of some sort in case the patient projectile vomits in your direction. But if the inconsistency is obvious in the press announcements, are they repeated in the communications to hospitals?

Disease doesn't need to be airborne to be highly infectious.
I would think that much is obvious.

perhaps they need to explain that, at least to the health care professionals.

Which certainly suggests this virus has some ability to travel. Maybe in droplets.

If it depends on what the meaning of "airborne" and "direct contact with bodily fluids" is, and if as seems to have happened here those terms are interpreted differently from the CDC's meaning by hospital staff encountering an emergency situation (and assuming the CDC did in fact give adequate albeit ambiguously worded guidelines) then they need to make very clear what the meaning of the terms are within those guidelines. Because as two nurses as well as 800 people who are being monitored have discovered, there is no room for misunderstanding.

It's the $$people at the top that don't want to spend the money on appropriate PPEs and training.

They haven't been published, yet.

You can have tiny abrasions or invisible micro-cracks anywhere on your skin. Several years back, a teen in Texas found a bat in his bedroom. He and his family chased it out the window with a towl, but at one point it brushed against his chest. He wasn't bitten or even aware of any saliva or contact beyond the bat brushing against him. 3 weeks later he was dead from rabies. All it takes is a microscopic droplet of heavily infected body fluid coming in contact right where there is a tiny break in the skin, and in seconds -- faster than you can get to a sink to wash -- and virus can have penetrated. Shit happens really, really fast in the micro-world.

Ebola patients aren't just vomiting. They are projectile vomiting. I experienced projectile vomiting once, in response to anasthesia. Sorry for the graphic description, but I was in a hotel room, tried to head to the bathroom when I spewed vegetable soup clean across the room and coated the walls a good 5+ feet away. When you are treating a patient with projectile vomiting, you need to 100% covering and, because the vomit can "aerosolize" into small droplets, a separate air supply. Also, certain procedures can cause fluid to unexpectedly come spewing out. Again, complete precautions needed.

They followed the logic you suggested quite closely. But in practice, they have been found to be insufficient in this current outbreak in Africa, and it looks like they were insufficient here.

The main controversy was for close-up work with very ill people, and the fact that small amounts of aerosol could be generated in several ways. .

In practice, the outfits operating in Africa have been using a much higher level of PPE. But they still have infections.

Here's one side of the argument that hospitals that were adopting precautions that went beyond the CDC's recs then were effing up (from August):
http://annals.org/article.aspx?articleid=1899515

(from September):
http://globalbiodefense.com/2014/09/16/airborne-precautions-ebola-hcw-really-bad-idea/

Here's the intermediate argument (AGPs are the problem (Aerosol Generating Procedures):
http://allnurses.com/disasters-preparing-responding/ebola-why-respiratory-954469-page3.html

Current CDC:
http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html

Here's the extreme (HCW need respirators) (Sept 17):
http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

There is ample epidemiological evidence that if the disease ever does transmit by air, air transmission exclusive of close contact is not a factor in the outbreaks. On the other hand, we've never had an outbreak like this one. But it does seems as if it is hard to prevent the spread in health care settings without the full-body/respirator equipment, and that has become the standard of the groups operating in Africa right now.

It is in part a political debate, because it would cost a lot to fund this for the health care workers in Africa if it became dogma (as is discussed in the first link).

and very little medical knowledge. They could tell you chapter and verse about organization ladders and cost containment but absolutely nothing about infection control with one of the most deadly diseases on the planet.

This in a nutshell is what is wrong with our healthcare system.

Those suits resisted getting Duncan into an isolation room in the ER for hours. Those suits resisted getting protective gear to the nurses caring for him for days. Those suits are directly responsible for the two nurses down with Ebola right now.

It's time for an organizational shakeup. Doctors and nursing supervisors need to be able to overrule the suits on medical matters. That is not possible right now.

why in the world were 70 people in and out of that poor man's room?

Shift work, days off, specialists (once you are on dialysis and a ventilator, more people come into play).

Then there are those exposed on the back end of the process (labs, waste, etc).

Then there was at least one interviewing him for contract tracing. Who may not have worn PPE at all! Although no direct contact, that one is now isolated.

In large part, the hospital is being criticized now for following the CDC's published guidelines.

CDC now changed the guidelines saying limit the number of employees taking care of Ebola patient to absolute minimum, but those were not guidelines at the time.

For the sick and workers, and ALL contacts being monitored. No one leaves. Try to leave, you get shot. If we have to pay them to stay, so be it. In the long run it will be 100 times cheaper.

We are playing catch up instead of being out ahead of this. Each illness or disease starts with one patient. It has the potential to multiply with each person who comes into contact with an infected individual. I am not in bunker mode or donning a tin foil hat, but I am concerned that the powers that be are not proactive when it comes to Ebola. They have had decades to prepare for the possibility that this dreaded disease would find its way into this country. Apparently, they failed to do so.

for quite awhile and this is what happens when you cheap out on hiring the best and brightest. This is healthcare on the cheap, cheaper in mindset anyway for Texas Pres. willing to take on the liability (and you *know* there were meetings) rather than go all out and call in the CDC and never, ever even think of admitting him and taking on the responsibility for his care.

Who Bricked That Call? Why was that call not made when he came back. They, the "corporation," doctors, nurses, et al, someone should have stood up then and immediately called the CDC, whomever, for urgent care. The protocol for a phone call should be number 1 on the list.

Now, because of this ineptitude, I think we shall now see nurses' and other works boot camp for best practices at this time. Will it supersede 12-15 years of training. Not even. Now, there may be no other choice.

Because of this hospital, they released this virus inevitably into the U.S. at a greater degree than one person. Look at the people around the guy who died (sorry, don't know his name), they aren't falling ill. Just the healthcare workers - at this moment in time.

It's a sorry way to see if and when it does spread, but now all we have is time to see if it really does spread via the population. It looks like our sanitation and personal hygiene are doing marvelously there.