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Is it time to think about Ebola again?

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  • Fri, Jun 14, 2019 - 08:44am

    #21

    thc0655

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    Distrust is an impediment even if it’s warranted

https://www.apnews.com/5e4aee4f86ac49468f2d079efef47d5f

At last the pickup truck carrying the Ebola victim’s coffin arrived. The woman’s relatives were relieved. But a small group of young people hissed in anger.

They watched the burial team carefully put on protective suits and gloves, itching for a fight. They grabbed the rope meant to lower the coffin into the grave and used it to block the truck’s path. One brandished a stick.

“You will not leave this place if you do not bury the coffin and fill the whole place with soil,” he said, wary of contamination if the grave’s contents were left exposed. For the handful of young men, fear of contact with the deadly virus was high.

The second-worst Ebola outbreak in history has spread this week from eastern Congo into Uganda , and the brief confrontation as one of the first victims was buried late Thursday was a flash of the community resistance health teams have faced for months over the nearby border.

More than 1,400 people have died since this outbreak was declared in August, and the response has been hampered by misinformation and fear in a region that had never faced Ebola before. The disease can spread quickly via close contact with bodily fluids of those infected. Wary residents have attacked health workers or fled.

In Uganda, health workers had long prepared in case the virus got past the screening conducted at border posts. Earlier this week, it did.

A family exposed to Ebola while visiting Congo returned home on an unguarded footpath. Some already were showing symptoms. By the time Ugandan authorities who had been alerted by Congolese colleagues found them, a 5-year-old boy was vomiting blood. He was the first to die.

His 50-year-old grandmother, identified by a relative as Agnes Mbambu, was next. Already bleeding, she went straight to a local hospital upon returning to Uganda, relatives and health officials said. On Thursday morning, Ugandan officials confirmed her death.

Burying her took all day and into the night as health workers pulled together the means to do it safely. The need for safe burials conflicts with traditional customs of having loved ones wash and dress the corpse. In Congo, that has led to trouble.

  • Fri, Jun 14, 2019 - 10:41am

    #22

    thc0655

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    Even the best medical resources and facilities will fail if Ebola gets here

http://raconteurreport.blogspot.com/2019/06/do-math-2019-version.html

If you read the blog linked, she toured US and European Infectious Disease suites.
I’m here to tell you, looking at the procedures required, those are not going to operate well under higher pressure of actual patients, they will be degraded. Mistakes will happen. Staff members will screw up, and may die as a result. They will, in a short amount of time, realize this, and the people willing to suit up will not increase, it will dwindle, and the units will fail. Ditto for transport, laboratory, and ancillary staff. Most people don’t enter any medical occupations, including doctors, thinking they ought to risk their lives to treat patients. The whole point, in fact, is that the only person rolling the dice in any situation is the patient. Your heart attack isn’t going to kill me. Nor your gunshot wound, nor your stabbing. Even your HIV is defeatable with $0.03 worth of nitrile gloves.

But your Ebola?
The period in any sentence on this page would be a ball of 100,000,000 Ebola viruses in a patient fully involved and infectious. Enough to wipe out everyone east of the Mississippi.
The number of those viruses from that period-sized ball necessary to infect a medical caregiver, transport person, lab worker, and kill them just as horribly?

One.

With a patient convulsing, explosively sh*tting out their guts, literally coughing out their lungs, and blood running from their eyes, nose, and mouth, all rife with fatally infectious blood-borne pathogens.

Go back to that linked blog, and imagine someone with a couple of gallon jugs of red gloppy dye, and tell them, amidst everyone in their shiny hazmat suits, to randomly squirt out a turkey baster of it up, out, and down, while the staff walks and works in the room. Say once every couple of minutes. Splatter face shields, plop out a juicy glob or three on the floor, and let a constant amount dribble off the edge of the bed.

Some of the staff members will probably start to freak out, even knowing it’s just a drill, which is why we never do that even in drills, so as not to let the cat out of the bag.
Ask me how I know this.

Then, after 3-4 hours in those hot, claustrophobic suits, now dripping with deadly simulated goo on the outside, the masks fogged over with sweat and condensed breath on the inside, and not able to hear anything but the powered respirator blower whooshing loudly past your ears for every minute of those same 3-4 hours, and the inhabitants thereof dehydrated, tired, woozy, sensory-deprived, and hopefully not panicky, see how crisp and precise their procedures are. Like starting a simple IV, or drawing blood from the patient. Like we do 10-50 times a shift. (How many hospitals’ staff operate in diving gear at depths of >100′? None?? Why d’ya suppose that is, hmmm?)

Sh’yeah, that’ll happen.

And with truncated operating times, you’ll need 3-6x the number of staff you need for ordinary patients. {Hint: We can’t get adequate staffing in any hospital, anywhere, right effing NOW. Do you really think we’ll be inundated with 6X as many when Ebola hits?? Sh’yeah, as IF.}

Those people will do one or two shifts like that, and then they’re
g-o-n-e.
Called out sick.
Didn’t answer their phones.
Never heard from again.

Reality: left skidmarks in the driveway, after mailing in their resignations, loading up the family and gear, and pointing the car towards Bumfuck, Egypt, 500 miles from the next living soul out in the Great American Outback, beyond the black stump.

If they’re smart.

We make minor mistakes in clinical care every day, now.
In just scrubs, and comfortable and competent at our jobs.

Put people in unfamiliar environments, in uncomfortable working conditions, with nothing but the prospect of endless more, times months to years, and with the added prospect that the slightest error could result in slow, agonizing nightmarish death? And take out their family and friends as well?

Game. Over.

Throw in vaccination with a highly experimental and clinically untested Ebola vaccine (even one with >98% efficacy like RVSV-ZEBOV, but no idea of long term consequences to recipients; ask the Gulf War I vets how that experimental Anthrax shot worked out), which you don’t have enough right effing now of to cover even 10% of the health workers in only the U.S., let alone anyplace else, and you might get 1-5% compliance with hanging around a month or two. By which time, the outbreak will have doubled or quadrupled, for any value of Wherever You’re Talking About.
“Best wishes with that plan.
Love and kisses.
Wish you were here.”
-Aesop
BF,E

Now get your stuff together to either shelter in place in self-quarantine, or GTFO to your Happy Place, and do the same thing. For weeks to months, perhaps as long as a year or two. (The West African outbreak, in a population smaller – yes, also dumber, but not by much – than that of the U.S., lasted from December 2013-January 2016, 25 months, before it was officially declared Ebola-free.)
Think about that one long and hard.
BONUS: That will also come in handy for twenty-seven other potential crises. Win-win.

That’s what you could be dealing with, if/when it gets here again, and if it overwhelms our ability to adequately deal with it. The margin for error in such an outbreak is zero.
And if it never happens, you’ve wasted your time, and are now only prepared for a couple of dozen other major problems. How sad for you.

That sharp stinging sensation in the back of your head is Reality bitchslapping you back to itself, once the Official Partyline Happy Gas wears off.

  • Fri, Jun 14, 2019 - 11:25am

    #23

    davefairtex

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    ebola doom

I suspect if Ebola actually arrives, people who are offered the vaccine will be more than happy to get vaccinated.  The guy loses me when he suggests people would run in fear of the vaccine.  I suspect they’ll be fighting each other for the opportunity.  Bribery, mayhem, and whatnot.

With a CFR of 67%, your choice is: vaccination – with possible unpleasant side effects – or a 2/3 chance you die.

  • Fri, Jun 14, 2019 - 12:32pm

    #24

    sand_puppy

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    I'll get the Ebola Vaccine

So right Dave.

Aseop, who I believe is the author above, is a long time ER doc and does have a good perspective on the impact on healthcare workers, the EMS system and hospitals.

Just a few Ebola-like illness will shut down the nation.

  • Sat, Jun 15, 2019 - 01:36am

    #25

    thatchmo

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    Sharesies…

So, if THE BIG E comes to America first and starts taking a serious toll on the nation, I’m wagering TPTB/DeepState/whoever takes measures to insure China/Russia/Iran shares the experience (or vice versa)…gotta keep the playing field level, eh?  Aloha, Steve.

  • Sat, Jun 15, 2019 - 11:16am   (Reply to #24)

    #26

    davefairtex

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    ebola doom porn

While it’s always tempting to look at the doom porn, I can’t help but notice that we did manage to stop the Ebola epidemic in a thoroughly third world country back in 2014, without a vaccine, and without much of a healthcare system at all.

With a vaccine, presumably the effort would be more successful.

I do agree that the economic dislocation would be immense if it came to the US.  But I don’t agree that we’d all have to head for the hills for 1-2 years to survive.  We’d figure out a way.

Again, a very low tech nation managed to survive.  Buckets of chlorine, less movement, change in burial practices, change in interpersonal contact, treatment centers (really isolation camps), and contact tracing.   And now a vaccine too.  And also treatment options too, rather than palliative hope-for-the-best care.

The only reason we are having such a difficulty in stamping it out in the DRC is because there is an ongoing civil war, and angry people are actively running around shooting at (or otherwise intimidating) the healthcare workers.

I think our “problem” here in the US is that we aim for 100% success in everything (and we sue everyone in sight when that perfection doesn’t appear), and it will be very, very difficult to get 100% success in ebola care.

Something as simple as, “if you agree to show up for work, you get the vaccine, and so does your family” might just be incentive enough to keep the system intact.

But if the epidemic were large enough, the loss to GDP would be monumental.  Historic, even.

That’s my sense.

  • Sat, Jun 15, 2019 - 03:49pm

    #27

    thc0655

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    Ebola math

Are any of you medical professionals here on PP.com willing to tell us what your plan is if Ebola comes to your facility, practice, or town?

https://raconteurreport.blogspot.com/2019/06/where-problem-is.html

And if/when this gets here, some medical professionals will decide they’re Special Snowflakes, and don’t need to follow all the rules, and don’t have to be quarantined, because it violates their rights or harshes their mellow, and exactly like the family from DRC that sneaked into Uganda, they’ll transplant the outbreak to others. And we won’t find out for another 3-21 days, on average, and some not for longer, by which point it’s already an epidemic shitshow here.

That should be a shoot-on-sight situation, followed by burning the corpses immediately, after obtaining a blood sample under BL-IV precautions.

But this is America, and we’re too squeamish to do that, and we’ll end up killing people with kindness by not doing it. (Like letting infectious nurses travel commercial air, rather than sending a BL-IV jet to whisk her and her stuff into full containment. Like your government did in 2014.)

Also, the people working with Ebola in Africa for MSF are only providing palliative care, i.e. assistance for the 80-90% who’re going to die, to do so less uncomfortably than they would in a rut by a dirt road.

They aren’t taking blood samples, starting IVs, or 57 other things. Their height of care is a cool cloth for the forehead, a cup of water (which becomes the next bout of projectile vomitus), and trying to contain the piles of bloody diarrhea being launched into bedding and over at the patient on either side.

And they burn the entire treatment center when they’re done, down to the concrete pad (unless, like in DRC, the locals don’t wait until its over, as they’ve already done over 40 times during this outbreak, and killing or injuring over 80 health workers there, which is why 25% of the affected areas in DRC have zero MSF or WHO presence). Now, think of your local ghetto ‘hood or barrio. Think it will be better here??

It isn’t just HIPPA concerns that keep TPTB from showing you that bloody reality in each and every outbreak. People would be at the White House fence line with AR-15s and Molotovs in earnest, clamoring for POTUS to nuke Africa if they knew that and saw it on the Nightly Snooze on the major networks. You’re being lied to daily, including by massive omission, and have been since forever. I post what I post because I figure people can handle the reality with the bark on. But in 2014, I had to drop it, because by Presidential Fiat Decree, the news media were told Not To Talk About Ebola Anymore. Leaving us with just the happygas from foreign sources (who largely also complied with the gag order) and the lying African nations’ self-serving press releases that under-reported the breadth and depth of things, on purpose, by a minimum of 300%. Even the UN/WHO admitted that, during the outbreak, openly. “It’ll be different this time.” Sh’yeah, as if. Neither there, nor here.

And one of those factoids is that once it’s more patients than our BL-IV beds can handle, the care and protocols and training become so sketchy as to constitute gross professional negligence on the part of all hands participating, from POTUS and the CDC director, down to the sloppy housekeeping person with a GED who’ll be sent in to mop up after patients #16 to #Infinity, with half-assed don/doff training, protocols, faulty equipment, and insufficient staff.

Ebola’s always going to find the weak links in any chain of infection.

In the West in general, the weak links are the chain itself.

Instead of screening this stuff and keeping it at arm’s length, because of ignorance, deliberate stupidity, negligence, malpractice, and malign indifference to all of the above, the very people who stay and play with it are going to be the same ones who insure that everyone else gets it, mostly through accidental exposures like the two nurses in Dallas, along with the selfish and stupid infectees who won’t seek treatment, and will keep sending sick kids to school and going to work until either one collapses shooting blood out their eyeballs.

That’s before we even talk about the open borders and lackadaisical attitude towards quarantine that’s been rampant non-stop from 2014 until now. This is deliberately engineering Ebola’s arrival and release among the population, which we’ve already seem with measles, TB, Chikungunya virus, West Nile virus, and a witches’ brew of other diseases we had formerly whipped here.

Verstehen sie?

We aren’t set up for this, and we’re doing nothing to stop it getting here (rather the opposite in fact).
And when it does, after those first 15 beds are occupied, we’ve done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we’ve done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can’t bullshit me or countless other doctors, nurses, and ancillary staff who’ll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we’re standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can’t collect paychecks at Forest Lawn, and I won’t be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you’ll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly – by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO’s lackadaisical clipboard commandos – we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.
There’s just death.

I’ll do my damnedest to save your life if you come into my ER.
But I won’t kill myself to do it, and I won’t die for you because TPTB at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain’t in my contract, and unlike joining the Marines, I took no such oath, and it isn’t part of the deal.

I don’t know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Unless you’re one of the original few cases in the outbreak, before anyone knew it was here, so you didn’t have the sense to self-quarantine while you were uninfected, if you come to the hospital with Ebola, you’re de facto part of the problem, not the solution.

And you’re probably going to die, and there’s a better than even chance you had it coming.

  • This reply was modified 2 months, 1 week ago by  thc0655.
  • Sat, Jun 15, 2019 - 05:54pm   (Reply to #27)

    #28

    davefairtex

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    re: Ebola math

Right.  And if you and your staff were offered the ebola vaccine in exchange for staying on the job, would your answer change at all?

 

  • Sat, Jun 15, 2019 - 06:14pm

    #29

    sand_puppy

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    The effect of Ebola-like illnesses on hospitals

This is a multifaceted issue.

1.  Suppose little Johnny sprained his ankle and went to Central Hospital for an x-ray.  While he was there the guy in the next door room with bloody diarrhea contaminated the spaces and Johnny picks up Ebola and dies the next week.   That hospital is now done, it’s image as a safe and nurturing place forever destroyed.  No one will ever go there again.  Bankruptcy.  Bulldoze the building.  Two EBV cases shut down that Texas ED in 2014.

2.  Hospitals cannot allow people who MIGHT be shedding the virus into their rooms and hallways and bathrooms.  One contamination incident would destroy the hospital.  So tents are setup outside the ED entrance for “possible Ebola” cases while the lab tests are done to rule it out.

3.  Now comes all of the Ebola like illnesses. Billy has a headache fever and has vomited. Eventually determined to have a simple viral syndrome.  But, for the first hours must be treated as “possible Ebola.”   To the tent.   Fred has an exacerbation of his Crohn’s Disease with fever and blood tinged diarrhea.  To the tent.  Bob has a spot of rectal blood later found to me a hemorrhoid.   We’d better be safe—to the tent until EBV is confirmed negative.  John has a temperature and just wants an off work note.  To the tent.  You get the idea.

4.  The tent gets full and people start to understand the the danger of CATCHING EBV IN THE TENT is higher than anywhere else.  They won’t let their family members be sent to the tent.  The hospital must now supply individual tents for each “possible ebola patient.”  And after a patient has died and left an open tent, would you accept assignment to that tent?  No.

5.   You can see as one of your nurse’s other patients has just been rolled away in a body bag, dead.   Do you feel sure that that nurse has disinfected perfectly and can now touch you without risk?  You shouldn’t.

6.  It is almost impossible to do basic medical care from the inside of the hazmat suit.  Hands are clumsy in double gloves and it is hard to start IVs on dehydrated patients.   You cannot put a stethoscope in your ears.  You can’t hear well with the PAPR blowing.  The suit is plastic and does not breathe.  Sweat trickles down your armpits.  In Africa, 30 minutes was max before medical personnel had to come out and disinfect, peal off the suit, then sit and drink gatorade to cool off.

7.  You are a young husband with two small children.  Your wife is a nurse and you have the discussion about whether caring for Ebola patients is really what is best for your family.  You decide that it is not.   The chance of losing mom or bringing home the virus to the family is too great.  You resign.  You employer threatens you. You give up nursing and look for another line of work and a safer place to live.

8.  You care for an Ebola patient and your shift is over.  Is it truly safe to go home and climb in bed with your wife?  Remember that the infective dose is ONE virion.  Was your decontamination perfect?

 

  • Sat, Jun 15, 2019 - 08:28pm

    #30

    davefairtex

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    the numbers

In the hotzone, a bunch of healthcare workers have died from Ebola.  But, surprisingly, given the stories I’ve read here, the answer isn’t “all of them.”

I get the sense that most workers who die do so because they deal with patients who are infected, but they don’t realize it, and the workers themselves are not vaccinated.  But I do not know this to be true.

So my question is – what are the numbers?

If you work in an ETC in the DRC, and you are vaccinated, what’s your chance of catching the virus?  Presumably you have the highest hazard level.

If you are just a “normal” healthcare worker in the DRC, and you’re vaccinated, what’s your chance of catching the virus?

Same thing, but for an unvaccinated healthcare worker.

Same thing, but for a contact (family member, co-resident) of an infected patient.

Same thing, but for a patient who went to a hospital that had a case of Ebola.

Same thing, but for a patient who was treated by a healthcare worker that was infected with Ebola.

I’m pretty sure the WHO has this data.  What does it look like?

Scary stories are great for motivation, but I’d also like to follow the data.  That’s what we do here, supposedly.  If, for instance, I can simply avoid hospitals, wash my hands with chlorine wash, and be really careful around sick people – how do my odds improve?  Assume I’m living in the DRC, in one of the million-person African cities that has had a few dozen Ebola cases.

[EDIT: Here is a paper I uncovered with a little bit of googling…well actually “startpaging” but I digress]

https://academic.oup.com/ije/article/45/1/102/2363618

A total of 31 reports were selected from 6552 found in the initial search. Eight papers gave numerical odds for contracting filovirus illness; 23 further articles provided supporting anecdotal observations about how transmission probably occurred for individuals. Many forms of contact (conversation, sharing a meal, sharing a bed, direct or indirect touching) were unlikely to result in disease transmission during incubation or early illness. Among household contacts who reported directly touching a case, the attack rate was 32% [95% confidence interval (CI) 26–38%]. Risk of disease transmission between household members without direct contact was low (1%; 95% CI 0–5%). Caring for a case in the community, especially until death, and participation in traditional funeral rites were strongly associated with acquiring disease, probably due to a high degree of direct physical contact with case or cadaver.

  • This reply was modified 2 months, 1 week ago by davefairtex davefairtex.
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