Yet Another Ebola Case In Dallas (With Addendum)

Confirmed: another healthcare worker who took care of pathogen-carrying, pathogen-spreading criminal Thomas Eric Duncan has Ebola.

Now there are two cases from an individual index patient. An outbreak is not contained until there are fewer than two additional cases from any one individual index case.

As if the above isn't bad enough...No hospital 'protocols' for Ebola treatment: US nurses' group.

Nurses Union Releases Statement That Ebola Patient Duncan Was Left In Open Area of the ER For Hours

FoxNews

A statement from National Nurses United also says Thomas Eric Duncan was left in an open area of an emergency room for hours. 

A spokesman for the group says nurses were forced to use medical tape to secure openings in their flimsy garments. It's said that the patient had explosive diarrhea and projectile vomiting. 

In a conference call with reporters executive director RoseAnn DeMoro says the allegations are based on revelations from "a few" nurses and that the claims were vetted. 

The nurses also said that Duncan's lab samples were allowed to travel through the hospital's pneumatic tubes, opening the possibility of contaminating the specimen delivery system. The nurses also alleged that hazardous waste was allowed to pile up to the ceiling.

AND HERE'S THE GUY WHO IS LEADING US:

CDC Director Frieden: If the US Bans Travel From West Africa Ebola Will Spread



Meanwhile, some 4500 West Africans with visas enter the United States every month. How many new index cases are among them?

Additional reading...Ebola Preparation ‘Will bankrupt my hospital!’ Director Reacts to CDC Prep Call.

ADDENDUM

Tammy Swofford's comment this morning at my blog site:

I have discussed with AOW for literal weeks (since the Ebola numbers climbed in W. Africa) that we were unprepared for Ebola in America.

This morning I called her. Tears are streaming down my face and I do not cry easily. When I saw images of nurses with their necks exposed on videos, supposedly "ready" for Ebola, I knew we were doomed. Having trained constantly and consistently in the USNR for chem-bio scenarios wearing MOPP IV gear in sweltering heat, I KNOW what it takes to train and be safe. The military, does it right. Period. They set the standard. They set the standard in many things in medicine.

For weeks, I have brought this concern to my own hospital. Finally, we will provide training for critical care nurses. Now that a unit of labor is down, and nurses may flee the hospitals in Dallas, we will train. And then, in an act of bureaucratic genius, we will have "daily briefings" on Ebola.

We cannot talk Ebola to death. We can only contain Ebola by proper gear, worn by healthcare workers with weeks (not one damn session) of training in wearing the gear.

How many nurses will die because of bureaucratic incompetence and callous disregard for our lives? Naturally, my own hospital will continue along with their yearly holiday tradition of gratitude for our labor. We get a fifteen dollar Target card to cover Thanksgiving and Christmas.

Yeah, now you understand the sacrifices that nurses make for you every day.

And how many clients did the nurses infect after they cared for Mr. Duncan?

Tammy Swofford
Reporting from the hot zone

18 People Came In Contact With Ebola Patient AFTER He Was Symptomatic - UPDATED AT BOTTOM OF POST

From Ace of Spades:

Our patient's name appears to be Thomas Eric Duncan of Liberia. Check out Bryan Preston's brief rundown of the NY Times article. He came into direct contact with a friend who had Ebola. He rode with her in a taxi and carried her from the taxi to a hospital on September 15, four days before he flew to the United States. She was turned away from the hospital because the Ebola ward was full. She died of Ebola early the following morning. Her brother also got sick and shows Ebola symptoms. That was at the same time that Duncan started getting sick. 

He left Liberia and arrived in Texas on September 20. Six days later he sought treatment at Texas Presbyterian Hospital, and was sent home. He returned two days later, and has been confirmed to be infected with Ebola. 

Duncan also abruptly quit his job on September 4, so he might have already planned the trip to see his family in the U.S. But he certainly knew that he had been exposed to Ebola by the time he boarded that plane and came to Texas, four days after his friend died of it. He must surely have known it when he first visited the Texas Presbyterian Hospital, and he must have known it when the doctors sent him home. 

(Editorial note: it has NOT been established that he was feeling sick prior to getting on the plane, despite the above blockquote.)

Let that sink in, though: he knew he'd been exposed, and it's not unfair to deduce that he thought to himself, "the Americans will save me". 

We'll get back to that in a moment, as there's more fun. Via Reuters: Two days after he was sent home from a Dallas hospital, the man who is the first person to be diagnosed with Ebola in the United States was seen vomiting on the ground outside an apartment complex as he was bundled into an ambulance. 

"His whole family was screaming. He got outside and he was throwing up all over the place," resident Mesud Osmanovic, 21, said on Wednesday, describing the chaotic scene before the man was admitted to Texas Health Presbyterian Hospital on Sunday where he is in serious condition. 

Now, that's not good, obviously, because you have to assume that the ground around the apartment- as well as probably the building's ventilation system- are contaminated. The good news is that bleach and Lysol can handle contaminated surfaces, and there are good professional decontamination groups who can handle those ventilation systems. Still, that means he was (obviously) pretty sick when EMS picked him up, and that ambulance stayed in service. 

Now, having worked in the D/FW area, I've never known an EMS crew in the neighborhood that didn't aggressively decontaminate their ambulances daily. Certainly, one takes no chances, but the ambulance was decontaminated per CDC guidelines, and will be back in service again shortly. 

I don't have a problem with that. The above link also notes that five school-age children came into contact with Duncan. That would be a nightmare scenario if the kids were already sick, but again, the bug doesn't spread until you're symptomatic. 

The indications are that as many as 18 people may have come into contact with Duncan while symptomatic, and they'll be monitored and kept at home for three weeks while we wait and see if they get sick. 

Now, there was a mishandling of Duncan when he was initially assessed at the emergency room (this was prior to him getting his ambulance ride). He indicated to one of the staff that he was in from Liberia, but that was not communicated to the rest of the crew working on him. 

So, with those facts out there, let's get back to our dear Mr. Duncan, who not only jeopardized an entire continent, but set things up for an even uglier scenario down the road. 

IF he survives- and he's still in pretty bad shape- then it's not much of a leap of logic to figure a lot of sick and potentially sick people will make the decision that it's worth the effort to get over to North America.

UPDATE ---

Health Officials Now Monitoring 100 Ebola Contacts, Up From "12-18"