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[KMOD]

This message was self-deleted by its author (KMOD) on Sat Nov 7, 2015, 09:34 PM. When the original post in a discussion thread is self-deleted, the entire discussion thread is automatically locked so new replies cannot be posted.

[Warpy]

1. She was not vomiting, producing diarrhea stools, or bleeding anywhere

any person could possibly be contaminated. She was LOW RISK for contagion.

Low fevers with no other symptoms don't indicate anything except there might be an inflammatory process going on somewhere and note that weasel word, I said might.

Most people run higher temperatures with a flu shot.

Any nurse taking care of Mr. Duncan with the piss poor support they were getting from hospital administration is a heroine.

[KMOD]

2. Any nurse taking care of Mr. Duncan with the piss poor support they were getting from hospital

Any nurse taking care of Mr. Duncan with the piss poor support they were getting from hospital administration is a heroine.

Yes, indeed!

[KMOD]

3. She was LOW RISK for contagion

This also cannot be stressed enough.

[LisaL]

4. Incubation period is anywhere from 2 to 21 days. And maybe even longer than 21 days.

It doesn't have to be typical.
So you can not make any conclusions.
I think it's very obvious she didn't feel well due to Ebola.
Spanish nurse didn't feel well with mild symptoms for the whole week before being finally diagnosed with Ebola. Her fever was low. Then she went into decline.
I have no idea who came up with 101.5 degrees nonsense.
Clearly at first fever could be low.

[KMOD]

5. I'm not sure it's obvious as you say

clearly at first, in Ebola, fever could be low, but that still does not mean she was contagious.

btw, the Spanish nurse is improving as well. So it's all good, fingers crossed.

Spain’s deputy prime minister, said Ms. Ramos, was “stable, with a slight improvement” in her condition.

[Yo_Mama]

14. Some patients never run the high fever.

It varies a lot.

[Ms. Toad]

21. 13% never run any fever at all. n/t

[Yo_Mama]

23. Well, that's one study!

The problem is that this outbreak has already run so far ahead of anything ever seen before that one wonders how good any stats are?

But CERTAINLY claiming that everyone has to run a fever to be really ill with Ebola makes no sense. Observation has contradicted it.

[ecstatic]

6. the reason for the discrepancy is

the same reason why they're now admitting their protocols are no longer sufficient. They think the virus is airborne now. They're not going to come out and say it, as that would cause panic... But let's look at what they've done recently:

1. They're moving up the timeline of Amber's symptoms: If someone on those flights catches it, at a time when she is supposedly without symptoms, how would that be explained? Better to adjust her symptoms start date. Meanwhile, they didn't give the memo to Amber's uncle, who had been talking directly with Amber all day. He pretty much exposed the lie, but it's OK, since most will just assume that he's the one who is lying.

2. Why did they have to contact 800 people if the risk was so low?

3. Why did Amber and Nina catch Ebola in full PPE?

None of those questions have answers yet, and the CDC has indirectly admitted that their understanding of the virus is wrong.

[Delphinus]

9. They think the virus is airborne?

Boy, I don't recall reading that.

[mnhtnbb]

11. There are infectious disease professionals that are worried about aerosolization,

but primarily because of health care workers handling heavy viral loaded bodily
fluids when taking care of an Ebola patient (not from sitting next to someone on an airplane
who has been exposed but not showing any symptoms).


The doc from Texas Presbyterian-- who was involved in providing care to Mr. Duncan and both nurses who
subsequently contracted Ebola-- gave an interview recently to a local Dallas TV station.
He speculates that it's possible both nurses may have contracted the disease PRIOR to the use
of respirators (originally not recommended by the CDC). Use of respirators HAS been recommended
for health care personnel treating Ebola patients for some time.

See this:

http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

And the interview:

http://www.wfaa.com/story/news/health/2014/10/18/texas-health-presbyterian-doctor-talks-about-ebola-response/17483917/

[KMOD]

17. I had read the transcipt of the Dr.'s interview

thank you for posting this. I think he may be right in his suspicions, of course, we'll probably never really know.

[morningfog]

10. All of those questions have answers.

Overreaction to a PR disaster. It is not airborne, people are in a panic.

[Yo_Mama]

13. They don't believe it is airborne in a normal situation

CDC does have some concerns about AGPs (Aerosol Generating Procedures) in critical care for Ebola patients. But that's totally different than claiming that it is airborne like flu, a cold or such.

They just decided to follow the Nigerian protocol once they realized they had secondary cases. Too many variables - they just decided to shut it down now with very strong precautions, which should work.

If the virus were truly airborne, you would expect Duncan's household members to be ill by now.

[Marrah_G]

26. They do not think it is airborne. It is NOT airborne.

Please do not spread misinformation

[Avalux]

31. Please provide a link stating that Ebola is now airborne. I bet you don't find one.

If Ebola mutated into a form that can be transmitted as aerosolized droplets (like the flu), we would absolutely know without a shadow of a doubt. The number of infected would increase exponentially over a very short period, like a wildfire.

Here are the answers to your questions:

1. Amber is the only person that knows when here symptoms started, all we have is her word. She may have talked to people in Texas and people at the CDC, but NO ONE examined her until she returned to Texas. So basically, we have no facts.

2. They contacted 800 people as a precaution; especially since Ebola hysteria is off the rails and the CDC is being blamed for not being prepared.

3. Their gear was inadequate; and mistakes were probably made - usually happens when taking everything off. I'm not faulting anyone, but getting in and out of the gear is intensive and exhausting. A once-a-year training isn't enough. Plus, end stage Ebola infection is incredibly messy; body fluids everywhere.

[pugetres]

7. Putting in a dialysis cath and intubation is riskier than average

but sometimes it is the simpler things that need to be considered, too.

I do not believe this strain of Ebola is airborne. But, even the simple act of emptying a bedpan or catheter into a toilet and then flushing that toilet can result in the aerosolization of infectious material that normally would not be suspended in the air for any length of time. *That is why dentists recommend that we keep out toothbrushes at least 6 feet away from the toilet.

I did read that one of the hospitals, NIH/Emory, had a chemical to pour into the toilet 10 minutes prior to flushing. I doubt the Dallas hospital had any protocol for the contents of the toilet.

Even the contents of the vent suction canisters were dumped into the toilet (rather than using a gelling agent) where I used to work. Dump, flush, ick.

[TorchTheWitch]

8. I was trying to figure this out myself

And no apology necessary. I'm sure you've seen how obnoxious people can be on a perpetual basis here.

I don't think there is any way to know when or how either nurses became infected. So far, I haven't even seen any information on what days Vinson cared for Mr. Duncan. I tend to believe they were probably infected at a point in their care that had them showing symptoms within the 8-10 or thereabouts average period. Just because they got appropriate PPE after the first two or three days from the date of his admission doesn't mean that they were able to get out of it without infecting themselves, and there was still no disinfecting happening.

We're constantly told by everyone that has the experience and knowledge in this about the buddy system, supervision in PPE removal by a trained and experienced person and that disinfection before removal is KEY.

With all that went wrong, just like the CDC said, I don't think it can be known when or how either became infected. But since the average person starts to show symptoms somewhere between 8-10 days since infection, I can't help but believe that both of these nurses likely also fall into that spectrum. Just doesn't seem to be any way to know.

It also could be that the nurses were a hell of a lot more careful when they knew they weren't appropriately suited up but became too lax when they got the appropriate PPE without even realizing it. They had no previous experience or knowledge, were continually given changing protocols, weren't being appropriately supervised by anyone else that did and still with no disinfection process before removing the PPE. Infection could have happened at any time.

I had posted an article recently that discussed that 10% of caregivers in West Africa who become infected that are experienced and knowledgeable with the correct PPE and disinfection protocols become infected at the removal of PPE stage. I watched a video recently (can't recall now which one it was - I've watched so many) that the US missionary that became infected around the same time as Dr. Brantly didn't see patients and was only helping to suit up caregivers or other workers, spraying them down with disinfectant and supervising their removal of PPE. All I remember about the video as far as trying to identify it was that the whole thing was an interview with her and her husband after she recovered.

Be as tinfoil hat as you want to be. You should see some of the tinfoily things that get posted here pretty regularly. It was a good post. I bookmarked it soon after you posted it since I didn't have time to reply at the time, and I rarely bookmark any posts here to return to.

[Yo_Mama]

15. WHO recently recalculated mean incubation at 11.4 days

I am quite sure you would expect incubation to vary based on the initial level of exposure. That's a commonality among viral illnesses.

At one point CDC was concentrating on the later AGPs. Now they are concentrating on the first few days with skin exposure, etc. There's no way to tell.

I think it could have happened when surfaces became mildly contaminated during the doffing procedure. Unless you have a dedicated area that is constantly cleaned, it is easy to have slight surface contamination during the removal process.

We'll never know for sure.

[TorchTheWitch]

16. surface areas likely weren't constantly cleaned

Waste piled up, there was no disinfection of the bottoms of their shoes, etc. They could have gotten infected pretty much at any time. And without knowing what days Vinson cared for him or what she even did to care for him I don't think anyone is likely to know.

[KMOD]

18. Thank you Torch,

Great post! I agree with everything you wrote.

[LisaL]

20. This information was released.

"Vinson was among the team of medical professionals who treated the first person to die of Ebola on U.S. soil, Thomas Eric Duncan. Between Sept. 30-Oct. 2 and Oct. 5-Oct. 8, Vinson actively engaged in caring for Duncan, records show. She inserted catheters, drew blood, and dealt with Duncan's body fluids while wearing protective gear."

http://www.cbsnews.com/news/ebola-patient-amber-vinson-hires-high-powered-attorney/

[magical thyme]

12. the "full protective gear" left their necks totally exposed.

According to one of the nurses who treated Nina Pham, even the gear provided by the CDC was not appropriate. The one nurse who has gone public stated unequivocably that the tyvek suits with double hoods, zippers taped, high gloves taped, OR booties plus high level boots, under hood filtered air left their necks totally exposed. And that the CDC rep showing how to use it could not explain to her why they were leaving their necks totally exposed.

They also didn't get adequate training or a buddy system for removing the gear.

So consider those Dallas nurses as never adequately protected. Every nurse that went into Duncan's room was potentially exposed.

[KMOD]

19. So consider those Dallas nurses as never adequately protected

So sadly true.

[Fumesucker]

22. I hadn't heard before that the CDC directly interacted with the nurses

Is it the CDC who told them to tape up their necks?

If so that's shocking, I would expect that from hospital management but the CDC?

[magical thyme]

25. she said when she asked the CDC why their necks were exposed with

everything else 2-3 layers thick, they couldn't answer.

She never mentioned the neck-taping in the interview, so I don't know when that happened. My impression was that was from the hospital prior to the CDC, but I honestly have no idea.

[Ms. Toad]

24. If you have medical training,

you were exposed to a patient with Ebola, you have flu-like symptoms including a low grade fever, and you are still in the 21-day window, you assume it is Ebola until proven otherwise. That is the only responsible thing to do.

That doesn't mean she is at fault for catching it, or failed to follow protocols, or didn't check in before the flight and have some moron at the CDC tell her she was cleared to fly. It means that even if all those things are true, it was still a stupid thing to do, and her medical training should have kept her from doing it.

There were enough mistakes to go around - and the fact that others ALSO made mistakes does not excuse her mistakes.

[KMOD]

29. You know what, Ms. Toad?

If Ohio didn't completely and unreasonably freak-out, her flight would never have been an issue.

You know we disagree on Amber Vinson, we discussed this several times over the weekend. So I'm not going to argue that anymore.

I will agree with you that there we a lot of mistakes. Hopefully, these will be corrected should we have another case in the future.

[KMOD]

30. Hello, ann

She really was in contact with the CDC through Dallas Health. 3 times that day. They cleared her to fly.

While Vinson was caring for Duncan in the days before his death, she inserted catheters, drew blood and dealt with Duncan’s bodily fluids, according to medical records provided to The Associated Press by Thomas Eric Duncan’s family.

http://thescoopblog.dallasnews.com/2014/10/second-health-care-worker-tests-positive-for-ebola-in-dallas.html/

I hope Amber and Nina make full recoveries. And I hope we never have another Ebola patient again. But if we do, I think you and Ms. Toad should volunteer, since you both have superior common sense.

[etherealtruth]

28. At this point all I will say

I hope Ms. Vinson and anyone else infected recover completely.