My God, I almost can't believe it!

[PCIntern]

Today I heard an official of the CDC state that this little incident involving Ebola is an "outbreak".

Now, I do recall just a few short weeks ago that the director of the CDC stated that in the extremely unlikely event that there would be cases within the United States, it would not be an "outbreak".

I was horrified at this parsing of language at the time and continue to be horrified by the, well, frankly and colloquially, lame-ass attempts at managing this situation. I am on record as having stated that this Dallas Hospital was ill-equipped to handle this and boy was I correct. Unfortunately.

Now that I have stated some of my bona fides, please allow me to continue to state that the ridiculousness just continues. Today they were saying that once all of these medical-type-folks endure their quarantine, then this will be over once we have regained control.

I sincerely believe that we have handed control of this country over to the modern-day equivalent of the Marx Brothers. Having some experience with virology myself as an academic subject, I remain sadly shaking my head at the pure, unadulterated inability of those in charge to either grasp the science or manage the situation in a realistic and honest fashion. That particular syndrome seems to be the real pandemic affecting America today.

[Warpy]

1. Corporate suits do not belong in hospitals.

They have no medical training. They have little medical knowledge beyond a course in hospital administration. They don't understand infection control. They count the beans, short staff every department, come up with mission statements, and admonish nurses trying to keep people alive to smile and be happy perky people persons and in some hospitals, have even handed out customer service speeches for overworked nurses to read to patients, the hospital equivalent of "happy to serve you, want fries with that?"

The corporatization of health care makes this a perfect storm of idiocy, mismanagement and outright ignorance to make sure their staff dies off from treating people with deadly disease.

And now it looks like they've used their nurses caring for Mr. Duncan to expose other patients on the floor because they were too fucking ignorant to know that Ebola is different and nurses caring for patients down with it should never be assigned to other patients, especially when their nurses were so poorly equipped.

Let the lawsuits begin! It's the only language those corporate drones understand. It's the only thing that will cause an organizational shakeup in which doctors and nurses will have the final word on patient care issues.

[PCIntern]

2. Ex-actly. nt

[Autumn]

3. Yeah but they can manage, isn't that all that's important?

Anyone who has management experience can do anything!



Wish I could recommend your post.

[RKP5637]

51. I recall that so well in hitech R&D. The "suits" had no fucken idea what was going on, and

frankly did not care, they were glorified bean counters only interested in P&L, stockholder returns. And some of those companies, huge, are now gone ... because the idiotic suits couldn't get it into their thick skulls WTF was going on, that the technology was changing, and the stuff they were basing their P&L on was obsolete ... and more money needed to go into R&D if the company was to survive. And then, on top of that, are the massive egos the "suits" often have. It would be laughable, except then It destroyed a company, and now it's people. Yeah, we used to hear that all the time ... it does not matter what the product/service is ... a good manager can manage anything. What a load of bullshit that is having lived it first hand.

One thing that bothers me about Ebola, and I'm certainly no expert, can it morph into other viral strains, much like AIDS did. Someone posted something yesterday that one the of leading experts in viral infections has seen evidence that mutations are going on.

[brer cat]

4. Excellent summation of the situation, Warpy. nt

[KingCharlemagne]

6. I'll bet they'd understand the language of a general strike by all RNs, LPNs and Nurse's Aides. I'm

suprised and humbled that any nurse consents to care for Ebola patients any longer having witnessed the scapegoating and scorn they are subject to, not to mention threats to their life and health from catching the disease.

[mnhtnbb]

16. It was not a "corporate suit" who took Mr. Duncan's history and did the physical

in the ER when he first presented to Texas Presbyterian.

Go ahead and make fun of the suits--it's easy pickins' at DU--but the front line ER
nurses/docs are the ones who first screwed up. And it's not surprising. Have you
ever visited a busy ER of an 800+ bed hospital?

It doesn't operate like a movie. Who expected the VERY FIRST case of Ebola to walk
through their ER doors? Nobody. The hospitals at Nebraska and Emery were prepared...
meeting the Ebola patients who were transferred there from Africa. They knew what was
coming.

I'm not into laying blame, though, even though I retired as a "corporate suit", one with many
years of experience in a well known teaching hospital in Los Angeles, although my Master's
is in Hospital Administration--a 2 year graduate program at UCLA. It was, indeed, more
than a "course".

Guidelines for staffing and training are made by people with clinical expertise in EVERY
patient care department. Nurses make decisions about nurse staffing, and they do
the training. I'm not blaming the two nurses who have contracted Ebola because
they took care of Mr. Duncan. A lot of health care folks have died trying to take
care of Ebola patients in Africa. They are heroes. Mistakes happen. Lack of preparation
happens. Expectations are blown away.

I am not saying that I agree with the business model of providing health care in this country.
To speculate that things would have gone differently if Mr. Duncan had arrived at another hospital
in another state...or in another hospital in another country with universal health care, is useless.
It is imperative that we learn from the experience, and go forward.

I hope that both nurses recover.

[Warpy]

19. It was a corporate suit who overruled the nursing supervisor and left him in the open ER for hours

when the nursing supervisor (the only one with medical knowledge besides the doctor and staff nurses) wanted him put into an isolation bay immediately.

It was a corporate suit who decided nurses should take a full load of other patients while caring for a patient with Ebola.

It was a corporate suit who decided that barrier precautions that worked with HIV would work with Ebola, a disease that puts out rivers of infectious fluids.

Getting it yet?

[mnhtnbb]

22. cite your sources, please.

And be sure to verify that the "suit" who made these decisions had ZERO clinical expertise, because there are plenty
of nurses and MD's who have become management.

[Chemisse]

23. I haven't seen the info in your first paragraph.

Do you have a source for that? That is pretty scandalous.

[Jamastiene]

39. ABC News Link:

http://abcnews.go.com/Health/dallas-nurses-hospital-sloppy-ebola-protocols-union/story?id=26205956

5th paragraph down, right above the picture of Duncan.

"Duncan was left in a nonquarantined zone for several hours, and a nurse supervisor faced resistance from hospital authorities after demanding that Duncan be moved to an isolation unit, according to the union’s statement. Additionally, Duncan’s lab specimens were sent through the hospital’s tube system, potentially contaminating the system, the nurses said."

[Chemisse]

62. Were they TRYING to spread this disease!?

I can't understand why they weren't more cautious. If profit is the motive, I would think they would want this chance to show they were a superior hospital.

[jtuck004]

17. The cause, though, is far beyond the hospitals. This is what happens when the only political party

that could stand up for people abdicates their role, joins their oppressor, and sees little wrong in hospitals, and health care being run like our crooked, thieving finance sector.

This is just a symptom, eh intern?

[Mojorabbit]

18. Perfectly stated! nt

[woo me with science]

20. Thank you.

[RKP5637]

54. Well said, as always!!! n/t

[kestrel91316]

5. Well, IMHO it does qualify as a VERY MINOR outbreak.

If there are no further cases, and in particular no tertiary cases, that's how it will probably be described in the history books. And it wouldn't be false.

[PCIntern]

8. We're not done yet…not by a longshot. nt

[Logical]

32. I get the general feeling you think a lot of yourself. Just my opinion. nt

[PCIntern]

33. I know what I know

Denigrating me personally does not alter the fact that I stated that this would be utterly mishandled from the beginning while posters here were busy extolling the virtues of this Dallas hospital in particular and the great American healthcare system in general. I'm speaking from competence - I have worked in clinical, hospital, and instructional positions for 37 years. I know what happens institutionally and personally in this field. If this bothers you you can certainly put me on "ignore".

[Logical]

61. No need to ignore, it is more entertaining reading your rants. nt

[Logical]

63. Well your comment about "not being done by a long shot" will be interesting to track nt

[PCIntern]

65. I didn't read the article that stated that the outbreak in Africa was over!

Please share the link…I can't wait to tell everyone.

I'm not ranting, BTW…I simply state the facts. You did not refute a single thing which I stated, you just don't seem to like my P.O.V. That's fine, but no need to attempt to belittle and diminish.

[pnwmom]

14. "IF." n/t

[HereSince1628]

7. Yep, but it's also a "cluster"

Here on DU it's already been discussed as a clusterf--k.

But I'd not be surprised when it goes into textbooks if it isn't talked about as a workplace cluster, or merely nosocomial occurrences.

We live in a world in which unintended meanings often get played up. So people who communicate with the public are careful not to make those unintended communications available.

The word outbreak carries meanings to different people...including 'escape from containment. ' That's a concept that I'm pretty sure governments at all levels didn't want to convey.

[PCIntern]

9. Funny, because they had outbreaks in the other countries

but we have American Exceptionalism. No outbreaks.

[HereSince1628]

11. Proximity I suppose.

It's probably always safer to talk about bad things that happen to "them" far away

[VA_Jill]

12. More like a cluster f*ck

Sorry for the language, but seriously, folks, Texas Health Presbyterian screwed this whole thing up six ways till Sunday and they apparently aren't done yet!

[HereSince1628]

13. Yes, I said that in there right at the top.

[Beartracks]

15. Makes sense. An outbreak "over there" inspires action...

... and a sense of urgency, which are useful.

But an outbreak "right here" inspires panic, which is NOT useful.

==============

[superpatriotman]

10. Many bureaucracies are Too Big To Not Fail

Public service, in my opinion, has become a cruel joke.

CDC
VA
FDA
FEMA
...

[Doremus]

46. Those are the very agencies, among many others, that have bore the brunt of 10 years of

GOP budget cuts. They are rotten to the core with embedded repuke operatives whose only job description is to siphon public monies into private pockets.

Cruel joke? Not a fucking thing funny about it, "patriot" man. You might recall it wasn't very long ago that society would have called these these crimes against humanity unamerican. But that was before the country succumbed to its own ebola attack, aka the Koch brothers and similar minded plutocrats.

[OnyxCollie]

21. "Unlikely"

There's that word again.

“You Keep Using That Word, I Do Not Think It Means What You Think It Means”

[magical thyme]

24. have you watched the whistleblower nurse interview? about the biohazard suits

and instruction by the CDC official in the newer protocols?

They asked who had training to take care of Pham, and nobody had any training or was willing to admit to it. So they asked for volunteers and the whistleblower nurse and some others volunteered.

He had them dress in 2, and even 3 layers everywhere, 2 hoods with filtered air supply under the hood, apron to cover zipper on front of tyvek suit, 2 pairs of operating boots over tyvek foot covering.

And the front of her neck was totally and completely exposed.

And when she asked him why was her neck exposed when everything else was covered in 2 and even 3 layers plus filtered air supply...he couldn't answer her.

Texas Presb. was bad, but the CDC was not a heck of a lot better.
http://ac360.blogs.cnn.com/2014/10/16/whistleblower-nurse-i-would-do-anything-and-everything-not-to-be-a-patient-there/?cid=ob_articlesidebarall&iref=obnetwork

[IronLionZion]

25. This is why we need a surgeon general to handle the PR and communication

so that the CDC can focus on disease control and exposing the tea party's budget cuts.

[840high]

28. We have an Acting Surgeon General.

[IronLionZion]

34. What's he doing?

[Warren DeMontague]

35. ...

[840high]

57. He's waiting on Reid

to schedule a vote.

[Avalux]

26. It's both - inability to grasp science, and manage the situation.

I am not sure where we're going from here, just thankful ebola isn't easier to get.

[oldandhappy]

27. agree!!

in every area of our lives

"That particular syndrome seems to be the real pandemic affecting America today."

[alarimer]

29. What we have here is "ebolanoia"

A term I saw coined somewhere. I think it fits. A bunch of scientifically, illiterate kindergartners is what this country has come to. Fear, fear, fear. All the fucking time. I mean, Syracuse University canceled an appearance by a journalist who had been covering things in Liberia almost a month ago, because "you can't be too careful." Well, yes, you can actually. Fucking morons. Actually, no, I think they were afraid the parents of the precious snowflake students would raise hell. So that's a cover-their-asses move clearly. But it's stupid. Somebody needs to go on TV and say "Get a fucking grip, you idiots!".

And CNN and FOX fear-mongering are not helping one bit.

People are complaining about the government's response. Do they not realize that this is one of the functions of government? The CDC (and every other federal agency) has been starved of funding, "government employees" derided as do-nothings with cushy jobs. That sure helps morale.

Yeah, fuck you Republicans. You want government to drown in a bathtub? Fine. Cut taxes all you want. But then you can't complain that they didn't do enough. You cannot have it both ways. Public health is one of the things government HAS to do. The so-called free market will not (and probably cannot) serve those functions.

Also, the panic is a direct result of the scientifically illiterate being in charge of education. Stupid people elect stupid people and stupid things happen. Again, Fuck you, fundamentalist christian morons. I can only hope that this whole episode teaches people that we really do need a functioning government and we need Congress to do more that just cut fucking funding for the very agency that IS SUPPOSED TO BE ON THE VANGUARD. But they can't. Because Republican morons decided we needed more bombers instead of more infectious disease specialists.

[uppityperson]

31. ++++++++++++++++++++

[Major Hogwash]

30. It's become a PANICDEMIC, sir.

If you're not panicking already, or are not about to panic, or do not plan on panicking in the near future, then sir, you must know something that the good people over at Faux Snooze don't!!

[CanSocDem]

36. Taking the show-business out of....

...the medical industry is the first achievement of a government run public health system. In a free market like the USA, "show-business" is the strategy that keeps the whole scam together.

The 'lack of management' that you and others cite is predictable in that, in any failing industry, the first and only thing to consider is human error rather than system failure.

Are any of you asking yourselves why there isn't a vaccine available for you to take....??? Somebody down there could be making serious money....


.

[PCIntern]

37. I' would be certain that they have weighed the cost/benefit ratio

of producing a vaccine and decided that the lawsuits brought following bad reaction to a vaccine for a disease which is considered by many to be rare would not be worth it. They would need an exemption from Congress like a Good Samaritan Law which would exempt the company from liability. It could happen…as you say, there's a lot of money involved.

In the novel Goldfinger, the villain tells Bond that he made a fortune in the post-WWII period buying up stocks of penicillin, watering them down, and selling it to people who "crave the stuff". Same idea, only more advanced meds. DOn't ask why and how I remember this stuff verbatim (or nearly so).

[CanSocDem]

38. And despite the fear and trepidation...

... I like to believe that it is all for a higher purpose. The current drama certainly weighs the 'random chance' philosophy against a variety of pseudo-scientific solutions that should convince 'the consumer' to eventually shut out the advertising and begin to take control of their personal health.

.

[randome]

40. It's strange, though, that in a situation like this, everyone is castigated as being 'incompetent'.

Except DUers, of course, who always know how best to handle things. You'd think that fully 90% of Americans are incompetent at any given time in any given situation.

Granted, mistakes were made and will probably be made in the future. But there is nearly always a good mix of incompetence and genius in any group of people working hard toward a common goal.

But we don't hear much about the smart decisions that were made, do we?
[hr][font color="blue"][center]Don't ever underestimate the long-term effects of a good night's sleep.[/center][/font][hr]

[PCIntern]

41. Which 'smart decisions" were they, pray tell?

your thesis is of the "Other than that Mrs. Lincoln, how was the theater?" routine.

Yes, the ER physician did not French kiss the patient and then go to an orgy twelve days later….does that count?

[randome]

42. It's random chance during the process.

Randomly speaking, some bad decisions will be encountered. Also randomly speaking, good decisions will be made. The fact that only 2 individuals 'slipped through the cracks' is a good sign that someone in the mix of responsible officials is thinking clearly.

I know that's nothing that can be proved, like proving a negative, but overall, it's a good sign.

We don't expect open carry gunners to really be on their guard 24/7. Look at that guy who had his gun stolen from him at gunpoint recently.

We can't expect our health officials to be 'on guard' 24/7, either. They have the training and the resources but it's inevitable when they don't use that training or those resources for extended periods of time, the 'muscle' loses some tone.

All that the training does is mitigate disaster when it arrives. I think that has happened in this case because, like it or not, it could have been much worse.
[hr][font color="blue"][center]Don't ever underestimate the long-term effects of a good night's sleep.[/center][/font][hr]

[PCIntern]

44. I understand your point entirely...

but what happened in Texas is the equivalent of holding an automatic weapon with the safety off and a finger on the trigger in a playground full of children. That's not random it's beyond stupid...

[PADemD]

43. +1000

[Savannahmann]

45. Ivory Coast closed their borders to the infected nations.

They are still sending what little help they can, but they are not letting anyone in. They closed their borders back in August.

First, isolate those who have the disease, or may have it. Public health lesson number one. You try not to wait until they are symptomatic, you do it immediately. But today, we have science that tells us that it's simply not possible that two caregivers could get the disease.

Honestly, I"m about ready to give the hell up on the Administration. Shutting down travel to the affected areas should have been response number one. It was for Mexico, and Belize.

Science tells us that the risk of infection is one in a thousand, or perhaps one in ten thousand. The math would seem to indicate that we have little to fear. But the results of that risk even if it is one in a hundred thousand are catastrophic.

By Catastrophic I mean people die from preventable causes. Right now, someone is researching the lawsuit. Right now, someone is sitting at a desk and has the gleem in their eye of massive payday. The Hospital is going to get sued, and so is the CDC. Two nurses got infected, and now more than 800 people are being notified that they have a slight, almost miniscule chance of getting sick too.

Risk and reward are calculations that belong in some things, but not public health. Every day that the insane course of action charted by the administration continues, the worse the Party will do in November. Republicans are on the populist side of yet another issue, with more than two thirds of our citizens wanting a travel ban. We sit on the crumbling edge of the cliff and tell everyone that science says that we're all totally safe, not to worry.

When events turn out that it wasn't totally safe, the first thing we do is blame the victim, like we're asshole sexists who blame victims for being raped.

Then when we point out that nobody has talked to the Nurse who got infected, then we admit it was a bit presumptuous to blame the victim, but we continue, she must have done something wrong, because she got it, and you can't get it unless you do something wrong.

To say I am disgusted is an understatement. Do you realize that all the Republicans have to say to get elected is that they believe we should institute a travel ban? FFS when the President says it's not an outbreak, when everyone knows it is, then we look like idiots.

So what are the definitions of the words? http://dictionary.reference.com/help/faq/language/d24.html

What is the difference between an outbreak, epidemic, and a pandemic?

An epidemic is a disease that affects many people at the same time, such as the flu. The US Centers for Disease Control and Prevention's official definition of epidemic is: 'The occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time'. A pandemic is a very extensive epidemic, like a plague, that is prevalent in a country, continent, or the world. There is also the word endemic, which is a disease native to a people or region, which is regularly or constantly found among a people or specific region. The term outbreak describes the sudden rise in the incidence of a disease, especially a harmful one. An outbreak is characterized by a disease's bypassing of measures to control it. Often, the difference between these terms is determined by the percentage of deaths caused by the disease.

So out of curiousity. How many deaths do we need before we decide to categorize it as an outbreak. Because it looks to me like we have an outbreak when it bypassed the measures to control it and the Health Care Workers got the disease in a modern hospital.

[randome]

47. So seal our borders to the affected nations.

What about caregivers who travel to those countries then travel to England then travel to the U.S.? Others who may have been in the country but then went somewhere else? Maybe we should demand proof of the entire global population's travel history? What about U.S. troops and health care officials? U.N. officials. Products shipped from those countries that eventually make their way here.

Response number one? So everyone in Texas and the CDC is simply ignorant, in your opinion?

It's never as simple as DU makes it out to be.
[hr][font color="blue"][center]I'm always right. When I'm wrong I admit it.
So then I'm right about being wrong.[/center][/font][hr]

[Savannahmann]

49. Have you ever heard of a little thing most travelers carry called a Passport?

It's a new invention. On it's various pages are stamps and dates that show when you entered and left a foreign nation. The idea behind this relatively new invention is that it shows what nation you are from, and where you have been. It is used as identification in both foreign nations, and domestically. I understand that the next generation is going to have computer chips built in to make it even easier for people to be identified when they enter a nation.

Now, if we only had a group of people who met travelers who are either returning or entering the nation to see if they have contraband or perhaps some sort of authorization, we could call it a travel visa. Then this group, we could call them Customs Agents, could be told to look for people who have been in the nations of Guinea, Sierra Leone, or Liberia and then we could shunt them to a holding facility for some sort of extensive screening more advanced than a thermal scanner. We could even provide these people with pictures of the stamps to look for.

Oh, I guess it will never happen. With the Republicans in charge of the House we'll never get a bunch of people out to the airports and docks to screen people arriving in the nation.

Do I really need to add the

[PCIntern]

50. Sadly funny! Thanks!

Great post!

[randome]

53. Fair enough. But entry by sea has different requirements.

People who come into contact with people from the proposed banned countries need not identify them.

There are places a U.S. citizen need not have a passport to visit so coming into contact with someone from one of the banned countries would still be a possibility.

Closing our borders will simply not work.
[hr][font color="blue"][center]I'm always right. When I'm wrong I admit it.
So then I'm right about being wrong.[/center][/font][hr]

[Savannahmann]

60. You need a passport these days.

If you haven't left the national boundary lately, you must have a passport.

But for the sake of argument, let us say that the passport idea is only 90% effective at screening out people who have been in the affected area. Let's pretend that it's like the good old days when you could travel from San Diego to Tijuana for lunch, and be back without anything but a Hi to the guy at the gate. Let's even agree that it does not protect against people who came into contact with those who might meet someone from the affected areas, and potentially be infected.

A 90% reduction in risk is a hell of a thing. Even if it was only a 50% reduction, that is thousands and then by extension tens of thousands of people not at risk.

Apollo 11 and 12 crews spent time in isolation, because while the risk of some space born disease was a one in a million chance, the results of such a disease could wipe out a significant portion of the population. Look at the situation now, a thousand people just from the activities of two nurses. More than 800 alone from the flight. Sure, we're assured by the same people who told us there was no risk of infection that only ten or so actually have a slightly higher risk, but look at the math on that. From one, to two more, to potentially ten, to potentially hundreds.

We have the mechanism, it's already in place. We do lots of things that are not 100% effective. We spray for insects to prevent everything from roaches to termites. It's not 100% effective, but we do it anyway because the results are horrid if we do nothing. Lysol kills less than 100% of the germs, but we use it to do just that. No disinfectant is 100% but still we use them to clean surgical suites. We may not be able to eliminate all of the risk, but we damn sure bust our asses to do what we can. Hospitals get sued if they don't take every precaution that is available to prevent the spread of infection.

We have the mechanism, and it would take two words from one man to make it happen. All President Obama would have to do is discuss this with his advisors, and then say those two magical words. "Do it." He might have to sign a piece of paper with more than that, but it would be done.

That is the reason we have an executive based Governmental system. So that one individual can issue instructions when time is of the essence. He wouldn't need Congress, he could call them back and ask for more money, but realistically, he can issue the order today and reduce the risk by more than 90%. Every hour he delays in this action is one in which his esteem falls, and every hour the Democratic Party is silent in demanding this action is one in which we lose supporters by the hundreds.

[Jesus Malverde]

64. +1...nt

[PCIntern]

48. Very frustrating, isn't it?

Public Health measures transcend certain personal liberties…note I said certain. But you can't seem to get through to some…

Great post, BTW.

[RKP5637]

52. Is this happening, can it happen?

... except from my other post.

One thing that bothers me about Ebola, and I'm certainly no expert, can it morph into other viral strains, much like AIDS did. Someone posted something yesterday that one the of leading experts in viral infections has seen evidence that mutations are going on.

[PCIntern]

55. Good National Geographic article on that...

don't have the link but you can Google it…fascinating.

[RKP5637]

56. Thanks! n/t

[RKP5637]

59. I found it! Tracking a Serial Killer: Could Ebola Mutate to Become More Deadly?

Thanks again! Here's the link for anyone looking for this National Geographical article. I notice they seem to have done some excellent reporting on Ebola.

http://news.nationalgeographic.com/news/2014/10/141015-ebola-virus-outbreak-pandemic-zoonotic-contagion/