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2014-10-02 -Signs, Portents, and the Weather-

CDC Official: TX ER "dropped the ball" on 1st US Ebola case

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Posted by Anguper Hupomosing9418 2014-10-02 09:12|| || Front Page|| [11126 views ] Top

#1 The CDC has been vigorously emphasizing the need for a travel history," Fauci told CNN's "The Lead with Jake Tapper."

Here's a novel idea. How about we isolate the threat and simple suspend fok'n travel to and from affected areas until this thing runs it's course ?

Posted by Besoeker 2014-10-02 11:09|| 2014-10-02 11:09|| Front Page Top

#2 That'd make too much sense, B.

Posted by Ebbang Uluque6305 2014-10-02 12:18|| 2014-10-02 12:18|| Front Page Top

#3 White House Places No Ebola Travel Restrictions

Posted by Ebbang Uluque6305 2014-10-02 12:40|| 2014-10-02 12:40|| Front Page Top

#4 Immigration official sez regime is to blame.

Posted by Besoeker 2014-10-02 12:43|| 2014-10-02 12:43|| Front Page Top

#5 Any one who comes here who is from that area, they may try a round about set of connections to avoid restrictions from direct flights, will be quarantined for 21 days in a "leprosy center" so to speak. If they aren't sick and still alive, they are free to go.

Posted by Ebbomosh Hupemp2664 2014-10-02 12:49|| 2014-10-02 12:49|| Front Page Top

#6 The patient had to have known that he'd come in contact with folks suffering from Ebola. Supposedly he had helped carry a dying woman, who told everyone she had it, some distance while he was in Liberia, and later had come in contact with a child diagnosed as having it.

A couple weeks later, he was sick.

Even if there was a severe language problem, wouldn't you find a way to tell the doctors/nurses treating you that you had been in contact with it? Was he in denial?

Or, did someone not pay attention?

A few questions left unanswered at this point.

Posted by Mullah Richard 2014-10-02 13:18|| 2014-10-02 13:18|| Front Page Top

#7 He says he told them his travel history. The hospital says it is investigating. Meanwhile, some of his closets contacts have been ordered to stay home, with no visitors.

What if they run out of food before they get sick?

Posted by Bobby 2014-10-02 13:36|| 2014-10-02 13:36|| Front Page Top

#8 I'm starting to be reminded of a cartoon my dad made once for his desk. It showed someone with an "Engineering" name tag in aptoplectic shock, shouting "Oh Shit! You did it just like I told you!"

Posted by Thing From Snowy Mountain 2014-10-02 13:47|| 2014-10-02 13:47|| Front Page Top

#9 .What if they run out of food before they get sick?

I would call the pharmacy at my grocery store -- where they know me very well -- and ask them about getting basics delivered to the house, charged to my credit card. Or Amazon -- they deliver, and if I go through Rantburg, Fred even gets a kickback. Of course I'm in this country legally, I have a valid credit card, and a front stoop where things can be left without personal interaction. An illegal living on a cash-only basis in an apartment building without a doorman would have to rely on the telephone and personal contacts willing to drop groceries on the doormat.

Posted by trailing wife 2014-10-02 14:04|| 2014-10-02 14:04|| Front Page Top

#10 I bet he had no insurance so they gave him two aspirin and showed him the door.

Posted by BrerRabbit 2014-10-02 14:06|| 2014-10-02 14:06|| Front Page Top

#11 Because at this point the odds are that most of those exposed won't get sick, they'll just be bored to tears as a precaution. Nigeria (?) seems to have scotched their possible outbreak by using the same kind of contact tracing and isolation of all possible contacts of the idiot who came down ebola on the flight to their airport, and subsequently died in hospital.

Posted by trailing wife 2014-10-02 14:08|| 2014-10-02 14:08|| Front Page Top

#12 We did more to prevent the spread of mad cow.

I recently heard Texas has upwards of 10,000 liberians. If so the hospitals should be very aware of the chances and should have set up quarantine facilities just in case. better to inconvenience a few than to deal with a real outbreak.

Posted by rjschwarz 2014-10-02 14:21|| 2014-10-02 14:21|| Front Page Top

#13 "We did more to prevent the spread of mad cow." Which was a non problem.

Posted by Bright Pebbles 2014-10-02 15:28|| 2014-10-02 15:28|| Front Page Top

#14 TW, I'm not so confident. The way Ebola arrived in the US seems similar to how it arrived in Nigeria. But there some important differences, and not in our favor.

Patrick Sawyer collapsed in the Lagos airport and was taken directly to the hospital. From him, it spread only to health workers who had direct contact with him, and their families.

Health workers are much more likely to know and follow strict hygiene and quarantine procedures than Joe Q. Public, or children.

Sawyer was not out roaming around in Lagos for 4 days while symptomatic.

He did not directly expose a number of his own relatives and five children, who attend four different schools, and apparently were in school for at least a few days after being exposed.

In sum, Duncan created many more potential chains of transmission than Sawyer did. And many of the people he exposed are not health workers.

Furthermore, US officials' insistence that we are so much sophisticated than Africans is bunk. We are still humans, and idiots.

For example: many Americans have a strongly ingrained sense of entitlement to personal rights and freedoms even under the most exigent circumstances, such as an extinction-level pandemic. I find it unlikely that Ronulans and the Free Sh!t Army, for example, would submit to 3 weeks of quarantine without the threat of force, or actual use thereof.

Finally: the more I hear from CDC Director Tom Frieden and other honchos, the less confidence I have. Frieden could barely suppress the panic in his own voice. Others are confidently downplaying any concerns, by making assertions with no basis in fact.

And the more they insist everything is under control, the more it seems like no one has any idea what they're doing. Compared to Africa, the US health system has almost no real-world experience with widespread infectious disease. Further: no travel restrictions? Open borders? Business as usual, nothing to see here, move along? Seriously? It's like there's no one in charge.

So, IMHO, I think it will be sheer blind dumb luck, or an act of G-d, if things here turn out as well as they did in Nigeria.

Posted by RandomJD 2014-10-02 15:45|| 2014-10-02 15:45|| Front Page Top

#15 Likely story? Busy nurse, didn't chart the data. With the Electronic stuff we have going on (mandated by Obamacare), all she had to do was miss a checkbox on a "structured note" when taking the H&P, and nobody would ever know it was even asked. Thus the busy ER Doc may not have had it available for him to see. Absent the travel info, all the doc is working with is a fever and pain. That could be a simple norovirus, whcih means go home push fluids, take tylenol and ride it out - come back only if it gets worse.

Secondarily, the fact that the patient was at an ER for a fever and headache obliquely tells me he was likely uninsured - because insured folks go to their family doctor, or a local clinic, not a hospital. That puts him in there with lots of other patients who use the ER like a regular doctors office, most of whom do not need to be there, many of whom are illegals in Texas.

Posted by OldSpook 2014-10-02 16:07|| 2014-10-02 16:07|| Front Page Top

#16 Nonetheless, what kind of Doc sees a patient who speaks English with an African lilt displaying the symptoms and doesn't even think to himself, "Jeez, I sure hope this guy doesn't have Ebola cause I just took his pulse?" Or do Docs not touch their patients any more?

Posted by Nimble Spemble 2014-10-02 16:18|| 2014-10-02 16:18|| Front Page Top

#17 Liberian worked for FEDEX. Got fired. Made contact with an EBOLA victim. Then went immediately to the US.

Posted by Ebbomosh Hupemp2664 2014-10-02 16:38|| 2014-10-02 16:38|| Front Page Top

#18 NS, in a busy ER, it is possible the doc read the chart, didn't see anything amiss, talked to the patient for a moment, checked McBurney's point (appendicitis), noted the pain was upper abdominal, and called it "stomach virus" and sent him home with instructions to hydrate and take tylenol or motrin.

As for the accent, its a downtown hospital in the 5th largest metropolitan area in the US -- lots and lots of accents, especially uninsured in the ER, so that likely did not raise any suspicions (its typical, not atypical in an urban ER).

Posted by OldSpook 2014-10-02 17:43|| 2014-10-02 17:43|| Front Page Top

#19 One other FYI, the patient was asymptomatic - they did check temperature when boarding. And apparently you don't start shedding the virus until symptoms appear, which was several days after being in the US.

Posted by OldSpook 2014-10-02 17:47|| 2014-10-02 17:47|| Front Page Top

#20 One question for the Libertarians: how does your ideal of "open borders" (i.e. uncontrolled) deal with this? Hmmm?

Yeah, thought so. Libertarians are idiots when it comes to the border and national sovereignty - and dealing with irrational leaders of aggressive countries. Foreign policy stupidity (or, more charitably, naivete) is what drove me out of the libertarian movement. Unlike them and their fantasy world where everyone can be bargained with financially, I know there are people that live off hate and power, not rationality, I've met them and fought them. They can only be stopped with force, and can only be prevented from acting by the certainty of overwhelming destructive and deadly force directly against their person and/or family. The first thing you need is a good barrier to keep them out, and to control who you let in.

Posted by OldSpook 2014-10-02 17:50|| 2014-10-02 17:50|| Front Page Top

#21 Another ball might have been dropped:
”So who cleaned up the (Ebola patient's) vomit, and where are they now…?…..what system did the vomit pass into?”

Top men!

Posted by Elmerert Hupens2660 2014-10-02 18:03|| 2014-10-02 18:03|| Front Page Top

#22 TW, I'm not so confident. The way Ebola arrived in the US seems similar to how it arrived in Nigeria. But there some important differences, and not in our favor.

I'll stock the pantry, then, and get some bottles of stable bleach and a box or two of trash bags. This is my reference for nursing items for the duration. But if it really gets bad, I'm toast; my condition makes me more susceptible to infections, less able to fight them, and I lack the sustained attention to detail necessary to avoid infection under such circumstances.

Furthermore, US officials' insistence that we are so much sophisticated than Africans is bunk. We are still humans, and idiots.

Oh yes. Not just officials -- I've seen similar nonsense on Facebook. And, the anti-vaxxer types are as likely to reject the idea of a threat as any ignorant African villager believing it's the result of black magic.

many Americans have a strongly ingrained sense of entitlement to personal rights and freedoms even under the most exigent circumstances, such as an extinction-level pandemic. I find it unlikely that Ronulans and the Free Sh!t Army, for example, would submit to 3 weeks of quarantine without the threat of force, or actual use thereof.

Agreed. Although I'm not sure who the Ronulans are in this statement.

On the other hand, we have a lot more doctors and hospitals per capita, and they are a good deal more sophisticated than anything in Nigeria, even if there have been entirely too many shortages in supplies and medications recently -- thanks in part to an overzealous FDA, as far as I can tell. And, thanks to the large percentage of people living in the suburbs, getting about in their own cars, and doing things like shopping, work, and socializing via the internet, we have fewer interactions with others at close quarters on daily basis than the Nigerians, and therefore a somewhat reduced chance of being in the same space as an infected person. I'd think this would somewhat slow the rate of transmission, giving people more time to prepare and respond.

And finally, we do have at least some plans in place for a pandemic: I've a friend who is a factory Quality Assurance manager, and several years ago she was tasked with drawing up plans and stocking her factory with supplies against the H1N1 possibility. The assumption was that people would be locked in for the duration to prevent spread, either if a worker came in sick or if there was sickness offsite. She told me that all mid-and large size companies were supposed to quietly do the same. It was going to be hard on the families, she admitted, but they had a responsibility to do what they could.

Finally, there's this: Israeli app helps inform about ebola. A little thing, but free and Apple could easily push it to all iDevices -- and the other guys to their smartphones -- with as little effort as they did that song/album that people are fussing about having received. Apparently it's proving a big help where it's been deployed in the affected bits of Africa.

Bottom line, I can be more sanguine, RandomJD, because you and others are handling the worrying and the wargaming. And if it doesn't get bad, my supplies will get used, as did the duck tape and plastic bags I would have used to seal off my closet in case of a post-9/11 gas attack, and the pantry supplies I keep on hand for a two week long, weather-induced power outage. We've gone up to ten days, you see, here at the far end of the power lines.

Posted by trailing wife 2014-10-02 18:57|| 2014-10-02 18:57|| Front Page Top

#23 Or do Docs not touch their patients any more?

Pulse and other vitals are usually done by Nurse, Nurse's aid, or some other assistant aren't they? The Doctor's seldom soil their fingers with such mundane procedures.

Hmm... I wonder if anyone checked on the unlucky bastard[ette] who did it.

Posted by CrazyFool 2014-10-02 19:41|| 2014-10-02 19:41|| Front Page Top

#24 The Doctor's seldom soil their fingers with such mundane procedures.

Not if you're trying to cover, diagnose, and treat a dozen to two dozen emergency beds, get your patients' notes down correctly (and before you forget,) enter scrips, consult with other physicians at other hospitals for them to accept, the patients you're trying to transfer to them. Et cetera, et cetera.

Which is Latin for "stop being ignorant."

This ain't kindly Doctor Brown the town medico schtuff, hombre.

Posted by Pappy 2014-10-02 22:42|| 2014-10-02 22:42|| Front Page Top

#25 Oh sorry TW - "Ronulans" are the Ron Paul lunatic fringe. Like the author of the "ethics" piece I linked. As silly and dangerous as the anti-vaxxer crowd.

You're right, we do have some structural factors going for us. It's just, I've read detailed accounts of previous Ebola outbreaks in the boonies, and scientific reports on how this virus works. Ebola is the worst pathogen imaginable in an urban setting. Like flicking a cigarette butt into bone-dry underbrush.

From that perspective, it's just very hard to see how this isn't going to be an unmitigated disaster.

Posted by RandomJD 2014-10-02 23:05|| 2014-10-02 23:05|| Front Page Top

#26 Houston Chronicle today: Law enforcement posted to enforce quarantine:

The family of America's first Ebola patient initially did not comply with an order to stay at home, Dallas officials revealed Thursday amid a scramble to eliminate any chance of the deadly disease spreading.

About 100 people may have had at least brief contact with Thomas Eric Duncan before he was isolated in a Dallas hospital, officials said Thursday, but four members of the 42-year-old Liberian man's family are of particular concern.

Police officers on Thursday took up posts outside the family's Dallas apartment to ensure compliance with an official order to stay, County Judge Clay Jenkins said in an afternoon news conference.

"They were non-compliant with requests to stay home," said Jenkins, who did not elaborate.

Posted by Anguper Hupomosing9418 2014-10-02 23:09|| 2014-10-02 23:09|| Front Page Top

#27 "Checklist for Patients Being Evaluated for
Ebola Virus Disease (EVD) in the United States" date marked 1 Oct 2014

First item:

Upon arrival to clinical setting/triage

Does patient have fever (subjective or ≥101.5°F)?

Does patient have compatible EVD symptoms such as headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage?

Has the patient traveled to an Ebola-affected area in the 21 days before illness onset?

Posted by Anguper Hupomosing9418 2014-10-02 23:30|| 2014-10-02 23:30|| Front Page Top

#28 WFAA: Patient Zero apartment neighbors informed for first time about quarantine

For the first time, one of the residents inside the apartment where Thomas Eric Duncan was staying walked outside Thursday.

He was given permission to come out briefly to get supplies and food left on the porch by the Red Cross.

"No one is supposed to go inside the apartment. They can not come out. They are not even allowed to come out on the porch," said the Ivy apartment complex manager.

Pretty difficult to bring in boxes from the porch without getting out on the porch.

The manager said there is no need for alarm. She said no one has reported seeing Duncan outside the apartment at any time while he was here and he was not in the common areas, like the laundry.

The CDC has also cleaned the apartment and bagged items, including bedding.

Translation has been one hindrance to keeping residents at the Ivy Apartments informed, because as many as eight different languages are spoken there. The apartment manager said they will hold meetings for residents in various languages to make sure everyone gets the information they need.

I wonder how the residents understand the health department notices, news media, etc.

Posted by Anguper Hupomosing9418 2014-10-02 23:51|| 2014-10-02 23:51|| Front Page Top

23:51 Anguper Hupomosing9418
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23:21 Procopius2k
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23:09 Anguper Hupomosing9418
23:05 RandomJD
22:50 Pappy
22:42 Pappy
22:34 JosephMendiola
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22:10 Glenmore
22:00 Besoeker
21:45 Frank G
21:27 JosephMendiola
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20:23 Classical_Liberal
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