Dallas Morning News:
Health care workers treating Thomas Eric Duncan in a hospital isolation unit didn’t wear protective hazardous-material suits for two days until tests confirmed the Liberian man had Ebola — a delay that potentially exposed perhaps dozens of hospital workers to the virus, according to medical records.
The 3-day window of Sept. 28-30 is now being targeted by investigators for the Centers for Disease Control and Prevention as the key time during which health care workers may have been exposed to the deadly virus by Duncan, who died Oct. 8 from the disease.
Duncan was suspected of having Ebola when he was admitted to a hospital isolation unit Sept. 28, and he developed projectile vomiting and explosive diarrhea later that day, according to medical records his family turned over to The Associated Press.
But workers at Texas Health Presbyterian Hospital Dallas did not abandon their gowns and scrubs for hazmat suits until tests came back positive for Ebola about 2 p.m. on Sept. 30, according to details of the records released by AP.
The misstep – one in a series of potentially deadly mishandling of Duncan — raises the likelihood that other health care workers could have been infected. More than 70 workers were exposed to him before he died, but hospital officials have not indicated how many treated him in the initial few days.
Hospital officials have likewise not responded to repeated requests for comment about what types of protective gear was used the first few days, and why officials felt a need to change the gear being used on Sept. 30.
Yeah, I'd focus on that 3 day window. Sounds kinda important. And it puts discussion of whether personal protective protocols failed in a different light.
NY Times:
Instinctual reactions are quick and automatic, useful in times when the facts are not known or there is not enough time to process what little is known. Analytical reasoning is much slower and much harder; if we relied on analysis alone, decisions about risk would paralyze us.
In everyday life, the mind juggles the two methods of risk assessment. Research into this process, some of it by the Nobel laureate Daniel Kahneman and his research partner Amos Tversky, demonstrates that instinctual biases can alter how people gauge the odds in making a wide variety of presumably rational decisions, from investing money to preparing for disasters.
For example, most people appreciate that a chance of infection of one in a 100 million is near zero. But if a friend says he knows an infected person, then our instinctive risk-assessment system is much more likely to focus on numerator than the denominator. Am I the one in 100 million? Me?
“The system often flips from one extreme to another, from ignoring risks altogether and then overreacting,” said George Loewenstein, a professor of economics and psychology at Carnegie Mellon University.
And we are not immune to it.
By the way, congrats to the surprise KC Royals on making the World Series.
Privately, Republicans/Rick Scott loyalists are telling me the moment he didn't go onstage over fangate was the moment he lost the election
— @MarcACaputo
More politics and policy below the fold.
WaPo on what looks like a CDC screwup:
The experts had warned that fighting Ebola is hard, and Wednesday’s drumbeat of bad news proved them correct. The day began with a bulletin about another health-care worker stricken with the deadly disease, and the news got worse with the revelation that she had flown with a slightly elevated temperature from Cleveland to Dallas on a crowded airliner barely 24 hours before her diagnosis.
Before she boarded that flight, the woman, identified by Ohio officials as Amber Joy Vinson, 29, informed the Centers for Disease Control and Prevention that she was running a temperature of 99.5 degrees, a federal official told The Washington Post.
That was below the 100.4-degree threshold in CDC guidelines for screening travelers who have been in Ebola-affected countries, and which triggers a secondary screening. The CDC did not prohibit Vinson from traveling on the plane back to Dallas, said the official, who spoke on the condition of anonymity because of the sensitive nature of the issue.
More from
WaPo on the critical nature of communication:
A main culprit of government fecklessness, Light wrote, is communication. This is in part “because information has to flow up through multiple layers to reach the top of an agency, while guidance must flow down through the same over-layered chain. The result is a disastrous version of the childhood game of ‘gossip’ in which key information gets lost, discarded, distorted, or ignored as it is passed from one child to another.”
So now, as the officials contend with the likelihood of additional Ebola victims in the United States, they’re again discussing more plans. “We are preparing contingencies for more” Ebola patients,” Dallas County Judge Clay Jenkins said. “And that is a very real possibility.”
CDC doesn't pick up the phone and text every doctor and nurse in America. They convey information to state public health and down the chain. Think about it.
NY Times:
On Tuesday evening, a nurses’ union, National Nurses United, released a scathing statement that it said was composed by nurses at Presbyterian hospital. The statement told of “confusion and frequently changing policies and protocols,” of inadequate protection against contamination and spotty training among the nurses who treated Mr. Duncan when he arrived by ambulance at the emergency room on Sept. 28.
Dr. Frieden confirmed some of the nurses’ claims and complaints. He said the critical period was the first three days of Mr. Duncan’s care before he was confirmed to have Ebola and before the C.D.C. team arrived in Dallas — Sept. 28, 29 and 30. Both Ms. Pham and Ms. Vinson had extensive contact with Mr. Duncan during those three days, and although officials have not yet determined how the two nurses became infected, they were focusing on their use of protective clothing and gear.
“We see a lot of variability in the use of personal protective equipment, and when our team arrived, the same day the case was diagnosed, we noticed, for example, that some health-care workers were putting on three or four layers of protective equipment in the belief that this would be more protective,” Dr. Frieden said. “But in fact by putting on more layers of gloves or other protective clothing, it becomes much harder to put them on and much harder to take them off, and the risk of contamination during the process of taking these gloves off gets much higher.”
The problems identified by the C.D.C. involved using protective gear in “unfamiliar ways,” he said.
My bold.
Science:
One more question, Dr. Frieden: 11 things we'd like to know about the new Ebola case
Q: You said that the two health care workers may have been particularly vulnerable between 28 September, when Duncan was admitted to the hospital and isolated, and 30 September, when he received his diagnosis. Was infection control inadequate during those days--and how so? Why is it less likely that they became infected after his diagnosis?
Q: Nurses at the Dallas hospital have specified shortcomings in the way their hospital has handled Duncan's case. Has your investigation confirmed these mistakes?
Q: What training, specifically, did health care workers receive prior to treating Mr. Duncan? Who provided the training and how long did it last?
Q: Why is the second case being moved to Emory? Are you concerned about the level of care at Texas Presbyterian, further infections, or both?
Q: Should all future patients be moved to one of the four Ebola-specialized treatment centers in the U.S. if their condition allows it?
Q: What Ebola-specific training is provided now at Texas Presbyterian and at other hospitals around the country?
Q: In West Africa, some health care workers have been afraid to care for Ebola patients and some have not shown up for work or even left their homes. Has anyone at Texas Presbyterian refused to take care of Ebola patients?
Q: At CDC's Ebola training course in Anniston, Alabama, health care workers are told to strictly limit shifts in Ebola treatment units, starting with one-hour rotations. Is Texas Presbyterian using a similar strategy? Are Emory and the other dedicated centers?
Q: You said that about 50 health care workers entered Duncan's room and that you want to limit the number of people exposed to Ebola patients. How do you do this? What is the minimum number needed for a single patient?
Q: Are people taking care of Ebola patients allowed to help other patients?
Q: You have repeatedly assured the U.S. that we know how to stop Ebola. Are you concerned about the impact the two cases have on your credibility?
Q: Do you think the media are paying too much attention to the U.S. outbreak and too little to the epidemic in West Africa?
Arthur Caplan:
Ebola needs to be treated in the U.S. with an expert, regional response.
The notion that every hospital can deal with Ebola has been shown wrong by the events in Dallas. Every hospital cannot deal with Ebola. But many can. They have the training, the equipment, the experience with other infectious diseases and the skilled personnel to engage Ebola safely. Pride about what any hospital can do must yield to the reality that having a moonsuit does not mean everyone is trained properly in how to put it on and take it off. So let’s designate the national 100 hospitals that can take Ebola patients, figure out how to get them there safely and stop creating more anger among health care workers who we are asking to take unnecessary risks in dealing with infectious patients.
Let's figure out what quarantine means.
Does it mean you try to stay home or you must? Does it means if you come out the door the cops Taser you and you lie there until a HAZMAT team comes to drag you back inside? Does it mean your pets stay there too, or must they be euthanized at a shelter if there is no way to keep them from putting others at risk when they go outside?
Don't miss that the
NY Times had a huge story on the legacy of chemical weapons in Iraq and how troops were lied to about them. No, it doesn't prove Saddam had WMDs. But it did put our troops at risk.
Here's a series of tweets that brings the point home.
Why the fucking secrecy? All it accomplished was to diminish the level of care for exposed troops, and put countless others in danger.
— @CombatCavScout