<p>I see that NYC is smugly patting itself on the back for handling its ebola patient so much better than Dallas did. Of course NYC had the benefit of preparation time and it had a medical doctor for a patient who was forthright about his exposure to ebola victims.</p>
<p>Apologies if this was already posted and somehow I missed it. I’m surprised that I didn’t see this on Oct. 20, since I live in Dallas and follow WFAA, but I did.</p>
<p>Very interesting report on some of the actions taken by Louise inside the apartment:</p>
<p><a href=“http://www.wfaa.com/story/news/health/2014/10/20/thomas-duncan-family-precaution-ebola-spread-stop-contamination/17632771/”>http://www.wfaa.com/story/news/health/2014/10/20/thomas-duncan-family-precaution-ebola-spread-stop-contamination/17632771/</a></p>
<p>Also, this report claims that nurses at Bellevue are calling in sick to avoid being assigned to Spencer.</p>
<p>I would, however, consider the source and refrain from judgment just yet:</p>
<p><a href=“Bellevue staffers call in ‘sick’ after Ebola arrives”>http://nypost.com/2014/10/25/many-bellevue-staffers-take-sick-day-in-ebola-panic/</a></p>
<p>From the Oct 22 NEJM paper - secondary infections may contribute significantly to the high mortality of Ebola patients:</p>
<p>“The patient also had severe gram-negative sepsis, presumably caused by bacterial translocation from the inflamed intestinal tract. Sepsis led to severe illness when the viral load was already decreasing (Figure 1), which suggests that sepsis may contribute substantially to the mortality observed in the current outbreak, specifically with regard to deaths occurring late after disease onset.2 The patient was treated initially with ceftazidime in Sierra Leone to prevent septicemia, as recommended by Médecins sans Frontières.8 However, bacteremia in this case was related to a multidrug-resistant gram-negative organism, suggesting the importance of monitoring patients for signs of infection by means of laboratory tests (e.g., C-reactive protein). Sepsis may have contributed to the development of severe encephalopathy in our patient and may explain, at least in part, the confusion and coma or unconsciousness that have been observed in 13% and 6% of patients, respectively, in the ongoing EVD outbreak2; both symptoms have been associated with death.”</p>
<p>The NEJM article is good and bad news, BB. It’s good news for patients being treated in American hospitals, because if they develop secondary bacterial infections they can be treated. But it’s bad news for African patients-- one more way to die of this terrible disease.</p>
<p>Dr. Spencer and his fiancee are 1000x better people than I am. Here’s hoping he recovers quickly, and she never develops the disease.</p>
<p>So in layman’s terms is this normal gut bacteria that “translocated” systemically because of ebola related breakdown in the intestinal linings? Is the multi-drug resistant nature likely to be an aberration or something that would be common to people all over? </p>
<p>p.s. Don’t worry . . . I’m not dead. I’ve moved on the the fantasy hot stone massage. </p>
<p>"Also, this report claims that nurses at Bellevue are calling in sick to avoid being assigned to Spencer.</p>
<p>I would, however, consider the source and refrain from judgment just yet:"</p>
<p>If that is true, I don’t blame them a bit. Nobody should have to take care of someone if they feel they aren’t adequately trained and protected from the disease. This shouldn’t be duty that just goes to whomever the junior person is. Particularly since the nurses have seen how poorly protected some health professionals have been in the past, despite assurances to the contrary.</p>
<p>This should be senior nurse duty, will specially trained nurses, who are getting additional hazard pay. Not to the unlucky newest, youngest nurse on staff.</p>
<p>Hopefully, Bellevue learned the lesson from Dallas about putting the newest youngest nurses on the case.</p>
<p>Just last week, there was a huge training for healthcare workers in NYC:
<a href=“At Ebola Training Session in New York, Calm and Caution Are Urged - The New York Times”>http://www.nytimes.com/2014/10/22/nyregion/new-york-health-care-workers-gather-for-ebola-training.html</a></p>
<p>“Also, this report claims that nurses at Bellevue are calling in sick to avoid being assigned to Spencer.”</p>
<p>The NY Post is a rag. </p>
<p>According to Channel 11 (a NY station): </p>
<p>“However, what about the properly trained nurses, who according to the New York State Nurses Association, volunteer to deal with patients like Dr. Craig Spencer?
Dr. Ram Raju, President of New York City Health and Hospitals offered the following update:
“The people who are being trained to take care of this patient right now are highly skilled, experienced and very trained nurses. They’ve been training for the last two-and-a-half months, putting on the ‘pp’ taking them off and making sure what needs to be done.”
However, following the infection of a nurse in Spain, along with the two nurses in Dallas who contracted the virus and the concerns generated when it was revealed that one had traveled days following treatment, PIX 11 News asked Dr. Raju if the nurses who are treating Dr. Spencer on the seventh-floor isolation unit at Bellevue are being isolated or monitored after their shift. He did not answer the question directly, but Mayor de Blasio did answer with the following:
“We need the best people, the most capable people, doing this work and we need to protect them but they also do have the rest of their lives and so long as they are taking those precautions, we can make that work.”
After the news conference Dr. Raju did ultimately confirm that the nurses are allowed to go home after their shift and self-monitor, which is exactly what Dr. Spencer was doing after he returned from his trip to Guinea.
The union representing the nurses did confirm that the trained nurses who have volunteered to take care of Dr. Spencer are given an option to stay at the hospital or go home.”</p>
<p><a href=“Bellevue nurses treating Ebola patient to self-monitor at home | PIX11”>http://pix11.com/2014/10/25/bellevue-nurses-treating-ebola-patient-to-self-monitor-at-home/</a></p>
<p>It does not sound to me that they are going to willy nilly assign nurses to care for the Dr. and that they have been training for just this for months. </p>
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<p>Nina Pham had been a nurse for 4 years. I don’t know about Amber, but she is pushing 30. </p>
<p>When I had been practicing for 4 years I was pretty darn competent. Just because Amber was recently certified for critical care did not mean she wasn’t a very good nurse already.</p>
<p>If nurses are refusing to care for a patient, you have to hope you have good ones stepping up to help. Dr. Gary Weinstein said that everyone who worked for Mr. Duncan had asked to be included.</p>
<p>OK, so the nurses and doctors taking care of Dr. Spencer are not quarantined. They can go home from work, and self-monitor. They can go bowling, evidently.</p>
<p>New Jersey nurse that was briefly quarantined says [she</a> never had a fever:](<a href=“http://www.nytimes.com/2014/10/26/nyregion/nurse-in-newark-tests-negative-for-ebola.html]she”>http://www.nytimes.com/2014/10/26/nyregion/nurse-in-newark-tests-negative-for-ebola.html)</p>
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<p>^They are probably riding the subway and buses, too. </p>
<p>I assume the HCW at Emory, NIH & in Nebraska also self monitor. </p>
<p>Nrdsb, I heard somewhere that Pham had just recently gotten a critical care certification of some type. Regardless, please don’t misunderstand me; I’m not criticizing either of the Texas nurses, or any nurses. This is a decision which should be made by medical higher-ups at the hospital. And before those specific nurses step into the isolation room, I would hope that Bellevue will give them an intensive, hands-on refresher on PPEs, observe the protocol about monitors, etc. So far, it seems they’ve learned lessons from what happened at Texas Pres.</p>
<p>On another topic, when Dr. Spencer, and later the NJ woman, were transported to the hospital, why do the ambulances have their lights and sirens going?</p>
<p>I think that’s just standard practice, LasMa. Plus, it sure gets the traffic out of the way.</p>
<p>Interesting. Around here, they usually don’t use them unless minutes matter. Otherwise, they just drive in the normal traffic.</p>
<p>I was just wondering if it was a planned-to-be-visible part of the city’s ebola response.</p>
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<p>Yes, I mentioned that above. It doesn’t necessarily follow, however, (as others have previously insinuated) that she lacked the experience or the expertise to provide supportive care to Mr. Duncan. Specially trained respiratory therapists handle the ventilators at Presby, and only dialysis nurses take care of patients while receiving dialysis there. </p>
<p>When it was first made public that the PPE of the health care team was incredibly deficient, it seemed that was most certainly the reason nurses became infected. At the time, I was sick inside, anticipating that high numbers of HCW would surely follow. The fact that so far we have not seen that happen is surprising, so I wonder what exactly caused these two infections on that brave team. From the outside, it seems very confusing. </p>
<p>In his interview with Janet St. James, Dr. Weinstein, when asked, replied that he really didn’t believe anyone else on the health care team would become ill. I wondered if he was just being a positive thinker, or if he knew something specific which could explain his confidence.</p>
<p>Good article in today’s NYTimes. </p>
<p><a href=“As Ebola Spread in Dallas, New York Honed Protocol - The New York Times”>http://www.nytimes.com/2014/10/26/us/new-york-ebola-response-polar-opposite-of-dallas.html</a></p>
<p>Agreed, sally. Even if the transport isn’t an emergency, it tells vehicles and pedestrians to get out of the way!</p>