<p>I can understand wanting to avoid air travel - even if the risk of Ebola is low, the hassle factor just went up a lot. And tge risk of exposure to the enterovirus is high.</p>
<p>The people in moon suits do need to be in a buddy system. And they need enough time to decontaminate the suits before taking them off.
If we get one infected healthcare worker per Ebola patient we’ll run out of willing healthcare workers pretty quick.</p>
<p>I just read that before traveling, Mr. Duncan had been helping a very sick neighbor who later died from ebola. It is not known if he knew her diagnosis before he boarded the airplane…how can an airline even begin to screen everyone who has had recent contact with a feverish person? </p>
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<p>I don’t think everyone in those airports is being screened. If you fly from Chicago to JFK, you aren’t getting your temperature checked.</p>
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<p>His statement deserves a Homer Simpson, “Duh.” </p>
<p>The CDC has not trained them well. He knows that, so of course, he is not surprised. He knew this was a very real possibility even though he kept telling people not to worry and it was contained. </p>
<p>You cannot tell people not to worry, nothing to see here, and then expect everyone to also be on highest alert and precaution - that is illogical. And even more illogical without proper training. </p>
<p>Ah… proper training, proper equipment. All cost money. Which I think has been hard to come by for the CDC in recent years. If you want a robust public health system (which suddenly everyone seems to want), it requires year in and year out investment for these types of “just in case” scenarios. </p>
<p>Has the health care worker identified a specific breach of protocol? CDC director “No.”</p>
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<p>And whose policy fault is that? </p>
<p>At some point, I assume Americans are going to ask the question, “Who is responsible for defending the borders and the people within this country of ours?” I wonder how many unnecessary infections it would take to get around to asking this question.</p>
<p>I think the hospital needs to put 24/7 surveillance camera on this patient and those treating her including when they take off their moongear so that if another healthcare worker caring for this nurse gets infected they might be able to see where exactly the protocol is being breached.</p>
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<p>No, that is not what people want. </p>
<p>What many are saying is for the people who say they do policy to do it correctly. No one is asking for take over of the healthcare system. The CDC is not a healthcare system; it and the FDA regulate the healthcare system., for whatever good that does.</p>
<p>If they do not know what they are doing, then get out of the way and stop making stupid policy.</p>
<p>All the money in world is not going to stop stupid people from being stupid. So paying for more stupid bureaucrats is not the answer. </p>
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<p>However, he is saying there was a breach in protocol, even though he is clueless if there was really one. </p>
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<p>This is just bad science because there is another valid question that needs to be looked at - “What if there is something wrong (ineffective) with the protocols and the nurse did everything correctly, but still got infected?” </p>
<p>The fact that he is assuming the protocols are 100% perfect is faulty at best. Clearly they are not - just look at the infected workers in Africa. Anyone blaming Dr. Brantly for breaching protocols?</p>
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I’m not sure that a breech in protocol is blaming the nurse. Couldn’t that mean there was a breakdown in protocol somewhere along the line…what was supplied to the nurse, the training the nurse got, actions of those around the nurse, that sort of thing? </p>
<p>Besides needle sticks, the point in the protocols that can be most likely breached is the removal of protective gear, because at that point the gear is contaminated, and the worker wearing it is tired. </p>
<p>You can’t compare Dr Brantly’s situation with this. He not only worked but also lived and was surrounded by a community of people where this infection is rampant. Different situation. </p>
<p>You also have to understand that all this talk about breach is not to find someone to pass the blame on, but to identify these weakest links and to strengthen them. Please do not spin this as CDC blaming the nurse or the hospital. </p>
<p>We just came back from an 18 day trip and have opted to minimize our future air travel for a while. </p>
<p>We did have a trip to TX that we were wavering about whether or not to take but have opted to not to do because flu season is starting and this last trip was already pretty tiring (got sick just after returning–headache and nausea). If the TSA folks and others at the airport will be having to screen for more health issues, this will just increase the hassle factor for flying. </p>
<p>Am glad H and I are applying for Global Entry, which includes pre-check, as I prefer not to have the full body scan and want to get thru customs and TSA as easily as possible. </p>
<p>Patients with Ebola and other very infectious diseases have been successfully cared for by many many healthcare staff who have worn full protective gear and have not contracted the disease. Ditto for people working in research laboratories with hi risk infectious samples. To conjecture that someone tore or poked a hole in the protective gear (have no idea what it is made of, but its doubtful that it is flimsy and easily torn) or to minimize the likelihood that the helathcare worker, who may not have experience with/used/worn the personal protective equipment is immune from make an error that leads to a breach in protocol makes little sense.</p>
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<p>I recently read that an entire virus has not yet been seen in sweat, just pieces. I also read that the virus is found in saliva mostly not until the person is extremely ill. It sounds as if Duncan’s condition worsened very rapidly on Sunday morning. So if he were able to use the bathroom himself until the point at which he left the apartment, and since Louise’s D–a health worker–cleaned the apartment as much as she could with bleach, and told her mother not to go into the bedroom, that might explain it. </p>
<p>Although they obviously aren’t out of the woods yet.</p>
<p>I think that the CDC director’s comments on the protocols indicate a concern about figuring out where they aren’t working, even though they should. Not blaming anyone. I seem to recall that in Africa they are spraying them down with bleach solution, using the buddy system, and so forth. We have the example of the young nursing student in Africa who cared for 3 or 4 family members solo, and brought all but one through successfully without becoming infected herself by rigidly observing a protection protocol she created herself, using garbage bags. And of course, maybe she was just lucky, in addition.</p>
<p>Regarding the suggestion that the CDC isn’t training “them” as well as they should, I guess it depends who you mean by “them.” I don’t think the CDC trains individual health workers. The hospitals do the training.</p>
<p>The nurse and her co-workers have been interviewed and none of them have been able to identify any breach in protocol. And, neither can the CDC. So, just saying there obviously was one seems more like guessing than science or fact. And.people are noticing, which is the bigger point, imho… Also, Dr. Nancy who was supposed to be self-quarantined has been spotted out and about picking up take-out food in dark glasses. Really, you can’t make this stuff up.</p>
<p>Flossy, of course no one can remember every little step they took. That does not mean a breach had not happen. As others said up the thread, the media makes it sound as if the CDC is looking for a scapegoat. No. This is not the question of who needs to be blamed and punished; this is the question of where the extra efforts are needed to make the system stronger. I have been involved in investigation of lab accidents, and the protocol is simple: no finger pointing, no blaming, just collaborative work to prevent such events from ever happening in the future. </p>
<p>CNN just showed a panel of doctors from several US hospitals who were talking about this. The doc from Vandy brought up an excellent point: there has been talk about the PPE being “inadequate”, but more PPE is not necessary better. E.g., triple-gloving could be worse than double-gloving because now the wearer needs to wrestle with 3 layers of gloves instead of 2 when removing PPE Also, a buddy system is always a good idea when removing such gear - to have someone watch for potential exposure while the worker removes the PPE. </p>
<p>Despite protocols, training and more than adequate infection control supplies, I routinely watch workers break the rules. Yes, I watch professionals break policy daily. How often have you had your veins washed by an alcohol pad only to watch the phlebotomist dry it with an unsterile, unpackaged cotton ball. I had this discussion just last week with one who looked at me as if I was being “difficult”. I’ve had to fire someone for reusing syringes. So, I am not surprised that protocol had to be broken even with Ebola. </p>
<p>To add to the lackadaisical behavior is the fact that most hospitals are significantly understaffed to maximize profits. In the rush to care for the maximum amount of patients, staff are cutting corners. Something has to give.</p>
<p>The other disturbing fact is that I arrived from West Africa and no one questioned me of my whereabouts or who I came in contact with. I was there on a medical mission. Everyone arriving to the US, whether from Africa or not, should be screened.</p>
<p>The family is not out of the woods yet. But that they are currently still reportedly asymptomatic is good news. I believe incubation is 21 days from exposure to the virus in an actively ill person.</p>
<p>It is now being reported and an associate of the female nurse with Ebola is being placed in quarantine for safety precautions.</p>