By the way how practical does the president’s plan for Ebola sweeneys (Cockney rhyming slang: “flying squad” = “Sweeney Todd”, shortened to sweeney) to deal with the cases that will occur here in the United States sound to you? To me it sounds as though he’s been advised of the time and expense of training doctors and nurses all over the country (which will run well into the billions) and tried to come up with a better, cheaper plan that could be put in place quickly. How much better would these sweeneys be?
How many of them would there be? How long would it take to train a team? If there aren’t many of these teams, what do you do when a member of one of the teams contracts Ebola? It seems to me that the plan can only work if the number of cases of Ebola in the U. S. is kept very small which in turn implies that you’re taking steps to limit the number of cases.
I haven’t heard about this plan. Are there any details available?
It does look like they’ve shifted course toward flying the patients to the specialized hospitals, which makes sense for now but will quickly exceed capacity if more people become ill with Ebola.
Thanks. There was supposed to be a link there which I’ve now added.
Not much detail. Which I think suggests how improvised the plan is.
Yes, clearly the new plan to fly patients to the handful of places that have provided care to Ebola patients suffers from the same defects as the sweeney plan does. They aren’t so much plans as reactions. If you have one or two cases, the plans are fine. If there are ten cases, they’re not as fine. If there are a hundred cases, they’re unworkable.
The clear implication is that you’ve got to ensure that the number of cases you’re dealing with remains small. If you don’t take positive steps to ensure that remains the case, it’s just wishful thinking.
http://www.nbcnews.com/storyline/ebola-virus-outbreak/cdc-promises-special-ebola-response-teams-n225636
Thanks for The link.
And yes, these plans are inadequate once the rate if infection gets ahead if us. That was part of the reason for the epidemic in Africa getting out of control, and we could quickly get to that point here.
Also relevant is the difficulty in tracking contacts, without clear plans to limit the number of patient contacts and then restrict the movements of the contact people during the 21 day period. It quickly becomes overwhelming.
I think the Sweeneys are a fine idea to start. Use them in combination with the four isolation wards. And then put in eight defensive backs and play defense.
…
So Obama has appointed an Ebola Czar. It’s the guy that was in charge of the stimulus. Myfirst thought on hearing that was
We’re doomed.
With the screening we do, we are unlikely to see many cases coming here. It’s not as if we have tons of travel to that part of the world and the travel will self limit itself quite a bit now.
Steve
Steve,
Your pessimism about Ebola in the US is pretty ridiculous.
Steve, we’ve had at least two medical people intentionally break their quarantines already (the doctor for NBC News & the second infected nurse in Dallas), and a lab worker that may or may not have been under quarantine but who should have avoided public transportation on a cruise ship.
And that’s the trained professionals working under guidance from the CDC. We’ve gotten lucky so far, but we just need one bad day and the problem gets worse.
I don’t think it will spread, but it is distressing to see the first line of defense being this reckless.
Also, Steve, are you referring to the screening that let Duncan into the country or the screening that let Vinson fly around after she started getting sick?
… The screening that has allowed only one Ebola patient into the country even though the outbreak in Africa has been ongoing for 5-6 months.
As to your other comments, this is a disease new to the country. The Texas hospital didn’t do everything right. Part of that was due to incompetence on their part. You can’t control for stupidity very well. As to the CDC they are using information gleaned from MSF and their work in Africa, the best data they have. They actually did send out protocols an slots of advice. Hospitals ignored it. Since our screening had been so effective, they didn’t see the need. But, as was inevitable, a case got through. Mistakes were made, just like we did with AIDS when it first came on the scene, same as with SARS.
I think that the CDC may have ben too optimistic. They thought we could handle these patients as well as they do in Africa, where they have many fewer resources. They have this not to be the case so they are quickly adapting. To be fair, we may be seeing a different manifestation of the disease than that seen by MSF. Their patients get better or die. We keep them alive longer with invasive procedures like dialysis and mechanical ventilation. We may be seeing end stage patients with a much higher viral load than they were seeing.
So, I really didn’t expect them to get it all correct on the first try. I also didn’t expect any hospital to perform as poorly as the one in Texas. However, we are adapting quickly, which is really what I want. I am potentially at risk with these people, so I have some self interest here.
Steve
Steve, the countries most impacted are dirt poor, and therefore not that many people are likely to make it here based solely on costs.
Steve, they were assuring us they would get it right on the first try, to the point of initially refusing to accept that there were problems on their end. That was compounding interest stupid, and they’ve since back tracked. TheCDC director being incapable of consistency from one paragraph to the next in his public comments is another problem.
And again, how has the CDC let two people allegedly under travel restrictions or even quarantined get out and about, including on a commercial airliner? They might be learning on the medical side but this speaks of simple administrative incompetence. Great job, Brownie!
I think we are hearing through different filters. I don’t hear them talking in absolutes. They always sway stuff like very low or very unlikely, not 100%. I think you are hearing them incorrectly, but maybe since I am in the trade my hearing is biased. I don’t know. Still, the CDC really did send out the protocols and tell the hospitals what to do. Their mistake was assuming hospitals would follow that advice, though as I note above, it may also be a result of the disease behaving differently than was foreseeable.
As to the two who traveled, I think they are learning to adjust the protocols. They made the mistake of applying a general protocol to someone who had, maybe been exposed. I also suspect they were put off because sit was a nurse that probably tilted their thinking. They forgot that nurses also sometimes think emotionally. That nurse didn’t need anyone to tell het to not fly. She should have known better. Also, her leadership let her down. They should have told her to not fly. Finally, the state authorities could have made it mandatory and they did not. On the lab tech the CDC had issued protocols on how they should handle labs. It looks as though the hospital also ignored those. If the CDC had known that then I suspect they would have also had put techs on the no fly list.
Steve
The CDC needs to clarify what the protocol is for people who are exposed but not yet known to be infected. We know that 21 days is widely accepted as the incubation period…so are the people who’ve been exposed supposed to self quarantine, or just “self monitor”? It sure seems like they’ve been told to do the latter, not the former.
The people with training in epidemiology and infectious disease control need to determine those protocols, and then communicate with the people in the field and figure out how the protocols can be implemented.
If the 21 day period is supposed to involve quarantine (and also need to know if that applies to all contacts, or are there specific risk levels according to the type and timing of the contact), then the healthcare workers, hospital administrators, and the local authorities need to know that from day one and plan accordingly. Administrators and staff supervisors should have pulled a specific group of staff members who were willing and able to adhere to the quarantine period. They should have determined the minimum number of staff needed to provide appropriate care for the patient.
All of this could have been figured out on the fly by the hospital administrators, and perhaps should have been even if they didn’t have detailed guidance. But if it ultimately not the responsibility of CDC and HHS and Homeland Security to plan and implement this response, then what the hell are we paying them to do?
Blaming the “emotional nurses” for the decisions they made is meaningless unless we know whether or not the people whose job it is to plan the response have taken into account the realistic expectations of human behavior. It’s like the blame that was ascribed after Hurricane Katrina to people who ignored the evacuation order…well, yes, but it was entirely predictable that people would do this, and yet the planners didn’t account for that. If your job is to plan, and your plan doesn’t account for human behavior, then you are not doing your job.
Steve, you’re the one arguing about adjectives and definitions. You’ve dismissed the WHO definition out of hand and inserted adjectives like “serious” into statements that contained no such modifiers.
My complaints are twofold.
First, the messaging has been terrible. I’m not the only one that feels this way, there are lots of us. If you’re trying to reassure me and inform me, the heaviest part of the burden of communication is on your end. If you can’t explain yourself clearly, without resorting to legalisms and an endless stream of oft contradictory clarifications, that’s on you, not me. In this case the “me” has been the public at large, and the “you” has been the CDC specifically and “the government” more generally. (The failures have not all been at the federal level, though they bear the greater burden.)
According to the NYT this morning, the president also feels this has been botched.
Second is the response itself. Inadequate screening, inadequate communication to hospitals (sending an email with no follow-up isn’t communication, it’s spam and will be ignored accordingly), inadequate explanation to people under observation what they can & can’t do safely, inadequate control of such people, etc.
So far we’ve been mostly lucky because the disease is isolated both by geography and economics. If Ebola were “Danube” instead, we’d be looking at another Great Plague, because Europeans can travel easily due to location and wealth.
We’ve also been lucky because once the disease manifests fully it is both debilitating and deadly. So people aren’t going to go far once the get sick.
But it would be nice to believe we didn’t just have to get lucky all the time.
Oops, I see CStanley already covered a lot of that. Good comment.
CStanley, you know doctors never make emotional decisions. I’m not sure if it’s because they’re superhuman, subhuman or nonhuman, but it never happens. Never ever.
The CDC is doing pretty much what they did in Nigeria, which worked to stop spread of Ebola over there. They took their advice seriously. Here in the states, the same info was sent out, but largely ignored. No one wants to spend the money to prepare. Should the CDC have known that hospitals would ignore everything they sent out? Maybe, I don’t know. There was certainly no way to even imagine that the Texas hospital would be so incompetent as they were in their first contact with the Ebola patient. However, now that they have figured out that hospitals can’t or won’t prepare adequately they have quickly altered their plans.
As far as the emotional nurse goes, people have a tendency to lionize nurses. Heaven knows there are a lot who deserve it, but that doesn’t mean they will always make rational choices. They should have realized that even though she was a nurse, she might not tell them if she was not feeling well. I also think they made a mistake in assuming that our staff in the US would be as proficient with protocols as people in Africa. They should have leaned towards a more conservative approach. I know for a fact that they were, but maybe still are, letting the folks from Emory who work on the specialized units go home after caring for patients. They weren’t quarantine them all. I have good reason to believe they are doing the same thing in Germany (second hand info from an ID person).
“You’ve dismissed the WHO definition out of hand ”
Quite a lawyerly thing to do in even bringing up the definition. As I said, if you want to define an outbreak as one case, then all of the public health people said there was 100% chance of an outbreak. Heck, all of us int he trade, and most people possessed of common sense knew that. What has clearly been meant all along is that it is very unlikely that we will get uncontrolled spread that will affect many people.
Steve
I have to agree with Steve on the use of the word “outbreak”. Technically it is correct and in fact is the mildest of a series of terms: outbreak < epidemic < pandemic. But in common use it has a serious connotation and the general public isn't hearing it according to the epidemiological definition- they're more likely hearing it as the title of a movie.