A second Texas healthcare worker who treated Thomas Eric Duncan, the man who died of Ebola last week in Dallas, has contracted the disease:
DALLAS — A second hospital worker who helped care for Ebola patient Thomas Duncan has tested positive for the disease, prompting local officials to warn Wednesday that more cases are “a real possibility.”
The unidentified health care worker, who was described as a woman who lived alone without pets, reported a fever Tuesday and was immediately isolated at Texas Health Presbyterian Hospital in Dallas.
At an early morning news conference, Dallas County Judge Clay Jenkins said he could not rule out more cases among 75 other hospital staffers who cared for Duncan and were being monitored by the CDC.
“We are preparing contingencies for more and that is a real possibility,” Jenkins said.
As I pointed out yesterday by the definition of disease outbreak used by both the World Health Organization and the Centers for Disease Control, this constitutes an outbreak of the disease here in the United States. If you disagree with that assertion, you’re not disagreeing with me. You’re disagreeing with the CDC and WHO and in order to prove your case you need to do two things. First, you must produce a recognized definition of disease outbreak that does not cover the situation in Dallas and, second, you must demonstrate that it does not cover the situation in Dallas and you must do so without resorting to sophistry.
I continue to believe there is no cause for panic but there’s plenty of cause for greater prudence and honesty.
Let’s do a little back-of-the-envelope calculation. There are about 5,000 hospitals in the U. S. If we train five people from each hospital in the correct protocols and procedures for treating Ebola, by my (again back-of-the-envelope) estimate it will cost $10,000 per person to train and equip them. Preparing the hospitals to isolate and treat the disease will probably cost (given the costs in healthcare) another $50,000 per hospital. That’s (5,000 X 5 X 10,000) + (5,000 X 50,000) or $500 million dollars. Let’s say a round billion. Remember, we still haven’t treated anybody yet.
I’ve seen widely varying estimates of daily ICU costs, anything from $1,000 a day to $20,000 a day. $1,000 a day is obviously not credible—the average doc earns more than that. Arguendo, let’s use the $10,000 a day figure and let’s use ICU costs as a gauge for treating an Ebola patient. The accounts I’ve read suggest that treating an Ebola patient takes from 2 to 4 weeks. Let’s use 30 days as a good, round number. 30 X 10000 = $300,000. That means that treating the two patients we already have will cost more than a half million. As you can see, the costs mount rapidly with more cases.
My point here is that because of the outrageously high cost of healthcare in the United States we have powerful incentives to avoid treating Ebola patients here and should be willing to go to substantial lengths to avoid it and hold the outbreak to its epicenter in West Africa. I don’t think that means we need to ban all travel to and from West Africa but it does mean we need to do more than wishful thinking and jollying people along.
Agreed, except that we’ve already failed to hold the disease to its epicenter and have to go to Plan B.
Which hopefully will be revised (or actually created) now, after the initial screw ups. And hopefully we can play catch up, to implement a plan that doesn’t involve 76 healthcare workers without adequate training, treating each new patient.
But hey, on the bright side, apparently we are completely prepared for Smallpox.
The report by the nursing union does not paint the situation in that Dallas hospital in a good light. I believe that’s why the CDC and the mayor of Dallas are telling everyone to expect more cases.
And it appears this second infected person was on a flight from Cleveland to Dallas on Monday.
This is getting better & better.
The story in Dallas just keeps getting better.
First, I’m hearing the nurse had been instructed by the CDC to not fly. Second, she had a low grade fever on the flight to Dallas. So much for containment and screening procedures.
I foresee many lawsuits in this second nurse’s future, should she survive.
The CDC has been sending out warnings to hospitals about this for months. They have been sending out the protocols, though in theory all (large) hospitals already have people trained in isolation techniques. In reality, they don’t have people trained in these techniques because no hospital wants to spend the money on a low probability event like this. Dave’s per person estimate is about right, but he severely underestimates the number of people you need to train. An ICU is a 24 hour facility. People have days off and take vacations. You probably need to train at least ten nurses to account for this. Then, you have X-ray techs, lab techs, etc. You will need to train the dialysis nurses, respiratory therapists. You will need to train the specialists who might need to care for the patient, i.e. surgery, anesthesia, pulmonary, renal. Multiply Dave’s 5 by 5 and you are a lot closer.
The only way this is going to happen is if this is made mandatory, with a penalty. To be honest, I don’t think the CDC has the authority to do that. I don’t know who does. CMS? We might want to look more seriously at the idea of transporting to specialty centers.
On a side note, it has now been reported that the staff in Texas were putting on 3-4 layers of gear and taping some stuff down to provide better protection. That would actually make it much riskier when taking the stuff off.
Steve
I’ve been involved in isolation and reverse-isolation situations. The protocol is rigorous even for less risky situations, that’s for sure. But, this Ebola event seems to have produced more ‘unknowns’ than were originally anticipated. The video distributed to hospitals for training purposes showed double gloving etc., but still had skin exposure around the neck areas evident. One wonders how those two nurses attending the Ebola patient were garbed; if they had any scratches, skin lesions, even hangnails on their own body. Until the etiology of how they were infected is resolved, there will continue to be a fog hanging over our ability to treat patients without infecting HC personal at their bedside. That’s a biggie, IMO.
Also, if professionals remain vulnerable to this virus while administering to those having it, how are our military men and women expected to fare being at the virus’s epicenter in Liberia? I would not be comfortable having a loved one being assigned such a duty.
Perhaps, with so much confusion, ‘mistakes,’ and uncoordinated medical protocols in place here in the US, I am beginning to join those who see the need for temporarily banning those having visas or passports from countries with Ebola outbreaks — expanding isolation measures to geographical areas as well as those being created here in our own medical facilities. The goal should be to contain first and then aggressively treat those already infected, abroad and here.
“But, this Ebola event seems to have produced more ‘unknowns’ than were originally anticipated.”
The essential point. How various people and organizations could be so sure is worrisome. Politics again?
Now there are reports that Vinson called the CDC to report her fever before she got on the plane – and the CDC told her it was okay. Thank God we have such competent people running the country.
Ice,
The fact that some person at the CDC gave that nurse an ok to fly is beyond belief! My head is exploding that even a low-level person, at the CDC, somehow would not be aware of this woman’s history of being in contact with an Ebola patient, that another nurse on the same detail had Ebola, etc., etc., These are stupid mistakes!
As for this CDC director, well he is going down fast in being a credible information resource, as so much of what he has said has been downplayed and closing in on untrue. The nurse’s union and others are thankfully coming into the picture strongly, detouring around this guy’s obliviousness as to the seriousness of this virus, going directly to the POTUS, with their concerns and complaints, which is awesome, IMO.
I’m reminded of my own experiences being a medical-surg RN, where we were responsible for all the close contact patient care — IV’s, catheter insertions everywhere, wound irrigations, NG tubes. We did digital exams, changed beds, monitored not only vital signs but also the patient’s mood and nuanced complaints. A doctor might waltz in, now and then, to oversee everything, write orders, and if he had an undersized ego might listen to a nurse’s suggestions on motifying care because of a patient’s changing condition — including medication tolerances etc. A competent nurse, though, one who advocates for a patient’s well being, is indispensable, IMO. So, when I hear the nurses association/unions going to bat for better on-the-ground nursing protocol, I can only applaud.
Also, as a side note — I heard tonight that the doctor who caught Ebola in Liberia, was flown back to the states, recovered, and has been donating his blood to those infected with the same blood type, was said to have been fastidious in his own protocol of garbing and ungarbing. When he caught the virus it really unnerved people because it raised a lot more questions about what do caregivers have to do to protect themselves?
Consequently, I find it troubling that a virus which is said to be hard to transmit seems so capable of finding any and all human weaknesses in going from one person to another.
Yeah, the reaction to that bugged me, too. It was immediately assumed that he had breached protocol rather than that the protocol was flawed or even unworkable.
Why were you surprised by the reaction? Dictats from on high can’t possibly be flawed, therefore the problem must be with those charged with implementation.
I didn’t say it surprised me but that it bugged me.
jan: Consequently, I find it troubling that a virus which is said to be hard to transmit seems so capable of finding any and all human weaknesses in going from one person to another.
Ebola patients at advanced stages of the disease have the virus in large numbers, so their copious body fluids are highly contagious. Health-care professionals working to save lives are taking a risk, but this doesn’t have a significant impact on the spread to the general public, which is still a low risk. Previous outbreaks have been contained in West Africa, with far fewer medical resources.
Protocols for health-care workers need to be reviewed, but according to reports, the Dallas U.S.A. hospital was not implementing the protocols correctly.
I think some of this is just poor communication. These protocols involve a lot of steps that require near perfect compliance, and is not unusual that the first thing to rule out is human error.
Of course that also means that the protocols should be reviewed to help prevent human error as much as possible.
CStanley: Of course that also means that the protocols should be reviewed to help prevent human error as much as possible.
Any protocol that requires perfection needs to be reconsidered.
Prior outbreaks have mostly been in fairly isolated areas, according to reports I was reading a couple of months back. Geography, poverty and a high mortality rate helped. This is the first time it has slipped into urban areas, the first time it has made it to Europe and the USA and been transmitted there.
And this outbreak dwarfs all the others combined, with all indications that it will get much worse before it gets better.
…: And this outbreak dwarfs all the others combined, with all indications that it will get much worse before it gets better.
Very unlikely. This outbreak will be quickly contained. There may be other outbreaks, but the disease is not very transmissible, so new outbreaks will likely be contained as well. For those infected, it’s a very serious issue, and society should avoid complacency, but it’s not that big a threat to the public at large.
Oh, and while the flu kills more people, it has a much lower mortality rate. This current strain of Ebola making the rounds has a death rate of about 70%, more than twice the historic mortality rate of smallpox. Not to mention that shitting one’s liquified organs out sounds like a particularly nasty way to go. So people are right to find Ebola scary.
And as yet I haven’t seen any actual panic. People are concerned, even moreso because the government seems to have no clue as to how the world actually work. All those categorical statements I was complaining about have had produced the expected results. I’ll also note that I’ve seen reports now from orgs like CNN & the WaPo pointing out that the government made unforced errors on this front. So it’s not just crazy right wingers pointing out that the government has behaved irresponsibly.
So, you disagree with the WHo assessments? Your reasons for doing so are what, exactly?
And if it is so easy to contain, why wasn’t it contained months ago?
Any protocol that requires perfection needs to be reconsidered.
That requirement is a function of the virus itself. If, as seems to be the case, tiny droplets of body fluids emitted at the end stages of the disease contain an infective viral load, then the people who are in proximity have to follow the protocol perfectly to ensure no contact with those droplets (or disinfecting any areas where the contact may have occurred.)
The only way to deal with that effectively is to build checklists, duplication and fallbacks into the protocol. Have spotters checking the personnel as they robe and disrobe. Follow up the disrobing with disinfection. Take more care to handle the waste, limit the number of people going in and out, disinfect surfaces more frequently, etc.
My reaction may be atypical but when I hear people referring to ordinary, prudent expressions of concern or temperate discussion of policy alternatives as “panic” I have a very difficult to resist impulse to beat them to death with a baseball bat. Fortunately, decades of training have enabled me to resist these impulses albeit with considerable effort.
What makes it even more galling is that we know with a confidence rooted in experience that when the political winds shift they’ll enthusiastically support what they were condemning as panic just days before.
So, for example, while I think that banning air travel to and from West Africa is premature, characterizing the raising of the question as “panic” is reprehensible.
The reason for all the pushback on the ban is ideology. When I heard somebody from the left describe it as “stigmatizing Africans”, it confirmed my suspicions about the racism angle.
If Russians were downtrodden minorities, there would be outcries about placing sanctions on them. If Putin was really smart, he would hire a PR firm to do this.
Leftists will only help people who are their inferiors. If a person is their equal, they will not help them.