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  1. Link the Writer
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    Link the Writer Flipping Out For A Good Story. Contributor

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    The Ebola Outbreak

    Discussion in 'Debate Room' started by Link the Writer, Oct 12, 2014.

    So with Ebola being on the news and cases appearing in the US, I'm curious as to your opinion on the whole thing. Overblown? Is it something to be taken seriously? Why is it spreading? Is your country doing anything to safeguard against it?

    So...yeah, that's basically the thread in a nutshell. Do you think the news is overblowing this a tad? How serious/benign is it, really?
     
  2. Lemex
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    Lemex That's Lord Lemex to you. Contributor

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    Isn't it seriously hard to catch? I've read it's completely overblown as a problem, but to be honest, I don't find myself worrying about it anyway.
     
  3. Jack Asher
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    Jack Asher Wildly experimental Contributor

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  4. Ulramar
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    Ulramar Contributing Member Contributor

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    Ebola is a serious problem, if you're in Africa with little access to water. It's a minor problem here. If we put the person on dialysis and keep them hydrated, they should survive. The news is being overly dramatic about it to stir the people up. Ebola is not the next Buobonic Plague that's going to wipe out the world.

    It's also stupidly hard to get it. Keep the people who have it in quarantine and do better jobs of locking down airports and we'll have no problem.
     
  5. Link the Writer
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    Link the Writer Flipping Out For A Good Story. Contributor

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    That's what I figured. Yes, it's a horrible illness, but unless you literally touched someone who had Ebola, you won't get it.
     
  6. GingerCoffee
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    I started a thread already but this thread is better for a more general discussion.

    First, should we be worried? No. But there have been some interesting developments.

    Considering the heath care worker infected from the Dallas patient was after the patient was isolated, and the fact none of the household contacts of the patient have yet become ill (there's still another week before their 21 days are up so we don't know for sure) and given all that is being said by public health officials that infection risk begins with symptoms, the conclusion I draw from that is the patients symptoms begin when there is relatively low levels of virus circulating. But by they time the patient becomes seriously ill that viral load has likely become extremely high.

    So what we are seeing are extremely contagious patients for the most part when they are close to death or dead. Those people present a severe risk to health care workers who will be in close proximity to them when they are seriously ill, but not much of a risk to the population at large who will mostly have contact with less seriously ill patients.

    There may be more health care workers who become ill from the Dallas patient. When he was first seen in the ED he had a CT scan of the head and abdomen and he was there for 4 hours. It's unlikely much was done to protect health care workers on that first visit. But hopefully it will turn out he still wasn't very contagious then.

    Family acquired medical records
    There's discrepant information in the chart about his initial fever.
    It wouldn't surprise me to see a fever spike in a four hour period, especially if he'd had aspirin or acetaminophen before coming to the ED and hours later it wore off.
     
  7. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Or unless you are a health care worker taking care of the patient who becomes critically ill.
     
  8. Ulramar
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    Ulramar Contributing Member Contributor

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    I'm going to ask a really ignorant question here, but don't they have bubble suits? Like, airtight suits they can wear while working with the infected?
     
  9. GingerCoffee
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    The "bubble suits" are pretty much a movie thing, and there are a couple designated facilities in the US for "level 4" isolation. They exist in case of biowarfare pathogens like smallpox.

    Instead all major hospitals (and most smaller ones) use full body PPE, meaning everything is covered by disposable gowns, shoe and head covers, gloves, and face shields.

    For airborne isolation it's tricky. Both PAPRs and N100 masks only filter out bacteria sized organisms. That works for most things and would be adequate for droplet spread organisms like ebola. And they are adequate for TB which is an airborne bacteria.

    To protect health care workers from the true airborne viral pathogens like measles and chicken pox you have to have vaccinations. You cannot keep those out without that level 4 isolation where the health care worker not only has that bubble suit, but they also have supplied air to breathe.

    The problem comes when there is so much contamination of those full body coverings. Try taking the PPE off without contaminating yourself in the process. It's really hard and the workers have to be incredibly meticulous, something they are not used to.

    We learned a lot with the SARS outbreaks, sometimes too late to save some health care workers.
     
  10. GingerCoffee
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    The SARS epidemic in Hong Kong: what lessons have we learned?
    One of the lessons Toronto was able to share with us in the US was health care workers were reusing the gowns, hanging them on hooks in the anterooms, then donning them again to go back in the room. They were contaminating themselves without realizing it.

    SARS was amazing, not because of the illness, but because we identified the organism and stopped it within months. It was a science miracle. Compare that to HIV which took years to find the organism. In any other era SARS would have been a pandemic on the level of the Black Plague or the 1918 Flu.
     
  11. Lewdog
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    Lewdog Come ova here and give me kisses! Supporter Contributor

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    In Dallas the guy was at the hospital for a long time and exposed to several people before he was diagnosed with Ebola. So no, people weren't wearing bubble suits for a long time while treating him.
     
  12. GingerCoffee
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    No one ever wore a "bubble suit" taking care of Dunkin. And the infected nurse worked in the ICU and was only exposed while wearing full body PPE.
     
  13. GingerCoffee
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    Ignore the fact this is a fear mongering website but use it to see the difference between true level 4 isolation and the standard isolation for a SARS or an ebola patient in the US:
    Ebola protective gear inadequate? Medical staff in USA and Spain infected while wearing isolation gear.

    Like I said, look at the pictures, but ignore the BS.

    Here's what CDC recommends for smallpox. It's a Power Point presentation but it's very clear what is needed for an airborne virus. Ebola seems to be droplet spread, that is very different from airborne.

    What I teach healthcare workers is to think about level of contagion and route of transmission separately.

    TB is an airborne bacteria but not very contagious. A patient (with rare exceptions for upper airway disease and some immunocompromised patients with fulminant TB) needs to cough for hours in order for the organisms to become concentrated enough in the air to infect a person. But once in the air, a cloud of organisms stay suspended for hours and can travel down hallways and through the ventilation system.

    Ebola, SARS, and pertussis (whooping cough) are droplet spread, but can be highly contagious at times. The droplets containing the organisms don't travel very far, but can also contaminate surfaces that if you touch, then inadvertently inoculate your eye, nose or mouth, they can infect you.

    It's likely the nurse was infected because she inadvertently inoculated herself hand to face.
     
  14. Jack Asher
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    Jack Asher Wildly experimental Contributor

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    Great, now everywhere on my face itches.
     
  15. GingerCoffee
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    :rofl:
     
  16. Cogito
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    And as noted on the news, getting out of contaminated protective gear is probably how she was exposed. It's harder than you think to shed such gear without either coming un contact with the contaminated exterior (direct exposure) or with surfaces that have come in contact with the gear (indirect exposure}.

    I've had personal experience with this. Not to an infectious agent, but to a chemical agent that caused severe skin reactions on contact.
     
  17. Ulramar
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    There was the video from the plane where the guy shouted "I have Ebola!" And then people in bubble suits came in, but I guess those aren't common practice then.
     
  18. GingerCoffee
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    Those weren't bubble suits, those were PAPRs. It's essentially a hood that goes over your head, room air is sucked through a filter and blown under the hood so the wearer is breathing filtered air.

    Unless you saw air tanks on their backs, they were PAPRs. You are seeing a hood instead of separate face and head covering. But the actual barrier is not much different.

    It would surprise me if the nurses didn't have full head covering. You wouldn't want to leave exposed hair.

    It all comes down to the air supply, filtered or supplied and negative or positive pressure respirators.

    http://www.cdc.gov/niosh/topics/respirators/

    PAPR images

    Level 4 biosafety suits aka bubble suit
     
    Last edited: Oct 13, 2014
  19. Lewdog
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    Lewdog Come ova here and give me kisses! Supporter Contributor

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    The guys on the plane were wearing tanks with air masks under the suits.
     
  20. Ulramar
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    I'm pretty sure they were bubble suits. I looked at some of the google search images then rewatched the video.



    They've got something on their backs within the suit.
     
  21. GingerCoffee
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    I see. Then those are fully contained bubble suits. They probably have them for all sorts of haz-mat and bioweapons responses.

    They are not practical for most hospitals. There are 4 hospitals (the number may be off) in the US that have level 4 biosafety isolation capability. In hindsight, maybe ebola patients should be sent there. The CDC continues to argue they don't need to be.
     
  22. GingerCoffee
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  23. Ulramar
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    I'm glad they're looking out for details. The wrong details, nonetheless, but they're looking for details. Better that than something getting through.
     
  24. Jack Asher
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    Jack Asher Wildly experimental Contributor

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  25. GingerCoffee
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    Second infected nurse and now we begin to see what really happened. If the complaints by the nurses are true, and they certainly sound credible, this was a hospital whose administrators had their heads up their asses. They had inadequate isolation equipment, inadequate training, and fools for managers.

    I thought it was just a matter of contamination on the back of one's PPE. When one removes PPE you do so with the assumption the back is free from contamination, clearly a mistake with this kind of illness. But it turned out they had the usual gowns, no covers below the knees, no shoe covers. That is ludicrous. There are shoe covers in every OR. There's no way they didn't have shoe covers in the hospital. And their head covers didn't cover their necks. They used tape! Then had trouble removing it.

    And no practice drill putting on or taking off PPE. At a minimum you show people how then watch a return demonstration. In the fire department they use chocolate syrup like Dr Guptay did on CNN. When you're done with the drill, you see if any of the syrup got on your skin.

    This hospital was a total fuck up and sadly, I see it all the time.
     
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