patient in Texas showing Ebola signs, in isolation

[dragon]

well hopefully it's negative

A patient in a Dallas hospital is showing signs of the Ebola virus and is being kept in strict isolation with test results pending, hospital officials said Monday.

In a statement released Monday evening, a spokesperson for Texas Health Presbyterian Hospital said the patient is undergoing evaluation for Ebola based on the patient's symptoms and recent travel history.

WHO: Ebola Death Rate 70 Percent, 20K Cases Expected

Further details on the patient were not released due to medical confidentiality and personal privacy reasons.

"The hospital is following all Centers for Disease Control and Texas Department of Heath recommendations to ensure the safety of patients, hospital staff, volunteers, physicians and visitors," according to the hospital's statement.
Preliminary test results are expected by the CDC on Tuesday.

According to the CDC, Ebola symptoms can include fever, muscle pain, vomiting and bleeding, and can appear as long as 21 days after exposure to the virus.

Brantly Speaks at Senate Ebola Hearing

Ebola is spread by close contact with blood and other bodily fluids.

In July, Fort Worth physician Dr. Kent Brantly was diagnosed with Ebola while working in a Liberian clinic.

Brantly was eventually taken to Emory University Hospital in Atlanta, where he remained in isolation for several days before he was declared cured of the potentially deadly virus.

Earlier this month, Brantly testified before a congressional panel in Washington, where he compared Ebola, which has killed thousands of people in West Africa this year, to "a fire straight from the pit of hell."

Ebola Survivor Brantly Donates Blood to Help Save Life

The National Institutes of Health recently admitted an American doctor exposed to the virus while volunteering in Sierra Leone. Along with Brantly, three other patients have been treated at hospitals in Georgia and Nebraska.

link

[Knife]

Nothing in there about if this Pt could have possibly been exposed to the virus. Without that, just sounds like fear mongering.

[dragon]

Nothing in there about if this Pt could have possibly been exposed to the virus. Without that, just sounds like fear mongering.

So he was in area where the virus is

CBS 11 News spoke with Dallas County Health and Human Services director Zachary Thompson, who confirmed that the patient had been in an area where the Ebola virus exists

link

[Knife]

Fair enough. Now we wait to see if he has it.

[Jaepheth]

Aaaand.... it's here:

Dallas' Ebola case confirmed by CDC, first diagnosis in U.S.
SHERRY JACOBSON
Staff Writer
sjacobson@dallasnews.com
Published: 29 September 2014 11:20 PM
Updated: 30 September 2014 04:17 PM

The Centers for Disease Control and Prevention notified the media at 3:32 p.m. Tuesday that Dallas has the first diagnosed Ebola case in the nation.

The federal agency scheduled a media briefing at 5:30 p.m. from its headquarters in Atlanta. Dallas County officials are expected to participate.

Dallas County went through a day-long anxiety attack Tuesday, waiting to hear if the first Ebola diagnosis in the nation would happen here.

An unnamed patient at Texas Health Presbyterian Hospital of Dallas was placed in isolation while awaiting test results for the dreaded virus. Apparently, the patient had traveled recently to a West African country, where the disease is spreading, and later developed symptoms that suggested Ebola.

A blood specimen from the patient was sent to Centers for Disease Control and Prevention in Atlanta, a testing process that can take 24 to 48 hours to confirm an Ebola infection -- or not.

The results came back about 3:32 p.m.

Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks of Ebola among humans have appeared sporadically in Africa.

County health officials told county commissioners that the Centers for Disease Control and Prevention is dispatching a team to Dallas in case a patient at a local hospital tests positive for Ebola.The Centers for Disease Control and Prevention notified the media at 3:32 p.m. Tuesday that Dallas has the first diagnosed Ebola case in the nation.

More details to follow.

It would happen in my city. Oh well, I will be greatly surprised if any case pops up who hadn't traveled to Africa.

[Elheru Aran]

This was basically inevitable. Sooner or later some traveller (almost always a medical or ministry volunteer or career missionary of some sort) would return to the States from the affected areas, despite proper precautions-- or lack thereof-- and be contaminated with this disease. At least here in the States it can probably be contained far better than it would be in Africa...

[Mr Bean]

This was basically inevitable. Sooner or later some traveller (almost always a medical or ministry volunteer or career missionary of some sort) would return to the States from the affected areas, despite proper precautions-- or lack thereof-- and be contaminated with this disease. At least here in the States it can probably be contained far better than it would be in Africa...

You forget the panic that is already sweeping the area. Pretty much everyone who was in Dallas/Fort Worth during this time is now assuming every little sniffle is Ebola, if our heathcare was not so screwed up you'd see a flood of people stopping by the hospital in Dallas. At the moment it's limited to facebook freakouts.

[fgalkin]

If you think the US is ready for Ebola, think again....

http://www.cnbc.com/id/102027557

U.S. hospitals may be unprepared to safely dispose of the infectious waste generated by any Ebola virus disease patient to arrive unannounced in the country, potentially putting the wider community at risk, biosafety experts said.

Waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training, infectious disease and biosafety experts told Reuters.

Many U.S. hospitals are unaware of the regulatory snafu, which experts say could threaten their ability to treat any person who develops Ebola in the U.S. after coming from an infected region. It can take as long as 21 days to develop Ebola symptoms after exposure.

The issue created problems for Emory University Hospital in Atlanta, the first institution to care for Ebola patients here. As Emory was treating two U.S. missionaries who were evacuated from West Africa in August, their waste hauler, Stericycle, initially refused to handle it. Stericycle declined comment.

Ebola symptoms can include copious amounts of vomiting and diarrhoea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up.

"At its peak, we were up to 40 bags a day of medical waste, which took a huge tax on our waste management system," Emory's Dr. Aneesh Mehta told colleagues at a medical meeting earlier this month.

Read MoreIs climate change key to the spread of Ebola?

Emory sent staff to Home Depot to buy as many 32-gallon rubber waste containers with lids that they could get their hands on. Emory kept the waste in a special containment area for six days until its Atlanta neighbor, the U.S. Centers for Disease Control and Prevention, helped broker an agreement with Stericycle.

While U.S. hospitals may be prepared clinically to care for a patient with Ebola, Emory's experience shows that logistically they are far from ready, biosafety experts said.

"Our waste management obstacles and the logistics we had to put in place were amazing," Patricia Olinger, director of environmental health and safety at Emory, said in an interview.

Not if, but when

The worst Ebola outbreak on record is now projected to infect as many as 20,000 people in West Africa by November, while U.S. officials have said that number could rise above 550,000 by mid-January without an international intervention to contain its spread. Experts say it is only a matter of time before at least some infected patients are diagnosed in U.S. hospitals, most likely walking into the emergency department seeking treatment.

Already there have been several scares. As of Sept. 8, as many as 10 patients have been tested by U.S. hospitals for suspected Ebola cases, Dr. Barbara Knust, team leader for the CDC's Ebola response, said at a medical meeting this month. All tested negative.

Read MoreMining CEOs call for action against Ebola

The CDC has issued detailed guidelines on how hospitals can care for such patients, but their recommendations for handling Ebola waste differs from the U.S. Department of Transportation, which regulates the transportation of infectious waste.

CDC advises hospitals to place Ebola-infected items in leak-proof containers and discard them as they would other biohazards that fall into the category of "regulated medical waste." According to DOT guidelines, items in this category can't be in a form that can cause human harm. The DOT classifies Ebola as a Category A agent, or one that is potentially life-threatening.

DOT regulations say transporting Category A items requires special packaging and hazmat training.

Read MoreDeadly Ebola virus spreads—and so do fears

CDC spokesman Tom Skinner said the agency isn't aware of any packaging that is approved for handling Ebola waste.

As a result, conventional waste management contractors believe they can't legally haul Ebola waste, said Thomas Metzger, communication director for the National Waste & Recycling Association trade group.

A temporary fix

Part of Emory's solution was to bring in one of the university's large-capacity sterilizers called an autoclave, which uses pressurized steam to neutralize infectious agents, before handing the waste off to its disposal contractor for incineration.

Few hospitals have the ability to autoclave medical waste from Ebola patients on site.

"For this reason, it would be very difficult for a hospital to agree to care for Ebola cases - this desperately needs a fix," said Dr Jeffrey Duchin, chair of the Infectious Diseases Society of America's Public Health Committee.

Read MoreThe Alzheimer's epidemic: Where we stand

Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, said there's "no way in the world" that U.S. hospitals are ready to treat patients with highly infectious diseases like Ebola.

"Where they come undone every time is the management of their liquid and solid waste," said Macgregor-Skinner, who recently trained healthcare workers in Nigeria on behalf of the Elizabeth R. Griffin Research Foundation.

Skinner said the CDC is working with DOT to resolve the issue. He said the CDC views its disposal guidelines as appropriate, and that they have been proven to prevent infection in the handling of waste from HIV, hepatitis, and tuberculosis patients.

Read MoreWhy your boss wants you to see online doctors

Joe Delcambre, a spokesman for DOT's Pipeline and Hazardous Materials Safety Administration, could not say whether requiring hospitals to first sterilize Ebola waste would resolve the issue for waste haulers. He did confirm that DOT is meeting with CDC.

Metzger said his members are also meeting with officials from the DOT, the CDC and the Environmental Protection Agency to sort out the issue.

Until the matter is resolved, however, "We're bound by those regulations," he said.

Have a very nice day.
-fgalkin

[Broomstick]

First - yes, the gentleman has ebola.

Second - they're contacting and tracking as many potential contacts as possible, which is good and proper follow-up.

Third - the waste disposal problem is resolvable. It's a matter of conflicting regulations and, frankly, I'd rather they discover this now, when we have 1 or 2 ebola patients rather than, say, a repeat of the 1918 Flu Pandemic where the scope of the problem would be much, much worse. It will get sorted out.

[cosmicalstorm]

Very relaxed attitude from the government re this.

One of the many interesting aspects of how the US dealt with the AIDS epidemic is what we didn’t do – in particular, quarantine. Probably you need a decent test before quarantine is practical, but we had ELISA by 1985 and a better Western Blot test by 1987.

There was popular support for a quarantine.

But the public health experts generally opined that such a quarantine would not work.

Of course, they were wrong. Cuba institute a rigorous quarantine. They mandated antiviral treatment for pregnant women and mandated C-sections for those that were HIV-positive. People positive for any venereal disease were tested for HIV as well. HIV-infected people must provide the names of all sexual partners for the past sic months.

Compulsory quarantining was relaxed in 1994, but all those testing positive have to go to a sanatorium for 8 weeks of thorough education on the disease. People who leave after 8 weeks and engage in unsafe sex undergo permanent quarantine.

Cuba did pretty well: the per-capita death toll was 35 times lower than in the US.

Cuba had some advantages: the epidemic hit them at least five years later than it did the US (first observed Cuban case in 1986, first noticed cases in the US in 1981). That meant they were readier when they encountered the virus. You’d think that because of the epidemic’s late start in Cuba, there would have been a shorter interval without the effective protease inhibitors (which arrived in 1995 in the US) – but they don’t seem to have arrived in Cuba until 2001, so the interval was about the same.

If we had adopted the same strategy as Cuba, it would not have been as effective, largely because of that time lag. However, it surely would have prevented at least half of the ~600,000 AIDS deaths in the US. Probably well over half.

I still see people stating that of course quarantine would not have worked: fairly often from dimwitted people with a Masters in Public Health.

My favorite comment was from a libertarian friend who said that although quarantine certainly would have worked, better to sacrifice a few hundred thousand than validate the idea that the Feds can sometimes tell you what to do with good effect.

The commenter Ron Pavellas adds:

I was working as the CEO of a large hospital in California during the 1980s (I have MPH as my degree, by the way). I was outraged when the Public Health officials decided to not treat the HI-Virus as an STD for the purposes of case-finding, as is routinely and effectively done with syphilis, gonorrhea, etc. In other words, they decided to NOT perform classic epidemiology, thus sullying the whole field of Public Health. It was not politically correct to potentially ‘out’ individuals engaging in the kind of behavior which spreads the disease. No one has recently been concerned with the potential ‘outing’ of those who contract other STDs, due in large part to the confidential methods used and maintained over many decades. (Remember the Wassermann Test that was required before you got married?) As is pointed out in this article, lives were needlessly lost and untold suffering needlessly ensued.

http://lesswrong.com/r/discussion/lw/l1 ... orty_days/

[fgalkin]

So, apparently, the patient walked into the emergency room, was asked by a nurse about their travel history, told them he went to Liberia, the nurse then failed to inform anyone of this. The patient was given antibiotics and released home.

Brilliant

Have a very nice day.
-fgalkin

[Elheru Aran]

So, apparently, the patient walked into the emergency room, was asked by a nurse about their travel history, told them he went to Liberia, the nurse then failed to inform anyone of this. The patient was given antibiotics and released home.

A rather blatant dereliction of public-health good practice. Even in the optometrist's office I went to today-- a freaking eye doctor's, of all places (for my daughter, not myself, but that's beside the point)-- there were clearly posted signs telling patrons to notify the staff if they had recently returned from West Africa.

Did they not have any such in Dallas? One would think that these would have helped in this case...

[Broomstick]

I suspect the nurse the man told about his recent travel discounted what the patient said. It's not unknown for medical personal to discount or even ignore patient statements, even important ones. Was it exhaustion? Prejudice? Incompetence? Who knows - the point is, ANY foreign travel is relevant when you become ill shortly after a trip.

[TimothyC]

Fortunately, isolation is a great time to update your resume.

[LadyTevar]

I am just hoping the hysteria will be fought back by simple fact: Did you get blood/snot/semen/spit on you? Then you don't have EBOLA.

[Grumman]

I am just hoping the hysteria will be fought back by simple fact: Did you get blood/snot/semen/spit on you? Then you don't have EBOLA.

If you want people to calm down about ebola, telling them that the symptoms of the common cold are transmission vectors seems a rather poor way of doing it.

[Tsyroc]

I suspect the nurse the man told about his recent travel discounted what the patient said. It's not unknown for medical personal to discount or even ignore patient statements, even important ones. Was it exhaustion? Prejudice? Incompetence? Who knows - the point is, ANY foreign travel is relevant when you become ill shortly after a trip.

The article I read said that the nurse requested his social security number and he told her he didn't have one because he was visiting from Liberia.

So, if that is as far as it goes it mostly means that the nurse needs a geography lesson and to keep better informed. Truthfully, I can't see how the patient stating that he was from Liberia would get
by any ER nurse.

Supposedly she followed procedure etc... filling out the form, but somehow the information on where the guy was from didn't make it to the rest of the team who treated him. I'm trying to decide if this is just a random fuck up or if it's partially related to people being paranoid about violating a patient's privacy to the point of not informing people of information they NEED to know?

[Broomstick]

She might have also thought he was an illegal alien and maybe that played into it.

So far as I know, he's here legally.

[Knife]

One of two things:

Either the RN discounted that the guy was overseas lately, the MD didn't ask, and the guy just didn't mention it again representing a total breakdown in the system, or...

The information was obtained, and the team didn't suspect anything of it during his treatment.

It's not like the RN is the only vector for that information.

[mr friendly guy]

Let the ear fear begin. Or should that be fearmongering.

https://www.youtube.com/watch?v=oN_DpTqGbrE

[Broomstick]

From what's been said on the news here, I think the information about being from Liberia was obtained during the patient history taking, but the RN completely failed to relay the information to anyone else on the team and the patient didn't seem to mention it again. In other words, failed communication.

[fgalkin]

One of two things:

Either the RN discounted that the guy was overseas lately, the MD didn't ask, and the guy just didn't mention it again representing a total breakdown in the system, or...

The information was obtained, and the team didn't suspect anything of it during his treatment.

It's not like the RN is the only vector for that information.

Or, the hospital didn't want to deal with the expense of quarantining an uninsured patient for days because of flu-like symptoms, regardless of the recent travel, and are now looking for scapegoats.

Have a very nice day.
-fgalkin

[Tsyroc]

Does anyone know if this hospital uses electronic medical records or if they are still doing everything on paper?

[Broomstick]

Or, the hospital didn't want to deal with the expense of quarantining an uninsured patient for days because of flu-like symptoms, regardless of the recent travel, and are now looking for scapegoats.

While that is possible due to human nature and economic realities, it is unlikely given the volume of uninsured care a typical hospital dispenses. As a general rule doctors really don't think about care costs, they actually do try to make decisions based on medical need.

Does anyone know if this hospital uses electronic medical records or if they are still doing everything on paper?

Have no idea. I am curious as to why you asked that question?

[Raw Shark]

Or, the hospital didn't want to deal with the expense of quarantining an uninsured patient for days because of flu-like symptoms, regardless of the recent travel, and are now looking for scapegoats.

While that is possible due to human nature and economic realities, it is unlikely given the volume of uninsured care a typical hospital dispenses. As a general rule doctors really don't think about care costs, they actually do try to make decisions based on medical need.

I can back this up anecdotally: hospital doctors don't give a fuck about the hospital's money, they care about helping people, feeling good about themselves, and prestige, not necessarily in that order. Even my winter break job working for the hospital's bean counters doing an efficiency study in the ER was taken as a very adversarial role by the ER doctors (ie: "HOW DARE you accurately document how long that took in order to receive your meager paycheck!? I'm saving lives here!").