Archive for Health

Third Time’s the Charm

You know the evolution timeline chart?

Well, the CDC’s got an evolution chart of its own. On how to dress safely around Ebola:

Progressing to:

Before they finally got it right:

The Centers for Disease Control and Prevention issued new guidelines on Monday for health care workers caring for patients with Ebola.

The new guidelines “provide an increased margin of safety,” CDC Director Tom Frieden said in a conference call with reporters.

Frieden added that they represented a “consensus” by the health care workers who have treated people with Ebola in the United States, including those workers at hospitals in Atlanta and Nebraska that have treated Ebola without further transmission.

The CDC is, of course, reacting to what happened at Presbyterian Hospital Dallas, where two nurses caring for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, contracted the virus.

“The [old] guidelines didn’t work for that hospital,” Frieden said.

Because of the lessons learned, the CDC said it was implementing three new recommendations:

— First, they will make sure that health care workers dealing with Ebola patients are “repeatedly trained,” especially when it comes to learning how to put on and take off their personal protective equipment.

— Second, the equipment used should leave no skin exposed.

— Third, these regulations should be monitored by a “trained observer” or site manager, who watches each employee take on and off their personal protective equipment.

“All patients treated at Emory University Hospital, Nebraska Medical Center and the NIH Clinical Center have followed the three principles,” the CDC said in a press release. “None of the workers at these facilities have contracted the illness.”

Well, thanks for sharing. Finally! What’s it been, a month? Good thing our Ebola Czar reports for duty tomorrow. Finally!

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Ebola Ain’t No Thang

What, me worry?

Ron Klain, the man appointed by President Barack Obama on Friday to head up the government’s response to the Ebola virus in the United States, will not clock in on his new job until Wednesday.

White House Deputy Press Secretary Eric Schultz told reporters in Chicago on Monday that it isn’t unusual for it to take weeks or months for an appointee to complete the “onboarding process,” The Washington Examiner reports.

“It is not that long of a lapse,” Schultz said.

No, of course not. Ebola must be scared [bleepless], if you’ll pardon the pun, by this guy’s dogged determinism.

Press reports already have noted Klain missing two meetings with the president on Ebola since his appointment was announced. And he won’t testify on Friday before a Republican-led House hearing, because, Schultz said, “That will be day three of his tenure.”

Can’t he appear and just take the 5th, like Lois Lerner?

I just hope Ebola does the sporting thing and gives Klain the chance to set up his desk: fill his stapler, open his desk calendar to the correct date, get the right mix of coffee and Cremora. No fair infecting more nurses, Ebola! (Though Ebola has good taste; they’re cute!)

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Congratulations Nigeria!

We’re used to losing to Africans in marathons, but we thought we had them beat in medicine.

I blame our “coach”:

Nigeria has been declared officially free of Ebola after six weeks with no new cases, the World Health Organization (WHO) says.

WHO representative Rui Gama Vaz, speaking in the capital Abuja, said it was a “spectacular success story”.

Nigeria won praise for its swift response after a Liberian diplomat brought the disease there in July.

The outbreak has killed more than 4,500 people in West Africa, mostly in Liberia, Guinea, and Sierra Leone.

An estimated 70% of those infected have died in those countries.

The WHO officially declared Senegal Ebola-free on Friday.

Senegal? Senegal’s medical system bested ours? Words fail me…

The WHO can declare an Ebola outbreak over if two incubation periods of 21 days pass with no new cases. The last reported case in Nigeria – Africa’s most populous country – was discovered on 5 September.

The BBC’s Will Ross in Lagos says the nightmare scenario of Ebola spreading through Nigeria’s 170 million people has been avoided and the nation is heaving a collective sigh of relief.

I would have bet (someone else’s) money that once Ebola hit Lagos, it was goodnight Nigeria.

How’d they do it?

Officials credit tighter border controls, good patient-tracking and other medical practices, and just plain luck with keeping Ebola confined mostly to Liberia, Sierra Leone and Guinea since the outbreak was first identified nearly seven months ago.

Senegal did so well in finding and isolating a man with Ebola who had slipped across the border from Guinea in August that the World Health Organization on Friday will declare the end of the disease in Senegal if no new cases surface.

Nigeria is another success story. It had 20 cases and eight deaths after the virus was brought by a Liberian-American who flew from Liberia to Lagos, Nigeria’s commercial capital of 21 million people, in July. Nearly 900 people were potentially exposed to the virus by the traveler, who died, and the disease could have wreaked havoc in Africa’s most populous nation.

Border closings may also be helping halt the spread of Ebola.

Ivory Coast, Guinea-Bissau and Senegal, all of which share borders with at least one of the three most affected countries, have closed those borders.

Nigeria initially banned flights from countries with Ebola but relaxed the restriction once it felt that airlines were competent to take travelers’ temperatures and follow other measures to prevent people with Ebola from flying.

Nigeria has teams taking the temperature of travelers at airports and seaports.

Another factor is luck. All it takes is one infected person to slip around guards at a border post or get aboard a plane.

“God has been merciful we haven’t reported a case in Kenya, but we really need to up our disaster preparedness,” said Dr. Nelly Bosire, an official with Kenya’s main medical union.

“The fact we stopped doing the West African flights had an impact. On that part I think we got it right. But it still has more to do with luck.”

Luck is the residue of design, the saying goes. Meanwhile, we still haven’t cleaned up the residue where Thomas Eric Duncan hurled.

But we’ll get there! Look out, Senegal, we’re right behind ya!

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Coming to America

You don’t need a brain as big as this guy’s to know that travel from West Africa is a bad idea right now—but as long as he has one anyway:

[A]ccording to the head of a research institute in Cambridge, the new restrictions might still not go far enough.

Yaneer Bar-Yam leads the New England Complex Systems Institute, and for years he’s been arguing that in cases of severe infectious disease outbreaks, the best policy might be to prohibit travel from afflicted countries altogether.

“At the global level, I do think transportation should be curtailed from, but not to, West Africa,” he says.

Bar-Yam is trained as a physicist. His research primarily focuses on the behavior of complex systems, like, for example, the way an infectious disease moves through a population. In 2006 he coauthored a paper with Erik Rauch, a computer scientist at MIT, called “Long-range interactions and evolutionary stability in a predator-prey system.” The title is a mouthful, but the paper’s implications for the current Ebola outbreak are stark. Bar-Yam and Rauch used mathematical models to simulate the spread of an infectious disease; their analysis suggests that even small amounts of travel between regional populations may be enough to allow an infectious disease to jump from one country to another. “Even if significant mixing already exists,” the authors write, “a small amount of additional mixing may cause extinction.” And in this case, extinction means us.

And we all know how liberals love models. Sounds like “settled science” to me.

“Severe pathogens . . . can be stopped by the very fact that they’re destructive,” he says. “If they kill off their host, whatever’s going to happen is going to happen locally.” In other words, epidemics burn out on their own when the disease has no one left to infect, provided they’re not able to hop across oceans on airplanes.

One of the biggest arguments against travel restrictions is the sense that our health care system can handle isolated Ebola cases as they crop up here. Bar-Yam thinks that confidence is misplaced, a view which has gained some currency as it’s emerged that a Dallas hospital misdiagnosed and released Duncan when he first showed up for treatment.

Doctors trace the severity of an outbreak by the average number of people become ill after contact with an infected person. If the number is one or less, the outbreak is stable or declining. If it’s greater than one, it’s spreading. Thomas Eric Duncan infected two people (that we know of), trained nurses, in a “health care system can handle isolated Ebola cases as they crop up here”.

If you weren’t soiling your drawers before, now’s a good time to start. If you were, you should get checked out. It’s a symptom.

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Whose Ass to Kick?

Uh-oh, first the Gulf oil spill, then the IRS (phony) scandal—Obama is angry again!

On the surface, even in his weekly address Saturday, President Barack Obama is urging calm when it comes to the Ebola crisis, but people behind the scenes say that he is becoming more frustrated and even angry with how his administration has been handling the United States’ response.

For example, during his cabinet meeting on Wednesday, people briefed on the event said he was angry about medical information that was turning out to be wrong, including how to categorize Ebola patients, reports The New York Times.

Obama reportedly complained that the response, particularly from the Centers for Disease Control, was “not tight.”

But being in command without stoking panic is a challenge, said David Axelrod, a former close adviser of Obama’s.

“It’s not enough to doggedly and persistently push for answers in meetings,” Axelrod told The Times. “You have to be seen doggedly and persistently pushing for answers.”

Again with the “optics”!

Obama is about nothing if he’s not about the optics:

President Obama is hitting the links on Saturday, joined by ESPN commentator Tony Kornheiser after a hectic week for the White House in response to the Ebola outbreak.

Kornheiser is a well-known expert in the field of infectious diseases. His monograph on beri-beri is still considered the last word on the subject.

One last point: isn’t “angry” one of those “dog whistle” words when applied to black men? I could have sworn it was. Shame on the New York Times for wallowing in racial stereotypes.

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Wait, Ebola is Funny Again!

That didn’t take long (see post below):

Let Obama and Frieden Do Their Jobs

Now I have to excuse myself to wipe the coffee from my lower face.

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Ebola Failures

I said I would lay off Ebola for a while, and I will. Soon. Promise.

Until then:

Recent pledges of help and deployments to Africa’s Ebola-hit regions have had no impact on the epidemic, a senior Medecins Sans Frontieres official says.

Christopher Stokes, who heads the charity’s Ebola operation, said it was “ridiculous” his volunteers still bore the brunt of care for sufferers.

The remarks came as UN chief Ban Ki-moon pleaded for funds, as a drive for donations fell short of its target.

UN Secretary-General Ban said a $1bn trust fund he launched in September has received just $100,000 (£62,000) so far.

Donors have given almost $400m (£250m) to other UN agencies and aid organisations directly but the UN trust fund, intended to act as a flexible spending reserve, has itself only received pledges of just $20m (£12m).

The ultimate Jack Benny dilemma: Obama or the UN? I’m thinking, I’m thinking!

Untitled

I’m not sure whether the chart counts only pledges or aid delivered—indeed, whether it counts the troops we have over there now—but it would appear to me that America has provided (or will provide) more aid than the World Bank, the African Development Bank, the EC, the UK, Germany, and China combined.

But if the world looks at the UN as the savior of humanity from contagion, it’s no surprise it looks away in disgust.

PS: The fun is beginning to wear off:

The current Ebola outbreak is “running much faster” than the international response to it, the co-discoverer of the virus said Thursday.

“This is the first Ebola epidemic where entire nations are involved, where big cities are affected,” Peter Piot, a microbiologist and a former undersecretary general of the United Nations, told Global Public Square host Fareed Zakaria. “And I continue to be worried that the response to the epidemic is really running behind the virus.”

According to the World Health Organization’s latest update, there have been almost 9,000 confirmed and suspected cases, with almost 4,500 deaths. However, the WHO warned there could be as many as 10,000 new cases per week in Guinea, Liberia and Sierra Leone by the end of this year.

Piot, a member of the team that discovered the virus in 1976 in what is now the Democratic Republic of Congo, made headlines earlier this month when he told The Guardian newspaper he feared an “unimaginable catastrophe” if the virus became lodged in a mega-city such as Lagos.

“The three countries that are affected are being totally destabilized, not only in terms of people who are killed by Ebola — their families, the orphans that now are coming up because the parents died — but the economy has come to a standstill,” Piot said Thursday, speaking from Oxford.

“People are massively dying from other diseases that are normally treatable, like malaria, or women die while giving birth because hospitals are abandoned or are full with Ebola patients. So that’s a very, very destabilizing factor,” he said, adding that the impact of its spread is “beyond Ebola.”

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Ebola Follies

If you go to the Daily Mail (UK) website, there are at least a dozen separate stories on Ebola.

I’m thinking of taking a few days off from the story. It’s got enough momentum of its own.

Starting tomorrow, I promise. I swear. Maybe. I’ll try.

Officials in Dallas County are considering asking Gov. Rick Perry to issue a disaster declaration in response to Ebola.

Thanks, Obama.

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Ebola Follies

All hemorrhagic fever all the time:

U.S. standards for protecting healthcare workers from Ebola are weaker than those widely used in West Africa, according to the leader of a group treating victims of the virus in Liberia.

“We’re not comfortable with [Centers for Disease Control and Prevention (CDC)] procedures,” Ken Isaacs, the vice president of Samaritan’s Purse, told The Hill.

When Samaritan’s Purse health workers treat patients in Liberia, they wear two pairs of gloves and spray themselves with disinfectant twice before leaving the isolation ward. They have a three-foot “no touch” policy and hold safety meetings every day.

In U.S. hospitals — such as Texas Health Presbyterian Hospital Dallas, which has had three cases of Ebola — workers don’t have to hose down their gear and are told it’s OK for gloves to expose their wrists.

“If you slip, and you touch your skin on the wrist, you’re going to get Ebola,” said Isaacs, who has worked on-the-ground disaster relief in countries like Haiti, the Philippines and Bosnia.

“Can we trust CDC? They said they were going to stop it in its tracks, but I don’t know.”

The nurses don’t trust the CDC:

National Nurses United, the country’s largest nurses union, has unleashed fierce criticism of the hospital this week, alleging that the disease spread because of incompetent management and poor training.

Brianna Aguirre, a nurse at the Dallas hospital, told NBC’s “Today Show” on Thursday that she has watched people at her hospital “violate basic principles of nursing care and medical care.”

She said her garb left parts of her neck exposed, and some nurses would use tape to cover the area. She added that potentially exposed nurses would go into other patients’ rooms without disinfectants.

The CDC raised its standards for protective gear this week to include garb that does not expose a worker’s neck. It also added “an enhanced and detailed step-by-step disinfection of hands.”

But as good Dr. Frieden said yesterday, you can get Ebola, but you can’t give it.

In further developments:

On Monday, a CDC official cleared Vinson to fly from Cleveland to Dallas on board Frontier Airlines Flight 1143 despite the fact that she had called and reported having a slight fever, one of the common symptoms of the Ebola virus. Vinson’s reported temperature — 99.5 degrees — was below the threshold of 100.4 degrees set by the agency and she had no symptoms, according to CDC spokesman David Daigle.

Federal sources, though, are now saying she “lied” about how she was feeling. Though she told the CDC she had a low-grade fever, according to sources her family said she was feeling tired and not feeling well. But sources said this information was not conveyed to CDC officials when she called to ask about flying.

She called the CDC, reported her symptoms, and abided by their advice. She had tended a dying Ebola patient. And they’re calling her a liar?

Did it not occur to the bozos that 99.5 could be just a transitional temperature on the way to their beloved 100.4? Who checks their temperature anyway unless they’re not feeling well? She reported herself ill—after working with an Ebola patient—and they let her fly.

You almost have to laugh. I do, but it’s getting harder.

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Ebola Follies

I’m no doctor, no public health official, but these imbeciles make know-nothing criticism so easy anyone can do it.

Join me, it’s fun!

As news helicopters swarmed over Dallas’ Love Field this evening to watch the second U.S. nurse to contract Ebola board a private plane bound for Atlanta, one lone mysterious man stood out from the pack.

Holding a clipboard and directing the transfer, the unidentified man seemed to be the only person on the tarmac without protective clothing, wearing just a button down shirt and trousers.

While Ebola is not an airborne disease, his presence so close to patient Amber Vinson’s medical team sparked fears after he was seen grabbing a container and hazmat trash bag from one of the workers’ in full-protective gear and later boarding the flight.

It is believed he flew with Vinson and the other hazmat-suited medical staff to Atlanta and local television crews spotted him with the stricken nurse as she disembarked at the airport in Georgia to be transferred to Emory University Hospital.

When the plane landed in Atlanta, the man had still not donned any protective clothing and was seen openly interacting with Vinson and the other medical professionals caring for the nurse.

This would be Nurse Vinson’s third flight while infected, by the way:

The second Dallas nurse to contract Ebola after treating U.S. ‘patient zero’ Thomas Eric Duncan received permission from the CDC to get on a commercial flight with a low-grade fever on Monday.

Miss Vinson was one of the nurses at Texas Health Presbyterian Hospital to treat Duncan when he was admitted a second time on September 28, in the first ‘high-risk’ days.

But on October 10, Miss Vinson left the Dallas area to plan her upcoming wedding in Cleveland, Ohio. Before her return flight on Monday, the nurse noticed a spike in her temperature and called the CDC several times to see if she should get on the plane.

When she finally got through to a CDC representative, she was cleared since her 99.5F fever was beneath the 100.4 threshold.

CDC Director Dr Thomas Frieden admits that was the wrong call.

‘Those who have exposures to Ebola, she should not have traveled on a commercial airline,’ Dr Frieden said Wednesday. ‘The CDC guidance in this setting outlines the need for controlled movement. That can include a charter plane; that can include a car; but it does not include public transport. We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement.’

Wait a minute, doc. You have some ‘splainin’ to do too:

Dr. Tom Frieden, director of the Center for Disease Control and Prevention (CDC), said during a telephone press briefing Wednesday that you cannot get Ebola by sitting next to someone on a bus, but that infected or exposed persons should not ride public transportation because they could transmit the disease to someone else.

“I think there are two different parts of that equation,” he continued. “The first is, if you’re a member of the traveling public and are healthy, should you be worried that you might have gotten it by sitting next to someone? And the answer is no.”

“Second, if you are sick and you may have Ebola, should you get on a bus? And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you,” he said.

I title this series Ebola Follies because it resembles a goofy stage farce. But it keeps getting funnier. I see this show running for years.

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Ebola Follies

Sow the wind, reap the whirlwind: [A few additional thoughts to Aggie's similar post below]

A second Texas nurse who has contracted Ebola flew on a commercial flight from Ohio to Dallas with a slight temperature the day before she was diagnosed, health officials said on Wednesday, raising new concerns about U.S. efforts to control the disease.

Chances that other passengers on the plane were infected were very low, but the nurse should not have been traveling on the flight, U.S. Centers for Disease Control and Prevention (CDC) Director Dr. Thomas Frieden told reporters.

The woman, Amber Vinson, 29, was isolated immediately after reporting a fever on Tuesday, Texas Department of State Health Services officials said. She had treated Liberian patient Thomas Eric Duncan, who died of Ebola and was the first patient diagnosed with the virus in the United States.

As Aggie reported earlier, Obama canceled a fundraising junket so as to appear to be involved (if not interested) in the effort to stave of an epidemic. No wonder stocks tanked (see below). If he cancels golf this weekend, move to New Zealand as soon as you can.

Frieden said Vinson had been monitoring herself for symptoms of Ebola and failed to report that her temperature had risen to 99.5 degrees before she departed for Dallas. Even so, Frieden said the risk to other passengers was “very low” because she did not vomit on the flight and was not bleeding.

He added that authorities had identified three people who had direct contact with her before she was isolated.

Dr. Mary DiOrio, interim chief of the Ohio Department of Health’s Division of Prevention and Health Promotion, told reporters Vinson visited family in Akron from Oct. 8 to Oct. 13 before she flew to Dallas on Frontier.

Lovely young woman, I’m sure. Doing God’s work. Of course she should not have taken the flight; of course she should have reported herself a week ago. But she did, and she didn’t. People do s**t like that all the time, sometimes with consequences, sometimes without.

I just love (as in hate) the fact that the CDC declares that an American citizen should not have taken a flight, yet recoils in horror at the suggestion that Liberian nationals from a Hot Zone be denied entry. We are so [bleeped]. Hello, Auckland!

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Whoopsie

Ebola patient flew day before reporting symptoms.

Don’t you hate it when that happens?

The second health-care worker diagnosed with Ebola in Texas flew between Cleveland and Dallas hours before she reported symptoms to state health workers, U.S. health officials said today.

The caregiver caught the deadly virus while treating patient Thomas Eric Duncan at Texas Health Presbyterian Hospital in Dallas this month. She flew to Dallas on Frontier Airlines flight 1143 the night of Oct. 13, according to a e-mailed statement by the U.S. Centers for Disease Control and Prevention. She then reported symptoms the next morning.

“Because of the proximity in time between the evening flight and first report of illness the following morning, CDC is reaching out to passengers,” the agency said. The plane had 132 passengers, the CDC said.

Reaching out, eh? I feel sick just thinking about those poor people.

– Aggie

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