Read this and tell me who's in charge in Dallas

[B2G]

‘It’s positive for Ebola.’ Dreaded words set CDC’s emergency operation in motion.

By Amy Ellis Nutt October 3 at 5:51 PM

The emergency operations office at the Centers for Disease Control and Prevention in Atlanta was very quiet. It was late in the afternoon on Tuesday, and a dozen or more CDC staff had gathered to hear the latest news out of Dallas about the suspected Ebola patient, Thomas Eric Duncan.

David Kuhar, an infection control medical officer at the CDC, was listening in.

He knew he might be flying out sooner rather than later, which is why he drove to work that day instead of riding his bike, as he usually did. On the conference call were local and state health officials from Texas.

And they had news about Duncan’s lab results:

“It’s positive for Ebola.”

http://www.washingtonpost.com/news/to-your-health/wp/2014/10/03/its-positive-for-ebola-dreaded-words-set-cdcs-emergency-operation-in-motion/

[valerief]

1. "We got this. No need to worry. We know what we're doing."

And then they fuck up, one fuck up after another.

Why was no clean quarantine location identified BEFORE the diagnosis? You know, when all those hotshots were practicing their ebola emergency procedures.

I love the way pants-shitting Perrynoid scoots out of Texas during this. So typical.

[MineralMan]

2. Sounds like they're following established procedure.

That's good.

[B2G]

3. Seriously?

I don't know whether to laugh or cry at that comment.

[MineralMan]

5. Seriously.

What did you expect them to do? How would you do it any differently if you were the Director of the CDC? Should they send the full team for every suspected case? They can't do that. This was the very first actual case in the US. They've been working on protocols, sending out advisories for hospitals to follow and updating the information on their Ebola website pages. In the meantime, they were in communication with the hospital in Dallas and with the labs doing the testing.

They've also been planning exactly what to do when the first case showed up in the US for some time. When it did, they followed the procedure that had been established, and that has been used many times for many different diseases. Whether it was the Marburg Virus case several years ago, or the Lassa Fever case here in Minnesota earlier this year, it's the same procedure.

You may not think it is fast enough or panicky enough, but you're not an epidemiologist and you don't work at the CDC. You also don't know about the communications they had with that hospital in Dallas prior to going there, when the case was just a possible case of Ebola. I guarantee that such conversations took place between the hospital and the CDC. I understand that you want everything to happen immediately, but that isn't how it works.

The procedures have been developed with the goal of providing the most effective response to the situation. Those procedures were followed. As soon as the patient was confirmed to actually have Ebola, the response team was on the way. That's how it works. They don't go before then, because another case might have been identified in Minneapolis and the one in Dallas could have been a false alarm.

Minneapolis has a large population of Liberian immigrants and people travel frequently between the two places. What if the man in Dallas hadn't had Ebola, but a patient in Minneapolis did? They don't have dozens of such teams. There's no budget for that and no continuing need for it. I live in St. Paul, just across the river from Minneapolis. I'm keeping an eye on what happens here. I expect our first case of Ebola here at any time, and our hospitals are having drills and rehearsals for what they will do if and when that happens. They're also consulting with the CDC, I have no doubt.

So, if you think it should have been done differently, why not outline what you think the response should have been?

[B2G]

7. Well for starters

1) Immediate evacuation of Louise and her family from the contaminated apartment. Why they left them there for so long is beyond my comprehension. Seal up the apartment until they knew how to deal with the decontamination process.

2) Immediate isolation of Louise's daughter and her family in a similar manner they just did for Louise. She had physical contact with him the day he left in the ambulance. Right now they are under orders to stay at home with extremely limited assistance. They are being relied on to monitor their own health and segregation. Unbelievable.

3) Hired actual hazmat teams to clean up the exterior of the apartment. I'm sure you saw the pressure washing pictures. Duncan's car just sat there for 6 days before they 'bagged it up'.

4) Be much more forthcoming on what is going on with the other people who had direct contact...EMTs, hospital workers, etc. From what I've read, they are being given very limited guidance.

5) The ambulance that transported him should have been taken out of service immediately, not 48 hours after the fact. It transported other patients. The driver didn't even find out until it was taken out of service.

6) At least some of those 8 kids who are now under observation returned to school after they were told not to go and had to be pulled out by the Dept of Health. That's because no one was watching them.

That's just off the top of my head.

[MineralMan]

8. None of those things are part of what the CDC does.

The article at the link was about the CDC's response team. Everything you mentioned is the responsibility of the local jurisdiction, not the CDC. The CDC is a federal agency and its mission is to do research and provide guidance and information. When a rare and dangerous instance of a disease is identified, they send a team to the location to assist in tracking contacts, etc. They also publish and maintain information and best practice protocols for a wide range of diseases.

The CDC is not a healthcare delivery organization, nor is it in charge of the items on your list.

I'm discussing the article at the link, which is about the CDC's response to this instance of Ebola. You're discussing things that were not mentioned in that article and that are not part of the CDC's mission.

Go to the link below and explore. You'll find out what the CDC does in cases like this and what information they offer to local jurisdictions. What's on that website is what the CDC does for a very wide range of health issues:

CDC Ebola Update Website Page - Lots and lots of resources and links to important information
http://www.cdc.gov/vhf/ebola/index.html

[B2G]

10. So you're telling me they trace the contacts

and their job is done in that regard. No helpful hints on isloation, decontamination, monitoring procedures, etc.

Nothing on my list is their responsiblity. Gotchya.

Well I have news for you, if that's the case and they leave all of that up to the locals, we are in a world of hurt.

[uppityperson]

12. CDC has lots of helpful comments but the job of doing it is up to the locals. And indeed, that could

very well be a problem.

CDC. State Health Department. County Health Departments. Each has responsibilities unto themselves. And indeed, what they do can widely differ.

[MineralMan]

13. What do you mean by no hints?

Did you visit the website? They have detailed instructions on such things there. There are dozens of links to such "hints" there. Local healthcare providers have 24/7 access to that information, as do you.

That's the CDC's job: information.

As epidemiologists, they are highly skilled in running down contacts and evaluating them. So, yes, they lend that expertise to the local jurisdiction, as needed. But information is their main product, and you can find it and read it, if you bother to. I assure you that the local hospitals have already done so. Whether or not they have followed those directions is another matter.

Decontamination instructions are part of the information you'll find at the link I provided. Following the correct procedures is the responsibility of the local jurisdiction, though.

A lot of people have mentioned the guy with the pressure washer outside, washing the sidewalk down. However, nobody has asked whether what was being sprayed was a disinfectant that is recommended for that job. The Ebola virus does not remain infectious for long on surfaces like sidewalks. I'm betting that some disinfectant was being used, so that treatment was probably sufficient, as long as one of the suitable disinfectants was used. As for the people exposed in that apartment, they were exposed before the man was hospitalized. I agree that the locals fumbled with proper handling of those people and that apartment. Again, though, that's not the CDC's responsibility.

Frankly, I expect that at least one of the people who were with him in that apartment will become a victim of Ebola. Once he began showing symptoms, he became contagious. If any of those contacts gets sick, they'll be treated early and will have a fair chance of survival. The original patient began receiving treatment rather late, so there's a fair chance that he will not survive, I think. Everyone exposed now knows what symptoms to watch for, and will probably seek treatment quickly if they develop those symptoms. Most of the contacts will not contract the disease, though. And since only symptomatic patients are contagious, only basic quarantine procedures are needed, and not even those for lower-risk people. The odds are very high that this outbreak will be confined to a very few patients and then it will be over.

I'm discussing the CDC only, since that's the subject of the linked article posted in the opening thread. The overall handling of this incident is not solely the CDC's responsibility. In fact, very little of it is. The CDC's role is an educational, research, and advisory one.

[MineralMan]

9. Here are some CDC links you should read.

It seems like you're not really that familiar with that agency's responsibilities and roles are in cases like these:

http://www.cdc.gov/phpr/whatcdcisdoing.htm

http://www.cdc.gov/about/organization/mission.htm

The CDC is not a local healthcare provider, nor does it have some sort of extraordinary powers that override local jurisdictions.

[kestrel91316]

6. You would feel that way, not knowing diddly squat about epidemiology and its protocols.

[world wide wally]

4. Forget all that stupid "sciencie" stuff and bomb the fucking Ebolas!

[Cleita]

11. Isn't GWB domiciled in Dallas?

Maybe that should give you an idea of how things are run there.

[locks]

14. Thank you MM for your information about the CDC

You got the CDC's job right around the world. They do not take over in other countries or in the states but do lots of research, work out systems and protocols and then train workers to make the protocols work. This hospital got the information and held training sessions but did not complete every aspect of the protocol correctly. All institutions and agencies have human problems but we hope they can learn from mistakes or systems that didn't work.

I am thankful for the committed people who work in our government and hope we can stop this virus and ones which certainly will come in the future by supporting them at home and around the world. If Liberia, Guinea, and Sierra Leone had had working public health systems ebola would have been stopped before it spread out of those countries.