maybe CDC needs to revise their Ebola guidelines

[magical thyme]

"2) isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting Ebola symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); "

"Ebola infection is associated with fever of greater than 38.6°C or 101.5°F, and additional symptoms "
http://emergency.cdc.gov/han/han00371.asp
http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf
http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf


There are 3 basic criteria patients are supposed to meet for ebola suspicion:
1. travel history to Ebola country
2. temperature greater than (or equal to) 101.5F
3. other Ebola symptoms


This is why the hospital says the nurses and doctors followed protocol. Duncan's temperature was reportedly below 101.5F when he was first went to the ED. He met only 2 of the 3 guidelines.

Furthermore, on reviewing the CDC flyer, it says that patients that don't meet the 3 criteria but do present a low risk are to be reported to state health authorities. However, the checklist does not state that.

"Although his family had informed the healthcare workers of his recent arrival from Liberia, the hospital personnel decided he did not meet the criteria for Ebola suspicion since he did not have a temperature greater than 101.5 degrees Fahrenheit."
http://emergencypublichealth.net/tag/prevention/

[Warpy]

1. Don't forget disposable shoe coverings this time around

Hospitals being too fucking cheap to provide them is what got MRSA out into the community.

They also need to begin these precautions on anyone with a history of travel from west Africa within the previous three weeks.

Unfortunately, the word "uninsured" on his intake form was the most important one when he first went in for treatment. He told them where he was from. That red flag should have trumped the "uninsured" but it didn't.

[dixiegrrrrl]

2. I am seriously surprised there are not more Ebola patients here or in Europe.

If I were in one of the Ebola countries/areas, and started to feel sick, my choice would be:

to remain in a place that has over-run medical facilities and over-worked health staff ( if they are even working anymore and have not been run off or died)
or
get myself to an airport, take 2 aspirin to reduce any fever, and fly away to where there are better care facilities.

[magical thyme]

3. poverty and no time once infected

from what I've read, Duncan was already planning to come to the US, already had his visa, etc.

[ecstatic]

4. Most of the early symptoms are subjective and can be confused with something else!

Sore throat, headache, "weakness," muscle pain, abdominal pain, etc. Is temperature the only symptom required for someone to be considered contagious? Is an infected person contagious if he has a headache or feels a sore throat, even if he doesn't yet have a fever?This is very important because officials seem to be betting the house on current CDC guidelines.

[magical thyme]

7. any symptom = contagious. the CDC guidelines are the best knowledge they have.

Fever with headache, achiness/general malaise, abdominal pain are the first symptoms. Fever is an innate immune response as your body basically is trying to cook the pathogen. Later comes nausea, vomiting, diarrhea, rash, red eyes, chest pain and cough. Last is the hemorrhagic phase.

When you don't have direct experience, you have to rely on the guidance of those who do.

[pnwmom]

5. I think a temperature of 100, along with the travel history and other symptoms should be enough.

Not everyone has the same baseline fever. My baseline is low so 100 is as high as I usually get, even when I have something as serious as pneumonia.

[magical thyme]

9. viral pneumonia doesn't have an exceptionally high fever

and in older people or with a weakened immune system, you can actually have a lower than normal temperature with pneumonia, according to mayo clinic.
http://www.mayoclinic.org/diseases-conditions/pneumonia/basics/symptoms/con-20020032

[pnwmom]

10. I'm referring to bacterial pneumonia and I wasn't old or with a weakened immune system.

As I said, my baseline temp is low, so 100 degrees is a fever for me.

[magical thyme]

14. wow. that really is low! And I just found this: his temp was 100.1 when admitted.

so they do need to drop that threshold to 100.

Duncan arrived in Dallas from Liberia on Sept. 20. He first visited the hospital’s emergency room on Sept. 25 with a temperature of 100.1 degrees, abdominal pain, a headache and trouble urinating, according to a statement released by the hospital late Thursday.

A nurse asked Duncan whether he had traveled during the past four weeks, and he said he had been in Africa, according to the hospital statement.

Read more here: http://www.bnd.com/2014/10/04/3437351/dallas-hospital-us-ebola-patient.html?sp=/99/166/286/#storylink=cpy

[pnwmom]

15. Wow. You're right -- they should lower that number. n/t

[Barack_America]

6. So they sent him home with antibiotics and no plan for follow-up...

...Mmm hmm. Try again. Is this hospital fundamentally unable to admit a mistake?

[magical thyme]

8. I don't speak for the hospital. This is my take on what I read at the CDC site and elsewhere.

I have read his temperature did not meet the CDC criteria for Ebola risk and that was the basis of the doctor's decision.

I don't know what instructions they did or did not give him when they released him. I haven't seen anything about that. For all we know, they may have sent him off with a prescription and told him to go to a clinic if he got worse or didn't improve within some specific time frame.

I don't speak for the hospital. I'm just looking at this from my perspective for what can be done to prevent a repeat.

It's easy to blame the doctor and presume everything else is ok, but that won't prevent a repeat.

[Barack_America]

11. My cynicism was directed at the hospital.

This is, what, the 5th or 6th excuse they've come out with?

[magical thyme]

13. I didn't read this from a hospital release

I'm not sure where this source got the info from, but not any general hospital releases or statements that I've seen.
http://emergencypublichealth.net/tag/prevention/

I've seen 2 basic statements from the hospital: first that the info was not thoroughly reported to all the doctors, with more detailed explanation of due to it not crossing from nurse info-flow into doctors; and second that whoops, doctors had all the info after all.

I'm chalking it up to panic and general incompetence from the spokesperson.

Beyond that, I haven't seen anything about what instructions were or were not given to the patient when he was 1st released.

[seveneyes]

12. Nah, just let all comers keep lying and flying here to help spread the misery

Why should anyone be forced to stay in their own country that they picked up their disease from?