It's been 2 weeks (14 days) since Duncan started vomiting, no signs of new infections

[morningfog]

Just to keep track of the timing, it has been 18 days since he first had a fever (9/24/14). From the 24th through the 28th, he was not vomiting and was not likely to infect others. The incubation period from the 24th is quickly closing with no signs of any other person being infected. This is consistent with how the virus is known to spread.

He started vomiting on the 28th and was quarantined on that day. It has been 14 days since then. No one in his family and no first responders have shown any symptoms of infection as of yet, thankfully. Since the incubation period for the majority with this strain is 7-10 days, this is also a very good sign.

It is unlikely that anyone who had contact with him prior to his isolation, or anyone who participated in cleaning the apartment were infected.

As was the case with the Spanish nurse, there was still a slight risk to care providers until his death, on October 8th.

However, those care providers will be closely observed and are not scattered throughout the city of Dallas and they were almost certainly not infected.

The point being, it is looking quite promising that Ebola was contained in Dallas.

[uppityperson]

1. Wouldn't that be nice. And the woman in Spain, now they say she was a volunteer assistant

with minimal training and poorly fitting gown/gloves, not a nurse. I wish her the best but it should be nurses taking care of people, not people like her.

[Warpy]

2. "People like her" are perfectly adquate for most things

but are going to need much better training in the use of barrier methods with contagious patients.

I hope she survives. I hope people who came into contact with her before she went in for treatment aren't doing the magical thinking thing that if they deny they're sick, they are not sick. I hope modern medicine can stop this thing dead in its tracks here and in Africa, although I'm not optimistic about the latter.

[uppityperson]

3. I agree, they are adequate for many things. But they are not nurses and saying they are is wrong

I hope she survives of course. My complaint is with media or wherever they get that she was a "nurse" as she was not.

[Bluenorthwest]

19. The first article I read called her a 'Sanitary Tech' and I was castigated on DU for saying

that a tech is not a nurse, a nurse is an actual professional title, not the word for 'woman who works in a hospital.
I asked if anyone knew what the duties of a 'Sanitary Tech' might be. That was deemed offensive.

[uppityperson]

27. I remember that, about the sanitary tech. Someone posted some job description from

somewhere of what that was, but there has not been much talk here about what she was. I reported an untrained doctor's assistant once for calling herself a nurse when calling patients, finally had to pull the liability thing to get the clinic manager to get her to stop, and tell her I was going to report to the state board that licensed professionals. "but she's acting as a nurse". No, she isn't and wtf.

Nurse is a professional title, earned by training, passing rigorous test, paying money for the licensing fee, doing continuing education to make sure they are knowledgeable on current things, etc.

I have asked that question also and have not gotten replies.

[Yo_Mama]

7. Tne problem wasn't with her "magical thinking" - it was the advice she was given by the hospital

She called and reported her first symptoms immediately, and was apparently told that it was nothing to worry about. She reported them to the hospital hotline.

[Warpy]

60. Read it again

I'm talking about her contacts.

[djean111]

4. Well, not so fast, sadly......

http://www.democraticunderground.com/1014915965
(Reuters) - A Texas health worker who provided care for the first person diagnosed with Ebola in the United States has tested positive for the deadly virus in a preliminary examination, a state health official said on Sunday.

The health care worker at the Texas Health Presbyterian Hospital reported a low-grade fever Friday night and was isolated and referred for testing, the Texas Department of State Health Services said in a statement.

"We knew a second case could be a reality, and we've been preparing for this possibility," said Dr. David Lakey, commissioner of the health service.

The first person in the United States diagnosed with Ebola, Liberia citizen Thomas Eric Duncan, died in an isolation ward of the Dallas hospital on Oct. 8, 11 days after being admitted.

(link to article provided at DU post)

[Savannahmann]

5. Or something

Close. Very close though.

[Yo_Mama]

6. The morning fog just burned off and revealed an ominous cloud in the sky

Just like the OP, I was counting down the days.

It is likely that the incubation period is dependent on the degree of first exposure - i.e. a very small first exposure should take longer to generate the first overt symptoms of illness, but it also means that the patient's body has longer to generate an immune response. We have a week to go to end the period for the family, and more than two weeks to go to end the period for those exposed during his final hospital stay.

With one more known infection, we have three moire weeks for all those contacts.

The mathematics do not favor us here. We're going to have to get better at this fast.

[pnwmom]

37. More than three weeks to wait with the 2nd infection -- three weeks from any individual's

LAST exposure to this new individual, as long as s/he's contagious.

[Yo_Mama]

59. Correct, but now we will hope for no further hospital contagion

Because I think now they are getting serious about decontamination.

Still, it's not impossible that there are other cases among those who cared for Duncan. They are still waiting on the results of the Spanish chain.

Supposedly the ER at Texas Presbyterian is no longer accepting patients, so maybe they are working their way through the hospital.

At best, late November before we can be sure this transmission chain is stopped.

[pnwmom]

64. I'm guessing they closed the ER because they're observing the staff members

for possible Ebola infection.

What a disaster.

[Yo_Mama]

72. Shocking - and terribly bad news for future cases.

What more can we say?

In a way, it is possible that we were a bit lucky to have this happen early. It gives us time to rethink. But the rethinking is going to be shocking for the American public.

What is now being rethought is the feasibility of providing kidney dialysis and intubation/ventilation safely(AGPs), so future cases may not get the type of care Duncan got.

So in just a few short weeks, the US protocols are moving toward the "isolate" dynamic that is prevailing in Africa, rather than the "isolate and intensively treat" dynamic we were planning:
http://www.ft.com/intl/cms/s/0/b296bcee-522d-11e4-b55e-00144feab7de.html#axzz3Fy6i4sF0

Why we are letting potentially infected people in is now the question!

The bottom line is that we are not prepared. We have less than 100 beds in which it appears that high-level care can be safely provided. Maybe 150. We don't know.

If we treat intensively, we run the risk of knocking out our own healthcare infrastructure, because it is obvious that they are going to sequester a number of those involved in Duncan's care at Texas Presbyterian.

[LisaL]

76. Yep. The new cdc guidelines are about effective isolation while

providing minimal care.
I don't think new patients are going to get ventilators and dialyses.

[Yo_Mama]

80. Too dangerous.

But realizing that they are more dying wards than anything else isn't going to do much for morale. They'll be lucky to get IVs!

I told my family two weeks ago to get prepped up for home care if this thing takes off, and that's probably the best we can do. God help those without resources if things blow up.

[etherealtruth]

8. a healthworker may have become infected in dallas

(CNN) -

A health care worker at Texas Health Presbyterian Hospital in Dallas has tested positive for Ebola after a preliminary test, the state's health agency said.

http://www.clickondetroit.com/lifestyle/health/2nd-person-in-us-tests-positive-for-ebola/29075742

[LisaL]

9. Jumped the gun, didn't you?

Health care worker tested positive for Ebola. Was supposedly wearing full protective gear.
So we need to start counting 21 days from the day Duncan's body was cremated, not just from when he got symptoms.

[Savannahmann]

10. Perhaps we should start a poll on the over under.

How long until the OP is deleted by the original poster? BTW, I had to rec this thread.

[morningfog]

14. I don't self delete. The op is accurate.

[alcibiades_mystery]

20. Awwwwww.... Somebody got an alert time out!

On Sun Oct 12, 2014, 08:37 AM an alert was sent on the following post:

I don't self delete. The op is accurate.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5655104

REASON FOR ALERT

This post is disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate.

ALERTER'S COMMENTS

Refusing to edit or self delete a post is deliberately misleading DUers about Ebola. Sickening. (The OP claims no one was infected by Duncan; a health care worker in Texas was infected; OP says health care workers don't count).

You served on a randomly-selected Jury of DU members which reviewed this post. The review was completed at Sun Oct 12, 2014, 08:50 AM, and the Jury voted 0-7 to LEAVE IT.

Juror #1 voted to LEAVE IT ALONE
Explanation: I've seen a lot of inside-baseball, piddling alerts in my day, but this one really takes the cake. Alerter: get a hold of yourself. This is a message board.
Juror #2 voted to LEAVE IT ALONE
Explanation: alert police!!
Juror #3 voted to LEAVE IT ALONE
Explanation: No explanation given
Juror #4 voted to LEAVE IT ALONE
Explanation: If the OP is wrong people will figure that out for themselves.
Juror #5 voted to LEAVE IT ALONE
Explanation: No explanation given
Juror #6 voted to LEAVE IT ALONE
Explanation: Even if the OP were deliberately misleading, and it does not appear to be, that would not make this reply hide worthy.
Juror #7 voted to LEAVE IT ALONE
Explanation: No explanation given

Thank you very much for participating in our Jury system, and we hope you will be able to participate again in the future.

----------------------------------

[morningfog]

23. That's funny.

[LondonReign2]

47. They will alert on anything

I can guess which Ebola-is-going-to-kill-us-all poster made this alert.

[bigwillq]

66. Why would anyone alert on that post?

Misleading? Half of DU is misleading. LOL

[morningfog]

13. Not at all, reread it.

I specifically referenced the possibility of a health care provider.

It is still contained. No one of the general public has been infected.

[LisaL]

15. You don't know that, do you?

Incubation period is up to 21 days. That hasn't even passed yet.
We don't know that his contacts haven't been infected.

[morningfog]

17. The majority show signs at 7-10d days.

I would bet money none of his family ever show symptoms. They would have already.

[LisaL]

18. You also thought that health workers are almost certainly not infected.

You thought wrong.

[scarystuffyo]

31. Yeah don't quit your day job

[pnwmom]

36. And then another 21 days for this second patient -- although that really won't be the

extent of it, since it would really be 21 days after anyone's LAST exposure to the contagious patient.

[TBF]

11. Bumping this up -

new case in Dallas.

There was a comment from CNN that the affected worker had protective gear on. Not sure this has been confirmed.

The latest from Dallas: http://www.dallasnews.com/news/local-news/20141012-health-care-worker-at-presbyterian-hospital-in-dallas-tests-positive-for-ebola.ece

[randome]

12. The question no one is asking is...

...what happened to the vomit? Is our water supply infected now? I'll keep a close eye on my pet goldfish, Eric, and let you know what happens.
[hr][font color="blue"][center]I'm always right. When I'm wrong I admit it.
So then I'm right about being wrong.[/center][/font][hr]

[kestrel91316]

29. Urine, feces, and at least some vomit go down the toilet.

Wastewater treatment takes care of it.

But I sure wouldn't want to be a sewer worker downstream of the hospital before it hits the treatment plant.

[ChisolmTrailDem]

16. Oooor...maybe not. nt

[DemocratSinceBirth]

21. ???????

http://www.cnn.com/2014/10/12/health/ebola/index.html?hpt=hp_t1

[HereSince1628]

22. The nature of surveillance, nothing, nothing, nothing, something!

It's important to know that that something occurred

but, it'd be nice to steer clear of schadenfreude on this.

[distantearlywarning]

25. The danger of counting one's chickens at 14 days

When the incubation period is 21.

[morningfog]

26. Does no one do reading comprehension?

[kestrel91316]

28. The 21 day count starts when they put him in hospital isolation

on the 28th. It should NOT end for the 4 in lockdown until 21 days after they left the apartment IMHO. And it does not end for Dallas and in fact the US until 42 days from the time this nurse went into isolation.

I'm not making this up. I'm just going by CDC guidelines.

ETA: Frankly I don't think anyone should cheer until 42 days after this nurse is either free of virus or cremated.

[LisaL]

32. In this case, 21 days should start after he was cremated and buried.

Nurse who got infected was apparently part of his treating team. Wearing PPE didn't protect her. That's for primary infection from him.
The same would go for the nurse. 21 days should start when she either recovers or cremated and buried.

[pnwmom]

34. You got it. n/t

[morningfog]

38. Absolutely, for the health care providers with direct contact. Not the family, or first responders.

Or public at large. The OP distinguishes the various classes at risk.

The nurse breached protocol, unfortunately.

[kestrel91316]

43. Anyone who had any contact needs to count 21 days from that contact.

The 42 days is a community protocol to ensure against any undetected secondary cases spreading it to tertiary victims.

[pnwmom]

35. Actually, the 21 days is different for every person who was exposed to Duncan.

It's based on each individual's LAST possible exposure to Duncan (which will vary, depending on the person), not based on when he first became contagious.

[magical thyme]

83. they are now monitoring the other healthcare workers

so not only this nurse, but the rest of the staff that had contact must clear 42 days.

They finally are recognizing that standard PPEs are not necessarily enough.

[philosslayer]

30. Your post is inaccurate

Specifically your last sentence. There is no reason to believe Ebola was contained in Dallas, as officials now have to monitor all contacts the health care worker had. The clock begins anew.

[morningfog]

39. The 2nd infection is of someone who has been under strict observation,

taking temp twice a day.

There is no risk that she infected anyone yet. Again, there is no risk to the public at large. She is isolated and the risk of infection is to those providing her care only.

Her case is much more contained than Duncan's, who did not infect anyone outside the quarantine.

[LisaL]

40. She wasn't even considered to be at serious risk.

Or one of the primary contacts. So I am not sure what you mean by strict observation?
She was staying at her home, not in isolation somewhere. Up until last two days, she was working in the hospital.

[morningfog]

42. She was taking her temp teice a day. That is strict observation.

They caught it because of her temp taking regime. And she was quarantined.

Why does everyone want so badly to make this worse than it is?

[LisaL]

44. That's not strict observation.

That's self monitoring.
There is no need to make it worse than it is, it's already very bad.

[morningfog]

46. And is the way to catch it before she is contagious.

It worked.

“It appears at this time that there is only one (person) who may have had contact with her,” Frieden said. “That individual is under active monitoring.”

http://www.ajc.com/news/news/local/cdc-chief-frieden-more-ebola-cases-possible/nhhBr/

[LisaL]

51. So that person she was in close contact with doesn't count?

[morningfog]

52. Not in actuality. She had such low levels and was not puking.

On edit: It is possible that they were having sex, so there is that.

[LisaL]

54. This person is in isolation in the hospital.

So obviously his/her level of exposure is not considered minimal or impossible.

[morningfog]

56. I don't know who it is. Maybe her sexual partner?

That would make sense to watch them, out of an abundance of caution. Still, her levels were very low, she had no other symptoms. They caught her at the point were Duncan was sent home. He didn't start vomiting until four days later and it appears he didn't infect anyone during that time. Not even the person he was sharing a bed with, and not even with his sweat.

[pnwmom]

33. Spoke too soon, didn't you? Your problem is that the 21 days did not begin on Sept. 24 or

even Sept. 26 or even Sept 28. It began on the day Duncan died (or hours later, for anyone handling his body and/or fluids).

The 21 day incubation period isn't counted from when Duncan first became contagious. The incubation period is counted differently for every exposed person -- ever family member, health care worker, or other exposed person -- depending on when THAT person last had contact with Duncan. A person who is exposed to the virus has a 21 day incubation period before they might become ill -- and contagious -- themselves.

[morningfog]

41. Re-read my post. Reading comprehension is important.

I have no problem. I specifically said there was still a clock running on the health care providers and referenced the Spanish nurse. Maybe you didn't read it?

I clearly addressed the various classes, and time periods, of the groups who were exposed.

The point of the OP, which has not been contradicted, is that it becoming quite clear that despite the bemoaning and fear peddling, Duncan's family was not infected. The first responders we not infected. The guys hosing the vomit were not infected. No person on the bus, at the store, etc was infected. As has been the case with everyone who has been infected, the nurse was infected by direct contact with Duncan when he was severely ill.

And the nurse was taking her temp twice a day. She is now in isolation prior to being contagious, for all intents and purposes. It is still contained. Now, hopefully, everyone treating her will follow protocol and hopefully she will recover.

[LisaL]

45. It hasn't become clear because 21 days have not passed.

Furthermore, you claim that Ebola is most likely contained in Dallas (which was a point of your OP) is clearly WRONG.

[morningfog]

48. It's been 18 and the vast majority show signs at 7-10 days.

It has been 18 since anyone outside the hospital was exposed.

The nurse who was infected is now isolated. She could not, in reality, have infected anyone yet.

It is still very much contained.

[LisaL]

49. How do you know she couldn't have infected anyone yet?

Do you realize that her close contact has been isolated in the hospital also?
I guess not.

[morningfog]

50. She had very low levels of the virus.

It takes a significant build-up to spread. She also wasn't puking or bleeding anywhere.

This goes back to the larger point of the OP. YOU and a few other hair-on-fire posters were all bent out of shape that Duncan could have infected a large number of people before his isolation. He didn't. We are very close to saying that not one person was infected by him before his isolation. The reason is because it is very hard to catch the virus unless you are handling the bodily fluids of an ll and infected person.

That is why health care workers catch it at such a rate they do.

[LisaL]

53. OMG.

Nurse who was wearing PPE got infected. So what about the other nurses taking care of Mr. Duncan?
They potentially could be infected as well.
And the incubation period is not over for you to claim that Mr. Duncan didn't infect anyone before isolation.

[morningfog]

55. Of course the other nurses COULD be infected.

I have never said otherwise. If they breached protocol, it is possible. But still not likely. I feel very bad for the nurse. I hope she recovers and I hope no health workers treating her are infected either.

As for the others, outside the hospital, I would put money on them never showing signs. They are at 18-19 days. Looking very good.

[LisaL]

57. Breached protocol?

Infected nurse doesn't recall breaching any protocols.
So it would appear to be total speculation with intent of blaming the nurse for contracting Ebola.

[pnwmom]

63. They are NOT at 18-19 days. Count again. The family last had contact with him on the 28th,

and the niece bagged his infectious materials after that. And the worker outside sprayed the vomit in the parking lot even later.

And today is only the 12th.

[morningfog]

67. You are correct, I used the wrong number there.

We are at 14. 21 days will be next Sunday.

[magical thyme]

84. and the WHO and CDC don't count it as contained until 2 consecutive periods of 21 days

so until 42 days after the last patient either clears or dies, it is not considered contained.

[pnwmom]

62. He didn't get admitted till the 28th. That was 14 days ago, not 18 days.

The last day someone from the family was exposed to him was 14 days ago.

And the apartment wasn't sterilized for days; and the parking lot contained his vomit, which was sprayed by someone not wearing protective gear, days later.

[pnwmom]

61. It doesn't matter how carefully anyone reads your post. It's wrong.

You said:

It's been 2 weeks (14 days) since Duncan started vomiting, no signs of new infections [View all]

Just to keep track of the timing, it has been 18 days since he first had a fever (9/24/14). From the 24th through the 28th, he was not vomiting and was not likely to infect others. The incubation period from the 24th is quickly closing with no signs of any other person being infected. This is consistent with how the virus is known to spread.

Your subject line says "no signs of new infections." It doesn't address the family alone.

But as to the family, its exposure only ended whenever the last live Ebola contamination in the apartment ended, and no one knows exactly when that happened -- but let's pretend it was on September 28th, when Duncan finally got admitted to the hospital. Today is the 12th, so it's only 14 days after that day -- way too early to send up the all clear.

But that's assuming that the man who sprayed the vomit off the parking lot days later wasn't exposed, and that the virus in the apartment died right after Duncan left -- and we really don't know that's true.

And why is it so wonderful that the family hasn't tested positive -- yet -- when a health care provider in full protective gear DID get infected?

[morningfog]

65. How the hell is it not a good thing that the family has not shown any symptoms?

Especially when so many have been crying "IT"S AIRBORNE !!1!1!1111"

And emphatically saying it is easy to catch. That the family, who was living with him, has not shown symptoms is a very good thing. It is very good that we can keep it confined to the hospital. Now, we need to figure out where the protocol was breached or how training needs to change to protect the staff.

[pnwmom]

68. It will be a WONDERFUL thing, if and when it turns out that none of them caught this.

But it's too early to make any pronouncements on that.

[VanillaRhapsody]

58. the infection rate is 0/2....meaning he is likely to spread it to 2 more people....

that is the average....but compare it to Measles with has a 0/15 rating

[pnwmom]

73. That isn't a great comfort given the fatality rate. Look how fast it's spread in Liberia

with that same infection rate. They started with one case last April and now it's in the thousands.

[VanillaRhapsody]

74. Right but it shows you how you defeat it.....

its not the measles...

[pnwmom]

75. I wish it was the measles, since we have a vaccine for that,

and measles doesn't have a 70% mortality rate.

[ohnoyoudidnt]

69. It's possible there are cases we don't know about

Due to patient privacy laws

[morningfog]

70. I don't think so.

If there were other cases, it is a public health concern. They would let us know, while keeping identification protected.

[ohnoyoudidnt]

71. Ok, time will tell .

[cwydro]

77. Except for the nurse at the hospital.

And a possible case in Boston.

The nurse is positive for the virus. The other I don't know.

[morningfog]

78. My op predated disclosure of the nurse.

The Boston case would be unrelated, even if Ebola, which isn't known now.

[cwydro]

79. True, let's hope for the best.

My bad on not checking your OP date/time.

Apologies.

[magical thyme]

82. The countdown doesn't start with his vomiting. It starts with Duncan's death

and the safe removal of his body.

Healthcare workers were potentially exposed up until his death. And now there is a case.