Texas health care worker tests positive for Ebola

[cali]

A health care worker at Texas Health Presbyterian Hospital has tested positive for Ebola after a preliminary test, the hospital said in a statement.

Confirmatory testing will be conducted by the Centers for Disease Control and Prevention in Atlanta.

The employee helped care for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States. Duncan died on Wednesday.

"We knew a second case could be a reality, and we've been preparing for this possibility," Dr. David Lakey, commissioner of the Texas Department of State Health Services, in a statement Sunday morning.

<snip>

http://www.cnn.com/2014/10/12/health/ebola/index.html

[alfie]

1. I was so hoping this wouldn't happen

Wonder if it was from first or second trip to hospital.

[HereSince1628]

20. I wonder what position the healthcare worker was in...

I'm sure that's a known known at this time.

Just that training/education varies tremendously across healthcare roles. Folks with the less training can have substantive exposure risks.

It's preliminary and early of course but a risk of something of maybe a bit less than 1 in 100 for transmission to hospital staff in developed nations suggests in-service training and supervision needs to be done to lower exposure and tighten up hygiene.

Infection control isn't rocket science, but it takes discipline and it seems ebola is going to be unforgiving.


on edit... so an answer is available to this...cnn has it as a nurse.

[riverwalker]

26. all the training in the world

does not make up for inadequate equipment and supplies.

[seabeyond]

27. or one little simple natural mistake. nt

[HereSince1628]

41. Has this been blamed on bad logistics at the hospital?

One of my several anxieties about for-profit healthcare is the propensity of CFO's to generally advocate minimizing inventory and going with cheap-products.

[magical thyme]

87. yup. my lab switched from spring-loaded butterfly needles to manual retraction

to save money. Within 2 months, a co-worker with 12 years experience as a phlebotomist had a needlestick with a HCV+ drug addict.

I nearly had one a few weeks ago when a "helpful" patient decided he would press down on the stick before I'd removed the needle. He knocked my hand right out of his way and sent it flying with the needle totally exposed.

[adigal]

93. My friend is a very competent nurse and she said to me

that isolation procedures are only as good as the people doing them.

Not encouraging.

[magical thyme]

86. it was the 2nd trip, when they were interacting with him heavily

and doing more risky procedures, eg intubation, dialysis.

[SoCalDem]

2. This was probably someone who tended to him on his first visit

someone took his temp and someone probably checked his throat for strep.. This poor person had no idea how ill he was

[nitpicker]

4. We don't know that yet

Per the BBC http://www.bbc.com/news/world-us-canada-29587803

However, given the issues with the first visit, I wouldn't be surprised.

[adigal]

9. It was in the hospital where he died, which I think is different than the first hospital

I'm not 100% sure, but that is how I read it.

[LisaL]

30. No, it's not different. It's one and the same hospital.

[adigal]

94. Yes, you're right. Thanks for correcting. Nt

[SickOfTheOnePct]

12. I'm guessing that too

Which begs the question, since they did so very little for him there, i.e., taking his temp, looking at his throat, were they not practicing even the most basic protective measures when dealing with him on the first trip?

[seabeyond]

23. actually, the did more than a little. i have been concerned about the cat scan, and all

they people that have used it since. the upside though. he was not nearly as contagious then. when was not throwing up at that point. that would be the second visit.

[LisaL]

31. You are way out of line here. They didn't do very little for him there.

He got all kind of tests including a CT scan.
But this nurse was infected during his second visit, so your whole point is moot.

[SickOfTheOnePct]

35. Yes, I've since read that the nurse cared for him during his hospitalization

As for giving him a CAT scan, great.

Perhaps they should have skipped the CAT scan, listened to him when he said he had just arrived from Liberia, looked at his symptoms, and done a minimal amount of thinking, such as "Hmmm, stomach pain, vomiting, fever, Liberia" and isolated him while he was tested for Ebola.

My understanding is that there are some awesome hospitals in the Dallas area. If I lived there, I think I would utilize those rather than Presbyterian.

[LisaL]

38. Actually, during his first visit, it was noted he arrived from Africa.

Not Liberia specifically.
They never saw a case of Ebola before and didn't make the correct diagnosis.
Do you think doctors always make correct diagnosis from the start? If so, you are sadly mistaken.

[SickOfTheOnePct]

39. According to his relatives

He specified Liberia. Unless the actual paperwork is released, we'll probably never know if that is true or not.

And no, I don't expect doctors to make the correct diagnosis 100% of the time. But this man exhibited the classic symptoms of Ebola AND he had just arrived from Liberia. That should have immediately raised red flags.

[LisaL]

42. During the second visit, Liberia was specified.

And Ebola was immediately suspected.
During the first visit, nurse's chart noted he was from Africa. For whatever reason this was not even conveyed to his doctor.
Mr. Duncan also specifically denied being around anyone sick.
Considering the pregnant woman who died from Ebola, that he helped (according to his neighbors in Liberia), he clearly was around someone sick who died.
But he denied being around anyone sick.

[seabeyond]

44. no ebola in the u.s., busy er, flu symptoms during flu season.

and the man tells one nurse from africa, or liberia.

you think, if he had stated that he cared for a women that died, 10 days prior with ebola.... that might have helped with the puzzle pieces?

but hey.

throw out one word as a clue, to one person and hope they put a whole puzzle together.

why didnt he tell the doctor that came in the room, that he was from liberia dealing with sick people?

doctors walk in and immediately start asking questions. why? so they can competently diagnosis.

[SickOfTheOnePct]

47. Warnings about Ebola were not new

"We do not anticipate this will spread in the U.S. if an infected person is hospitalized here," CDC Director Tom Frieden said in a statement Tuesday. "We are taking action now by alerting health care workers in the U.S. and reminding them how to isolate and test suspected patients while following strict infection-control procedures."

http://news.nationalgeographic.com/news/2014/07/140729-ebola-america-disease-epidemic-africa-medicine-science/

This article was published on July 29, 2014. So, for at least two months prior to Mr. Duncan's first visit, word had been going out regarding the possibility of encountering Ebola patients in the U.S.

I just don't think it's unreasonable to expect healthcare providers to connect obvious dots. I don't think there was any malice or bigotry or anything else involved here - I think it was just shoddy care on the first visit.

[seabeyond]

49. you know what. i am really puzzled, at people that work so damn hard to "not get it"

[SickOfTheOnePct]

50. I'm puzzled as to what you mean

By people not getting it.

Just because someone disagrees with you doesn't mean they don't understand what you're saying. It just means they disagree with you.

[Jim Beard]

65. I read AlJezera news and was well aware of the growing infection and death rates in July too.

I was amazed at the number of people who had never even heard of the disease at all.

http://america.aljazeera.com/articles/2014/7/8/ebola-health-africa.html

[ctaylors6]

40. He "denied having been in contact with anyone sick"

according to the AP reporting of the medical records he obtained from the family.

And Presby is a good hospital. They did lots of testing on him. Maybe they shouldn't have taken him at his word that he hadn't been in contact with anyone sick. If he or his family were concerned about Ebola specifically, they should have said so.

[SickOfTheOnePct]

43. He denied that he had been around anyone sick when he left Liberia

Did he say the same thing at the hospital? I don't know, as I haven't read one way or the other.

And I agree 100000% with the notion that his family should have been yelling "EBOLA!!" if they had any notion that that could be what he had.

I guess I just believed that hospitals would be proactive in screening for possible Ebola patients, seeing as the outbreak in West Africa has been ongoing for months, is by far the worst outbreak in recorded history, and it was only a matter of time until someone arrived in the U.S. carrying Ebola with them.

[LisaL]

45. Per hospital records, he denied being around anyone sick to the doctors.

[kestrel91316]

57. Ebola guidelines kick in as soon as the word Africa coincides in with

a patient with a fever. The physicians ignored guidelines from CDC, probably because they think they know more than those stupid government workers. This IS Texas, you know.

[Jim Beard]

60. Yes

University of Texas Southwestern school of medicine. Huge operation.

[Ms. Toad]

21. The article says the second visit. n/t

[seabeyond]

24. they were not dealing with vomit and diarrhea the first visit. much less likely. nt

[Dreamer Tatum]

51. What are you talking about? I was assured they knew he had ebola

and sent him packing anyway. Because racism.

When did the narrative change?

(Prediction: "the hospital admin, safe at a distance, ordered the nurses and doctors to release him immediately&quot

[kestrel91316]

56. She took care of him when he was hospitalized and they knew he had ebola.

Frieden hinted she had been involved in his intubation and dialysis, and she apparently was extensively involved in his care for days.

[AngryAmish]

3. This is a disaster

The sound you just heard was a bunch of health care workers noping away from the infectious disease ward.

[WhiteAndNerdy]

5. Re: This is a disaster

[SickOfTheOnePct]

13. Hopefully that's not the case

but if it is, then they should lose their jobs.

[XemaSab]

15. You think health care workers should risk their lives?

Everyone I know who became a nurse did it because it's interesting and there's a decent paycheck. Dying of Ebola is not part of the deal.

[SickOfTheOnePct]

17. I think that if someone becomes a healthcare worker

They accept the risks and do the job that comes with being a healthcare worker.

"...because it's interesting and there's a decent paycheck" may be what it is most of the time (don't know, I'm not in healthcare), but only an idiot would go into healthcare believing that they'll NEVER have to treat someone that might have a dangerous, contagious disease.

Using your reasoning, Ebola patients should be stuck in a sealed off ward and left to die if no one wants to work with them.

[riverwalker]

29. bullshit

not just nurses will care for Ebola. You have lab techs, and nursing assistants making not much more than minimum wage. They are supposed to risk their lives and their families for 8 bucks an hour?

[SickOfTheOnePct]

33. If they accept the job

They should accept what comes with the job.

What is your proposal for treating Ebola patients if healthcare workers refuse to do their jobs?

[magical thyme]

88. what is your proposal? force them to at gunpoint? nt

[SickOfTheOnePct]

90. Not at all

Anyone that doesn't want to do their job and treat Ebola patients can turn in their ID and go look for another job.

I have complete confidence that the vast majority of healthcare workers will fulfill their obligations and care for their patients. Any that refuse should be shown the door.

[magical thyme]

91. a bunch have refused in Spain. Some called out; others cancelled their contracts.

I would agree with you if budgets, staff and materials hadn't been slashed to the bone. And if healthcare workers treating Ebola patients had the same gear that the BSL-4 hospitals have.

We use the cheapest needles, including some that greatly increase the chance of a needlestick. Twice in 3 years gram stain has permeated my gloves. Our lab coats are threadbare. They finally ordered "new" ones, and what we got were used, worn and all size XL or XXL in a lab of mostly tiny people.

We are short-staffed all the time compared to 3 years ago.

And it concerns me that they insist that standard precautions are all you need, when in the field you see them dressed in hazmat suits with a spotter to help them, and decontaminated with a bleach spray.

Same thing at the 4 BSL-4 facilities, where the patients were in plastic isolation units.

Ordinary hospitals do *not* offer anything like those levels of protection.

[kestrel91316]

59. They should ignore the possibility of a deadly disease and send the patient

away because they are afraid of a deadly disease????

Medical professionalism FAIL. What they should do is attempt to diagnose and treat the patient, while exercising safety precautions.

If they don't like that their job entails possible risk of exposure to patients with deadly diseases, they are in the wrong line of work, honey.

That's like me looking at a cat who bit its owner unprovoked, is salivating and twitching, and has blown pupils and a serious wobble in its walk, and saying "I don't want to hang onto this possibly rabid cat and follow established protocol because I don't want to incur any risk. I'll just send the cat home." If I did that, IMHO I should just be frogmarched out and shot.

[uppityperson]

63. it is incredible, what people are coming up with.

seriously wtf stuff

[magical thyme]

89. as a vet, you are vaccinated against rabies

and can get additional vaccination in the event of exposure.

There isn't an Ebola vaccine yet.

And there's a difference between being assured that standard precautions are all you need, and seeing the doctors and nurses in the field in the equivalent of hazmat suits with a spotter helping them to dress, and a decontamination rinse with bleach prior to undressing after.

[uppityperson]

62. I became a nurse knowing I would come in contact with deadly diseases and scary people

There are many different nursing fields, specialties, but working with sick people, we know we might catch what they have. Dying with HIV or Hep C or getting stabbed by a tweaker is not part of the deal, but always a risk that we know of.

It is interesting, a good way to work with and help people, and an ok paycheck. Dealing with people, illnesses, diseases is part of it.

[XemaSab]

83. But from a risk standpoint

I would wager that more health care workers have *died* from Ebola that they caught on the job in the last 6 months than have *contracted* HIV/AIDS on the job in the last 30 years. And that's with almost no PPE for HIV/AIDS.

Of course there's a risk working in health care, but the what, one in ten thousand? One in a hundred thousand? chance that you'll die of something you caught on the job in modern American medicine is way less risky than, like, being a farm worker.

[uppityperson]

84. I've a funny story for you.My first nursing job was medical floor of a hospital, I had x-mas eve off

I came back to work 2 days later and noticed most the staff were hobbling. It turns out a patient with unknown illness had Hepatitis A. They had their family bring in cheese, cut it up and arranged it nicely on trays for all the staff who had to work. Me and 1 other person missed getting gamma globulin shots in our butts, which everyone said was quite painful. All the nurses, nurse aides, all the different therapists, lab people, cleaning people, supervisors, everyone who worked on x-mas eve and x-mas who ate any of that cheese that was handled by the person with Hep A and potentially infected.

All those cookies and candies patients gave me over the years? Never ate them.

Nurses know there are risks in working with people.

[seabeyond]

25. wow. pretty damn insensitive. i think it take a huge amount of courage to face that possibility of

death in a horrible manner every day.

your dismissiveness of it is so very uncaring.

[SickOfTheOnePct]

28. I agree, it does take a huge amount of courage

And if a healthcare worker that is charged with providing doesn't have that level of courage, then they shouldn't be in that job.

Would you have supported healthcare workers refusing to treat AIDS patients? In the early days, contracting AIDS was a death sentence.

What do you recommend we do with Ebola patients if healthcare workers are permitted to say "Nope, I'm not working in that ward"?

[seabeyond]

32. there will always be those that step up. and there will always be those that are too fearful

and i will be impressed as hell with those who step up. i will understand about those that are fearful.

not a tough one buddy.

there is a video in video forum, 27 minutes by pbs on ebola doctors on the border. every day, they know it just takes one little mistake.

[riverwalker]

34. maybe an all volunteer force

will enter the rooms, I'll sign you up. No advanced nursing skills really are needed for ebola, just basic supportive care you would do for a relative.
We will give you the substandard cheap gowns, no shoe covers, and insufficient N95 mask, pat you on the back and shut the door.

[SickOfTheOnePct]

36. There is already an all volunteer force

All of the healthcare workers that voluntarily became healthcare workers. Did someone force them into this work? Was there a medical conscription that occurred that I didn't hear about?

No advanced nursing skills needed? Doubtful.

Substandard cheap gowns, no shoe covers, an insufficient N95 mask? Are you claiming that what's the healthcare workers at the hospital were/are using?

[seabeyond]

37. actually. the people who lost family volunteer to be the grave diggers in sierra leone.

distance. watching a half hour video from doctors at the border.... distance is the big one. very interesting video.

these people were walking into villages to get a hold of sick people. they could not wear protective, because it scared the villagers. and they became uncooperative. so, they defense, was keeping a distance from people, as they talked.

and vomit, spray with bleach and water.... always, the bleach and water.

[uppityperson]

64. That was quite a video, saw it last night also. So much fear, misunderstanding of basics like virus

viruses and bacteria, prevention of transmitting a disease, etc.

[seabeyond]

78. totally.... lol. i saw you over watching. and ya. it was very good,

just in the day to day. that allowed one to put it together rather easily. people need to watch.

and uppity

i have a son, very oh, high level on research. he is fascinated in the scientific aspect, as i am more the sociology of behavior.

i know we do not sit right on, with this issue. but... fact based in the disease, i think, that i love to see what you are thinking. ya know.

[Dreamer Tatum]

52. It really shows you how some people think about work.

Throughout this whole episode, there's been a presumption that doctors and nurses
don't care about anything or anyone, they're racists, they don't care about public
safety, they have no integrity or character, and they're just in it for a paycheck.

Tells you all you need to know about some people.

[SickOfTheOnePct]

53. I can tell you for certain that I've never believed any of those things

But when someone posts something like (and I'm paraphrasing here) "my nurse friends are in it because it's interesting and the pay is good" as a reason why someone should be able to refuse to provide care, it certainly makes it seems as though those particular people "... have no integrity or character, and they're just in it for a paycheck"

[seabeyond]

67. that realy is what is bothering me so much with this. create these people as is being. no quarter

at all

busy er, no ebola in u.s. ever, flu season, and the man said nothing, but.... africa or liberia to ONE nurse early on.

doctor always ask tons of questions. yet nothing said.

cat scans, blood drawn. all kinds of people talking to the man, interacting. and nothing.

and those DAMN doctors, insensitive, horrible, racist, poor hating, greedy nasty people. ..... how dare they fear for their life now.

it is so beyond absurd in reasoning. it .... surprises me.

i feel NO animosity for duncan. i empathize with the plight he was in. i am sadden by the sorrow of the loss for all the family. we can actually hold parallel thinking.

[PuraVidaDreamin]

6. How many people did

This person come into contact with? Friends, family, patients, commuters? Grocery carts, money??

[mfcorey1]

7. Oh my!

[SickOfTheOnePct]

14. Unless they came into contact

after the person became contagious, it doesn't matter.

I have to believe that everyone that had been treating him was under close observation for symptoms and would be isolated immediately upon symptoms being displayed.

[mucifer]

46. Yeah it looks like she came in to the hospital with a low grade fever and

no other symptoms. I hope that means it is more promising that she will recover.

[SickOfTheOnePct]

48. I agree

Apparently, everyone that has been involved with treating Mr. Duncan is on a strict self-monitoring protocol.

[kestrel91316]

69. After she developed a fever? Probably her husband and

no one else. I doubt she is a complete idiot. She was SELF-MONITORING FOR EBOLA.

[HereSince1628]

73. There was also mention of a pet.

Not much is known about alternative hosts
various monkey species, chimpanzees, gorillas, baboons, and duikers are natural animal hosts for ebolavirus Footnote 1 Footnote 2 Footnote 5 Footnote 22 Footnote 23 Footnote 24 Footnote 25 Footnote 26 Footnote 27 Footnote 28 Footnote 29 Footnote 30 Footnote 31.

Serological evidence of immunity markers to ebolavirus in serum collected from domesticated dogs suggests asymptomatic infection is plausible, likely following exposure to infected humans or animal carrion Footnote 32 Footnote 33.

The Ebolavirus genome was discovered in two species of rodents and one species of shrew living in forest border areas, raising the possibility that these animals may be intermediary hosts Footnote 34.

Experimental studies of the virus have been done using mouse, pig, guinea pig, and hamster models, suggesting wild-type ebolavirus has limited pathogenicity in these models Footnote 35 Footnote 36.

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

[adigal]

8. This was in the hospital where he died, not the first hospital

But don't worry - they told us that their isolation procedures are foolproof!

http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?hp&action=click&pgtype=Homepage&version=LedeSum&module=first-column-region&region=top-news&WT.nav=top-news&_r=0

[boston bean]

10. There is a difference?

Thought he only went to Presbyterian. Discharged then admitted later. Same hospital, no?

[Yo_Mama]

19. You're right, just one hospital involved. n/t

[adigal]

92. You are right, I'm wrong

Thanks for clearing that up. I thought I read they were two different hospitals, but they are not. That makes me feel better.

[SickOfTheOnePct]

11. It's the same hospital

He only went to one hospital, or at least that's what's been reported

[Blue_Adept]

16. Close all flights out of Texas.

Time to lock down the state.

[MoonRiver]

18. Could become more dangerous than Liberia!

[In_The_Wind]

22. Block the highways.

put a dome over it





I keed
I keed

[kestrel91316]

70. Yep. Especially since it's mostly the red-staters frothing at the mouth

about closing borders.

Don't let your diseased vermin come to California, asshats.

[cherokeeprogressive]

76. Very intelligent... let's remove the #2 GDP by state from the economy! That'll teach er... someone!

The #6 state ranked by GDP produces less than half that of Texas, and it goes down drastically from there. Man, that's gotta burn the asses of some Texas haters huh? Here's an illustration of what the 50 states produce relative to those of the rest of the world. Where does yours fall?

[Blue_Adept]

85. I hate the fact that unless you use the sarcasm tag, nobody can figure it out

Folks take things way too seriously.

[FarPoint]

54. CDC claiming a breach in protocol...

Yet, no idea at what step and when...Are they blaming the nurse here?

[brentspeak]

55. Sounds like they're blaming the nurse and/or the hospital

CDC has already been proved wrong multiple times since this story began.

[FarPoint]

61. The CDC is all about textbook protocol without including realization.

This line of leadership is easy when sitting hundreds of miles away.

[seabeyond]

79. because there will ALWAYS... be human error. and it can be fatal. MOST of us, recognize that

"phenomenon."

not really addressing only you brent, but....

shit is going to happen. better recognize, so we can address as it happens. instead of being aghast that someone made a mistake.

[hedgehog]

58. Wait a minute - they gave him a CAT scan to rule out appendcitis?!?!?

but missed the note on the chart that he'd just come form Liberia?

How does this hospital react to other, more likely and very contagious diseases such as MRSA?

[uppityperson]

66. And from how the stories about MrDuncan's er visits changed? I don't trust them one hoot.

[mia]

68. Infectious diseases: "Specialists say the greatest risk comes from taking the gear off."

This individual was following full C.D.C. precautions,” Dr. Varga said, adding, “Gown, glove, mask and shield.” Asked how concerned he was that even after those precautions the worker tested positive, he replied, “We’re very concerned.”

Dr. Thomas R. Frieden, the director of the federal Centers for Disease Control and Prevention, said, however, that the latest report indicated a clear breach of safety protocol at the hospital....

The case also raises questions about whether the protective equipment recommended by the C.D.C. is adequate, and whether health care workers in American hospitals are receiving enough training and supervision in using it properly.

The protective gear is meant to keep the patient’s body fluids from coming into contact with health workers’ skin or mucous membranes in the eyes, nose or mouth. But even if the gear seals out the virus, it can become contaminated, and health workers can infect themselves if they remove it improperly and touch the outside of it. Specialists say the greatest risk comes from taking the gear off. It is supposed to be peeled off layer by layer according to a strict protocol, with a helper supervising and disinfecting parts of it at certain steps....

http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?_r=0

[hedgehog]

71. "with a helper supervising and disinfecting parts of it at certain steps...."

Was this step followed?

[AverageJoe90]

74. Unfortunately, it does appear there has been some sort of mistake.

And that mistake could prove fatal.

[customerserviceguy]

75. Good point

And since the questionnaires that people travelling from West Africa ask about "did you use protective gear at all times when seeing people with Ebola" they are thus completely ineffective at preventing its spread from there. Revising the question to "did you always fully, completely follow protocol 100% of the time" means nothing, because I'm sure that everyone using protective gear feels that they did the job adequately enough to protect themselves.

Travel bans will be the only way to contain this so that we can deal with it most effectively at its source. When hospitals in cities all around the world hoard protective gear, there won't be enough for those who will go to West Africa to attack this disease at the place where it is the greatest problem.

[LawDeeDah]

72. A hero.

This is what a hero is, not some jerkoff that gets paid a million bucks for throwing a freaking ball around.

May she heal well and fast.

[seabeyond]

81. ya. i agree. you gotta go in and watch the 27 min PBS doc on the doctors on the border....

sitting up the ebola clinic, and a day to day'ish of experience. very informative. and it allows ones to see, the brave.... and the hero. and risk.

[Jim Beard]

82. Yes, these are the health givers who deserve the good pay and more.

The greedy medical shysters need a monetary attitude adjustment.

[herding cats]

77. I hope they're going to be alright.

The good news is if it's caught early then they'll have a better chance at surviving the illness. Hopefully they'll be able to apply for compassionate treatment with one of the experimental medicines and get it approved more quickly, too.

I'm wondering if they should be transferred to one of the more specialized facilities for infectious diseases in the country. I'm sure the hospital in Texas was trying to be as safe as possible, but they still managed to make a mistake. Maybe it would be better to send this patient out before their viral load makes them more contagious and place them in a hospital better trained in these matters?

[Jim Beard]

80. One thing about this situation

I doubt anyone will miss it again unless the care givers are lied to. I suspect the man that dies knew he would get it and could be treated for it in the USA.