Healthcare worker was wearing CDC approved protective gear.

[Savannahmann]

That's what I'm getting from the news this morning. While we don't know the method of transmission, according to the first reports, the worker was wearing the protective gear.

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

The health care worker at Texas Health Presbyterian Hospital in Dallas who preliminarily tested positive for Ebola and was involved in the care of Thomas Eric Duncan was wearing protective gear, Texas Health Resources chief clinical officer Dan Varga said Sunday.

[NutmegYankee]

1. It could be as simple as the Spanish case.

Simply touching the face with the gloved hand during a season known for nasal irritation.

[Savannahmann]

6. The problem I have with that excuse is it doesn't make sense.

They cleaned the room, the Spanish nurse helped clean the room. Almost certainly using chemicals to kill the ebola virus. That's the situation. Then after cleaning, she may, may have touched her face with her gloved hand.

So the chemicals they were spraying around, the UV lights they were presumably using, and yet enough Ebola was left viable to remain on the glove while she went to the room where she would change out of her protective gear. Then presumably Ebola worked it's way in through her skin, or migrated into her nose, from the surface of her skin, all the while having been exposed to things designed to kill the little bugger.

Um, OK.

So after wiping down every surface with bleach or some other disinfectant solution, we think some ebola remained on her glove.

[LisaL]

7. From what I read, one time she removed the patient's diaper, the other time she removed patient's

belongings.
She wasn't in charge of cleaning the room as far as I can tell.

[Savannahmann]

9. I've read she cleaned it.

Here's one link.

http://elpais.com/elpais/2014/10/08/inenglish/1412761626_527533.html

Her last job was to clean García Viejo’s room after his death. When the first Ebola patient to be treated at Carlos III, Miguel Pajares, died in August, the room was cleaned out by a robot that belonged to the same US company that cleaned the Washington DC central post office after the 2001 anthrax attacks.

[yardwork]

18. She may have been exposed before she cleaned the room. We don't know exactly when she was exposed.

If she handled bodily fluids and then touched her face, she could have deposited the virus directly into her nose or mouth. It's very easy to do. We touch our faces all the time without thinking.

I read that she had not received much training. In the U.S., health care and law enforcement personnel receive intensive training about how to avoid transmitting blood borne pathogens. It's not as simple as telling people to put on gloves and handing them bleach. There are a lot of ways to accidentally infect yourself or others. There's a protocol for removing the gloves, for instance. It's very easy to contaminate your hands while removing the gloves.

[Ms. Toad]

21. It doesn't say that was her only contact with him -

just the last job she did.

This article says she had contact twice:

In one case, she entered the room to change his diaper; another time, after he had died, she entered to collect his belongings, according to Mercedes Vinuesa Sebastian, Spain's public health director. Both times, the nurse wore personal protective equipment.

http://www.washingtonpost.com/news/to-your-health/wp/2014/10/07/after-nurse-contracts-ebola-spanish-health-workers-raise-concerns-about-protective-equipment/

[kestrel91316]

34. All that needs to happen is a single virus particle coming into contact with

mucous membrane of the eye, nose, or mouth. No mysterious "working its way through skin", though a microscopic cut/scrape is also vulnerable.

[Demsrule86]

60. Sneezing and coughing release droplets which is how 'flu' is caught

How is Ebola different?

[Demsrule86]

59. It is much more contagious than reported

They pretended this was like aids....body fluids etc...but it is transmitted like regular flu from what I can see and may be even more contagious...with a fatality rate of 70% we need more honesty about this.

[TBF]

2. Someone on CNN suggested that a few regional centers

are going to have to be set up to handle these patients. Getting them there without infecting others will be the trick. There are bound to be more cases whether we "seal" borders or not.

It will be interesting to see how this is handled to say the least.

[hobbit709]

3. If not properly used and proper procedures not followed it's not all that "protective"

[WinkyDink]

5. Well, DUH. Except there is no evidence as yet for even mentioning this.

[hobbit709]

8. And there's even less evidence that the virus magically got through all the protection.

Having experience with Haz-Mat tells me that all it takes is one little slipup and all that protective gear has been bypassed.

[Savannahmann]

10. Um. Yeah.

http://www.cnn.com/2014/10/08/world/europe/qa-ebola-spain/

"There are protocols that if you follow carefully, you diminish greatly the likelihood that you're going to get infected," explained immunologist Dr. Anthony Fauci, of the U.S. National Institute of Allergy and Infectious Diseases.

http://www.merriam-webster.com/dictionary/diminish

Diminish, not eliminate. Even if you make no mistakes, there is no guarantee.

[WinkyDink]

15. You grasp at your straw, and I'll sip at mine.

[hobbit709]

17. Sluuurp!

[etherealtruth]

11. Sadly, protection is only acheived

...when EVERYONE utilizes the gear appropriately and follows procedures precisely (this requires training and practice). I am surprised they are not doing this in teams (one person watching the actions of another to prevent contamination via reflex activity (scratching an itchy nose) and helping to insure policies and procedures are strictly followed.

[hobbit709]

13. One of Murphy's Laws.

It's impossible to make things foolproof because fools are so damn ingenious.

[etherealtruth]

20. Unfortunately, any one of us can act foolishly

...without appropriate ONGOING training and practice

[hobbit709]

23. Even with proper training and practice it only takes one little slip and it all becomes worthless

And even downright deadly. I've seen it happen.

[etherealtruth]

24. So have I (seen it happen) ....

.... mercifully, without deadly consequences

[SickOfTheOnePct]

4. Protective gear is a good start

But it has to be taken off properly, sanitized properly, etc.

[etherealtruth]

12. Exactly ....

.... there needs to be adequate training, practice and supervision!

[HereSince1628]

19. Yes, the discipline to properly implement the use of the gear

is hugely important. Lack of discipline is how Duncan got turned away the first time.

Western hospitals learning through experience what it means to 'get disciplined' is looking to include unforgiving harsh lessons.

I hope the transmission wasn't due to some corner cut to meet in the least expensive way to meet the CDC recommendations, or that it involved a minimally trained low-level person being put in a circumstance they didn't fully understand.

[Yo_Mama]

14. Emory & Nebraska setups are far more intense

And workers are fully trained in the precautions.

It's not as simple as just wearing the gear, first. You have to have several layers of protocol for exiting the gear. Also at Nebraska, for example, there is a much higher level of protective gear used. I believe there are only three hospital setups such as that in the country, and they are very limited in the number of patients they can handle. Nebraska can only handle 10 or 12 at most.

More about Nebraska:
http://www.nebraskamed.com/biocontainment-unit

So, for example, in Nebraska staff treating Ebola patients were wearing whole-body suits. They have been drilled in the decontamination procedures and in getting out of the suits.

I think there is evidence for Ebola transmitting skin-to-skin, so I think whole-body suits are necessary for acutely ill patients. The mask/goggle thing is not going to be sufficient always - the skin needs to be entirely protected.

The reason why Ebola is so infectious under certain conditions is that it only needs to get into ONE of your cells to start replicating.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581432/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491695/

Very small point mutations in this outbreak may be facilitating the spread.

[ileus]

22. do folks actually believe the infected dr's were all having sex with their patients?

[distantearlywarning]

25. Some of them believe

that the doctors were wading barefoot through piles of feces with cuts on their feet.

You can only get it through direct contact with someone else's poop and you have to have an open wound - this is what we have been told by DU'ers who are very concerned that people not "panic" (i.e., have discussions about Ebola). They couldn't possibly be wrong, could they?

Or, let's see - that it's harder to get than HIV (because health care workers are TOTALLY in grave danger of coming down with HIV when they spend time in an HIV-positive patient's room or when they touch an HIV-positive patient's stuff and then touch their face.)

Or, that Ebola is so hard to get that nobody should ever worry about being in the same space as a symptomatic Ebola patient, but also that the only reason gloved, shielded, and gowned nurses have contracted it is because they failed to follow every step of a complex medical protocol to the letter (See? Nothing for the average non-gloved, non-shielded, and non-gowned citizen to worry about!)

Just for the record, I am not the slightest bit concerned about personally getting Ebola. My hair is not on fire, there is no screaming or shouting, I spend days on end not thinking about Ebola at all. I am not buying an Ebola kit from natural news (or whatever that dumb woo woo website is), and I would be perfectly fine taking a business trip to Dallas if I were asked to go there. Also, yes, I got my flu shot this year. However, I also have never believed that denial, downplaying actual risk so we can feel better emotionally, or refusing to even discuss things is a good way to prepare for possible negative outcomes. Let's talk about Ebola some more, before more cases arrive on our shores, so that we are better prepared to deal with it as a society than we were with the Dallas case. Let's talk about Ebola some more, so that we can get more momentum toward dealing with the problem in Africa, before it infects 1.4 million people (the epidemiologists' forecast for the next few months)*. Let's not just whistle past the graveyard and assume it will all work out fine because "Ebola is so hard to get".

*Someone on Discussionist (of all places) made the analogy about the Ebola epidemic that we are like people living in a house a few streets over from a wildfire. Right now the fire (in Africa) is small, but a couple of sparks still drifted over our way (here in the US) and we had to run and put them out before they started a fire on their own. Luckily, we have sophisticated fire containment measures over here on our street, so it's not a big deal yet. However, if we wait and refuse to do anything about the fire a few streets over, eventually it will grow bigger and bigger. And the bigger it gets, the more sparks will drift over our way. Eventually we will be spending a lot of time and resources running around having to put out all the sparks that are landing in our yard, and the likelihood grows that we will miss one and it will start a real fire on our street too. It would be much better to just loan some of our fire-fighting equipment to our neighbors now to prevent having to deal with all those sparks later.

[Mojorabbit]

36. + a gazillion. nt

[magical thyme]

61. +a trillion. nt

[laundry_queen]

63. Excellent post. nt

[seabeyond]

33. wtf? the nurse in spain, without thought touched her face. ooops. can = infected. nt

[still_one]

26. Some protocol was not followed

[scarystuffyo]

27. CDC has assured us Ebola not very contagious

[LisaL]

29. But you can get it while wearing full protective gear.

Go figure.

[LiberalArkie]

28. I would highly recommend that everyone watch this. It really is simple

http://www.democraticunderground.com/1017220126

[seabeyond]

32. it is. i did. it was very very informative. an excellent watch in better understanding. nt

[riverwalker]

30. Ebola Spread Shows Flaws in Protective Gear and Procedures

(Yet the CDC is not recommending this protection for nurses. The guys who cleaned up the apartment in Texas had better protection then the nurses who performed Dialysis)

http://www.scientificamerican.com/article/ebola-spread-shows-flaws-in-protective-gear-and-procedures/

•Rubber surgical apron
•Surgical trousers and tunic
•Wraparound protective goggles
•Antifog spray (for goggles)
•Gloves
•Rubber boots
•Hood
•Cape
•Respirator mask/face protector

[seabeyond]

31. t took a couple days, for the nurse in spain to pin point, where she probably got it.

so many of our movements and actions are automatic. i imagine this is would be they challenge. at one point she touched her gloved hand to her face, without thought. like an itch, or whatever. cover mouth with a yawn or cough, ect....

over time, i think we will learn more. when there is time to go thru actions.

[uppityperson]

47. seabeyond, she was not a nurse, not a professional, but an inadequately trained unlicensed volunteer

As a professionally trained and licensed nurse, I appreciate when people do not refer to assistants like she was as nurses. Thank you.

[seabeyond]

48. and this was THEIR first. and you learn. and people will continue to make mistakes because...

they are people. and they will die. a few will not.

and i believe. it will easily be contained. we in no way, have the same environment i watched in sierra leone last night.

[uppityperson]

49. Indeed, we do not have the same environment at all.

[SheilaT]

35. Expressing it that way, that the worker was wearing the approved protective gear,

implies very strongly that Ebola is a whole lot easier to get than is being said. No. It's hard to use the protective gear with absolute 100 percent perfection. It is the removal of that gear that is the weak point in the system, and all it takes is a very tiny amount of the virus to get the disease.

Some other diseases require a whole lot more of the virus to get into a person for that person to get sick. Which is why when some idiot goes to work with a cold or the flu not every single person in the office gets a cold or the flu. Or that my older son, back before the chicken pox vaccine, went through three separate bouts of chicken pox outbreaks in his classrooms over two years, before he finally contracted it.

[Savannahmann]

37. So one little element. One single strand if you will.

One single strand, and you've got it?

[SheilaT]

40. Basically, yes.

And it is quite deadly, killing half or more of its victims.

It is probably that the reason Duncan died was because he was sent home even though he was already symptomatic, and was very sick by the time he returned to the hospital. It's possible that nothing at all could have saved him, even the blood or plasma from others who have recovered. We will never know.

It does look as if getting people into hospital and treating them as quickly as possible, meaning at the first sign of symptoms, may save most people. But if by some horrible chance we get a few dozen, let alone several hundred, people sick here with Ebola, our ability to properly care for them will not be as wonderful as it is right now when we've had what? three people so far? No, four, because there's the camera man.

And care can be crucial, even in far less deadly diseases. Influenza, for example, is something that the vast majority of people are going to survive just fine. But if, for instance, everyone in the household is sick with flu at the same time, and there's no one available to fix a little food, to make sure that the sick ones get fluids, then more will die than would if only one person is sick at a time. I remember reading somewhere about the 1918 flu epidemic, and that was one thing that was pointed out, that in that epidemic (pandemic because it was world-wide) so many people were sick at once, that even minimal care wasn't happening for a lot of people, and so they died. Now I'm not discounting the fact that it was a particularly virulent strain that time, but when there's no one well enough or available to help, there will be many more deaths than might otherwise happen.

[HereSince1628]

41. experimentally, 1-10 in an aerosol exposure are enough

in a non-human host...according to the Canadian public health service

[Yo_Mama]

38. Several interesting articles with general background

I thought I'd post them here rather than in a new thread:
1) Emory doctor discussing treatment and PPE used with their two patients:
http://www.scientificamerican.com/article/ebola-doctor-reveals-how-infected-americans-were-cured/

Note that they said they followed CDC guidelines but that nurses with a lot of contact perhaps used hoods (which would be easier to manage and to properly remove).

2) Background article on the genetic work done earlier in the outbreak, which documents human-to-human transmission and discusses mutation rate:
http://www.dallasnews.com/news/local-news/20141009-patient-zero-believed-to-be-sole-source-of-ebola-outbreak.ece

Five of the named authors are dead already.

3) Better timeline for Duncan - note that he denied to doctors even at the second admission that he had been around anyone ill. He knew he had, because the poor lady died. Was he already disoriented?
http://bigstory.ap.org/article/17b709cea02d445d9ca2e462bebe37bb/ap-enterprise-records-chronicle-duncans-decline

He got brincidofovir (I can't spell this damned word - hope I got it right this time) on the 5th. FDA cleared on phone app from the doctors, which is how it is supposed to work.

There is more detail on the brincidofovir at this blog:
http://www.virology.ws/2014/10/09/treatment-of-ebola-virus-infection-with-brincidofovir/

I still think that's a hail mary type thing which is unlikely to work, but it would be wonderful if it did.

There's a doctor in Africa who is trying Epivir (lamivudine), an HIV drug. he says 13 out of 15 patients have survived. Epivir can be pretty toxic.

http://www.npr.org/blogs/goatsandsoda/2014/10/10/355164328/a-liberian-doctor-comes-up-with-his-own-ebola-regimen

[herding cats]

39. In other news water is wet.

Of course they were. An error was made in the process at some point though. Once the sick person has built up a high viral load they're highly contagious. Extreme caution is required to make sure the virus isn't spread at that point. They made a tragic mistake and this health care provider is paying for the mistake.

I'm wondering if this latest patient shouldn't be removed from this hospital and sent to one of our US facilities where they're better equipped and trained to deal with infectious diseases of this type. I'm not trashing the hospital, but the reality is one health care worker there did manage to contract the disease even through their precautions. Which isn't something which has happened with the other patients brought into the US.

[LisaL]

42. Yes, they should have moved him to Emory, Nebraska, or one of the other two hospitals

designed for biosafety level 4 virus.
But CDC is insisting regular hospitals can handle Ebola.
Sure doesn't sound like that to me.

[herding cats]

46. The hospital made the same claim they were capable of handling the Ebola case.

Which they should have been, just as the other healthcare workers caring for the Ebola patients here have been, if they would have followed strict protocol. Which is actually difficult, but not impossible to do.

This is what I just read a spokesperson for the hospital said today:

"We are confident that the precautions we have put in place will protect our health care workers," said Dr. Daniel Varga with Texas Health Presbyterian Hospital.
http://abcnews.go.com/Health/breach-protocol-led-ebola-diagnosis/story?id=26135108

I admit I may have to rethink my not wanting to lay blame on the hospital after that statement. If one of the hospital's staff wasn't sufficiently trained and accidentally broke protocol, they need to rethink their level of confidence in themselves. Or at least admit the possibility that they are in over their heads.

[LisaL]

52. Mr. Duncan was put on dialysis and ventillation.

Both high risk procedures for spreading the virus.
Could the cdc guidelines be inadequate for such procedures?

[AverageJoe90]

43. I hate to say this, but the latest reports appear to be making it clear.....

That, sadly, she made a mistake in taking it off.

[LisaL]

44. They are just speculating.

Nurse doesn't recall any breach in procedure.

[AverageJoe90]

45. I'm sorry, but that is almost certainly how it happened.

It doesn't really matter if the nurse recalls any breaches or not. Ebola only spreads thru direct contact with either a victim, or their bodily fluids. I am not ruling to rule out a certain few other possibilities, but they are rather miniscule.

[LisaL]

50. Shouldn't you postpone ruling things out, until you know how she got infected?

Mr. Duncan was put on dialysis and ventilator.
Apparently these are very high risk procedures for exposure to the virus.

"The two areas where we will be looking particularly closely is the performance of kidney dialysis and respiratory intubation," Frieden said this morning. "Both of those procedures may spread contaminated materials and are considered high-risk procedures. They were undertaken … as a desperate measure to try to save his life. In taking off respiratory protective equipment, we identified this as a major potential area for risk."

http://keranews.org/post/live-blog-obama-asks-cdc-investigate-ebola-protocol-breach-dallas-hospital

[MADem]

51. The worker may have taken the gear off wrong. nt

[LisaL]

53. Total speculation at this point.

[MADem]

54. Well, I was speculating....that's why I said "may have."

More speculation here, FWIW...

http://sync.democraticunderground.com/10025655796

[missingthebigdog]

55. Before we get too excited, let's confirm the diagnosis.

If i understand correctly, this is a "preliminary" diagnosis. There is a fair chance that it will turn out that this nurse just has some other virus, like the police officer we got all excited about earlier.

[LisaL]

56. No, you don't understand correctly.

This person tested positive for Ebola.

[missingthebigdog]

58. I see that since my last post, the diagnosis has been confirmed

[SoCalDem]

62. They need "spotters" to help with the undressing and video

so they can spot any errors.. and special showers that can clean off the outer gear before disrobing.

Can you really see hospitals eager to spend the extra salaries and money to do that?