As an MD, I'm starting to question whether the CDC knows what they're doing...

[Barack_America]

...or if they're too paralyzed by bureaucracy and "cost considerations" to function effectively.

Here's a link to their current suggestions for Ebola infection control standards:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Several things on that page shock me, quite frankly.

1. Under PPE, double-gloving remains an "optional" measure, only recommended if "copious" amounts of bodily fluids are encountered.

Really? So then do health care workers remove their contaminated masks and face shields with their contaminated gloves or with their bare hands?

2. The "Monitoring, Management and Training of Visitors" section.

Visitors? Really?

3. Under patient placement, "consider" placing personnel at the patient's door to ensure consistent use of PPE.

Consider?


The truly sad thing is that, really, EVERY hospital already has a place where adequate infection control is rigorously practiced and enforced. It's the operating room. If the CDC just told health care providers to "gown up for the OR", pretty much everyone would know exactly what they were talking about. Want a refresher on how to gown and ungown properly? Look no further than your "friendly" scrub nurse.

Standard OR attire (now generally with face mask due to HepC)



Standard orthopedic OR attire (because infected artificial joints are really bad)



All of this equipment, readily available in most hospitals these days. For a price, of course. And I'm really starting wonder if price isn't driving many of these recommendations.

[Fumesucker]

1. This layman agrees with you, Recced..

[LisaL]

2. Only starting?

CDC is supposed to be monitoring Mr. Duncan's contacts.
After first nurse got Ebola, CDC director plainly said it's quite possible more nurses will get Ebola.
Yet when second nurse that treated Duncan asked CDC if she could fly, they gave her permission.
And apparently when she called them and told them she had a fever, she was allowed to board the plane back to Dallas.
Director of CDC claims that Mr. Duncan's contacts shouldn't have been flying at all.
But this nurse was allowed by CDC to fly with a fever. Because it hasn't reached some magic number CDC thinks Ebola patients should have.
Now over a 100 people who were with her on the plane might have to stay home for 21 days.
CDC doesn't seem to know its own rules.

[morningfog]

5. None of the people on the flight should have to stay home for 21 days.

If they are worried (which they need not be) they can monitor themselves by taking temp twice a day.

[LisaL]

9. Well, I just read about children having to stay home for 21 days and not going to school,

simply because they were on that plane.
So children are missing on an education because CDC didn't tell this woman not to fly.

[Barack_America]

11. That may be at the request of the school district.

I don't think it is backed up by science.

[LisaL]

13. Regardless, the children aren't in school.

Because CDC allowed a woman they were supposed to have been monitoring and knew could be infected to fly with a fever. Which is a symptom of Ebola.
And then we got lies that this woman flew while not symptomatic.

[Bluenorthwest]

102. And during the panic around HIV/AIDS children were forced out of school for no reason but the

idiot fear blowing in the wind....did you also endorse that horrific behavior? Most straight Americans did, because of the idiot wind.

[No DUplicitous DUpe]

135. Re: did you also endorse that horrific behavior?

Pardon me for jumping in, but LisaL simply stated that she read that kids were missing school, and that the CDC made mistakes regarding the nurse that flew with a fever.

I don't think she deserves to be cross examined concerning her HIV/AIDS stance. She was simply stating facts.

Peace,

Jon

[ballyhoo]

144. How many people nationwide do you include in your "idiot fear idiots"? How about those who may not

know what palmar plantar pustulosis is but they know the 5:00 news is talking about people coming to America to die of a disease named Ebola, or something like that? They have kids in school and they are scared for them. Are these people part of your idiot fear club?

[morningfog]

14. Superintendent overreaction.

The district announced late Monday night that they will keep the children at home for 21 days from the day that they took the flight.

The district reiterated that it is safe for students to attend school.

“We anticipate that some parents will choose to keep their children at home,” she said.

No decision has been made on whether the absences of students who are kept home will be counted as excused or unexcused.

Additional information would be sent to parents Wednesday night, Kincannon said.

Bell County Health Department Epidemiologist Lacey Sanders told reporters that the two students won’t be quarantined or isolated because they did not have contact with the nurse and because the nurse was not symptomatic at the time.

They can continue to attend school, she said.

http://www.kwtx.com/home/headlines/Second-Texas-Health-CAre-Worker-Diagnosed-With-Ebola-Virus-279266452.html

[LisaL]

17. Nurse was symptomatic at the time.

Nurse had a fever. Fever is a symptom.

[morningfog]

22. First, she had minisule viral load, barely a fever.

She was not very contagious. Second, she was not spreading her bodily fluids all over. She wasn't vomiting or shitting.

Third, even if the kids were exposed to her bodily fluids and the viral load was high enough to infect them (which is virtually impossible) they could go to school until they get a fever and never infect anyone.

[LisaL]

24. What are you qualifications?

Because you keep saying all these things, yet even CDC directly said that she shouldn't have been flying anywhere.
This is how the infection spreads.
People who shouldn't be in public are in public, exposing others.

[morningfog]

27. Please. I beg of you, provide evidence of one person, just one, having been infected

by someone either asymptomatic or with just a fever. Surely in the 9,000 cases this year you could find one.

Just one.

Remember -- Duncan's family LIVED with him and his fever for 4 days. Day 18 and they are all fine.

[LisaL]

31. You know full well most of infected people are in Africa where some are dying on the streets.

How exactly can one document when and how they got infected?

[morningfog]

33. And they were infected during deaths and burials. It is well documented.

It is also why so many health workers get it. This is basic stuff.

[LisaL]

35. You don't know when they were infected.

[morningfog]

42. You haven't been following this, obviously.

You should start with these:

http://www.thedailybeast.com/articles/2014/08/13/kissing-the-corpses-in-ebola-country.html

http://www.washingtonpost.com/news/world/wp/2014/08/07/people-are-struggling-to-bury-the-ebola-dead-heres-why/

WHO: Traditional Burials Hamper Ebola Fight

"At the moment when a person died from Ebola, this is the moment when the person is the most infectious and when the viral load is the highest,"

http://www.voanews.com/content/traditional-burial-practices-hamper-efforts-to-fight-ebola/1970353.html

There is no evidence, NONE, that anyone has been infected by someone with just a fever.

[LisaL]

44. Cleveland clinic put their nurses on paid leave because they flew on the same plane as

the Ebola nurse.
Do you think Cleveland Clinic doesn't know what it is doing?
Fact is, Ebola nurse was already symptomatic. Therefore infectious.

[liberal_at_heart]

48. LisaL, I am sure am glad you're not in charge of quarantine. Geez.

[Aerows]

74. I don't know how

LisaL or any random lay person could do any worse that "it will never happen here" Frieden.

I'm sure he's a nice person, but I get the feeling that infectious disease is way out of his wheelhouse.

[morningfog]

49. They are being over cautious to control this, and for PR. I don't blame them.

But it is unnecessary. You will see in a few weeks.

[LisaL]

53. Yes, just like you were telling us that Mr. Duncan didn't infect anybody.

Already 2 and counting.

[morningfog]

54. Reading is not your strong suit.

At the time of my post, I clearly said no one had yet to show signs of infection, but that those most at risk were his health care providers and that the critical period for them was the coming days.

[QuestionAlways]

83. All I know, as my mother said, better safe then sorry

[pennylane100]

150. When Mr. Duncan was at his most infectious stage

is when the nurses probably became infected. That would have been the few days leading up to his death. The blame for that lies with the hospital that allowed their nurses to treat him without supplying them with the adequate protection needed for them to stay safe.

The first nurse to contact the disease had no contact with him without the protective gear provided by the hospital. The only way she could have become infected must have been because of inferior protection or inadequate protocols used by the hospital. The second person to contact the disease also came from the hospital where he died. All the people that were in contact with him either on his journey to this country and the time he was living at home in his apartment have shown NO SYMPTOMS. It does not take a rocket scientist, or in this case a expert in infectious diseases, to know that the problem was the substandard care he and his helpers received at the hospital.

If you want to ensure a safe environment for the public, you should spend you time ensuring that hospitals and the CDC do their job properly, it would be much more productive.

[pnwmom]

85. It isn't unnecessary. They are quarantining people who have been exposed for a very good reason.

This woman violated her quarantine by traveling and she took the chance of putting many others at risk. The other passengers were lucky she didn't start throwing up on the plane.But we shouldn't have to depend on sheer luck to protect us from a life threatening infection.

[Yo_Mama]

140. Cleveland isn't quaratining them - they are removing them from patient care.

Which I think is reasonable under the circs.

A quarantine is officially imposed and requires isolation from non-medical contacts. That's not being done anywhere except for those closely exposed (like Pham's one contact).

In Dallas, none of the HCW were quarantined, and indeed they were allowed to continue to treat patients. They were not told to go home and isolate themselves. They were just told to report if they got ill. So the nurse didn't violate her quarantine - she wasn't quarantined.

It was only after the first HCW tested positive that they even put the other HCWs on daily monitoring.

There isn't even (and still isn't) a CDC guideline for HCW wearing PPE and exposed to Ebola patients. It's considered too low-risk to warrant such a policy. In fact, CDC's current policy here:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Allows an HCW exposed to a known or suspected Ebola patient WITHOUT PPE to continue working and treating patients, so long as that exposure isn't percutaneous (through the skin, like a sharp stick) or mucocutaneous (eye or mouth contact).

In fact, an HCW who developed high fever or other signs of Ebola who treated an Ebola patient with PPE isn't even covered by CDC guidelines AT ALL, because CDC considers the risk so low. Please, read the link.

[pnwmom]

175. I don't think they should be working with other patients till their 21 days of observation are over.

But they are going to continue to insist that this is low risk till more people get sick.

[Aerows]

167. Thank you.

Well said.

[Aerows]

77. Exactly

They are taking preventative measures to prevent a major outbreak. I don't know why the word "Quarantine" sends people around the bend, but heck, you don't contain a virus like this by not keeping track of contacts, and where an infected person has been.

[treestar]

110. The CDC should have stuck to

Their guns and said yes it was ok for her to fly. Make it clear she would not infect anyone at that point. Rather than giving in to panickers.

[Aerows]

76. You do realize

that it takes exactly 1 virion to infect a patient, don't you? I'm not screaming fire in a theater here, I'm just stating bald facts. We need to get this under control before it becomes a public health catastrophe. It isn't there, yet. But let's face it, no one wants it to get to that level.

[pnwmom]

84. And yet Dr. Frieden, the head of the CDC, says she should NOT have flown.

And he also said that people like her who've been exposed shouldn't ride on buses.

Of course she shouldn't have. Because even though she boarded the plane with only a slight fever, it could have escalated during the flight -- just like Duncan's did on his first ER visit - and she could have started to vomit and throw up. And then she would have posed a terrible risk to the other passengers.

It's time for the CDC to change its threshold for a fever that might indicate Ebola. We have seen twice now how an Ebola patient can start out with a lower fever, and then quickly worsen.

[Aerows]

87. To be exact

Dr. Frieden said that you can't catch Ebola on the bus, but if you have exposure, you shouldn't ride the bus due to the potential to infect others.

That makes no sense to me. It's like kindergarten at the CDC.

[pnwmom]

89. Well, you obviously could catch it on a bus if another passenger suddenly threw up on you.

So he was wrong about that. I think he was saying you should not ride because you could cross the line from being not-contagious to contagious during the course of a bus-ride.

[Aerows]

91. Re read his statements

You can't catch Ebola from riding on a bus.

If you suspect you have Ebola, don't ride a bus.

I'm not sure where the logic short-circuited there, but it seems pretty broken to me.

He is saying "obviously you can catch it on a bus" and the CDC spokesman is saying you can't catch it on a bus ... unless the bus is carrying an infected passenger.

Great news from the department of DUH.

[ballyhoo]

146. Or sneezed and the droplets of sneeze hit you.

[Aerows]

164. And such a statement makes

sense to you? I surely doesn't to me.

[ballyhoo]

145. You can catch ebola on a bus from airborne droplets from a sneeze. I

was just at the doctors this morning and asked him about the comment on airborne droplets yesterday.

[pennylane100]

151. Also, at the time Dr Frieden gave that advice,

he stated that when the proper protocols are used and the protective gear is up to standard, there would be not risk. Well, the proper protocols and the inadequate gear were not used and he had no way of knowing that.

[Aerows]

165. This whole situation is

a fustercluck of epic proportions, in my view.

[Needa Moment]

141. appendages have been known

to hit porcelain when using public stalls. just saying....

[Aerows]

166. It takes 1 virion

1. To infect a person. The mortality rate is at 71%.

[morningfog]

170. It takes 1-10 to infect non-humans according to one study.

Whether it is true, or even possible, that is not how the the virus spreads in reality.

People are simply not being infected by casual contact, or by no direct contact. People are not getting infected by being on the same flight or in the same room. People are infected by direct contact with the bodily fluids of very ill persons, usually just prior to, or just after death.

[Aerows]

173. You are the one championing the CDC

that's what they say. Either you believe it, or you don't. I usually agree with you, but this has been mishandled from the get-go.

The CDC states 1 virion can cause infection. An infected person's body produces millions of them. Again, that is straight from the CDC. So either A. The CDC is attempting to use platitudes to prevent a panic or B. The CDC knows how bad this can get in our densely populated cities and dropped the ball.

If you have another scenario, please state it.

[morningfog]

174. I absolutely agree that the CDC has mishandled it.

They didn't ensure local hospitals knew what they were doing. They shouldn't have given the go ahead for the nurse to fly, out of an abundance of caution and, more importantly, because of the butchered PR. They have contradicted themselves now and that causes confusion and panic.

1 virion may be capable of causing an infection, but only if it gets inside another person. A person with with a low grade fever does not produce millions of them, nor do they spread them widely.

I think the issue here, the problem, is two-fold: 1) the CDC has done a poor job of educating the public on the risk and the hospitals on how to respond; and 2) they have reacted to these failures by trying to accommodate the public opinion.

It is absurd that the CDC is changing advice and information as a response to the media and public opinion. That is what causes mistrust and the fear that something is worse than it actually is.

What they need to do, although I am not sure how they can regain trust now, is what they seem to be trying. They need to send all new Ebola patients to the professionals at one of the four centers, at least until something is done to properly train the local hospitals. But, they need to explain the actual risk, not theoretical risk, at each stage of an infection, related to each symptom. And they don't need to sugar coat it or exaggerate it. Just be straight.

[Aerows]

176. Nailed it

Patients need to be treated at BL-4 hospitals.

CDC needs more training, and to tell the truth.

[liberalhistorian]

112. The nurse bears as much blame as the

CDC here. She was a medical professional, she should have known better than to travel in public at all, let alone fly halfway across the country and back. Period. The CDC isn't blameless, but neither is she.

And the school districts are grossly overreacting, frankly. Then again, I used to live in the Cleveland area and my mother and son still live there, I know how exaggeratingly hysterical that area can get.

[Demeter]

122. Better safe than sorry--and diagnosis while contaminating one's fellow man isn't "safe"

because by the time you have registered that temperature, you are a vector and have been for some unknown period of time.

[dixiegrrrrl]

131. Another Katrina moment.

Makes one think that CDC is hidebound or possibly filled with Bush leftovers,
or maybe just filled with inferior education grads.

IQ of this country seems to be sinking by the week.

[Gormy Cuss]

3. I'd say they're paralyzed by underfunding and other political considerations.

Price being one of those considerations.

[calimary]

4. I would guess the answer to your question at the bottom of your post is

"OF COURSE it is!!!"

If it's a private, for-profit hospital, and there's no union allowed - especially no nurses' union, I suspect controlling costs and maximizing profit is a double-barreled PRIORITY ONE. Patient care fits in there somewhere farther down the list.

[Barack_America]

8. What I worry about is this feeding back to the CDC...

...and affecting their suggestions, which should only be influenced by science, not the profit margins of our health care system.

Would the GOP dare call congressional hearings on this?

[calimary]

34. Probably not - because it involves NOT cutting spending.

This is what we have to throw money at. I'd take it from everywhere and plunk it down with the NIH. This is NOT something we can afford to nickel and dime. I'm sorry! We just can't! And the GOP doesn't know how to speak that language anymore. NOR do they speak science or objectivity. Hell, we can't even get the republi-CONS to get off their asses and come back to Washington so they can do some work on this, or at least approve a Surgeon General.

The last thing on Earth that we need in government is a bunch of reckless, willfully ignorant anarchists who hate government and want to do everything they can to bring it down.

[nitpicker]

96. The GOP already did

Probably in response to nurse #1's infection and the rising cry (( not just from the far right)) on call-in shows and elsewhere to ban persons from the three countries from flying to the US.

Airlines=commerce, so the House Committee on Energy and Commerce is hosting this one at noon:

http://energycommerce.house.gov/hearing/examining-us-public-health-response-ebola-outbreak

Probably to be carried on C-SPAN (local DC radio 90.1 FM) if not also elsewhere.

[KingCharlemagne]

28. Point of clarification: I believe Texas Presbyterian is part of a larger

not-for-profit medical group. I read somewhere though that this hospital tends to cater to an upper-class clientele. So when someone shows up with a 103-degree fever but no visible means to pay for Rolls-Royce care . . .

[KMOD]

6. How do you "rec" a thread?

Rec'd by me.

[lunasun]

60. Hi welcome to DU

There is a little yellow box lower left corner of post to rec the post
If you hit the number above where one can rec it shows who else rec'd the post
There was in the past an unrec box but that was removed and I miss it but you can always reply with your opinion although a jury may decide to hide it, although I have never had that so opinions comments are usually welcome either pro or con

[KMOD]

68. Thank you, lunasun

I'm still trying to figure this all out.

[lunasun]

70. got to start somewhere! Takes a little time...will look forward to your future recs and posts

[morningfog]

7. What incentive does the CDC have to keep costs at local hospitals down?

I don't disagree with the point of your OP, asking an honest question.

[magical thyme]

10. not necessarily an incentive. but who are they talking to?

I doubt they've spent much time down in the trenches interviewing the people who do the job.

More likely talking to directors and above.

Hence their assurances that our hospitals would have no problem with this.

[morningfog]

15. That makes sense.

[kestrel91316]

12. Excellent input from somebody I never realized was a physician!

And yes, the OR reference would immediately click for most nurses.

I am bothered by the exposed head/neck skin in the top photo when working with Ebola, and fluid resistance in the gown is imperative.

It being Texass, I assume cost drives all decisions at that hospital. And regulations are unwanted.

[Barack_America]

18. Wearing a hood, I think, depends on the level of contact...

...I strongly disagree with only double-gloving under special circumstances. The assumption has to be that everything in that room, and everything touching you is contaminated.

And, FWIW, I do not practice anymore, as of almost two years now. But I could still scrub in while sleeping, it becomes that engrained in you.

[Aerows]

16. I don't work in the health care field

But it seems as though MUCH more training and far better PPE equipment than available is needed.

[Aerows]

19. I know this is a horrible ethics question

but would you treat an Ebola patient extensively, knowing the risk?

I do not have a medical background, but have family members that do.

Would you walk into a contaminated room?

I'm not certain if I could pass that particular ethical test.

[LisaL]

20. The way it's going, we might end up sitting next to Ebola patients on the plane.

Over a 100 people just did.

[morningfog]

32. That's impossible.

There is no plane that has 100 people all sitting next to one passenger.

[LisaL]

36. They are all together in one small confined space.

Where air is circulating between all of them.

[morningfog]

43. It. is. not. airborne. For fucking fuck's sake. WTF?

[LisaL]

45. Thank heaven for small miracles.

But now children aren't going to school, and people aren't going to work. Simply because they flew on the same plane.
Because CDC couldn't tell this woman to not fly but to call 911 instead.

[Tumbulu]

62. And who sat in her seat after she left it? The virus does last for 2 days

on surfaces. TWO DAYS! That is a long time! Good grief, why in the world would they tell her she could fly with a fever knowing how inadequate her "safety" equipment was? And double gloving seems to be a minimal precaution.

I was talking this morning with my dentist, we both concluded that the CDC is more concerned about not interrupting commerce with giving info that might cause people to panic and stop flying in planes, etc.

We talked about the study of how the pigs became infected from lab rats kept in separate parts of the lab, with separate handlers.

No, we really do not know enough about it's means of transmission yet to think it is OK for people who are shedding the virus to be out and about in public.

[laundry_queen]

163. +1000 nt

[Avalux]

142. You really need to stop the fearmongering. n/t

[Barack_America]

25. If I had the required skills to treat that patient, yes, I would.

I took this oath, after all.

But if it was not necessary for me to do so, I would not. Both to minimize exposure and medical waste, but because this is a patient and not some side show.

You cannot convince me that 70 people needed to be in that room with Mr. Duncan. That is ridiculous.

[LisaL]

29. Exactly.

What kind of hospital sends 70 people into the room of highly infectious man who had all kind of body fluids coming out of him?
And the same people were treating other patients.
It's mind boggling.

[Tumbulu]

65. I just cannot beleive that hospital

and want the admins prosecuted. Seriously, 70 people? All going in and out and then going to other patients? How many more at that hospital will get it?

And do you think that every case found will actually be reported?

[magical thyme]

172. 70 people were not sent into the room

There could be a lab with 30 or 40 techs and lab assistants potentially exposed while processing and analyzing blood, urine and stool specimens, without ever having set foot in the room.

There would be housekeeping personnel potentially exposed to towels and sheets.

Staff is rotated in and out in shifts. So a different doctor for 1st, 2nd and 3rd shift, different nurses for each shift, and not necessarily every day of the week.

[Aerows]

30. bless you for having ethics

and willingness to do a difficult job. My grandmother was an RN that worked until she was 72, and the people she cared for were upset when she was forced into retirement.

[morningfog]

52. That was another lingering quesiton I had. Why were 74 people in and out of his room?

[LuvLoogie]

57. OJT?

It takes five people to operate the machine that goes Bing!

[procon]

61. Yeah, that's way too many people

which makes me think they were just rotating the regular floor staff through the isolation unit, adding his care to their regular patient load to cut costs. Otherwise they would have had a dedicated specialty team like in the ED, ICU, OR or NICU with the advanced skill set to do that job. The same small core group would be solely focused on that patient's care. Again, it comes down to the hospital's profit margin that demands cost cutting, so why pay top dollar for specialized staff to take care one patient when it's cheaper just to add that additional duty onto the backs of the 70, much cheaper, floor nurses.

[Barack_America]

66. It was likely all of the sub specialists.

ID, liver, nephrology, heme/onc, critical care, cards, etc. The point being that even most of those MDs did not actually need to personally enter the room and examine him.

[magical thyme]

98. 70 people were not in the room with him. but a large number could have

handled his specs in a busy lab -- as many as half that number over a period of a week or more.

The tiny lab I work in now has a total of 12 techs and 12 LAs rotating in and out on any given day or shift.

In my clinicals in a larger lab, during day shift only there were easily:

6 in hematology
3 in bloodbanking
2-3 in chemistry
8+ in microbiology

And that's just day shift in what is probably a smaller hospital than Texas Presb is. When all shifts are factored in, easily 40 total right there who may at one time or another have handled various specs.

And don't forget housekeeping. Many cleaning staff would have been cleaning floors, bedrails, bathroom, counter surfaces, collecting towels and sheets, etc. Again multiple people rotated in and out on any given day.

[FourScore]

21. I have lyme disease. The CDC lost all credibility with me a long time ago.

I hold them greatly responsible for prolonging my suffering.

[scarystuffyo]

41. I'm sorry you have that , I have a family member who contacted it in the early 80's

It was misdiagnosed for a long time before it was discovered what it was.
She's fine now but went through some real bad pain with it

[FourScore]

50. Thank you. Mine was also misdiagnosed for many, many years.

The CDC guidelines are woefully inadequate regarding lyme. So many people have needlessly suffered because of their willful ignorance. I have no confidence in them, and I think the US is going to join me in that assessment as ebola continues to spread.

I am sad to say that because a sweet aunt of mine worked for the CDC her whole adult life and has even received a national medal for her work in bacteria. Even today, in her late 80's, they pay for a driver to pick her up from her nursing home once a week to bring her into the CDC because they view her knowledge on bacteria as a "national treasure".

Still...the CDC is a stodgy, bureaucratic institution. And their refusal to listen to lyme experts has harmed many, many people.

I am glad your relative is well today. It is hard to treat lyme if not caught early.

[scarystuffyo]

55. Your Aunt sounds like she's one hell of a person

I hope you are doing well also

[FourScore]

59. I am. Thank you. n/t

[TorchTheWitch]

93. One of my brothers had it too

He's been fairly lucky that it hasn't caused him any great lingering misery though there are times that it flairs up and he gets joint stiffness and soreness and unreasonable fatigue. As a really athletic person this is the worst part for him. Like, having planned a rock climbing trip and not ending up being able to go because of it having flared up or not being able to teach his karate classes when it flairs up. Other than that, he's been pretty good.

The dog I had at the time also got infected with Lyme the same week my brother did, and we were nowhere near each other. It was a really bad outbreak that year with vets crammed with pets that got infected. It was that outbreak that had vets recommending Lyme prevention shots every year for peoples' pets. My dog didn't fair so well. Ever after he had joint soreness all the time though when he got Lyme he already had other issues from a comprised immune system.

Until this Ebola outbreak I had all kinds of faith in the CDC. Never again. Though I'm sure that probably most people in the bottom tiers know what they're about it's more the higher ups and agency head they probably are ignored by and want to bash in their stupid heads. Agency heads are often just butt kissing, paper pushing, bureaucratic boobs. Problem with that is obviously they're also the ones making the decisions.

I'm so sorry they dropped the ball on your Lyme disease.

[FourScore]

99. They've dropped the ball on lyme disease in general.

Their guidelines, both diagnostic and treatment, defy the science. They grossly depressed the number of annual cases, and suddenly increased it about a year ago from 30,000 cases to 300,000. Just google lyme and the CDC and you'll see the outrage by those who suffer. Doctors refer to the CDC and AMA guidelines for diagnosis and treatment guidelines, and it is so wrong.

I'm sorry to here about your brother. His sounds a lot like me, only I have other symptoms. Mine is a European variant, so it's a little different.

[KingCharlemagne]

23. It's so much easier (and cost effective) to attack nurses. Now if they

could simply find a way to lay it off on the LPN's, Nurse's Aides and PA's. Heck, blame the janitorial staff.

See, that wasn't hard.

Dripping in case it wasn't obvious.

[Fumesucker]

39. You notice they've started out attacking nurses several times now and had to retract

First it was the triage nurse who "didn't communicate that Duncan had been in Liberia", within a day or so that got retracted.

Then nurse Pham "breached protocol", that ended being a real doozy, there basically was no protocol or multiple conflicting protocols for several days.

Next it was the nurse who flew, then in the course of single day it turns out she called the CDC for advice and they screwed up.

And time after time some DUers have fallen for it, mostly I think because they want to deflect any possible blame from Obama.

[KingCharlemagne]

47. And it wasn't like this nurse flew to Ohio purely on a lark. She was planning her wedding but now

she may not live to celebrate it. And people are blaming her. I think I may need to tune out for awhile.

As for deflecting 'any possible blame from Obama,' my wife and I both think his "Heck of a job, Brownie" moment may be rapidly approaching, undeserved though it may be. I'm sure Frieden's incompetence and tone-deafness caught President Obama by surprise, as it did many of us accustomed to deferring automatically to the CDC.

[Tumbulu]

67. I see nothing here to blame on President Obama

and nothing but blame on the obstructionist rebulicons who demanded all the cuts.

I also blame our financial system that values moeny over all else. Money for the for profit hospital, concern for commerce over public health- claiming it could be contained easily when we have only a handful of biohazard 4 facilities in the entire country.

[KingCharlemagne]

107. I'm with you on this. While I can and do criticize President Obama's

policy choices often (from the far left), on this he is relatively blameless . . . PROVIDED HE DUMPS FRIEDEN NOW AND DOESN'T TRY TO DIG IN.

[Bluenorthwest]

103. 1,833 people were killed by Katrina. Heck of a job indeed.

Currently we have exactly one US death, a person who brought it with him from the hot zone. Ronald Wilson Reagan stood in silence for about 6 years during the dawn of the AIDS crisis. By the time St Ronnie bothered to so much as mention the crisis there were far more than 20,000 dead Americans, another 50,000 infected. The virus had spread to more than 100 countries and there were at least another 50,000 cases in the world.
In 2011, 1.7 million people died of AIDS in Africa alone, there were 2.5 million new infections and about 35 million people living with HIV worldwide.
Both of those Republican botched public emergencies make this Ebola 'crisis' look like small potatoes thus far. By comparison to either, the Obama administration is utterly stellar and swift as the wings of angels....

[KingCharlemagne]

113. These are excellent comparisons you raise (and I especially appreciated the

reminder of Reagan's willful negligence towards AIDS and HIV). I really think Obama needs to pressure Frieden to step down immediately to avoid the perception, fairly or not, of lassitude. Other than that, though, President Obama deserves little or no blame for Ebola's appearance in the U.S.

[littlemissmartypants]

26. You had me at double glove.

Thanks.

[Warpy]

37. Retired nurse here and me too

Businessmen instead of doctors are who are running hospitals now and we all know they're going to dither over every cent that is spent on protecting staff.

In this case, you're a healthy person protecting another healthy person from normal flora going where they're not supposed to go, like into the bone. Your garb wouldn't survive a decontamination shower and that is part of the problem. Nurses caring for these people don't have proper gear to begin with and there is no decontamination procedure in place, nor do hospital suits want to spend the money on any of it.

And visitors? Just what the hell are they smoking? Visitors shouldn't be any closer than a patient intercom.

[LisaL]

38. Why not?

You come visit in the hospital and they tell you "would you like to treat an Ebola patient today?
Here is your paper gown."

[Warpy]

40. One size fits nobody

and the damned things refuse to stay closed.

[Purveyor]

46. I concur. If the current resident of the WH was a republican, this forum would

be in meltdown mode with outrage.

Incompetency by all who should be responsible and in charge.

[Bluenorthwest]

104. Of course during the early days of HIV/AIDS, Republican Ronald Reagan took zero action while

more than 20,000 Americans died and another 50,000 were infected. By 'zero action' I mean just that, Reagan did not even mention this public health crisis for more than 6 years. During that time, Republicans and Moderate Democrats joined to elect Reagan again, then they elected Bush.
Those Republicans were never held to account.

[Purveyor]

120. I remember those dark, dire days quite well. I was all of 23 at the time and the

only reason I'm still typing today is because I didn't care for anal sex. Being a 'top', unknowingly saved my life without a doubt.

Still, no one knew what the hell was happening...

[Aerows]

171. Hell, it was horrible

for lesbians. We are the group that has the least chance of getting AIDS but if your sexuality came out, you were shunned.

[Purveyor]

178. Before aids happened during those days, gay liberation was on the fast track.

Aids did indeed set back gay rights a good 25+ years.

[Aerows]

169. This is NOT political

and attempts to make it so are tasteless. I don't think anyone, anywhere could deny that this has been mishandled by the CDC.

[liberal_at_heart]

51. Definitely agree with you about proper gowning and gloving, and that it is probably money

driving those decisions.

[MannyGoldstein]

56. I don't think the vast majority of hospital staff would/could comply

even if given proper direction.

As a member of the medico-industrial complex... I'm close to what goes on, and it's catastrophic.

American medicine is cowboy medicine. There's almost no discipline at all. Very little process and procedure.

Hundreds of thousands of patients get ventilator-associated pneumonia each year, the vast bulk pf which can be avoided just by using a #%^*ing checklist.

It averages something like a decade before a medical standard-of-care recommendation gets put into practice by more than half of docs, unless the change makes an immediate and substantial positive impact on the docs bank account.

I think that only the military hospitals and the VA can really do this correctly, perhaps a few others.

[Fumesucker]

64. It's been my experience that when a workplace is screwed up it's attributable to management

And also when a workplace is humming along smoothly that's attributable to management as well.

A huge number of our problems in America these days can be laid directly at the feet of shitty management, we are absolutely drowning in substandard, haphazard and often downright malevolent management.

[MannyGoldstein]

79. Agreed.

Docs run hospitals and they hate being told what to do.

Take a look at Atul Gawande's The Checklist Manifesto to see how how medicine ought to work - as a fellow techie, I think you'll appreciate it!

[littlemissmartypants]

118. Checklists and teams of two. nt

[moniss]

58. It's worse than most realize

First of all, from the very beginning you could see that Texas had botched this. State that hates regulations remember. However these nurses/doctors can't possibly tell me that they didn't cover stuff like this in college. Secondly, in Dallas of all places they are all acting like nobody had access to top-notch haz-mat gear. That's plain crap because you could open the Yellow Pages and find plenty of companies specializing in this gear and how to use it. There's a whole lot of CYA going on and playing dumb about this is just a part of that strategy. Also, I frequently see medical personnel coming in to local convenience stores on their lunch dressed in their scrubs. Nice way to pick up nasty critters and drag them back to your patients or vice-versa. I've seen some with gloves stuffed in the waist band. God knows where those gloves have been or will be. I've walked halls in hospitals and seen doctors in scrubs with a face mask hanging around their neck walking around out in a visitors area and walking right up close to assembled relatives and talking to them at length and then going back in to see a patient with the same mask covering their yap. Thanks Doc for bringing into the room whatever was floating around. I've seen nurses go right from handling all kinds of files and paperwork and go right in to a patient with a compromised immune system and not even wash their hands.

[deutsey]

106. +1 And welcome to DU

[RobinA]

121. Scrubs On The Street!!!!

My parents are a long retired doctor and nurse. For about two decades now they've been noting, with much disgust "scrubs on the street" whenever they drive by a person garbed that way.

I can explain the gloves in the waistband. I work in a healthcare setting, although I am not a medical person. Gloves are worn to protect the wearer, not the patient. They wear the same pair of gloves while handling all patient care and then remove them when done. And yes, often putting them in a waistband or pocket for the next time they need to protect themselves. Which is why none of this Texas stuff is the least bit surprising to me.

[Historic NY]

63. Its almost like they are too timid to act......

they have the power to "order" appropiate action or lock down...WTF is wrong with the leadership.

[TorchTheWitch]

69. not good enough

That photo of the OR nurse has a lot of her face and neck exposed. Ebola is a BSL-4 virus that requires full head to toe covering of every millimeter of skin, rubber gloves in case of tears or needle pricks, waterproof/resistant clothing and head to toe decontamination with chlorine spray before removal. The floor, walls bottom of protective boots, etc. also need to be disinfected with chlorine spray before removal. A BSL-4 virus requires more than a basic OR setting and trained, practiced, experienced staff with supervision to ensure that each person is protected correctly with no gaps or tears or flapping parts of the PPE.

Our military was trained for three days with experts even using respirators, and these people are not even to be coming into contact with any Ebola patients and already have been trained in the similar skills of protection because of bioweapons. They were drilled and drilled during their training in suiting up, decontamination, using the buddy system to ensure no mistakes, removal of the PPE and all under expert supervision. Perhaps aside from military medical staff, again, they aren't even supposed to be coming into contact with any Ebola patients but are meant to be setting up clinics and organizing the supplies.

Why would our medical staff in hospitals not also be getting this training using the correct PPE and decontamination protocols that Doctors Without Borders and similar other groups in West Africa are using also keeping possibly infected people, infected people, body removal and burial teams entirely separated? And despite this extensive protection 16 of the workers with Doctors Without Borders have become infected.

There is a reason the US has four hospitals designed to care for BSL-4 infected patients with trained, supervised, experienced workers. So that people in this country that are infected with a BSL-4 virus can be cared for in such a way as to ensure that any further spread doesn't happen. The US simply doesn't get BSL-4 infected people on any scale that requires more, and these specialized places are designed to halt any further spread by the high level of protection and containment. With only one single Ebola patient in the country there was every reason to have him sent to one of these hospitals just as all the infected Americans were not just for specialized care but to STOP THE SPREAD OF EBOLA. That's what these places are for... to care for the few infected while stopping further spread.

It makes no sense for every hospital in the country to have that level of infrastructure, equipment and trained experienced and supervised staff since this country just doesn't get such outbreaks of deadly infections that require a BSL-4 containment. There are very few viruses on the BSL-4 level list, and most of them are hemorrhagic fevers like Ebola, Marburg, Lassa fever, etc... we just don't get practically any patients with such an infection and needing that level of care. Just as it makes no sense for every hospital in the country to have a special burn unit or trauma center or children's' hospital, etc. There simply aren't enough patients in a single hospital's care area to warrant it, and those patients can and ARE sent to those hospitals that patients needing specialized care have the required set up and staff. My area hospitals don't have special burn units or trauma centers because it makes no sense for them to have them with so few patients needing that specialized care. Those patients are sent to one of the city hospitals that DO have a special burn unit or trauma center, etc. for care.

And sometimes that means having to send a patient to a specialized hospital in another state. When my father got cancer he needed surgery that could only be performed at the nearest facility with the set up, expertise and a special surgeon - one of few in the country - with the experience to perform the operation. He was sent out of state to Maryland and was operated on by the Chief of the surgical staff at John Hopkins though unfortunately his tumor had spread too far to be entirely cut out, but it did bye him about 6 months more of relatively pain free life. All paid for by Medicare that approved the transfer, and bless him, the surgeon waved any additional fees not covered by Medicare (which were probably extraordinary).

Just as with the Ebola infected Americans, Mr. Duncan needed to be sent to one of the country's four specialized hospitals for care not just to care for him in the hope that he might live but to STOP FURTHER SPREAD OF EBOLA by their specialized facility and staff containing it. Why on earth wasn't he? Why on earth were the two Dallas hospital workers that became infected because the hospital was not geared to this specialized care with staff trained and experienced to do it not also sent to one of these hospitals? It's what these places are FOR.

Thanks to the ineptness of the CDC they themselves CAUSED an outbreak.

[dixiegrrrrl]

132. The ill nurse now has been sent to one of the special hospitals.

Finally.

In fact, Texas hospital is apologizing all over the place. It is obvious that somebody gave them a big can of whoop ass.
Not to mention the likely mention of "lawsuit".
They have apologized to Duncan's family, admitted they screwed up, have sent the first nurse to a Bio 4 hospital.

[TorchTheWitch]

133. Thank goodness!

Has the recent second nurse also been sent there?

This is what the CDC should have known all along. There was no reason for Mr. Duncan to be treated in the Dallas hospital, and convincing the hospital that they could easily do it was an epic disaster. Of course the hospital made a ton of terrible mistakes, but they were getting their information from the CDC who didn't give them correct PPE protocol and erroneously believed that PPE alone without even disinfection would protect everyone who had no previous experience or special knowledge in caring for a BSL-4 infected patient. I can't even imagine what the CDC was thinking to allow this. They KNEW a regular hospital would be woefully unprepared.

The hospital got their information and direction from the CDC. From the top down this hospital was clueless, and it's the CDC's responsibility to first assess whether or not the hospital can deal with the situation (which of course it can't) and provide monitoring and supervision all the way along which they didn't. The CDC totally dropped the ball in everything they did which first of all deciding that Mr. Duncan could be successfully cared for in a regular hospital.

Regular hospitals do not ever handle a patient with a BSL-4 infection, so of course they don't have the infrastructure, equipment, trained and experienced staff, etc. But the CDC was so stupid as to insist than any hospital could do this and didn't provide the guidance, equipment, protocol, est. that is required.

Though the hospital should have known they couldn't do this appropriately they were convinced they could by the CDC telling them they could.

Thanks so much for the information about the nurse being transferred. Now it's obvious that both the CDC and the hospital know how and why the screwed up.

[nakocal]

71. Severe budget cuts by the republicans

The republicans have cut over $100 million from the CDC and NIH budgets. SO yes, they are having budget issues.

[Tumbulu]

73. and the public needs to be reminded of these idiotic and now deadly

cuts.

[Tumbulu]

72. My dentist and I were having a long conversation

this morning about this very thing.

I think that the blasé attitude of the CDC and hospitals will not have been the correct approach. We talked a lot about what systems need to be in place for a biohazard 4 facility. The negative air pressure, multiple air locks, the type of protective clothing, the ability to sterilize the medical waste......how many little town clinics will have any of this stuff? Even our larger hospitals in the area will be very hard pressed to follow any really appropriate protocol.

This is a rough time.

[LovingA2andMI]

75. K & R!

For getting straight to the point. Thank you Doc!!

[MattBaggins]

78. Zofran and Dignicare

Give Triage nurses bottles of zofran and start pushing for Dignicare stool management systems in all hospitals.

Did the hospital in Texas have dignicare in the "Ebola ward"

[lexington filly]

80. This hospital ought to lose its license or certification or whatever they have

Dallas Morning News: "Health care workers treating Thomas Eric Duncan in a hospital isolation unit didn’t wear protective hazardous-material suits for two days until tests confirmed the Liberian man had Ebola — a delay that potentially exposed perhaps dozens of hospital workers to the virus, according to medical records.

Duncan was suspected of having Ebola when he was admitted to a hospital isolation unit Sept. 28, and he developed projectile vomiting and explosive diarrhea later that day, according to medical records his family turned over to The Associated Press.

But workers at Texas Health Presbyterian Hospital Dallas did not abandon their gowns and scrubs for hazmat suits until tests came back positive for Ebola about 2 p.m. on Sept. 30, according to details of the records released by AP."

I imagine the CDC thought they had to do hospital hand holding but it appears in Presbyterian Hospital's case, they needed to help them blow their noses, brush their teeth and all you'd do for a toddler. Actually, I'm astounded that in a huge, fancy structure full of medically trained personnel and highly educated and paid physicians---in America---this lack of standards exists.
We've got the best medical care in the world....just don't test us.

[MontyPow]

81. Wake me up when a passenger from the plane Duncan travelled on also shows up with Ebola.

[C Moon]

90. +1

[uponit7771]

115. That's true, how long has it been so far? about a month?

[MontyPow]

123. It has been about a month, I believe.

If it were as casually contagious as some in the public sphere are fearmongering, there should be other cases being reported beyond the our patient zero and two of his nurses.

[uponit7771]

124. Who says its 42 days now... but point taken... some people should be showing more symptoms

... if it were that contagious

[MontyPow]

136. I don't know Who said it was 42 days

However, I didn't realize it was that long already.

[DhhD]

168. September 20, 2014 landed in Dallas-Fort Worth Metro. Hospital workers from all over Metro too.

[Hekate]

82. I was positive the US health care system knew what to do because of your picture #2. Past tense.

As a result I pooh-poohed panicky DUers in the early days of this event. I apologize. It now appears we have a cascade of idiocy going on, and there are people who are going to die needlessly. I am absolutely appalled.

I thank you for your input, Barack America, as I have thanked Kestrel in the past.

Caveat to my statements: unlike wingers, I don't think we're "all gonna die," just a bunch of folks (like nurses) who didn't have to.

[pnwmom]

86. I respect the fact that you were able to rethink your position when more and more evidence

came to light showing that, for whatever reasons, the CDC's and the hospital's response has been inadequate.

Like you, I wonder whether costs have been involved in affecting how Ebola has been handled. I also wonder if not being insured increased Duncan's chances of being hurried out the door.

[Barack_America]

161. I still do not think Ebola is a widespread threat.

I'm just starting to doubt the impact the CDC is going to have in that. These recommendations leave healthcare workers unacceptably exposed.

[suffragette]

88. 'Penny wise and pound foolish' is a real problem with all this

K&R for your thoughtful OP.

[Warren DeMontague]

92. Yeah

...exactly.

[blkmusclmachine]

94. ,

,

[Skittles]

95. ...

what is that doctor in the pic drilling into - it looks like a pumpkin

[Erich Bloodaxe BSN]

101. Orange colour is a result of being swabbed down with

one of several liquids (possibly chlorhexidine here) designed to make sure things are as sterile around the invasive procedure as possible. The bright colour isn't necessarily inherent, but is added to make sure you can very easily see where the antiseptic has and has not been applied.

[Skittles]

139. but what body part is that

[Tsiyu]

117. Looks like a bent knee

covered in Betadine

[democrank]

97. I know zero about ebola, but

double-gloving being an "option" doesn`t make sense to me.

[TBF]

100. A lot of us are wondering

about that. And I think most people on DU know exactly where the blame lies with that - it is Congress that appropriates funds for agencies like CDC.

[mainer]

105. The difference between OR and biocontainment is in removal.

When you gown up for the OR, you're doing it to protect the patient and everyone's trained to don gowns and gloves while protecting the "clean" side from the "dirty" side. Post-op, there's no need to stay sterile and personnel usually just strip it off without thinking about what's clean and dirty -- because sterility no longer matters.

When you gown up for biocontainment, you're doing it to protect yourself, and it's that process of removal that we're unaccustomed to. I've gowned up for the OR, and I know the drill for that. But when I think about removing those garments while still preserving sterility, I realize how difficult that's got to be.

[magical thyme]

125. exactly.

You're not generally operating on a patient that may spew a gallon or so of virus-riddled projectile vomit or explosive diarrhea onto you.

Dr. Sanjay Gupta demonstrated removing PPEs safely on a video, after smearing some chocolate on his gloved hands and gowned chest.

He ended up with a smear of chocolate on his non-dominant arm, above the wrist. Oopsie.

[Barack_America]

154. I agree.

Hence my incredulity over a single pair of gloves worn over the gown. The gloves come off with the gown. How do you safely remove the rest of your PPE?

[deutsey]

108. Like so much of today's organizational life, whether corporate or government

If the time, energy, and resources that normally go into creating the impression that all is well and managing appearances went into actually dealing with actual problems, we'd have fewer problems.

[Fumesucker]

130. Great point, well said.. n/t

[Petrushka]

109. Coming in late, but . . . K & R

[jwirr]

111. I think I agree with you. However, I don't think that some of this is exactly in their job

description. Exactly what was their job before this ebola situation developed? I understand that the actual care for this was in the hands of the states.

[In_The_Wind]

114. +1

[Helen Borg]

116. Great point about the OR procedures...

[rtracey]

119. Price Driving the recommendations?

Really, as a physician you really need to ask this? Our Privatized Health care System is the Problem. When profit control care, as it is today, there is the problem, and I would hope you object to that, but too many medical practitioners today do not object to it, and that is the real "assault" on our sick and poor. The CDC runs on funding, period... and if those funds are not available, you get.....well.....you get what we are seeing and getting now..complacency.

[joanbarnes]

126. Thanks for the perspective, I suspect the same motives, without your expertise to know for sure.

[Faux pas]

127. I'm not a doctor

and I agree! It's scary to think that these people are in charge of anything, let alone national health.

[Tweedy]

128. OR insufficient

I think OR would be insufficient. The protocols appear to be effective. There are very few instances where folks following them became infected. Usually when someone becomes infected, a breach of protocol is discovered.

As for the CDC, all of their protocols are guidelines. The CDC does not have the authority to order. The hospitals are under their state health department.

Remember, the sicker an Ebola patient is, the more infectious their bodily fluids are. Nobody got sick treating Mr. Duncan during his first visit, although no protocols were followed.

[McCamy Taylor]

129. Like most of the fed, the CDC employees are hoping for private contracter jobs when they retire

so they do and say what private industry tells them. When there is a new Hep C vaccine on the horizon they issue a statement calling upon ALL Americans over 40 to be tested...in order to drum up business. Look for someone to get a job with the makers of Soldavi soon. When devising safety precautions, they make sure it is something that hospital accountants can live with.

Maybe if we started funding public health the way we do other kinds of health care, we would get some public health.

[Yo_Mama]

134. Great post. n/t

[Divernan]

137. World Trade Center Rescue Workers Believed EPA- Ended Up Dead, Dying, or Chronically Ill

The big push after 9-11 was to immediately get Wall Street back up and functioning. To do that, workers had to be told that the area was safe. Families moved back into housing, children went back to school, workers returned to Wall Street, and of course the first responders/rescue workers/ etc. - all of them returned to an area because they trusted the EPA to protect their best interests, not Wall Street's. We later learned that the EPA's initial & immediately negative findings on air quality were supressed and promptly re-written by the White House Council on Environmental Quality, chaired by the infamous James Connaughton and approved by Condoleeza Rice.


http://www.ucsusa.org/our-work/center-science-and-democracy/promoting-scientific-integrity/ground-zero-air-pollution.html#.VEAfUmd5uSo

The EPA wasted little time in assuring New York residents and rescue workers that the area surrounding ground zero was safe. On September 13, 2001, just two days after the attacks, the agency issued a press release in which it explained "sampling of bulk materials and dust found generally low levels of asbestos. The levels of lead, asbestos and volatile organic compounds in air samples taken Tuesday in Brooklyn, downwind from the World Trade Center site, were not detectable or not of concern."¹ A September 18, 2001 press release was even more confident, quoting then-EPA Administrator Christine Todd Whitman: "Given the scope of the tragedy from last week, I am glad to reassure the people of New York and Washington, DC that their air is safe to breathe and their water is safe to drink."²

The EPA's proclamation of safe air was premature and, as it turned out, wrong. The collapse of the World Trade Center released nearly 2,000 tons of asbestos³ and hundreds of thousands of tons of concrete in the form of dust. A 2003 report from the Office of the Inspector General (OIG) of the EPA later charged that the EPA lacked the information needed to determine the air quality surrounding Ground Zero in the days following the September 11 attacks.

The EPA was not given full control over its press releases in the aftermath of the terrorist attacks. Administrator Whitman issued a memo on September 12 announcing that "all statements to the media should be cleared through the NSC [National Security Council] before they are released," and the New York Post reported that National Security Advisor Condoleezza Rice was "the final decision maker" regarding the release of information by the EPA. In addition the OIG report details how the White House Council on Environmental Quality (CEQ) pressed the EPA to "add reassuring statements and delete cautionary ones" from agency press releases. For example, information discussing the potential health risk for "sensitive populations" from exposure to particulate matter was discouraged from inclusion in a press release by a CEQ official, and language discussing detected levels of asbestos was softened. The involvement of NSC and CEQ officials raises questions as to whether public health concerns were trumped by political and security priorities.

Other news reports suggest that the EPA was not fully forthcoming about the air quality at ground zero. EPA scientist Cate Jenkins argues that the agency plainly lied in its public declarations. Jenkins told CBS News in September 2006 that the EPA knew "this dust was highly caustic, in some cases as caustic and alkaline as Drano." In September 2006, CNN reported that an October 5, 2001 letter from the EPA to the New York City Health Department warned of threats to worker safety from exposure to hazardous materials.10 Yet this knowledge failed to affect the EPA's unworried public statements.

[SunSeeker]

138. K & R

[Avalux]

143. You know, everything looks really good on paper. Nice and neat, all spelled out.

But when it comes to implementation, human beings are thrown into the mix and mistakes occur. It's difficult to ensure docs and nurses wash their hands between patients. We know nosocomial infections are a problem that could be reduced if infection control procedures were adhered to 100% of the time. Not only the medical staff, but janitorial staff, and anyone else engaging patients.

I'm not sure what the answer is. Maybe I know too much from working in hospitals for years and years. Human error is the biggest problem we face.

[Logical]

147. IMO you being an MD does not mean you know more than anyone else about this. nt

[Barack_America]

153. Your average person knows how to sterile scrub?

And how basic infection control in hospitals works?

[Logical]

156. Did the two nurses??? nt

[grahamhgreen]

148. Yes, they should shitcan the director and put a real epidemiologist in charge, IMHO.

[whereisjustice]

149. Frieden should be fired. Just imagine if a Republican President had appointed him. The

howling that would be taking place.

There is a dangerous trend - EPA, SEC, FBI, NSA, CIA, CDC - agencies are increasingly out of touch from the general public they are entrusted to protect.

Frieden is adding no value and is not up to the task.

No single person would be allowed to keep their jobs after fucking up as badly as he has.

Yet here we are again, choking on our own hypocrisy.

We saw it with banking fraud, the Deep Horizon oil spill, NSA spying, EPA fracking, and now the CDC. A refusal to hold leadership accountable for their mistakes. I suppose some will now argue that these weren't mistakes. It was deliberate. Maybe so, I'm almost there.

http://en.wikipedia.org/wiki/Resignation_of_Shirley_Sherrod

All we need to hear is how Frieden is doing one heck of a job.

[seveneyes]

152. The CDC is only as intelligent as the ones who comprise it

Reality tells us that it can't be fully populated by the upper ends of the percentile graph.

[bigwillq]

155. They don't.

Not sure if any government agency knows what they're doing.

[hopemountain]

157. cdc cannot FORCE private hospitals and medical personnel

to follow the cdc recommended guidelines, protocols. local health departments, under the direction of the cdc and surgeon general used to receive funding for trained public health nurses, etc to engage local private hospitals and private medical personnel in educations and adherence to protocols and guidelines for communicable diseases (hiv/aides, stds, measles, tb, enterics, etc.). but, that funding has pretty much dried up and been eradicated by the gop.

[GoCubsGo]

158. Thank you!

It should also be noted that we currently have no Surgeon General, thanks to those who are also responsible for the funding cuts at the CDC. Better to blame the CDC and the nurses (but not the doctors who were involved-funny that) than to blame congressional funding cuts, or the negligence of the corporate hospital owners and management that were responsible in the first place.

[Barack_America]

159. The guidelines themselves are poor.

That was the point of my OP.

[whereisjustice]

160. but they have the money and authority to monitor treament at any hospital, and considering

the hell this disease is creating, that would have been the prudent thing to do.

[Horse with no Name]

162. Price absolutely dictates what the hospital allows you to use

They prefer you to use the thin and flimsy masks. They frown when you use the more expensive respirator type masks (duckbills).

Some hospitals "suggest" that you hang your gown in an isolation room and re-use it.

It is always about the money....

[Politicalboi]

177. We should get more ideas from NASA

If anyone knows about keeping safe, it's NASA.